heart & vascular news, from upstate medical university

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UpsTaTE raTEs HiGH in ConsUmEr rEporTs e September issue of “Consumer Reports” magazine includes an exclusive rating of heart surgeons — and Upstate’s cardiac surgery program makes the list. e 2011 Society of oracic Surgeons coronary artery bypass surgery ratings can also be found at www. ConsumerReports.org/health. e data, from 2009 to 2010, looks at overall performance, complications and other quality measures. n wElComE Dr. sZomBaTHy Tamas Szombathy MD, FACC, has joined Upstate’s clinical faculty in the division of cardiology as an assistant professor of medicine. He comes from Tufts University and St. Elizabeth’s Medical Center in Boston, MA where he completed a fellowship in clinical electrophysiology. He is board certified in Internal Medicine; Internal Medicine and Cardiovascular Disease; Nuclear Cardiology and Echocardiography. from the Upstate Heart and Vascular Center, Upstate University Hospital Syracuse New York Fall 2011 HEART & VASCULAR NEWS Ray Kimball and his wife, Dorothy, live in Chaumont, outside of Watertown. CHilly TrEaTmEnT savEs warm-HEarTED man A t 75, Ray Kimball is a veteran of the Empire State Senior Games. He was competing in racewalking on June 9 in Cortland. Without warning, he collapsed. His heart had stopped beating correctly in a rhythm known as ventricular fibrillation. “I don’t think I made it halfway through the first lap,” Kimball recalls. Paramedics used a defibrillator to restart his heart and raced him to Upstate’s Cardiac “Cath” Lab where Danish Siddiqui MD performed emergency cardiac catheterization. Once stabilized, Kimball underwent bypass surgery with Gregory Fink MD, Upstate’s chief of cardiopulmonary surgery. e skill and precision of Upstate’s cardiac surgery team repaired Kimball’s heart. A more rudimentary technique known as “chill therapy” is credited with preserving his brain. When the heart stops beating and then is revived, cytotoxins are released into the bloodstream that can cause irreversible damage to the brain.“Chilling the patient with strategically placed ice packs slows blood flow and the absorption of cytotoxins, improving chances for the patient to survive neurologically intact,” explains Andre Poirier RN of the “Cath” Lab. Kimball was hospitalized 11 days. He continued healing for eight weeks. Today he’s walking two miles per day. “I feel good,” he says. “It’s just a matter of healing up.” He hopes to be back on his bicycle soon, if not to race, just to ride. n

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The newsletter for the Heart & Vascular Center at Upstate University Hospital, Syracuse's academic medical center.

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  • U p s TaT er aT e sh i g h i n C o n s U m e rr e p o rT sThe Septemberissue of

    ConsumerReports magazine includes an

    exclusive rating of heart surgeons and Upstates cardiac surgeryprogram makes the list. The 2011Society of Thoracic Surgeonscoronary artery bypass surgeryratings can also be found at www.ConsumerReports.org/health.

    The data, from 2009 to 2010,looks at overall performance,complications and other qualitymeasures. n

    w e lC o m e d r . s Z o m B aT h yTamas Szombathy MD,FACC, has joinedUpstates clinicalfaculty in the division

    of cardiology as an assistantprofessor of medicine. He comesfrom Tufts University and St.Elizabeths Medical Center inBoston, MA where he completeda fellowship in clinicalelectrophysiology.

    He is board certied in InternalMedicine; Internal Medicine andCardiovascular Disease; NuclearCardiology and Echocardiography.

    from the Up state Heart and Vascul ar Center , Up state Un ivers i t y Hosp i ta l

    S y r a c u s e N e w Y o r k

    Fal l 2 0 11

    H E A RT & VA S C U L A R N E W S

    Ray Kimball and his wife, Dorothy, live in Chaumont, outside of Watertown.

    C h i l ly T r e aT m e n T s av e s wa r m - h e a rT e d m a n

    At 75, Ray Kimball is a veteran of the Empire State Senior Games. He was competing in racewalking on June 9 in Cortland. Withoutwarning, he collapsed. His heart had stopped beating correctly in arhythm known as ventricular brillation.

    I dont think I made it halfway through the rst lap, Kimball recalls.Paramedics used a debrillator to restart his heart and raced him to UpstatesCardiac Cath Lab where Danish Siddiqui MD performed emergencycardiac catheterization. Once stabilized, Kimball underwent bypass surgerywith Gregory Fink MD, Upstates chief of cardiopulmonary surgery.

    The skill and precision of Upstates cardiac surgery team repaired Kimballsheart. A more rudimentary technique known as chill therapy is creditedwith preserving his brain. When the heart stops beating and then is revived,cytotoxins are released into the bloodstream that can cause irreversible damageto the brain.Chilling the patient with strategically placed ice packs slowsblood ow and the absorption of cytotoxins, improving chances for the patientto survive neurologically intact, explains Andre Poirier RN of the Cath Lab.

    Kimball was hospitalized 11 days. He continued healing for eight weeks.Today hes walking two miles per day. I feel good, he says. Its just amatter of healing up. He hopes to be back on his bicycle soon, if not torace, just to ride. n

  • ARural/Metro dispatcher is a renewedadvocate of automated external debrillators(AED) after his teenage son was broughtback to life by an AED on the lacrosse eld June 15.

    Sean Boland of Fayetteville was at his sons all-startryout at Fayetteville-Manlius High School. Hewent for refreshments at the nearby mini marketand was on his way back to the elds when theManlius Fire Department Ambulance ew by. Hesaid to himself, I hope thats not for Daniel.

    Then his cell phone rang as he turned into theparking lot. The voice on the other end he stillisnt sure who it was said, Were doing CPR onyour son. We just hit him with the AED, and hesback. Boland doesnt remember sprinting thelength of the eld to get to his son, who by thenhad been revived.

    survival depended on swift actionCochran, who plays defense, recalls that he wasdoing drills. His arm got checked by the lacrosseball in one. Then the coaches assigned 4-on-3s,to see how defensemen could work together.

    I was playing up near the goal. Some kid passedthe ball to someone else. I ran up to try to coverthat guy, and the guy tried to shoot. So I tried toturn clockwise to get out of the way of the shot,and it ended up just hitting me, he recalls.

    The ball struck a specic area of the heart, withthe exact force and at the precise stage of theheartbeat to cause whats known as commotioncordis, one of the more common causes ofsudden cardiac death in young athletes.Cochrans heart had stopped. His survivaldepended on swift cardiopulmonaryresuscitation, CPR, and rapid debrillation.

    Coaches and bystanders came to Cochrans aid.Among them was Mike Jordan RN, an operatingroom nurse at Upstate whose son was also tryingout. He had never performed CPR on a human,but his training kicked in. After the AEDshocked the teenager, Jordan did not make itthrough his second set of compressions beforeCochran began pushing his arms away.

    Without the AED, I dont think he would havemade it, to be honest with you, Jordan says. ThatAED, it was effective, thats for sure.

    Cochran faintly remembers falling. Then he remembersbeing awakened. He was on his back on a stretcher,and his arm hurt, where he was rst hit by thelacrosse ball. His dad was there. His mom, in tears,met the ambulance when it arrived at Upstate.

    home from Upstate hours laterCochran went home from the hospital the nextmorning and was back on the lacrosse eld withindays. His family felt gratitude.

    The nurse, and the coaches and the FM trainer,they all came together. These four strangers cametogether and saved my sons life, Boland says. Idont know how to thank them. n

    2 U p s t a t e H e a r t & V a s c u l a r N e w s F a l l 2 0 1 1

    P a t i e n t s F i r s t

    Dan Cochran, 15, is a junior at Jamesville-Dewitt High School. His parents are Danielle and Sean Boland.

    T e e n r e v i v e d o n l aC ro s s e f i e l d

  • U p s t a t e C o n n e c t 8 0 0 - 4 6 4 - 8 6 6 8 3

    P a t i e n t s F i r s t

    Expectant mother TashikoMelendez awoke Aug. 17,2010 with no clue that herlife, and that of her baby, woulddepend on the expertise andcollaboration of her obstetricianand multiple specialists at twoSyracuse hospitals.

    was it labor?She was due to deliver her secondson by Cesarean section atCrouse Hospital in another sixweeks. He would be a littlebrother to her rst son, Jaxson.

    As the day progressed, Melendezdeveloped pain in her chest andback. Since she had neverexperienced labor, she recalls, I wondered if this might be it,even though I was only 34 weeksalong. The pains were constantand eventually became unbearable.Melendezs mother took her tothe emergency room at Crouse.Initial tests showed that the babywas ne and Melendez was notin labor. Then a sonogramrevealed the cause of her pain: atear in her aorta, the largestartery in the body that carriesblood to and from the heart.Melendez was in the midst of alife-threatening emergency.

    With deliberate speed, she waswhisked through the hallwaysthat connect the two hospitals toUpstates operating room.Melendezs obstetrician, AlexandraSpadola MD, of Upstates PerinatalCenter delivered baby Joseito byC-section, and the newborn boywas returned to the CrouseNeonatal Intensive Care Unit.

    Immediately after,Melendez was preppedfor open-heart surgerywith Charles Lutz MD.She remembers feelingterried.

    an Unusual diagnosisMelendez had what isknown as a Type A aorticdissection, which occursin the ascending aorta,the part that branchesinto coronary arteriesthat supply the heartwith oxygenated blood.Seventy percent of casesare brought on by highblood pressure, whichMelendez had. The aortawithstands signicantpressure changes witheach heart beat. Overtime, an elevated bloodpressure can weaken the lining ofthe aorta causing it to tear.

    smooth recoveryAortic dissection is a fairlycommon diagnosis, but notduring pregnancy. High bloodpressure is usually a majorcontributing factor. But itsalways a serious situation requiringimmediate surgical intervention,says Dr. Lutz, who replaced thedamaged portion of Melendezsascending aorta with a Dacron tubegraft. Ms. Melendez was fortunateto be treated so quickly and insuch a collaborative environment.

    It would be seven days beforemother and child could bereunited. Baby Joseito remainedin the NICU while Melendezrecovered at Upstate.

    A year later, both are doing well.Melendez continues to befollowed by Dr. Lutz, whoexpects no further complicationsas long as her high bloodpressure is controlled withmedication.

    Although dramatic, this is anotherexample of the cooperative relation-ship between the Crouse and Upstatehospital teams. For decades, the twoinstitutions one a communityhospital, the other an academicmedical center have enjoyed asymbiotic relationship, wherecomplementary services andprofessional expertise combine tobenet patients, professional staff,students and employees. n

    a B a By a n d o p e n h e a rT s U rg e ry T h e s a m e d ay

    Tashiko Melendez with baby Joseito.

  • 4 U p s t a t e H e a r t & V a s c u l a r N e w s F a l l 2 0 1 1

    G o o d t o K n o w

    what is venous disease?Understanding of the functions of the vascular system is an importantpart of understanding venous diseases, which can be sudden or chronic.

    The vascular system is made up of a pump known as the heart, which circulates blood and oxygen throughout the body throughtubes called arteries. The veins are the tubes that return the blood to the heart.

    Within the thin walls of the veins are valves that permit the blood to ow in only one direction.

    These valves open during contraction and close when the muscle isrelaxed to prevent blood ow from going backward. If the valves closetightly they are called competent valves. If they dont, they areconsidered incompetent. Over time, veins can be damaged orweakened and several problems can develop.

    varicose veinsRoughly 12 percent to 15 percent of the population has varicose veins,which are bulging, discolored veins that are sometimes described asa bag of worms under the skin. They tend to occur in women andcan develop or become worse during pregnancy. They may be painful,ranging from a full, heavy ache to itching and burning or crampingwhen standing for a long time. Some veins may be painful to touchand occasionally can bleed. Left untreated they can lead to chronicvenous insuciency.

    Intermittent leg elevation, good exercise and stocking support cantreat varicose veins. If they are painful or bleeding, the veins can beremoved or ablated, using a special laser device.

    venous ThrombosisA condition known as thrombosis exists when clots form, blockingthe interior of blood vessels.

    Deep Venous Thrombosis, DVT, describes the formation of a thrombus, orblood clot, in the deep vein system. It can occur in one or more veinsof the leg, causing reduced blood ow back to the heart andsignicant leg swelling. The condition is serious because it can lead to apulmonary embolism, when a piece of a clot breaks loose and travels tothe heart and lungs, causing problems with breathing and heartfunction and quickly leading to death. DVT accounts for 600,000hospital admissions per year, with 200,000 thousand deaths as aresult of pulmonary embolism.

    Symptoms may include sudden leg swelling, aching pain and skindiscoloration. Treatment includes blood-thinning medication, alongwith leg elevation, leg stockings and a plan that includes exercise.

    w h aT i s v e n o U s d i s e a s e ?

    Blood flow

    Valve

    Blood clot

    By Kwame Amankwah MD, Associate Professor of Surgery, Division ofVascular Surgery and Endovascular Services,Upstate Medical University

  • U p s t a t e C o n n e c t 8 0 0 - 4 6 4 - 8 6 6 8 5

    G o o d T o K n o w

    These therapies may continued for three months ormore, to help prevent the development of chronicvenous insuciency.

    Supercial thrombophlebitis can develop in a varicosevein where blood ow has slowed. It can occur afterinjury, exercise, surgery, or because of a bloodclotting disease. The vein becomes irritated, and asmall clot sticks to the vein wall. This supercialvein does not have muscle surrounding it like deeperones, which can squeeze and move the clot off thewall. This is why supercial thrombophlebitis rarelycauses pulmonary embolism.

    Symptoms include a tender cord-like structure,sensitive to touch, which may appear red, warmand swollen in the area around the affected vein.Supercial thrombophlebitis responds readily towarm, moist heat applied to the area. Over-the-counter ibuprofen and elevation of the leg will also help.

    Chronic venous insufficiencyWhen the valves inside the veins become injured as a result of long-standing varicose veins, or an

    event like DVT the scarring and thickeningprevent the valves from closing properly andmaintaining one-way ow.

    When a person stands or sits for a long time, bloodpools in the veins, and the uid may leak into thesurrounding tissue, resulting in ankle swelling. Theleg may ache, or feel heavy by the end of the day. Atnight when the legs are elevated, the aching andheaviness is lessened, and by morning, the legs areless swollen and less painful.

    Chronic venous insuciency cannot be cured. Legelevation compression stockings are the bestcurrent treatment. If the swelling is not controlledit can lead to more swelling, which irritates theskin and tissue beneath the skin. This will cause theskin to develop a permanent reddish brown color,and the skin gradually will become thick andleather-like.

    The skin can also become dry and itchy. A break inthe skin can lead to development of a painful soreor venous ulcer. If these ulcers become infected, itmay require being admitted to the hospital forantibiotic and other treatments. n

    p r a C T i C e o p e n s i n C a m i l lU sTimothy D. Ford MD is thenew medical director of Upstate Cardiology West, at5700 W. Genesee St., Camillus inSuite 128 of Medical Center West.

    This satellite oce of Upstates Departmentof Medicine, Cardiology Division opened in January and is accepting new adultcardiology patients.

    The oce is staffed by Dr. Ford, DanishSiddiqui MD, and Jeanne Pietrzak NP. Thephone number is 488-2372. n

    f r e e va s C U l a r s C r e e n i n gaT T r a C T s 1 6 5The Division of Vascular Surgery andEndovascular Services conducted the 7thannual Vascular Screening Program in June atBethany Baptist Church. This years eventscreened 165 people, bringing the totalCentral New Yorkers screened to well over1,000 over the last several years.

    Participants received free, non-invasivetests for three of the most prevalent vasculardiseases, including carotid ultrasounds toevaluate for the risk of stroke, abdominalultrasounds to detect aortic aneurysms, and lower extremity blood pressuremeasurements to evaluate the circulation to the legs. n

  • 6 U p s t a t e H e a r t & V a s c u l a r N e w s F a l l 2 0 1 1

    G o o d T o K n o w

    Patients facing surgery have the same desiresas their surgeons: reduced risk of infectionand blood loss, brief hospital stays, minimalpain and scarring, and quick recovery. Often patientshave heard about the da Vinci surgical robot andask whether it is an option in their situation.

    The answer: It depends.

    It depends on the type of operation, the extent ofdisease, whether the hospital has invested in arobot, the surgeons judgment and experience, andthe patient himself or herself. As for any minimallyinvasive surgery, pregnant women and people withbleeding disorders or signicant cardio-pulmonaryconditions are not candidates. (Health insurers, bythe way, generally treat robotic surgery like anyminimally-invasive procedure.)

    Some surgeons believe the robot is a tool thatallows them to perform certain operations better.Heres how: The da Vinci is designed for use duringcomplex procedures in small, hard-to-reach spaces.Four arms enter the patient through 1- to 2-centimeter incisions or ports. One is a camera.

    That cameras view is magnied up to 15 times to aconsole where a surgeon sits near the operating table.He or she manipulates the camera and three other armsusing controls that look like computer game joysticks.The robots hands have better dexterity than humanhands, and they have no tremors. They t into mini-scule spaces where a surgeons hands would not.

    The visualization with the robotic system is muchsuperior to conventional surgery, Charles Lutz MD,director of robotic and minimally invasive cardiacsurgery at Upstate, told The Post-Standard newspaper.At the same time, plenty of surgeries are still bestdone in the conventional open fashion, wheresurgeons have access to a wide operating eld.

    Upstate doctors use the da Vinci for some mitraland tricuspid valve repairs, single vessel coronaryartery bypasses, atrial-septal defect repairs andtumor removals. n

    w h y y o U r d o C T o r m ay r eC o m m e n d s U rg e ry w i T h a ro B oT n a m e d d a v i n C i

    pa r k e r l eC T U r e f e aT U r e s m i n i m a l ly - i n va s i v es U rg e ry p i o n e e rA pioneer of minimally-invasive mitral valve surgery, including robotic-assisted techniques, will lecture Oct. 5 at Upstate Medical University. RandolphChitwood MD, will give the second annual Frederick B. Parker MD EndowedLecture in Cardiothoracic Surgery from 8 to 9 a.m. in Weiskotten Hall.

    Chitwood is the senior associate vice chancellor for health affairs at EastCarolina University. He is director of the East Carolina Heart Institute andChief of the Division of Cardiothoracic and Vascular Surgery.

    The lecture honors Parker, long-time surgery professor and chair at Upstate,who retired in 2001. Last years event featured Toby Cosgrove MD, chiefexecutive ocer of the Cleveland Clinic. The lecture is open to the public. n

    Frederick B. Parker MD, ProfessorEmeritus, Cardiothoracic Surgery

    Cardiac surgeon Charles Lutz MD, examines one fo the interchangeablearms of the da Vinci surgical robot, while Karkiehalli Dilip MDobserves one of the monitors.

  • U p s t a t e C o n n e c t 8 0 0 - 4 6 4 - 8 6 6 8 7

    G o o d t o K n o w

    Afailing heart cannot pump eciently enoughto meet the bodys demands. Vigilant carecan help improve function and maintainquality of life.

    Untreated or undertreated hypertension, injury to the heart muscle or valves, cardiovasculardisease, and congenital heart problems are just afew of the causes of chronic heart failure, explainscardiologist Robert Carhart Jr. MD, FACC, professorof medicine at Upstate Medical University anddirector of Upstates Heart Failure Center. We alsotreat patients who have heart damage caused byviral infections or cancer treatments, says Dr.Carhart, and those who have other conditionssuch as diabetes.

    At Upstates Heart Failure Center, Dr. Carhart andhis team develop individualized patient careprograms to monitor and treat the breadth of issues associated with congestive heart failure:stress on the cardiovascular system which affectsthe lungs, kidneys, and liver; and blood poolingand uid build-up that causes swelling andshortness of breath.

    Heart failure has many proles, Dr. Carhart says, and it demands lifelong, consistent attention to avoid progression that can become a downward spiral.

    At Upstate, we are seeing encouragingdevelopments on every front in the treatment of heart failure, no matter what its origin, assures Dr. Carhart. We are evaluating newmedical treatment protocols and researchingadvancements in assistive, implantable devicessuch as pacemakers and debrillators.

    Upstates commitment to outstanding care forheart failure patients is designed to keep patientsout of the hospital and pursuing healthy lifestylesthat can help their hearts function at the highestpossible level. The programs effectiveness andcomprehensiveness has earned the unique-in-the-region designation as a silver performer from theAmerican Heart and Stroke Associations Get withthe Guidelines Heart Failure performance program.

    Heart failure patients are monitored andencouraged by the specialists in the cardiologydepartment, and connected to the resources theyneed at Upstates Heart and Vascular Center andcardiac rehabilitation program. Upstates new heartfailure nurse coordinator is making these servicesaccessible and seamless.

    We emphasize to our heart failure patients thatrecognizing symptoms and listening to their bodiessignals on a daily basis are good ways to stay aheadof a condition that, although not curable, can bebest managed as a team effort, says Dr. Carhart. n

    a n a l ly f o r T h o s e w i T h h e a rT fa i lU r e

    Robert Carhart Jr. MD, FACC confers with cardiology fellowsVasundhara Muthu MD, seated, and Prasad Cherian MD about astress echocardiography study done in the Heart and Vascular Center.

  • U p s t a t e H e a r t & V a s c u l a r N e w s F a l l 2 0 1 1

    newsletter staffEditors:Karen A. Gibbs MSN, RNC, Nurse Practitioner, Cardiopulmonary SurgeryAmy Tetrault RN, Head Nurse, Cardiac Catheterization Lab Melanie Rich, Director Amber Smith, Senior EditorMarketing and UniversityCommunications Designed by Upstate Marketing and University Communications

    11.225

    b 911 8.3k ag

    kc

    Knowing changes everything.SM www.upstate.edu

    C e n t e r N e w s

    g r i l l e d T ro p i C a l T e r i ya k i k e B o B s

    Many grill favorites can be high in saturated fat and sodium, butyou can keep your diet heart healthy by enjoying the bountyof fruits and vegetables this season brings. Choose meats thatare lean. Flavor them with herbs, spices, or low sodium sauces. Trythese Grilled Tropical Teriyaki Kebobs for a healthy take on a summermeal! Danielle Stegman, RDINGREDIENTS:Sauce:15 oz. (1 bottle) low sodium soy sauce1/2 cup pineapple juice (from fresh pineapple or from can)2 tsp. sesame oil2 tsp. vinegar2 tsp. ground or 1 tbsp. fresh nely minced ginger2 tsp. garlic powder or 1 tbsp. fresh nely minced garlicPepper to taste

    2 skinless boneless chicken breasts, 1-2 inch cubes (about 1 pound)1 pint cherry tomatoes, washed 1/4 lb. snow peas, washed1 fresh pineapple, cut into 1 inch chunks

    (may use canned pineapple chunks, 20 oz. can)2 cups whole grain rice, cookedkebab skewers

    DIRECTIONS:1. Combine all teriyaki sauce ingredients in bowl and whisk until combined

    evenly.2. Marinate cubed chicken breast in most of teriyaki sauce for 2 hours. 3. If using wooden kebob sticks, soak in water for about 5 minutes to prevent

    from catching re on the grill.4. Begin to assemble the kebobs alternating chicken, pineapple, tomatoes,

    and snow peas.5. Grill kebobs until chicken reaches an internal temperature of 165 degrees.6. Serve over whole grain rice and enjoy!

    Makes approximately 5 kebobs

    h e a rT a rTArtist LudwigStein, a professorat SyracuseUniversity,donated his seriesof Valentinepaintings toUpstate University Hospital, inmemory of his wife, Dr. NancyJermanovich, and their 22 yearstogether.

    On their second Valentines Day,Stein presented Jermanovichwith a painting which featured astylized heart. When she askedwhere her painting was the nextyear, an annual tradition wasborn. Until Jermanovichs deathin 2000, Stein presented herwith a new painting everyValentines Day.

    The collection of 22 works isdisplayed in the hospitals Heartand Vascular Center. n

    NUTRITION:Serving Size: 1 Kebob with 1/3 cup rice

    Calories: 325 Carbohydrate: 32gProtein: 26gFat: 4gSodium: 500mg(Values are approximate)

    Karen A. Gibbs

    Amy Tetrault

    Throbber (above) and Straight to theHeart are two of the 22 painting LudwigStein donated to Upstate University Hospital.