Drexel Health Q&A Series: Heart Health
My father and grandfather both died of a heart attack in their 50s. Am I destined to get heart disease too?
Coronary artery disease is a slow process, during which cholesterol deposits within the coronary arteries, which supply blood flow to the heart. The danger and fear are that at some point the arteries will get clogged and a "heart attack" will ensue. There are many risk factors for coronary artery disease, including high blood pressure, elevated cholesterol, diabetes, smoking and family history. Emerging risk factors also include obstructive sleep apnea and any chronic condition that causes inflammation. Although you cannot alter your family history, it is certainly possible to alter the remaining risk factors. This includes regular cardiovascular exercise, adherence to a heart-healthy diet, smoking cessation and maintaining good control of blood pressure, diabetes and cholesterol.
Paulina Gorodin-Kiliddar, MD, is a cardiologist at Drexel Medicine specializing in non-invasive cardiology, including stress testing and echocardiographic imaging. She is also an associate professor in the Division of Cardiology at Drexel University College of Medicine. She sees patients in two locations – Center City and Rittenhouse Square.
My mother has heart failure, and her doctors have said she could benefit from a VAD. What is a VAD, and will it make a big difference in her health?
A ventricular assist device or VAD is a mechanical pump that is implanted in the chest. It is used to provide additional blood flow to the organs of patients with severe heart failure whose hearts are unable to provide adequate blood flow to other organs. Patients who are being considered for a VAD have typically failed to respond to medical therapy such as ACE inhibitors, diuretics and beta blockers, as well as device therapy with pacemakers. VADs are implanted in the chest and have one tube that goes from the left ventricle to the VAD and another tube that goes from the VAD to the aorta. A spinning rotor in the VAD pushes blood from the heart into the body. A wire leads from the VAD to a battery pack outside the body. VADs can be used either as bridges to transplant (to keep patients alive until a donor heart becomes available) or as destination therapy, where the VAD is left in long term instead of a transplant. For patients with severe heart failure, VADs may improve survival and quality of life.
Howard J. Eisen, MD, is chief of the Division of Cardiology at Drexel University College of Medicine and one of the most experienced transplant cardiologists in the world. His areas of expertise include heart failure and heart transplant care, including the use of non-invasive procedures to diagnose transplant rejection. Dr. Eisen sees patients at Drexel Medicine in Center City, Northeast Philadelphia (Cottman Avenue/Mayfair) and in Langhorne, Pennsylvania.
My husband was just diagnosed with an arrhythmia. Is that dangerous?
An arrhythmia is an abnormal heartbeat arising from the upper or lower chambers of the heart. Electrical activity of the heart may be too slow or too fast. A slow heart rate sometimes necessitates treatment with a pacemaker, and fast arrhythmias require treatment with medication. A common arrhythmia originating from the upper chambers is atrial fibrillation. In this condition, the atria are beating at a rate of 350 beats per minute or more. The bottom chambers do not beat that fast since the rapid impulses cannot travel to the bottom chambers that quickly. Patients with this arrhythmia often require blood thinners or anticoagulants to prevent clot formation and a stroke. Arrhythmias originating in the ventricles at a rapid rate, called ventricular tachycardia or ventricular fibrillation, often require resuscitation with an automatic external defibrillator (AED). Such arrhythmias also may be treated with an implantable defibrillator, which is a device similar to a pacemaker that is implanted under the skin near the collarbone, capable of terminating the arrhythmia with a shock. This treatment modality is a highly effective technological advancement that saves lives.
John M. Fontaine, MD, is director of cardiac arrythmia services at Drexel Cardiology and a professor in the Division of Cardiology at Drexel University College of Medicine. He specializes in cardiac electrophysiology, which is the study of the electrical system of the heart. His areas of expertise include implanting pacemakers and defibrillators, managing arrythmias, and performing ablations, a technique used to treat abnormal heart rhythms. Dr. Fontaine sees patients in Center City and Manayunk.
The leads on my pacemaker aren't working properly, and I've been told I need to have an extraction. Is this a risky procedure?
Leads from a pacemaker or defibrillator flex with the heartbeat 100,000 times per day. Sometimes leads break, and sometimes they become infected. When this happens, and the leads could cause you harm if they are left in place, your doctor may recommend that they be removed or extracted. Lead extraction has become one of the mainstays of lead management. Though the procedure is complex, it can be performed safely by an experienced cardiac team. The risk of lead extraction mainly depends on how long the leads have been in place. For example, leads that were implanted 15 years ago would be more difficult to remove and have more risk than leads that were just inserted two to three years ago. Though the risk of lead extraction can be greater than the risk of implanting your leads in the first place, nearly all patients have a safe and successful extraction procedure.
Steven P. Kutalek, MD, is director of cardiac electrophysiology and associate chief of the Division of Cardiology at Drexel University College of Medicine. His specialties include pacemakers and new defibrillators, the metabolic aspects of rate-responsive cardiac pacing, and antiarrhythmic medications. He is a national expert in lead extraction, which is the removal of one or more leads or wires that deliver energy from a pacemaker or implantable cardioverter defibrillator (ICD). He sees patients in Center City and Northeast Philadelphia (Cottman Avenue/Mayfair); Langhorne, Pennsylvania; and Marlton, New Jersey.
The information on these pages is provided for general information only and should not be used for diagnosis or treatment, or as a substitute for consultation with a physician or health care professional. If you have specific questions or concerns about your health, you should consult your health care professional.
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