September 20th, 2012 By Emory Heart & Vascular Center
Saint Joseph’s Hospital patient and triathlete, Joe Michalak, narrowly missed a heart attack by listening to the risk factors of heart disease. On Father’s Day weekend, he felt some tweaks in his chest and instead of ignorning his symptoms, he went to the hospital right away. Luckily, Joe listened to his body. In hindsight, he had a 95 percentage blockage in his left anterior artery and 80 percent blockage in another one.
Learn more about Joe’s symptoms and what prompted him to make a trip to his local E.R. at Saint Joseph’s Hospital.
Barry Chaney is an Emory Heart & Vascular Center patient and Emory Healthcare employee who after having chest pains while working out was told he had to have cardiac bypass surgery to relieve blockages in his heart.
Barry chose the robotic approach to surgery as opposed to traditional cardiac open heart surgery because of the less invasive nature and faster recovery time associated with robotic surgery. Barry returned to work after 3 weeks and is now back to living an active life! Learn more about cardiac robotic surgery and Barry’s experience with the procedure by watching his amazing story video story below:
Joan Jahnke, Emory Clinic patient and patient of Emory Heart & Vascular physician, Dr. Habib Samady, shares her journey through her diagnosis and treatment of Cardiac Microvascular Endothelial Dysfunction with Vasopastic Angina.
I have led an active life and thought I was doing everything possible to keep my heart healthy – eating right, exercising and not smoking, and trying to maintain a relatively low stress life. I was also a cardiac nurse and knew what it meant to be healthy, and why I wanted to remain healthy. So when I closed in on retirement age, I was surprised when I started clutching my chest first, with shortness of breath then with chest pain.
I was diagnosed with Cardiac Microvascular Endothelial Dysfunction (MVD) with Vasospastic Angina in 2008 during a drug challenge catheterization test at Emory Healthcare after two and one-half years of chest pain. My case was very severe and I had a cardiac arrest during the procedure. Each episode of an angina attack is like having an individual heart attack and I was barely able to keep up activities of daily living. I had attacks multiple times during a day, for days on end, with few periods of pain–free stability.
MVD is a form of heart disease found predominantly in women of a certain age. The etiology, or cause, is unknown and each woman with MVD can have different degrees of heart attack-like symptoms. I have had chest, arm, axilla, jaw, ear and back pain, and just simple fatigue with this MVD.
Treatment is dependent on symptoms and presenting complaints. The first important treatment step is opening up the affected small heart muscle microvessels with nitroglycerine. This allows oxygenated blood to flow freely through the heart muscle to supply it with oxygen and then out to the body’s general circulation. This relieves the angina pain greatly and reduces the shortness of breath that occurs. Nitroglycerine can be in sublingual, oral spray, patch or in a pill form.
The second important treatment is with a medication called a Calcium Channel Blocker that greatly reduces the irritability of the affected vessels and again, reduces pain.
To help these microvessels from developing plaque, I am very careful about keeping my cholesterol numbers low both by diet and medication.
The heart-sensible treatment for MVD is to attempt a regular exercise regime. In my case the endothelium doesn’t open up when I try to increase my heart’s rate, so I cannot exercise and it has been three and one-half years since I have had any exercise. However, my lipid numbers are wonderful and my weight has not ballooned out of control.
Most of the medications I take for MVD are the same ones given for hypertension, and I may have days when my BP is low so I am careful about sudden changes in position. Further treatment can also include pain management.
Although I have stabilized nicely after treatment at Emory, I am dependent on many medications 24/7 and still have frequent episodes of vasospasm with crippling angina. I visit Emory every few months to monitor the disease. My Emory cardiologist and my local cardiologist both follow my changing symptoms carefully. Emory takes the lead in any changes or additions in medications and both doctors follow my blood work for cholesterol issues. I recently had my first change in three years with my nitroglycerine medication. Initially, I started at a very low dose and gradually worked up to a higher dose sufficient to make me as close to pain free and without chest tightness and shortness of breath. This also allowed me to return to some low level of exertion.
I have learned that these vasospasms can occur by some demand I have caused, like attempting a flight of stairs too quickly or by some other unknown to me demand when I am resting or asleep. The daily calcium channel blockers keep the vasospasms away most of the time so this has greatly helped reduce chest pain from the painful spasms. Over the years as I have developed tummy, feet and leg swelling, my Emory doctor has been careful to prescribe not only medication to help with that sign, but also advising me of simple things as watching salt in my diet and elevating my legs. I also have not been subjected to the many tests or additional heart caths that many physicians might request. I have been tested for sleep apnea and use a CPAP which helps my heart rest at night.
I am very healthy and have developed no other health complaints in six and one-half years. The most wonderful part of having this odd dysfunction is having the Emory doctors who not only understand this dysfunction, but also know how it should be treated for each individual patient as their symptoms develop. They also understand that this difficult, exhausting ailment impacts the very simplest of daily functions, social interactions and normal exercise activities. Dr. Samady listens when I tell him how I must change my lifestyle, stop all exercise and avoid those activities or emotions that could cause a demand on my heart and cause me pain or discomfort.
A big frustration with many MVD patients is that our complaints and symptoms often bring us to an urgent or emergent care setting where none of our signs show on any EKG, echocardiogram, ultrasound or stress test. We look well, present with chest pain and shortness of breath – perhaps anxious – but the tests are generally negative, even the cardiac enzymes. We understand that we may have to rule out other causes with GI and pulmonary tests, but we repeatedly return seeking help, knowing that it is our heart but we repeatedly fail the best current technology tests.
My care at Emory from first contact was relatively pleasant as each physician I saw was confident of my diagnosis. And I am confident in my care because of my doctor’s confidence and superb care in an area of cardiology with so many unknowns.
About Joan Jahnke
Joan Jahnke is now a retired RN. She has enjoyed many career opportunities and great jobs traveling around the world with her husband, who is in the Navy. She is an Emory Clinic patient and sees Emory Heart & Vascular Physician Dr. Habib Samady.
It’s been a busy last few weeks at the Emory Heart & Vascular Center. Earlier in November, we shared with you a story of a recent milestone for our Heart & Vascular program when Emory physicians completed their 200th Transcatheter Aortic Valve Replacement. Milestones such as this one have tremendous implications for our patient community. We are consistently putting into practice innovative technology that means longer, fuller lives for our patients. For Sean Dookwah, from Athens, Georgia, this notion rings especially true this holiday season. Sean will be able to enjoy his first Thanksgiving holiday with a new lease on life after Emory physicians implanted his new ventricular assist heart device at Emory University Hospital. Sean’s VAD implant was the 100th such procedure performed at Emory.
The first ventricular assist device was implanted in Georgia at Emory in 2006 as a form of destination therapy (in place of a donor transplant) for individuals who are not eligible for–or unable to undergo–a heart transplant. Ventricular assist devices are battery-operated mechanical pumps that help a weakened heart pump blood throughout the body. They are most commonly used as a bridge to transplant for those whose medical therapy has failed and who are hospitalized with end-stage heart failure. More recently, the VAD is providing an alternative to transplant. VADs allow a near normal quality of life, with most patients returning home with their families while they wait for a donor heart to become available.
Sean Dookwah at Emory University Hospital
Sean, who is 39 years old, began his journey to receiving his ventricular assist device and returning home to his family just two years ago. He had spent years as a construction worker, which kept him fairly active and fit. But after pursuing an office-based career in IT, Sean fell into a more sedentary lifestyle, which included lack of exercise, poor eating habits, long, stressful hours, all accompanied by a 20-year smoking habit.
It was in 2009 that Sean began to feel weak and ill enough to justify a visit to his local emergency room in Athens. “I felt weak, tired, sick, terrible. I was not having a heart attack, but it was there that I was diagnosed with cardiomyopathy, which is basically a weakening of my heart. That was a wake-up call,” says Sean.
After receiving the news, Sean moved in with his family and immediately adopted a healthier lifestyle, which included exercise, healthier eating, and dropping the smoking habit. Within about 18 months he dropped almost 150 pounds – from 480 to a current 330 pounds. He attributes much of his success in turning around his lifestyle to his friends and family.
“My friends and family have been incredible help and an inspiration to me – helping to keep me encouraged and on track, and some of my friends have even quit smoking themselves – both for me and them. I hope to eventually be added to a heart transplant list, but I have some work to do to still lose weight and get down to a healthier frame.”
And after his successful ventricular assist device implantation just a few days ago, Sean is eager to return home to his family for the the Thanksgiving Holiday and continue making healthy progress and enjoy his already drastically improved health. “I feel incredible compared to where I was just a few weeks ago. I was so tired and weak I couldn’t walk from one part of the room to the other,” Sean says. “Today, I feel alert, strong, healthy and like I could run a marathon. It’s amazing, and I am definitely thankful for everyone who made this possible for me – from the doctors and nurses at Emory – to my friends and family. I can’t wait to get home.”
It is milestones like our 100th VAD implant and stories such as Sean’s that make us especially thankful for the positive impact our team is able to have on our community. “Until fairly recently, surgeons have been implanting VADs as a temporary bridge to heart transplantation. We now have the ability to also offer those patients who are unable to undergo a heart transplant to dramatically improve the quality with what we refer to as destination therapy – meaning the device will stay with the patient indefinitely,” remarks David Vega, MD, professor of surgery and director of the heart transplant program in the Emory Transplant Center.
“This technology offers new hope and a much greater quality of life. And with more than five million Americans who suffer from congestive heart failure, with another half million diagnosed each year, this device is a viable, and often-times live-saving – option for our patients,” Vega continued.
Sean will be released for home today, one day before Thanksgiving and just a few days after his procedure, where he will join his family and friends for what very likely will be the most thankful of holidays.
We too are thankful to have the opportunity to improve the lives of people like Sean. And for those of us that are part of the Emory team, but are not in clinical roles, we are tremendously grateful for and appreciative of our researchers and care teams who make saving lives like Sean’s possible.
November 1st, 2011 By Emory Heart & Vascular Center
Emory patient, Donna Fielding, a healthy looking 41 year old mother of two is sure that stress and her high-intensity type A personality lead to her heart attack at 37. Her heart attack taught Donna to “take a step back, take a deep breath, and make a decision.” She doesn’t let the “little things” in life ruin her days any longer.
Emory physicians are doing research to study the connection between stress and heart attack risk. According Emory physician, Dr. David Sheps, when you get stressed your heart rate and blood pressure go up.
View Donna’s story and learn about the research Emory is doing in a video from Fox 5 Atlanta, below:
Take control of your stress and potentially reduce your risk for heart disease!
October 27th, 2011 By Kathy Lee Bishop MS, PT, CCS; Manager, Emory HeartWise Risk Reduction Program
We hope having a heart attack on Stone Mountain is not something you will never have to worry about, but for one Emory Heart & Vascular Center patient, he had to take quick action to save his life. Luckily Howard Dean survived to tell the story and is now participating in the Emory HeartWise Heart Disease Risk Reduction program. He has even returned to hike Stone Mountain since that crazy day. View this Fox 5 Atlanta piece on Howard’s story:
To help keep your heart healthy, register to join us this Saturday, October 29th for the American Heart Association’s Metro Atlanta Heart Walk! If you don’t have a team, you can join our Emory team!
October 24th, 2011 By Malia Veator, Emory Heart & Vascular Patient
Nine years ago I was diagnosed with cardiomyopathy and heart failure. I was very weak, but I improved with medication and diet. At this point, I decided to get a second opinion at Emory Healthcare based on Dr. Andy Smith’s recognition in the heart failure community. I quickly felt very comfortable with Dr. Smith and his staff at the Emory Heart Failure Clinic.
My husband and I concluded that we had met the best doctor to manage my progressive illness. Due to our confidence in Dr. Smith, we followed his advice to have a defibrillator implanted in 2006 to help manage my arrhythmias. In 2007, I became symptomatic again because my mitral valve was leaking significantly. Dr. Smith and my local cardiologist in Macon, Dr. Thomas Terry, advised that I have valve surgery. In 2008, Dr. Robert Guyton, at Emory, performed a mitral valve repair on my heart. A few weeks after surgery, I began having more arrhythmias that could not be controlled. As a result of this new challenge, I had a cardiac ablation in Macon by Dr. Felix Sogade. My heart continued to weaken over the next two years, and I was placed on the heart transplant waiting list in February 2010.
Living with advanced heart failure has been challenging at times. Before my heart transplant in March 2010, there were the days when I couldn’t grocery shop, vacuum or even walk for five minutes. I even dreaded having to wash and dry my hair because I would get exhausted and had trouble breathing.
Life has changed for my family over the last nine years but my husband and I believe that these changes have been beneficial to improving our way of approaching life. Due to my illness, we were unable to have children and our greatest gift has been our beautiful son that we adopted in 2008. We now appreciate each day that we are given and feel very blessed that I have been given a second chance at life.
Waiting for a new heart can be a difficult challenge. But, my family was blessed when we received a phone call about a new heart only 10 days after being placed on the waiting list. Having the heart transplant was such an exciting time for me. When I first came off the ventilator after the surgery, I could already feel an improvement. I noticed my chronic cough was gone and my husband quickly told me I had color in my cheeks again. Four days after surgery I was walking the hospital halls. In fact, I was walking faster and further than I had in the previous two years. I have been exercising ever since: walking, running, light weight training and tennis. These are activities most people take for granted; activities I used to take for granted. Not any more, now I appreciate all activities of daily living. I even enjoy working again!
Since having my transplant, I am followed at the Emory Transplant Clinic and I am proud to say I have met many more remarkable doctors and nurses. I call my clinic doctors, typically Dr. Book, Dr. Laskar or Dr. Cole, my biopsy buddies since I have to have heart biopsies on a regular basis to check for rejection of my new heart. They are great at their jobs, but I would not expect anything less from such a superb hospital. My confidence in Emory, my faith in God and my support from my family give me the courage to continue living life to the fullest each and every day. I could not ask for anything more.
There is no doubt that I was able to benefit from the research and advances made possible by organizations like Emory Healthcare and the American Heart Association, and receive a heart transplant – when 50 years ago there would not have been any options for me!
I am proud to be participating in the 2011 Metro Atlanta Heart Walk! The American Heart Association has made huge advances in the treatment of heart disease resulting from funding heart research, and I want to give back so that others can benefit and hopefully we will one day find a cure for heart disease. I am also walking to honor my family, my heart donor and their family, and the many staff at Emory Healthcare who have been with me on my journey from heart failure to heart transplantation.
Malia Veator, Emory Heart & Vascular Center patient and 2011 Atlanta Heart Walk Participant
In his last blog post, Dr. Veeraswamy outlined what aortic dissection is, what the symptoms are and what you can do to prevent it. Although it is best to detect aortic dissections early, it is possible to survive one. Emory Healthcare patient, Gene Winfrey is a living example. At another local hospital Gene was told he wouldn’t survive surgery to repair the aortic dissection. But Gene is tenacious and decided to schedule an appointment at Emory and he is glad he did. Gene not only survived surgery he is thriving and traveling all over the country as an evangelist. Gene says, “I tell people everywhere I go about Emory and about what happened to me. I am living proof about what happened.”
As mentioned in the last aortic dissection blog, men ages 60 – 70 are most likely to have an aortic dissection and it is relatively uncommon but it is the most common aortic emergency we see at the Emory Heart & Vascular Center. Most patients come in urgently with severe chest or abdominal pain. If not recognized and treated immediately, the tear will go through blood vessel and it is unlikely the patient will survive.
Gene knew he needed help and needed it quickly. We explained to him that if the outer layer of the aorta burst, he would have little chance of living through the dissection. We were adamant that the stent needed to be put in right away.
Luckily for Gene, treatments have changed from the past so he was a candidate for a more minimally invasive method to treat the dissection called endostents. In the past the only way to treat an aortic dissection was through open surgery. The patient benefits from the less invasive ways of performing surgery and is typically able to get home more quickly and return to work sooner with limited complications. Emory is unique in that we have access to devices that are not yet on the market.
Gene had run the Peachtree Road Race 27 straight times before this and wanted to make sure he could maintain his active lifestyle that included riding horses, playing golf and playing tennis. I advised Gene that he could do whatever he feels like doing, and he is doing just that. He is one of the most active 88-year-old persons I have ever met!!
Gene summarizes his experience at Emory as follows “They (the other hospital) said we can’t do it. You can’t live through it. I came here and Dr. K said you can. I am 88 years old and still living. I advise anyone to come to Emory, I think it is the greatest in the world.”
About Karthik Kasirajan, MD: Dr. Kasirajan specializes in surgery and vascular surgery, and has been practicing at Emory since 2003. Several of his areas of interest include peripheral arterial disease, endovascular surgery, abdominal and aortic aneurysm, vascular surgery, thrombotic disease, and stroke. Dr. Kasirajan holds many organizational leadership memberships, including the European Society for Vascular Surgery, International College of Surgeons, and the Peripheral Vascular Surgical Society, and is widely published in publications such as the Journal of Endovascular Therapy and the Journal of Vascular Surgery.
Herbert Grable was diagnosed in 2000 with congestive heart failure. When he was diagnosed, it came as a shock and he was scared. He didn’t know what caused his heart to fail and he didn’t know what heart failure treatments were available for him. He was very grateful to have the Emory Heart & Vascular Center near his home, as it offered a unique treatment for patients who are not candidates or can’t get a heart transplant right away – called Ventricular Assist Devices (VAD).
As we have discussed in previous blogs, a VAD is a mechanical device that is implanted in the heart. This pump takes over the function for the ventricle and circulates blood to the rest of the body. The goal of a VAD is to improve a patient’s survival and quality of life while they wait for a transplant (if they are a candidate for a transplant). The number of heart failure patients is tremendous, and with the number of transplants regulated per year at around 2,500 the VAD is another option for non-transplantable candidates as well.
After receiving the VAD, Herbert smiled and joked that he felt like himself again. His wife commented that the she got the “old Herbert back.” After eight months with the VAD, Herbert was again upgraded to the transplant list. One week later, he received the call from Emory Transplant Center that a heart was available for him. Before transplant, Herbert was scared but he had faith in Emory and was determined that everything would work out. His wife was hopeful and optimistic that Herbert would be with her for many more years and would possibly see some grand kids one day.
Transplants are complex procedures. Emory transplant physicians are experts in their field and aware of all possible nuances that occur with each individual transplant patient. Should an unusual complication arise during a transplant experience, Emory has the skill to reach the most optimal outcome for a patient.
After Herbert received the heart transplant, he was able to live a normal lifestyle and do everything he always did before he was diagnosed with heart failure. He sums up his care “Emory is not just hospital, they care about the patient as well. I am so glad to have a place like Emory to treat me for this condition.”
For more information about heart transplant after the VAD procedure, watch this video:
About Dr. Vega
Dr. David Vega is a cardiothoracic surgeon at the Emory Heart & Vascular Center and the Director of Emory’s Heart Transplant program at Emory University Hospital. He implanted Georgia’s first dual pump ventricular assist device (VAD) in 1999 to serve as a bridge to heart transplantation, a procedure that initiated Emory’s ongoing national position at the forefront of the use of mechanical circulatory assist devices. In 2006, he implanted the state’s first VAD as a form of destination therapy for individuals who are ineligible for or are unwilling to undergo a heart transplant, and in 2007 he implanted an even smaller VAD for the same purpose that featured an automatic speed control mode designed to regulate pumping activity based on different levels of patient or cardiac activity.
Michael Armstrong joined the gym to get some aerobic exercise and lose some weight. One day, he was walking on a treadmill when he noticed pain in his chest as well as pain that went up into his throat. The pain then began radiating down his left arm.
Michael has worked in the health care industry for many years, so he quickly realized what he was experiencing could be signs of a heart attack, and he consulted his primary care physician. Michael told his physician about the symptoms and the physician quickly referred him to me at Emory University Hospital Midtown for an innovative procedure called hybrid coronary revascularization.
As I mentioned in my previous blog post about hybrid coronary revascularization, this procedure is typically performed on a patient who has blockage in the artery in the front of the heart and one other blood vessel with disease in it. This unique approach is a best of both world’s strategy where we combine durability of surgery with the minimally invasive nature of a procedure called stenting. Optimal therapy with this minimally invasive approach translates into shorter recovery time, potentially fewer complications and a quicker return to work. Emory is one of only a few centers in the nation offering this procedure.
Michael Armstrong sums up his experience:
“I didn’t know what to expect, this was my first hospitalization in my life but I was comfortable getting my heart care at Emory University Hospital Midtown. Dr. Halkos had done more than 100 robotic surgeries so I was very impressed with that. Dr. Halkos knows the road you are about to take together is treacherous and comes across as very knowledgeable while still friendly and empathetic. Now shortly after the surgery, I am back to full exercise, I walk around the neighborhood with my wife, and even last weekend I walked to the top of Stone Mountain with a friend. That made me feel good. I know Emory talks about quality patient and family centered care, but actually experiencing it was pretty wonderful.”
Do you have questions or feedback? If so, please leave them in the comments section below.
About Michael Halkos, MD Dr. Halkos is a cardiothoracic surgeon at the Emory Heart & Vascular Center. He specializes in minimally invasive adult cardiac surgery. He is leading the innovative Emory work with the hybrid coronary revascularization procedure being performed at Emory University Hospital Midtown. He finished his Medical School, Residency and Fellowship at Emory University School of Medicine and is a member of the American Medical Association.
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