Cardiologists atUpstate are usinga new pumping

device to extend thelives of patients withsevere forms of heartdisease. Patientssuffering heartfailure, and thosewhose hearts are too weak to tolerateangioplasty are candidatesfor the device calledImpella®.

Doctors insert the pumpthrough a catheter thatenters the heart through its mainartery, the aorta. The pump isabout the size of a triple Abattery. It spins rapidly, like acorkscrew, propelling bloodbackward from the left ventricleout to the body to maintaincirculation.

Hani Kozman MD says somepatients require the Impelladuring a medical crisis such as asevere heart attack. Otherpatients are considered high-riskfor repairs to their coronaryarteries, and the Impella isplaced before the patientsundergo their procedure. Thedisposable pumps, which mayremain for a few hours up toseveral days, connect tomonitors that provide theelectrical source.

“It’s for the really, reallysick patients, forwhom there is noalternative,” saysKozman, director ofthe Cardiac Catheter-ization Laboratory at Upstate.

David Grugan wasjust such a patient

earlier this year. The62-year-old Auburn

man said he had comeclose to death twice. Hewas grateful to Dr.Kozman and the

Impella. After a heart attack in2009, Grugan had four stentsplaced to prevent blockages inhis coronary arteries. Later, LunaBhatta MD, director of theElectrophysiology Laboratory,implanted a defibrillator thatwould automatically restart hisheart if it stopped beating.

Months later, he began havingvery limiting chest pain andtrouble breathing. He was foundto have additional blockagesforming in his coronary arteries,however with his weak heartfunction, these would be risky.Kozman spoke with Gruganabout his options, and Grugansaid he appreciated the doctor’s

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

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impella device aSSiStS patientS with Severe heart diSeaSe

One Of new YOrkState’S tOp heartSurgeOn practiceS at upState

For the last two yearsUpstate UniversityHospital’s Gregory Fink MD

was ranked as one of the topperforming cardiac surgeons inNew York State. According to theNYS Department of Healthcardiac services report, he andhis team have lead Upstate’sCardiac Surgery Service tocontinue outperforming otherhospitals in New York State.

From 2006 t0 2008, Dr. Fink,Chief of Cardiac Surgery,operated on 252 patients. He wasone of four surgeons in the statewith a significantly lower thanaverage mortality rate.

The latest report published inFebruary of this year states thathe operated on 274 patients in2007-2009. Once again he wasranked among the top surgeonsin the state.

Gregory Fink MD

Continued on page 4

A catheter in the aorta is used to insert a pump.

frOm the editOrS

Congratulations to theStrong Women, StrongHearts committee on a

great February day of education,health screenings and hearthealthy food provided for thecommunity. Through lecturesand health screenings, 350 women increased theirawareness of heart disease.Knowing that many women havesubtle symptoms of coronaryartery disease that can gounrecognized by their physiciansand themselves, the committeeprovided education along withfun and camaraderie.

This issue of Heart and VascularNews highlights risk factors thatcan lead to heart, kidney andvascular disease. We describestate-of-the-art technology thatcan diagnosis and treat heartdisease. There are articles aboutpatients who have undergonelife-threatening surgeries andare now leading active lives. We offer exercise, nutritional andpharmacological information.

Our mission is to keep youinformed, and hopefully toimprove the quality of life foryou and your family. Enjoy thisissue of Heart and Vascular News!

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The aorta is the largest blood vessel in the body. It starts in the heart and

runs through the chest into theabdomen. The part of the aortathat goes through the chest is called the thoracic aorta.Aortic dissection occurs whenthe inner layer of the aortabegins to tear. Type A Dissection,in the first part of the aorta, is considered a medicalemergency. Delay in diagnosiscan make a huge diffence in theoutcome. Left untreated, tearsmay eventually burst causingsevere bleeding. This can rapidlylead to shock or death.

Symptoms are similar to a heart attack. Pain is sudden. The patient complains of chest,back or abdomen pain. Someexperience nausea, vomiting and lightheadedness.

Such was the case of actor JohnRitter, the 54-year-old star of“Three’s Company” and “EightSimple Rules…for Dating MyDaughter.” He was rushed to the emergency department ata Burbank hospital, complaining

of nausea, vomiting and chest pain. He died later that evening from a Type A aortic dissection.

US special envoy to Afghanistanand Pakistan Richard Holbrookefell ill during a meeting at theState Department with Secretaryof State Hillary Clinton. He wasrushed to George WashingtonUniversity Hospital, takenimmediately to surgery, but diedtwo days later of complicationsfrom a Type A aortic dissection.

As stated earlier, diagnosis maybe difficult as symptoms can bemistaken for other disorders. Most dissections require surgeryto repair the tear. When treated promptly, surgicaloutcomes are relatively good.

Risk Factors Include:� Marfan’s Syndrome� Syphilis� Obesity� High Cholesterol� High Blood Pressure� Smoking� Crack Cocaine Use� Family history

To prevent aortic dissection,healthy diet, exercise, bloodpressure control and stressreduction are recommended. If there is a family history, a full cardiac work up should be considered.

John Sardella is well aware ofhow critical his condition was.The 60-year-old NativeAmerican musician woke at 1 a.m. on May 15 with sharpchest, back and abdominal pain.He began sweating profusely. He told his wife he felt like hewas having a heart attack.

tYpe a aOrtic diSSectiOn: rare But deadlY

John Sardella and his wife, Cherie

Karen Gibbs RNCNurse Practitioner,CardiopulmonarySurgery

Amy Tetrault RN BSNAssociate Director,Heart and VascularCenter

Continued on page 3

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Rita Fischer’s doctor heard aheart murmur and sent the 78-year-old Cleveland

woman to have an echo-cardiogram (echo), whichprovided pictures of her heart inmotion. The echo, along withother cardiac exams, revealed aspot on her heart. Her physiciansent her to Ali Salah MD atUpstate University Hospital for acardiac MRI. Dr. Salah is anexpert in the field of cardiacimaging. In Syracuse, the cardiacmagnetic resonance imaging(MRI) is only available at theUpstate Heart and VascularCenter.

“You know how you dread it?Well, I’ve got to say, it was a breeze,” Fischer recalls. “Dr. Salah is the sweetest man.”

The cardiac MRI showed thatFischer had a large cyst pressing

on her heart. The cyst wasdrained, relieving hersymptoms.

A cardiac MRI is just like aregular MRI from a patient’spoint of view. It is a minimallyinvasive procedure that does notinvolve radiation and deliversunparalleled image quality. It isused to evaluate a wide variety of heart disease including causesfor heart failure, evaluate formyocardial disease, myocardialscar imaging, myocardialviability, heart masses, valvularheart disease and complexcongenital heart diseases.

“This service is not widelyavailable due to a lack of expertsin the field of cardiovascularimaging,” states Dr. Salah,director of the Cardiac Imagingprogram at the Upstate Heart andVascular Center.

After completing a cardiologyfellowship, Salah did anadvanced cardiovascular imagingfellowship at SUNY Stony Brookand Georgetown University. To reach him for consultations,call 315-464-4536.

  cOmplex heart aBnOrmalitieS cOme intO fOcuS with cardiac mri

Cardiologist Ali Salah MD at Upstate’s cardiac MRI lab.

“I wanted him to have the besthospital,” said Mrs. Sardella, “so I insisted he go to Upstate.”

He arrived at the emergencydepartment where a CT of the chest was obtained. Thediagnosis was made and Dr. Finkand his team were notified. They immediately took him tothe operating room. He returnedto the intensive care unit incritical condition. Dr. Fink andthe nurses encouraged the familyto stay with him during thiscritical time.

His wife covered him with a redprayer blanket, attaching hand

written prayers and pictures. “I can’t explain it,” says KristenIglesias, a cardiac critical carenurse. “I truly believe thefamily’s Native Americanspiritual practices helped his recovery."

“Dr. Fink kept me very wellinformed,” states Cherie, Mr.Sardella’s wife. “He met with me every day and would go over his progress.”

“The family was very involved,”says Dr. Fink.

“Chanting, prayers and othernon-tangibles are so real to manyof us,” says the Rev. Terry

Culbertson, who managesUpstate’s Department ofSpiritual Care. “There is a lot of amazing research out there. A regular, active worship lifeextends life expectancy. Ask any hospitalized patient whatkeeps them going, and almostevery one mentions some form of prayer."

Mr. Sardella is back at home with his wife performing in theirband, Gypsy Red. He sees Dr.Fink every six months with a CT scan of the chest to monitorhis repair. He is doing well andgrateful for the care Dr. Fink andhis team provided. �

Aortic Dissection — continued from page 2

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honesty. Hisheart wouldneed helppumping duringthe procedure.Grugan wouldbe on theImpella pumpwhile additionalstents wereinserted into hisheart arteries. Grugan agreed.

“I thought I was going to bethere for the weekend, because I had this done on a Thursday, he recalls. But the day after the procedure, Kozman said Grugan could go home.

Gurgan has recovered well. His symptoms have improvedsignificantly and he is able tocontinue with life as usual.

Impella — continued from page 1

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The free WomenHeart MonthlySupport Group is held on the lastFriday of the month.

Support group topics include:Heart failure – Oct. 29 Stress management – Nov. 26Holiday celebration – Dec. 17

WomenHeart is the only nationalorganization dedicated toadvancing women’s heart healththrough advocacy, communityeducation and patient support.As the leading voice for the 41million American women livingwith or at risk of heart disease,WomenHeart advocates for equalaccess to quality care andprovides information andresources to help women takecharge of their heart health.

To register for the free supportgroup, or for more information,contact Leisha Doherty MSW atherheartbeatcny@gmail.com or315-663-1712.

Upstate University Hospitalattained a Gold PlusQuality Achievement

Award from the American HeartAssociation for excellence in thetreatment of patients with heartfailure. Upstate UniversityHospital also has a Gold Plusaward for excellence in thetreatment of patients withstrokes.

To get gold plus status, a hospitalmust “Get with the Guidelines,”the association’s qualityimprovement initiative, whichprovides hospital staff withevidence-based guidelines forcaring for patients with heartfailure, stroke and othercardiovascular problems.

The guidelines are designed toimprove outcomes, preventfuture hospitalizations and save lives.

To be gold plus in heart failure, ahospital must achieve 85 percentor higher adherence to all of theassociation’s “Get With TheGuidelines” measures for two ormore consecutive 12-monthintervals and achieve 75 percentor higher compliance with fourof nine additional qualitymeasures. Following theguidelines, heart failure patientsare started on aggressive risk-reduction therapies which mayinclude beta-blockers, ACEinhibitors, or anticoagulantsduring their hospital stay.

Upstate is also fully accredited by the Society of Chest Pain Centers, an international nonprofit that is focused on helping hospitalsimprove quality, cost and patientsatisfaction in cardiovascularcare. Upstate is an accreditedChest Pain Center, with “PCI,”or percutaneous coronaryintervention, which isemergency treatment thatreduces the amount of heartmuscle permanently damaged by heart attack. For moreinformation, contact LorrieLangdon, heart failure programcoordinator, 315-464-5399.

wOmenheart SuppOrt grOup

heart failure gOld pluS award

Hani Kozman MD

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Strong Women, Strong Heart committee members.

Save the DatesWomenHeartMonthly meetings though December 176 to 7:30 p.m. HealthLink/OASIS Center6333 Route 298, East Syracuse (next to the DoubleTree Hotel, off Carrier Circle)

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Many people who havebeen diagnosed withheart failure believe that

they can no longer exercise.However, if done properly,exercise can help you feel better,make it easier for you tocomplete daily tasks, and mayeven improve your heart’sfunction.

If you are not used to exercising,it is very important to beginslowly. Adding just 5 or 10minutes of exercise to your daywill help you move toward betterhealth. Most people with heartfailure should aim to accumulate30 minutes of physical activityon most days. However, if youare not exercising now, it maytake you a few months to reachthis level. If you cannot exercisefor 30 minutes continuously, youcan spread several 5-10 minuteblocks of activity throughoutyour day.

There are many different ways toexercise. The best type ofexercise for you is one that you

enjoy, because you will be morelikely to stick with it. Exercisingwith a family member or friendcan also help motivate you toexercise and make it more fun.Walking is the easiest activity formost people, because it doesn’trequire any equipment and canbe done almost anywhere. Bikingand swimming are also goodchoices. Muscle strengtheningexercises using weights,resistance bands, or justresistance from gravity can helpyou improve strength andbalance and reduce joint pain.Even enjoyable activities likegolf, gardening, shopping, ortaking your grandchildren to thezoo can be considered exercisewhen they involve continuousmovement.

It is important to do gentlestretches or walk at an easy pacefor a few minutes to warm upbefore and cool down after eachsession. You don’t needexpensive shoes to exercise, butyou should make sure you have

well-fitting, supportive footwearto decrease the risk of injury. Youshould never exercise to thepoint of complete exhaustion.You should be able tocomfortably carry on aconversation while exercising. Ifyou are breathing so hard that itis difficult to speak, you shouldstop and rest. Make sure youcontinue to monitor yourself asyour doctor has instructed you,including taking your pulse andweighing yourself daily.

Be sure to talk to your doctorbefore beginning a new exerciseprogram, or if you have newsymptoms while exercising, suchas dizziness, feeling like yourheart is racing, or becoming veryshort of breath with only lightactivity. A physical therapist canalso help design a safe andeffective exercise program foryou. The most important thing isto just start moving a little moreeach day, and to have fun!

By Kerry Walsh, PT, DPT, GCS, CEEAA

Upstate’s coronary carenurses would like to bringawareness to our patients

of an educational event that isclose to your heart. StrongWomen Strong Hearts wasestablished last year to increaseawareness for women and heartdisease. This event is similar tothe national campaign, HeartTruths, and the American HeartAssociation’s Go Red initiative.We, the nurses of the CoronaryCare Unit at Upstate, created thisevent over a year ago and

through our efforts we were ableto educate over 350 women. Thisday, that we have dedicated tothe women of our community, isfree and provides educationalopportunities and pampering for all.

Join us in February for nutritionalinformation, heart-healthytasting, health screenings,exercise, Reiki therapy, massage,yoga and meditation, andvendors with jewelry, food and more.

exerciSe

Above right: The youngest “strong woman” atlast year’s event.

StrOng wOmen StrOng heartS event: feBruarY 2, 2013

Save the DateStrong Women Strong HeartsSaturday, February 2, 201310 a.m. to 4 p.m. HealthLink/OASIS Center6333 Route 298, East Syracuse (next to the DoubleTree Hotel, off Carrier Circle)

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what causes varicose veins?When valves in the leg veins no longer function,this can cause blood to pool in the legs and createvaricose veins. The condition is often hereditaryand can affect many people in the same family.Other risk factors include older age, female gender,current or previous pregnancy, and lifestyles thatrequire standing for long periods of time.

are varicose veins dangerous?They do not pose a risk to life or limb. They do notcause deep vein clots that can be dangerous if theybreak off and travel to the heart or lungs.

can varicose veins be prevented?Usually not, however some symptoms of varicoseveins can be controlled with several lifestylechanges including:

� avoiding prolonged standing;

� elevating the feet above the thighs when sitting,and above the heart when lying down;

� avoiding clothes that are tight around the waist,thighs or legs;

� strengthening calf muscles through anappropriate exercise plan.

are there any treatments to remove varicose veins?Several minimally invasive procedures cancompletely eliminate varicose veins. Unlike veinstripping surgery in the past, these new proceduresdo not require large leg incisions and do not leaveany noticeable scars. Patients go home the sameday and usually recover completely and return tousual activities and work within one week.

what could happen if i completely ignore my varicose veins?In severe cases, varicose veins may progress tochronic venous insufficiency, which can causepermanent skin damage and non-healing ulcers.Some patients with large varicose veins haveproblems with bleeding from the veins or painfulblood clots that form in the veins under the skin.

what are spider veins?These are damaged veins that appear in the form ofred or blue branches or “spider webs” close to thesurface of the skin. They are similar to varicoseveins, however they are thinner and usually do notbulge out from the skin. Spider veins can be treatedwith laser treatment or sclerotherapy whichinvolves using very small needles to inject the veins with scar-forming liquid or foam.

how can i get evaluated for varicose veins?Physicians with an expertise in varicose veins andvenous disease can evaluate your condition and goover the various treatment options. Vascularsurgeons at the Upstate Heart and Vascular Centerhave wide experience treating patients withvaricose veins and can perform minimally invasive procedures. To schedule an appointment,call 315-464-8668.

minimallY invaSive prOcedureS treat varicOSe veinS tOdaY

By Michael Costanza MD, associate professor of surgery and director ofendovascular services at Upstate University Hospital. Pictured at left.

Varicose veins are enlarged blood vessels that are often raised above the skin on the legs. They can beblue, red, or flesh colored, and they appear as twisted, bulging chords. More than 30 million menand women have varicose veins. For most people, varicose veins are not just a cosmetic problem but

the cause of pain, swelling, restlessness and leg fatigue.

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dietarY SOdium: fact Or fictiOn?By Danielle Stegman, registered dietitian

less sodium means less flavor.Fiction. Plenty of flavorful alternatives to salt exist. Use small amountsof these herbs — about ¼ teaspoon dry and 1 ½ teaspoons fresh — for every four servings of food, and experiment with these seasoning suggestions:

Sea salt is better than regular table salt.Fiction. While sea salt has slightly less sodium per gram than regulartable salt, it does not make a big difference in your overall sodiumconsumption and, as with table salt, should be limited.

processed foods are usually higher in sodium.Fact. Sodium lengthens product shelf time by preserving foods. It canalso enhance the flavor and color of foods, and food manufacturerstake advantage of this to make their products appealing.

the american heart association recommends daily sodium intake of less than 1,500 milligrams per day.Fact. This is the current recommendation.

a food labeled “reduced sodium” is okay to have on a sodium restricted diet. Fiction. Regardless of the claim, you need to read the food label to find out how much sodium the food actually has per serving. Thedefinition of “reduced/less sodium” is that the product has at least 25 percent less sodium than the original product, making for a verywide variation from product to product. “Low sodium” means that a product has fewer than 140 milligrams of sodium per serving.

Beef — basil, onion or sageChicken — rosemary, tarragon or

thyme Fish — lemon juice, dry

mustard or cuminCarrots — cinnamon, allspice

or ginger Potatoes — chives, rosemary, garlic

or paprika

Rice — turmeric, cumin,allspice, honey or onion

Broccoli — vinegar, basil, oreganoor garlic

String Beans — nutmeg, dill seed or sage

Corn — green pepper, onion,curry or paprika

suggest lifestyle modifications tohelp bring your blood pressureunder control. These includeeating a diet low in salt,exercising regularly, andavoiding alcohol and cigarettes.

Coupling these changes withmedication can help to decreaseyour risk of heart attack, heartdisease, stroke and kidneydamage.

Lifestyle modifications areimportant not only for thosewith hypertension, but also forthose with risk factors who wantto prevent hypertension fromdeveloping.

Drug class How it works Medication examples

Diuretics Help the body excrete sodium Lasix® (furosemide)(salt) and water. They are often Hydrodiuril®

used in combination with other (hydrochlorothiazide)types of antihypertensive meds. Aldactone®

(spironolactone)

ACE Help the body produce less Lotensin®

Inhibitors angiotensin (a chemical that causes (benazepril)the arteries to narrow, often Vasotec®

referred to as ACE). When there is (enalapril maleate)less angiotensin, the blood vessels Zestril® (lisinopril)can relax and open up, in turn, lowering blood pressure.

Angiotension ARBs block the receptor that Diovan® (valsartan)II Receptor angiotensin binds to, inhibiting it Atacand®

Blocker from constricting the blood vessel. (candesartan) (ARBs) The blood vessel stays open and Avapro®

blood pressure is reduced. (irbesartan)

Beta-Blockers Reduce the heart rate, the amount Tenormin® (atenolol)of blood the heart pumps out, and Lopressor®

the workload of the heart which (metoprolol tartrate)lowers blood pressure. Toprol-XL®

(metopolol succinate)Inderal® (propranolol hydrochloride)

Calcium Prevent calcium from entering the Norvasc®

Channel smooth muscle cells of the heart (amlodipine besylate)Blockers and arteries. This decreases the Cardizem CD®, SR®

force of the heart’s contraction, (Diltiazem thus reducing blood pressure hydrochloride)and lowering heart rate. Calan SR® (Verapamil)

Alpha Reduce the arteries’ resistance to Cardura® (Doxazosin Blockers blood flow by relaxing the muscle mesylate)

tone of vascular walls. Minipress® (prazosin hydrochloride)Hytrin® (terazosin hydrochloride)

Combined Originated for use as an IV drip Coreg® (carvedilol)Alpha and in patients with hypertensive crisis. Normodyne®,Beta blockers *See mechanisms above Trandate® (labetolol

hydrochloride)

Central Decrease the blood vessels’ Catapres® (clonidine Agonists ability to contract. hydrochloride)

Tenex® (guanfacine hydrochloride)

Blood Causes relaxation of the muscle in Apresoline®

Vessel the walls of the blood vessels, (Hydralazine Dilators allowing the vessel to dilate. Hydrochloride)(Vasodilators) This allows blood to flow through Loniten®

with greater ease. (Minoxidil)

HEART MEDICATIONSEXPLAINED

High Blood Pressure — Continued from page 8

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preparatiOnPlace oil, orange juice, vinegar,garlic, orange zest, soy sauce andpepper in a bowl or a jar with atight-fitting lid; whisk or shake until well combined.

Place greens in an individual saladbowl; toss with 2 tablespoons of the dressing. (Refrigerate theremaining dressing.) Top the greens with chicken, orangesegments, goat cheese and walnuts.

tipS & nOteSMake Ahead Tip: Cover and refrigerate leftover dressing for up to 5 days.

Note: If you don’t have cooked chicken, you can quickly poach aboneless, skinless chicken breast for this recipe. Place the chickenbreast in small skillet or saucepan. Add lightly salted water (orchicken broth) to cover and bring to a boil. Cover, reduce heat to lowand simmer gently until the chicken is cooked through and no longerpink in the middle, 10 to 15 minutes.

To segment citrus, slice both ends off the fruit. Use a sharp knife,remove the peel and white pith; discard. Working over a bowl, cut thesegments from their surrounding membranes. You can also usecanned Mandarin oranges.

To toast whole nuts, spread on a baking sheet and bake at 350°F,stirring once, until fragrant, 7 to 9 minutes.

Orange walnut Salad with chickenOne serving

1/3 cup walnut oil

1/3 cup orange juice

1 tablespoon red-wine vinegar

1 clove garlic, minced

1 teaspoon freshly grated orange zest

1 teaspoon reduced-sodium soy sauce

1/4 teaspoon freshly ground pepper

3 cups mixed greens

1/2 cup diced or shredded cookedchicken breast

1 orange, cut into segments (see Notes)

2 tablespoons crumbled goat cheese

2 tablespoons toasted walnuts (see Notes)

ingredientS

NutritionPer serving: 466 calories; 29 g fat ( 6 g sat , 6 g mono ); 71 mg cholesterol; 24 g carbohydrates; 0 g added sugars; 31 g protein; 8 g fiber; 294 mg sodium; 1060 mg potassium.

Source: EatingWell.com

Advanced age

Gender: High bloodpressure is morecommon in men, but the risk factor for women increasesafter menopause

Tobacco use

Lack of physicalactivity

Poor diet — esp.high salt diet

Overweight

Alcohol consumption

Stress

factS aBOut highBlOOd preSSure

More than 75 millionAmericans have beendiagnosed with high

blood pressure, also known ashypertension. About one in threeadults have high blood pressure,and 23 percent of them areunaware of their condition.

A blood pressure reading consistsof two numbers. The systolic (top number) is a measure of thepressure in the arteries when theheart beats; the diastolic (bottomnumber) measures the pressurein the arteries betweenheartbeats.

A healthy blood pressure foradults is below 120/80.

Your doctor will likely prescribeone or more medications if yourblood pressure rises above140/90, and he or she will likely

Continued on page 7

Heart attack

Heart disease

Congestive heart failure

Stroke

Kidney damage

Peripheral arterydisease

Memory loss

Angina

Erectile dysfunction

UNTREATED HIGH BLOODPRESSURE CAN LEAD TO:

HIGH BLOOD PRESSURE RISK FACTORS: