Dr. Sreedivya Cha-va is board-certified in Interventional Cardiology, Cardio-vascular Disease, Echocardiogra-phy, Vascular Im-aging, and Internal Medicine. She received her Fellowship in Gen-eral Cardiovascular Medicine and Inter-ventional Cardiolo-gy through the Uni-versity of Vermont,

Burlington. Dr. Chava completed her Critical Care fellowship, residency and internship in medicine at SUNY Upstate Medical University, Syracuse, NY.

Her special interests are cardiac catheterization through the radial artery (wrist) approach, and mini-mally invasive, catheter based valve replacement (TAVR). She has a particular interest in women’s heart health and preventing cardiovascular disease in women. Dr. Chava consults at the Baywood and Gil-bert office locations.

A cardiac catheterization (cath) is a non-surgical pro-cedure performed by an interventional cardiologist in a catheterization laboratory (cath lab). Interventional car-diologists perform this minimally invasive procedure to find out if a patient has disease in the heart muscle, valves or coronary (heart) arteries. A coronary angiogram can help diagnose heart conditions and is the most common type of cardiac cath procedure. A coronary angiogram checks if a patient has atherosclerosis (plaque buildup) that is causing a blockage or narrowing of the coronary arteries. If a patient has blockage, this procedure shows

Dr. Kelly E. Guld is board-certified in Interventional Cardiology, Car-diovascular Dis-ease and Inter-nal Medicine. She completed her Fellowship in Cardiology and Fellowship in In-terventional Car-diology at the University of Cali-fornia, San Fran-cisco. Dr. Guld

completed her internship and residency in Internal Medicine at the Hospital of the University of Penn-sylvania. She received her undergraduate degree at Dartmouth College, and her Master’s and Doctor of Medicine, cum laude from Boston University.

Dr. Guld specializes in general cardiology as well as interventional cardiology with a focus on coronary artery intervention and minimally invasive transcath-eter aortic valve implantation (TAVR). Her research project during fellowship focused on heart disease and frailty in an aging female population. Dr. Guld consults at the Dobson location.

where the blockages are, how severe they are, and how many arteries are involved. Results from a coronary an-giogram help interventional cardiologists determine the best treatment option for their patient, including medical therapy, angioplasty or stent, or coronary artery bypass surgery. An angioplasty or stent can also be performed using cardiac cath to open blockages in the coronary arteries. A cardiologist may order a coronary angiogram if their patient is experiencing these symptoms:

The Transradial Approach: An Alternative to Traditional Cardiac Catheterization

TRI-CITY CARDIOLOGY

4th Quarter 2017 Page 1

Leaders in Cardiovascular Excellence …Where Patients Come First

www.TriCityCardiology.com

Hot Topics in Cardiology

• Chest pain, tightness, or heaviness in the chest, which is an indication of coronary artery disease.

• Weakness, dizziness, trouble breathing, swollen legs or feet, which may indicate a problem with a heart valve or the heart muscle.

• If other diagnostic test results, including stress tests, heart scans, and echocardiography show signs of a problem with the heart.

An Alternative Approach to Traditional Cardiac Cath

During a cardiac cath procedure; a thin, hollow tube called a catheter is inserted into a patient’s femoral artery, in the groin, and is passed through the blood vessels of the body that leads to the heart. A dye is then injected through the catheter into the heart arteries and chambers while x-ray pictures are taken. The x-ray images show the dye as it flows through the heart arteries and helps to identify where the arteries are blocked. There is now a newer, less invasive, lower-risk option called the transradial cardiac cath approach. The tran-sradial approach is done through the radial artery in the wrist rather than the groin. When using this newer ap-proach, a non-invasive test is performed in the cath lab to be sure that there is significant blood flow to the hand. If this test is normal, the interventional cardiologist can then access the same coronary arteries through the wrist as done through the femoral artery. If the patient’s con-dition indicates a need for a stent or angioplasty, it can be done through the radial artery as well.

What are the advantages of the transradial cardiac approach?

The transradial cardiac cath approach has several ad-vantages, including:

• It reduces the amount of bleeding complications where the catheter is inserted. This is an advantage for patients who have bleeding disorders or other medical conditions.

• Patients can sit up, walk, and eat immediately af-ter the procedure, compared to a patient undergoing the traditional approach who must lie flat for two to six hours.

• The recovery time is much faster and the hospital stay is shorter.

• It is more comfortable for the patient.

Research has shown increased patient satisfaction with the transradial approach compared to the femoral, as most patients prefer not lying flat if they have back pain, congestive heart failure, or get confused due to sedation.

What can a patient expect from a transradial cardiac cath?

The procedure is done in a hospital cath lab performed by an interventional cardiologist with a team of nurses and technicians. Before the procedure begins, an IV line is started in the arm to deliver medicine (sedative) to help the patient relax. When the procedure begins:

• The patient lies on an X-ray table and the skin over the insertion site in the wrist is numbed.

• The interventional cardiologist makes a tiny punc-ture or incision into the artery in the wrist where a catheter is inserted and threaded through the major blood vessels to the heart.

• A contrast dye is injected into the catheter into the arteries. The dye is used so the arteries show up better on X-rays.

• The test checks the condition of the patient’s heart and arteries and determines if further treatment is needed.

• When the procedure is finished, the catheter is re-moved and direct pressure is put on the insertion site to help prevent bleeding.

The hospital staff closely monitors the patient’s blood pressure, heart rate, oxygen levels, and breathing after the procedure. Many patients feel temporarily disori-ented and experience grogginess, but should not expe-rience any pain. If the interventional cardiologist has performed addi-tional treatment, the patient could experience a longer hospital stay and will receive additional medication. Dis-charge instructions might specify the need to schedule additional tests, including an echocardiogram or an elec-trocardiogram. Tri-City Cardiology has a team of interventional cardi-ologists who perform the transradial approach for diag-nostic and treatment options for their patients.

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Dr. Kai Sung is an electrophysi-ologist at Tri-City Cardiology. He is board certified in Cardiovascular Disease, Cardiac Electrophysiol-ogy, and Inter-nal Medicine. Dr. Sung completed his education and training at Co-lumbia Univer-sity, Baylor Col-lege of Medicine,

and Brown University. While at Brown, Dr. Sung trained under Dr. Alfred Buxton, a world renowned expert in arrhythmia medicine. Dr. Sung is a Fellow of the American College of Medicine and a Fellow of the Heart Rhythm Society. He has lectured ex-tensively in both national and international forums, and has conducted advanced research in the fields of arrhythmia ablation and heart failure devices. Dr. Sung consults at the Baywood and Dobson offices.

The Micra® Transcatheter Pacing System (TPS) is a new type of heart device, approved for Medicare reimburse-ment, which provides patients with the most advanced pacing technology at one-tenth the size of a traditional pacemaker. Bradycardia is a condition characterized by a slow or irregular heart rhythm, usually fewer than 60 beats per minute. At this rate, the heart is unable to pump enough oxygen-rich blood to the body during normal activity or exercise, causing dizziness, fatigue, shortness of breath or fainting spells. Pacemakers are the most common way to treat bradycardia to help restore the heart’s normal rhythm and relieve symptoms by sending electrical im-pulses to the heart to increase the heart rate.Comparable in size to a large vitamin, Medtronic’s Micra TPS is unlike traditional pacemakers, the device does not require cardiac wires (leads) or a surgical “pocket” under the skin to deliver a pacing therapy. Instead, the device is small enough to be delivered through a catheter

Miniaturized Heart Device Provides Patients with the Most Advanced Pacing Technology Available

and implanted directly into the heart with small tines, providing a safe alternative to conventional pacemak-ers without the complications associated with leads – all while being cosmetically invisible. The Micra TPS is also designed to automatically adjust pacing therapy based on a patient’s activity levels. The Mirca TPS also incorporates a retrieval feature to enable retrieval of the device when possible; how-ever, the device is designed to be left in the body. For patients who need more than one heart device, the miniaturized Micra TPS was designed with a unique feature that enables it to be permanently turned off so it can remain in the body and a new device can be implanted without risk of electrical interaction.The Micra TPS is the first and only transcatheter pac-ing system to be approved by both 1.5 and 3 Tesla (T) full-body magnetic resonance imaging (MRI) scans to allow patients to be followed by their physicians and send data remotely via the Medtronic CareLink® Network. The Micra TPS was approved by the U.S. Food and Drug Administration in April 2016, and has been grant-ed Medicare reimbursement, allowing broad patient access to the novel pacing technology.Tri-City Cardiology electrophysiologists have elected to use this technology for patients with chronic atrial fibrillation, a history of lead or pacemaker infection or in a patient with infrequent, but significant pauses. The implantation process is smoother, and the postop-erative recovery appears to be easier for the patient.

Page 4 4th Quarter 2017www.TriCityCardiology.com

Dr. Atmakuri is an interventional car-diologist at Tri-City Cardiology. He is board-certified in Interventional Car-diology, Echocar-diography, Cardio-vascular Disease, Peripheral Vascu-lar Disease, and Internal Medicine. Dr. Atmakuri was trained at Columbia University, Baylor College of Medi-

cine, and Emory University. He is one of the most re-spected and versatile experts in interventional car-diology, where he performs coronary intervention, peripheral intervention for PAD and carotid disease, and structural valve intervention with his expertise in catheter based valvular replacements. He has done ex-tensive research and written many articles for publica-tions in the field of interventional cardiology and vas-cular medicine. Dr. Atmakuri consults at the Baywood, Dobson, Gilbert, and San Tan Valley offices.

The heart beats thousands of times per day, pumping dozens of gallons of blood each hour. It pumps blood through the lungs, where the blood is replenished with oxygen, and pumps it back out to the rest of the body. The upper two chambers of the heart are the left atrium

Breakthrough Treatment Option for Patients with Severe Mitral Regurgitation Who Are Too High Risk for Surgery

and right atrium, and the lower two chambers are the left ventricle and right ventricle. Heart valves act as a doorway between these chambers, opening to let blood pass from one chamber to the next, then closing quickly between heartbeats so blood does not flow backwards. The mitral valve is the valve between the left atrium and left ventricle of the heart, and in a normally functioning mitral valve, blood flows in a single direction between the left atrium and left ventricle. A leak in the mitral valve occurs when the flaps, or doors, do not close com-pletely allowing some blood to flow backward through the valve back into the left atrium. This leakiness of the valve is called mitral regurgitation and slowly progresses to severe regurgitation leading to symptoms. Mitral regurgitation is the most common type of heart valve disease, affecting nearly 1 in 10 people aged 75 years and older, approximately 4 million people in the U.S. Over time, some people may develop an enlarged heart because it has to work harder to pump blood through the body. If it is not treated, mitral regurgitation can cause other, more serious problems to your heart, such as heart failure, a condition that occurs when your heart can’t pump enough blood adequately to meet the needs of the body.

Symptoms of mitral regurgitation include:• Shortness of breath• Fatigue• Coughing• Lightheadedness• Swollen feet or ankles• Excessive urination One type of mitral regurgitation is called degenerative mitral regurgitation (also called primary or organic). It can be related to age, a birth defect, underlying heart disease, or a history of rheumatic fever. Treatment op-tions for degenerative mitral regurgitation depends on how severe the condition is and if it’s getting worse. The goal of treatment is to improve the heart’s function while minimizing symptoms and avoiding future complica-tions. There are medications available to reduce symp-toms, such as fluid buildup in the lungs, but no medi-cations address the underlying problem with the mitral valve. Open heart surgery has been the only option for effective treatment of degenerative mitral regurgitation, but 50% of patients are unable to receive surgery due to the presence of illness or advanced age. If a patient is not a candidate for surgery, they may be eligible for a less-invasive treatment option. The MitraClip® Delivery System is the world’s smallest transcatheter mitral valve repair therapy for the treatment of people with a severe leak in the mitral valve who are too high risk for open heart surgery, and do not have other treatment options available to them. Unlike sur-

4th Quarter 2017 Page 5www.TriCityCardiology.com

gery, the minimally invasive MitraClip® procedure does not require opening the chest and temporarily stopping the heart. The MitraClip® is a mechanical clip that grasps and coapts the mitral valve leaflets, resulting in fixed approximation of the mitral leaflets throughout the cardiac cycle. The cardiologist accesses the mitral valve by using a catheter that is guided through a vein in the leg to the heart. The cardiologist will then implant the clip at the appropriate position on the mitral valve. The clip will grasp the mi-tral valve leaflets to close the center of the mitral valve and the implanted clip becomes a permanent part of the heart, allowing the mitral valve to close more tightly reducing the backward flow of blood. The MitraClip® procedure offers cardiologists an important treatment option that can help patients with degenerative mitral regurgitation regain their quality of life.

Don’t let the Stress of theHoliday Season Get You DownThe holidays are a happy time of the year to reconnect with family and friends, but while it is a joyful time, it can bring plenty of stress. Stress during the holidays can be caused by many factors, including the pressure to buy and give gifts, worries about money, and simply not enough time to get things done. Everyone feels and reacts to stress in dif-ferent ways. How much stress you experience and how you react to it, can lead to a wide variety of health problems.

Stress may affect behaviors and factors that increase heart disease risk, including high blood pressure, smoking, physi-cal inactivity, high cholesterol, and overeating. Some peo-ple may choose to drink too much alcohol or smoke ciga-rettes to help manage their stress, however these habits can increase blood pressure and may damage artery walls. Help to reduce stress during the holidays by following these simple tips. • Know your spending limit and set a budget for gifts

this year. • Give something meaningful and personal.• Get organized to utilize the most of your time.• Share tasks with friends and family.• Learn to say “no” to events that aren’t important to

you. It will give you more time to say “yes” to the ones you want to attend.

• Be realistic and don’t put pressure on creating the per-fect holiday for family and friends. Focus on traditions that make the holidays special for you.

• Take breaks from group activities and pay attention to your own needs.

• Keep a regular sleep, meal, and exercise schedule. Tak-ing care of yourself will help you deal with stressful situations during the holidays.

• Stress during the holidays can sometimes trigger de-pression. Get support if you need it.

Resource: CardioSmart (https://www.cardiosmart.org/)

INDICATION FOR USE (of images): The MitraClip® NT Clip Delivery Sys-tem is indicated for the percutaneous reduction of significant symptomatic mi-tral regurgitation (MR≥3+) due to primary abnormality of the mitral apparatus [degenerative MR] in patients who have been determined to be at prohibitive risk for mitral valve surgery by a heart team, which includes a cardiac surgeon experienced in mitral valve surgery and a cardiologist experienced in mitral valve disease, and in whom existing comorbidities would not preclude the ex-pected benefit from reduction of the mitral regurgitation.

Additional information about MitraClip® NT, including Important Safety In-formation, is available online at:

http://www.abbottvascular.com/docs/ifu/structural_heart/eIFU_Mitraclip_NT.pdf

Abbott 3200 Lakeside Dr., Santa Clara, CA. 95054 USA, Tel: 1.800.227.9902

Caution: This product is intended for use by or under the direction of a physi-cian. Prior to use, reference the Instructions for Use provided inside the prod-uct carton (when available) or at

www.abbottvascular.com/ifu for more detailed information on Indications, Contraindications, Warnings, Precautions and Adverse Events.

Illustrations are artist’s presentations only and should not be considered as en-gineering drawings or photographs.

MitraClip is a trademark of the Abbott Group of Companies.

www.AbbottVascular.com

©2016 Abbott. All rights reserved. AP2943280-US Rev. A & AP2943285-US Rev. A

The Power of Giving Back to the Community

Save the Date for the 2018 Phoenix Heart Walk

Page 6 3rd Quarter 2017www.TriCityCardiology.com

Tri-City Cardiology is pleased to announce the open-ing of our new Arrhythmia Center, located at 6750 E. Baywood Ave., Suite 506, Mesa, AZ, 85206. The new Arrhythmia Center will enable us to provide special-ized services to patients with abnormal heart rhythms and cardiac devices.Our board-certified electrophysiology (EP) providers will be located at the new Arrhythmia Center:Kai Sung, MDArun Kolli, MDHicham El Masry, MDAmy Kleinhans, DNP

On Oct. 14, several Tri-City Cardiology employees, along with their families and friends, had the oppor-tunity to make a difference by giving back to those

Save the date for the 2018 Phoenix Heart Walk in Down-town Phoenix at CityScape on Saturday, April 7. Con-tributions for the Heart Walk go to the American Heart Association and will help to change the future and make life easier for those who are affected by heart disease and stroke.For more information or to join our Tri-City Cardiology team, visit our “Events” page on our website at TriCi-tyCardiology.com.Our EP team has advanced training in diagnosing,

treating and caring for patients who have electrical conduction irregularities of the heart or abnormal heart rhythms. The abnormal heart rhythms can cause ir-regular heartbeats, skipped beats, or extra beats, and can be symptomatic; including heart palpitations, diz-ziness, and syncope (fainting). Our goal is to bring state-of-the-art treatments and procedures to our clinic and provide quality care to our patients.

less fortunate in our community. At the Feed My Starv-ing Children facility, the volunteers hand-packed rice, soy, dried vegetables and a nutritionally complete blend of vitamins and minerals into bags that were sealed, boxed, and placed on pallets. These hand-packed meals are shipped to partners working to reach the neediest children around the world.At the end of the two hour session, the volunteers made an impact on hundreds of children by helping to pack 147 food boxes that were sent to the Philippines. That is enough food for 33,912 meals, and enough to feed 92 children for a year! We thank all of the volunteers who participated and supported this wonderful charity event.

TRI-CITY CARDIOLOGYArrhythmia Center

“I had a minor stroke around the first of April 2017. My eye doctor learned of my strokes and insisted that I con-tact a Heart Doctor. He took me to his Clinic Manager, who made my first appointment with Dr. Berkowitz. Dr. Berkowitz scheduled me for several tests. After the first one he had special meeting with me and scheduled an ap-pointment with a heart surgeon. After that all went very fast and surgery was scheduled for April 17, 2017.After my surgery I started to have pain in my legs and it became difficult to sleep at night. I scheduled an appoint-ment with Dr. Berkowitz and recently had the minimally invasive radiofrequency ablation procedure for my veins.My wife is also a patient at Tri-City Cardiology and we are very blessed to have all of its great support services. All of the personnel I came in contact with, went above and beyond to help me with my medical problems. All showed great concern for my problems and words cannot express my gratitude for their efforts. They, as a team, saved my life!”-Charles, Mesa

“I was referred to Tri-City Cardiology after I tested posi-tive for the MTHFR gene and family history of heart at-tacks resulting in death at a young age. First I was thank-ful that my primary care physician cared enough to refer me to them and second I am very thankful that I went and saw Dr. Sharma. I’ve been to two of their locations to see him and I can’t say enough at how wonderful the staff are at the Banner Baywood location and the Gilbert location. It’s obvious that they love what they are doing and they truly care about their patients and that they really want to make a difference. I have felt listened to, have never had to wait because they were running late or felt like an imposi-tion. It turned out that I do need a procedure for which I am scheduled for with Dr. Sharma, and I feel very positive about it and feel confident with Dr. Sharma actually doing the procedure. I highly recommend these clinics. Thank you Tri-City Cardiology!”-Karen, Gilbert

The Patient ExperienceAt Tri-City Cardiology, patient satisfaction is a top priority and we value our patient’s feedback. Hear what our patients have to say about their experience.

Gingersnaps

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Ingredients • 1 cup almond flour• 2 to 4 teaspoons ground ginger (depending on

how gingery you like it) • 1 tsp ground cinnamon • ¾ tsp baking powder• ¼ tsp salt • ½ cup almond butter (stir well before measuring) • ¼ cup butter, softened • ¾ cup Swerve or Truvia, Granular Sugar Sub-

stitute• 1 large egg, room temperature • ½ tsp vanilla extract

InstructionsPreheat oven to 325F and line a large baking sheet with parchment paper. In a medium bowl, whisk to-gether the almond flour, ginger, cinnamon, baking powder, and salt. In a large bowl, beat the almond butter and butter together. Beat in the Swerve un-til well combined, then beat in the egg and vanilla extract.Add the almond flour mixture and beat until fully incorporated. Roll the dough into 1 inch balls and place on the prepared baking sheet. Cover a flat bot-tomed glass with parchment or cling wrap and use to press the balls down into ¼ inch thick circles. Bake about 15 minutes, until they are just set. Remove from the oven and reduce oven temperature to 200F. Place the cookies back inside until they are golden brown and quite firm to the touch, about 20 more minutes. Remove and let cool completely. They will crisp up as they cool.

*Note: the thinner and smaller you make the cook-ies, the crispier they will be.

Makes about 24 cookies. 2 cookies per serving.

Recipe provided by Heather M. Duquette-Wolf, RD,CSSD, a Registered Dietician and Certified Specialist in Sports Dietetics.

1520 S. Dobson Rd., Ste 209, Mesa, AZ 85202 • 6750 E. Baywood Ave., Suites 301 & 506, Mesa, AZ 852063530 S. Val Vista Dr., Ste 103, Gilbert, AZ 85297 • 36543 N. Gantzel Rd. Bldg. 15, Ste. 101, San Tan Valley, AZ 85140

Vein Center

6402 E. Superstition Springs Blvd., Ste 114, Mesa, AZ 85206

Main Phone: (480) 835-6100 • Central Fax Number: (480) 461-4243

Website: www.TriCityCardiology.com

The physicians and staff at Tri-City Cardiology look forward to providing patients and their families with very good care and service.

Convenient East Valley Locations