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Heart & Vascular Update President’s Message A publication from Welcome to the second issue of the Thoracic and Cardiovascular Institute’s Heart & Vascular Update. You may find some very use- ful, interesting, and perhaps surprising information among the variety of articles in this magazine. This issue reports on “natural” and prescription substances for lowering your cholesterol levels, how heart disease can affect the dynamic power and endurance of the human heart, and studies indicat- WWW.TCIHEART.COM ing that anger can be a dangerous risk factor contributing to cardiovascular Thoracic and Cardiovascular Institute problems and even heart attacks. An article on sudden cardiac death explains the Ingham Professional Building cause of about half of all deaths from heart disease. Another article details the 405 West Greenlawn Avenue, complications of congestive heart failure, a progressive syndrome and serious Suite 400 threat to your health. Lansing, Michigan 48910 We hope that you find these articles helpful. We also plan to present similar (517) 483-7550 reports in future issues of Heart & Vascular Update. We welcome your suggestions for future topics to help us provide medical information most pertinent to the Mid-Michigan’s communities we serve. Heart & Vascular TCI strives to provide the highest quality service and up-to-date technol- ogy for our patients. Each of our eight convenient locations provides the highest Specialists standard of patient care available. And our cardiologists are very well trained T. Michael Brown, DO, FACC and dedicated to deliver excellence in diagnosis and treatment of cardiovascular Mark D. Castellani, MD, FACC conditions. These are just a few of the reasons our practice continues to grow. We at TCI are pleased to report on the advances in cardiology to help Nam S. Cho, DO improve the awareness of cardiovascular medicine in our communities. I hope Joel M. Cohn, MD, FACC you enjoy and learn something helpful from this issue of TCI Heart & Vascular Christopher M. D’Haem, DO, FACC Update and invite you to share this issue with your friends and loved ones. Edward T. Helble, DO, FACC Juan O. Hernandez, MD, FACC Michael J. James, DO, FACC, FACOI Todd G. Hickox, DO, FACC President John H. Ip, MD, FACC Michael J. James, DO, FACC Contents Ellen L. Kehoe, DO George E. Kleiber, DO, FACC 4 Treating High Cholesterol Choose a natural cure or prescription drugs? Kirk B. Laman, DO, FACC 5 TCI Physicians Daryl R. Melvin, MD, FACC 6 Sudden Cardiac Death Richard M. Pinke, DO You can assess your risk to improve survival odds James A. Schafer, MD, FACC 9 Take Your Workouts Outside David J. Strobl, DO How to get the most from your time in the great outdoors Joni R. Summitt, DO, FACC 10 Your Private Dynamo R. K. Thakur, MD, FACC The heart can beat 2.5 billion times per lifetime Mark Veenendaal, MD, FACC 12 Congestive Heart Failure Ronald A. Voice, MD, MS, FACC Patient shares how he felt before and after a heart transplant Matthew D. Wilcox, DO 14 Manage Your Anger Avoid the health risks of losing your temper Heart & Vascular Update is an informative and educational resource for health-care professionals, medical affiliates, employer groups, and the general public. This publication will feature physicians and facilities of the Thoracic and Heart & Vascular Update is published by QuestCorp Media Group, Inc., 885 E. Collins Blvd., Ste. Cardiovascular Institute, communicate educational news 102, Richardson, TX 75081. Phone (972) 447-0910 or (888)860-2442, fax (972) 447-0911., qcme- and treatment trends, and contain various health-oriented dia.com. QuestCorp specializes in creating and publishing corporate magazine for businesses. articles of interest. The information contained in this publi- Inquiries: Victor Horne, [email protected]. Editorial comments: Darren Nielsen, dnielsen@ cation is not intended to replace a physician’s professional qcmedia.com. Please call or fax for a new subscription, change of address, or single copy. Single consultation and assessment. Please consult your physician copies: $5.95. This publication may not be reproduced in part or in whole without the express on matters related to your personal health. written permission of QuestCorp Media Group, Inc. To advertise in an upcoming issue of this publi- cation, please contact us at (888) 860-2442 or visit us on the Web at qcmedia.com. October 2007 4 Treating High Cholesterol Choose a natural cure or prescription drugs? By David J. Strobl, DO

Most Americans are well aware that high choles- terol levels are dangerous and linked to risk of a future heart attack and stroke. However, patients frequently are reluctant to take prescription medications to treat this genetic condition because they fear potential side effects. I am frequently asked if a “natural” cure is a safer alternative. Diet is probably the safest alternative to drugs and clearly plays an important part of any treatment plan. Restricting saturated fat (commonly found in dairy products, red meat, and many commercial baked goods) will cause some reduction in cholesterol. However, this effect may be modest in most patients. Only one of five high-risk patients will be able to achieve their cholesterol goal with diet alone. Many patients find it difficult to sacrifice their favorite foods and follow a strict diet. Regardless, I still emphasize diet as the cornerstone of therapy for my clinic patients. Even if medication is needed, lower dosages will be effective if the patient follows a low saturated fat diet. Patients frequently ask about or attempt on their own a nonprescription “natural” cure. Unfortunately, we are Choosing low-cholesterol foods can be simple, but hard to do when the exposed to exaggerated claims of the choice eliminates a favorite food. Heart-healthy eating and prescription benefits of a variety of advertised “natural” medications are two proven ways to reduce your cholesterol levels. products. There is very little scientific evi- dence that most of these products produce any significant changes in cholesterol levels. A very popular agent called polico- not demonstrate a reduction in lipid levels I am never opposed to a patient attempt- sanol (a sugar cane derivative) was proved beyond the placebo results. ing a so-called “natural” cure, but I insist ineffective in lowering cholesterol levels in Another agent, red yeast rice extract, a well designed actually contains lovastatin (a member study published in of the statin drug class) and can cause a “Many patients find it difficult to sacrifice the Journal of the reduction in LDL cholesterol levels. However American Medi- the unsupervised use of red yeast rice their favorite foods and follow a strict diet. cal Association. extract can cause side effects, including Regardless, I still emphasize diet as the Previously, most liver toxicity. cornerstone of therapy for my clinic patients.” of the support- Niacin, a water-soluble B vitamin, ing positive data can also modestly lower triglycerides – David J. Strobl, DO about policosanol and LDL cholesterol as well as raise the as a lipid-lowering beneficial HDL cholesterol levels. Niacin on a check of the patient’s cholesterol agent came from small studies in Puerto is available over the counter, but again is level before and after treatment to make Rico. However, the much larger multicenter not recommended for use without medical sure they are not wasting their money on a study conducted in concluded supervision. The short-acting forms are useless pill. that policosanol in usual and high doses did poorly tolerated with significant flushing 5

Cholesterol Countdown TCI Physicians The American Heart Association associates Each of the physicians practicing at Thoracic and Cardiovas- risk of heart disease from cholesterol levels cular Institute demonstrates high competence in his or her by these numbers: cardiology specialization. In addition, every member of our Total Cholesterol: medical staff stays proficient in the latest medical proce- dures and technology to ensure that TCI delivers the highest standard of patient Desirable: Below 200 mg/dL care. TCI has proud history of providing the most comprehensive diagnostic and Borderline High: 200 to 239 mg/dL treatment options for cardiovascular concerns in the Mid-Michigan region. High: 240 mg/dL and above. Twice the risk for coronary heart disease as at 200 mg/dL or below. HDL Cholesterol: High density lipoprotein, the good stuff. Low: 40 mg/dL for men, 50 mg/dL for women. T. Michael Brown, DO, Mark D. Castellani, MD, Nam S. Cho, DO Joel M. Cohn, MD, FACC FACC FACC A major risk factor for heart disease. High: 60 mg/dL or above. Protective against heart disease. LDL cholesterol: Low density lipoprotein, the bad stuff. Optimal: Below 100 mg/dL Christopher M. D’Haem, Edward T. Helble, DO, Juan O. Hernandez, MD, Todd G. Hickox, DO, Near optimal: 100 to 129 mg/dL DO, FACC FACC FACC FACC Borderline high: 130 to 159 mg/dL High: 160 to 189 mg/dL Very high: 190 mg/dL and above

and occasional hypotension, particularly in patients treated with Michael J. James, DO, Ellen L. Kehoe, DO George E. Kleiber, DO, Kirk B. Laman, antihypertensive medications. The long-acting forms are better tol- FACC FACC DO, FACC erated, but have a greater risk of liver toxicity. Niacin can also cause atrial dysrhythmias and can aggravate peptic ulcer disease. Patients often are understandably reluctant to take prescribed medications, but for many high risk patients (such as diabetics or heart attack survivors), drugs such as statins can be life saving and are considered as safe as aspirin. Unlike many of the “alternative” or “natural” products mentioned above, statins have been studied Daryl R. Melvin, MD, Richard M. James A. Schafer, MD, David J. Strobl, DO in multiple trials with thousands of patients to document their FACC Pinke, DO FACC efficacy in reducing heart attack and death. Side effects can occur with prescribed medications, but they are generally infrequent and can be minimized by choosing the right drug for each patient. I encourage open discussion with the patient regarding their individual risk with treatment versus their risk without. For most, the fear of medication side effects shouldn’t outweigh a more realistic fear of future heart disease. ♥ Joni R. Summitt, DO, R. K. Thakur, Mark Veenendaal, MD, Ronald A. Voice, MD, FACC MD, FACC FACC MS, FACC

David J. Strobl, DO, who completed his cardiology fellowship at the Cleveland Clinic, is director of the Heart Disease Prevention Program and Lipid Clinic at the Thoracic and Cardiovascular Institute. Dr. Strobl has been appointed Professor of Medicine and Chairman of the Section of Cardiology in the Department of Internal Medicine Matthew D. at Michigan State University’s College of Osteopathic Medicine. He is Wilcox, DO one of the first physicians in the country to achieve certification as a Diplomate of the American Board of Clinical Lipid Management. 6 Sudden Cardiac Death You can assess your risk to improve survival odds By Mark D. Castellani, MD, FACC

She FELT HER HEART BEAT RAPIDLY FOR THE THIRD TIME THAT DAY. At first she thought it was just from the anxiety she had been experiencing lately concerning her husband’s health. Feeling dizzy, she sat down. Sheila Browne (fictitious) put her hand over her heart hoping she could quiet the noise of the beating in her head. “Something is wrong,” she thought. Sheila picked up the phone and dialed 911. Soon she was being examined by an Emergency Room Physician who informed her that she was experiencing the early signs and symptoms of what is called sudden cardiac death (SCD). SCD (also called sudden cardiac arrest) is a sudden, abrupt loss of heart function. It is responsible for about 50 percent of all deaths due to heart disease. SCD occurs most frequently in adults. It affects men twice as often as it does women. SCD is rare in children. Because it often occurs in people who otherwise appear healthy, prediction and prevention are difficult. During the 2007 eight runners collapsed from SCD. Only one of those who died previously had reported symptoms suggestive of cardiac disease. All developing nations are seeing an increase in SCD events. One theory attributes the increased incidence to changes in dietary and lifestyle habits.

“During the 2007 eight runners collapsed from SCD. Only one of those who died previously had reported symptoms suggestive of cardiac disease.” Mark D. Castellani, MD, FACC

Signs of trouble TCI has the experience and best diagnostic equipment to conduct the most accurate assessments of risks of SCD Common risk factors include an ejection fraction (the percent- available in mid-Michigan. age of blood ejected from the left ventricle with each heartbeat) of less than 40 percent, high blood pressure, diabetes, high choles- terol, inactivity, obesity, smoking, poor diet, coronary artery disease, fibrillation (uncoordinated or chaotic contraction of the cardiac previous heart attack, abnormal heart rate or rhythm of unknown muscle in the lower chambers/ventricles in the heart), a common cause, or family history of heart problems. In more than 90 percent cause of cardiac arrest leading to SCD. People experiencing ven- of cases, SCD results from reduced blood flow to the heart muscle tricular tachycardia combined with an ejection fraction of less than due to fat accumulation (atherosclerosis) in two or more major 40 percent are at high risk for SCD. coronary arteries. Scarring from a previous heart attack is found in two-thirds of SCD victims. Survival tactics SCD also may result when the heart’s electrical system Surviving an SCD event depends on the presence of individu- malfunctions to cause an arrhythmia – an irregularity in the normal als who are competent to perform basic life support. The rapid rhythm of the heart. Arrhythmias, whether rapid (tachycardia) or arrival of personnel trained in the use of cardiopulmonary resus- very slow (bradycardia), can cause the heart to stop beating sud- citation is crucial to maintain oxygen flow to the lungs and brain denly (cardiac arrest). Ventricular tachycardia can cause ventricular until the normal heart rhythm is restored. Without this life support 7

Exactly What Is SCD? physician to determine the type of heart rhythm abnormality and SCD causes about 330,000 adult deaths the best way to treat it. TCI is the only facility in the mid-Michigan each year in the U.S. It is the abrupt and region with three physicians qualified and experienced to perform unexpected loss of heart function in a person Electrophysiology testing. with or without diagnosed heart disease. It occurs instantly or soon after symptoms appear. SCD results from almost all known “Surviving an SCD event depends on the heart diseases. It causes about half of all presence of individuals who are competent deaths from coronary heart disease, including to perform basic life support.” half of deaths due to atherosclerosis (arteries lined with fatty deposits) and half of deaths – Mark D. Castellani, MD, FACC due to degeneration of the heart muscle or to cardiac enlargement in patients with high blood pressure. SCD is not the same as a ICD monitoring “heart attack,” or myocardial infarction, which If study results indicate the need for an ICD, TCI is only practice is the death of heart muscle tissue from loss in the mid-Michigan area with physicians qualified and skilled >> of blood supply that does not necessarily cause death of the person. Life-threatening arrhythmias such as ventricular tachycardia or fibrillation precipitate most SCD events.

system, death can occur within minutes. More than 70 percent of SDC victims die before reaching a hospital. Patients who have survived an SCD event and certain individuals at high risk of developing ventricular fibrillation or life-threatening ventricular tachycardia are generally candidates for an implantable cardioverter-defibrillator (ICD). An ICD is a small electronic device, typically implanted under the left collarbone. It has a generator and a system of leads, or wires, that connect the generator to the heart. The ICD tracks and records heart rhythms. When it detects irregular rhythms, it sends a shock to the heart to return the rhythm to normal.

Assess your risk Physicians at TCI are experts at diagnosing individuals at risk for SCD and determining who will benefit from an ICD. Available tests range from simple, noninvasive services such as Electrocar- diography, Echocardiography, and Treadmill Stress Testing to more complex procedures such as an Electrophysiology Study (EPS) or a MUGA (multiple gated acquisition) scan. The MUGA scan is a noninvasive procedure that can assess heart function by tracking a radioactive substance injected into the blood stream. The scan produces a moving image of the beating heart that allows the physician to evaluate the functioning level of the cardiac ventricles. In patients who have had a heart attack, the MUGA scan can also localize the portion of the heart muscle that has been damaged and assess the degree of damage. An EPS is a type of heart catheterization conducted to study the electrical system of the heart, which controls the heart’s rhythm. During the study one or more thin, flexible wires are inserted into veins in the arm, groin, or neck and threaded into the heart. Small Prevention is your best bet against suddent cardiac electrodes on the ends of these wires are positioned inside the death (SCD). Preventive care includes testing now to assess, treat, and monitor any risk of SCD you may have, heart to measure electrical signals. Electrical currents can also such as high blood pressure. Here, Kirk B. Laman, DO, be sent through the wires into the heart to determine whether FACC, visits with a TCI patient undergoing testing for abnormal rhythms can be triggered in the heart, thus allowing the cardiovascular risks including her potential for SCD. 8 Sudden Cardiac Death

in ICD implantation. In fact, three TCI physicians Sheila learned from her physician that have these credentials. The procedure takes 30 to 45 she was one of the lucky ones. More than minutes. An overnight stay is required but recovery half of the SCD cases occur in people takes only a few hours. Risks include infection, who experienced no previous symp- a reaction to a drug used during surgery, toms. These individuals usually die, blood loss, or damage to a blood vessel, generally within 1 hour of symptom the heart wall, or other organ. The risk onset, unless they receive proper of dying is low. Using an implantable care. Shelia got to the Emergency Room in time. ♥

“Using an implantable ICD to stabilize Mark D. Castellani, MD, arrhythmias has been shown to reduce FACC, is board certi- mortality and morbidity from SCD.” fied in Cardiovascular Disease. He specializes in – Mark D. Castellani, MD, FACC Electrophysiology with Thoracic and Cardiovascular Institute. A gradu- ICD to stabilize arrhythmias has ate of Wayne State University School of Medicine, been shown to reduce mortality and he completed his medical training with a residency in morbidity from SCD. Internal Medicine and a fellowship in Cardiology at William Patients who receive ICDs require Beaumont Hospital and an Electrophysiology fellowship at the regular monitoring. TCI has the region’s largest ICD University of Michigan Medical Center. Dr. Casetellani has published and Pacemaker follow-up clinic staffed with three specially trained research in several medical journals including The New England Journal nurses who provide a full range of evaluations and follow-up ser- of Medicine. He is an active member of professional societies includ- vices. These include in-office consultations, phone evaluations, and ing the American College of Cardiology, the Michigan State Medical wireless home monitoring. Society, and The Heart Rhythm Society. 9 Take Your Workouts Outside How to get the most from your time in the great outdoors

If exercise is becoming routine and repetitive, take it al fresco. Try moving your work- outs outdoors where you can work off the calories, work up a sweat, and work out with a change of scenery. Fresh-air bicycling, hiking, swimming, skating, and walking can do wonders for your health. These exercises work out the lower body most. Exercisers won’t bulk up from these workouts, but they will slim down. Exercising outdoors is feasible year-round in most parts of the country. Just think creatively and dress appropri- ately to enjoy an outside workout more often than you might think possible. Cold weather strategies: Bundling up in layers lets you Power walking: The potential long-term detrimental effects continue routines you might otherwise only pursue when it’s warm. of high-impact jogging make walking a preferred choice for many Include an empty backpack with your workout gear — you can fill outdoor enthusiasts. To get a workout equivalent to what you get it with excess clothes as you warm up. by running, consider power-walking. This striding may look odd, but Wet-weather gear: Rainy days need not keep you from it is a low-impact, highly effective technique that burns as many enjoying great outdoor workouts. Many sportswear companies calories as running. Swing your hips through each step, take long produce lightweight, breathable wet-weather gear that helps your strides, and use a long arm swing. You will find yourself moving very perspiration escape while keeping you dry. If your community has fast — the goal is to reach a speed fast enough to break into a jog. safe exercise paths, dry gear is all you need to enjoy bicycling, inline When you get there, just keep walking! That’s your workout zone! skating, jogging, or walking, even before, during, or after a refresh- Walking: Ordinary walking can also be a solid workout if you ing rain shower. choose the right places to go. Climbing hills at your normal walking If you are ready to incorporate some outdoor pursuits into pace increases your calorie-burn by up to 30 percent. Walking is your daily life, here are a few ideas: one of the simplest and safest aerobic exercises. One minute of Bicycling: Cycling is a nonimpact exercise that will not dam- walking can extend your life by 1.5 to 2 minutes. age your joints. You can ride for pleasure and exercise at the same time. Bicycling is enjoyable as a casual, purposeful, and athletic pursuit. For physical fitness, bicycling is most effective when you Many sportswear companies produce employ specific techniques. The first is to vary your speed and lightweight, breathable wet-weather gear change the gears. This interval training works the large and small leg and glute muscles, producing a total lower body workout. Ride that helps your perspiration escape while in hilly areas that require you to switch gears and speeds. This tactic keeping you dry. will free you from repetitious pedaling, thereby giving you a better overall workout. Swimming: You can get a complete cardiovascular and major- Whatever form of outdoor exercise you choose, you may muscle workout in the water. Swimming is an excellent exercise and benefit most by following a few suggestions. Work out early in the another nonimpact sport. Though you may like to find a comfort- morning or late in the evening to avoid too much sun. Warm up able stroke and stick with it, the most effective way to work out by walking or running in place or on a treadmill for a few minutes is to alternate and mix up your swimming strokes. Complete a before heading outside. Stretch before you start exercising to number of laps with the crawl then switch to the backstroke. Use increase your range of motion and help prevent injury. After these a variety of strokes to get a more complete workout for all your preparations, go ahead and get outside for some healthy exercise muscle groups. and fun in the sun – or the rain. Enjoy! 10

Your Private Dynamo The heart can beat 2.5 billion times per lifetime By Juan O. Hernandez, DO

Intuition tells us good health heart must combine with oxygen to release the energy. Small blood begins with the heart. This hard-working, chambered organ vessels supply the heart muscle with energy molecules and oxygen. sustains us day after day, year after year, without whimper or com- The heart performs two big tasks. One is to pump blood plaint even though most of us routinely ignore it. Many of us never around the entire body so that every body part receives oxygen think about the heart until something goes wrong, threatening our from blood that has been refreshed in the lungs. The other function well-being or even our lives. Often these malfunctions cause us to is to pump blood to the lungs so that it can be refreshed by picking recognize for the first time the amazing work the heart does for us. up oxygen and getting rid of carbon dioxide. The heart pumps blood around the body. The integrity of ves- The rhythmic contraction of the heart, source of the lub-dub sels (arteries and veins) that carry the blood benefits from a heart sounds physicians listen to and evaluate, begins in a special mass that beats predictably. Major organs like the brain rely on an unin- of tissue called the sinoatrial node. The tissue is autonomous, or terrupted supply of blood, which is the carrier of oxygen. Deprive self-regulating. When this node sends out an electrical signal, the the brain of blood for even a short time and expect grave results. rest of the heart responds when the heart is healthy. Heart attack and stroke are the names given to two serious medical events. A heart attack occurs when a heart stops pumping What can go wrong? or cannot pump optimally. A stroke occurs when a blockage or a rup- When the small blood vessels supplying the heart muscle with ture in a blood vessel prevents blood from reaching part of the brain. energy and oxygen become clogged, significant problems ensue. Less energy and less oxygen are available to the heart muscle. The Heart basics heart may begin to falter or beat so erratically that it either cannot The heart is an extremely powerful muscle. Each day, it beats contract at all, or it contracts but cannot relax. That is the essence about 100,000 times. In 70 years it beats 2.5 billion times. Like of a heart attack. other muscles, the heart requires a constant, reliable supply of Why would the small vessels become clogged? Just as old energy to contract. Molecules that deliver potential energy to the pipes and hoses begin to accumulate material on the inside, so do 11 blood vessels. Certain aspects of modern diets also accelerate the Keeping blood moving accumulation of material in blood vessels. Arteries with paste in them make the heart work harder to Preventing blockage in a vessel, particularly the arteries that keep blood moving, which elevates blood pressure. Again, think of carry oxygenated blood, demands the same tried and true methods how a pump has to work to achieve the same flow rate through a used to keep household pipes clear. In short, do not feed them fats. narrow hose compared to a larger-diameter hose. The root words of atherosclerosis, the technical term for hardening Many medical conditions also require the heart to work or accumulation of materials inside the walls of arteries, illustrate harder. Among them are kidney disease and diabetes. Lifestyle the phenomenon vividly. choices such as inactivity, being overweight, smoking, or drinking Athero comes from the Greek word for gruel or paste. Sclerosis derives from the Greek word for hardness. Many undesirable health outcomes short of a heart attack can occur because the vessels that supply the heart with oxygen are blocked. Recurring pain, or angina, is often a symptom of what’s going on as well as a problem in itself. Blockages in vessels outside the heart impede the flow of blood around the body and can cause problems for any organ. When walls of blood vessels weaken and break, that is also a problem. It is comparable to a garden hose; if a garden hose is so old that part of its wall is very thin, it could rip apart at any instant. An aneurysm, for example, is a thin, ballooning part of a blood vessel in danger of breaking. The amount of damage done corresponds to the place a blockage or rupture occurs in a vessel. The brain does not tolerate or recover well from a disruption of blood supply. If such a disruption occurs in the brain, the event is commonly referred to as a stroke. Hearts can sometimes be jolted back to action if they stop excessively put more pressure on vessels and consequently, increase beating. However, the portion of a brain cut off from blood supply demands on the heart. takes a long time to regroup, and recovery may never be complete. Higher blood pressure increases pressure against the walls of Motor functions, or those that move limbs and enable speech, are blood vessels, which stretch and lose elasticity. In turn, the heart often lost following a stroke because they depend on direction from has to work harder and harder to pump blood around the body. As the brain. it pumps harder, blood pressure goes up. It is a vicious cycle. It is Seek immediate medical also a dangerous one because high blood pressure can contribute to the rupturing of blood vessels. help if you experience these The stress of modern life is also a major contributor to …warning signs of a heart attack: increases in blood pressure because of the antiquated fight or flight hormones it causes the body to release. So try to reduce stress. discomfort in the chest or upper body Catch the next rainbow in the sky. ♥ difficulty breathing Juan O. Hernandez, MD, FACC, earned undergraduate cold sweat, nausea, or lightheadedness and graduate degrees from Indiana State University and … warning signs of a stroke: his medical degree from Ponce School of Medicine in sudden numbness or weakness where he was class valedictorian. He com- pleted internship and residency at Akron General Medical sudden confusion, garbled speech Center in Ohio. Dr. Hernandez then took training as a cardiology fellow sudden vision impairment at Temple University in Philadelphia. He is board certified in internal and cardiovascular medicine with extensive experience in all aspects of sudden, severe headache cardiology. At Memorial Healthcare Center in Owosso he is a Medical sudden loss of balance or coordination Director of Cardiovascular Services and Cardiac Rehabilitation Services. Dr. Hernandez is also a member of the American College of Physicians. 12

Congestive Heart Failure Patient shares how he felt before and after a heart transplant

“Father, into your hands I com- service. He had quit smoking in 1961. He and Nancy ate mostly mend my spirit, and thy will be done.” With those well-balanced meals. While convalescing, Ed thought about what words, Edwin Fitzpatrick was wheeled into the Cleveland Clinic might have triggered the heart attack. He knew he’d been rejected operating room on Nov. 12, 1998, to receive a new heart. for additional life insurance because of a heart murmur. Then he But the story began in May 1984. One night he woke with remembered. His mother died of a massive heart attack at age 41. excruciating chest pain. His spouse, Nancy, called their family doc- His father had a massive heart attack at 34, but died of coronary tor, who met them at the emergency room. The diagnosis: minor arrest at 41. His younger brother had a massive heart attack at 34. Ed’s family history was his No.1 risk factor. “I knew I was dealing with a disease I had no control over,” he says. “My family doctor referred me to Darryl Melvin, MD, a car- His mother died of a massive heart attack diologist at Thoracic Cardiovascular Institute in Lansing, Michigan. at age 41. His father had a massive heart He did an angiogram and found several severe blockages. My case attack at 34, but died of coronary arrest at then went to Seong Chi, MD, who performed quadruple coronary artery bypass graft (CABG) surgery on Aug. 13, 1984, which was, 41. His younger brother had a massive heart ironically, our wedding anniversary. attack at 34. Ed’s family history was his No.1 “While we’d always been fairly healthy eaters, Nancy started risk factor. limiting the fats we ate, added more vegetables, and I continued to walk to work. I finally decided to take early retirement because I was experiencing angina. I was taking two to three nitroglycerin pills to handle the pain of that limited walk.” Angina is chest pain heart attack. After release from the hospital he recuperated at because of damage to the heart muscle. home for a number of weeks. He was advised, “Be careful.” “When I told Dr. Melvin, he referred me to Michael J. James, Ed Fitzpatrick has always been fit. Each workday he walked DO, Medical Director of the Heart Failure/Infusion Center at TCI. I seven blocks to Michigan State, where he oversaw the placement went in one day a week for infusion of fluids to help my heart beat 13 more strongly and relax the blood vessels. Dr. Melvin and Dr. James must have consulted because they recommended I go to the Univer- sity of Michigan to see about getting on a heart transplant list. The university chose not to accept me as a candidate because of my heart history. They didn’t think they could manage me medically. “Meanwhile, I could hardly walk 20 feet without having to stop to take a breath. My heart had enlarged to the point it was crowd- ing my lungs. I was depressed and had very little appetite. Dr. James thought the Cleveland Clinic would accept me for a heart transplant, and his nurse practitioner Carol Wank set me up with an appointment. “On Nov. 3, we were in the office of Randall Starling, MD. The first words out of his mouth were, ‘Your team ruined my team’s (Ohio State) football season last Saturday.’ I knew he had read my file. He told me they were accepting me for a heart transplant, and the next thing I knew, I was in intensive care. I guess I was lucky to have Type A blood because within a week they had two hearts. The first heart was rejected for transplantation. “On Nov. 12 at 5 p.m., a nurse came in and Coordinated patient care from Daryl R. Melvin, MD (left), Michael J. said a donor heart was James, MD, and a third TCI surgeon waiting for me. I would helped Edwin Fitzpatrick’s failing be transplant number heart keep going for about 14 years 109, setting a record for until the progression of CHF made a U.S. hospitals complet- transplant the only option. ing that many heart transplants in one year. I had complete confidence in my transplant team, which included Patrick McCarthy, MD. I remember nothing of the operation until I was in intensive care. “When I awakened, I felt blood pumping to areas that hadn’t seen blood for months. I felt like I could do anything I wanted. But I was so weak I could hardly lift my hands. The first day I walked a few steps and felt like I’d done four days’ work without stopping. Each day I started to feel better. It was good to have Nancy and my two sons with me. “Then, when a nurse showed me my heart’s perfect tracing, it was as if I’d never had heart problems, I thought: ‘This isn’t my heart. It belongs to someone else.’ I was so grateful for my good fortune, but felt that the family whose heart I had must be in grief over their loss. So, I wrote a letter to the family expressing gratitude for this gift, and tried to comfort them in their loss.” The National Organ and Tissue Donation Registry forwards these letters on to donor families. “After about a month of physical therapy, I was released from the Cleveland Clinic on Dec. 15. They gave high praise to TCI and Ingham Regional Medical Center for keeping me in such great shape. I kept a journal throughout the transplant process and included some of my own drawings in the book. I return every six months for a checkup. “I later learned the Cleveland Clinic has the highest percentage of lon- gevity for heart transplant patients – 68 percent have well-functioning heart transplants five years postsurgery. “Nancy and I haven’t changed our lifestyle much. We cut salt out of our foods a long time ago, and I still exercise three or four times a week. Whenever I’m over at TCI and see Dr. James, he says, ‘Fitz, you’re a marvel.’” ♥ 14

“Anger is a powerful emotion. If left unchecked it can actually cause a heart attack.” – Kirk Laman, DO

Manage Your Anger Avoid the health risks of losing your temper By Kirk Laman, DO, FACC

“Well, you should ”I didn’t want to think about it,” he daily. But did you know that anger isn’t just have thought about shouted back at her. Now my meal was emotionally damaging? Anger can have that first!” starting to lose its flavor, disrupted by the deleterious effects on our physical bodies. It The woman’s voice was loud, too loud unpleasant outbursts projected from across can actually produce heart disease. for the restaurant. We were trying to enjoy the room. Sound far-fetched? It shouldn’t. Medi- a relaxing meal when the argument erupted It’s called anger. We all know it. We’ve cal science has known about the harmful a few tables over. They were a couple in all experienced it. For some of us it happens effects of anger for hundreds of years, but open disagreement. rarely. Others dip into its dark shadows only lately have physicians been recom- mending people address their anger. Kirk Cool it! Calm down. Laman, DO, is a board-certified cardiologist The Mayo Clinic offers anger management tips to help you keep your cool with a special interest in heart disease prevention who suggests that we look at under pressure (www.mayoclinic.com/health/anger-management). These tips anger just as we look at other risk factors are paraphrased loosely from that site: for heart disease. • Take a time out. Count to 10. Leave the situation. Anger is a powerful emotion. If left • Get physical. Walk, run, shoot baskets. Wear yourself out. unchecked it can actually cause a heart attack. All of us are aware of the traditional • Chill out. Listen to music, do yoga, breathe deeply, write in your journal. risk factors for heart disease – smoking, • Tell a friend. Express your anger to someone you trust. Get it off your chest. high cholesterol, diabetes, and high blood pressure. Yet the American Heart Associa- • Forgive whoever made you mad. Don’t hold a grudge. tion (AHA) has recognized that emotional • Watch what you say. Don’t blurt out something you’ll regret saying. issues can also place us at risk for develop- • Use humor. Tell a good joke. ing heart problems. 15

Numerous medical studies have cited anger as a cause of heart trouble. In the AHA medical journal Circulation (October 1995) anger was shown to precede and actually trigger a heart attack. The article reported on a study of 1,623 men and women that evaluated the amount and timing of anger in people’s lives. These researchers found a direct relationship between having anger and developing a heart attack. Another study on anger (Circulation, May 2000) found that 12,986 people who carried more anger were twice as likely to have a heart attack, die, or need angioplasty or bypass surgery as compared to a group of people with less anger. Indeed, anger isn’t just an emotional issue. It truly can harm our health. What can you do about anger? The first thing is to become more aware of when you are angry. One useful approach is to set aside 20 minutes each evening for reflection. Jour- naling can also be helpful. Reflect on how you felt throughout your day. Were you upset or frustrated? Just by spending time reflect- ing, you can begin to conquer the harmful feelings that overtake your emotions. If you’re angry a great deal of the time seek professional help. Find a psychothera- pist or counselor and work on developing the skills needed to create a more healthy response to your daily frustrations. Anger is a risk factor you can avoid to help prevent debilitating heart disease. ♥

Kirk Laman, DO, FACC, is board-certified in Cardiology and Internal Medicine by the American Osteopathic Board of Internal Medicine. He also is board-certified by the Certification Board of Nuclear Cardiology. Dr. Laman earned his medi- cal degree at the University of Health Sciences College of Osteopathic Medicine in Kansas City, Missouri. He interned at Garden City Hospital and completed his residency in Internal Medi- cine at Pontiac Osteopathic Hospital, both in Michigan. His two fellowships at Sinai Hospital in Detroit were in cardiovascular disease and peripheral vascular disease and in cardiology and nuclear cardiology. Dr. Laman specializes in preventive cardiology. He is a member of the American Osteopathic Association, American College of Cardiology, American Society of Nuclear Cardiology, and Michigan Association of Osteopathic Physicians and Surgeons. 17

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