february 2013

A new heart valve gave Kelli a new outlook on life

+ A Leg UpPAge 3

+ An easier Way to Your HeartPAge 3

+ Know the SymptomsPAge 4

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CardiaC Care

LooKing for A cArdioLogiSt?Keep these three things in mind.

• make sure he or she is board-certified. Whether through online research or by simply asking the office, make sure the doctor is board-certified in cardiology.

• Ask your primary care physician. “Encourage your primary care doctor to suggest a cardiologist,” Dr. Berbarie says. If you’re comfortable with your doctor, you probably will be able to communicate and work with a cardiologist he or she recommends.

• trust is key. A doctor you trust is a doctor you’ll be honest with, and that’s essential.

Look After Your HeartIf you’re experiencing symptoms of a heart attack, call 911. For a referral to a cardiologist near you, call 1.800.4bAYLor.

Know the SymptomsA heart attack may feel different than what you expectWhen a heart attack occurs, it’s important to act quickly to get medical care to save the person’s life and prevent as much damage to the heart muscle as possible. That’s why understanding the symptoms of a heart attack is critical—but they don’t always look like what you’ve seen in the movies.

“When we think about heart attack, the first symptom we worry about is chest pain,” says Rafic Berbarie, MD, a cardi-ologist on the medical staff at Baylor Jack and Jane Hamilton Heart and Vascular Hospital. “But in women, it might not be a pain sensation. I’m always careful to ask all of my patients more about discomfort rather than pain.”

WAtcH for WArning SignSPain or discomfort as well as nausea, sweating, shortness of breath, and neck or jaw pain

are all signs of a heart attack (whether alone or in combina-tion), especially if they come on when you’re walking or expe-riencing stress or anxiety, Dr. Berbarie says. Women are also likely to experience lighthead-edness, dizziness and fatigue.

PrActice PreventionTo help prevent a heart attack, Dr. Berbarie says, be sure to eat a low-fat, low-cholesterol diet, and get 20 to 30 minutes of aerobic exercise most days of the week. Plus, see your pri-mary care physician regularly to make sure your blood pressure, cholesterol and blood sugar lev-els are within healthy limits. If these numbers are higher than they should be, talk to your doctor about lifestyle changes and medications.

“Modifying those risk factors upfront can help prevent heart attacks,” he says.

The material in Heart Smart is not intended for diagnosing or prescribing. Consult your physician before undertaking any form of medical treatment. Physicians are members of the medical staff at one of Baylor Health Care System’s subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers or Baylor Health Care System. Photographs may include models or actors and may not represent actual patients. If you are receiving multiple copies, need to change your mailing address or do not wish to receive this publication, please send your mailing label(s) and the updated information to Robin Vogel, Baylor Health Care System, 2001 Bryan St., Suite 750, Dallas, TX 75201, or email the information to robinv@baylorhealth.edu.

BHCSCV_33_2013 RT

Heart Smartfree HeArt diSeASe riSK ASSeSSment. Learn more at baylorHealth.com/Heart

Congenital heart defects are the most common type of birth defect in the U.S.

The percentage of babies born each year in the U.S. who are affected by congenital heart defects.

The estimated number of heart valve procedures performed annually in the U.S.

The approximate number of Americans each year who have open heart surgery to replace a heart valve.

No. 1 Nearly 1% 100,000+ 50,000

WGoing with the Flow

When Kelli Freeman was 3 months old, her pediatri-cian detected a heart murmur, and she was diag-nosed with a congenital heart defect in her aortic valve. She had surgery then—and again when she was 6—to widen the aorta, the body’s main artery.

Throughout her life, Freeman, now 48, has had regular checkups to monitor her heart. But after a recent dizzy spell at work, she called her cardiologist.

“I chose to come to Baylor because I wanted a team of doctors that could take care of me,” Freeman says. “I had a phenomenal team of doctors that not only took care of my medical needs, but they took care of me as a human being.”

WHen SYmPtomS meAn SUrgerYMany valve problems don’t require treatment, explains Gonzalo Gonzalez-Stawinski, MD, car-diovascular surgeon at Baylor University Medical Center at Dallas.

“The fact that it’s not working properly doesn’t mean you’re going to have a problem,” he says. “But when you have symptoms, we can predict with a certain degree of confidence how long you’re going

One patient’s valve replacement surgery helped her get back to her active life

to live without treatment. Once symptoms start, your life span is cut down.”

Freeman’s cardiologist recommended open heart surgery to replace the aortic valve.

The aortic valve, Dr. Gonzalez-Stawinski explains, controls the flow of blood from the heart to the body.

“That valve can develop two types of problems,” he says. It can become incompetent, meaning it doesn’t close properly or leaks (called regurgitation), or it can become closed off (stenosis), which is the more common of the two.

Symptoms include chest pain with exertion or at rest, fainting spells and shortness of breath.

mAKing A cHoiceThough treatment varies by person, valve replace-ment—with either a tissue valve or a metal valve—is common.

Freeman chose a tissue valve. Today she says she has more energy and is able to stay active with her kids, and she’s thankful for her Baylor experience.

“You can just feel when you’re in the right place,” Freeman says. “They said, ‘We don’t have problems here, we just have solutions,’ and it made me feel very comforted. They had a team of doctors that would help me through everything, and they have, and I’m grateful for that.”

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Cardiac catheterization is a procedure that lets your doctor evaluate heart disease and, if necessary, treat blocked arteries. The procedure requires inserting a tiny catheter into the body and threading the catheter through the arteries.

The catheter can be inserted through a site in the groin or the wrist.

“You can do it either way. It’s highly successful in both,” says Jeff Schussler, MD, a cardiologist on the medical staff at Baylor Jack and Jane Hamilton Heart and Vascular Hospital. “But my default is to go through the wrist because of the benefits to the patient.”

it’S ALL in tHe WriStGoing through the wrist, which is also known as the radial approach, has become more common in recent years. Dr. Schussler notes that in 2007, just 2 percent of heart catheterizations in the U.S. were done through the wrist. Just four years later, data showed that number had jumped to 11 percent.

This approach, he says, allows patients to sit up right away after the procedure and walk more quickly afterward. (After a procedure through the groin, patients must lie flat for three to six hours.) The radial approach also can reduce the chances of bleeding, especially in those who are prone to such complications. And it is the preferred approach for patients who are obese.

For some patients, such as those who are taller than 6 feet 5 inches, the radial approach isn’t an option. But for most people, Dr. Schussler says, it’s the better choice.

Kelli Freeman

An Easier Way to Your HeartA different approach to cardiac catheterization

Heart Trouble?If you’ve been experiencing troublesome signs and symptoms, talk to your doctor and

consider undergoing a stress test. For a referral to a cardiologist near you, call 1.800.4bAYLor.

Trust Us with Your HeartTo learn more about the Baylor Heart and Vascular Services at Dallas, call 1.800.4bAYLor.

Screening Saves Livesget Screened. Saturday, march 9, 8:30 a.m.–4:30 p.m. at Baylor Jack and Jane Hamilton Heart and Vascular Hospital.

Call 1.800.4bAYLor to schedule your screening.

If you’re experiencing leg pain, it could be a sign of a more serious condition. Peripheral artery disease (PAD) is a condition in which narrowed arteries lead to reduced blood flow in your legs and arms.

“PAD is a manifestation of the hardening of the arteries and can also be a marker of heart disease,” says Stephen Hohmann, MD, a vascular surgeon on the medical staff at Baylor Jack and Jane Hamilton Heart and Vascular Hospital. “It’s a warning sign.”

SPot tHe SYmPtomSThe first sign of PAD is usually painful cramping in the calf muscles, Dr. Hohmann says. The pain sometimes occurs in the buttocks or thigh muscles, and typically occurs with motion and goes away with rest.

“As your PAD worsens, you could

get pain that occurs all the time, and your legs could be painful or cold to the touch,” he says. “You might also notice numbness.”

Other symptoms include nonhealing foot wounds, loss of hair or slower hair growth on the leg, and a change of colors in the leg.

cUt YoUr riSK The main risk factors for PAD are smoking, high blood pressure, diabetes, family history and high cholesterol levels. Treatments include medications to reduce cholesterol and blood pressure levels, control blood sugar, prevent blood clots and widen blood vessels.

A healthy diet and stopping smoking are key, Dr. Hohmann says, and for many people, a walking program helps. In serious cases, angioplasty or bypass surgery may be necessary.

Are YoU At riSK for PAd?To discover your potential risk factors for peripheral artery disease and other vascular conditions, answer the following yes-or-no questions.

If you answered yes to any of these, add up the numbers to the right of the question. If your total is 3 or more, you may be at an increased risk. Talk with your physician about your risk factors and screening options.

A Leg UpPain in your limbs could be a sign of vascular problems

Y n Are you older than 60? +1

Y n Do you have high blood pressure (hypertension) or take medication for this? +1

Y n Do you have high cholesterol levels or take medication for this? +1

Y n Do you have diabetes? +1

Y n Have you used tobacco products for more than one year of your life? +2

Y n Do you have a known history of abdominal aortic aneurysm (AAA) in your family? +2

Y n Do you experience calf pain when exercising or walking? +1

Visit us at baylorHealth.com/Heart february 2013 / Heart Smart 32 Heart Smart / february 2013 Visit us at baylorHealth.com/Heart