Matters

Helping HandsFrom seminars to pedometer programs, taking care of the community is Fort Wayne Cardiology’s first priority

Matters of the HeartFort Wayne Cardiology Presents

www.fortwaynecardiology.org • Vol. 1 No. 1

Drug eluting stents: controversy or cure?

Boost your heart with functional foods

Matters of the Heart 3

www.fortwaynecardiology.org

Carew Medical Park

1819 Carew Street

Fort Wayne, IN 46805

(260) 481-4700

(800) 637-6505 – for Indiana

(800) 334-4371 – for Ohio

and Michigan

Lutheran Medical Park

Lutheran Heart Pavilion

7910 West Jefferson Blvd., Suite 112

Fort Wayne, IN 46804

(260) 432-5613

Indiana Satellite Offices:Angola, Auburn,

Columbia City, Huntington,

Kendallville, LaGrange,

Portland, Wabash, Warsaw

Ohio Satellite Offices:Hicksville, Paulding

Physicians

Basil C. Genetos, MD

Robert W. Godley, MD

Michael J. Mirro, MD

Kevin J. Kelly, MD

Fred Doloresco, MD

Patrick J. Daley, MD

William W. Wilson, MD

James J. Heger, MD

Raymond E. Dusman, MD

Charles F. Presti, MD

Stephen E. Brown, MD

Mark A. O’Shaughnessy, MD

Roy W. Robertson, MD

William C. Collis, MD

T. Eric White, MD

David E. Schleinkofer, MD

Kevin K. Hart, MD

Hollace D. Chastain II, MD

Ronald J. Landin, MD

Linda M. Landin, MD

Mark D. Cohen, MD

Nurse Practitioners

Joyce Fisher, RN, MSN, FNP-C

Ann Rademaker, RN, MSN, ANP-C

Matters of the Heart is an educational and informative resource for physicians, health care professionals, our patients, and the general public. This publication features news and trends involving cardiovascular-related diseases, injuries, and treatments, and other related topics of interest. Information contained in this publication is not intended to replace a physician’s professional con-sultation and assessment. Please consult your physician on matters related to your personal health.

On the cover: Fort Wayne Cardiology conducts health awareness events and programs to encourage heart healthy behavior among its patients and the community.

4 Helping handsFrom seminars to pedometer programs, taking care of the community is Fort Wayne Cardiology’s first priority

7 Eat and be healthy

Functional foods will give your heart the boost it might need

8 Controversy or cure?

Drug eluting stents are just one stop on the road to better coronary care

10 An important number to know

Educating patients about their Ejection-Fraction

Vol. 1 No. 1 In this issue

Matters of the Heart is published by QuestCorp Media Group, Inc., 885 E. Collins Blvd., Ste. 102, Richardson, TX 75081. Phone (972) 447-0910 or (888) 860-2442, fax (972) 447-0911, www.qcmedia.com. QuestCorp specializes in creating and publishing corporate magazines for businesses. Inquiries: Victor Horne, [email protected]. Editorial comments: Darren Nielsen, [email protected]. Please call or fax for a new subscrip-tion, change of address, or single copy. Single copies: $5.95. This publication may not be reproduced in part or in whole without the express written permission of QuestCorp Media Group, Inc. To advertise in an upcoming issue of this publication, please contact us at (888) 860-2442, or visit us on the Web at www.qcmedia.com. March 2008

On behalf of the physicians and staff of Fort Wayne Cardiology, I would like to encourage you to browse through Matters of the Heart, an educational resource for physicians, patients, and the general public. We value this opportunity to share stories about important community activities and events in which our organization is involved, as well as timely articles about the prevention, diagnosis, and treatment of heart and cardiovascular diseases.

As one of the leading cardiology practices in Northern Indiana, the physicians and employees of Fort Wayne Cardiology are dedicated to providing a center of excellence for comprehensive cardiovascular care to our patients. Through the relationships we develop and the state-of-the-art medical care that we provide to our patients, our goal is to create a better quality of life for people in the Fort Wayne area and surrounding communities.

In our premiere issue, the first article, “Helping hands,” highlights prevention of heart disease and discusses a number of local, state, and national initiatives our organization has been involved with to make a healthier community. This issue will also discuss the importance of knowing your EF (Ejection-Fraction) as well as a timely discussion about the recent controversy raised in the media about drug eluting stents, an important and effective treatment for coronary artery disease. Another article, “Eat and be healthy,” gives practical tips about eating smarter for a healthier heart.

If you have any ideas or suggestions of topics for future publications, we invite you to call or leave a voice mail at (260) 481-4868. We also encourage you to visit our Web site at www.fortwaynecardiology.org to learn more about the services and locations offered at Fort Wayne Cardiology and additional educational informa-tion about your heart and cardiovascular disease.

We appreciate you taking the time to read and share our newest publication.

Sincerely,

William W. Wilson, MD, FACC

Welcome

4 Matters of the Heart

Helping handsHelping hands

“An ounce of prevention” … at Fort Wayne Cardiology we take this adage seriously, understand-ing that the majority of the cardiovascular disease we encounter daily is largely preventable.

Th rough our active wellness program, headed by Marsha Worthington and Sarah Mohrman, we have worked diligently to spread the message of good health through prevention. Along with these eff orts, the physicians of Fort Wayne Cardiology off er more than 100 lectures every year to health care profes-sionals and the community covering topics such as basic cardiovascular research, cutting-edge treatment,

and prevention.

Cardiovascular disease is the leading cause of death of both men and women in the United States. Th e vast major-ity of this disease is preventable with modest lifestyle changes that are at-tainable even on limited budgets.

Most of our patients who have coronary artery disease — fat build up inside the arteries that results in heart attack — are suff ering because of poorlifestyle choices, specifi cally, tobacco use, sedentary lifestyles, poor dietary choices, and obesity.

Th e number one cause of this disease is cigarette smoking. Although controversial in its stance, the Fort Wayne City Council joined cities and states across the country enacting clean air acts by banning cigarette smoking inside public buildings within city limits. While this law pits personal freedom against public health issues, there is no controversy in the scientifi c literature as to the causal relationship be-tween cigarette smoke, fi rsthand or secondhand, and the development of cardiovascular and respira-tory disease. Th e City Council looked to members of the health care community for their knowledge and support on this sensitive issue. Initiatives such as this one, while controversial, will serve to im-prove the health of the Fort Wayne communityand ultimately make it a more competitive market and ultimately make it a more competitive market prove the health of the Fort Wayne communityand ultimately make it a more competitive market and ultimately make it a more competitive market


and prevention.

Cardiovascular disease is the leading cause of death of both men and women in the United States. Th e vast major-ity of this disease is preventable with modest lifestyle changes that are at-tainable even on limited budgets.

From seminars to pedometer programs, taking care of the community is Fort Wayne Cardiology’s fi rst priority

By Mark A. O’Shaugnessy, MD


PHOTOS: Clockwise, from left: Fort Wayne Cardiology physicians, medical staff , and patients work together to maximize heart health. Many of our doctors and members of the wellness department actively participate in local community events, such as Science Central Doctors Day. Sarah Mohrman, Fort Wayne Cardiology’s registered dietitian, presents information on the importance of meal planning at the Fueling Your Family Fair. Participants in the Fort Wayne Walks One Million Miles program, which Fort Wayne Car-diology helped organize, celebrate their eff orts by walking in the Th ree Rivers Festival Parade. One of many children who enjoyed hands-on activities during the Fueling Your Family Fair in August.

Matters of the Heart

for future employers. Th rough various communityaffi liations and educational initiatives, Fort WayneCardiology has been instrumental in bringing lo-cal and national programs that stress prevention to the Fort Wayne area. With the generous support of many organizations, national speakers such as Rob-ert Sweetgall (pedometer walking), Anne Fletcher (diet success), and James Hill (America On the Move) have come to Fort Wayne to present programs to both health care professionals and the commu-nity. Each of these free programs has stressed smallattainable lifestyle changes that will lead to large health benefi ts.

Motivation through education has been a mainstay of our community wellness initiative with the ul-timate goal of making Fort Wayne a healthier and more productive city.

America On the Move (AOM), a program developed by James Hill at the University of Colorado Health Sciences Center (Colorado is the least obese state in the Union), stresses energy balance through small changes that reap huge benefi ts. Simply cutting100 calories from our daily food consumption and burning an additional 100 calories throughexercise will have a huge impact on weight gain >>


and overall health. Small at-tainable changes that can reap huge benefi ts areavailable on its Web site (www.americaonthemove.org). AOM lists programs and information on how a few simple lifestyle modifi cations can help a person get on the road to overall health improvements.

Th e Web site also lists all the local Fort Wayne area initiatives, accessed by clicking on the Indiana pages. Th e local AOM board, with representatives from business, churches, hospitals, and schools, continues to spread the message of small attainable lifestyle changes with large health benefi ts.

Members of AOM’s board went one step further by linking up with the Fort Wayne Sports Corporation and Fort Wayne Cardiology to develop a program — Fort Wayne Walks One Million Miles — in response to Fort Wayne being named one of the fattest cities in America. Th is 12-week program tracked activity levels of participants using pedometers with a goal of collec-tively walking 1 million miles in 12 weeks. More than 10,000 participants logged more than 1.3 million miles. At approximately 100 calories per mile that equates to 130 million calories burned or almost 400 pounds lost from the waistlines of our participants. Th is suc-cessful program has led to the formation of multiple pedometer walking programs in schools, business, and churches; and it spurred the development of a half marathon scheduled for September 2008.

Fort Wayne Cardiology with help from community organizations also assisted in developing the Fuel-ing Your Family health fair, which allowed families to learn about healthy food and activity choices in a fun and interactive manner. More than 200 participants gained valuable insight into simple and cost-eff ective ways to improve the health of the entire family.

In addition to these community collaborations, Pio-neering Healthier Communities, an initiative spon-sored by the YMCA of the USA, selected Fort Wayne as a pilot community to develop programs stressing family health. Th is collaboration has also been instru-mental in educational opportunities for more than 5,000 children who participate in the Fort Wayne Parks & Recreation summer program. With the gener-ous support of local dietitians, this program teaches children how to make healthy food choices.

Fort Wayne Cardiology’s partnership with the Fort Wayne Track Club, Fort Wayne Parks & Recre-ation, Greenway Consortium, restaurants, univer-

sities, schools, corporations, churches, and many oth-er businesses have assisted in promoting healthy life-styles. Restaurants have been willing to off er healthy portions along with healthy option substitutions for sides at no additional cost. Waitstaff s have been educated on these healthy options and off er advice to diners who wish to make healthier meal choices.Th e Fort Wayne Track Club (www.fwtc.org) and Greenway Consortium (www.greenwayconsortium.com) off er safe and enjoyable opportunities to ex-ercise in both competitive and noncompetitive en-vironments. With health care costs sky-rocketing and obesity rates growing at epidemic levels, pre-vention through healthy lifestyle choices is essential for our community to be able to compete in the global economy. Multiple businesses have adopted wellness programs modeled after AOM principles have taken advantage of the knowledge and expertise of the Fort Wayne Cardiology wellness staff to begin wellness and prevention initiatives within their organi-zations. Each of these organizations is committed to the improvement of health and prevention of disease in the broader Fort Wayne community.

Th e vast majority of the heart disease we encounter on a daily basis is preventable with a few simple and attainable lifestyle modifi cations. With the commit-ment of our community partners, we will be able to realize the dream of a model city where health is not just a lofty goal, but a reality. Fort Wayne Cardiology remains committed to the prevention of cardiovas-cular disease, and we will continue to work with our many community partners to disseminate the message of prevention through attainable lifestyle choices. ■

For more information on programs sponsored byFort Wayne Cardiology or in the community at large, please contact Marsha Worthington, Wellness Director,at (260) 481-4868 or at [email protected].

Mark A. O’Shaughnessy, MD, spe-cializes in congestive heart failure, noninvasive cardiac evaluation, and prevention. He is actively involved in community education regarding the prevention of cardiovascular disease.

Dr. Mark A. O’Shaugnessy of Fort Wayne Cardiology participated in the Science Central Doctors Day, which helped families to learn about healthy foods and activity choices.

and overall health. Small at-tainable changes that can reap huge benefi ts areavailable on its Web site (www.americaonthemove.org). AOM lists programs and information on how a

In addition to these community collaborations, Pio-neering Healthier Communities, an initiative spon-sored by the YMCA of the USA, selected Fort Wayne as a pilot community to develop programs stressing family health. Th is collaboration has also been instru-mental in educational opportunities for more than 5,000 children who participate in the Fort Wayne Parks & Recreation summer program. With the gener-ous support of local dietitians, this program teaches children how to make healthy food choices.

Fort Wayne Cardiology’s partnership with the Fort Wayne Track Club, Fort Wayne Parks & Recre-ation, Greenway Consortium, restaurants, univer-

sities, schools, corporations, churches, and many oth-er businesses have assisted in promoting healthy life-styles. Restaurants have been willing to off er healthy portions along with healthy option substitutions for sides at no additional cost. Waitstaff s have been Dr. Mark A. O’Shaugnessy of Fort


Eat and be healthyFunctional foods can give your heart a needed boost

By Sarah L. Mohrman, RD, MA

A heart-healthy diet recommendation from your physician does not indicate a diet solely of fruits and vegetables. Following a heart healthy diet may include trimming the unhealthy fats (saturated and trans fats) from your diet, but it also includes adding functional foods to your everyday eating. Functional foods can be whole, fortified, or enhanced foods that provide health benefits be-yond their nutrient composition. The following functional food suggestions may help boost your heart’s overall health.

Juice derived from a pomegranate, a Middle East-ern fruit that contains crunchy seeds surrounded by juicy pulp, is rich in potassium, vitamin C, and anti-oxidants. Recent studies indicate that pomegran-ate juice should be the beverage of choice to fight hardening of the arteries. Not only does the juice ap-pear to prevent hardening of the arteries by reduc-ing blood vessel damage, but the antioxidant-rich juice may also reverse the progression of this disease. Studies suggest pomegranate juice contains three to five times more antioxidants than green tea or red wine. In order to reap the benefits of this juice, try consuming 2 to 4 ounces of the juice daily.

Did you know that eating one ounce of nuts five or more times per week can reduce your risk of heart disease by 25 to 39 percent? Although nuts are high in fat, the fat is primarily unsaturated fat that has a beneficial effect on heart health. Nuts are also good sources of protein, fiber,

magnesium, copper, folic acid, potassium, and vitamin E; some contain omega-3 fatty acids. One ounce of nuts is equivalent to 3 to 4 tablespoons of walnuts, 23 almonds, or 20 mixed nuts.

Plant sterols are found naturally in fruits, vegetables, nuts, and grain products. These plant sterols help to lower bad (LDL) cholesterol and triglycerides naturally. The goal should be to consume 2 grams of these plant sterols per day to help lower cholesterol levels (see sidebar).

Fish, in particular salmon, mackerel, lake trout, her-ring, sardines, and albacore tuna, are rich in omega-3 fatty acids, which have been shown to provide sig-nificant benefits for the heart including decreased risk of sudden death, improved arterial health, and decreased plaque development. Try incorporating fish, especially those listed above, at least twice per week. For those who are not fish lovers, there are alternatives for omega-3 benefits; food products such as ground flaxseed, canola oil, walnuts, and soy- beans provide the heart with benefits, as well.

As you can see, there are many healthy foods you can add to your diet and enjoy, knowing you are improving your heart health. If you have more ques-tions about heart healthy eating or functional foods for your heart, please do not hesitate to contact the Fort Wayne Cardiology Registered Dietitian

at (260) 481-4858. ■

Plant sterols

some foods with added

plant sterols include Kroger

active lifestyle Fat Free

Milk (0.4g per 8 oz), nature

Valley Heart Healthy Chewy

Granola Bars (0.4g per bar),

Minute Maid Heart Wise

orange juice (1g per 8 oz),

Benecol spreads or take

Control margarines (1g per

tablespoon), and Promise

activ supershots (2g/3 oz).

Pomegranates are rich in potassium, vitamin

C, and antioxidants.

Eating one ounce of nuts five or more times per week

can reduce your risk of heart disease by 25 to 39 percent.

Sarah L. Mohrman, RD, MA, is the Registered Dietitian at Fort Wayne Cardiology, who educates patients on nutrition for disease management and prevention. She is also active in promoting nutrition and wellness for heart disease prevention in the community.


Last year was the 30th anniversary of the first coronary balloon angioplasty. This procedure was the first type of percutaneous coronary inter-vention (PCI), marking the beginning of the modern era of invasive, nonsurgical treatments for coronary artery disease. During this time, many advances have pushed invasive treatment forward, but possibly one of the greatest advances in nonsurgical coronary in-tervention since PCI is the drug eluting stent (DES).

Since the release of medicated coronary stents, DES has generated great excitement, intense utilization, and close scrutiny mainly because its effectiveness at keeping the artery open has been much greater than the success of bare metal stents (BMS) that don’t use drugs. Initial studies of DES established a 70 percent reduction in restenosis (renarrowing), along with increased safety. Since its approval in 2002, clinical research studies have shown striking and profound reductions in the need for repeat PCI procedures (due to renarrowing) as compared with standard BMS. As a result, the use of DES rose rapidly to 80 to 85 percent of coronary procedures performed.

However, during 2005 to 2006, studies in the U.S. and Europe suggested the possible potential for

greater late risks (one year or more after stent-ing) of cardiac events with DES, including

an increased risk of death from myocardial infarction or

heart attack. These reports were

caught by the press and exaggerated, which led to a more cautious approach of DES use by some cardiologists, as well as much anxiety in our patients.

In order to understand the risks related to stenting and DES, it is necessary to start from the beginning and understand the advances that have occurred during the past 30 years in treating blocked coro-nary arteries, beginning with coronary artery bypass graft (CABG).

Developed in the 1960s, CABG has gained a great measure of success and patient acceptance. Coronary artery bypass surgery procedures in the early era, as well as into the mid-to-late 1980s, were accompanied by a 3 to 5 percent mortality rate. Some procedures were associated with mortality rates as high as 10 per-cent, but this was accompanied with a 3 to 5 percent risk of stroke and other significant complications.

Nonetheless, coronary artery surgical methods to improve blood flow to the heart, known as revascu-larization, began an era of nonmedical treatment of advanced coronary disease. During the past 25 years, CABG has evolved and developed as a safe and pro-ficient procedure with a dramatic reduction in the risk of stroke. Despite advances, CABG is a major surgery and risks of death, heart attack, and stroke remain a concern.

Investigation of other treatment options were also being explored and in 1977, Andreas Gruentzig, MD, published articles about patients being treated with

coronary artery balloon dilatation known as per-cutaneous transluminal coronary angioplasty

(PTCA). This entailed the inflation of small plas-tic balloons after they were inserted into the narrowed coronary artery to crack (tear) un-derlying blockages, expand the arteries, and improve blood flow. These early PTCA ap-proaches were limited both by the size of the artery and by the location of the blockage.

Throughout the 1980s there were marked improvements in PTCA equipment resulting in

Controversy or cure?Drug eluting stents are just one stop on the road to better coronary care

By Mark D. Cohen, MD

Problems with early coronary angio-plasty led researchers to develop bare metal stents (below), which were made out of surgical steel. These then led to the development of drug eluting stents.


significant competition to CABG. Early coronary angioplasty, however, was limited by its own mecha-nism of action — inflating a balloon within the artery led to large uncontrolled tears and the recurrence of the blockages or restenosis. These two problems prompted intensive investigation and research, which eventually produced small metal meshes made of surgical steel known as coronary stents. These stents were initially made of bare metal and offered a mod-est reduction in restenosis or renarrowing. However, stents did lead to a marked reduction in the need for urgent coronary artery bypass surgery and death, and thus improved patient safety.

However, the greatest weakness of coronary inter-ventional techniques, and its most difficult challenge, was restenosis. Restenosis was caused by a response to injury from the balloon or stent and was associ-ated with extensive new tissue growth within the artery, similar to a scar developing after cutting your skin. Even with enhanced utilization and improve-ment in BMS, restenosis was still a common prob-lem. It also should be noted that stents initially were designed as an emergency “back up” for failed PTCA. Restenosis of BMS thus led to further research and the eventual development of DES, a stent that was coated with drugs to help keep blood vessels from reclosing (restenosis).

The arrival of the DES seemingly conquered this problem of restenosis. Developed between 1997 and 2000, DES underwent extensive clinical trials showing a marked reduction in restenosis of approximately 50 to 70 percent compared to BMS.

This effect was present across all patient settings, ves-sel sizes, and vessel lengths. This dramatic reduction in restenosis and need for repeat procedures or coro-nary bypass led to an increased usage of DES, essen-tially dominating PCI, with 85 percent of procedures utilizing a DES by the year 2005 to 2006. However, as with all other procedures, some questions were raised with respect to safety and long-term outcome.

In 2005 and 2006, research in the U.S. and Europe raised concerns about the possibility of stent-closure

clotting (stents becoming blocked due to clots de-veloping from scar tissue). To date, data is limited, but early research may suggest that with the dra-matic reduction in repeat revascularization and restenosis, there may be accompanied by a higher, but very low risk of late stent blockage due to clot formation.

In 2007, more data became available from the National Heart Lung and Blood Institute and other investigators showing that, although there may be a slightly greater risk of late stent closure by clotting, the risks for death and heart attack is identical to BMS the first four years following stenting. Several studies have shown DES to have about the same rate of death and heart attack as BMS patients. Further-more, the initial trials investigating the results of DES have shown slowed progression of cardiovascular disease for at least five years with dramatic reduction in the need for repeat PCI procedures.

Thus, it is important to remember that DES have been viewed not as a destination treatment, but as a stop along a long and extensive road of patient-care techniques that have evolved during the past 30 years to improve the health and well-being of patients.

The next step in this ongoing process is the devel-opment of new dissolvable stents. Further develop- ments in drugs to prevent restenosis and newer medical therapies to prevent clotting and reduce inflammation will hopefully lead to lower rates of recurrences and long-term improvements in the care we deliver to our patients. The future seems bright with even more impressive advances yet to come. ■

Drug eluting stents are coated with drugs designed to limit the exagger-

ated tissue growth associated with restenosis (renarrowing of the arteries).

The arrival of the drug eluting stents (DES) conquered the problem of

restenosis, reducing the rates from 25 to 30 percent for bare metal stents to 7 to 9 percent for DES. These stents, which were initially developed between 1997

and 2000, underwent extensive investi-gation and clinical trials and showed a restenosis reduction in all patient set-tings, vessel sizes, and vessel lengths.

Mark D. Cohen, MD, specializes in the fields of interventional cardiol-ogy, peripheral vascular disease, and general cardiology. He is an active clinical investigator on new device therapy for coronary artery disease.

Des has generated great excitement, intense utilization,

and close scrutiny mainly because of its effectiveness at

keeping the artery open.


Dr. Ronald Landin of Fort Wayne Cardiol-ogy explains the importance of Ejection-Fraction (EF) to a patient. EF can be measured by diff erent techniques, suchas an echocardiogram (an ultrasoundof the heart) or nuclear scans.

Most people can tell you what their blood pressure or cholesterol is. But how many of us know what our EF is?

EF stands for Ejection-Fraction, and it is arguably the single most important factor (among many) in deter-mining prognosis in patients who have heart disease. Th e EF is usually conveyed as a percentage, such as 30% or 32%; and it is the most widely accepted measure of the strength or vigor with which the main pumping chamber of the heart, the left ven-tricle, pumps. It is also commonly known as the leftventricular ejection-fraction (LV EF).

It is important to point out that the normal EF is not 100% — in fact, not even close to that. A normal EF ranges from approximately 50 to 55% up to 75 to 80%. Th is number represents the amount of the blood in the heart that is ejected with each contrac-tion of the heart muscle. If the heart muscle, specifi -cally the left ventricle, becomes damaged or weak-ened in some manner, then the less power the heart has to pump blood. Th erefore, less blood is ejected from the heart with each contraction and the lower the EF. By convention, cardiologists usually consider

an EF of 45 to 50% to represent a mildly damaged heart muscle; an EF of 35 to 45% to represent moder-ate damage; and an EF of less than 35% to represent a severely weakened heart muscle.

When a patient has damage to the heart muscle, the condition is known as a cardiomyopathy. Th ere are many possible causes for cardiomyopathy. In the United States and other developed countries, the most common cause is atherosclerotic coronary artery disease. In atherosclerotic disease, fat and other deposits form in the walls of the coro-nary arteries, the arteries that feed the heart muscle. Th is build up is called plaque. Eventu-ally the plaque can rupture, resulting in a sud-den obstruction of blood fl ow. Th is occurrence causes a heart attack, or acute myocardial infarc-tion, which leads to death or damage to areas of the heart muscle. Myocardial infarctions can be large or small, singular or multiple, mild or severe; and consequently, they can result in diff erent de-grees of heart muscle damage and thus, diff erent EFs. Cardiomyopathy may also be caused by other con-ditions, including valvular heart disease, uncon-trolled hypertension, viral infections, and a host of other disease or medical problems. Not infrequently, the specifi c cause of a cardiomyopathy is unknown and is referred to as an idiopathic cardiomyopathy. Whatever the cause, cardiomyopathy frequentlyAn important

number to knowEducating patientsabout their ejection-fraction

By William W. Wilson, MD


results in a weakened heart muscle, causing a decrease in the EF.

The EF is an important measurement to deter-mine when investigating any potential heart problem. It can be measured by different tech-niques, but the most common way is with an echocardiogram, or ultrasound of the heart. An echocardiogram is a safe, noninvasive test that can be performed quickly and can give an ac-curate EF. Nuclear cardiac scans also measure EFs accurately. Finally, cardiac catheterizations, while usually performed to visualize the coro-nary arteries, can also provide the patient with an EF value.

A low EF means the pumping power of the heart is weak. As one might surmise, a person with a low EF is prone to develop heart failure, which if left untreated, can be fatal. Thus, once a cardiologist identifies a patient with a low EF, an aggressive medical regimen is initiated to help strengthen the heart and prevent heart failure.

Another problem associated with a low EF is that the patient is prone to develop irregular rapid abnormal heart rhythms without warning. These abnormal heart rhythms, if not terminated by an electrical shock, can cause death. Patients with very low EFs have been shown to be at risk for sudden cardiac death due to arrhythmias. These lethal rhythm disturbances are effectively treated with a device called an implantable cardioverter defibrillator (ICD). ICDs function to automati-cally detect the rhythm disturbance promptly at any time and terminate the arrhythmia with ei-ther pacing or, if necessary, a programmed shock. Because these arrhythmias occur unpredictably and without warning, and are much more com-mon in those patients with low EFs, ICD devices are now recommended for patients with low EFs, even if they feel fine. In this manner, cardiologists hope to reduce the incidence of sudden cardiac death due to arrhythmias. ■

William W. Wilson, MD, specializes in the fields of nucle-ar cardiology, interventional cardiology, and hemostasis/thrombosis. He is the founder and director of the Parkview Anticoagulation Therapy Unit and continues active clini-cal research through the Parkview Research Center.


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