Cardio-Oncology

Cardio-Oncology

PATIENT EDUCATION

Assembling The Best Minds To Treat Cancer Patients And Protect Your Heart

A team of doctors will soon be working together to fight the two main causes of death in the United States

Cardio-oncology is a new field in cardiology. Thanks to improvements in detection and treatment, cancer survivorship has increased significantly over the past several decades. Today, more than 14.5 million cancer survivors are living in the United States. But the aggressive chemotherapy and radiation treatments can cause damage to the hearts of the patient’s life they are saving, frequently putting the survivor at a greater risk for heart disease. Cardio-oncology describes the efforts to prevent or treat patients with cancer who face heart problems caused by cancer treatments.

Dr. Heather Stahura is spearheading the developing of Capital Cardiology Associates Cardio-oncology medical team, consisting of physicians, clinicians, and medical staff in the Capital Region. “The big institutions, like Yale, have started these cardiology oncology programs. CCA would like to bring this here for our people. We want to make a team effort, working with local oncologists to address the awareness to create protocols to aid in risk assessments before treatment or cardiac functions as they are undergoing therapy,” said Dr. Stahura.

Cardio-Oncology

It’s hard to believe that the idea of including heart health in cancer treatment is a relatively new practice. “Cardio-Oncology is a new field that is coming into practice, I’d say really, over the past five years. We see a real need for it. What we are looking to address is people for traditional risk factors for heart disease or not at all, before you undergo chemotherapy,” stated Dr. Stahura. Emerging data indicates that newly developed drugs for cancer treatment have unanticipated side effects. The numbers also show that less than 30% of hospitals and medical centers offer specialized cardio-oncology services. Anthracyclines are a class of drugs used in cancer chemotherapy. While it is very effective in the treatment of breast cancer, “anthracyclines, when given in high-doses during treatment or to patients as part of the regular treatment protocol, can lead to an increased risk of congestive heart failure,” shared Dr. Stahura. Also, a variety of new drugs that are very effective in treating cancer can have other effects on the cardiovascular system.

“Just as the world of cardiology is ever changing, oncology is rapidly changing with new treatment options. I think that working in team formats to address these issues – we know these are life-saving treatments, they are what’s best for the patient. We don’t want to stop the treatments we want to keep them safe.”

Dr. Heather Stahura

Cardiologist, Capital Cardiology Associates

The goal of the Cardiac-Oncology team is to treat the complete patient safely. Simply put, kill the cancer cells without damaging other areas. “Oncologists and radiation oncologists have done a fantastic job at evaluating their treatments and procedures using machines to minimize risk to their patients. Radiation to the chest can cause advanced coronary disease, especially valvular dysfunction. These doctors have realized that we have to minimize the field of exposure to miss the heart and important internal organs while trying to target that cancer as best they can. Our job on the cardiologist side is never to interfere or stop these life-saving treatments that the oncologists are administering but rather, to work as a team format, addressing issues before they arise or catch them before your heart pump starts to fail or hypertension develops. We want to assist in your care.”

Preventive care

Cancer survivors are educated on lifestyle changes they will need to make following their successful treatments. Eating healthy, staying active, getting a flu shot, frequently washing their hands, limiting their exposure to the sun and tanning beds, and of course, staying away from alcohol and tobacco smoke. Sometimes monitoring your heart health can be lost in the massive amount of information a survivor receives. “That often can be difficult for patients to understand,” says Michelle Giwerc, a Physician Assistant at Capital Cardiology Associates. “Cancer patients are at a greater risk of developing hypertension (high blood pressure), for example. That can lead to coronary heart disease. One of the major goals moving forward is to screen people regularly, whether that is with yearly physicals with your primary doctor to look for high cholesterol, high blood pressure, or diabetes. Awareness will help in early detection to treat these symptoms.”

In all matters of the heart, Capital Cardiology Associates is consistently seeking opportunities to improve our patients quality of care. “In big cities, major institutions are responding very well. I think we can do even better in our area. We have a great medical community here. I would love to see a survivorship clinic in the future. We would get the people who are done with their treatment five, ten years down the road,” said Dr. Stahura. For those of us who live in the Northeast, a nationwide survey shows that medical centers in our area are aggressively working to establishing a team of medical professionals capable of recognizing the growing population heart disease patients in addition to collaborative cancer treatment protocols. Dr. Stahura is seeking to create such a medical community here in the Capital Region. “I know oncologists definitely talk about the risk factors of medications. But as cardiologists, we want you to keep following up with us five, ten, fifteen years after your successful treatment so that you can become a cardiac survivor as well.”

Written by: Michael Arce, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Diabetes and Heart Disease

Diabetes and Heart Disease

PATIENT EDUCATION

After Smoking, Diabetes is The Second Most Preventable Cause of Heart Disease

A “wake-up call” to 7.5 million Americans

Diabetes Alert Day is observed annually on the fourth Tuesday in March. Diabetes Alert Day is a one-day “wake-up call” that focuses on the seriousness of diabetes and the importance of understanding your risk.

America’s rising obesity rates along with our aging population have elevated the concern that diabetes is more than a risk factor for heart disease; the relationship of heart failure and diabetes is deadly. The CDC states that more than 30 million people in the United States (422 million worldwide) have diabetes, and 1 in 4 of them don’t know they have it. The World Health Organization (WHO) reports that the number of people with diabetes has nearly quadrupled since 1980 due to obesity and widespread physical activity. WHO also states that “a large proportion of diabetes and its complications can be prevented by a healthy diet, regular physical activity, maintaining normal body weight and avoiding tobacco use.”

What was once thought to be a disease you are born with or something that only affects people who overeat sugar now causes more deaths per year than breast cancer and AIDS combined and having diabetes nearly doubles your chance of having a heart attack.

Types of Diabetes

The two major types of diabetes are Type 1 and Type 2. Diabetes is a metabolic disease that occurs when your body cannot regulate its blood sugar (glucose) levels. Type 2 is the most common form of diabetes, accounting for about 90% to 95% of all diagnosed cases of diabetes. 1 in 3 Americans are pre-diabetic, which is not Type 1 or 2 diabetes but a red flag warning that you are dangerously close to diagnosis. The risk factors for Type 2 are an adult over 45, family history of diabetes, not physically active, and a history of gestational diabetes. Certain ethnicities are at a higher risk of a pre-disposed risk of diabetes: African Americans, Hispanic/Latino Americans, American Indians/Alaska Natives, Pacific Islanders, and some Asian Americans. Type 2 can be managed with a healthier lifestyle, weight loss, a regular activity or exercise, and by taking medication. You can prevent Type 2 diabetes but not Type 1.

Type 1 diabetes (T1D) used to be called “juvenile diabetes” and can strike at any age. Just because you are 50 years old doesn’t exclude you from being diagnosed today. When you have type 1 diabetes, your pancreas does not make enough insulin for your body, subject patients to a life-long insulin dependency through injections or wearing an insulin pump. There is no pill form or cure for T1D. Denise Nicastro is Director of Development and Outreach Manager of JDRF, Northeast New York Chapter. Her daughter was diagnosed with Type 1 diabetes when she 15 years old. “With Type 1 you can’t seem to quench your thirst, your vision is affected sometimes. I know with my daughter when her blood sugar levels were high or low, her moods would be altered. You want to look for those signs and tell your doctor,” she said.

Increasing Awareness

The death of Carson Daly’s mother, Pattie Daly Caruso, from a heart attack at the age of 73 in 2017, brought attention to the fact that people with diabetes need to be aware of their heart health. Diabetes can lead to atherosclerosis, the build-up of fats, cholesterol, and other substances in and on the artery walls. This a widespread disease with more than 3 million cases in the United States every year. Atherosclerosis has no symptoms until a plaque ruptures causing a stroke or the buildup is severe enough to block blood flow, triggering a heart attack. This condition is affecting people as young as 19, some born with Type 1 diabetes who do not regulate their insulin levels, others due to poor lifestyle choices that have led to high blood pressure and bad cholesterol.

While atherosclerosis, unless discovered during routine medical visits or investigated by your doctor after evaluating your risk, can go undetected — the other concern with medical professionals is that diabetics wouldn’t feel the onset of a heart attack. Not every patient feels the pressure, tightness, pain, or a squeezing or aching sensation in your chest or arms that may spread to your neck, jaw or back that are common with heart attacks. Researchers are investigating the nerve damage (diabetic neuropathy) that over time, can lead to pain and numbness in the feet (peripheral neuropathy) to problems with the functions of the heart (autonomic neuropathy).

Carson Daly (l) and his mother Pattie Daly Caruso (r)

Searching for a cure

People with diabetes can live a long and healthy life when their disease is diagnosed and managed. Danielle Unser-Slater, Outreach Manager for the JDRF Northeast New York Chapter, explained one of the popular blood sugar monitoring methods. “Many people with Type 2 choose to manage their disease with insulin.” She described the daily regiment of meal planning, physical activity, medications, and glucose monitoring. “The hard part is diabetes takes such a mental toll on the whole family. Suddenly you go into the hospital, you are put on insulin right away, and you start to feel better. However, unlike when you have a cold or the flu, where you stop taking medicine after a while, comes the realization that you have to take an insulin shot every time I put something in my mouth – but I feel fine. Moreover, we see that happening a lot with Type 2 diabetes; people choose not to manage it properly because they feel fine when in reality they have no idea what damage is being done inside their body. It’s a challenge.”

Currently, there is no known cure for diabetes. The goal of the JDRF is to find one. There are 500 research grants worldwide that the JDRF is working on, “it turns out that 80% of our research will also affect Type 2 diabetes and other auto-immune diseases,” says Nicastro. The cure could be a vaccine in the distant future. “Closer on the timeline would be encapsulation. In an auto-immune disease, your immune system identifies something as your body and attacks it. The challenge is finding beta-cells that protect insulin produced in your pancreas to protect the immune systems attack,” Unser-Slater shared. One way researchers are studying this in human clinical trials is by using an encapsulation device made of seaweed and water, that allows the oxygen and nutrients to flow through while protecting those cells from the immune response.

In 2006, the JDRF started an extensive research project to create an artificial pancreas. The makers of the Omnipod Insulin Management System recently announced successful results in early clinical trials of its artificial pancreas system. The JDRF also is investing resources in developing ultra-concentrated insulin. “We are trying to figure out what trigger might be that causes the pancreas to stop functioning properly. Could it be a virus that settled into the organ? There are many thoughts out there, but there is no concrete evidence that proves the exact cause of T1D, like any other auto-immune disease,” said Nicastro.

With every exciting discovery, the fact remains that until a cure is found, detection and education awareness will be necessary. “We know, no matter what, the longer you have diabetes, the greater risk you have for stroke and heart disease,” Unser-Slater said.

Written by: Michael Arce, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Detecting Irregular Heartbeats

Detecting Irregular Heartbeats

PATIENT EDUCATION

The Next Generation
of Heart Tracking

Monitoring the rhythm of
your heart and alerting
you to changes

Smartphones are innovating how we diagnose irregular heartbeats. According to their press release this week, the results of the Apple Heart Study, Stanford Medicine verified that the Apple Watch can detect and report an “irregular heart rhythm (that) appears to be suggestive of atrial fibrillation (AFib).” AFib is quite common in the United States with more than 200,000 cases reported every year. At least 2.7 million Americans are living with AFib. People with untreated atrial fibrillation may be at greater risk for stroke than people with normal heart rhythms. Because blood does not flow through the atria regularly, blood clots may form in the heart. If a blood clot escapes from the heart, it can travel through the bloodstream to the brain and cause a stroke.

Your heart’s rhythm

Dr. James O’Brien is board-certified in clinical cardiac electrophysiology. An electrocardiogram (ECG, EKG) is a test that allows your doctor to see how well your heart is working. Dr. O’Brien describes his specialty as to an electrician, a specialist who investigates the wiring of the heart. “That’s where the heart is amazing. Our hearts are kind of like nerves, in the sense that they are electrically active; some of the nerves contract and that’s more muscular, some of them don’t, they conduct electricity. There’s an area called the sinus node that spontaneously fires and it’s kept in check by nerves. As we start to exercise or are active, our heart rates pick up. That area, the sinus node, is responsible for that change. The rest of the heart is inert. It sits there and waits for that sinus node to tell it what to do.”

Graphic of Heartbeat

When the heart beats, arteries expand as they fill with blood. When the heart relaxes, the arteries contract. It’s this rhythm between the heart and the arteries that powers your circulation system and keeps your blood flowing.

Dr. O’ Brien continued to explain the function of a heartbeat. “Some of the areas of the heart misbehave by themselves, and they try to run the show; those are atopic areas. People have, the term is PVC’s or premature ventricular beats, the most common reason for extra beats or skipped beats that leads for people to come in and say, ‘I feel palpitations or a sensation that my heart is beating abnormally.’ Many of those are due to PVC’s in an area of the lower chamber of the heart that depolarizes or fires by itself, competing with that normal rhythm. Many times when we sit down our heart rate slows down, and that area gets to discharge. If we get up to run the sinus rate is a little quicker, quieting down the PVC. This is why people say, ‘I don’t get them while I’m up and around, but I feel it more when I’m sitting.’ Some arrhythmias (abnormal heartbeat rhythms) are reentrant; those are different if you’ve had a heart attack or scare on your heart. As opposed to firing from a focus it re-enters, where the signal is spinning around, going from the healthy tissue, slowly through the scare and around again. That’s a reentrant arrhythmia, and those are much more serious.”

Before technology made it possible to see heart rhythms on a screen, doctors read EKG paper tapes. “We used to call them the squiggles,” he recalled. He explained the importance of understanding the difference between your heart rate and your heart’s rhythm. “When people say, ‘My heart rate was 72,’ well that’s good to know, it’s a significant number, 60 to 100 is normal at rest. But, what is the rhythm? Is it a regular rhythm? A top-bottom rhythm? Or is there atrial fibrillation, where the upper chamber is quivering, and the heart is not squeezing at all? This is when clots can form, and the electricity is being conducted to the bottom, you may have a heart rate of 72, and you may have AFib or an irregular rhythm. The rhythm of your heartbeat is what we are looking at on an EKG.”

Remote heart rate monitoring

It’s worth noting that the 2017 Apple Heart Study used older Apple Watch versions, not the Series 4 Watch that was unveiled this past fall, which has a built-in electrocardiogram (ECG) on top of the standard pulse sensor. Also, remote heart rate monitoring isn’t new technology. Dr. O’Brien pointed out that similar products have been on the market for the past 15 years. “AliveCore (the company who makes Kardia products) uses single lead EKG systems to detect the heart rate and the rhythm: regular, normal sinus or irregular, AFib.” The KardiaBand offers a replacement band for Apple Watches where users can conduct an “EKG anytime, anywhere” by placing their thumb on the band strap sensor for “a medical-grade EKG in just 30 seconds.” KardiaMobile pairs with most smartphones & tablets and uses a wireless strip sensor where users place their index and middle finger for “a medical-grade EKG in 30 seconds anywhere, anytime.” As Dr. O’Brien notes, these devices “create a PDF report on your phone which patients can send to us for review at the office.”

In September of 2018, Apple introduced the Apple Watch Series 4. This was the first smartwatch that can monitor your heart, and if it detects an irregular heart rhythm, notify you and record the episode. It instantly became the “hot-holiday” gift for heart patients. Apple continued its heart monitoring research with an announcement in January of this year that it had partnered with Johnson & Johnson to develop an app that can accelerate the diagnosis of a leading cause of stroke. Their study will start later this year, focused on US adults over 65 who wear the Apple Watch Series 4. “My strong suspicion is the study will be positive. For a device to give us information from an all-day sample is very helpful” stated Dr. O’Brien.

In a statement, Paul Stoffels, Johnson & Johnson’s executive vice president and chief scientific officer, said: “the goal is to identify early on AFib and prevent stroke by combining the physical know-how from Apple.” Both companies believe that the future of heart detection and treatment will involve cloud based technology, using virtual storage spaces that allow users to safely share their information with a click of a button. The Capital Cardiology Associates Patient Portal is a secure portal that allows you, as a patient, access to medical records including medications, lab results, and medical history — online. If you are interested in signing up for the Patient Portal, click here to download the policy form to print out and return at your next visit.

The role of wearable trackers in your health monitoring

There is a difference in the quality of the EKG on an Apple Watch, KardiaBand, Fitbit, or any other wearable tracker versus the diagnostic ability of a 12-lead EKG. Dr. O’Brien summed up the difference as “a single lead EKG is a screening test. It’s appropriate for monitoring and detecting rhythm states. A 12-lead gives us a more accurate picture for problems and locating their origins, but that doesn’t diminish the value of a single lead EKG.”

While the device manufacturers continue to test their products for accuracy, innovate with more sharing and reporting advancements, and the size of the device gets smaller with every new release, medical professionals generally support wearable trackers in monitoring your health and daily life. “For a device to give us information from an all-day sample is very helpful,” said Dr. O’Brien. “Patients will have more ownership of their heart health, making them active participants. The watch may say they are irregular. After an exam, we’ll see they are single isolated beats, completely benign, but that’s fine. We’ll be able to say, ‘look you’re okay!’ We’ll also have patients who we haven’t seen before coming to the office who say, ‘my watch says I have abnormal beats.’ We can look and find that their blood pressure is at 150 and that will bring up a whole different preventative issue of high blood pressure.”

Written by: Michael Arce, Capital Cardiology Associates
Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

Luke Perry Stroke

Luke Perry Stroke

PATIENT EDUCATION

Stroke is no longer
an “old age” risk

Adults as young as
40 are now at risk.

Here’s what you need
to ask your doctor.

Luke Perry’s death, just four days after FOX announced that it would be re-booting “Beverly Hills, 90210”, the TV show that made him 90’s icon, came as a surprise to fans who were hoping he would return as “Dylan McKay.” This role cemented Perry’s iconic image as the standard of cool for the generation who grew up after Jim Stark, the troublemaking teen played by James Dean in the epic 1955 film “Rebel Without A Cause.” The two characters not only shared similar backstories, dangerous loners who lived on the edge; the actors also shared a striking similarity in appearance.

The news report that The Los Angeles Fire Department responded to a “medical assistance” call at Perry’s home on Wednesday, February 27, dominated the headlines. At first, officials say Perry was talking to first responders and was fully conscious. This was just days after TV announcement; fans were shocked to learn that the star, at 52 years old was hospitalized due to a massive stroke. We were all saddened when the news broke the following Monday of his passing.

Redefining stroke

Stroke, as with many other forms of heart disease, is often thought of as an “old person’s” health concern. While there are more than 200,000 stroke cases in the US every year, making it the fifth leading cause of death in our country, the primary age affected is 60 years old and up. However, recent health trends have shown a growth in diagnosis with adults aged 41-60. “People can have strokes at any age,” says Maryellen King, Nurse Practitioner at Capital Cardiology Associates. Ultimately, if you have a concern about your risk of stroke, heart attack, or heart disease make an appointment with your doctor or primary care provider, today.

The traditional factors that put you at risk for stroke are lifestyle, diet, physical activity – which are controllable — tobacco use and smoking double the risk of stroke when compared to a nonsmoker. Smoking increases clot formation, thickens the blood, and increases the amount of plaque buildup in the arteries. Abusing alcohol and drugs (cocaine, amphetamines, and heroin) have been associated with an increased risk of stroke. The uncontrollable risk factors are your family history, age, race, gender, and prior heart health history.

There are also uncommon causes of stroke which are usually congenital (birth disorders) or rare vascular blood vessel diseases.

The recommendations for adults in their 40’s who are concerned about lowering their risk of stroke, heart attack or heart disease are:

• Eat a healthy diet, including reducing salt intake.
• Engage in regular physical activity and maintain a healthy weight.
• Manage stress.
• Avoid tobacco smoke.
• Take your medication as prescribed.
• Limit your alcohol consumption.

What is a stroke?

The National Stroke Association defines a stroke as “a brain attack.” Essentially, you have an instance where you’re losing blood flow to a part of the brain. “There are different types of stroke, hemorrhagic (bleeding in the brain), embolic (a blood clot that travels),” says King. Hemorrhagic strokes are less common; only 15 percent of all strokes are hemorrhagic, but they are responsible for about 40 percent of all stroke deaths. They can occur as a cerebral aneurysm, a congenital malformation of the arteries in the brain that can rupture. “There is no way to know if you have an aneurysm or not. If it ruptures, you can have bleeding on the brain, and people can die from that. They would experience sudden severe headache, the bleeding in the brain, patients will say the worst headache of their life. It’s not a warning sign, that’s a symptom,” stated King.

The other form of stroke is called an ischemic stroke. This can happen when a sticky, fatty material called “plaque” builds up in a blood vessel in your brain. Plaque slows your blood flow. It may cause your blood to clot. This can stop the flow of blood completely. This kind of stroke can also happen when a clot travels to your brain from another part of your body, even if you don’t have plaque buildup in your vessels. The most common cause of this type of stroke is A-Fib (atrial fibrillation) when your heart has an abnormal rhythm that produces the opportunity for a clot to form in the left side of the heart, dislodge and travels up and through to the brain.

A patent foramen ovale (above) is a hole in the heart that didn’t close the way it should after birth. The condition affects about 25% of Americans, but many do not know it.

The other type of embolic stroke would be a patent foramen ovale (PFO) or some different kind of congenital hole in the right and left sides of the heart. “The sides of your heart are supposed to be separate; blood comes from the right side of the heart is pushed to the lungs. It comes to the left side of the heart and gets pushed through the body. When there is a hole between the two sides, clots form and can travel from one side to the other,” said King. Most patients with a PFO do not have any symptoms. However, the condition may play a role in migraine headaches and it increases the risk of stroke, transient ischemic attack and heart attack.

Advances in testing

For patients who present stroke symptoms (Numbness or weakness in your face, arm, or leg, especially on one side. Confusion or trouble understanding other people. Difficulty speaking. Trouble seeing with one or both eyes. Problems walking, staying balanced, or loss of coordination. Dizziness. Severe headaches that come for no reason.) there are testing procedures. “The only way to find the holes in the heart would be with an echocardiogram, an ultrasound of the heart, to evaluate to see if a PFO has formed,” said King. Echo tests are performed by specially trained technicians at Capital Cardiology Associates. The test is painless, has no side effects, and usually takes an hour. “Using an echocardiogram (ECG) we can inject ‘fizz’ essentially, a trace amount of agitated saline that we call a ‘Bubble Study.’ These tiny bubbles can be seen on an ECG moving across the septum,” King explained. An ECG allows a physician to view the heart’s structure and check how the heart functions.

The other test available is the Transcranial Doppler (TCD), a non-invasive ultrasound method used to examine the blood circulation within the brain. A specially trained technician at Capital Cardiology Associates Imaging Suite performs this test to determine the amount of blood flow to specific areas of your brain. “The main reason that we started doing this is to detect a shunt or a hole in the heart,” shared Dr. Jeffrey Uzzilia of Capital Cardiology. “Patients that had a stroke, one of the reasons why they had a stroke that is not obvious at the time, is they can have a hole in their heart where a blood clot can form somewhere in the body and cross through that hole from the right side of the heart to the left. Once that blood clot is on the left side of the body it can travel anywhere in the body, including the brain and cause a stroke. Something like a PFO that everyone is born with, for most people it will close, for about 25% of people it will stay open. The TDP is the most accurate, sensitive test to detect that. It’s a very easy thing to see. There’s a good portion of patients, like Luke Perry, that you are shocked as to how young they are when they have a massive stroke,” said Dr. Uzzilia.

Written by: Michael Arce, Marketing Coordinator, Capital Cardiology Associates Any medical information published on this website is not intended as a substitute for informed medical advice, and you should not take any action before consulting with a healthcare professional.

National Heart Valve Disease Awareness Day

National Heart Valve Disease Awareness Day

Patient Education

National Heart Valve Disease Awareness Day

Identifying “the mystery killer”

February 22nd marks the third annual National Heart Valve Disease Awareness Day. As many as 11 million Americans have heart valve disease (HVD) — a potentially disabling and deadly disease. It’s known as the mystery killer and for good reason. Most patients mistake symptoms like fatigue or shortness of breath as exhaustion. According to a recent national survey, 3 out of 4 Americans know little to nothing about HVD. This year, Capital Cardiology Associates is proud to join the movement to raise awareness about heart valve disease and protect patient lives.

The big problem

More than 1 in 10 adults ages 75 and older have HVD. One of the awareness challenges with valve disease is that it’s a problem much bigger than one description. Dr. Donna Phelan has a special area of interest in echocardiography and non-invasive cardiology. She explained the different types and severities of valve disease. “HVD is a very general, broad term that encompasses any problems relating the four valves of the heart.” The heart has four valves, separating the various chambers of the heart, allowing it to pump blood. “When a person develops HVD, any of the four valves or multiple valves may be involved in the condition, and the valves are a lot like doors, they are supposed to open when they need to, to let the blood flow, they are supposed to close to keep the blood in the location needed.”

A heart with valve disease can experience stenosis when the valve becomes narrow. A narrowed or “stenotic” valve requires the heart to pump harder, which can strain the heart and reduce blood flow to the body. Another condition, called valvular insufficiency (or regurgitation, incompetence, “leaky valve”), takes place when the leaflets of the heart do not close properly, allowing blood to leak backward through the valve. This condition causes the heart to work harder to pump blood through the body. “Or they can become thickened or calcified and not open as well as they should, restricting the blood flowing through them,” pointed out Dr. Phelan.

Identifying valve disease

Typically in the early stages of most types of HVD people may not have any symptoms. “The first step in identifying a person with heart valve disease is asking questions, building their family history, and obtaining their risk of developing heart valve disease,” stated Dr. Phelan. Patients with high blood pressure, high cholesterol, and diabetes have an increased risk of heart valve disease. Common causes of valve disease include rheumatic fever, birth defects, degeneration over time and infection. “The second step is putting your stethoscope on their chest and listening for the murmurs that are often associated with valve disease. Then we move on to EKG’s, echocardiograms, and stress tests, which all to help us diagnose the type of valve disease and what needs to be done next.”

Getting an accurate diagnosis is critical, as Dr. Phelan noted the various conditions of heart valve disease could be linked together or they can be problematic on their own. “The electrical system can cause palpitations and arrhythmia. The plumbing of the heart, as most people think of as far as atherosclerosis [the buildup of fats, cholesterol and other substances in and on your artery wall] as heart attacks are concerned, the muscle of the heart is supplied by that blood flow. And the valves of the heart are the reason why the heart can function as a muscle and pump the blood, and hold the blood when it needs to, and then generate each next beat to pump the blood out. Without those valves that wouldn’t be possible. They all work in sync; the heart is an amazing muscle.”

Living with heart valve disease

The good news: recovery statistics are encouraging for people who receive proper treatment. “Most often HVD is something people can live with for decades,” said Dr. Phelan. There are also multiple treatment options due depending on the severity of the disease stage. “Often, in the early diagnosis there is an observational period, there may not be a need for treatment. At certain levels of HVD, there are certain levels of treatment that we use medication, including adjusting blood pressure medications that help to reduce the effect of the strain of the blood pressure and the pumping functions of the heart on those valves, providing the time for the valves to rest for lack of a better way of describing it.”

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In some cases, open-heart or minimally invasive surgery will be necessary to repair, restore, or replace the heart valves. Your doctor will discuss with you whether heart valve repair or replacement is most appropriate for your condition. Most often, physicians recommend repair when possible as that option preserves the valve and heart function. At Capital Cardiology, our Valvular Clinic performs the TAVR procedure, a minimally invasive surgical procedure repairs the valve without removing the old, damaged valve. Instead, it wedges a replacement valve into the aortic valve’s place. This procedure is reserved for patients in their 70’s or 80’s and often have other medical conditions, for whom an open heart procedure poses an intermediate risk.

Lifestyle changes will also be a significant part of your treatment. Expect your doctor to advise modifications in physical activity, a healthy diet, stress management and avoiding tobacco use. You will also have regular visits with your cardiologist. “Follow-up appointments help keep tabs on the condition or valve problem before it gets too late or is not treatable any longer,” noted Dr. Phelan. Her biggest advice for patients with heart valve disease or those looking to reduce their risk of developing a condition, “keep an eye on your blood pressure.”

Written by: Michael Arce, Marketing Manager Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional.