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Last spring, 57-year-old Georgi Duprey of Ogdensburg, NY, was inextra-high gear, juggling her career as a health teacher with hercherished, hands-on role as grandmother. Then one morning,

during a spring-break visit with a daughter in Baldwinsville, NY,Georgi was gripped by sudden, stabbing chest pains. “Withoutskipping a beat, my daughter said, ‘I’m taking you to Upstate.’”

Forty-five minutes after entering the Emergency Department atUpstate University Hospital, “I was having three stents placed in twoblocked arteries,” Georgi reports. “The last thing I remember saying,as they wheeled me off to the cardiac catheterization lab, was ‘Tell thelittle ones I love them.’”

A few months later, Georgi delivered that message in person (with hugs and kisses), when her six grandsons — and two brand-new granddaughters — assembled at the family cottage on the St. Lawrence River. “I was so lucky to be with them — and so lucky tohave been taken to Upstate when I had the heart attack,” says Georgi.“The skills, knowledge, and passion of their heart team made all the difference.”

S U &   N B A B A S k e t B A l ll eg e N d t o U r SH e A rt C e N t e r

Basketball star DerrickColeman visitedUpstate’s Heart and

Vascular Center where he metstaff and toured the newfacility. See pages 3, 6 and 8for more on the new center.

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

Syracuse , New York

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Heart & Vascular Center

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Georgi with grandkids and husband

At 6’8”, Derrick Coleman towers above Upstate’sOR team members (left to right) Velma Thomas,surgical technologist; Shannon Card RN andLeanne Devito, surgical technologist.

Coleman played basketball at SyracuseUniversity (1986-1990), then spent 15 yearsplaying in the NBA. He was sidelined by a heartcondition in 2004.

U p S tAt e S U rg eo N H e A d S e A S t e r N vA S C U l A r S o C i e t y

Vivian Gahtan MD, chief of the division of vascular surgery andendovascular services at Upstate, is the first woman to head the largest regional vascular society in the United States.

She became president of the Eastern Vascular Society in October.

The Eastern Vascular Society has over 575 members who are primarilyvascular surgeons representing both major academic medical centersand community hospitals in the eastern United States and Canada.The society seeks to promote the exchange of scientific andtechnologic advances among its members.

Dr. Gahtan, the Lloyd S. Rogers Professor of Surgery at Upstate, is adirector of the Vascular Surgery Board of the American Board ofSurgery and former president of the Association of Women Surgeons.

Dr. Gahtan specializes in treating aortic aneurysms, carotid arterydisease, peripheral arterial disease, varicose veins, diabetic footproblems, and providing dialysis access. In addition to her clinicalwork, she maintains a significant research agenda with federal grantfunding from the Veterans Administration. Dr. Gahtan joined theUpstate faculty in 2003.

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Cardiac surgeon Gregory Fink MD

k e y M e M B e r o fo p e N H e A rt S U rg e ry t e A Mr eC o g N i z e d

Upstate UniversityHospital’s cardiac surgeonGregory Fink MD had one

of the lowest cardiac mortalityrates in the state for open heartsurgery between 2006 and 2008,according to a recently releasedreport from the New York StateDepartment of Health. Dr. Fink,Upstate’s chief of cardiac surgeryand an associate professor ofsurgery, was one of only fiveheart surgeons in New York with a statistically lower-than-average mortality rate. That ratewas zero.

Upstate’s Vascular Surgery team, from left: M. Asad Khan MD, RVT, assistant professor of surgery;Michael J. Costanza MD, associate professor of surgery; Vivian Gahtan MD, chief, section ofVascular Surgery and Endovascular Services; and Kwami S. Amankwah, assistant professor of surgery

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The Upstate Heart and VascularCenter opened in January 2011.The 18,500-square-foot center

is located on the renovated sixth floor of Upstate University Hospital in Syracuse.

With a staff of 30, the Upstate Heartand Vascular Center offers invasiveand non-invasive cardiac diagnostictesting in one space with integrateddata management systems formaximum efficiency.

An endovascular imaging suite accommodates peripheral* andhybrid** vascular and cardiac procedures; a digital-based cardiaccatheterization lab; a new Stereotaxis magnetic navigation system;and expanded echocardiography capabilities that offer 3D and 4D imaging.

Cardiac computed tomography and magnetic resonance imagingcapabilities have also been expanded in the new center.

The Center features an 8-bed recovery area and family and patienteducation and consultation centers and waiting rooms.

Upstate cardiologist Timothy D. Ford MDtalks with Derrick Coleman during a tour of the new Heart and Vascular Center.

* procedures on arteries that lead from the heart to other organs** a combination of invasive and non-invasive procedures

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Upstate is the only hospitalin Central New Yorkoffering the new

Stereotaxis magnetic navigationsystem, pictured at left. Thesystem assists in the diagnosisand treatment of both common and complex cardiac arrhythmias.

Through precise catheterpositioning, often in hard toreach regions of the heart, the system uses computerizedmagnetic navigation to guide the catheter to the region of theheart requiring treatment. In atreatment procedure calledablation, the arrhythmia isstopped by a burst of radio-frequency energy aimed at smallareas of heart tissue that give riseto abnormal electrical signals.Normal rhythm pattern isrestored.

The traditional procedure usesrelatively inflexible catheterswhich are manually guided intothe blood vessels and then to theheart muscle. Of concern is thepotential for damaging heartstructures which can occur whenthe procedure encounters acomplex heart chamberanatomy. The Stereotaxissystem, on the other hand,features a catheter that is softerand more flexible and usescomputer mapping and magnetswhich safely guide the catheterto its target. This cathetercannot be used in traditionalablation procedures because it istoo flexible to be guidedmanually.

Members of Upstate’s Electrophysiology Lab team, from left: Jen Lagoy RT(R); Amy Tetrault RN,supervisor; Dee Geb RN; and Lynne Costello RN with the Stereotaxis® magnetic navigation system.

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G o o d T o K n o wHeart & Vascular Center

Peripheral arterial disease (PAD) is poor circulation in the legscaused by atherosclerosis, the narrowing or blocking of arteries.PAD can lead to pain in legs, feet and toes; sores; blisters on feet;

cold feet; and cuts that won’t heal. PAD can be a disabling and limb-threatening condition.

the Cause of pAdNormal arteries have a smooth inner lining that allows blood to flowfreely to muscles and other organs. Atherosclerosis causes plaque tobuild up inside blood vessels, restricting blood flow. It can occur inany artery.

related ConditionsMany people with PAD have atherosclerosis in other blood vessels aswell. Most heart attacks are caused by atherosclerosis in the coronaryarteries (blood vessels supplying the heart). Strokes are often causedby atherosclerosis in the arteries that go to the brain.

SymptomsThe most common symptom of PAD is claudication— discomfort inthe hip, thigh, or calf muscles brought on by walking. It occursbecause there is a mismatch between blood supply and energydemand in the leg muscles. With PAD, blockages in the arteries causelack of blood flow, resulting in pain and cramping because muscles areenergy- and oxygen-deprived. Standing still or sitting allows musclesto recover and the pain and cramping usually goes away after 5 to 15minutes of rest. About 50 percent of patients with PAD have blockagessevere enough to experience claudication. As PAD becomes moreadvanced, leg pain occurs after shorter distances.

In extreme cases, PAD causes critical limb ischemia, constant pain inthe feet or toes. This occurs because the leg muscles are not gettingenough circulation, even at rest. If circulation does not improve, drygray or black sores on the feet can become dead tissue, gangrene.

risk factorsRisk factors for developing PAD include smoking, diabetes, high bloodcholesterol, high blood pressure, and a family history of circulationproblems. PAD also occurs more frequently in older people: 1 in 3 people over the age of 70 have PAD.

testingSymptoms and risk factors often determine if PAD could be present,and a physical exam checks pulses in legs and feet. (Many patientswith PAD do not have pulses that can be easily felt.)

p e r i p H e r A l A rt e r i A l d i S e A S e ( pA d )W H y d o M y l eg S H U rt W H e N i WA l k ?By Michael Costanza MD, Associate Professor of Surgery, Division of Vascular Surgery and Endovascular Services

p r e v e N t i N gp e r i p H e r A l A rt e r i A ld i S e A S e ( pA d )

You can prevent PAD bydecreasing your risk factorsfor atherosclerosis.

� If you smoke, stop!� Follow your health care

provider’s instructionson diet, exercise, andmedications in order tokeep your arterieshealthy.

Michael J. Costanza MD

Artery narrowed by plaque

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Ankle brachial index (ABI) is a painless test thatcompares blood pressure at the ankle and the arm.People with PAD have ankle pressures that are morethan 10 percent lower than their arm pressures.

Other tests for PAD include ultrasound, computedtomography angiography (CTA), magnetic resonanceangiography (MRA), and contrast angiography.

treatment All treatments for PAD begin by addressing the riskfactors for atherosclerosis. People with PAD shouldstop smoking. Medications can normalize bloodpressure, lower cholesterol, and control diabetes.Aspirin and clopidogrel (Plavix) thin the blood andreduce the chance of heart attack, stroke, andblood clot. Daily exercise and a well-balanced diethelp maintain healthy blood vessels.

Patients with mild PAD symptoms may improvewith medication and regular walking. The

medication cilostazol (Pletal) relaxes blood vesselsand may increase blood flow to the legs, allowingsome patients with PAD to walk farther withoutdiscomfort.

Procedures to improve circulation may be requiredfor severe blockages. Endovascular treatmentinvolves threading a wire through the blocked areaand inflating a small balloon to widen the arteryand increase blood flow. Sometimes a stent (asmall, flexible metal mesh tube) is inserted and leftin place to keep the artery open. Endovasculartherapy immediately improves blood flow and therecovery time is short.

Blockages that cannot be treated with a balloon orstent may require surgeryto remove the blockage orcreate a bypass around the blockage using a piece ofvein or synthetic material. Surgery for PAD ishighly successful, but recovery can be lengthy andthere is a higher risk of complications.

Many Upstate employees celebrated “Go Red for Women Day” by wearing red,including these members of the 8E and 8F

cardiac care floor at Upstate University Hospital. “Go Red for Women” is a fundraising andawareness-building initiative of the American

Heart Association which is held in February,commonly known as “Heart Month.” Donationssupport medical research, awareness, educationand community programs — all designed to helpwomen improve their chances of living longer,heart-healthy lives.

r A i S i N g AWA r e N e S S o f W o M e N A N d H e A rt d i S e A S e

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By Jackie Fredericks, PharmD

The most common cardiacarrhythmia is atrialfibrillation, commonly

referred to as AFib. Thiscondition is characterized by aquivering of the heart muscleresulting in an erratic heart beat.Often this arrhythmic actionencourages blood to pool andform clots. When a blood clotbreaks off, it can travel to thebrain and cause a stroke. Thestandard medical treatment foratrial fibrillation has been theblood-thinning drug Coumadin(warfarin sodium).

Recently, a new blood-thinningdrug, Pradaxa® (the genericname is dabigatran etexilate),was approved by the FederalDrug Administration (FDA) as aneffective alternative toCoumadin. Unlike Coumadin,Pradaxa does not requirefrequent monitoring of bloodlevels and studies show that it isequally effective.

Patients should know that like allmedications, dabigatranetexilate has side effects. Inclinical trials, the most commonreason for stopping themedication was gastrointestinalsymptoms such as upset stomachor indigestion. Because it is ablood thinner, dabigatranetexilate has the potential toincrease bleeding. Patients maynotice that they bruise more

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Chantel Henry RT(R), radiology, with James Fitzgerald RN and JamesGlowacki RT(R), cardiac catheterization lab, in a control room adjacent toone of the diagnostic labs in the Upstate Heart and Vascular Center.

The new vascular hybrid suite (above) is one of three diagnostic labs in the new Upstate Heart and Vascular Center.

v i e W S o f t H e N e W U p S tAt e H e A rt &   vA S C U l A r C e N t e r

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Craving a hearty pasta dish?Try this recipe, which islow in sodium and fat.

Using low-fat ricotta, part-skimmozzarella and reduced-fatParmesan you’ll find these lowfat alternatives are really tasty.Enjoy!

ingredients

1.5 cups uncooked whole-wheat or high fiber ziti or penne pasta

1 cup thinly sliced onion

2 cups chopped brown mushrooms

1 tbsp. chopped garlic

2 cups fresh spinach

¾ cup low fat/light ricotta cheese

2 tbsp. chopped fresh basil

1 ½ cups canned crushed tomatoes

½ cup plus 2 tbsp. shredded part-skim mozzarella cheese, divided

2 tbsp. reduced-fat Parmesan-style grated cheese topping

Cooking instructionsPreheat oven to 375 degrees

Prepare pasta al dente according to package directions. Drain well, place in largebowl, and set aside. Meanwhile, spray an extra-large skillet with nonstick sprayand heat it to medium heat on the stove. Add onion and, stirring occasionally,cook until slightly softened, about 3 minutes. Add mushrooms and garlic, and raisetemperature to medium high. Continue to cook, stirring often, until mushroomsare soft, about 3 minutes. Add spinach to the skillet and, stirring often, cook untilspinach has wilted and excess moisture has evaporated, about 8 minutes. Removefrom heat, and stir in ricotta cheese and basil.

Transfer contents of the skillet to the bowl with the cooked pasta. Add tomatoesand ½ cup mozzarella cheese. Toss gently to mix.

Spray an 8 in. x 8 in. baking pan with nonstick spray, and fill with contents of thebowl. Evenly top with Parmesa-style cheese topping and remaining 2 tbsp.mozzarella cheese.

Bake in the oven until entire dish is hot and the cheese on top has melted, about 15 minutes. Allow to cool slightly. Makes 4 servings.

easily or that it takes longer forthem to stop bleeding.Potentially harmful activitiesshould be avoided. Any signs ofbleeding should be reported to ahealth care provider as soon aspossible.

Dabigatran etexilate therapy maynot be suitable for all patientsrequiring blood-thinningtherapy for stroke prevention.Patients with impaired kidneyfunction may need lower or lessfrequent doses than patientswith normal kidney function.Other medications may increaseor decrease the effect of thismedication. For instance, itshould not be taken with othermedications that increase therisk of bleeding, such as aspirin,clopidogrel (Plavix®) or prasugrel(Effient®). Over-the-counter andherbal medications also have thepotential to interact withdabigatran etexilate. Patientsshould always consult theirpharmacist or physician beforetaking any new medications.

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Serving size: 1/4th of recipe•Calories: 286

•Fat: 7 g

•Sodium: 455 mg

•Carbs: 41 g

•Fiber: 5 g

•Sugars: 7 g

HeArt-HeAltHy lASAgNeBy Jill Weatherly RD, CDN

U p s t a t e H e a r t & V a s c u l a r N e w s S p r i n g 2 0 1 1

Newsletter StaffEditors:

Karen A. Gibbs MSN, RNC, Nurse Practitioner,Cardiopulmonary Surgery

Amy Tetrault RN, Head Nurse, Cardiac Catheterization Lab

Melanie Rich, Director, Marketing & University Communications

Designed by Upstate Marketing and University Communications

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Knowing changes everything.SM www.upstate.edu/hvc

A H e A rt f e lt g i f t

The new Upstate Heart and VascularCenter has a number of amenitiesthat make it comfortable and

attractive for patients and families (seepages 3 and 6). Among these features arethe Valentine Paintings, a collection of 22 original works of art created by therenowned painter, Ludwig Stein, for his wife, Dr. Nancy Jermanovich.

On their second Valentine’s Day, Steinpresented Jermanovich with a paintingwhich featured a stylized heart. When she asked where her painting was the following year, an annual tradition was born. Until Jermanovich’s death in 2000,Stein honored every Valentine’s Day with a new painting for her, each with a heart as its central theme.

“Beating Hearts” (above) and “Dear Heart” (below right) are two of the 22 Valentine paintingsthat adorn the walls of the new Upstate Heart and Vascular Center.

Lugwig Stein with his late wife, Dr. Nancy Jermanovich

Artist Ludwig Stein, a professorat Syracuse University, donatedhis series of Valentine paintingsto Upstate University Hospital inmemory of his wife, Dr. NancyJermanovich, and their 22 yearstogether.

Dr. Jermanovich was an internistwho taught nephrology atUpstate Medical University’sCollege of Medicine.

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