pulseTHE SPRING 2015 The Physicians' Quarterly Newsletter of the Heart & Vascular Institute

Sports at the Heart & Vascular Institute

45-year-old man was making plans to evaluated by their primary care physicians for physically intense sports such as basketball, fulfill his lifelong dream of climbing the appropriate type of exercise programs.” soccer and football. The most common cause A the Himalayas and sought medical of this devastating event is hypertrophic advice from Dr. David Hsi, Chief of Cardiology “I consider it prudent to perform cardiac , which can be identified and Co-Director of Stamford Hospital’s Heart & screenings that include ECG on most at-risk through cardiac screening. Vascular Institute (HVI). The active gentleman, adults who want to exercise,” Dr. Hsi continued. who was also a physician, had a history of “Cardiac screenings can identify and prevent “Sports cardiologists have an obligation hypertension, high cholesterol and abnormal heart problems before they become serious to reassure people at low risk for cardiac echocardiogram (ECG) and was concerned and can unmask problems that haven’t disease that they avoid excessive testing and about the risk that such a rigorous, high-altitude surfaced yet.” provide guidance to high-risk patients to exertion may have on his heart. Dr. Hsi, who prevent serious cardiac events,” said Dr. Hsi. Many healthy adults who participate in at the time was Chair of the Department “As a general rule, adults with known health endurance sports such as long-distance of Cardiology at the Deborah Heart and risks should be screened before they begin running, cycling, rowing and swimming Lung Center in New Jersey, performed a exercising. Adults who want to participate develop Athlete’s Heart Syndrome, cardiac comprehensive sports cardiac evaluation and in certain sports such as marathon running, remodeling in response to vigorous considered the patient’s heart able to handle scuba diving and high-altitude mountain endurance exercise. Exercise-induced cardiac the climb. Subsequently, the patient summited climbing should undergo the appropriate remodeling can also cause arrhythmias such the Himalayas without any cardiac events. sports-specific pre-screening evaluations.” as in currently or previously 1. J Am Coll Cardiol. 2002;40(10):1856-1863. doi:10.1016/ Sports cardiology addresses the unique trained athletes. “One elegant MRI–based study demonstrated balanced, biventricular S0735-1097(02)02478-6 physiology and needs of active persons of all 2. N Engl J Med. 2008; 358:152-161 ages and fitness levels, a concept that perfectly enlargement among endurance athletes,” said 1 dovetails with the HVI’s commitment to Dr. Hsi. “For patients who present with these providing individualized, patient-centered care. findings it is critically important to distinguish “A very viable segment of the population wants extreme cases of exercise-induced ventricular to participate in sports to maintain a healthy remodeling from mild forms of hypertrophic lifestyle,” said Dr. Hsi. “Our goal is to help patients cardiomyopathy, familial or acquired dilated select appropriate sports and fitness activities cardiomyopathy and arrhythmogenic right and to identify those patients who may be at ventricular cardiomyopathy.” risk for cardiac events.” Another study concluded that “markedly “One hotly debated issue in sports cardiology abnormal ECGs in young and apparently is which patient populations should be healthy athletes may represent the initial referred for cardiac screening,” said Dr. Hsi. “The expression of underlying European literature suggests that all athletes that may not be evident until many years later and young healthy adults be screened, but and that may ultimately be associated with 2 in the United States there is less support for adverse outcomes.” screening in these populations. Although it’s While extremely rare, sudden cardiac death difficult to prove the efficacy of screening, it is is more likely to occur in participants of usually recommended that adult patients be pulseTHE

Sports Cardiology Screening Guidelines

The American Heart Association’s 12-Point • Exercise-induced hypotension Screening Procedure • Exercise-induced myocardial ischemia • Syncope Personal medical history • More than moderately severe valvular disease 1. Exertional chest pain/discomfort • Prior embolic event 2. Syncope/near syncope 3. Unexplained excessive exertional dyspnea Symptoms and Clinical Signs in Young Athletes or fatigue that Should Raise Concern and Initiate Referral to 4. Prior recognition of a heart murmur a Sports Cardiologist 5. Elevated blood pressure • Chest pain or discomfort on exertion From The: Editor Family medical history • Unexplained syncope or near syncope during exertion am pleased to present the Spring 2015 6. Premature death related to • Dyspnea that is disproportional to the amount of issue of The Pulse, the physicians’ quarterly cardiovascular disease exercise being performed Inewsletter of Stamford Hospital’s Heart 7. Disability from cardiovascular disease at age & Vascular Institute (HVI). This issue features <50 years • Palpitations associated with any of the above sports cardiology, an emerging subspecialty 8. Hypertrophic cardiomyopathy, dilated • A family history of hereditary cardiac disorder or that addresses the cardiovascular effects cardiomyopathy, Marfan syndrome, arrhythmias, sudden cardiac death in a first degree relative and risks of exercise. At the HVI we are channelopathy (Long QT syndrome) when young (≤40 years) dedicated to providing cardiology services • Suspicion for Marfan syndrome to all individuals who embrace an active Physical examination • Left parasternal, systolic heart murmur that lifestyle, from athletes to “weekend warriors” 9. Heart murmur increases in intensity when standing or with to patients recovering from cardiovascular 10. Femoral vs. radial pulses to exclude Valsalva maneuver disease so they may safely pursue their aortic coarctation • Electrocardiographic abnormalities sports and exercise activities. 11. Physical stigmata of Marfan syndrome • Athletes with clinical symptoms and signs of We are also proud to highlight the 12. Brachial artery blood pressure an infection (e.g., flu-like symptoms) should be Hands for Life® Program spearheaded by advised against intense exercise until they have Sports Cardiology Recommendations by Interventional Cardiologist Dr. Thomas Nero made a complete recovery to avoid the risk Dr. David Hsi, Chief of Cardiology and who, with a team of passionate Stamford of Co-Director of the Heart & Vascular Institute Hospital physicians, is galvanizing the • Special consideration should be made regarding community to learn Hands-OnlyTM CPR. Contraindications to High-Intensity Competitive scuba diving for patients with certain conditions Sports (e.g. football, basketball, soccer) such as atrial septal defect, patent foramen ovale Our hope is that this issue of The Pulse • Left ventricular ejection fraction <50% or other intra-cardiac shunts provides valuable information and insights • Exercise-induced tachyarrhythmias that will enhance your clinical practice. I invite you to read on about our news and services and encourage you to provide your feedback and suggestions to make this A Fond Farewell to Peggy Martino, RN, MSN, MBA newsletter a valued resource to physicians in our community. he staff and the hybrid convergent procedure known for physicians at treatment of persistent atrial fibrillation; a hybrid T the Heart and OR to support state-of-the-art cardiac and vascular Vascular Institute (HVI) procedures; a new Structural Heart Disease program; — Joonun (Chris) Choi, MD wish a fond farewell and a successful Valve Center, which utilizes a The Heart Physicians to Peggy Martino, multidisciplinary Heart Team approach in the Stamford Health Integrated Practices Director of the HVI, evaluation of patients with valve disease. This spring, [email protected] Integrative Medicine the HVI will offer the TAVR (transcatheter aortic valve and Population Health replacement) procedure, an alternative for patients at and Prevention at high risk for traditional open-heart surgery. Stamford Hospital. Peggy has accepted A longtime champion of the Planetree model of the position of Vice President of Nursing for the patient-centered care, Peggy has been instrumental NewYork-Presbyterian Healthcare System. in creating an environment at the HVI in which patients and their families feel empowered Peggy was instrumental in expanding the scope and to be partners in their own healthcare. This has breadth of HVI services including the addition of led to exceptional quality outcomes and Preventive Cardiology; an Advanced (EP) Arrhythmia patient satisfaction. Center with the latest bi-plane system that offers SPRING 2015

Hands for Life® Program Saves Lives

Hands for Life® team broke the world record participate. “I brought my husband and two when they trained 5,141 people in CPR and the kids to the last event and we had a wonderful use of an AED in a single day. time,” said Dr. Ann Williams, Family Practitioner at Stamford Hospital. “It was a huge bonding “After that event we saw a modest increase experience for the entire community.” in the use of CPR and in survival rates,” said Dr. Nero. “However, we know we can do better.” A new, high-tech feature at the upcoming event is PulsePoint Respond, a mobile phone To that end, Dr. Nero and a steering committee app that reduces collapse-to-CPR times by comprised of members of the City of Stamford’s alerting citizens trained in CPR that they are in government, education, business and medical the vicinity of a person in cardiac arrest. The Thomas Nero, MD communities are planning a Hands for Life® app also directs rescuers to the exact location training event at Westhill High School in of the closest AED. “There’s also a fun game Stamford on Saturday, September 26, 2015, portion of the app that enables you to ‘geotag’ ince 2008 Dr. Thomas Nero has directed with the ambitious goal of training 15,000 a defibrillator when you see one,” said Dr. Nero. the Hands for Life® program with far- people including the high school’s students, CPR trainees will have the opportunity to load reaching success, resulting in higher S faculty and staff. The committee has launched a the app onto their phones at the event. patient survival rates and an ever-expanding communications campaign to elicit widespread community of people who know how to save community participation. For more information, visit the website at: lives. Now, they are expanding the program to www.HandsForLife.org. To volunteer for create even more community lifesavers. Physicians can play a vital role in convincing the event or if you have any questions please their patients to learn CPR. “Most people know contact Jami Sherwood at 203.667.3500 “Only 25% of patients in cardiac arrest that CPR is a good thing, but few actually make or [email protected]. receive CPR at the time that first responders the effort to learn it,” said Dr. Robert Labarre, arrive, and every minute that treatment is Cardiologist at Stamford Hospital. “When a delayed increases mortality by 10%,” said physician tells a patient that he or she should Dr. Nero, Interventional Cardiologist at Stamford learn CPR, the message is delivered with a high Hospital. “If more people knew how to provide level of trust and credibility, which goes a TM effective, simple-to-apply Hands-Only long way.” CPR, more victims could be helped, instantly doubling their chances of survival.” Dr. Labarre is a member of the Hands for Life® physician outreach committee at Stamford According to the American Heart Association Hospital along with Dr. David Hsi, Chief of (AHA), 70% of Americans feel helpless to act Cardiology at Stamford Hospital, Dr. Michael during a cardiac emergency because they do Coady, Chief of Cardiac Surgery at Stamford not know how to administer CPR or are afraid Hospital and President of the Fairfield County of hurting the victim. The goal of the Hands for chapter of the AHA, and Dr. Henry Yoon, Family Life® program is to teach people that they can Practitioner at Stamford Hospital. rescue a person in cardiac arrest by knowing how to Check, Call and Compress ­— check “We need to explain to our patients that CPR for breathing, call 911 and administer chest does more than save lives,” said Dr. Hsi. “Early compressions at 100 beats per minute. The resuscitation can minimize neural injury and program teaches Hands-OnlyTM CPR without reduce complications from cardiac arrest, mouth-to-mouth resuscitation and how to use thereby improving the victim’s quality of life.” an automated external defibrillator (AED). Dr. Nero hopes physicians in the Fairfield County To date, the Hands for Life® program has trained will volunteer at the event and encourage over 10,000 people. In 2012 Dr. Nero and the their patients, friends and family members to Stamford Hospital 30 Shelburne Road Stamford, CT 06902 203.276.1000 StamfordHospital.org

2015 Westchester-Fairfield Go Red! HVI News & Achievements ® For Women Luncheon Congratulations to our HVI physicians named Top DoctorsTM by Castle Connolly Medical Ltd*: s Cause Sponsor of the American Heart Association (AHA) Go Red For Women® campaign, Stamford Hospital is co-hosting the 2015 Westchester-Fairfield Go Red for Women® Luncheon Top Doctors in Cardiovascular Disease: on Thursday, May 7 with Keynote Speaker Jane Condon, comedian and local Greenwich A • Charles B. Augenbraun resident. Preceding the luncheon will be a Health & Wellness Exhibition where Stamford Hospital nurses will offer free health screenings and Learning Sessions led by Stamford Hospital physicians • Joonun (Chris) Choi and staff. • Evelyn J. Cusack • Jeffrey A. Green Thursday, May 7, 2015 • Mark D. Heiman 9:30 a.m. to 2 p.m. • Steven F. Horowitz Stamford Marriott • David J. Lomnitz 243 Tresser Blvd., Stamford, CT • Stephen P. Michaelson • Francis J. Neeson Session I: 10 a.m. to 11 a.m. — Breaking Barriers in Heart Disease • Edward H. Schuster Panel discussion about the new Prevention Guidelines on Heart Disease in Women with Stamford Hospital physicians Dr. Michael A. Coady, Chief of Cardiac Surgery; Dr. Evelyn Cusack, Cardiologist; Top Doctors in Thoracic and Cardiac Surgery: and Dr. Sandhya Dhruvakumar, Chief of Electrophysiology. • Michael A. Coady • William C. Feng Session II: 11 a.m. to 11:30 a.m. — Cooking with Heart — Family Style Preparation/cooking demo of healthy versions of summer family favorites with chefs Gavin Pritchard, Top Doctors in Cardiac Electrophysiology: Dietician-Chef, Population Health and Prevention at Stamford Hospital; and Hunter Zampa, youngest Food Network “Chopped” champion. • Sandhya Dhruvakumar • Michael R. Pittaro Session III: 11:30 a.m. to Noon — Stress Less For Your Heart Learn stress reduction techniques in this interactive workshop with Dr. Jennifer Edythe Cohen, Fellow, Top Doctors in Interventional Cardiology: Center for Integrative Medicine & Wellness, Stamford Hospital. • Robert D. Jumper • Thomas J. Nero Go Red for Women Luncheon — Noon to 2 p.m. • Edward L. Portnay • Jared G. Selter For more information contact Deena Kaye at 914.640.3269 or [email protected]. * This list contains all Stamford Hospital’s affiliated Top DoctorsTM who have been selected to-date as TM ew ocations or he eart hysicians Castle Connolly Top Doctors . Castle Connolly’s N L F T H P Top DoctorsTM are selected based on nominations n its continuing endeavor to bringing the best cardiac medical services to Fairfield County by their peers and reviewed by Castle Connolly’s residents, The Heart Physicians, part of Stamford Health Integrated Practices (SHIP), has expanded to physician-directed research team. Iadd two new satellite locations in Darien and New Canaan: The Heart Physicians – Darien The Heart Physicians – New Canaan 1500 Post Road, 2nd Floor 161 Cherry Street Darien, CT 06820 New Canaan, CT 06840 203.276.4940 203.276.4301