Posts Tagged ‘treatment’

Coronary Artery Disease Treatment – A Patient Story

Michael Halkos, MDMichael 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.”

Watch Michael’s story in this video.

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.

Heart Failure – What Should I Know?

Sonjoy Laskar MD

A heart failure diagnosis may sound frightening, but with the right treatment, heart failure can be controlled. Once you are on a stable medical regimen, you can often return to a full and enjoyable life. With the recent passing of actress and icon, Elizabeth Taylor, we would like to take some time to provide some information about congestive heart failure.

Facts:

  • Congestive Heart Failure (CHF) affects nearly 5 million Americans
  • Approximately 550,000 new cases are diagnosed in the U.S. each year.
  • Congestive heart failure affects people of all ages, from children and young adults to the middle-aged and the elderly.
  • Almost 1.4 million persons with CHF are under 60 years of age.
  • CHF is present in 2 percent of persons age 40 to 59.
  • More than 5 percent of persons age 60 to 69 have CHF.
  • CHF annual incidence approaches 10 per 1,000 population after 65 years of age.
  • The incidence of CHF is equally frequent in men and women, and African-Americans are 1.5 times more likely to develop heart failure than Caucasians.
  • More than half of those who develop CHF die within 5 years of diagnosis.

Symptoms:

  • Shortness of breath with little exertion
  • Feeling weak or tired after little activity or exertion
  • Difficulty sleeping due to breathing problems
  • A new or different cough, especially while lying flat
  • A swollen and/or tender abdomen
  • Loss of appetite
  • Increased urination at night
  • Swelling of the feet and legs

Early diagnosis and treatment for heart failure is very important. Heart failure is a chronic condition that may follow a varied and unpredictable course. If you are experiencing heart failure symptoms, you should see your cardiologist. If you have been diagnosed with heart failure, adhering to the treatment plan designed by your doctors and nurses can help you navigate this challenge. Your symptoms can be controlled with proper medical care.

About Sonjoy Laskar, MD:
Dr. Laskar joined Emory Healthcare in 2005 and has devoted his career to providing direct care to patients with heart failure, heart transplantation and ventricular assist devices, as well as to teaching residents and fellows. He is an active researcher in the areas of echocardiography and ventricular assist devices as destination therapy, and is a member of the American College of Cardiology, Heart Failure Society of America and the International Society of Heart and Lung Transplantation

New Treatment for CAD – Hybrid Coronary Revascularization

hybrid revascularization treatment for CADIn our last blog, Dr. John Douglas discussed Coronary Artery Disease (CAD). Now, we will cover a new procedure to treat CAD, called Hybrid Revascularization, that we are performing at the Emory Heart & Vascular Center.

Currently, Emory is one of the few centers in the country offering this procedure. Standard guidelines call for patients with blockages in the left main artery (the artery that provides most of the blood to the heart) to undergo bypass surgery.

Hybrid revascularization’s advantage is a combination of coronary artery bypass surgery (CABG) and percutaneous coronary intervention (PCI). Emory physicians are leaders in performing these procedures “off-pump” in a minimally invasive fashion, without breaking open the chest.

The minimally invasive CABG procedure uses robotic-assisted techniques that allow surgery to be performed using small incisions between the ribs rather than through a midline incision dividing the sternum.

The recovery from robotic assisted CABG is shorter and expected to have fewer complications. Impressively, most patients are able to leave the hospital within three to four days and return to full activity, including work, in two to three weeks rather than the two-month recovery generally required following traditional CABG.

This approach is a “best of both worlds strategy”- minimally invasive off-pump left internal mammary artery (LIMA) graft plus a stent placed via ultrasound from the left main to the left circumflex artery.

For more a case study about this procedure view the March issue of The Chamber, our heart and vascular e-newsletter.

About Dr. Halkos
Dr. Halkos is a cardiothoracic surgeon at the Emory Heart & Vascular Center. He specializes in cardiovascular disease, coronary artery bypass surgery and valve repair/replacement. He finished his Medical School, Residency and Fellowship at Emory University School of Medicine. He is a member of the American Medical Association.

“Back to Life” After an Aortic Aneurysm

September 2, 2010 was a memorable day for Emory patient Warren (Allen) Owens when he realized years of heart trauma were behind him.

Previously, Mr. Owens had experienced 8 heart attacks, had been diagnosed 21 times with congestive heart failure, had 13 stents placed, had 5 bypass surgeries ( (4 of them failed) and had taken 4 life flights (emergency helicopter rides to the hospital). On each life flight he was not expected to make it to the hospital because of his critical status.

Mr. Owens was referred to Emory after physicians at his local hospital were no longer able to help him with his life-threatening condition, an 8-cm aortic aneurysm that was at risk of rupturing. At Emory, patients with complex aortic aneurysms like Mr. Owens now have an option they did not have before – the fenestrated and branched endograft procedure that we discussed in a previous blog post. Now over a year later Mr. Owens is able to perform the daily tasks that he could not do before the surgery. He credits Emory physicians with “bringing him back to life.”

“I can’t put it into words how thankful I am that he was able to do what he did and bring me back to a semblance of my former life.” – Warren Owens

Listen to Mr. Owens touching story by watching the video below.

About Joseph J. Ricotta II, MD:
Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010. His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases. He has authored several journal articles and book chapters on the topic of fenestrated and branched endografts, and holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery and the Society for Vascular Surgery.

The Emerging Role of Fenestrated & Branched Aortic Endografts in the Treatment of Complex Aortic Aneurysms

Dr. RicottaAs Dr. Kasirajan mentioned in the last blog about aortic aneurysms, this condition can cause serious medical issues or even death. For patients with large complex aneurysms, there is a new procedure that we are performing at the Emory Heart & Vascular Center called a fenestrated and branched stent graft. This procedure is a viable option for patients who may have once been considered inoperable. These grafts are now used in select high-risk patients with complex aneurysms that are located throughout the entire length of the aorta.

In addition to being a safe and effective option for high-risk patients, fenestrated and branched endograft implantation provides patients with a number of benefits including:

• No incisions
• Shorter hospital stays (one or two days vs. 10 to 14 days for open surgical repair)
• Quicker recovery

Unfortunately, these devices are not yet commercially available in the United States. In countries where they are available, the grafts must be customized for each patient, a process that can take up to 12 weeks. During this time patients are at risk for a rupture in their aneurysm. As an alternative since 2007, several vascular surgeons in the United States have been custom-making fenestrated and branched stent grafts using available components.

Emory currently is one of only a few institutions in this country and the only one in the Southeast that offers these investigational procedures.

Fenestrated and branched endografts appear destined to play a key role in the management of complex aortic aneurysms. Research results have shown that these devices are both safe and effective in treating carefully selected patients, with low incidence of complications. Although additional research is needed to substantiate these results, Emory is poised to participate as a primary site in proposed clinical trials of these innovative devices.

You can learn more about Emory’s fenestrated and branched aortic stent graft program at www.emoryhealthcare.org/vascular

Do you have questions about fenestrated and branched aortic endografts? If so, feel free to ask away in the comments section.

About  Joseph J. Ricotta, MD:

Dr. Ricotta specializes in vascular and endovascular surgery, and came to Emory from the Mayo Clinic in August 2010.  His areas of clinical interest include fenestrated and branched endografts to treat aortic aneurysms, thoracoabdominal aortic aneurysms, peripheral aneurysms, PAD, carotid endarterectomy and carotid stenting, mesenteric and renal artery disease, and venous diseases.  He has authored several journal articles and book chapters on the topic of fenestrated and branched endografts, and holds organizational leadership memberships at the American Medical Association, the American College of Surgeons, the Society for Clinical Vascular Surgery and the Society for Vascular Surgery.

Peripheral Artery Disease: Donna Seaman’s Story

My name is Donna Seaman, and I’d like to share my story of Peripheral Artery Disease with you.

First—a little background for you: I’m from Massachusetts, and I’ve lived in Atlanta for over 35 years now. I attended Emory University and majored in business before becoming a buyer for Rich’s (now Macy’s). I enjoyed the best of both worlds in that I spent several years as both a working Mom, and several as a stay-at-home Mom. I live in Dunwoody, and I have two children—a 26-year-old daughter, and a 23-year-old son.

I’ve been playing tennis now for over 20 years, and once I hit my late 40s I began to notice some leg pain and swelling. At the time, I attributed it to normal wear and tear, and assumed it was also due to all of the years I spent on my feet working in the retail industry. When the pain worsened after about a year or so, I knew it was time to seek medical help.

When Dr. Niazi asked me if I was experiencing any other symptoms, I shared the fact that my tennis game had been really “off”, and that I had noticed that I was stumbling around more and feeling clumsier in general. I would also pick up items and unintentionally drop them. I didn’t think much of these particular symptoms, but the folks at Emory really took notice when they heard me mention them, and decided to run some more tests.

After the tests, Emory called me with the results and informed me that not only did I have peripheral artery disease in my legs, the carotid artery in my neck was 97% blocked. (My neck artery blockage was what was causing the stumbling and clumsiness.) Dr. Niazi immediately warned me not to have any neck rubs or massages, and to exercise caution when I was getting my hair washed at the salon or bending my neck. With 97% of the artery blocked, I was dangerously close to experiencing a stroke.

Initially, I had less invasive procedure that involved the physician going through my groin area and then up into my neck in order to place a stent. However, after reviewing the results of the procedure, Dr. Niazi realized that my condition was worse than he anticipated. He recommended that I undergo total carotid artery surgery, which was necessary given my younger age and the severity of the blockage.

A week later (in October of 2009), I was back at Emory for the carotid artery surgery that would clean out the build-up of plaque.  I was in the hospital for three days for the procedure. I left Emory with a scar on my neck and the knowledge that I’d come dangerously close to having a potentially fatal stroke. In my mind, it’s a sort of miracle that my condition was discovered the way it was—if it weren’t for Dr. Niazi’s proactive treatment of my PAD, I’m not sure I’d be here to tell you my story today.

About a month later, I was treated for the PAD that was present in my legs. This was a much simpler procedure—and was practically right in and out of the hospital for it.

Since the surgery, I started taking medication for cholesterol and high blood pressure, and I have yearly checkups to the doctor. I no longer feel any pain in my legs when I exercise. My walking is better, and my balance has improved greatly.

I can’t say enough good things about Dr. Niazi and the team at Emory who treated me. They’re personable, professional, and top-notch, and they took a personal interest in me and carefully listened to me speak about my concerns and symptoms. I feel very fortunate that I was in such good hands and that I escaped the life-threatening repercussions of PAD.

Treatment Options for Peripheral Artery Disease

In this post, we’ll continue our blog series by examining the various treatments for treating peripheral artery disease (PAD).

Lifestyle

Before we delve into the various medical treatment options for PAD, we must point out the importance of taking control of your own health. If you’re suffering from diabetes, this means that you must carefully monitor your blood sugar levels. If you’re a smoker, we cannot stress the importance of doing everything in your power to quit the habit. PAD is very common among smokers, and smoking only exacerbates the effects of the condition.

Additionally, we strongly encourage regular exercise as a means of treatment—it increases blood flow to your legs and can actually alleviate symptoms. For some, exercise may be painful; however, you can often work your way up to a level of exercise that’s extremely beneficial as well as tolerable.

Medication

Medication may be necessary to offset the effects of PAD and lower the risk of heart attacks and stroke.

Antiplatelets affect blood platelets, causing them to be less likely to stick together to form blood clots. One of the most common antiplatelets is aspirin.

Anticoagulants prevent blood clotting, but must be monitored carefully for side effects. Two examples of anticoagulants are heparin and warfarin.

Cholesterol-lowering drugs have also proven to be effective in preventing heart attacks and stroke. Additionally, they can improve atherosclerosis and alleviate painful symptoms resulting from claudication. Statins and niacin are both examples of cholesterol-lowering drugs.

Angioplasty & Surgery

Many times, PAD patients require treatments such as angioplasty or surgery. As we described in our last blog post, angioplasty involves the insertion of a catheter into the groin area and then into the narrowing arteries. Partially blocked arteries can be opened through the insertion of a tiny stent or balloon.

For patients with more severe instances of PAD, more invasive means of surgery may be necessary, such as endarterectomy, which removes the buildup of plaque within the affected arteries. Bypass surgery may also be performed, which involves the replacement of blocked arteries with a graft. This encourages blood flow to move around the narrowed or blocked arteries.

If you have questions on any of these procedures or treatments, please be sure to let us know in the comments.

About Gregory Robertson, MD:

Dr. Robertson specializes in Cardiology and Internal Medicine, and is an Assistant Professor of Medicine at Emory. Some of his areas of clinical interest include atherosclerosis, cardiac catheterization, cardiovascular disease, valve disease, and peripheral artery disease. Dr. Robertson holds an organizational leadership membership at The American College of Cardiology, and has contributed to multiple publications in his field.

About Ravi Veeraswamy, MD:

Dr. Veeraswamy specializes in surgery and vascular surgery, and has been practicing with Emory since 2006. Some of his areas of clinical interest include aortic aneurysm, carotid endarterectomy, peripheral arterial and vascular disease, and vascular surgery. Dr. Veeraswamy had major or recent publications in the Washington University Manual of Surgery, Vascular and Endovascular Challenges, and the Annals of Vascular Surgery.

Understanding Heart Failure

Heart failure, put simply, is a condition in which the heart doesn’t pump as well as it should. Nearly 5 million Americans currently suffer from it, and approximately 550,000 new cases are diagnosed every year. So, why does it occur? Unfortunately there’s no straightforward answer to this question—heart failure can stem from a number of factors, including diabetes, obesity, lung disease, coronary artery disease, heart valve disease, congenital heart disease, irregular heartbeats, long standing high blood pressure and more.

A normal, healthy heart pumps plenty of oxygen-rich blood out of the heart and into the system, nourishing the entire body. Signs of heart failure enter the equation when the heart doesn’t eject blood efficiently enough to meet these oxygen demands. The condition can occur suddenly, or it may advance slowly over time.

In order to understand heart failure, we must first examine the two main types: systolic and diastolic. With every heartbeat, the heart contracts and relaxes. Systolic heart failure (the most common type) occurs when the heart doesn’t contract properly due to weakness in the heart muscle, which causes the ventricles to stretch. In the case of diastolic heart failure the heart contracts well, but is unable to relax properly, causing the muscles to thicken and harden.

Both types of heart failure render the heart unable to properly fill with blood, which can cause the blood to accumulate into the lungs, hands, abdomen, legs and feet. This “backing up” of fluid is often referred to as “congestion”, or congestive heart failure.

Symptoms of heart failure include:

-       shortness of breath with little exertion

-       weakness or fatigue with little exertion

-       difficulty sleeping

-       unfamiliar coughing

-       swollen/tender abdomen

-       loss of appetite

-       increased urination at night

-       swelling of feet and legs

The importance of early diagnosis and treatment of this condition can’t be overstated. Further, it’s critical to identify the underlying cause of heart failure in order to determine the best course of treatment, which can range from medications, to device implants to surgeries, depending on the severity of the condition.

We strongly encourage patients to take an active role in controlling their symptoms by taking their medication regularly, monitoring their weight, heart rate and blood pressure, following diet and exercise recommendations and managing stress.

Heart failure is a chronic, progressive condition; however, patients who proactively monitor their key symptoms and adhere to their treatment plans can drastically improve their outlook for the future.

Have you or someone you love been affected by heart failure? If so, please feel free to share your thoughts or questions with me in the comments.