This is the website of the Cottage Heart and Vascular Center. I found it interesting because it explains (in lay terms) all of the procedures (CABG, PCI, Ablation, etc) performed at our local hospital and what patients should expect. The interactive symptom checker, local cottage heart-hotline, and list of heart attack warning signs are all easy to navigate and seem helpful (also for those of us studying for a test!). While in a clinical rotation I once witnessed a PCI in the cardiac cath lab, and beforehand saw the pt give informed consent after the doctor explained the procedure extremely rapidly. The information on this website would have been extremely helpful to the pt before the emergency procedure– but how many people read up on cottage’s heart services when they’re feeling fine? The website also talks about how the hospital goal for all cardiac events is a 90 min or less timeline from door-to-“definitive treatment” since becoming a Cardiac Receiving Center and Level II Trauma Center for Santa Barbara County.

http://www.cottagehealth.org/services/heart-vascular/services-treatments/

Article: Too Much, Too Little Sleep May Harm the Heart

We’ve all heard that proper diet and exercise is crucial to lowering our risk for heart disease. This study focused on another major factor that often doesn’t receive as much attention, sleep. With the American mentality of work hard, play hard it often seems that there isn’t much time left for sleep. In fact, it almost seems that individuals pride themselves on their ability to keep up despite minimal amounts of sleep. While these individuals may feel like they’re living life to its fullest, they are missing out on the major benefits of getting a good nights sleep.

With attempting to balance work, school, and some form of a social and healthy lifestyle I often find that sleep gets thrown by the wayside. Recently it’s become a personal goal of mine to try to get better quality sleep and more of it.

I found this article interesting because it discusses not only the importance of sleep as it relates to cardiovascular health, but the importance of the right amount of sleep.

According to the article, a study of 47,000 participants showed individuals who:

• got five or fewer hours of sleep a day had 50 percent more calcium in their arteries than those who slept seven hours a day.
• slept nine or more hours a day had at least 70 percent more calcium compared to those who slept seven hours.
• reported poor sleep quality had more than 20 percent more calcium than those who reported good sleep quality.

So, as with most things in life, sleep is good in moderation. It looks as though oversleeping may actually be more harmful to your heart than not getting enough sleep!

Heart Healthy Text Messages

We do everything on our phones, expect what they were originally meant for, talk. Texting is quick and easy but could improve your health. A study, posted in Journal of American Medical Association, looked to see if semi-personal text messages could reduce LDL, BMI, blood pressure and even smoking status. The participants in the intervention group received 4 texts a week from an automated service and the other group received regular care. In the end, the intervention group, saw a reduction in BMI, blood pressure, LDL and even smoking status. Although this was a fairly small study of 700 participants for only 6 months, I think there is some reliability.

Text messages are seen as personal and a useful form of communication. Texts also allow an automated service to send out messages to a large number of people. It shows increased interest in the patient’s health and can hold them more accountable.  I think an additional benefit would be an option to respond to the text messages and get feed back about food choices, exercise ideas and possible list of resources in the community for additional resources.

Healthcare will be forced to keep up with digital communication age and I think texting can make health care information more accessible and convenient for everyone with a cell phone.

Chow, C, et al. Effect of Lifestyle-Focused Text Messaging on Risk Factor Modification in Patients With Coronary Heart Disease. JAMA. 2015.

I had a chance to take care of a patient who had multiple heart problems. He had CABG open hart surgery in the past. Now the patient developed heart valve problems and needed another surgery. However, the doctor stated that last surgery led to a complication that would not allow this patient to have another traditional open-heart surgery. Therefore, minimally invasive aortic and mitral valve replacement surgery was recommended. I was interested to find specific details about this procedure.

I found the article “Minimally invasive aortic valve replacement (MIAVR) – pros and cons of keyhole aortic surgery” that compares different approaches to heart surgeries and demonstrates the benefits of the latest approach that is minimally invasive (Kaczmarczyk, et al., 2015). This type of surgery has been evolving for the last twenty years and proves to safe, well-tolerated and efficient method. The authors explain that “minimally invasive” refers to any procedure not performed with a full sternotomy or cardiopulmonary bypass (Kaczmarczyk, et al., 2015).

There are two main types of MIAVR: partial sternotomy and intercoastal access. Lower hemisternotomy is the most popular partial sternotomy method. It provides excellent access to the heart and its vessels as well as stability of the rim of the upper limbs in postoperative period. Important advantages of this approach also include less surgical trauma, less postoperative bleeding and blood units transfused, faster recovery, shorter hospital stay and ICU stay, and less pain. It is however more technologically demanding and can often lead to failure if the surgeon does not have much experience.

Right anterior minithoracotomy scar vs. full sternotomy scar

References

Kaczmarczyk, M., SzaaÄski, P., Zembala, M., Filipiak, K., Karolak, W., Wojarski, J.,…Embala, M. (2015). Minimally invasive aortic valve replacement – pros and cons of keyhole aortic surgery. Cardiac Surgery, 12(2), 103-110.

Recently I had the experience of caring for patients on a hospital’s telemetry floor. One of my patients had just received a transcatheter aortic valve replacement (TAVR), sometimes referred to as transcatheter aortic valve implantation (TAVI). The TAVR procedure is a new cardiac procedure being performed at the hospital. TAVR procedures have been performed in Europe since 2007, but were only approved by the FDA in the United States in 2011 (Buntz, 2012). A transcatheter aortic valve replacement is used as an alternative to traditional aortic valve surgery in patients with aortic stenosis who, either because of age or comorbidities, are not candidates for traditional cardiac surgery (Khatri et al., 2013). The TAVR procedure does not require a sternotomy, but instead threads a balloon catheter with the replacement valve through the femoral artery (transfemoral approach) and into position (American Heart Association, 2015).

The research efforts of Khatri et al. (2013) investigate the adverse effects associated with transcather aortic valve replacement and attempt to identify if certain approaches (transarterial or transsapical) or types of valves (CoreValve or Sapien valve) have different adverse effects. From their research Khatri et al. (2013) concluded that heart block, vascular complications, and acute renal failure were the most common side effects of the TAVR procedure. The CoreValve was more often associated with heart block but less likely to cause vascular complications (Khatri et al., 2013). In addition, the transapical approach has lower thirty day survival rates than the transfemoral approach (Khatri et al., 2013). The study highlights the fact that most patients receiving the TAVR transapically had significant peripheral vascular disease and therefore greater comorbidities than those who’s vasculature was adequate for the transfemoral approach (Khatri et al., 2013). Further research is needed to assist physicians in making decisions about the best valve types and approach to use when preforming the TAVR procedure.

References

American Heart Association. (2015). What is TAVR? In Heart valve problems and disease. Retrieved from http://www.heart.org

Buntz, B. (2012). TAVR: Still the next big thing in cardiology? Medical Device and Diagnostic Industry. Retrieved from http://mddionline.com/article/tavr-still-next-big-thing-cardiology

Khatri, P., Webb, J., Rodes-Cabau, J., Fremes, S., Ruel, M., Lau, K., … Ko, D. (2013). Adverse effects associated with transcatheter aortic valve implantation: A meta-analysis of contemporary studies. American College of Physicians, 158, 35-46.

Once upon a time there was an active 22 year old, African American male named Devone who loved playing basketball. His grandpa recently passed away from a pulmonary embolism.   He came into the ER today because he had a syncopal episode during the last quarter of the division finals for his basketball team. The nurse assessed the patient finding an irregular, thready pulse; he is pale and more fatigued than usual after a game, which has been worsening over the last week; his capillary refill is 3-4 second. His 12 lead EKG revealed atrial fibrillation with a heart rate of 140-157 bpm with no p waves.  The nurse began to assist the patient by attempting to stimulate the vagal response by having him blow through a straw which was successful in reducing heart rate to 80 bpm. The nurse also conferred with the physician to determine recommendation of anticoagulation therapy. The nurse also educated the patient on lifestyle modifications and the necessity of follow up appointment. As a result of these actions the patient was discharged with a follow-up appointment with primary physician, and prescription for 325mg of aspirin daily.