Penn Heart and Vascular

Penn Heart and Vascular Update

Monday, June 29, 2015

How Your Heart Valves Are Like Traffic Controllers

You're driving down the highway. The road is congested, but it's moving steadily. And then you see something ahead, a construction worker forcing traffic to slow down or stop.

Your heart valves play a similar role as a traffic controller, regulating the flow of blood by opening and closing, millions of times each year. The primary function of these valves is to ensure blood flows in only one direction—toward your lungs. Your lungs are where blood gets oxygenated, so it can be sent out to the rest of your body.

"When heart valves fail, the flow of blood through the heart is disrupted. So, you can have varying problems, most seriously heart failure," says Maureen Julien, MSN, CRNP, lead nurse practitioner for interventional cardiology at Penn Medicine.

To get a better picture of the impact heart valve disease has on your body, we'll look at how blood circulates through your heart.

The Road Map

First, let's outline the route. Your heart is comprised of four valves: pulmonary, aortic, tricuspid and mitral, each with its own flaps that open and close with each heartbeat. That familiar "lub-dub" sound your heart makes is your heart valves regulating traffic, or opening and closing to move blood through your heart.

How heart valves function, enabling blood to flow throughout the body.

The flow of blood is only as good as the traffic controllers, conditions and flow of traffic. However, if the valves aren't functioning properly, you can experience a range of symptoms, including:
  • Shortness of breath
  • Chest pain
  • Swelling of the legs
  • Unexpected weight gain
  • Dizziness
  • Fatigue

Let's take a look at three of the main issues that happen with heart valves:

  1. Stenosis: an over-restriction in blood flow
  2. Regurgitation: blood leaks through or flows backwards
  3. Atresia: occurs when valves are not properly formed, often at birth

Stenosis: An over-restriction in blood flow

Valve stenosis occurs when a valve fails to open properly. The flaps of the valve—also called leaflets—may be too stiff, too thick, or even fused together.
Aortic stenosis obstructs normal blood flow in the heart
It’s similar to when traffic controllers merge four lanes of traffic into one. Because all traffic must now move through this single lane, the volume of traffic flow is restricted. The same applies to your heart.

This happens for a variety of reasons. “Sometimes, leaflets just degenerate. The leaflets can be attacked by diseases like rheumatic heart failure if they have rheumatic fever as a child,” explains Maureen.

“A valve can also become calcified, which sometimes happens just with age,” she adds. Valve calcification occurs when calcium in the blood builds up on heart valves. With valve stenosis, the body gets less oxygenated blood, which if left untreated can lead to heart failure.

Regurgitation: Blood leaking through or flowing backwards

Valve regurgitation is also referred to as a leaky heart valve. Unlike in stenosis, the valve opens up completely but doesn’t close tightly enough. Blood may leak or backflow through the valve after closing.

Leaky valves are the equivalent of a traffic controller slacking on the job. Although the traffic controller is working, he’s not helping you get from point A to point B. So, a rogue driver may get a crazy idea to back up on the shoulder looking for another exit ramp.

“That annulus, or the circle that holds the heart valve, can dilate if you have an enlarged heart, for example,” Maureen says. “Sometimes, that shape can change. That change and dilation can cause distortion, so the valve does not properly close.”

When valve regurgitation occurs, the supply of oxygenated blood moving through the heart is reduced. This makes the heart work harder, which may produce fatigue or shortness of breath.

Atresia: Valves that are not properly formed

The last type of heart valve disease called atresia can actually result in stenosis or regurgitation. Atresia occurs if a heart valve isn’t formed properly, often at birth.

Improper formation of valves, which usually occurs with pulmonary or aortic valves, may include:

  • Too few leaflets or flaps
  • Incorrect valve size or shape
  • No opening to allow blood to flow through properly

“A lot of times, those valves don’t cause you problems even though you were born with it. Until you become an adult,” says Maureen.

Regulating Traffic Flow

If you feel like you’re headed for a major traffic incident, it’s important to get the heart valve issue diagnosed and monitor the condition. Ultimately, to prevent a major traffic incident, Maureen recommends talking with your physician. “I think it’s important to keep open lines of communication with your doctor. If you’re feeling a change in your symptoms and something is different, then let them know,” she says.

Do you have questions about heart valve disease?

Penn's Heart Valve Disease Program is the largest in region, with more valve surgeries performed than any other hospital in Pennsylvania.

Learn more about Penn's Heart Valve Disease Program.

Friday, June 19, 2015

5 Tips For Understanding Your Heart Failure Medications

For people with heart failure, medication is an important part of the treatment plan. But the medications themselves can quickly become confusing and overwhelming.

Here are five tips that will give you a better understanding of heart failure medications and where to get answers when you have questions.

1) Understand Which Medications Are Recommended — And Why

Different types of medications treat different symptoms or aspects of heart failure, which is why it’s important to understand what they’re prescribed to treat and why they’re being prescribed.

Amy Marzolf, MSN, CRNP, a Heart Failure Clinical Practitioner at Penn Medicine, explains: “Sometimes when people look at the patient's medications, they will say something like, ‘Why are you on all of those blood pressure pills when you have low blood pressure?’” In this case, she offers the following clarification, “Heart failure patients are on these medications not necessarily for blood pressure management, but rather for heart failure management.”

2) Always Talk To The Physician Or Pharmacist If You Have Questions.

Physicians and pharmacists can answer any questions you may have about the prescribed heart failure medications.

Also, be sure to speak with the physician or pharmacist before you take any other medications, including over-the-counter products, such as ibuprofen.

Medications can sometimes interact with one another, even if they are used to treat completely unrelated issues. Interactions can increase or decrease medications' effectiveness, or increase the risk for harmful side effects.

3) Watch For Certain Side Effects

The most common side effect with heart failure medications is dizziness, particularly when changing positions.

“Typically, people will describe getting dizzy after they lean down to pick something up, when they get up out of bed, or if they change positions quickly,” explains Amy. “It should last only a few seconds and should improve as you change positions slowly.”

“But if patients are having sustained dizziness that is inhibiting their life or lasting for a longer period of time, they should talk to their provider,” she recommends.

Side effects can also vary depending on the type of medication. Some side effects may not be outwardly noticeable and therefore need to be monitored with blood work.

“Many of the medications used for heart failure require blood work to monitor your kidney function and electrolytes,” Amy says. “Ask the provider if this is necessary, and make sure to have the requested follow-up lab work to ensure your loved one’s safety.”

4) Develop a System For Taking And Tracking Medications

Use a tracking system to monitor your medications.

Once you know the what, why, and how of your loved one’s heart failure medications, it’s time to come up with a tracking system.

“Heart failure medications need to be taken as prescribed on a daily basis (some once, twice, or even three times a day),” explains Amy.

It takes a few months on these medications to see any changes. Even after a patient is feeling better, these medications must be continued. Most medicines will be continued for life.

Amy adds that, “If you run out of a medication or there is no refill, do not assume the medicine is ‘done.’ Speak with your provider. Don't stop anything without reviewing with their cardiologist.”

You may want to start by drawing up a list of medication instructions. Include a description or picture of what the medication looks like to avoid confusion.

The American Heart Association has a chart you can print and fill out to keep track of various medications. You can also use a spreadsheet or medication tracker app for a digital copy of this information.

If your loved one has to take various medications throughout the day, consider colored stickers (red for morning, yellow for afternoon, blue for nighttime)—just remember to write down what each color represents. Most major pharmacies also carry timer caps, days of the week packs and offer automated reminders, by email, text or phone.

5) Surround Yourself with People that Support Your Lifestyle Changes

“Often times, it is difficult for patients with heart failure and their loved ones because they may not look sick, but they feel very tired and weak,” says Amy.

For caregivers, Amy says: “Keep an eye on your loved ones to make sure they are adjusting to their medication regimen. Remember that in addition to medical therapy, managing heart failure involves very significant lifestyle changes, including limiting salt and managing fluid intake as well as writing weights down daily.”

She explains that these aspects of care can be as critical as medical therapy in managing heart failure. Patients will need a lot of support and understanding as they deal with these changes and their medical therapy.

Heart failure is a complex, yet manageable disease. The right care team can help you not just live with heart failure, but thrive with heart failure. At Penn Medicine, we’ve built one of the nation’s largest heart failure programs. For patients, this means access to more advanced and specialized clinicians than anywhere else in the region.

Learn more about our Heart Failure Program,
and schedule a consultation today.

Wednesday, June 3, 2015

Consistency, Not Avoidance: The Truth About Blood Thinners, Leafy Greens, And Vitamin K

If you take blood thinners, chances are you've heard that certain foods—like leafy greens—can cause potentially dangerous food-drug interactions.

"I get a lot of patients who come to me and say, 'I was told to avoid these foods because they interfere with my medication'," says Fran Burke MS, RD, a clinical dietitian in the Preventive Cardiovascular Program at Penn Medicine. "But the issue isn't avoidance, it's consistency."

Here are 4 questions and answers about blood thinners and foods rich in vitamin K.

"It's the consistency that's important," says Fran Burk, MS, RD,
when asked about vitamin K and blood thinners.
  1. Who Takes Blood Thinners—And Why?

    Patients are placed on blood thinners for a variety of medical conditions, including atrial fibrillation (A-Fib).

    In A-Fib, blood isn't properly pumped out of the heart, which can cause clots to form. The blood clots can then dislodge from the heart and cause a type of stroke called ischemic stroke.

    "People who have A-Fib are at risk of having a stroke, so they're put on blood thinners to prevent blood clots," explains Fran.

  2. How Do Blood Thinners Interact With Vitamin K?

    The body uses vitamin K to help clot blood, explains the National Library of Medicine (NLM). Because people with A-Fib are at risk for clots in the heart, vitamin K has important implications.

    Warfarin (the generic version of Coumadin) is the most widely used blood thinner that works by blocking a vitamin K-dependent step in clotting factor production.

    This is why consistency in vitamin K intake is important: Your body needs to keep a balance between the amounts of vitamin K and warfarin in your system.

    However, not all blood thinners interact with vitamin K, so ask your physician about your specific medication.

    "The new anticoagulation agents include Rivaroxaban (Xarelto), Dabigatran (Pradaxa), and Apixaban (Eliquis). These agents have no food-drug interactions and therefore do not interact with vitamin K," explains Fran.

  3. How Can You Keep Vitamin K Levels Consistent?

    "What you should try to do is keep your intake of foods rich in vitamin K about the same each day," says Fran. "For example, if you eat one serving of broccoli on one day, you should plan on eating one serving of a high vitamin K food the next and so on. One serving a day, several days a week would help to keep your vitamin K intake consistent."

    Fran explains that the adequate intake (AI) for vitamin K for men and women who are 19 or more years old is 120 mcg and 90 mcg, respectively. A cup of raw spinach contains about 145 mcg of vitamin K, whereas 1 cup of cooked broccoli contains about 220 mcg of vitamin K.

  4. How Are Patients Who Take Blood Thinners Monitored?

    Warfarin doses need to be monitored closely. Patients can go to an outpatient warfarin clinic where they are monitored—initially once a week for about one month, then every two weeks, and finally once a month.

    The main blood test used to monitor patients on warfarin is called prothrombin time (PT). A PT test measures how long it takes for plasma (the liquid portion of your blood) to clot, says the NLM.

    The result is often listed as a number called an international normalized ratio (INR). People who are not on blood thinners should have an INR between 0.8 and 1.1, according to the NLM. People who are on warfarin should be between 2.0 and 3.0 for most conditions.

If you are on blood thinners, the key to minimizing food and drug interactions is through consistency, not avoidance. Eating a steady amount of vitamin K rich foods each day helps ensure a healthy, well-balanced body.

A physician at Penn Medicine's Cardiac Arrhythmia Program can help you determine the best course of action to keep your vitamin K and blood thinner levels balanced.

Thursday, May 7, 2015

5 Scary Myths about Heart Failure

Heart failure: Two words no one wants to hear a doctor say.

The fact is that nearly 6 million people in the US have heart failure—and that number is only growing, according to the National Heart, Lung, and Blood Institute (NHLBI).

Yes, heart failure is a serious health issue—one that should not be taken lightly. But a diagnosis of heart failure is not necessarily a death sentence.

Here are some of the myths, and the truth, about heart failure:

  1. Myth: Heart Failure Means Your Heart Has Stopped Working.

    Yes, the word "failure" typically means that something is no longer working. But that's not the case with heart failure, the NHLBI explains. Heart failure develops as the heart's ability to pump weakens.

    A person can have heart failure on the right side of his heart, the left side, or both. During right-side heart failure, a person's heart cannot pump enough blood toward the lungs to receive oxygen. During left-side heart failure, the heart cannot pump enough of that oxygen-rich blood out to the rest of the body. Most people with heart failure have it on both sides of the heart, says the NHLBI.

    The important thing to remember is that the heart is still pumping, but at a weakened capacity.

  2. Myth: You Can't Do Anything To Prevent Heart Failure.

    Heart failure—and heart disease in general—has two different types of risk factors: those you cannot control, and those you can, says the National Library of Medicine (NLM).

    While you may not be able to change some factors—like your age, gender, or genes – you can reduce your risk of heart disease and heart failure in other ways.

  3. Myth: There's Nothing You Can Do To Get Better After Being Diagnosed With Heart Failure.

  4. Heart failure can be treated through a combination of medication, surgery, implanted devices, and lifestyle changes, says the NLM.

    Lifestyle changes that improve quality of life with heart failure are similar to those that reduce your risk in the first place:

    • Adopt healthy eating and drinking habits.
    • Exercise.
    • Stop smoking.
    • Manage your weight and cholesterol.
  5. Myth: You Can't Tell If Your Heart Failure Is Getting Worse Until It's Too Late.

  6. Warning signs appear before things get worse, so it's important to know your body and any telltale signs. Monitor your symptoms to identify potential problems before they become too serious, according to the NLM.

    Make note of any changes to your:

    • Blood pressure
    • Heart rate
    • Weight

    If you notice any abnormal changes, contact your physician.

  7. Myth: Heart Failure Is A Death Sentence.

  8. Because of advances in early diagnosis and treatment—as well as increased public awareness of symptoms–many people with heart disease are able to lead normal lives, says the Heart Failure Society of America (HFSA).

    A heart failure patient's outlook depends on a number of factors. Perhaps the most noticeable one is what the American Heart Association (AHA) calls functional capacity—that is, how a patient's body reacts to physical activity.

    According to the AHA, functional capacity is measured on a scale of 1 to 4, from mild to severe symptoms.

A physician at the Penn Medicine Heart Failure Program

can help you get the best treatment for your condition.

Thursday, April 30, 2015

What You Need to Know About Aspirin

Image of Chileshe Nkonde-Price, MD, director of the Women's Cardiovascular Center at Penn MedicineDr. Chileshe Nkonde-Price, director of the Women’s Cardiovascular Center, weighs in on the latest American Heart Association recommendations for aspirin use.

Aspirin has been making the news lately, with controversy surrounding who should be taking the drug, and how often. With half of American adults aged 45-75 are taking aspirin regularly, it’s a good time to reevaluate whether or not you should take it daily.

Even though this commonly used blood-thinner comes in “baby” doses, aspirin is not a medication to be taken lightly. It can cause serious side effects such as bleeding and gastrointestinal issues, even for people without a complicated medical history.


In my practice, I follow the current American Heart Association aspirin recommendations: people at high risk for heart attack or who have had a cardiac event should take a daily aspirin, but only under the supervision of your healthcare provider.

The decision to start aspirin in a person that has never had a heart attack is more complex.

My approach starts with assessing a patient’s risk for cardiovascular events, cancer, and bleeding. Then, we consider the importance of preventing each of those possibilities. The final decision to start aspirin is a shared decision between patient and provider that balances risks, benefits, and an individual’s preference.

In summary, no matter your risk level, you should never start taking aspirin without consulting your healthcare provider.

If you are interested in doing something now, you can take our Cardiac Risk Profiler. This risk assessment tool contains questions based on The Framingham Heart Health Study and is widely used to gain an understanding of your risk. Just remember to follow up with your doctor or come see us at Penn.

Wednesday, March 4, 2015

Celebrating Heart Heroes in 2015

At Penn Heart and Vascular, we are inspired every day by the actions of our clinicians, patients and their caregivers. We want to pass that inspiration on.

By recognizing Heart Heroes, we are highlighting just some of the people that are making a heartfelt difference in the Philadelphia area.

So feel inspired, motivated and moved by these stories, and nominate your own Heart Hero today!

Mariell Jessup, MD

Dr. Mariell Jessup works with a multi-disciplinary team each day to bring the best individualized care to every one of her patients. A driving force in their care, Dr. Jessup has dedicated her entire professional career to building healthier lives free of cardiovascular disease. And she’s still learning: “I am never bored -- I learn something each day -- and someone or something touches my heart each day.”

Fermin C. Garcia, MD

Cardiac arrhythmia specialist Dr. Fermin Garcia often sees patients with complex conditions who have had failed procedures elsewhere. Searching for answers, they come to him for hope and a sense of confidence that he won’t settle for anything but the best. As one of his patients says, “Dr. Garcia has been my doctor for years. He gives it to me straight. He makes my wife feel at ease, doesn’t rush us even though these procedures could take hours. Dr. Garcia saved my life and for that he is my Penn Heart Hero!"

Anna Santos

A highly skilled nurse in the cardiac catheterization lab at Pennsylvania Hospital, Anna Santos has an energy and enthusiastic attitude that is infectious. Never failing to show empathy and compassion, Anna puts her patients and their loved ones at ease. Combined with her warm, kind and caring personality, these qualities make her a true heart hero to many patients every day and an inspiration to her co-workers!

Kelly Anne Spratt, DO

Every day new patients come to Penn Medicine with the hope of finding an answer. As a cardiologist at Penn’s Valley Forge community location, Dr. Kelly Anne Spratt exemplifies the Penn ‘never settle’ attitude. During an appointment, she takes the time to listen and hear the concerns of her patients and their families; always taking that extra step to improve lives. She thinks outside of the box, ensuring that answers will be found. Dr. Spratt’s clinical expertise combined with unwavering patience and positivity makes her a true heart hero.

Debbie Gordon, MSS, LCSW

Having been a social worker at Penn Medicine for over 20 years, Deb Gordon has gotten to know her patients and their families quite well. Working with heart failure and transplant patients, as well as those needing mechanical circulatory support, her job begins the moment she meets a new patient and continues throughout their lives. One of Deb’s patients describes her as “full of both encouragement and support, as well as tireless when it comes to taking care of her patients. Deb aids patients and their families in coping with their diagnosis, connecting them with support systems and resources, and finding solutions to the daily challenges of heart failure life. This unflagging support for her patients makes Deb a true Heart Hero!

Stefany McTighe

Staffing an experienced cardiac unit is not something that is quick or easy, yet Stefany McTighe does the job with grace. Day in and day out, Stephany coordinates patient needs, making sure that the appropriate staff is available to care for each patient on all five units at Pennsylvania Hospital. As a charge nurse she is a true leader. When it comes to making sure that patients get the best possible care, Stefany gives it her all, making her a true heart hero.

Christina Constans

Christina Constans is the epitome of patient-centered care. To Christina, the individuals she treats are more than just patients. They are someone's mother, father, sister, brother, friend; and at all times, Christina shows that she is honored to take care of them. She exudes a compassion that is truly genuine.

Often staying late to help her co-workers in Pennsylvania Hospital’s Cardiac Catheterization Lab, Christina shows a dedication to her job that does not go unnoticed. Those that work with her, and those whose hearts have been in her care, certainly consider her nothing less than a Heart Hero.

Theresa Ryan

A beacon of light - this is how Terri Ryan is described by both patients and co-workers. For 30 years, Terri has been a nurse at Pennsylvania Hospital. Caring for cardio-thoracic surgery patients is what she does best. Only it isn’t just that. By reassuring them before and after they leave the hospital for surgery, and providing them with the education they need to heal, Terri embodies everything it means to be a great nurse!

Terri goes above and beyond. She’s always there, putting a smile on every face and and never settling for anything but the best!

David J. Callans, MD

Known for never giving up on his patients, Dr. David Callans is often described as being a Heart Hero. As an expert in the field of electrophysiology, many times patients with heart rhythm conditions and complex symptoms are referred to him. But Dr. Callans never wavers; he accepts and tackles every clinical challenge that comes his way.

Patients not only describe him as dedicated and compassionate, but go on to talk about how he goes above and beyond, offering a new found hope - character traits of a true Heart Hero.

Joseph E. Bavaria, MD

Cardiac surgeon Dr. Joseph Bavaria has a way of making patients feel at ease. It is a common feeling amongst his patients that the stress and anxiety of their diagnosis begins to recede moments into their appointment. Beginning with a thorough explanation of the treatment plan to addressing every question and concern to operating with confidence and experience, Dr. Bavaria is a true Heart Hero.

As one patient says, “Thank you Dr. Bavaria for making my days better. With just the comfort of having you as my surgeon, I'm healthier mentally, feeling safe having you on board with my health care. Your calm, direct, yet warm manner has made a difference in my life.”

Check back for more Heart Heroes throughout the month!

Make sure to read about our past Heart Heroes as well here.

Friday, February 20, 2015

7 Gifts to Warm a Loved One’s Heart

When it comes to gift giving, we all have people in our lives that have everything they need. But do they really?

Here's a different way of thinking about gifts: try giving them something that shows them you care and helps their heart.

Below are a few suggestions to get you started on your hunt for heart healthy gifts!

Fitness Tracker

Wearable fitness trackers can be a chic and healthy gift. Tracking steps, calories burned, or monitoring one's heart rate can start a friendly competition with oneself, and help motivate your loved one to go out and be active!

Bonus Tip: Check out some of the best fitness trackers of 2015 from CNet!


What do french fries, buffalo wings, and donuts all have in common? Well, other than being delicious? They are all deep fried -- brimming with fats and laden with calories. Enter the air fryer — a modern marvel of kitchen gadgetry that fries your favorite foods with just a fraction of the fat. Only a few brands exist today, but this health-conscious appliance is already rocketing the home kitchen into the future.

Blood Pressure Cuff

Not only a must have for heart disease patients, but for all exercise fanatics. A blood pressure cuff measures your systolic/diastolic blood pressures, heart rate and pulse so you can track your numbers and make sure they're within a normal range before, during and after workouts.

Bonus Tip: The American Heart Association recommends an automatic, cuff-style, upper-arm monitor. Wrist and finger monitors are not recommended because they show less reliable readings.

Tea Set

Studies have found that drinking green tea is associated with a decreased risk of stroke. This drink, filled with catechins, may lower systemic blood pressure and support healthy cholesterol levels - but make sure to have this conversation with your physician if you are already taking medications prescribed for these conditions. A cup of tea can also be very relaxing and ease some stress!

Bonus Tip: Pick a mug that evokes a happy memory as a part of your gift. We can all use reminders of happy times!

Water Bottle

Staying hydrated is essential and water bottles are easy to carry, eco-friendly and most importantly, can help replenish fluids lost during your most intense workouts. With so many varieties that actually work while you're exercising, you'll never go thirsty!

Bonus Tip: Need somewhere to store your medications while exercising? We have the answer. Several brands now make a small accessory for the top of water bottles. An excellent find for patients with heart disorders.

Meditation Cushion

We're in the midst of a mindfulness revolution, at least according to Time magazine. While definitions vary, mindfulness is a meditation practice that emphasizes the awareness of moment-to-moment experience with openness and without judgment. Extensive clinical and neurological research has shown that the practice of mindfulness can improve mood and quality of life, enhance emotional regulation, and provide a number of physical health improvements - including cardiovascular benefits. While mindfulness can be done without a cushion, many practicing meditators find a dedicated cushion, sometimes called a zafu, aids their practice.

Bonus Tip: The Penn Program for Mindfulness provides an eight-week introductory course to mindfulness that has helped more than 10,000 people start their meditation journey.

Bluetooth earbuds

Paired with a streaming music gift card, this techy gift can be perfect for those who have made fitness one of their heart healthy goals. Without no wires in the way, your loved one can listen to tunes while walking, running or exercising – minus the tangled mess.

Bonus Tip: Create a workout playlist for each kind of activity - one to get the heart pumping and one to relax/cool down. Check out Be Well Philly's workout playlist, updated every Friday.