AND HEALTHY LIFE - Oklahoma Heart• A few days later, Nick was released ... popcorn, pickles,...

The Heart Healthy PrimerSECRETS TO A LONGAND HEALTHY LIFE

Oklahoma Heart Inst i tuteOklahoma Heart Inst i tuteOklahoma Heart Inst i tutevolume 3 • number 1 • winter 2007

11 t h & U t i c a , Tu l s a O k l a h o m a • tel. no. 9 1 8 . 5 8 5 . 8 0 0 0 • t o d a y s h i l l c r e s t . c o m

At 62, Broken Arrow native Nick Aston was spending

his retirement traveling the Pacific Northwest and

Florida in his motor home. • It was on a visit home

last February that he awoke with severe pressure in his

chest. • He drove himself to Hillcrest Medical Center

where a team of cardiologists was waiting to treat

him. • Testing revealed he had three blocked arteries.

Within hours a balloon angioplasty was performed and

a stent inserted. • A few days later, Nick was released

to Hillcrest’s outpatient cardiac rehab program. • Today

Nick is feeling better than ever and is once again

ready to hit the road.

The difference

is our doctors.

StoriesFROM THE Heart.

“They saved my life.”

3

OKLAHOMA HEART INSTITUTE AT UTICA

1265 S. Utica Avenue

Suite 300

Tulsa, OK 74104

Phone: 918.592.0999

Fax: 918.592.1021

OKLAHOMA HEART INSTITUTEAT SOUTHPOINTE

9228 S. Mingo

Suite 200

Tulsa, OK 74133

Phone: 918.592.0999

Fax: 918.878.2499

THE DOCTORS OF OKLAHOMA HEART INSTITUTE

Wayne N. Leimbach, Jr., MD

Robert C. Sonnenschein, MD

Robert E. Lynch, MD

James J. Nemec, MD

John G. Ivanoff, MD

Gregory D. Johnsen, MD

Alan M. Kaneshige, MD

Ernest Pickering, DO

Edward T. Martin, MD

Roger D. Des Prez, MD

Christian S. Hanson, DO

Rebecca L. Smith, MD

Tobie L. Bresloff, MD

David A. Sandler, MD

Raj H. Chandwaney, MD

D. Erik Aspenson, MD

Frank J. Gaffney, MD

Michael J. Fogli, MD

Eric G. Auerbach, MD

Kelly Flesner-Gurley, MD

Kambeez Berenji, MD

The Oklahoma Heart Institute magazine

is mailed directly to referring physicians

and other referring health care profes-

sionals in the Tulsa area and is also

available in our patient waiting areas.

4 The Basics ofEating a HeartHealthy Diet

9 DevelopingHealthy Eating Habits

11Being Heart Smart With Diabetes

13Herbal Teas Growing and Brewing Your Own

23 A Stress TestDo You Need One?

26Pilates A new way to look at

exercise

20A Shaper

Cardiac Image

22Renal Artery

StenosisA CurableCause of

Hypertension

29 Pacemaker andDefibrillator Technology

28Heart Failure in Adults A Major and GrowingProblem

30 Nobody Does It Better

19High Blood Pressure A Risk Too Great to Ignore

7 The Importanceof LoweringCholesterol

25 Cardiac

RehabilitationA Return to

Good Health24Get thePicture CT Scans ofthe Heart

Cover painting by Tulsan Christopher Westfall

4

A healthy dietdoesn’t justmean eating less.

It means eating smart.The good news is thateating a healthy diet real-ly does pay off. Heartdisease and diabetes arepreventable, and ahealthy diet can increasethe quality and length ofyour life. While there isno “best” diet thatapplies to everybody,there are some basicfacts that are impor-tant to know.

SALT: Salt is listed as sodi-

um on food labels. Thereason we care about theamount of salt in the diet isthat salt intake is related toblood pressure. High saltintake raises blood pres-sure in people with hyper-tension. High salt intakewill also cause fluid reten-tion and can even lead toheart failure in people

By Wayne N. Leimbach, Jr., MD

The Basicsof Eating a HeartHealthy Diet

High fat diets with largeamounts of saturated

fats may help withweight loss, but they

increase the risk of having a heart attack.

5

with a weakened heart.It is generally recom-mended that you eatless than 2500mg ofsodium a day. Highsalt-containing foodsinclude potato chips,popcorn, pickles, olives,cured meats (like ham), canned veg-etables and many soups.

FACE THE FATS Fats contain about three times as

many calories as sugar. Eating toomuch fat makes you fat. You doneed some fat in your diet, but it’simportant to eat the right kind of fat.

Saturated fats are consideredthe bad fats. This is because theynot only make you fat, but theycause your body to make largeamounts of cholesterol. Highblood cholesterol levelsincrease your risk of heartattacks and strokes. Eating3 1/2 ounces of steak, whichhas a high saturated fatcontent, raises blood cho-lesterol as much as eating13 pounds of fish, whichcontains the good fats(unsaturated fat).

Unsaturated fats are consid-ered the good fats. They

are still high in calo-ries, but they don’tdramatically raisecholesterol levelslike the saturated

fats. Some unsatu-rated fats can have aprotective effect inregards to heart dis-ease. Canola oil, sun-flower oil, flaxseedoil, and olive oil areconsidered good fats.Good fat food sourcesinclude fish, avocados

and walnuts. Good fats not onlyprotect your heart, but theyalso keep you from feelinghungry soon after eating.This is why high fat dietsare popular. They seem tosuppress appetite. However, it isimportant to remember that the

high fat diets need to contain highamounts of unsaturated fats andnot high amounts of saturated

fats. High fat diets with largeamounts of saturated fats may helpwith weight loss, but they increasethe risk of having a heart attack.In contrast, people who eat highcarbohydrate/low fat diets oftenget hungry soon after eating. Thiscan lead to increased caloricintake, making successful weightloss difficult.

CARBOHYDRATES Carbohydrates are sugars and

starches and can come from grains,cereals and fruit. All carbohydratesare broken down in the body tomake simple sugar (glucose).Glucose is the principal fuel of our

bodies. Unfortunately, we eattoo many simple or refinedcarbohydrates, which our

body quickly con-verts to simplesugar. Eatinglarge amounts

of these carbohy-drates leads to an

increased risk of diabetes,high triglycerides and the meta-bolic syndrome - all risk factorsfor heart disease. People withdiabetes must pay particularattention to carbohydrates sincecarbohydrates dramatically raiseblood sugar in diabetics. Thesolution is to eat complex carbo-hydrates such as whole grain foodand legumes (peas, beans, lentils).For non-diabetics, fruits and veg-etables are a good source of car-bohydrates since they also pro-vide other important nutrients.

A healthy diet should have lessthan 30% of calories coming from

fats, and the fatsshould be unsaturat-

ed fats. Theamount of fat in afood product canbe determined byreading the

Nutrition Factlabels now available

on all packaged foods.

The first thing to look at is thenumber of servings in the package.Often, people assume that a packageis one serving size. In fact, the num-ber of servings per package is oftentwo or three. Eating multiple servingsleads to excess calories and obesity.

The next thing to look at on thefood label is the number of caloriesper serving. Next to this are the calo-ries from fat. Dividing the calories perserving by the fat calories per servinggives you the percent of fat calories.For example, if the number of caloriesper serving was 240 calories and thefat calories were 60, then the food has25% fat calories. The goal of a hearthealthy diet is to have less than 30% ofdaily calories coming from fat.

The next thing you should look atis the type of fat in the product.Saturated fats should be limitedbecause they raise cholesterol; trans-fats should be limited because theymay increase the risk of cancers. Fatsshould be primarily unsaturated fats.

Sodium is then listed, and theamount of sodium (salt) per dayshould be less than 2500mg. In addi-tion, food labels also indicate other

6

important nutrients that should bemaximized. These include vitamin A,vitamin C, calcium, and iron.Vitamin D is also a good vitamin tohave in your diet.

It is important to realize thathealth claims made on food pack-ages by the manufacturers are oftenmisleading. This is because there isnot a standard definition as to whatis healthy. Therefore, “lite” does notnecessarily mean that the product islow in fat or calories. It often meansthat the product has a lower amountof fat or calories than some otherproduct, which has been arbitrarilychosen as the standard by the foodindustry. For example, “lite” mayon-naise is still a high fat food. Whereregular mayonnaise is 100% fat, “lite”mayonnaise is greater than 80% fat.In order to obtain health informa-tion, read the Nutrition Fact label,not just the wording on the label.

As you become more familiarwith Nutrition Fact labeling, you willfind that shopping becomes mucheasier. The good news is that the ini-tial extra effort does pay off inimproving quality of life. It is possi-ble to eat a healthy diet that is notonly satisfying, but also delicious.

(Wayne

Leimbach is

a subspecial-

ist in inter-

ventional

cardiology,

including

cardiac

catheteriza-

tion, coro-

nary angio-

plasty and

related interventional procedures

such as stents, atherectomy, laser,

intravascular ultrasound imaging

and direct PTCA for acute myocar-

dial infarction.)

A healthy dietshould have less

than 30% of calories coming

from fats, and the fats should be

unsaturated fats

Everyseconds

7the life of someone is improved bya Medtronic product or therapy.

With your support,

Medtronic is the world’s leading medicaltechnology company, providing lifelongsolutions for people with chronic disease.

[email protected]

7


So, what exactly is cho-lesterol?

It’s a waxy substancefound in foods like meatsand dairy products. It isalso produced in our bodiesand is necessary for us tofunction normally.Cholesterol is used to makehormones and is used incell walls and membranes.Excess cholesterol levelsbuild up and cause narrow-ing of blood vessels (Figure1). When the blood vesselsbecome narrowed enough,blood flow becomes restricted to theheart or the brain, which producessymptoms. If a blockage (plaque)ruptures, a clot will form on top of thenarrowing, and this will actually causea heart attack or stroke.

But, if you lower your cholesterol,your risk for heart attack and strokedrops dramatically. In fact, we nowknow that very aggressive lowering ofcholesterol levels can even causeregression of blockages in the bloodvessels to the heart and brain.

Current guidelines state that totalcholesterol levels should be less than200mg/dl. However, we now knowfrom several recent studies that evenlower levels of total cholesterol arebetter. In evaluating cholesterol levelsyou need to understand that there aretwo types of cholesterol: the HDL cho-lesterol is considered good cholesterol.

HDL cholesterol levels reflect thebody’s ability to remove cholesterolfrom the body. LDL cholesterol is con-sidered the bad cholesterol. LDL cho-lesterol is the type of cholesterol thatgets under the lining of the blood ves-sels and leads to heart attacks andstrokes. Triglycerides are anothertype of fatty substance. Triglyceridesalso contain LDL cholesterol.Markedly elevated triglyceride levelsalso increase the risk of heart attacks.

Diet has a significant effect on cho-lesterol levels. Eating foods high incholesterol will raise blood cholesterollevels. These foods include red meat,egg yolks, and organ meats, such asliver. In addition, eating saturated fatscause the body to increase productionof cholesterol. Eating 3? ounces ofcheddar cheese raises the cholesterollevels in the blood as much as eating

21 pounds of fish!Although the fish may behigh in fat, it is unsaturatedfat that does not raise cho-lesterol levels. The signifi-cance of saturated fats isthat they raise cholesterollevels by causing the bodyto produce cholesterol.Unsaturated fats do notstimulate the body to makecholesterol.

Foods high in saturatedfats include beef products,the skin of chicken andturkey, and milk products,

such as cheeses. In addition, coconutoil and palm oil are both high in satu-rated fats.

Good sources of unsaturated fatsinclude almonds and walnuts. Fishhigh in fat, such as salmon and tuna,not only contain good fats that do notraise cholesterol levels, but they mayhave heart protective effects.Cooking oils that are consideredhealthy include canola oil, saffloweroil, and flaxseed oil. In addition, oliveoils have been shown to be benefi-cial.

People unable to effectively lowertheir cholesterol levels with dietarychanges now have several very effec-tive medications available. The mostcommonly used medicine for the treat-ment of high cholesterol are thestatins. The statins help block the pro-duction of cholesterol by the body.

The Importance of Lowering Cholesterol How Low Can You Go?

The reason you should care about cholesterol is that high cholesterol levels area major risk factor for heart attacks and strokes — the number 1 cause ofdeath in the United States.

Figure 1

8

Some of the statin medicines currentlyavailable include Lipitor (atorvastatin),Crestor (resuvastatin), Zocor (simvas-tatin), Pravachol (pravastatin),Mevacor (lovastatin) and Lescol (flu-vastatin). In addition, there are med-ications that block the absorption ofcholesterol. These include medicinessuch as Zetia (ezetamide), whichblocks absorption of cholesterol in theintestines. Bile acid binders such ascholestyramine and colestipol also

help block the absorption of choles-terol. Niacin is a B vitamin that lowersbad cholesterol and raises good cho-lesterol. Its dose is limited by the sideeffect of flushing. Fibricacids (gemfi-brozil) and fenofibrates (Tricor) andniacin all help lower triglyceride levelsand raise good cholesterol. The omega3 fatty acid fish oils also help lower

triglyceride levels. All adults should have their choles-

terol levels checked. If elevated,changes in the diet must be made tolower cholesterol. If diet alone doesn’tlower cholesterols to adequate levels,they should start medication therapy.

Guidelines suggest that for low riskpeople, LDL cholesterol should be lessthan 160 mg/dl. However, ideally, LDLcholesterol should be kept less than130. For people with multiple risk fac-

tors for heart disease, LDL cholesterolshould be kept less than 100mg/dl. If aperson already has evidence of heartdisease, peripheral vascular disease orhas diabetes, LDL cholesterol shouldoptimally be kept less than 70.Triglycerides should be measuredwhen a patient has been fasting.Fasting triglyceride levels should be

less than 150mg/dl. Triglyceride levelsover 500mg/dl are considered very highlevels and significantly increase therisk of heart attacks.

Many studies have demonstratedthat lowering cholesterol levels reducesheart attacks and strokes by at least30%. Newer studies suggest that it maybe possible to prevent as many as 70-80% of heart attacks with aggressivetreatment of risk factors. In addition,very aggressive lowering of cholesterollevels can cause regression of block-ages. Thus, the benefit of knowing andtreating one’s cholesterol level is worththe effort. Prevention still remains thebest therapy for heart attacks andstrokes.

(Wayne Leimbach is a subspe-

cialist in interventional cardiolo-

gy, including cardiac catheteri-

zation, coronary angioplasty and

related interventional procedures

such as stents, atherectomy,

laser, intravascular ultrasound

imaging and direct PTCA for

acute myocardial infarction.)

Many studies havedemonstrated thatlowering cholesterollevels reduces heartattacks and strokesby at least 30%.Newer studiessuggest that it maybe possible toprevent as many as70-80% of heartattacks withaggressive treatmentof risk factors.

As a veteran of the fitness

industry, I am certain that

if you asked 100 physicians,

personal fitness trainers,

nutritionists/dieticians, or

bodybuilding professionals

for the best prescription for

eating, you'd get 100 differ-

ent answers. Although the

perfect eating plan is differ-

ent for every person, nutri-

tion is not as complicated

as many make it. My per-

sonal belief is that if we

define nutrition as complex,

then we have an excuse to

remain a society in which

64 percent of the popula-

tion is considered obese.

When beginning a new nutritionregiment, I encourage clients todetermine realistic parameters inwhich he or she can live, reach per-sonal goals, and make temptingfood the exception, not the rule.This thought process allows a per-son to look at his or her eating andfitness habits in a personal wayand eliminates the idea of living alife of deprivation and eating bor-ing foods. A balance of living life(going to parties, eating pizza, andconsuming alcoholic beverages),and living right (exercising regular-ly and eating healthy) does exist

and having both can make for avery successful life.

What is clean eating? The bestdescription would be eating thosefoods closest to their original statewith little or no processing, addi-tives, or preservatives. The follow-ing are examples of foods regardedas clean within their respectivegroups:

Clean Proteins: Egg whites,boneless/skinless chicken breast,tuna steak, and turkey breast.

Clean Carbohydrates: Complex— oatmeal, brown rice, sweet pota-toes, russet potatoes, and

legumes/lentils; Simple — fruitsand some vegetables.

Good Fats: Avocado, olives,olive oil, nuts, seeds, and naturalpeanut butter.

What can you do with all of thefood choices out there? First, youmust claim responsibility for yourchoices. In order to get leaner, loseweight, and perform better, youdon't have to starve yourself or eatonly oatmeal, egg whites, and tuna.However, you can't wonder whyyou are over your ideal weightwhen you've eaten upsized fastfood meals, pizza, consumed 12

9

Developing Healthy EatingHabits

By Stacy K. Dempsey

10

beers with three bags of potatochips, and a box of Twinkies — allin one week. Eating better requiresplanning, preparation, measuringfood intake, and charging yourselfwith making conscious nutritiondecisions.

So, what should be eaten andwhen? The following outlines ageneral prescription for betternutrition habits:

• How many calories are needed?Begin by determining your idealbody weight with this formula.Females should give themselves100 pounds for the first five feetof height, plus five pounds foreach additional inch. Thus, theideal weight for a five-foot-seven-inch woman would be 135pounds. Males should givethemselves 110 pounds for thefirst five feet of height, and addfive pounds for each additionalinch. Thus, a six-foot-three-inchtall man should weigh about 185pounds.

Next, to figure your dailycaloric requirement, multiplyyour ideal weight by 15. This fig-ure is for a relatively sedentaryadult of either sex. More activeadults need to multiply by 20.For active adolescents, multiplyby 30.

• How often should one eat? Agood goal is to let no more thanfour hours pass without takingin calories. Many people areconfused if they are told to eatsix meals a day. I often explain itto clients as taking in 200 to 400calories every two to four hours,letting no more than four hourspass. This allows your bloodsugar levels to remain stable, soyou don't experience a starvingfeeling, which tends to triggerpoor eating choices. Your bodywill perform better on all levels— physiologically and psycho-logically.

• How should the intake of caloriesbe broken down per designatedeating time? Both balance andmoderation are important. Our

bodies need good, clean, complexcarbohydrates, lean proteins,good fats, and simple carbs.I usually have clients begin with

a 40-30-30 plan. With this, 40 percentof calories are from carbs, 30 per-cent from proteins, and 30 percentfrom fats. Depending on the per-son's goals, the percentages mightbe altered. A person whose caloricintake should equal about 2,800calories a day would divide thetotals as follows: 1,120 calories ofcarbohydrates, 840 calories of pro-teins, and 840 calories of fat. Then,those totals could be broken downin each small meal or calorie con-sumption time.

The way people relate to foodcan help or hinder efforts to achievegood health and reasonable bodyweight, so identify your motiveswhen you eat. Keep a daily foodjournal to help reveal a pattern ofeating. Food diaries shed light ontypes of foods being eaten, quanti-ties, and their nutritional value.Also, they can help you understandyour eating habits and triggers forthose habits. If you find yourselfeating out of boredom, loneliness,or depression, have a plan of“removal” from the moment by tak-ing a walk or calling a friend.Removing yourself within the firstminute of the urge to eat unneces-sarily may help you establish newhabits and keep you from taking inextra calories.

Water is also an important part ofweight management. On the aver-age, a person should drink eighteight-ounce glasses of water everyday. Overweight people should takein one additional glass for every 25pounds of excess weight. Thisamount should also be increased ifyou exercise at high intensities or ifthe weather is hot and dry.

If you are in the process of begin-ning a fitness or nutrition program,seek out professional help, such as apersonal fitness trainer or a clinicaldietician/nutrition specialist. And doyour homework by finding out aboutyour trainer's or nutrition coun-selor's education and experience.

Water is animportantcatalyst for weightmanagement.Here aresome factsabout waterand weightmanagement:■ The body will not

function properlywithout enough waterand can't metabolizestored fat efficiently.

■ To get rid of excesswater, you must drinkmore water and avoidincreased salt intake.

■ Retained water showsup as excess weight.

■ Drinking water isessential to weightmanagement.

11

By Tobie L. Bresloff, MD

Diabetes is a disease in which thebody either doesn’t produce or prop-erly use insulin. It affects 21 millionAmericans and, amazingly, it isestimated that nearly one-third ofthese people are unaware theyhave the disease. About 41 mil-lion people in the United Statesare thought to have pre-diabetes.

This is a disease that leads toheart disease, vascular disease,stroke, kidney failure, and blindness.Diabetics are at greater risk fordeveloping buildup of cholesterol inthe lining of their arteries (athero-sclerosis) than the general popula-tion. Also, cardiovascular disease isthe leading cause of death amongdiabetics, and adults with diabetesare 2 - 4 times more likely to haveheart attacks or strokes.

More than 90% of Americans diag-nosed with diabetes have type 2.This form of diabetes results fromthe body’s resistance to the action ofinsulin. For a while, the pancreascompensates by making moreinsulin, but eventually the ability tocreate insulin is exhausted, and canno longer be made at all.

Unfortunately, the prevalence oftype 2 diabetes is expected to sky-rocket as our population ages andmore and more Americans becomeoverweight. On a positive note, peo-

ple with pre-diabetes can help pre-vent progression to type 2 diabetes

by making changes in their dietand increasing their level ofphysical activity. Blood glucosemay even return to normal lev-els. While some medicationsmay delay development of dia-betes, diet and exercise work

better. Moderate physical activityfor 30 minutes a day, along with a

5–10% reduction in body weight,produces a 58% reduction in dia-betes.

There are also many new medi-cines that have been developed tokeep blood sugar from being highwithout causing constant highinsulin levels.

Metformin has been availablesince the 1990s. Primarily, it makesthe blood sugar better by decreasingthe liver’s production of sugar. It isgreat for those who have high fast-ing blood sugars. It also doesincrease the use of sugar by the cellsof the body.

Glitazones (piolitazone, rosiglita-zone) were first approved in 1999.These make the cells more sensitiveto the effects of insulin, so smalleramounts of insulin are needed to dothe same work. They also have beenshown to have many other helpfuleffects on the lipids (cholesterol and

Being Heart SmartWith Diabetes

The exact cause of diabetes is still unknown. But what we do know is thatgenetics and environmental influences, such as being overweight and lack ofexercise, are often factors.

Cardiovasculardisease is theleading cause ofdeath amongdiabetics, andadults withdiabetes are 2 - 4times more likelyto have heartattacks or strokes.

12

triglycerides), blood pressure, andinflammation. All of these makethem ideal to decrease the risk ofheart disease, stroke and similarcomplications. The DREAM studyshowed that pre-diabetics were lesslikely to develop overt diabetes withuse of glitzaones.

A newer agent, which wasapproved in 2005, is Byetta™. This isa chemical that was originally foundin Gila monster saliva. It affects thebody just like a naturally occurringprotein called GLP-1, but Byetta lastsfor up to 12 hours where GLP-1 isbroken down in 1-2 minutes. GLP-1causes insulin to be released fromthe pancreas only when the bloodsugar is high (over 120). Insulin thenshuts off when sugar is normal. Inaddition, it deceases glucagon releasefrom the liver. Glucagon worksagainst insulin and is part of whysome people have high fasting bloodsugars in the morning. Byetta hasbeen extremely helpful in patientswith diabetes mellitus who are over-weight. It keeps food in the stomachlonger after eating, thus decreasingthe tendency to overeat or snackafter eating. In addition, it increasessatiety, so patients are not as interest-ed in food. Many patients have amuch easier time losing weight whiletaking Byetta.

There are even more agents thatincrease the body’s own GLP-1 lev-

els by inhibiting its breakdown.These are the DPP-4 inhibitors thatwere approved in October of 2006.Galvus works on the same systemand is expected to be approved inFebruary of 2007. These do not raiseGLP-1 as much as Byetta, but seemto avoid possible side effects. We donot know yet how much effect theywill have on appetite and satiety, butat least they should not cause anyweight increase.

One more agent is before theFDA waiting for approval. It hasalready been approved in Europeunder the name of Accomplia. Thisworks by inhibiting the endo-cannabinoid system, which makes

us less hungry when it is shut off.Studies have shown that people atrisk for heart disease who takeAccomplia have decreases in theircholesterol and triglycerides,decreased weight, and diabetics mayimprove their blood sugar control.Only time will tell if, and when, thiswill be approved for use in theUnited States.

For those whose bodies do notmake enough insulin, there are newagents and new ways to give them.A new faster, shorter acting insulin,Apidra, is especially good for thosewho may have sugars that go toolow. A new 24-hour insulin, Levimir,is given once a day, as Lantus is,with the potential to cause lessweight gain and fewer low sugars.

It is very exciting that there arenew agents for diabetes that work ina much more physiologic way tocontrol blood sugar. Many of theserequire the pancreas to still be ableto make some insulin. For that rea-son, it makes sense to start therapyearlier, rather than waiting until thepancreas is “on its last leg.”

Aggressive management of bloodsugars in diabetics, along with treat-ing their other risk factors, reducesthe risks of blindness, kidney failure,heart attacks and strokes. By keep-ing blood glucose, blood pressure,and cholesterol levels as close tonormal as possible, people with dia-betes can live long, healthy lives.

(Tobie Bresloff is a specialist in

Endocrinology, Metabolism and

Hypertension, with expertise in

diabetes, lipids, hypertension

and thyroid diseases.)

While almost 21million Americanshave diabetes, it is estimated thatnearly one-third ofthese people arenot aware theyhave the disease.

13

Once I began blending and test-ing herb teas to sell under myGarden Party label, I knew what Ididn’t want. An herb tea shouldnever be flat and flavorless.Whether it’s fruity or spicy, soothingor lively, simple or sophisticated, itneeds taste and personality.

I found my homegrown mint,lemon balm, and chamomile weremore flavorful than the herbal ingre-dients I could buy. I also learnedthat many of the old-fashioned bev-erage flavorers, such as rose petalsand toasted sunflower hulls, are stilldelightful additions. And for simplepleasures, few things equal the fra-grance and flavor of a few freshleaves of lemon verbena steeped inboiling water.

Here are my picks for the mostflavorful and widely adapted “tea”plants for home gardens, along withtips for harvesting and my favoriterecipes. All of these plants growwell throughout the United States.

They are hardy perennials (up to-20˚F) that do well in sun or partshade, except where noted.

■ Bee Balm (Monarda didyma), amember of the mint family, is nativeto the Eastern U.S. and Canada.

Here in the drier West, I pamperit, making sure it’s in water-retentivesoil. Both the brightly-colored flow-ers and the leaves, with their com-plex flavors of citrus and spice, areused for tea.

■ Catnip (Nepeta cataria) is atwo- to three-foot-tall mint familymember. The fuzzy, scalloped leaveshave a lemon-mint flavor. If youhave cats, you know they roll in it.My solution: Grow a surplus and drythe leaves on top of the refrigeratorwhere the cats can’t reach them.One caution: Pregnant womenshould avoid drinking catnip tea.

■ Chamomile bears small, daisy-like flowers that have long beenused in Europe for tea. Germanchamomile (Matricaria recutita)

is a two-foot annual. Roman orEnglish chamomile (Chamaemelum

nobile) is a lush green perennialground cover bearing small, yel-low, button-like flowers. Althoughmany references designate Germanchamomile as the sweeter type pre-ferred for tea, I harvest the matureflowers of both chamomiles for alight, apple-scented tea.

■ Fennel (Foeniculum vulgare) isa three- to five-foot perennial oftencultivated as an annual. In cold climates, you can succession-plant through the early spring andsummer, and it will often self-sow.Here in the desert, I plant in the fall.

Fennel likes full sun. Both the feath-ery leaves and the seeds are usedfor licorice-flavored teas.

■ Sunflower Seed Hulls, roastedand ground, were usedby Native Americans andpioneers as a coffee sub-stitute. I run a rolling pinover the seeds to crackthem, then remove thekernels for baking andsnacks. I place the hullsin a dry cast-iron fryingpan and stir over medi-um-high heat for a fewminutes until they’reblackened. It’s a smokyoperation, but the aromais toasty and inviting.The hulls add a heartyflavor to teas, as well asdarken them.

HARVESTINGAromatic oils are most concen-

trated when herb plants are in bud,so that’s a good time to harvest,although you can certainly take cut-tings here and there during thegrowing season. Cut back the entireplant by two-thirds. In my region, Iget about three cuttings before let-ting the plants go.

The plants listed here can all beused fresh for tea, or they can bedried first. To dry them, I spread thestems on trays in a warm, airy placeand turn them twice a day. Whenthey’re dry (four to eight days), Igently strip off the leaves, buds, orflowerheads and store them inclosed containers.

I cut stalk fennel and corianderwhen the seeds are barely mature,but before they shatter, and invertthem in paper sacks. In a fewweeks, when the seeds havedropped to the bottom and dried, Ifunnel them into storage containers.

BLENDING AND BREWINGIn “merry olde England,” a tea

with one ingredient was called asimple. Start by sampling some sim-

By Evelyn Gaspar

Herbal TeasGrowing and Brewing Your Own

14

ples and get familiar with the vari-ous teas. That way, you’ll know ifyou’re one of a very small percent-age of people that may experience areaction to one of these ingredients.

Once you discover the art ofblending, however, you’ll probablyprefer the made-to-order tastes and

subtle accents you can create. Butjust as mixing contrasting colorscan make a muddy mess, mixingunrelated flavors can be unsatisfy-ing. The trick is to choose one fla-vor or family of flavors to carryyour message. Then, for accent, addsmall amounts of other herbs or bits

of dried fruit or citrus peel, toastedalmonds or walnuts, or wholespices. Use about three parts ofyour dominant ingredient(s) to onepart of accent items. Crumble theleaves if necessary to mix evenly,but not enough to go through yourstrainer or tea ball.

Gallagher Benefit Services, Inc.A Subsidiary of Arthur J. Gallagher & Co.

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SERVICES OF OKLAHOMA HEART INSTITUTE

Noninvasive Cardiology• Nuclear Cardiology• Echocardiography & Doppler Studies• Nuclear and Echocardiographic Exercise

& Pharmacological Stress Testing• Transesophageal Echocardiography• Arterial Venous Peripheral Vascular

Imaging & Doppler Studies• Peripheral Arterial Ultrasound Studies

& Duplex Imaging• Cardiovascular Magnetic Resonance

Imaging• External Counterpulsation (ECP)

Therapy• Transcranial Doppler

Invasive Cardiology• Cardiac Catheterization• Coronary Angioplasty• Atherectomy• Rotablator Atherectomy• Thrombolytic Therapy• Coronary Stents• Carotid Stenting• Intravascular Ultrasound• Myocardial Biopsy• Pericardiocentesis• Intravascular Radiation Therapy• Peripheral Angioplasty• Peripheral Stents• Percutaneous PFO Closures• Percutaneous ASD Closures

Electrophysiology

• Electrophysiology Studies

• Ablation Therapy

• Pacemaker Implantation

• Pacemaker and Lead Extraction

• Pacemaker Programming

• Pacemaker Monitoring & Clinic

• Implantable Cardioverter

Defibrillator (ICD) Placement

• ICD Replacement

• ICD and Hardware Removal

• ICD Programming

• ICD Monitoring and Clinic

• Holter Monitoring and Interpretation

• 30 Day Cardiac Event Monitors

• Implantation and Interpretation of

Long-term Heart Monitors

• Signal Averaged EKG’s and Interpretation

• Head Up Tilt Testing and Interpretation

• Direct Current Cardioversion

• Antiarrhythmic Drug Loading

and Monitoring

Metabolic Disorders

• Endocrinology

• Diabetes

• Hypertension

• Hyperlipidemia

• Thyroid

• Other Metabolic Disorders

Specialty Clinics

• Hypertension Clinic

• Adolescent & Adult Congenital

Heart Clinic

• Lipid & Wellness Clinic

• Heart Failure Clinic

• Dysrhythmia & Pacer Clinic

• Same Day Appointment Clinic

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15

Wayne N. Leimbach, Jr., MD, FACC, FSCAI, FCCP, FAHADr. Leimbach is a subspecialist in interven-

tional cardiology, including cardiac catheter-

ization, coronary

angioplasty and relat-

ed interventional pro-

cedures such as

stents, atherectomy,

laser, intravascular

ultrasound imaging

and direct PTCA for

acute myocardial

infarction. He is Chief

of Cardiology at Hillcrest Medical Center,

where he is also Director of the Cardiac and

Interventional Laboratories at Hillcrest

Medical Center. Dr. Leimbach is Co-Director

of the Lipid and Wellness Clinic at Oklahoma

Heart Institute. He is Director of the James D.

Harvey Center for Cardiovascular Research

at Hillcrest Medical Center, as well as

Director of the Oklahoma Heart Research

and Education Foundation. He also serves

as Clinical Associate Professor of Medicine

at the University of Oklahoma College of

Medicine – Tulsa. Dr. Leimbach completed a

Clinical Cardiology Fellowship and a

Research Fellowship at the University of

Iowa Hospitals and Clinics. He also complet-

ed his Internal Medicine Internship and

Residency programs at Iowa, where he was

selected Chief Resident in Medicine. He

received his medical degree from

Northwestern University in Chicago and his

Bachelor of Science degree from the

University of Michigan.

Board certified in Internal Medicine, CardiovascularDisease and Interventional Cardiology

Robert C. Sonnenschein, MD, FACC, ASE, RVTDr. Sonnenschein specializes in echocar-

diography and noninvasive peripheral vas-

cular imaging. He is

Director of Peripheral

Vascular Ultrasound

Imaging at Hillcrest

Medical Center and

Oklahoma Heart

Institute and serves

as Clinical Associate

Professor of Medicine

at the University of

Oklahoma College of Medicine – Tulsa. He

completed his Cardiology Fellowship at the

State University of New York Upstate

Medical Center in Syracuse, where he also

completed his Internal Medicine Internship

and Residency programs. Dr. Sonnen-

schein received his medical degree from

Rush Medical College in Chicago and his

Bachelor of Arts degree from the University

of Pennsylvania.

Board certified in Internal Medicine, CardiovascularDisease and Adult EchocardiographyRegistered Vascular Technologist

Robert E. Lynch, MD, FACCDr. Lynch is a specialist trained in noninvasive

and invasive cardiology. He is former Chief of

Cardiology at Hillcrest

Medical Center, where

he also has served as

Chief of Medicine and

President of the med-

ical staff. Dr. Lynch is

Co-Director of the Lipid

and Wellness Clinic at

Oklahoma Heart

Institute and Director

of the Executive Health Program. He is also a

Clinical Assistant Professor at the University of

Oklahoma College of Medicine – Tulsa. He com-

pleted his Cardiology Fellowship, as well as his

Internal Medicine Internship and Residency, at

the University of Oklahoma Health Sciences

Center. Dr. Lynch received his medical degree

from the University of Oklahoma School of

Medicine and his Bachelor of Science degree

from the University of Tulsa. Before establish-

ing his practice in Tulsa, he served as Chief of

Medicine at the U.S. Army Hospital, Bangkok,

Thailand.

Board certified in Internal Medicine andCardiovascular Disease

James J. Nemec, MD, FACCDr. Nemec is a subspecialist in echocardiogra-

phy, stress echocardiography and nuclear car-

diology. He serves as

Director of Nuclear

Cardiology for

Oklahoma Heart

Institute. Dr. Nemec

has served as

Assistant Professor of

Internal Medicine,

Division of Cardiology,

at Creighton University

and as Assistant Professor, Department of

Radiology, also at Creighton University. He

completed his Clinical Cardiology Fellowship

at the Cleveland Clinic Foundation and his

Internal Medicine Internship and Residency at

Creighton University. Dr. Nemec also complet-

ed a year of training in pathology at the

University of Missouri, Columbia, MO. He

received his medical degree from Creighton

University, where he also received his

Bachelor of Arts degree.


John G. Ivanoff, MD, FACC, FSCAIDr. Ivanoff specializes in interventional cardi-

ology, including cardiac catheterization, coro-

nary angioplasty and related interventional

procedures such as stents, atherectomy and

direct PTCA for acute myocardial infarction. He

is Director of the Catheterization Laboratories

at SouthCrest Hospital. Dr. Ivanoff serves as

Clinical Associate Professor of Medicine at the

University of Oklahoma College of Medicine –

Tulsa. He has also

served as Assistant


at the Medical College

of Pennsylvania, as

well as Associate

Director of the

Coronary Care Unit and

Assistant Professor of

Medicine at

Hahnemann University Hospital, where he

also completed his Cardiology Fellowship. He

completed his Internal Medicine Internship

and Residency at the Medical College of

Pennsylvania, where he served as Chief

Resident. Dr. Ivanoff also received his medical

degree from the Medical College of

Pennsylvania. He completed his Masters

degree in biochemistry at Columbia University

and received his Bachelor of Arts degree from

the University of Pennsylvania.

Board certified in Internal Medicine,Cardiovascular Disease and InterventionalCardiology

Gregory D. Johnsen, MD, FACC, FSCAIDr. Johnsen is an interventional cardiologist

with expertise in cardiac catheterization,

angioplasty and relat-

ed interventional pro-

cedures, such as

stents and atherecto-

my. He is Director of

Cardiac Rehabilitation

at Hillcrest Medical

Center and Director of

the Hillcrest Exercise

and Lifestyle

Programs. He completed his Clinical

Cardiology Fellowship at the University of

Oklahoma – Oklahoma City, where he then

finished an extra year of dedicated training in

interventional cardiology. He completed his

Internal Medicine Internship and Residency

training at the University of Oklahoma –

Oklahoma City, where he also received his

medical degree. Dr. Johnsen received his

Bachelor of Science degree from Oklahoma

State University.

Board certified in Internal Medicine, CardiovascularDisease and Interventional Cardiology

Alan M. Kaneshige, MD, FACC, ASEDr. Kaneshige is a noninvasive cardiologist

with expertise in adult echocardiography,

stress echocardiogra-

phy and trans-

esophageal echocar-

diography. He is past

Chief of Cardiology at

Hillcrest Medical

Center. Dr. Kaneshige

is also the Director of

the Adolescent and

Adult Congenital

Heart Clinic at Oklahoma Heart Institute

and Director of the Congestive Heart

THE DOCTORS OF OKLAHOMA HEART

INSTITUTE

16

Failure C.A.R.E. Center at Hillcrest Medical

Center. Dr. Kaneshige completed his


at Creighton University School of Medicine,

where he also received his medical degree.

He received a Bachelor of Science in chem-

istry at Creighton University. Dr. Kaneshige

completed his Clinical Cardiology

Fellowship at Creighton, where he also

served as Chief Cardiology Fellow for two

years. He completed an additional Cardiac

Ultrasound Fellowship at the Mayo Clinic in

Rochester, MN. Dr. Kaneshige served as

Assistant Professor of Medicine at

Creighton University School of Medicine,

where he was Director of the Noninvasive

Cardiovascular Imaging and Hemodynamic

Laboratory.

Board certified in Internal Medicine,Cardiovascular Disease and Adult andTransesophageal Echocardiography

Ernest Pickering, DO, FACOIDr. Pickering is a cardiology specialist

trained in noninvasive and invasive cardiolo-

gy with subspecialty

expertise in cardiac

catheterization and

angioplasty. He is

Chief of Cardiology at

SouthCrest Hospital

and past Chief of

Cardiology at Tulsa

Regional Medical

Center. He completed

a Cardiovascular Disease Fellowship at

Baylor College of Medicine in Houston, TX.

Dr. Pickering’s Internal Medicine Residency

was completed at Oklahoma Osteopathic

Hospital in Tulsa. He received his medical

degree from Philadelphia College of

Osteopathic Medicine and his Bachelor of

Science degree from Shelton College,

Ringwood, NJ.


Edward T. Martin, MS, MD, FACC, FACP, FAHADr. Martin is a noninvasive cardiologist with

subspecialty expertise in non-invasive imag-

ing. He is Director of

Cardiovascular

Magnetic Resonance

Imaging at Oklahoma

Heart Institute,

SouthCrest Hospital

and Hillcrest Medical

Center. Dr. Martin is

also Director of

Nuclear Cardiology at

SouthCrest Hospital. In addition, he is a

Clinical Associate Professor of Medicine at

the University of Oklahoma College of

Medicine – Tulsa. Dr. Martin has specialty

training in Nuclear Medicine, as well as

additional training dedicated to

Cardiovascular Magnetic Resonance

Imaging. He completed his Cardiology

Fellowship at the University of Alabama. Dr.

Martin’s Internal Medicine Internship and

Residency training were performed at

Temple University Hospital in Philadelphia.

He received his medical degree from the

Medical College of Ohio. Dr. Martin complet-

ed his Master of Science degree in mechani-

cal engineering at the University of

Cincinnati and his Bachelor of Science

degree in physics at Xavier University. Dr.

Martin is a founding member of the Society

of Cardiovascular Magnetic Resonance and

is an editorial board member of the Journal

of Cardiovascular Magnetic Resonance.


Roger D. Des Prez, MD, FACCDr. Des Prez is a noninvasive cardiologist

with subspecialty expertise in echocardiog-

raphy, nuclear cardi-

ology and trans-

esophageal echocar-

diography. He is

Director of

Echocardiography

and Peripheral

Vascular Ultrasound

Imaging at

SouthCrest Hospital.

Dr. Des Prez received his medical degree

and Bachelor of Arts degree from

Vanderbilt University. He completed his

Residency in Internal Medicine and

Pediatrics at University Hospital of

Cleveland. Dr. Des Prez practiced for six

years as an internist with the Indian Health

Services in Gallup, NM. He returned to

Vanderbilt University as a member of the

Internal Medicine Faculty, at which time he

also completed his cardiology training. In

addition to noninvasive cardiology, Dr. Des

Prez is interested in outcomes research

and computers in medicine.

Board certified in Internal Medicine,Cardiovascular Disease, Adult andTransesophageal Echocardiography,Critical Care and Pediatrics

Christian S. Hanson, DO, FACEDr. Hanson is a specialist in Endocrinology,

Metabolism and Hypertension at Oklahoma

Heart Institute with

expertise in diabetes,

lipids and hyperten-

sion. He also serves

as Clinical Associate


in the College of

Osteopathic

Medicine –

Oklahoma State

University. He completed a Fellowship in


Hypertension at the University of

Oklahoma in Oklahoma City. Dr. Hanson’s

Internal Medicine Residency and Rotating

Internship were completed at Tulsa

Regional Medical Center. He received his

medical degree from Oklahoma State

University and his Bachelor of Science

degree from Northeastern Oklahoma State

University in Tahlequah.

Board certified in Internal Medicine,Endocrinology and Metabolic Diseases

Rebecca L. Smith, MDDr. Smith is a noninvasive cardiologist with

subspecialty expertise in transesophageal

echocardiography,

intra-operative

echocardiography,

stress and pharmaco-

logical echocardiogra-

phy and contrast

echocardiography.

She completed an

Advanced Cardiac

Imaging Fellowship at

the Cleveland Clinic Foundation and her

Cardiology Fellowship at the University of

New Mexico Health Sciences Center,

Albuquerque, NM. Dr. Smith’s Internal

Medicine Internship and Residency training

were performed at the University of Arizona

Health Sciences Center in Tucson. She

received her medical degree from the

Medical College of Ohio. Dr. Smith complet-

ed her Bachelor of Science degree at

Cleveland State University.

Board certified in Internal Medicine

Tobie L. Bresloff, MDDr. Bresloff is a specialist in Endocrinology,

Metabolism and Hypertension, with expert-

ise in diabetes,

lipids, hypertension

and thyroid diseases.

She also serves as

Assistant Professor in

Clinical Medicine at

the University of

Oklahoma College of

Medicine - Tulsa. She

completed an NIH

Fellowship in Endocrinology and

Metabolism at Vanderbilt University in

Nashville, TN. Dr. Bresloff's Internal

Medicine Internship and Residency were

completed at Sinai Hospital of Detroit,

Detroit, MI. She received her medical

degree from Wayne State University School

of Medicine in Detroit and her Master of

Science and Bachelor of Science degrees at

the University of Michigan, Ann Arbor, MI.

David A. Sandler, MD, FACCDr. Sandler is a cardiologist with subspe-

cialty expertise in electrophysiology. He

completed his

Cardiac

Electrophysiology

Fellowship and his

Cardiovascular

Medicine Fellowship

at New York

University Medical

Center, New York, NY.

17

Dr. Sandler's Internal Medicine Internship

and Residency were performed at Mount

Sinai Medical Center, New York, NY. He

earned his medical degree from

Georgetown University School of Medicine

in Washington, DC. Dr. Sandler received his

Bachelor of Arts degree at the University of

Pennsylvania in Philadelphia.

Board certified in Internal Medicine,Cardiovascular Disease and CardiacElectrophysiology

Raj H. Chandwaney, MD, FACC, FSCAIDr. Chandwaney is an interventional cardi-

ologist with expertise in cardiac catheteri-

zation, coronary

angioplasty and

related interventional

procedures such as

coronary stents,

atherectomy,

intravascular ultra-

sound and peripheral

vascular intervention-

al procedures. He

completed his Clinical Cardiology

Fellowship at Northwestern University

Medical School in Chicago, IL., where he

also completed an Interventional

Cardiology Fellowship. Dr. Chandwaney's


were performed at Baylor College of

Medicine in Houston, TX. He received his

medical degree from the University of

Illinois at Chicago. Dr. Chandwaney com-

pleted his Master of Science degree at the

University of Illinois at Urbana-Champaign,

where he also received his Bachelor of

Science degree.

Board certified in Internal Medicine,Cardiovascular Disease and InterventionalCardiology

D. Erik Aspenson, MD, FACE, FACPDr. Aspenson is a subspecialist in


Hypertension at

Oklahoma Heart

Institute, with expert-

ise in diabetes,

lipids, hypertension

and thyroid diseases.

He completed a fel-

lowship in

Endocrinology at

Wilford Hall Medical

Center, Lackland AFB, Texas. Dr. Aspenson's


were completed at David Grant Medical

Center, Travis AFB, California where he

served as Chief Resident. He received his

medical degree from the University of

Oklahoma and his Bachelor of Science

degree at Oklahoma State University.


Frank J. Gaffney, MD, FACCDr. Gaffney is an invasive and noninvasive

cardiologist with subspecialty expertise in

transesophageal

echocardiography. He

completed his

Cardiovascular

Medicine Fellowship

at Scott & White

Memorial Hospital in

Temple, Texas. Dr.

Gaffney completed

his Internal Medicine

Internship and Residency at Brooke Army

Medical Center in San Antonio. He then

remained on staff at Scott & White

Memorial Hospital for several years, before

entering his Fellowship in Cardiovascular

Medicine. Dr. Gaffney earned his medical

degree from New York Medical College,

Valhalla, New York, and he received his

Bachelor of Arts degree at Hofstra

University in Hempstead, New York.


Michael J. Fogli, MD Dr. Fogli is a subspecialist in magnetic reso-

nance imaging, nuclear cardiology, echocar-

diography, stress

echocardiography and

transesophageal

echocardiography. He

completed a fellow-

ship in Advanced

Cardiac Imaging at the

University of Texas,

Southwestern Medical

Center in Dallas, TX.

His Cardiology fellowship was also per-

formed there, as were his Internal Medicine

Internship and Residency. Dr. Fogli earned

his medical degree at the University of

California, San Francisco School of Medicine

and his Bachelor of Arts degree at the

University of California, Berkley.

Board Certified in Internal Medicine andCardiovascular Disease

Eric G. Auerbach, MD, FACCDr. Auerbach is a subspecialist in magnetic

resonance imaging, nuclear cardiology,

echocardiography,

stress echocardiogra-

phy and trans-

esophageal echocar-

diography. He com-

pleted his

Cardiovascular

Magnetic Resonance

Imaging fellowship at

Oklahoma Heart

Institute, Tulsa, OK. His Cardiology fellow-

ship was performed at the University of

Miami/Jackson Memorial Hospital in Miami,

FL. Dr. Auerbach's Internal Medicine

Internship and residency were also complet-

ed at the University of Miami/Jackson

Memorial Hospital in Miami. Prior to that, he

performed a Surgery Internship at New York

Hospital/ Cornell Medical Center, New York,

NY. Dr. Auerbach earned his medical degree

at the University of Miami School of

Medicine, Miami, Florida and his Bachelor of

Arts degree at Princeton University,

Princeton, New Jersey.

Board Certified in Internal Medicine andCardiovascular Disease

Kelly Flesner-Gurley, MDDr. Flesner-Gurley is a subspecialist in


Hypertension at

Oklahoma Heart

Institute, with expert-

ise in diabetes, lipids,

hypertension and thy-

roid diseases. Prior to

joining Oklahoma

Heart, she was at St.

John Medical Center in

Tulsa. She completed

her fellowship in Endocrinology at the

University of Texas at Galveston. Her Internal

Medicine Internship and Residency were

completed at the University of Texas in

Houston, where she also received her med-

ical degree. She earned her Bachelor of

Science degree at Texas A&M University in

College Station, TX.


Kambeez Berenji, MDDr. Berenji specializes in interventional car-

diology including cardiac catheterization,

coronary angioplasty

and related interven-

tional procedures

such as coronary

stents, atherectomy,

intravascular ultra-

sound and peripheral

vascular intervention-

al procedures. He

completed an

Interventional Cardiology Fellowship at St.

VincentHospital/ Indiana Heart Center in

Indianapolis, Indiana, where he then com-

pleted additional training dedicated to

peripheral vascular intervention. Dr. Berenji

performed his Clinical Cardiology Fellowship

at the University of Texas Southwestern

Medical Center in Dallas, Texas and at the

University of Iowa Hospital and Clinics in

Iowa City, Iowa. He received his medical

degree from Tehran University of Medical

Sciences and then completed his Internal

Medicine Internship and Residency at Wayne

State University/ Detroit Medical Center in

Detroit, Michigan.


18

19


A blood pressurereading uses twonumbers to repre-sent the pressure inthe blood vesselsduring the twophases of the heart-beat. The systolicreading (top num-ber) corresponds tothe blood pressurewhen the heart con-tracts. The dias-tolic pressure (bot-tom number) corre-sponds to the pres-sure in the blood vessels when theheart relaxes. High blood pressureis a systolic pressure of 140 mmHg or higher or a diastolic bloodpressure of 90 mm Hg or higher. Aresting blood pressure of 140/90mm Hg that persists over time ishigh blood pressure (hyperten-sion). For people with diabetes orkidney disease, high blood pres-sure starts at 130/80 mm Hg.

Hypertension is a major risk fac-tor for cardiovascular disease.Compared to the people with nor-mal blood pressure, if you havehypertension you are three timesmore likely to develop coronaryheart disease, six times more likelyto develop heart failure, and seven

times more likelyto have a stroke.

More than two-thirds of patientsexperiencing theirfirst heart attackand three-quartersof those with a firststroke have highblood pressure. Forpeople with hyper-tension, about onein six will diebecause of compli-cations caused byhigh blood pres-

sure. Hypertension is a contribut-ing factor to many medical prob-lems, including heart attacks,

stroke, heart failure, kidney fail-ure, coronary artery disease, andblindness.

There is good reason hyperten-sion is called the “Stealth Killer”.Most people with hypertensionhave no symptoms. When symp-toms do occur, they includeheadaches, nosebleeds, fatigue,flushed face, shortness of breath,blurred vision, and abnormalitiesin heart rhythm.

When the cause of hypertensionis mostly unknown, it is referred toas essential hypertension. In somecases, high blood pressure iscaused by another problem, suchas kidney disease, hormonal abnor-malities, narrowing of the aorta

High Blood Pressure A Risk Too Great to Ignore

One in four adults in the United States has high blood pressure. Even if yourblood pressure is normal at age 50, you have a 90% risk of developinghypertension (high blood pressure) sometime during your lifetime.

20

(coarctation) or pregnancy. Lifestyle changes that may help

lower blood pressures includeweight loss, smoking cessation, exer-cise, and eating a low sodium diet.

If you are unable to lower bloodpressure tonormal levelswith lifestylemodification,there are nowmultipleeffectivemedicationsavailable.Studies havenow shownthat normaliz-ing bloodpressure cansignificantlyreduce therisk of heartattack orstroke withinjust five yearsof treatment.Every adult

should know his or her blood pres-sure. Optimal blood pressures areless than 120/80 mm Hg.

With aggressive treatment, youdon’t have to die of a heart attackor stroke. It is much better to visitthe doctor to treat the risk factors,such as high blood pressure, thanto see the doctor for a heart attackor stroke.

It is much betterto visit the doctorto treat your risk factors thanto see the doctorfor a heart attackor stroke.

Almost everyone has heard of mag-netic resonance imaging (MRI). Manypeople associate the imaging techniquewith brain, bone, joint, and back or can-cer problems. Indeed, it is common tohear that an injured athlete is undergo-ing an MRI to rule out ligament damage.However, few people realize that, overthe last 15-20 years, MRI has undergonesignificant hardware and softwarechanges that now allow it to be used tofind problems in the heart and bloodvessels. This discipline is called cardio-vascular magnetic resonance imaging(CMR), and it provides very detailed andaccurate images of the heart and bloodvessels without the use of contrastmedia that may damage the kidneys.Images are also obtained with-out harmful radiation that isused with other imagingmodalities.

Cardiovascular MRI is anaccurate and reproducibleimaging procedure that allowsthe identification of structuralproblems in the heart muscleand heart valves.

It is also useful in diag-nosing congenital heartdefects. These defects occurat birth and can sometimescause significant impairment.CMR can aid the physician inhelping to decide if heart orvascular surgery is neededand also aid in the correct timing ofthat surgery. More importantly, CMRmay help in the decision to pursue anon-surgical option. The cardiovascularMR technique can also diagnose block-ages in blood vessels throughout theentire body accurately, quickly and non-invasively, thus eliminating the risks ofblood vessel damage, kidney impair-ment or strokes, which can occur withother more invasive procedures.

The CMR procedure is easily tolerat-ed by patients. Study times can rangefrom 15 minutes for simple exams, toover an hour for complicated studies.Patients must lie very still during theexam, but can come out of the scanner

if a break is needed. Breath-holding forbrief periods is required in the majorityof cases. Earphones are also providedfor listening to music and hearinginstructions from the technologist.

This imaging procedure may not beright for the severely claustrophobic or inthose people who have certain types ofimplanted devices. Ask your doctor if thisprocedure is right for you.

Oklahoma Heart Institute’s MRICenter has an international reputationand not only evaluates patients fromthe Tulsa area and surrounding states,but also from other countries. All inter-preting cardiologists are certified at thehighest attainable level of competence,and the center is accredited by the

Intersocietal Commission for theAccreditation of Magnetic ResonanceLaboratories. The MRI Center special-izes in cardiovascular MR, but also per-forms all types of general MRI studies.In addition to routine clinical studies,the MRI Center is also involved in multi-ple research trials, including a currentstudy that allows patients with pace-makers to undergo MRI.

(Edward Martin is a noninvasive cardiolo-gist with subspecialty expertise in non-invasive Imaging. Dr. Martin has specialtytraining in Nuclear Medicine, as well asadditional training dedicated to Cardiovas-cular Magnetic Resonance Imaging.)

A SHARPER CARDIAC IMAGECARDIOVASCULAR MAGNETIC

RESONANCE IMAGING

By Edward T. Martin, MD

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21

22

THE LINK BETWEEN RAS AND HYPERTENSION

Hypertension (elevatedblood pressure) is a verycommon medical problem.But did you know that inabout five percent ofpatients, it is secondary tosomething called RenalArtery Stenosis (RAS)? RASis a narrowing of the bloodvessels to the kidneys. If itcan be diagnosed, hyperten-sion can be improved oreven cured.

Kidneys have an impor-tant regulatory role for theadjustment of blood pres-sure in controlling bodywater and sodium. Theyalso secrete a hormonecalled renin that canincrease blood pressure.

In renal artery stenosis,

kidney blood supply isdecreased; in response, thekidneys increase the secre-tion of renin to compen-sate for their decreasedblood supply. Thisincreased secretion of reninincreases overall bloodpressure and eventuallycauses hypertension.

RENAL ARTERY STENOSIS:WHAT IS IT?

Each kidney is usuallysupplied with one renalartery; although some peo-ple have multiple vessels(Fig-1).

The most common causeof renal artery stenosis isatherosclerosis (Fig-2), thethickening and hardening ofthe arterial walls because ofcholesterol build up. In fact,in patients with evidence of

Renal Artery Stenosis A Curable Cause of Hypertension

By Kambeez Berenji, MD

23

atherosclerosis in the heart bloodvessels, also known as coronarydisease, there is up to a 35% riskof having RAS. Smoking, diabetesand elevated cholesterol are riskfactors for atherosclerosis.

RAS can be present withoutany symptoms other than hyper-tension. When RAS affects bothkidneys, it can cause renal failure.Renal artery stenosis can alsoworsen the symptoms of patientswith angina or heart failure.

Renal artery stenosis can bediagnosed by ultrasound, CTscan, MRI or angiography (Fig- 1& 2). In most patients, treatmentof symptomatic RAS can beachieved without surgery.Instead, angioplasty and stentingare used to open the stenosis(Fig-2).

TREATABLE WITH SCREENINGRenal artery stenosis is one of

the treatable causes of hyperten-sion and renal failure. Anyonewhose hypertension is difficult tocontrol should consider screeningfor RAS. Screening should also bedone in patients with hyperten-sion and evidence of significantcoronary disease or peripheralvascular diseases.

(Kambeez Berenji specializes

in interventional cardiology

including cardiac catheteri-

zation, coronary angioplasty

and related interventional

procedures such as coronary

stents, atherectomy, intravas-

cular ultrasound and periph-

eral vascular interventional

procedures.)

You hear a lot about people gettingstress tests, but just who really needsone? Since one-quarter to one-third ofheart attacks occur without prior symp-toms, most adults over 40 should con-sider having a stress test.

Certainly anyone with symptoms ofblocked heart arteries should also beevaluated – chest pressure,breathlessness, burning inthe neck, jaw, or back, eitherat rest or following physicalactivity. Sometimes, evendiscomfort that feels likeheartburn can be due toblocked arteries.

In some cases, peoplewithout any symptoms at allshould be considered for acardiac stress test. Forexample, you should consid-er one if you have risk fac-tors such as diabetes, highblood pressure, smoking,high cholesterol levels, or afamily history of heart disease.

Apart from its advantages in detect-ing blocked heart arteries, cardiac stresstesting can offer very useful informationabout your cardiac health. Evidenceshows that people who are able to per-form at high exercise levels on a stresstest are much less likely to experience aheart attack in subsequent years,regardless of underlying blockage. Thiscan be reassuring and give you peace ofmind that all is well.

There are several types of stress tests.The nuclear and echocardiogram directedstress tests are more sensitive and specif-ic for detecting the presence of blockages.The standard EKG guided treadmill stresstest is more readily available.

The treadmill stress test procedure issimple. When you arrive at the doctor’soffice, a standard electrocardiogram isfirst performed, and heart rate and bloodpressure are monitored. Then, whileyou’re attached to the electrocardiogrammachine, you start walking on the tread-mill at a slow speed with a mild incline.As the test progresses, every three min-utes the treadmill gets faster and steep-

er, and blood pressure and the electrocar-diogram tracing is monitored throughoutthe study. The test concludes when youbecome fatigued or if a significant abnor-mality is detected on the electrocardio-gram.

Only a consultation with your doctorwill help determine if a stress test is right

for you. Any medical test result should beinterpreted and acted on depending onthe unique situation of that person, as notest is always perfect.

Why wait? Ask your doctor if now’s thetime for you to hit the treadmill and getthat stress test sooner rather than later.

A STRESS TESTDO YOU NEED ONE?

By Michael J. Fogli, MD

(Michael J. Fogli is a subspe-cialist in magnetic resonanceimaging, nuclear cardiology,echocardiography, stress echocardiography and trans-esophageal echocardiography.)

24

By Roger D. Des Prez, MD

Get the Picture CT Scans of When doctors look inside your

heart these days, they use manyhigh-tech, sophisticated imagingtechniques to see exactly what’sgoing on.

CT (Computed Tomography)scanners are cylindrical machinesthat produce three-dimensional x-rays. Recent technologicalimprovements have led to dramati-cally improved and detailed CTscans of the heart and the coronar-ies, the blood vessels that supplythe heart.

There are two types of CTscans of the heart: a CT calciumscan, and a CT angiogram (CTA).The CT calcium scan (Figure 1) issimpler, and less precise. Itcounts the calcium deposits in thecoronary arteries. The higher thecalcium count, the more likely itis that there is significant coro-nary artery disease, raising thepotential of angina or heart attack

25

in the future. This scan is mostuseful for a person who does nothave chest pain, but who is con-cerned about the risk of having aheart attack. Calcium scans arenot detailed cardiac pictures, andare not a good choice for apatient with symptoms.

Recently, faster CT scannershave been developed which takemultiple image slices of the heart –the best can take 64 slices – andreassemble these slices into high-quality, non-invasive images of thecoronaries (figure 2). OprahWinfrey and Matt Lauer both hadthese CTA scans done on nationaltelevision. The precise role of CTAis being debated. In many cases,however, CTA will be able toreplace invasive cardiac catheteri-zation to diagnose or rule outcoronary disease in patients withchest pain or other symptoms.CTA is an accurate, non-invasivetest that identifies patients at riskof a heart attack.

When you or someone you love has aheart attack, cardiac rehabilitation isextremely important in the recovery processto get back in the swing of things.Coronary heart disease is the leading causeof death for both men and women in theUnited States, but it is also a major cause ofphysical disability. Cardiac rehabilitationhelps patients resume active, productivelives. Importantly, it also helps preventfuture cardiac events.

Basically, cardiacrehabilitation is a med-ically supervised pro-gram designed to helpheart patients recoverquickly and improvetheir physical and men-tal health. Who doesn’twant to return to the lifeof good health they onceenjoyed?

Cardiac rehabilitationstrives to return thepatient to the best possi-ble health and to reducethe risk of recurrent car-diac illness. This requires a multidiscipli-nary approach. Cardiac rehab programsinclude the following:• Counseling, so the patient can under-

stand and manage the disease process • Beginning an exercise program• Helping the patient modify risk

factors, such as high blood pressure,smoking, high blood cholesterol, physi-cal inactivity, obesity and diabetes

• Providing vocational guidance to helpthe patient return to work

• Informing the patient about physical lim-itations

• Providing emotional supportFifty years ago, patients who survived a

heart attack were confined to bed rest fortwo months or longer and then urged tolimit physical activity. In the early 1960s,cardiac researchers realized that this was

the wrong approach. They realized thatcardiac patients who became active earlyhad much better recoveries than patientswho stayed in bed for extended periods.Comprehensive rehab programs eventuallygrew to include four phases.

Medicare has approved cardiac rehabfor patients who have had a heart attack,coronary artery bypass graft surgery, coro-nary stent or balloon procedure, heart valve

surgery, heart transplantor have stable angina.

A 20% reduction inoverall mortality and a26% reduction in car-diac mortality demon-strate the tremendousbenefits from cardiacrehabilitation.

Cardiac rehab is alsosafe. The occurrence ofcardiac events duringsupervised exercise israre, ranging from 1 per50,000 to 1 per120,000 patient-hoursof exercise.

For patients who want to return to theirbest possible functional status and reducetheir risk of a recurrent heart attack, cardiacrehab is a crucial component.

CARDIACREHABILITATIONA RETURN TO GOOD HEALTH

By Gregory D. Johnsen, MD

the Heart

(Roger D. Des Prez is a

noninvasive cardiologist

with subspecialty expert-

ise in echocardiography,

nuclear cardiology and

transesophageal echocar-

diography.)

(Gregory Johnsen is an inter-ventional cardiologist withexpertise in cardiac catheteri-zation, angioplasty and relatedinterventional procedures, suchas stents and atherectomy.)

26

If an hour of aerobicsleaves you feelingmore tired thanrefreshed, it may be time to discoversomething new in fitness — Pilates.

The Pilates (pronounced pul-LAH-tees) method of body condi-tioning is an exercise system usingspecially designed equipment toimprove flexibility, strength, circu-lation, and muscle mass withoutbuilding bulk. The method involvesa series of slow, controlled move-ments, most done while lyingdown, that bring together the mindand body, an experience that someliken to yoga.

“The emphasis is on the quality

of the movement as opposed to thequantity of the movement,” saysAmy Matton, owner of Body Workin Westport, Connecticut, and acertified pilates method instructor.“A few quality movements doneproperly are better than more donesloppily.”

Not Just AnotherPassing Fad

While pilates may be gaining inpopularity, it’s not a fad that willcome and go. The method has beenaround for 70 years. It was startedby a German immigrant who want-ed to build up his own body, and itwas later embraced by the dancecommunity.

Dancers have used the pilatesmethod for years because it con-centrates on the “powerhouse”area of the body — the abdomen,lower back — and builds a strongback while toning muscles.

Celebrities such as CandiceBergen and Glenn Close, as well asprofessional athletes, includingKristi Yamaguchi and the SanFrancisco 49ers, have also imple-mented the technique.

The Mind/BodyConnection

The key to pilates is usingspring-resistant machines, such asthe Universal Reformer, Cadillac,Spine Corrector Barrel, Chair,Tower, and Trapeze Table. Certifiedinstructors help people learn howto breathe properly and concen-trate on their muscles while doingexercises that target different areasof the body.

“You’re focusing on using sever-al different muscle groups at onetime, which requires a lot ofthought,” Matton explains. “But inlife, you rarely use one musclegroup at a time. Because it

A new way tolook at exercise

27

requires more thought, some peo-ple think it has a meditative quali-ty. You really have to focus andwork hard to execute the exerciseproperly.”

Matton say pilates exercises canbe done by anyone, from couchpotatoes to pregnant women, topeople in rehabilitation programsto active sports enthusiasts.

“Some people are very athleticand find pilates helps them withtheir sport or activity,” she says.“Other people are post-partum andare looking to get back into shapeor stay in shape.”

Pilates has been credited witheliminating or helping heal back-

aches, slumped shoulders, potbel-lies, and torn ligaments.

The Pilates Studio in New YorkCity certifies instructors after 600hours of classroom time andhands-on experience. Matton’sinstructors are all pilates-certified.

Because the pilates method isbecoming so popular (“Everypilates teacher I know is strugglingto keep up with the amount of peo-ple who want to take classes,”

Matton says), several facilities areteaching pilates without the equip-ment and sometimes without certi-fied instructors.

A Trained,KnowledgeableSource

The Westport YMCA offers a“mat class” in pilates that is taughtby a pilates-certified instructor.

“It’s a different type of classwithout the equipment,” explainsSuzy Gregory, Director of GroupExercise at the YMCA.

“The exercises are designed touse the body’s weight and gravityto tone the body. It is a wonderfulmethod of training the body to bestrong and supple.”

The Westport YMCA has offereda well-attended pilates methodclass for several years. “People areintrigued by it because movie starsuse it and it’s becoming populareverywhere,” says Gregory. “It’s agood complement to the way peo-ple are thinking these daysbecause it’s not pounding yourbody to death.”

Matton agrees. “In the ’80s, peo-

ple did a lot of aerobics and high-impact stuff. But ultimately bodiestook some wear and tear. Peopleare looking for something that iseffective and can make themstrong and give them an appear-ance they’re looking for, but that’salso a little more serene and leavesyou feeling invigorated and notwiped out.”

Join the PilatesMovement

Matton gives new clients a one-on-one session, then offers themmat classes for pilates floor workand small-group classes (one to

four people with an instructor) touse the equipment. Unlike many fit-ness centers, Body Work does notplay music in the background.

“I often hear people say howthey develop an increased aware-ness of their body, how they’rewalking, standing, and moving,”Matton says. “We’ve gotten moresedentary, spending more timebehind desks all day and gettingout of touch with our bodies.”

People are lookingfor something that is effectiveand can makethem strong and give them an appearancethey’re looking forbut that’s also alittle more serene.

28

By Alan M. Kaneshige, MD

Heart Failure in Adults A Major and Cardiovascular disease is the num-

ber one cause of death in the modernworld. Modern medicines, interven-tions, devices, and advanced surgicaltechniques allow patients to livelonger and richer lives. As the popu-lation ages, more patients will experi-ence a clinical syndrome called heartfailure. It is the most common diag-nosis in hospitalized patients overage 65.

Heart failure is a condition wherethe heart is unable to keep up withthe demands of the body. Symptomsof heart failure include shortness ofbreath, diminished exercise capacity,swelling of the legs and abdomen,and weight gain due to fluid reten-tion. In heart failure, the heartpumps less forcefully and fully thannormal (systolic heart failure). Anormal heart will pump out approxi-mately 55 to 65% of the blood thatfills it with each heartbeat (a numberknown as an ejection fraction).Hearts that pump less than 40% of theblood are said to have impairedpumping ability (left ventricular sys-tolic dysfunction). There are many

causes for impaired pumping: coro-nary artery disease, heart attack,severe leaking or blocked heartvalves, high blood pressure, infec-tious agents (viruses), and toxins(including certain drugs and medi-cines).

There are some patients who haveheart failure symptoms and a normalejection fraction. These patientshave heart failure from the inability

of the heart to relax as it fills withblood (diastolic heart failure) due toincreased heart muscle stiffness.Diastolic heart failure (stiff heart) isoften due to high blood pressure.

Heart failure is a major and grow-ing problem. An estimated 5 millionpeople in the United States have clin-ical heart failure. Approximately 20million people have risk factors forheart failure or have asymptomaticdamaged hearts. About 550,000 newpatients are diagnosed with systolicheart failure each year. Heart failurepatients will have 12 to 15 millionoffice visits to physicians andaccount for 6.5 million hospital days.There are 1 million patients hospital-

ized each year with heart failure as aprimary diagnosis.

The diagnosis of heart failure ismade with a detailed history andphysical examination. Patients withheart failure can present with a widevariety of symptoms that includeshortness of breath (with or withoutexertion), reduction in exercisecapacity, orthopnea (laying downwith head elevated in order tobreathe), paroxysmal nocturnal dysp-nea (waking at night or from sleep tosit up and breathe), and edema(swelling). Identifying the etiology ofthe heart failure condition is impor-tant for treatment plans. Identifyingrisk factors such as hypertension,diabetes mellitus, high cholesterollevels, physical inactivity, obesity,tobacco use, excessive alcohol use,and excessive salt intake can aid indetermining those patients at risk fordeveloping heart failure. Directingtreatment towards these risk factorsmay decrease heart failure incidence.

Treatment of patients with heartfailure starts with nonmedical meas-ures. Lifestyle changes includeweight loss, exercise, smoking cessa-tion, and sodium (salt) restriction.Cessation from excessive alcohol isimportant.

Until recently, doctors thoughtwhen the heart was damaged, itcould not recover. Today, by using acombination of medicines, manypatients can have significantimprovement in heart functions.Some patients waiting for heart trans-plantation have recovered enoughfunction with medical therapy to nolonger need the transplant.

Occasionally, when medicines andlifestyle changes are not enough, sur-gical intervention is necessary.Implantable devices called defibrilla-tors improve survival from suddendeath, common in patients with

29

advanced heart failure. Coronaryartery bypass surgery and valvereplacement/repair can improve car-diac function. Coronary revascular-ization with angioplasty and stent-ing can also be utilized. In somecases, surgery to modify the shapeof the left ventricle from a roundshape to a cone-shape will help withcardiac efficiency and improveheart failure symptoms. For a limit-ed number of patients with end-stage heart failure, heart transplan-tation is the best therapy.

Heart failure has high deathrates, frequent hospitalizations,potentially poor quality of life, andcomplex treatment regimens, aswell as strict lifestyle changes.Knowledge about heart failure isimportant, so that patients with riskfactors can be identified and appro-priate treatments started. Ifpatients at risk are followed andtreated early, progression of heartfailure can be stopped, reversed, orperhaps prevented altogether.

In August of 1953, Dr. Paul Zoll createdthe first pacemaker to restore a heartbeatto a dying patient. The “pacemaker” con-sisted of an external stimulator connectedto a needle placed through the skin into theheart. Although it only worked briefly, thefield of cardiac rhythm management wasborn.

Dramatic progress has been made overthe past half century in the development ofcardiac pacemakers and, more recently,implantable cardioverter-defibrillators (ICDs).Today, over 300,000 pacemakers and100,000 ICDs are implanted in the UnitedStates annually by electrophysiologists, car-diologists who specialize in cardiac rhythmdisorders.

What’s the difference in pacemakersand ICDs? Pacemakers are implantabledevices, which are able to prevent theheart from beating too slowly. Symptomscan include passing out (the medical termis syncope ) or simply fatigue. Somepatients (like Dr. Zoll’s patient described inthe introduction) lack any significant heart-beat, and the pacemaker becomes a life-saving device. For others, however, theheartbeat is too slow to maintain enoughoxygen to the body – leading to fatigue. Inthese patients, implantation of a pacemak-er is performed solely to improve the quali-ty of life. The impulses of the pacemakerare perceived as normal heartbeats, andthe patient is completely unaware of whenthe pacemaker is active.

Implantable cardioverter-defibrillatorsserve a quite different purpose. When apatient suffers Sudden Cardiac Death (SCD),usually the cause is an ineffective, very rapidrhythm or a quivering of the heart.Understanding how to prevent this problemis a major health care issue since approxi-mately 500,000 people die annually fromSCD! The only way to terminate theserhythms is delivery of a large jolt of energyto the heart to reset the rhythm. For thisreason, there has been increasing publicawareness on improving access toAutomatic External Defibrillators (AEDs).

People who are at increased risk, howev-er, cannot rely on a nearby AED (not to men-

tion a Good Samaritan to operate it promptlyand effectively!). Therefore, patients at elevat-ed risk of SCD are implanted with ICDs.Typically, patients who receive ICDs are thosewho have suffered a large heart attack and/orsuffer from congestive heart failure. Anothergroup of patients at high risk are those whohave inherited a genetic predisposition fordevelopment of lethal arrhythmias. These arepeople with a strong history of sudden deathin young family members.

Implantation of pacemakers and ICDsinvolves placement of a lead (essentially aninsulated wire) into a vein under the clavicle(collarbone) which is directed into the heartunder X-ray guidance. The lead is thenattached to the pacemaker or ICD generator

(essentially the computer) which is placedunder the skin. In some instances, theimplanting physician may choose to implanttwo or three leads, depending on the underly-ing heart condition. The entire procedure usu-ally lasts under one hour.

As you can see, we have come a long waysince Dr. Zoll’s initial landmark attempt atrestoring the rhythm of life. Today’simplantable cardiac devices dramaticallyimprove symptoms in many patients, as wellas prolong their survival.

Pacemaker andDefibrillator Technology

Restoring Life’s Normal Rhythms

By David A. Sandler, MD

Growing Problem

(Alan Kaneshige is a

noninvasive cardiologist

with expertise in adult

echocardiography, stress

echocardiography and

transesophageal echocar-

diography.)(David Sandler is a cardiologist withsubspecialty expertise inelectrophysiology.)

were the first in Oklahoma to closeholes in the heart in adult patients(ASDs and PFOs) percutaneously,without open heart surgery.

For patients with peripheral vascu-lar disease, some so severe they areunable to walk, Oklahoma HeartInstitute interventionalists offer thenewest and best techniques to restorethem to a normal life.

And for those with a rhythm prob-lem, patients’ hearts rest easier know-

ing that Oklahoma Heart Institute pio-neered many of the rhythm proce-dures being performed in Oklahoma.These include activity-sensing pace-makers, implantable cardiac defibril-lators and bi-ventricular pacemakers.

In short, Oklahoma Heart Instituteprovides complete cardiology care,from prevention and diagnosisthrough treatment. Their patients arelearning every day that it’s really true– today, you don’t have to die ofheart disease.

(Elaine Burkhardt is a writer, editor

and publisher at Newsgroup Communi-

cations, a Tulsa-based advertising/pub-

lic relations/publishing firm.)

30

Nobody knows Oklahomans heartsbetter than Oklahoma Heart Institute.Our patients are living proof. And noone in Tulsa has better success rates.When it’s your heart on the line, isn’tthat what you want?

The 21 doctors at Oklahoma Heartare subspecialists in all areas of cardi-ology and endocrinology. That makesthem uniquely qualified to care forany kind of heart problem. And that’swhat they have been doing success-fully for over 16 years.

They also know how to preventheart attacks, strokes and chronicheart disease. These are the #1 killersin America. But with careful, detailedevaluations and screenings, the doc-tors at Oklahoma Heart can actually

prevent these life-threatening prob-lems. They tailor prevention programsto each patient, treating the factorsthat cause heart attack and stroke andrelated metabolic diseases.

Be it cholesterol, blood pressure,diabetes, smoking cessation, or cus-tomized exercise programs, patientsat Oklahoma Heart Institute learnfrom the experts how to actuallyprevent cardiovascular problemsbefore they occur – in themselvesand their families.

With the only Division ofEndocrinology incorporated into aTulsa cardiology practice, OklahomaHeart is unique in offering patients ateam approach to heart attack preven-tion. Four endocrinologists’ expertisein the treatment of diabetes and othermetabolic diseases, in combinationwith Oklahoma Heart’s cardiovascular

subspecialization, can slow theprogress of cardiovascular disease inmany patients, and, in some cases,prevent it altogether.

If, however, someone doesencounter a heart problem, OklahomaHeart diagnoses it quickly and withprecision. They offer state-of-the artDiagnostic Imaging Services per-formed at both the Utica and SouthPointe offices and throughout north-east Oklahoma.

So, whether it’s a nuclear stresstest, cardiac MRI or ultrasound imag-ing that’s needed to pinpoint a diagno-sis, testing is easy for patients toaccess in a convenient setting. TheCardiovascular MRI and Nuclear labsat Oklahoma Heart are the only certi-fied labs in the state, ensuring patientsget the best technology available. Infact, their Cardiovascular MRI imagingis the most accurate cardiac assess-ment available – and with no radia-tion. Studies are also compared toeach other at Oklahoma Heart, so anychange in cardiac status is noted. Thatshows the physicians if the patient isbeing treated effectively, and, if fol-low-up studies show blockages in thearteries are progressing, therapy canbe intensified. Once a diagnosis hasbeen made, if there is a problem, treat-ment is handled by the OklahomaHeart subspecialist in that area.

If an interventional procedure iscalled for, with the latest advances intechnology and years of specializedtraining and experience, the interven-tional cardiologists at Oklahoma HeartInstitute can treat blockages in theblood vessels to the heart. By usingballoon and stent technologies, theyprevent the need for heart surgery.Blockages can usually be treated inthe hospital with only a one day hospi-tal stay, and patients can return towork within a couple of days.

Within 90 minutes most heartattack patients have their heartattacks interrupted in the cath lab,frequently with little damage to theheart muscle. The interventional car-diologists at Oklahoma Heart Institute

Nobody Does It BetterOklahoma Heart Institute

By Elaine Burkhardt

Within 90 minutesmost heartattack patientshave their heartattacks interruptedin the cath lab,frequently withlittle damage tothe heart muscle.

OKLAHOMA HEART INSTITUTE


Suite 300

Tulsa, OK 74104

Presorted StandardU.S. POSTAGE PAID

Little Rock, ARPermit No. 2437

Heart disease doesn’t fight fair.We can help you fight back.The next time you think a heart attack is something that happens to other people, here are a

couple of facts to consider.

Heart disease is still the #1 killer of American adults. And more women die each year from heart

disease than from all three leading cancers combined.

The good news is, we have more resources than ever to help you fight back. With a unique blend

of industry-leading technology and old-fashioned TLC, we can help you with both the prevention

and treatment of this deadly disease.

To find out more about cardiac care at SouthCrest, call us or log on to our Web site today.

THINKS HE’STOO YOUNG.

THINKS IT DOESN’THAPPEN TO WOMEN.

THINKS MAYBE IT WILL JUST GO AWAY.

When seconds count, SouthCrest-Tulsa’s Heart Hospital is ready and standing by at 91st and Highway 169. Call 294-DOCS or visit our Web site at www.southcresthospital.com

AND HEALTHY LIFE - Oklahoma Heart• A few days later, Nick was released ... popcorn, pickles,...

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Transcript of AND HEALTHY LIFE - Oklahoma Heart• A few days later, Nick was released ... popcorn, pickles,...