'It's Difficult to Die from a Heart Attack Today'

Check out the link below to a very interesting press conference with the president of the ESC -- here's a teaser of his comments:

"Adults today can expect to live 10 years longer than the average adult 30 to 40 years ago, and most of that extra decade resulted from advances in cardiovascular medicine, especially the treatment of myocardial infarction"

"In cardiology, we have contributed seven of those 10 years of life, while oncologists have contributed 2.4 months," said Roberto Ferrari, MD, PhD, President of the European Society of Cardiology.

http://www.medpagetoday.com/MeetingCoverage/ESCCongress/15750

What does a Calcium Score of 0 mean?

A recent study took a set out to answer the question: What is the value of a calcium score of 0?

On the basis of the review of more than 85,000 patients, the authors concluded that the absence of coronary artery calcium (CAC) was associated with a very low risk of future cardiovascular events.

In this cohort, 146 of 25,903 patients without CAC (0.56%) had a cardiovascular event during a mean follow-up period of 51 months.

A calcium score of 0 has very good negative predictive value (The negative predictive value is the proportion of patients with negative test results who are correctly diagnosed, also defined as the probability that the patient will not have the disease when restricted to all patients who test negative).

Therefore, in the workup of cardiovascular risk, a calcium score of 0 is a terrific thing.

JACC Img 2009;2:675-688

Few cholesterol-lowering supplements work

This is a terrific and educational article on supplements for cholesterol lowering. It is well researched and unbiased.

My take on all this:
1. Red rice yeast extract is a natural version of a statin. It will help lower LDL. However, it is unmonitored and each pill has varying amounts of active ingredient. Prescription statins are safer.
2. Niacin works. It has a lot of efficacy data on not just effecting cholesterol but for lowering "hard events" (reducing heart attacks, death...). It can cause serious liver problems, so liver function tests need to be monitored closely.
3. Fish Oil lowers triglyceride levels at high dosages but has other beneficial effects.

http://rss.cnn.com/~r/rss/cnn_health/~3/HF_YJmo0ZMM/index.html

--
This article was sent using my Viigo.
For a free download, go to http://getviigo.com

Sent from my Verizon Wireless BlackBerry

We need a Lance Armstrong

I'm a huge Lance Armstrong fan. His story of beating cancer and then coming back and winning the Tour de France was truly amazing.
Helps that he is built for riding. He has an unbelievable stroke volume. His resting heart rate is in the high 20's.

While this story has been widely publicized (as was his relationship with Sheryl Crowe), its his commitment to his Livestrong foundation that I find most inspiring. After retiring, Lance focused much of his attention towards forwarding the foundation and its quest to find a cure for cancer. Lance uses all of his celebrity power to continue to push his foundation forward. His used technology (website/twitter) to keep the Livestrong foundation current.

He has found that he is much more effective out of retirement than in, so he is back on his bike (his clothes and bike all billboards for the foundation). It does not hurt that he is fiercely competitive and despite his hiatus from competitive cycling, he was back on the podium in third place by the end of the Tour.

He just founded his own Tour de France cycling team with RadioShack.

He also just won the Leadville 100, an impossibly challenging 100 mile mountain bike race. He did not just win it, he won by almost 30min, smashed the course record by 15min and rode the final 10 miles on a flat tire.

As a dedicated cardiologist, committed to fighting heart disease, I'm jealous of Lance. I want a Lance for my cause. Heart disease and Stroke are the number one and three killers of all americans. We need a Lance for our cause.

Go Lance, you ROCK!!!

Sent from my Verizon Wireless BlackBerry

Blackberry - invaluable tool for Interventional Cardiologist

I am a technology freak. Specifically, I love mobile technology.

I was a very early Palm user. I had a Palm III, Palm V, Sony Clie.

Then I made the move to the world of smart phones with a Palm Treo 600, Palm Treo 650, and then a Palm Treo 700p.

I loved the Palm OS but it was stagnant and really started lagging behind other smart phones. I had become an attending and really need the best communication tool possible.

Therefore, I made the leap to the BlackBerry platform. My first device was an ATT Pearl. I loved this device. So small and compact with a great battery life (vital since I spend long days in cath labs with poor reception - kills battery life). I convinced our IT manager to install a BlackBerry Enterprise Server. Now all our Outlook Exchange data was automatically pushed to my device. All my calender, tasks, contacts, memos and email were in perfect wireless sync with my Outlook.

Email on a BlackBerry is just the best. I will get emails faster on the BlackBerry than I will to my Outlook on my desktop.

I have been such a fan on email as a mode of communication that I have convinced all my partners of its benefits. Thank god not more pagers (how 1980!!!).

As I became more of a power user, I found the Pearl device too limiting - its too difficult to type medical terms and proper nouns. ATT service was also sketchy here in Southwestern CT - so I switched to a full QWERTY Blackberry - the Verizon Curve. Great smartphone all around.

I have just recently upgrade again to a Verizon BlackBerryTour. Beautiful screen, better keyboard, faster with more memory.

How do I use my BlackBerry?

Communication:

• All nonurgent communication between my partners and the office is via email. This is huge, since I spend half my time out of the office. My office staff can now email me messages left by physicians or patients. They can also attach notes or test results which I can review on my BlackBerry and I can call them back -- all without going to a PC or being in the office
• All urgent communication between my partners is via phone call or SMS text message - all on the BlackBerry
• I love BlackBerry Messenger (Instant Messaging) - I use this to communicate with my wife and my friends

Programs:

• pMDsoft: A terrific, on device, mobile charge capture program. This program has truly been practice changes for myself and my partners.
• Viigo: An amazing RSS feed reader. On the fly, I can now keep up with all the most up-to-date medical news. I remain much more current this way than I was using Google Reader or waiting for email updates from journals or websites. I can share news articles via email or I can tweet directly from the program. (It has many more features but one that I use the most is its weather module - very cool and easy).
• SocialScope: I love twitter. It is a great way to keep up-to-date and network. It is a great way to spread the word about this blog as well. SocialScope is a terrific twitter client for the BlackBerry. I have used UberTwitter too but find SocialScope faster and I like the interface better too.

What do I miss:

• Epocrates: I terrific drug reference guide. This ran beautifully on the Palm. Unfortunately, was too big of a memory hog on my BlackBerry Curve or Pearl. I have not yet tried it on my Tour.

So - if you want absolutely the best communication tool on the market - get a BlackBerry. Its not as fancy or cool as an iPhone, Android, Palm Pre, or some Windows phones - but nothing is better at getting things done quickly and reliably.

************UPDATE****************

He's a link to an article discussing 8 new applications for the BlackBerry

http://www.cio.com/article/498472/Dr._BlackBerry_Eight_Apps_Making_Medicine_More_Mobile

5 Heart Healthy Reasons for Fish Oil

This is a reprint of an article written by Dr Carrie Jones on empowher.com.

I thought it was so good that it was worth re-posting here -- its a
great article on the benefits of omega-3, which I have been writing
about lately.

Written by Dr. Carrie Jones on August 17, 2009 - 8:18pm

___________________________________________________________

More and more Americans are taking their fish oil and eating
cold-water fish as part of a healthy diet. Fish oil is made up of
fatty acids called EPA (eiosapentaenoic acid) and DHA (docosahexaenoic
acid) that are part of the polyunsaturated omega-3 anti-inflammatory
pathways in your body. These two fatty acids are important to cell
membranes which ultimately help heart electrical conduction and tone.

According the American Heart Association, cardiovascular disease is
the number one cause of death followed by cancer and accidents. It is
also highly preventable and recent research shows that taking fish oil
or eating fish such as salmon, mackerel, herring, or anchovies can
help fight heart disease by reducing the risk of:

1) atherosclerosis (hardening of the arteries)
2) arrhythmia (irregular heartbeat)
3) heart attack (myocardial infarction or MI)
4) sudden cardiac death
5) heart failure

Omega 3 fatty acids are made by microalgae in the ocean which are then
eaten by cold-water fish. The oil is deposited into their organs and
stored in their fat tissue. When choosing your fish oil, make sure it
is free of heavy metals, pesticides, and herbicides and that the
manufacturer tests every batch for freshness. There are two forms of
fish oil: the triglyceride form and the ester form. Studies lean
towards the natural triglyceride form as being more digestible, but
the ester form is cheaper to produce.

If you puncture your fish-oil pill and it smells rancid, then you have
a bad batch. It should smell naturally like clean fish.

For the best heart benefits, take enough fish oil such that you are
receiving at least 500 milligrams of EPA and DHA. Your total omega-3
may read 1000 milligrams or more; however it's the actual EPA/DHA
numbers you add up. When choosing to eat fish as part of your healthy
diet, go for wild caught or farmed and free of dyes and chemicals.

References:
1. Lavie, C. Journal of the American College of Cardiology, Aug. 11,
2009; 54:585-594.
2. Lawson, L.D.; Hughes, B.G. (October 1988). "Absorption of
eicosapentaenoic acid and docosahexaenoic acid from fish oil
triacylglycerols or fish oil ethyl esters co-ingested with a high-fat
meal." Biochemical and Biophysical Research Communications 156 (2):
960–963.
3. Beckermann, B.; Beneke, M.; Seitz, I. (June 1990). "Comparative
bioavailability of eicosapentaenoic acid and docasahexaenoic acid from
triglycerides, free fatty acids and ethyl esters in volunteers."
Arzneimittel-Forschung 40 (6): 700–704.
4. www.americanheart.org

http://www.empowher.com/news/herarticle/2009/08/18/5-heart-healthy-reasons-fish-oil

Benefits of prescription omega-3

All omega-3 preparations are not the same. Those bought in the supermarket, Costco/Walmart, and GNC are very different than prescription omega-3

• Prescription omega-3 is concentrated fish oil

• Its uses a 5-step purification process that helps remove mercury and other environmental toxins that can be present in fish oil

• Each 1-gram capsule contains 465 mg EPA and 375 mg DHA, the active fatty acids proven to lower very high triglycerides

• It may take up to 4-5 capsules of an omega-3 supplement to achieve the same amount of EPA and DHA found in a 1gm pill of prescription omega-3

Omega-3 Supplementation Reduces Cardiovascular Events

Results of a new meta-analysis have demonstrated that dietary
supplementation with omega-3 fatty acids decreases cardiac deaths,
nonfatal cardiovascular events and all cause mortality. These benefits
were most apparent in patients with high risk disease (metabolic
syndrome, diabetes, obesity, known cardiac or vascular diseases).

Additionally, omega-3 fatty acid supplementaion appeared to confer
additional benefits in patients adhering to a Mediterranean diet.

While the optimal dose of omega-3 supplementation is unclear, even low
dose (1g/day) appears to be affective.

I am a proponent of using prescription omega-3 in my practice. It goes
through a 5-step process to create a highly purified
omega-3 medication and is the only omega-3 preparation monitored and
approved by the FDA.

Lower Cholesterol without Medications

While statins help lower cholesterol amazingly well and have pleiotrophic effects besides lowering cholestrol, like reducing inflammation, there are ways to lower cholesterol naturally.

Here is a list of ways:

1. Regular Exercise - Doing regular exercise for about 30 minutes of exercise 3 or 4 times a week can significantly lower the risk for many major life threatening disease. Regular exercise has been found to help lower cholesterol and reduce triglyceride levels. With regular exercise you can lower your body mass index and achieve a healthy weight. This helps you to reduce your risk for heart disease and diabetes.

2. Healthy eating

• Increase soluble fiber intake. By increasing your intake of soluble fiber to 10 grams per day, you can lower your cholesterol levels a great deal according to some recent studies. The best sources of fiber include certain types of fruits, bran and oat products, and many kinds of vegetables.

• Cut down on saturated fat and Trans fats.

- Saturated fats are found in animal-based foods, including meats, butter, whole-milk dairy products (including yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. The Nurses’ Health Study, which included more than 80,000 participants, showed that saturated fats increase the risk of coronary artery disease

- Trans fats are found mostly in fried foods, pastries, cookies, and other similar foods. Avoiding these types of foods limits your calories, fat intake, and helps lower your cholesterol. The American Heart Association`s Nutrition Committee recommends limiting trans fat to one percent of your daily calorie intake.

• Avoid Red Meat, Eggs, & Whole Milk - Red meats, whole milk, and egg yolks are concentrated cholesterol foods. They should be avoided and replaced with some of the healthier foods that are low in cholesterol.

• Omega-3 Fatty Acids - Stock up on foods containing Omega 3 fatty acids. Omega 3 fatty acids raise HDL and lower LDL cholesterol levels. Some good sources include salmon and herring fish, walnuts and almonds, dried cloves, and flaxseed oil. Many of these foods also contain antioxidants and vitamins.

• Blueberries, Garlic, & Apples - These three foods are tasty and can be easily combined with many other foods in home-made recipes. Garlic and Blueberries lower blood pressure and cholesterol. The fiber pectin in apples decrease the amount of cholesterol produced in the liver. Using these ingredients in your meals can make a healthy impact on your cholesterol.

• Soy. Soy products are another example of cholesterol lowering foods. Several studies suggest that foods containing soy can lower a person's bad cholesterol by about 10 percent. Soy contains natural chemicals known as isoflavones. Researchers believe that isoflavones, along with the protein contained in soy, help reduce the bad cholesterol.

- Watch cholesterol consumption. If you’re on a low cholesterol diet, you’ve got to pay attention to the food labels and make sure you keep your intake below 200 mg per day. That means watching serving sizes, too.

4. Reduce Stress. Stress and anxiety cause chemicals to be released into your body, raise your blood pressure, and reduce blood flow to your heart.

5. Stop smoking. Smoking increases the build up of plaque in the arteries, exacerbating the affects of high levels of LDL cholesterol.

6. Lose Weight - Being Overweight changes your metabolism and the way your body deals with fat and cholesterol. Losing weight in a slow and steady manner improves your health and lowers your cholesterol. Natural dieting results in consistent weight loss and reduces your risk of diabetes and high blood pressure.

More chocolate research

Turns out that the flavanols in cocoa can survive baking.

Now you have reason to not only eat raw chocolate but also to eat it in cooked foods.

Reminder: Please remember that you must not over eat, watch your caloric intake and eat "everything in moderation"

http://www.medicalnewstoday.com/articles/160733.php

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Cardiovascular Effects of Weight Loss in Obesity

Patients who are obese have significant cardiovascular responses - including:

• thickening of the walls of the heart
• increased stiffness of the heart leading to heart failure
• increased stiffness of the aorta leading to high blood pressure

In a recent article published in JACC, 30 patients with severe obesity were followed pre and post weight loss. The weight loss was by diet in 17 patients and bariatric surgery in 13 patients. Weight loss of also accompanied by improvement in patients sugars and decrease in cardiac CRP.

Irrespective of the mode of weight loss, with weight loss, study subjects had significant decreases in the thickness of the walls of the heart, smaller heart chambers, and less heart and aortic stiffness. 

Therefore, weight loss, whether by diet or surgery, can lead to significant improvements in the cardiovascular responses to obesity and their involvement in heart failure, diabetes and hypertension. 

http://www.cardiosource.com/pops/jaccjump.asp?vol=54&issue=8&page=718&journal=JACC

Eating Chocolate Reduces Risk of Death in Heart Attack Survivors

Here's one new piece of data that I'm very happy to pass along.

It turns out that new research from Stockholm shows that chocolate consumption decreases the risk of death post-MI. Is this because of the anti-oxidant properties of chocolate. Or is it that patients who eat chocolate are happier (patients with optimistic outlook and less depression always do better post-MI). Either way, does it really matter? So as long as its in moderation, go out and have some chocolate.

http://www.foxnews.com/story/0,2933,539254,00.html

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What is: Renal Artery Angiogram and Stenting

WHAT IS: Renal Artery Angiogram and Stenting

Renal Artery Stenting (RAS) is performed to open blocked arteries caused by Renal Artery Stenosis and to restore arterial blood flow to the kidney without the need for open-vascular surgery. RAS is usually comprised of both angioplasty (PTA – percutaneous transluminal angiolplasty), followed by stent placement. It is performed in an outpatient setting (to treat a severe renal artery blockage).

A special catheter is inserted through the major artery in the leg or arm and advanced to the blocked renal artery. Through the catheter, a tiny wire is inserted into the artery and threaded across the blockage. Over this wire, a tiny balloon is advanced to the blockage. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.

What is stent placement?
In the past few years, many refinements have been developed in the RAS procedure. One common procedure used in RAS is stent placement. A stent is a tiny, expandable metal coil that is inserted into the newly-opened area of the artery to help keep the artery from narrowing or closing again.

Once the stent has been placed, tissue will begin to form over it within a few days after the procedure. The stent will be completely covered by tissue within a month to one year. It is necessary to take anti-platelet medications, such as aspirin or clopidogrel (Plavix™), which decreases the “stickiness” of platelets (a type of blood cells that clump together to form clots to stop bleeding), in order to prevent blood clots from forming inside the stent

Renal Artery Stenosis

Renal artery stenosis (RAS) is the narrowing of one or both arteries that carry blood to the two kidneys. “Renal” means “kidney” and “stenosis” means “narrowing.” RAS can cause high blood pressure and reduce kidney function. RAS is often overlooked as a cause of high blood pressure.

You are at greater risk of developing RAS if you smoke or are overweight. RAS is most common in men between the ages of 50 and 70, but women and younger adults can also have it. High cholesterol, diabetes, and a family history of cardiovascular disease are also risk factors for RAS. High blood pressure is both a cause and result of RAS.

What are the kidneys?

Your two kidneys are bean-shaped organs, each about the size of a fist. They are located just below the rib cage, one on each side of the spine. The arteries that carry blood to the kidneys—called the renal arteries—branch off directly from the abdominal aorta, the main vessel from the heart that supplies blood to most of the body’s organs.

Healthy kidneys filter out wastes and extra fluid from the blood that passes through them. Those wastes and extra fluid become urine, which flows from the kidneys to the bladder through tubes called ureters. Urine is stored in the bladder until released through urination.

What causes RAS?

In an overwhelming majority of cases, RAS is caused by atherosclerosis, hardening of the kidney arteries. Thus, RAS develops when a material called plaque builds up on the inner wall of one or both of the renal arteries. The plaque makes the artery wall hard and narrow. This narrowing reduces or cuts off the blood supply, possibly damaging the kidney. The damaged kidney is less efficient at removing wastes and extra fluid from the blood. This plaque is similar to plaques blocking the arteries supplying the heart, which cause heart attacks, and those blocking arteries supplying the brain, which cause strokes.

In renal artery stenosis, plaque builds up on the inner wall of the artery that supplies blood to the kidney.

When the kidneys fail, wastes and extra fluid build up in the blood. This condition, called uremia, causes nausea, headaches, fatigue, and swelling in the legs and abdomen. With total kidney failure, you will need dialysis or a kidney transplant to stay alive.

What are the symptoms of RAS?

RAS can be silent, meaning you will not feel any symptoms, until it becomes severe.

The first sign of RAS may be high blood pressure that stays high even when you take blood pressure medicine. High blood pressure caused by RAS is called renovascular hypertension. Your doctor cannot diagnose RAS based on blood pressure alone because many conditions can cause your blood pressure to rise. If you develop high blood pressure suddenly and have no family history of high blood pressure, or if your blood pressure is difficult to control, your doctor might suspect RAS.

How is RAS diagnosed?

When blood flows through a narrow vessel, it makes a whooshing sound, called a bruit (BROO-ee). Your doctor may place a stethoscope on the front or the side of your abdomen to listen for this sound. The absence of this sound, however, by no means excludes the possibility of RAS.

For a more accurate diagnosis, your doctor may order an ultrasound or an angiogram to get a picture of the artery. An ultrasound uses harmless sound waves to create images of internal organs; it does not require intravenous injection or oral administration of any substances. An angiogram is a special kind of x ray in which a thin, flexible tube called a catheter is threaded through the large arteries, often from the groin, to the artery of interest—in this case, the renal artery. A special dye is injected through the catheter so the renal artery will show up clearer on the x ray. The advantage of angiograms is that they give a better picture and therefore more accurate diagnosis of RAS; the disadvantage is that this procedure is more invasive.

More recently, doctors have been using computerized tomography (CT) scans and magnetic resonance angiograms (MRA) to evaluate RAS. CT scans use multiple x-ray images combined by a computer to create a three-dimensional image of your internal organs. MRAs use moving magnets to create similar three-dimensional images. CT scans and MRAs are less invasive than conventional angiograms, but the results may not be as clear or accurate. Researchers are exploring ways to improve these imaging techniques and make them more reliable for evaluating RAS.

How is RAS treated?

Approaches to RAS are threefold:

• preventing RAS from getting worse
• treating high blood pressure that results from RAS
• relieving the blockage of the renal arteries

Lifestyle Changes

The first step in treating RAS is making lifestyle changes that promote healthy blood vessels in general. Exercising, controlling your weight, and choosing healthy foods will help keep your arteries clean and flexible. If you smoke, quitting is one of the best things you can do to save your kidneys and other organs.

Blood Pressure Medicines

RAS causes high blood pressure, which can damage the kidneys. Damaged kidneys, in turn, can make your blood pressure even higher. If left uncontrolled, this vicious cycle can lead to kidney failure and damage the heart and blood vessels throughout the body.

Controlling renovascular hypertension is often difficult but usually achievable. It may require two or more different kinds of blood pressure medicine. Blood pressure medicines work in different ways.

Sometimes, by combining two or more blood pressure medicines that work in different ways, you may be able to control your blood pressure and stop the progression of kidney failure. Each type of blood pressure medicine has its own potential side effects; therefore, the choice of medicine is best determined by you and your doctor.

In addition to blood pressure medicines, your doctor may prescribe a cholesterol lowering drug to prevent the plaques from forming in the arteries, and a blood-thinner, such as aspirin, to help the blood flow more easily through the arteries.

Risks of the Procedure: Possible risks associated with PVI include, but are not limited to, the following:

• allergic reactions


• medication reactions


• bleeding


• leg pain or discomfort


• infection


• damage to the blood vessel(s) into which a catheter is inserted which could require surgical repair


• there is small risk (under 1%) of the coronary artery becoming narrowed during the procedure, resulting in the need for immediate, emergent arterial bypass surgery.


• damage to the kidneys which could require dialysis


• heart rhythm disturbances


• myocardial infarction


• stroke


• nerve injury


• death

The risk of any one of these serious complications is less than 1%.

The amount of radiation used in fluoroscopy during a angioplasty or stent procedure is considered minimal; therefore, the risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician due to risk of injury to the fetus from a PVI. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your physician.

There is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications (ASPIRIN), contrast dye, iodine, or shellfish should notify their physician. Also, patients with kidney failure or other kidney problems should notify their physician.

Since this procedure requires you to take anti-platelet medications, please inform you physician if you currently have or have a history of bleeding problems. Please also tell your physician if have any surgical procedures planned in the near or distant future.

For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure: Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine, seafood, or aspirin.

Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

You will need to fast for a certain period of time prior to the procedure. Your physician will notify you how long to fast, whether for a few hours or overnight.

If you are pregnant or suspect that you may be pregnant, you should notify your physician.

Notify your physician if you have any body piercings on your chest and/or abdomen.

Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.

Your physician may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.

You may receive a sedative prior to the procedure to help you relax.

The area around the catheter insertion (groin area) may be shaved.

Based upon your medical condition, your physician may request other specific preparation.
During the Procedure

A PVI may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, a RAS follows this process:

• You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of these.


• You will be asked to remove clothing and will be given a gown to wear.


• You will be asked to empty your bladder prior to the procedure.


• An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.


• You will be placed in a supine (on your back) position on the procedure table.


• You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.


• There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected.


• You will receive a sedative medication in your IV before the procedure to help you relax.
  Your pulses below the insertion site will be checked and marked so that the circulation to the limb below the site can be checked after the procedure.


• A local anesthetic will be injected into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.


• Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced to the blocked artery.


• The angioplasty catheter will be inserted through the sheath into the blood vessel. The physician will advance the catheter through the aorta into the artery. Fluoroscopy will be used to assist in advancing the catheter to the artery.


• The catheter will be advanced to the blocked artery. Once the catheter is in place, contrast dye will be injected through the catheter into your arteries in order to see the narrowed area(s). You may feel some effects when the contrast dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, and/or a brief headache. These effects usually last for a few moments.


• You should notify the physician if you feel any breathing difficulties, sweating, numbness, itching, nausea and/or vomiting, chills, or heart palpitations.


• After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. You may be instructed to take in a deep breath and hold it for a few seconds during this time.


• When the physician locates the narrowed artery, the interventional wire will be advanced to that location and the balloon will be inflated to open the artery. It is possible to experience some pain or discomfort at this point as a result of blood flow being temporarily blocked by the inflated balloon. Any discomfort or pain should go away when the balloon is deflated. However, if you notice any continued discomfort or pain, such as leg, back pain, arm pain, shortness of breath, or breathing difficulty, tell your physician immediately.


• The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening. In some cases, the stent may be inserted into the artery before the balloon is inflated. The inflation of the balloon will open the artery and fully expand the stent.


• The physician will take measurements after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.


• The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your physician will determine which method is appropriate for your condition.


• If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the physician (or an assistant) will hold pressure on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.


• Your physician may decide not to remove the sheath, or introducer from the insertion site for approximately four to six hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off. You will need to lie flat during this time. If you become uncomfortable in this position, your nurse may give you medication to make you more comfortable.


• You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends tucked under the mattress on both sides of the bed to form a type of loose restraint.


• If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (works like a belt around the waist) may be secured around the arm near the insertion site. The band will be loosened at given intervals and then removed at the appropriate time determined by your physician.

After the Procedure - In the hospital:
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.

You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
Bedrest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bedrest may be of shorter duration.

In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.

After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may resume your usual diet after the procedure, unless your physician decides otherwise.

After the procedure - At home:
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your physician.

If your physician used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin, where the insertion site was. This is normal. The knot should gradually disappear over a few weeks.

It will be important to keep the insertion site clean and dry. Your physician will give you specific bathing instructions.

You may be advised not to participate in any strenuous activities. Your physician will instruct you about when you can return to work and resume normal activities.

Notify your physician to report any of the following:

• fever and/or chills


• increased pain, redness, swelling, or bleeding or other drainage from the insertion site


• coolness, numbness and/or tingling, or other changes in the affected extremity


• chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

What is: Peripheral Vascular Angiogram and Intervention

WHAT IS: PVI - Peripheral Vascular Intervention = Angiogram +/- Angioplasty and Stent

Peripheral Vascular Intervention (PVI) is performed to open blocked arteries caused by peripheral arterial disease (PAD) and to restore arterial blood flow without the need for open-vascualr surgery. PVI is usually comprised of both angioplasty (PTA – percutaneous transluminal angiolplasty), followed by stent placement. It is performed in either an emergency setting (for treatment of critical limb ischemia) or in an outpatient setting (to treat a severe blockage causing leg pain).

A special catheter is inserted through the major artery in the leg or arm and advanced to the blocked artery. Through the catheter, a tiny wire is inserted into the artery and threaded across the blockage. Over this wire, a tiny balloon is advanced to the blockage. The balloon is inflated once the catheter has been placed into the narrowed area of the coronary artery. The inflation of the balloon compresses the fatty tissue in the artery and makes a larger opening inside the artery for improved blood flow.

What is stent placement?
In the past few years, many refinements have been developed in the PVI procedure. One common procedure used in PVI is stent placement. A stent is a tiny, expandable metal coil that is inserted into the newly-opened area of the artery to help keep the artery from narrowing or closing again.

Once the stent has been placed, tissue will begin to form over it within a few days after the procedure. The stent will be completely covered by tissue within a month to one year. It is necessary to take anti-platelet medications, such as aspirin or clopidogrel (Plavix™), which decreases the “stickiness” of platelets (a type of blood cells that clump together to form clots to stop bleeding), in order to prevent blood clots from forming inside the stent

Peripheral Arterial Disease:

Peripheral artery disease, also known as peripheral arterial disease, is a common circulatory problem in which narrowed arteries reduce blood flow to your limbs.

When you develop peripheral artery disease (PAD), your extremities — usually your legs — don't receive enough blood flow to keep up with demand. This causes symptoms, most notably leg pain when walking (intermittent claudication).

Peripheral artery disease is also likely to be a sign of widespread accumulation of fatty deposits in your arteries (atherosclerosis). This condition may be reducing blood flow to your heart and brain, as well as your legs.

Often, you can successfully treat peripheral artery disease by quitting tobacco if you smoke, exercising and eating a healthy diet. Early diagnosis and treatment can prevent peripheral artery disease from getting w

Risks of the Procedure: Possible risks associated with PVI include, but are not limited to, the following:

• allergic reactions


• medication reactions


• bleeding


• leg pain or discomfort


• infection


• damage to the blood vessel(s) into which a catheter is inserted which could require surgical repair


• there is small risk (under 1%) of the coronary artery becoming narrowed during the procedure, resulting in the need for immediate, emergent arterial bypass surgery.


• damage to the kidneys which could require dialysis


• heart rhythm disturbances


• myocardial infarction


• stroke


• nerve injury


• death

The risk of any one of these serious complications is less than 1%.

The amount of radiation used in fluoroscopy during a angioplasty or stent procedure is considered minimal; therefore, the risk for radiation exposure is very low.

If you are pregnant or suspect that you may be pregnant, you should notify your physician due to risk of injury to the fetus from a PVI. Radiation exposure during pregnancy may lead to birth defects. If you are lactating, or breastfeeding, you should notify your physician.

There is a risk for allergic reaction to the dye. Patients who are allergic to or sensitive to medications (ASPIRIN), contrast dye, iodine, or shellfish should notify their physician. Also, patients with kidney failure or other kidney problems should notify their physician.

Since this procedure requires you to take anti-platelet medications, please inform you physician if you currently have or have a history of bleeding problems. Please also tell your physician if have any surgical procedures planned in the near or distant future.

For some patients, having to lie still on the procedure table for the length of the procedure may cause some discomfort or pain.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure: Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

You will be asked to sign a consent form that gives your permission to do the test. Read the form carefully and ask questions if something is not clear.

Notify your physician if you have ever had a reaction to any contrast dye, or if you are allergic to iodine, seafood, or aspirin.

Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).

You will need to fast for a certain period of time prior to the procedure. Your physician will notify you how long to fast, whether for a few hours or overnight.

If you are pregnant or suspect that you may be pregnant, you should notify your physician.

Notify your physician if you have any body piercings on your chest and/or abdomen.

Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting.

Your physician may request a blood test prior to the procedure to determine how long it takes your blood to clot. Other blood tests may be done as well.

You may receive a sedative prior to the procedure to help you relax.

The area around the catheter insertion (groin area) may be shaved.

Based upon your medical condition, your physician may request other specific preparation.
During the Procedure

A PVI may be performed as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Generally, a PCI follows this process:

• You will be asked to remove any jewelry or other objects that may interfere with the procedure. You may wear your dentures or hearing aid if you use either of these.


• You will be asked to remove clothing and will be given a gown to wear.


• You will be asked to empty your bladder prior to the procedure.


• An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed.


• You will be placed in a supine (on your back) position on the procedure table.


• You will be connected to an ECG monitor that records the electrical activity of the heart and monitors the heart during the procedure using small, adhesive electrodes. Your vital signs (heart rate, blood pressure, breathing rate, and oxygenation level) will be monitored during the procedure.


• There will be several monitor screens in the room, showing your vital signs, the images of the catheter being moved through the body into the heart, and the structures of the heart as the dye is injected.


• You will receive a sedative medication in your IV before the procedure to help you relax.
  Your pulses below the insertion site will be checked and marked so that the circulation to the limb below the site can be checked after the procedure.


• A local anesthetic will be injected into the skin at the insertion site. You may feel some stinging at the site for a few seconds after the local anesthetic is injected.


• Once the local anesthetic has taken effect, a sheath, or introducer, will be inserted into the blood vessel. This is a plastic tube through which the catheter will be inserted into the blood vessel and advanced to the blocked artery.


• The angioplasty catheter will be inserted through the sheath into the blood vessel. The physician will advance the catheter through the aorta into the artery. Fluoroscopy will be used to assist in advancing the catheter to the artery.


• The catheter will be advanced to the blocked artery. Once the catheter is in place, contrast dye will be injected through the catheter into your arteries in order to see the narrowed area(s). You may feel some effects when the contrast dye is injected into the IV line. These effects include a flushing sensation, a salty or metallic taste in the mouth, and/or a brief headache. These effects usually last for a few moments.


• You should notify the physician if you feel any breathing difficulties, sweating, numbness, itching, nausea and/or vomiting, chills, or heart palpitations.


• After the contrast dye is injected, a series of rapid, sequential x-ray images of the heart and coronary arteries will be made. You may be instructed to take in a deep breath and hold it for a few seconds during this time.


• When the physician locates the narrowed artery, the interventional wire will be advanced to that location and the balloon will be inflated to open the artery. It is possible to experience some leg pain or discomfort at this point as a result of blood flow being temporarily blocked by the inflated balloon. Any leg discomfort or pain should go away when the balloon is deflated. However, if you notice any continued discomfort or pain, such as leg, back pain, arm pain, shortness of breath, or breathing difficulty, tell your physician immediately.


• The physician may inflate and deflate the balloon several times. The decision may be made at this point to insert a stent in order to maintain the artery's opening. In some cases, the stent may be inserted into the artery before the balloon is inflated. The inflation of the balloon will open the artery and fully expand the stent.


• The physician will take measurements after the artery has been opened. Once it has been determined that the artery is opened sufficiently, the angioplasty catheter will be removed.


• The insertion site may be closed with a closure device that uses collagen to seal the opening in the artery, by the use of sutures, or by applying manual pressure over the area to keep the blood vessel from bleeding. Your physician will determine which method is appropriate for your condition.


• If a closure device is used, a sterile dressing will be applied to the site. If manual pressure is used, the physician (or an assistant) will hold pressure on the insertion site so that a clot will form. Once the bleeding has stopped, a very tight bandage will be placed on the site. A small sandbag or other type of weight may be placed on top of the bandage for additional pressure on the site, especially if the site is in the groin.


• Your physician may decide not to remove the sheath, or introducer from the insertion site for approximately four to six hours, in order to allow the effects of blood-thinning medication given during the procedure to wear off. You will need to lie flat during this time. If you become uncomfortable in this position, your nurse may give you medication to make you more comfortable.


• You will be assisted to slide from the table onto a stretcher so that you can be taken to the recovery area. NOTE: If the insertion was in the groin, you will not be allowed to bend your leg for several hours. To help you remember to keep your leg straight, the knee of the affected leg may be covered with a sheet and the ends tucked under the mattress on both sides of the bed to form a type of loose restraint.


• If the insertion site was in the arm, your arm will be kept elevated on pillows and kept straight by placing your arm in an arm guard (a plastic arm board designed to immobilize the elbow joint). In addition, a plastic band (works like a belt around the waist) may be secured around the arm near the insertion site. The band will be loosened at given intervals and then removed at the appropriate time determined by your physician.

After the Procedure - In the hospital:
After the procedure, you may be taken to the recovery room for observation or returned to your hospital room. You will remain flat in bed for several hours after the procedure. A nurse will monitor your vital signs, the insertion site, and circulation/sensation in the affected leg or arm.

You should immediately inform your nurse if you feel any chest pain or tightness, or any other pain, as well as any feelings of warmth, bleeding, or pain at the insertion site in your leg or arm.
Bedrest may vary from two to six hours depending on your specific condition. If your physician placed a closure device, your bedrest may be of shorter duration.

In some cases, the sheath or introducer may be left in the insertion site. If so, the period of bedrest will be prolonged until the sheath is removed. After the sheath is removed, you may be given a light meal.

You may feel the urge to urinate frequently because of the effects of the contrast dye and increased fluids. You will need to use a bedpan or urinal while on bedrest so that your affected leg or arm will not be bent.

After the specified period of bed rest has been completed, you may get out of bed. The nurse will assist you the first time you get up, and will check your blood pressure while you are lying in bed, sitting, and standing. You should move slowly when getting up from the bed to avoid any dizziness from the long period of bedrest.

You may be given pain medication for pain or discomfort related to the insertion site or having to lie flat and still for a prolonged period.

You will be encouraged to drink water and other fluids to help flush the contrast dye from your body.

You may resume your usual diet after the procedure, unless your physician decides otherwise.

After the procedure - At home:
Once at home, you should monitor the insertion site for bleeding, unusual pain, swelling, and abnormal discoloration or temperature change at or near the insertion site. A small bruise is normal. If you notice a constant or large amount of blood at the site that cannot be contained with a small dressing, notify your physician.

If your physician used a closure device for your insertion site, you will be given specific information regarding the type of closure device that was used and how to take care of the insertion site. There will be a small knot, or lump, under the skin, where the insertion site was. This is normal. The knot should gradually disappear over a few weeks.

It will be important to keep the insertion site clean and dry. Your physician will give you specific bathing instructions.

You may be advised not to participate in any strenuous activities. Your physician will instruct you about when you can return to work and resume normal activities.

Notify your physician to report any of the following:

• fever and/or chills


• increased pain, redness, swelling, or bleeding or other drainage from the insertion site


• coolness, numbness and/or tingling, or other changes in the affected extremity


• chest pain/pressure, nausea and/or vomiting, profuse sweating, dizziness, and/or fainting

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.

Three Alternatives to Achieve Tort Reform

Tort Reform must be a vital part of the health care reform.

I recently had a long passionate discussion with my wife regarding the pros and cons of a national cap on medical malpractice awards. I know fully believe that a cap would be a very bad idea.

I do like some of the other alternative ideas for tort reform being discussed. Specifically, I like the idea of a "medical court" and a "safe harbor".

Please follow the link below for an interesting article on these two novel ideas for tort reform

http://www.healthleadersmedia.com/content_redirect.cfm?content_id=237385

--
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For a free download, go to http://getviigo.com

Sent from my Verizon Wireless BlackBerry

Studies Links Diet, Exercise to Dementia

Even more reason to eat the most heart healthy diet and be physically active -- 2 new studies have found a link between a Mediterranean-type diet and physical activity and a reduced risk for Alzheimer's disease.

http://feedproxy.google.com/~r/wsj/xml/rss/3_7089/~3/71TXszENvQw/SB10001424052970204251404574344582587608264.html

Sent from my Verizon Wireless BlackBerry

Time Magazine: Exercise makes you eat more????

Recently, an article in TIME magazine has raised an important health question: Is exercise really an effective means for weight loss?

As health and exercise professional, I can affirm that the answer is a resounding yes! A vast amount of research has definitively proven that exercise, when combined with a healthy diet, results in both weight loss and maintenance of a healthy weight. The American College of Sports Medicine just released an updated, evidence-based scientific position stand in early 2009 that proves these exact points.

Further, there is little evidence to the claim that exercising produces hunger so uncontrollable that it leads to weight gain. In fact, a recent study from the University of Pittsburgh proved just the opposite: overweight and obese women didn’t eat any more food after 40 minutes of exercise than they normally would when sedentary.

Exercise does require effort, and it does require self-control. But when these are combined to form a healthy lifestyle, the rewards are beyond substantial. Economically, expenditures are reduced (the recent Weight of the Nation conference reported that obesity accounts for some $147 billion in health care costs per year); and people lead more enjoyable, more energetic and happier lives.

Even for the non-overweight, exercise provides benefits that no single pill or prescription ever could. It treats and prevents numerous chronic conditions, such as heart disease, high blood pressure, type II diabetes, and even depression.

Exercise is a health tool we all need, regardless of our weight, and it is my sincere hope that the public takes its importance seriously. Further, advice about weight loss should come courtesy of a qualified health or fitness professional, instead of irresponsible articles that may not showcase the full realm of scientific facts surrounding the issue.

Dr Portnay's Healthy Heart "Twibbon"

Show support for "Dr Portnay's Healthy Heart" and add a twibbon to your twitter profile image

Hey all you Dr Portnay Blog and Twitter fans. Show your support by adding a Twibbon to your Twitter avatar. The Twibbon will simply add a small Dr Portnay logo to the upper right corner of your avatar. If at anytime you change your avatar, you'll have to add the Twibbon again. If for some strange reason you don't want the Twibbon after a while, all you have to do is update your avatar on your Twitter page and it will be replaced. Let's see how many supporters of Dr Portnay we can get!

Dr Portnay's Healthy Heart Twibbon (http://twibbon.com/join/Dr-Portnays-Healthy-Heart?justJoined=True&username=drportnay)

http://the-mediterranean-diet.com

I continue to be amazed with twitter and its ability to connect peopel of like interests.



Recently, I have met Ray Darken and his http://the-mediterranean-diet.com/ website.



I love this site and his frequent tweets (@HealthyDietz).



As you know, I am a huge proponent of the Mediterranean Diet. As a Cardiologist, no way of eating has been shown to be more "heart healthy" than consuming a Mediterranean Diet.



Ray's site is filled with tons of education and recipes. Here are some that I really like:



http://safe-and-easy-weightloss.com/MedDietPyramid.htm



http://the-mediterranean-diet.com/6-reasons-why-doctors-nutritionists-promote-the-mediterranean-diet.html



http://the-mediterranean-diet.com/the-mediterranean-diet-and-the-prevention-of-heart-disease.html



Check out his site -- I think you will like it too