Cardiac Care Network

Heart of Lancaster and Lancaster Regional Medical Centers are the first and only accredited Chest Pain Centers in Lancaster County.

Heart of Lancaster Regional Medical Center recently received full accreditation as a Chest Pain Center by the Society of Chest Pain Centers (SCPC), an international organization dedicated to eliminating heart disease as the number one cause of death worldwide.

When seconds count, Heart of Lancaster is equipped for immediate action and stabilization. Lancaster Regional’s Chest Pain Accreditation includes Percutaneous Coronary Intervention (PCI). Heart of Lancaster and Lancaster Regional work as a team and together, offer the comprehensive Cardiac Care Network.

Heart attacks are the leading cause of death in the United States, with 600,000 dying annually of heart disease. More than five million Americans visit hospitals each year with chest pain. The goal of the Society of Chest Pain Centers is to significantly reduce the mortality rate of these patients by teaching the public to recognize and react to the early symptoms of a possible heart attack, reduce the time that it takes to receive treatment, and increase the accuracy and effectiveness of treatment.

The benefits of having an Accredited Chest Pain Center right here in Lancaster County include:

• Reduced time to treatment during the critical early stages of a heart attack.
• Integrating the best practices for cardiac care into process.
• Better outcomes.
• Timely, accurate diagnoses of all patients presenting with signs and symptoms of heart disease that help reduce unnecessary admissions, saving patients money and inconvenience.
• Recognizable symbol of trust that helps patients and emergency medical service (EMS) make decisions at highly stressful times.
• Better public understanding of the symptoms of heart attack and how to deal with heart emergencies.

Heart of Lancaster also serves as a point of entry into the health care system to evaluate and treat other medical problems, and helps to promote a healthier lifestyle in an attempt to reduce the risk factors for heart attack.

About The Society of Chest Pain Centers 

Established in 1998, SCPC is a patient-centric nonprofit international organization focused on improving care for patients with heart disease. Central to SCPC’s mission is the question, “What is right for the patient?” In response, SCPC promotes protocol-based medicine, often delivered through a chest pain center model, to address the diagnosis and treatment of acute coronary syndrome and heart failure and to promote the adoption of process improvement science by health care providers. To best fulfill this mission, SCPC provides accreditation and education to facilities striving for optimum cardiac care. SCPC is headquartered in Columbus, Ohio. For more information on SCPC and accreditation opportunities, visit Society of Chest Pain Centers, or call toll free (877) 271-4176. You can also follow SCPC on Facebook.

Coronary Artery Disease - It’s Not Just for Men 

Paul Brown, MD, FACS, FACC, Cardiothoracic & Vascular Surgeons of Lancaster (717) 735-3920

Each year in February the American Heart Association (AHA) focuses on women and cardiovascular disease encouraging women to seek earlier treatments for cardiovascular disease to prolong and improve their quality of life. The AHA reminds women that coronary artery disease is not a just disease affecting an overwhelming number of men. In fact, just the opposite is true.   

Here are some startling statistics for you: 

• Heart disease kills 32% of American women and is the leading cause of death in American women. An additional 11% die from strokes, which have the same risk factors. 
• Eight million American women, 10% percent of women under the age 65 and 25% of women over age 65, live with the disease. 
• 13% of women over age 45 have had a heart attack. That equates to 435,000 American women having heart attacks each year, with 83,000 under age 65 and 9,000 under age 45. In total, 267,000 women are dying from heart attacks each year, which is six times the risk as from breast cancer. 

Contrary to popular belief, coronary artery disease is not just a disease of old age. It is a disease of uncontrolled risk factors such as hypertension, elevated cholesterol, diabetes, obesity, sedentary life- style and ongoing tobacco abuse. For example: 

• African American women ages 55-64 are twice as likely as white women to have a heart attack and 35% more likely to suffer from coronary artery disease. 
• Women who smoke risk having a heart attack 19 years earlier than non-smoking women. 
• Women with diabetes are two to three times more likely to have a heart attack. 
• High blood pressure is more common in women taking oral contraceptives, especially in obese women. 
• 38% of women, and 25% of men, will die within one year of a first recognized heart attack, and 35% of female and 18% of male heart attack survivors will have another heart attack within six years. 46% of female and 22% of male heart attack survivors will be disabled with heart failure within six years as well. 
• More women than men die of heart disease each year, yet women receive only 33-36% of angioplasties and open-heart surgeries. Women comprise only 25% of participants in all heart related research studies and 31,000 of women die each year of chronic heart failure, which is 1.6 times the rate as men. 

There are no "pills" that can reverse the disease, but there are many options to help prevent the blockages from getting worse. These options center round controlling risk. It is rarely too late to reduce one’s risk factors. For example, those with high cholesterol who engage in exercise three times per week cut their risk of death in half, from 15 times normal to 7 times normal. Taking cholesterol lowering medications may reduce the risk of death from a heart attack by 50% as well. 

If you are concerned you might be at risk, or because you are already having chest pains or shortness of breath with exertion, a visit to your internist or family physician or cardiologist is in order. The oldest and most reliable test to look for disease is probably the ECG, which shows if you have ever had a heart attack in the past or if you are actively having any problems. The next test is a physiologic test of heart function, the most common of which is an exercise treadmill test. One’s pulse, blood pressure and ECG are monitored while exercising. Nuclear imaging of the heart is usually done at the same time to show changes in blood flow to different areas of the heart with rest and exertion. For those unable to exercise, various medications are administered to cause the heart to pump vigorously to simulate exertion. 

Depending on risk factors and symptoms, your cardiologist may then recommend an elective cardiac catherization. This is the gold standard test that allows one to correlate the physiologic abnormalities of heart function with actual blockages in the coronary arteries. A cardiologist can then actually open up blockages or recommend that the patient be seen by a cardiothoracic surgeon who specializes in the surgical treatment of the heart. These treatments may include bypass grafting or valve repairs and replacements. 

The best news is that people who would have died just 50 years ago of coronary artery disease can now often go home in a few days after treatment. However, the real focus and best approach is the prevention of heart disease in the first place. The old adage of "an ounce of prevention is worth more than a pound of cure" has never been more applicable than to patients with coronary artery disease.

The Mediterranean Diet: A Succinct Overview 

Nehal D. Patel, MD, Red Rose Cardiology (717) 735-8150

It’s the type of diet which has received plenty of attention in the media during the last several years. Recent research articles have also been published in prestigious medical journals extolling its benefits. So, what exactly is the “Mediterranean diet”? Is it a dietary plan where the serving size is strictly calibrated and the cuisine is so toned down that it’s virtually flavorless and insipid? No, there’s more to this diet than one may expect at first. Let’s take a look at the history behind this diet so its full perspective becomes evident.   

The Mediterranean diet first gained attention back in the 1950s and 1960s when a research team led by Ancel Keys, PhD, found that inhabitants of Greece, Crete, southern Italy, Spain, southern France, and regions of the Middle East seemed to experience much lower rates of cardiovascular disease than their counterparts in North America and northern Europe. At that time, it was found that people residing in this Mediterranean basin consumed more produce and higher levels of monounsaturated fat (predominantly in the form of olive oil). Moreover, they also engaged in a greater degree of physical activity. In addition, the diet also existed in a specific cultural context: the people in the Mediterranean region seemed to foster strong social and family bonds around the dining experience. Eating meals was not done in a solitary and rushed fashion as is sometimes the case in the more fast-paced, industrialized nations. As Dr. Andrew Weil would remark when studying this diet, “eating together and taking pleasure in food” appeared to be central tenets in these healthy societies. What are some basic principles involved with the Mediterranean diet? Here are some guidelines to get started and also to whet your appetite. 

• Use olive oil as the primary cooking fat. The monounsaturated fat in olive oil seems to be the key element to many of the benefits of the Mediterranean diet. Extra-virgin olive oil is a worthwhile investment since it contains more antioxidant activity. Use olive oils in sprinkling salad, sautéed with vegetables, tossed with pasta, or as a dip for crusty bread.
• Experiment with whole, unrefined grains. This category includes various types of pasta as well as rice, couscous, barley, bulgur, and polenta (cornmeal).
• Incorporate beans. Legumes such as cannelloni, kidney, fava, and lima beans; chickpeas; and lentils will provide protein and texture to different dishes. They also provide a good source of vitamins, minerals, phytochemicals, and fiber.
• Enjoy produce during each meal. Consuming a rainbow array of fruits and vegetables will provide a good source of protective phytochemicals. Fresh, locally grown produce is preferred but even using canned fruits and vegetables during the colder months is a healthy alternative. Commencing lunch and dinner with salad is also a good technique. It will also promote satiety so you consume less calories.
• Cultured dairy products can be used. Historically, refrigeration was expensive for many inhabitants of the Mediterranean region. The cuisines included more cheeses and yogurt as opposed to milk. As a result, these were used as seasonings and flavorings rather than as a basis for a meal. Grating small amounts of cheese over pasta or soup is a healthy idea.
• Meat intake can be adjusted. Most of the protein in the Mediterranean diet derives from beans and fish. If you enjoy red meat, it can be used occasionally as a seasoning in soups and sauces. In this manner, it can add flavor to a meal as opposed to becoming a focus of the meal.
• “Going nuts” about the diet. Nuts historically have been abundant in the Mediterranean basin. They provide fiber, protein, folic acid, as well as vitamin E. Interestingly, omega-3 fatty acids are found in good amounts within walnuts. Munching on a handful of nuts is more healthy than eating other more processed snacks
• Transforming meals into a social event. Enjoy mealtime in the company of others. Eliminate distractions such as watching television and enjoy the time set aside for the meal. 

With practice, you will also learn to savor the various ingredients and elements comprising the meal. A sense of gratitude will also arise with such mindful eating in the company of loved ones and friends. These guidelines can help you to get acquainted with the general outline of the Mediterranean diet. For inspiration in being creative gastronomically, various cookbooks can be consulted. The New Mediterranean Diet Cookbook, by Nancy Harmon Jenkins, is a suggestion. Another good volume is The Mediterranean Diet, by Marissa Cloutier and Eve Adamson. This latter book also includes a good section on the historical context as well as objective research findings supporting the benefits of the Mediterranean diet. 

When implementing changes to your diet, it’s best to begin gradually and to experiment with a couple of the suggestions delineated above. Be creative and bon appétit.

ARTERIAL ANEURYSMS

Surya R. Kumar, MD, FACS, Cardiothoracic & Vascular Surgeons of Lancaster (717) 735-3920

An aneurysm is defined as a permanent, localized dilatation of an artery, having at least a 50% increase in diameter when compared to the diameter of a normal artery. Arterial aneurysms have been recognized since ancient Greek and Roman times and the term aneurysm is derived from the Greek word aneurysma, meaning “a widening”.

In the last fifty years, tremendous strides have been made in the management of aneurysmal diseases of the arteries. People who would have died many years ago can now go back home after just a few days in the hospital! The greatest risk of aneurysm has always been sudden rupture and prevention of rupture is the key in management of this condition.

Aneurysms occur due to a degenerative process in the architecture of the arterial wall and are classified according to their location, size, shape and etiology. Risk factors include family history­­­­­, smoking, COPD, disorders of cholesterol metabolism and male gender.

Rupture of an aneurysm is due to rise in wall tension. This causes severe bleeding and is mostly fatal. Aneurysms can also present in other ways. Clots that form within arteries can break away and be carried into the bloodstream, obstructing arteries elsewhere.  This can restrict blood supply and cause gangrene and tissue loss. They can also press upon other adjoining structures or rupture into them.

The most common site for degenerative aneurysms is the abdominal aorta, called abdominal aortic aneurysm (AAA). In the United States, ruptured AAAs are the 15^th leading cause of death overall and the 10^th leading cause of death in men older than age 55. Most AAAs are asymptomatic, which often leads to difficulty in their detection. Most AAAs that become symptomatic do so because of rupture or acute expansion. Rupture has a mortality rate of more than 75%, so early diagnosis via ultrasound, CT or MRI and subsequent treatment are vital.

The incidence of AAA in hospitalized patients in the United States is approximately 50 per 100,000. Non-aortic aneurysms are much less common - three per 100,000 for iliac aneurysms and 4 per 100,000 for femoropopliteal aneurysms. Popliteal aneurysms account for 70% of all peripheral aneurysms. Thoracic aortic aneurysms (TAA) are also lower in incidence in comparison to AAA. But the incidence of TAA has increased gradually and is estimated to be 10.4 cases per 100,000. Most TAAs are discovered incidentally in asymptomatic patients. Visceral and renal artery aneurysms are rare.

For aneurysm treatment, the choice between regular observation and surgical repair and is decided by several factors. Surgical techniques can include open repair or minimally invasive stent graft techniques.

If you have a family history of aneurysmal disease or are concerned that you may have an aneurysm of the abdominal aorta, a visit to your internist or family physician is in order ASAP! He or she may order an ultrasound of your abdomen. If an aneurysm is detected, he or she may refer you to a thoracic or vascular surgeon for follow up, which can include regular observation or repair to prevent rupture. Rest assured that the physicians associated with Heart of Lancaster can provide expert, timely and compassionate diagnosis and treatment.