Fetal echocardiograms can detect heart irregularities early | Page 8

Nearly half-century love threatened by silent heart attack | Page 6

Vol. 2, No. 2 | April 2011to yourHEART

A newsletter for friends of King’s Daughters Heart & Vascular Center

OPENING UP ABOUT HEART

VALVESCardiothoracic surgeon J.C. MacHannaford, M.D., talks murmurs | Page 2

A L S O I N S I D E . . .

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Chances are, you know someone who has a heart murmur. You may even have been told you have a murmur. But what is a murmur

– and what does it mean for your heart health? King’s Daughters cardiothoracic surgeon J.C. MacHannaford, M.D., has some answers.

Question: What is a heart murmur?

Answer: A murmur is an extra sound in the

heart caused by the opening and closing of

the heart valves. If your valves don’t close

completely, we can hear the blood flowing

backward. That’s called regurgitation. If a valve is too

narrow for the blood to pass easily, we can hear the

turbulence of the blood left behind in the chamber as

the valve closes.

Q. What causes murmurs?

A. Murmurs can be caused by a structural

defect at birth. Sometimes these require surgery.

Sometimes nothing needs to be done, but the condition

needs to be monitored closely as the child grows.

Adults can acquire a murmur as a result of underlying

disease. Causes include heart attacks, uncontrolled high

blood pressure, plaque on the valve leaflets, rheumatic

fever, exposure to toxic chemicals and drug abuse.

The most common valve disease in adults is aortic

stenosis, which is when calcium deposits on the

leaflets of the valve. They get stiff and can’t open

completely. Some of the blood that should pass into

the aorta remains behind.

Q. Can this happen to

any valve?

A. Yes. But the valve we are most concerned

about is the aortic valve. In aortic stenosis, the heart is

unable to push enough blood out of the left ventricle to

meet the body’s needs. The body doesn’t receive the

oxygen and nutrients it needs and the heart begins to

compensate.

Q. How does the heart compensate?

A. The walls of the ventricle grow thicker and

larger, which allows it to squeeze the chamber

more forcefully. This increases the pressure through

the aortic valve.

That might not sound bad, but as the muscle enlarges,

the chamber shrinks, so there’s less room for blood.

And the pressure on the valve increases as the muscle

squeezes more forcefully.

The heart will continue to compensate in this way until

it overloads. We know that all untreated valve disease

leads to biventricular overload – congestive heart

failure.

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What you knowshouldheart murmursab

out

Left ventricle

Aortic valve

Aorta

The Anatomy of Aortic Stenosis

Q. What if I’ve been told I have a murmur –

but not to worry about it?

A. Your doctor has likely told you this because

you have no symptoms. A lot of adults will never

develop symptoms.

Others live 10 or even 20 years without symptoms.

You don’t need to worry, but you should be vigilant.

Get regular checkups. If your doctor orders an

echocardiogram or stress test for you, get the tests

done. And if you develop symptoms, report them

immediately.

Q. What are the symptoms?

A. The three major symptoms are chest pain,

dizziness/fainting and shortness of breath.

If you have a murmur and develop any of these

symptoms, get to your doctor immediately. Of those

who develop symptoms and don’t receive a valve

replacement, only about half will live:

• Five years after developing chest pain

• Three years after developing dizziness/fainting

• Two years after developing shortness of breath

Q. Does valve replacement really work?

A. Yes. When it’s time to replace a defective

valve, there are a variety of approaches

available and patients – even those with multiple health

problems – see significant improvement in their health

following a replacement.

Dr. MacHannaford is associated with

Cardiothoracic Surgeons of Kentucky and

maintains office hours in Ashland, Ky., and

Portsmouth, Ohio. He can be reached by dialing

(606) 326-9847.

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Normal Aortic Valve

Stenotic Aortic Valve

It’s never too early to start learning about heart health and making decisions that will ultimately lead to a longer, healthier life. The decisions we make today will impact

our future heart health.

More than 120 Girl Scouts from all over Kentucky, Ohio and West Virginia, their parents and troop leaders descended upon King’s Daughters Feb. 19 to “Go Red” for heart health. The Girl Scouts came to earn their Go Red merit badges for heart health, learning about the importance of nutrition, exercise and not using tobacco products. KDMC cardiologist Jennifer Listerman, M.D., kicked off the

A buncha tough cookiesLocal Girl Scouts learn that heart health isn’t about sugar and spice, but eating right and exercising

program with a presentation about why these things are so important for heart health.

“As a woman and a mom, women’s heart health is especially important to me,” Dr. Listerman told the girls. “Traditionally heart disease has been thought of as a man’s disease, but it is the No. 1 killer of both men and women in the United States,” she said.

“With exercise, proper diet and avoiding tobacco products, you can actually help strengthen your heart and prevent heart disease. It’s important that these girls start getting this education now.”

Girl Scouts also learned how to stay active trying new exercises – such as yoga and zumba. “We want girls to know that exercise is not only good for your heart, but it can be fun, too,” said Sabrina Esenbock, manager of KDMC’s Team Wellness program.

The Girl Scouts explored nutrition by taste-testing unusual fruits and vegetables, learning about different types of fats and building a better breakfast. “Making wise food choices is a learned behavior. We need to educate our youth about what is good for them and why,” said Esenbock.

“Our hope is by educating these Scouts, they can avoid heart disease and live longer, healthier lives,” said Dr. Listerman.

The program was offered in conjunction with the Girl Scouts of Kentucky’s Wilderness Road Council.

By the end of the day, the Scouts had earned “Go Red” merit badges, honoring that they had studied the importance of heart health with the help of King’s Daughters team members.

Heart disease isn’t always dramatic. It isn’t always sudden. And it almost never unfolds like the movies, as Jimmy and Cozetta Bond can attest.

Jimmy’s journey with heart disease began in 1996. “Jimmy was cleaning out the gutters on the house,” Cozetta recalls. The ladder slipped out from under him and he fell, breaking his shoulder and several bones in his face.

During his hospital stay, the couple of 46 years first heard the words, “heart failure.” “Mostly, we just went on about our business,” Cozetta says. “We paid closer attention to our diets and his sodium intake, and we tried to be more careful.” And so the Olive Hill residents soldiered on, until 2000, when Jimmy was diagnosed with diabetes.

Diabetes has profound effects on the entire body, and the heart is no exception. Diabetics are two to three times more likely to suffer a heart attack than non-diabetics. And when they have those heart attacks, they are more serious, more subtle and more difficult to diagnose.

Although he knew he had health challenges, it wasn’t until 2004 that Jimmy started to feel something was very wrong. “I was mowing the grass when I realized I was doing more standing and resting than mowing,” he says.

Jimmy underwent cardiac catheterization, which revealed significant damage to his heart. “They told me I probably

had a silent heart attack,” Jimmy says. A silent heart attack – silent ischemia – is not uncommon in people with diabetes. It’s difficult to say when it occurred, but Jimmy’s situation was serious.

He underwent a quintuple bypass and received a pacemaker to keep his heart beating steadily. He also received an implantable defibrillator (ICD) to shock

his heart back to normal rhythm during episodes of ventricular tachycardia (v-tach).

As Jimmy’s disease progressed, visits to the emergency room became more frequent, as did admissions to the hospital. “From January to July 2010, Jimmy was admitted to the hospital four or five times,” Cozetta recalls.

“We were in the emergency room every time we turned around,” Cozetta says.

It was last July when Cozetta was facing her own health challenge that Jimmy’s situation came to a crisis. “I think he was stressed and worried about me,” Cozetta says. He experienced multiple bouts of v-tach, with his ICD firing each time.

Overwhelmed and in need of more support and direction, they knew there had to be a better way forward.

And then they met heart failure nurse Barb Davis. “Barb came and talked to us about the Heart Failure Clinic and

His heart attack was silent, even when his will to live and dedication to his 46-year love was not. Now, with the help of his wife, King’s Daughters Center for Heart Health and the telehealth monitoring program, Heart Failure patient Jimmy Bond again has a voice.

When failure isn’t an option

Diabetics often experience heart attacks that are more serious,

more subtle and more difficult to

diagnose.

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how it could help us,” Cozetta says.

Jimmy started attending the Heart Failure Clinic, a part of King’s Daughters Center for Heart Health. The team there – led by nurse practitioner Donna Holbrook – helped the couple understand Jimmy’s condition and the steps they can take to control it.

They now know how important it is to manage Jimmy’s potassium levels. Paying close attention to this has meant no more v-tach episodes. They manage his weight and water retention carefully. If there’s a question or concern, they call the clinic and get help.

Since July, the couple hasn’t made a single trip to the ER and Jimmy hasn’t spent a single minute in a hospital bed.

In addition to the clinic visits, Jimmy participates in the telehealth monitoring program, which monitors his blood pressure, weight, pulse and oxygen levels and transmits his results to the clinic every morning. If intervention is needed, the clinic is there to help. “They have never told us they can’t see us or they don’t have time. They always work us in,” Cozetta says.

“I can’t tell you the peace of mind it’s given me to know the Heart Failure Clinic is here. It’s such a relief knowing I can talk to someone who knows Jimmy, knows me and cares about us,” Cozetta says. “It’s been a godsend.”

Adds Jimmy, “I know they have kept me alive.”

Reducing the impact of heart failureHeart failure is a chronic, progressive disease in which the heart is unable to meet the body’s needs for blood and oxygen.

Risk factors include: • coronary artery disease; • heart attack;• structural defects of the heart;• diabetes; • excessive alcohol/drug use; • and untreated hypertension.

The Heart Failure Clinic at King’s Daughters Center for Heart Health works closely with patients and families to help them avoid hospitalization, stay on top of symptoms and reach out to people throughout the region with education and support.

Physician referral to the clinic is not required and clinic services are covered by most insurance plans, including Medicare.

“A diagnosis of heart failure can be frightening to both patient and family,” said Barb Davis, a nurse in the clinic. “By helping patients understand their condition and the things they can do to manage it, we give them a sense of control,” she said.

In the inpatient setting, King’s Daughters participates in the American Heart Association’s Get with the Guidelines (GWTG) program for Heart Failure.

King’s Daughters recently achieved Gold level performance in GWTG-Heart Failure.

For more information about services for patients with heart failure, please call (606) 408-6000.

To Your Heart is published four times a year by King’s Daughters Medical Center, Ashland, Ky., and is mailed, free of charge, to Kentucky, Ohio and West Virginia residents.

President/CEO: Fred L. Jackson; Senior Vice President, Service Line Development: Kristie Whitlatch; Vice President of Heart and Vascular Services: Stacy Patrick; Medical Director, Heart and Vascular Center: Richard Paulus, M.D.

To contact us about To Your Heart, please call toll free 1.888.377.KDMC (5362).

Marketing/Public Relations Staff: Carrie Bennett, Erin Bounds, Beth Caruthers, Tom Dearing, Kellie DeLaney, Betsy Donahue, Kevin Herrman, Chad Kinzel, Bill Napier, Jerry Pennington, Keri Stewart, Rachael Turner and Kerry Winkler.

To Your Heart is published for the purpose of disseminating health-related information for the well-being of the general public and its subscribers. The information obtained in this publication is not intended for the purpose of diagnosing or prescribing. Please consult your physician before undertaking any form of medical treatment and/or adopting any exercise program or dietary guidelines. To Your Heart is copyright 2011 by KDMC. All rights reserved. Subscriptions are free. To be included or taken off the mailing list, contact us by email at info@kdmc.net or call 1.888.377.KDMC (5362).

Pregnancy is filled with joyful firsts: Hearing the baby’s heart beat for the first time. Feeling her first fluttery kick. An ultrasound image of baby sucking his thumb.

Occasionally, the joy can be punctuated by concern, especially when the unborn baby’s heart is in question. Today, parents facing such a crisis can turn to the heart experts at King’s Daughters Heart & Vascular Center for help.

“We know how frightening it can be to learn your baby might have a heart defect,” said Stacy Patrick, vice president of the Heart & Vascular Center at King’s Daughters. “Getting answers quickly becomes the top priority for parents.”

King’s Daughters now offers fetal echocardiograms, a very detailed examination of the unborn baby’s

heart performed by specially trained technologists using specialized ultrasound equipment.

The images and information gathered during a fetal echo is much more focused and precise than a routine pregnancy ultrasound, said Kathy Cremeans, director of cardiac imaging at King’s Daughters.

Results are read by pediatric cardiologists Brian J. Holland, M.D., Mary Matta, M.D., and Lucinda Wright, M.D., who are on staff at both King’s Daughters and Kosair Children’s Hospital in Louisville.

“We are very fortunate to be able to partner with these outstanding pediatric cardiologists in caring for these tiny hearts,” Patrick said.

Dr. Holland, along with colleagues

Bradley Keller, M.D., and Robert Solinger, M.D., maintain regular office hours in Ashland, where they provide specialized care, referral to neonatologists and other services. Their Ashland office can be reached by calling 1-800-334-8635.

According to the American Heart Association, about 36,000 babies are born annually with a congenital heart defect. Detecting abnormalities during pregnancy allows doctors and parents to plan for the birth and services that may be needed shortly after delivery. In some cases, treatment of the defect may be done in utero – before the baby is born.

Most expectant parents will never face this crisis, Patrick said, but for those who do, having fetal echos available in Ashland will help them get answers quickly and conveniently.

Detecting heart problems before birth

Fetal echocardiograms at King’s Daughters can provide

expecting parents with answersDebbie Arnett, the only registered fetal echocardiographer in the Tri-State, and Eva Webb, technical director of noninvasive cardiology