Penn Heart and Vascular

Penn Heart and Vascular Update

Wednesday, October 7, 2015

4 Myths about Heart Murmurs

Lub DUB. Lub DUB. Lub DUB. Ah, the sweet sound of blood flowing through the heart.

This rhythmic pattern is the sound of heart valves opening and closing as blood makes its way to the heart. Heart valves make sure blood flows in one direction: toward your lungs.

When valves are too stiff, too loose, or aren’t formed properly, blood flow may sound more like a swishing or whooshing noise. This is called a heart murmur.

Heart murmurs are not always a warning sign of danger. But it is important to determine their cause and have them followed.

Here are 4 common myths about heart murmurs to help you understand this common diagnosis.

Myth #1: All Heart Murmurs Are The Same.

All heart murmurs are not equal. They come in two varieties: innocent and abnormal.

An innocent heart murmur does not cause problems with the heart’s function. It could be related to a condition, often temporary, causing high blood flow through the heart’s valves explains...It may just be related to an area of high blood flow, explains Maureen Julien, MSN, CRNP, lead nurse practitioner for interventional cardiology at Penn Medicine.

Healthy children often have innocent heart murmurs, she says.

An abnormal heart murmur is caused by disruption in blood flow stemming from a lesion (disease state?) or defect that has developed, affecting the circulatory system. , says Maureen. In children, congenital defects often cause abnormal heart murmurs, while in adults, the culprit is usually heart valve disease.

When blood flow is increased, valves must respond. So, it makes sense that conditions that increase blood flow temporarily can also cause heart murmurs, according to the American Heart Association (AHA). The conditions include:

  • Being pregnant
  • High fever
  • Hyperactive thyroid gland
  • Anemia

While they may be innocent and temporary, having these heart murmurs followed by a medical professional is still important.

Myth #2: You Can Tell It’s A Murmur Just By Listening.

Not always. Many times, people are referred to a cardiologist because their primary care physician hears a murmur. But you can’t necessarily—just by listening—diagnose exactly what it is, cautions Maureen.

Although a heart murmur doesn’t feel like anything, per se, she says the symptoms you may feel are related to the underlying cause.

A leaky heart valve causing a heart murmur may not be opening and closing properly causing blood to flow backwards in the circulatory system. In turn, your legs, swelling of the belly, and weight gain, says Maureen.

I’m talking about gaining more than 2 pounds overnight or 5 pounds over the course of the week. That’s a hallmark of heart failure weight gain. It doesn’t usually come from dinner the last couple nights, she explains.

Other signs and symptoms of a heart murmur can include:

  • Chest pain
  • Fainting
  • Dizzy spells
  • Constant coughing
  • Bluish lips and fingers
  • Inflammation
  • Excessive sweating with little physical exertion
  • Swollen liver
  • Enlarged veins in the neck
  • Poor appetite (in infants)

Myth #3: All Heart Murmurs Require Treatment.

Some heart murmurs disappear when children become adults, while others remain with them into adulthood. Innocent heart murmurs do not always require treatment but Maureen stresses that it is still important to have your physician monitor the condition.

In the cases of abnormal heart murmurs, it often depends on the cause. If other health conditions unrelated to heart disease exist, such as anemia or hyperthyroidism, then treating them should eliminate the heart murmur.

Myth # 4: Medication Will Repair The Heart Murmur.

Abnormal congenital heart murmurs may be treated with medicines or surgery. If the cause is heart valve disease, treatment may vary, depending on the severity.

Patients are hopeful that it can be fixed with medicines alone, and that may not always be the case, Maureen points out. You may initially be treated with medicine—and that may be for years—but it’ll be watched over time, she says.

If medicine is not successful, then the next step may be surgery to repair or replace a faulty valve.

Every case is different and it is important to make sure you are comfortable with the care that you are receiving and that your questions are being answered.

Consulting a physician is your best bet for determining if you have a murmur and how serious it is.

If your primary physician tells you, “I think I hear a murmur.”, you should see a cardiologist. Do some research and get a referral from your physician, or find somebody that you’ve heard or read good things about, adds Maureen.

Murmurs should be paid attention to. They signal that there is a disruption in blood flow and knowing the cause is important even if it turns out to be innocent.

Are you concerned that your heart murmur may signal something more serious?

Monday, October 5, 2015

Frightening Heart Complications from a Common Virus

An undiagnosed illness

Tina Frey knew there was something terribly wrong. Over the course of several months, she went from being a busy young mom with a demanding career to struggling with life's most basic activities, like walking and breathing.

Doctors close to Tina's home couldn't find anything wrong. They were convinced that the cause of her symptoms was the stress of a young working mom. They enouraged her to exercise more - to get back into shape. But the more Tina pushed, the more the sickness pushed back. She was getting worse as time went on.

"I felt like I was at death's door"

A normal heart fills up with blood and pumps out
about 65% of the contents during a single beat.
This is called the ejection fraction (EF).

After several months with no improvement, Tina went back to her primary care doctor and urged for thorough testing. A new X-ray showed that Tina's heart was enlarged; she needed a cardiologist.

At her cardiology appointment, Tina's echocardiogram - a routine test to check the heart – showed a dangerously enlarged heart. Tina was immediately admitted to her local hospital. There, it was discovered that her heart was weak and struggling to pump blood adequately. With an ejection fraction of only 25%, Tina was diagnosed with heart failure. To compensate, her heart tried to fill up with more blood, causing it to stretch and beat faster – a condition known as dilated cardiomyopathy.

With Tina's condition deteriorating, her local hospital recommended she go to the Heart Failure Program at the Hospital of the University of Pennsylvania. By the time Tina reached Penn, her EF had dropped to 15%. The doctors sprang into action, working to stabilize her heart.

Tina's road to recovery

A week later, Tina was strong enough to go home. When she walked out of the hospital, she had a fist-full of medications, a heart healthy lifestyle plan and, most importantly, a LifeVest external defibrillator. This device would shock her heart back into rhythm in the event of a cardiac arrest.

The diagnosis and treatment plan were daunting, but now there was a team of experts behind her. After months of medication adjustments, Tina felt better and her EF improved. She was monitored closely by the Penn Heart Failure team and over the course of the year she became healthier - slowly feeling like herself again.

Why did Tina get sick?

Cardiomyopathy can be caused by a number of different conditions; chemotherapy, uncontrolled blood pressure, pregnancy, heart attack and even genetics. For Tina, the most probable cause was viral. Her son had contracted the coxsackie virus over a year prior to her heart failure diagnosis.

Nearly a year later, the virus is undetectable in Tina's blood, her EF has improved to 40%, and she is stable enough to start cardiac rehabilitation.

Tina's message for everyone

Tina is participating in the 2015 Philly Heart Walk to share an important message. "If I would have gotten treatment sooner, we may have been able to stop or slow down the progression of this disease," says Tina. "I hope that my story can inspire others to be their own advocate, to live heart healthy, to be the change."

Help Tina share her message. Together, we can make healthier, longer lives possible for everyone.

Tuesday, September 22, 2015

Improving Your Health Literacy: 5 Tips for Managing and Treating Heart Disease in the Information Age

For people diagnosed with heart disease, the search for treatment information often begins in front of a screen.

“In this information age, patients are going to try to find ways to understand any diagnosis to the best of their ability,” says Lynn Washington, BSN, RN, nurse navigator for cardiac surgery and transitions coordinator for Heart and Vascular Service Line at Penn Medicine.

Physicians and in-person appointments are no longer the only source of information on one’s health condition. While an online search can yield a wealth of information about heart disease, and give patients the opportunity to research and understand their condition, it is important to know what information you can trust, as well as combine all sources of information to give you a better picture.

Finding the information you need from reliable sources is part of a skill called health literacy, the Office of Disease Prevention and Health Promotion explains. And while the digital age has changed the way we learn and grow this skill, many in-person sources of education are still very important and helpful.

Here are 5 tips for managing and treating heart disease in the information age.

1. Consider The Online Source.

When it comes to finding reliable health information online, “I would caution everybody on the internet to be aware of who’s providing you with the information,” says Lynn.

She suggests patients ask themselves, “Is there an agenda in play? Are there multiple ads on the webpage?”

For information on issues like heart healthy diets, reputable sources such as the American Heart Association can provide useful suggestions for patients.

2. Turn To The Hospital’s Website.

“Our own web page,, is relatively easy for patients to navigate,” Lynn says. “It can easily guide patients to the Heart and Vascular Care service page.”

She adds that, “These sites are usually accessible from myPennMedicine, Penn's patient portal. I always encourage my patients to sign up for the portal because there’s so much reliable information there.”

3. Talk To Other Patients.

“As healthcare providers, we can talk all we want about a procedure and how you can anticipate your recovery to go,” Lynn explains. “But—not ever having had heart surgery myself—it’s difficult for me to get into the emotions involved. And there is a large emotional component to this.”

That’s why Lynn encourages patients to reach out to others, in person or online, who have already had similar experiences. They can “explain what was difficult for them or how they dealt with the nuances of recovery.”

4. Build A Support Team.

Of course, in person appointments and explanations from your own physician are extremely important. Your doctor can see the whole picture and how co-existing conditions may relate to your heart disease. Therefore, it is important that the information talked about during your appointments is understood.

Lynn suggests you also bring a friend or loved one with you to appointments. “Any one person with just two ears cannot absorb all of the information that’s given to them, especially in a life-altering situation like heart surgery,” Lynn says.

That person can also take notes to help you remember what was discussed and to ask any important questions that may slip your mind.

“I highly recommend that you have someone who is going to be helping you care for yourself be there. You’re more likely to get all of the information if there are two people there to absorb it,” she explains.

5. Don’t Be Afraid To Ask Questions.

"During an appointment, there can be quite a large gap between the expectations of the patient and those of the medical staff," Lynn explains.

According to Lynn, "patients should not hesitate to guide their providers into telling them what they want to know. I very much encourage patients to tell me what information I can give to them.”

Lynn acknowledges that this can be difficult if a patient has multiple chronic health conditions. She says that having good coordination between healthcare providers is important. Because these patients "are seen by multiple doctors in multiple specialties, there can be conflicting information provided if you’re just narrowly looking at one condition.”

“I would love for patients to know how to be their own advocates, and know the right questions to ask every provider they see.”

Understanding your condition is what health literacy is all about. Gather information from a wide variety of reliable sources and then ask questions to make you feel comfortable. Then use the knowledge you’ve gained to make the decision that is right for you.

Thursday, September 10, 2015

Know Your Family's Heart Story

Your family history holds key information about your past and clues to your future health. Many of your physical traits, such as eye color, hair color, and height, are inherited. So, too, are risks for certain genetic conditions and health problems, such as heart disease and abnormal cholesterol levels.

In fact, studies show that having a brother, sister, or parent with a history of early heart attack or stroke increases the risk of these events two to four-fold.

Many conditions, including high cholesterol and early coronary artery disease, may run in families.

By collecting your family’s health history, you can learn what health problems you may be at increased risk for in the future. And while you can’t change your genes, you can change behaviors that affect your health and raise your risk even more, such as smoking, physical inactivity and poor eating habits.

Make your family health history a family tradition

The best way to learn about your family’s heart health history is to talk to your family members directly. Pick up the phone and ask the important questions. Catch up at family gatherings. Send a group email asking others to share their health information with you.

You can also use this family history tool to help collect and record valuable medical information from your relatives. Once your health history is in one place, you can download, print and bring it to your next appointment with a healthcare provider.

If your family's heart history has you concerned, take action. The Preventive Cardiovascular Program at Penn Medicine sees many different types of patients in our clinics, including patients without any known cardiovascular disease, but with a worrisome family history.

Thursday, September 3, 2015

Treating Your Risk for Cardiovascular Disease

Being heart healthy can prevent a heart attack or stroke by lowering your risk for heart disease. To start you on the right path, there are several risk factors that doctors will tell you to focus on.

With few exceptions, physicians at the Preventive Cardiovascular Program at Penn will recommend that people at risk of heart attack and stroke do the following:

Eat a healthy diet:

Eating well is a fundamental part of keeping your heart healthy. The "right" diet depends on your treatment goals, but there are also certain foods that can help lower your risk of heart disease. Whether you're aiming for weight loss, trying to lower your cholesterol or triglycerides, working to reduce your blood pressure or improve your blood sugar levels, it helps to work with a registered dietitian. At the Preventive Cardiovascular Program, our patients receive nutritional counseling from an experienced dietitian.

Maintain a normal weight:

When you're overweight or obese, you can develop hypertension, diabetes, and atherosclerosis (hardening of the arteries). All of these can put you at an increased risk for heart disease. The experts at Penn Medicine can help you lose weight and then maintain weight loss through a combination of diet and exercise.

Exercise regularly

Regular exercise can keep your weight in check, reduce your blood pressure and lower cholesterol levels, making it one of the most important things you can do to reduce your risk for cardiovascular disease. Talk to your healthcare team about creating an exercise plan that's right for you.

Stop smoking:

Smoking decreases oxygen to the heart and increases your blood pressure and heart rate. It can also increase blood clotting. All of these can lead to an increased risk of cardiovascular disease. At Penn Medicine, our Smoking Cessation program is an excellent resource for patients looking to kick the habit and stay smoke free for life.

If you have a family history of heart disease or at increased risk, making these healthy lifestyle modifications can help prevent heart attacks and strokes. Making changes can be hard, so it is important to get the help you need.

Tuesday, August 18, 2015

Dine Out with Us and Fight Heart Disease!

2 Great Restaurants, 1 Great Cause

Fight heart disease by choosing healthy meals at two award winning Philadelphia restaurants!

Doc Magrogan’s and Harvest Seasonal Grill and Wine Bar have once again teamed up with Penn Medicine to raise money for the Philadelphia Heart Walk.

Show your server a Penn Medicine ID or this flyer any time between August 1 and November 7, and 10% of your total bill will be donated to the American Heart Association.

Additionally, if you order the heart healthy menu options marked with a Penn shield an additional 10% on those items will be donated to the AHA.

Join Penn's Heart Walk Team

The 2015 Philadelphia Heart Walk is on November 7 at Citizens Bank Park. If you would like to become a 2015 Heart Walk team captain, register as a walker or make a donation, visit Penn's Team Page, or contact Cara Feldman at

Monday, August 17, 2015

What’s Your Risk for Cardiovascular Disease?

Emil deGoma, MD, Medical Director,
Penn Preventive Cardiovascular Program

Cardiovascular disease is the #1 cause of death for both men and women in the U.S. — and heart attacks and strokes frequently happen without warning.

Knowing your risk before cardiovascular disease strikes is a key first step to living a long, heart-healthy life. That's because with knowledge about your personal risk comes power — the power to make lifestyle changes and begin a plan that can actually prevent you from suffering a heart attack or stroke.

"With some diseases knowing your risk doesn't always help, because there might not be anything you can do to reduce your risk," says Emil deGoma, MD, FACC, medical director of the Preventive Cardiovascular Program at Penn Medicine.

"Understanding your risk for cardiovascular disease is different," adds deGoma, "because there is a lot you can do to prevent it. You can change your risk and do things to help avoid heart attacks and strokes."

The impact of heart disease in the United States

  • 1 out of every 3 deaths is caused by cardiovascular disease.

  • Every 34 seconds, someone will experience a heart attack.

  • Most people who die suddenly of heart disease have no previous symptoms.

Determining your risk

To start determining whether you're at risk for cardiovascular disease, you'll need to know a few of your key numbers:

  • Bood pressure
  • Blood glucose (sugar)
  • LDL (bad) cholesterol
  • HDL (good) cholesterol
  • Triglycerides

You can get these numbers by requesting a fasting blood test from your health care provider.

You can also take Penn Medicine's HeartAge Cardiac Risk Profiler to get a better understanding of your personal risk factors for heart attack and stroke. The assessment tool takes into account lifestyle risk factors (such as cigarette smoking, poor nutrition, a lack of regular physical activity, and being overweight) as well as family history to calculate your risk for cardiovascular disease.

If you are worried about your risk, the Preventive Cardiovascular Program at Penn uses advanced technology and techniques unavailable anywhere else in the Philadelphia region to better understand your individual risk of heart attack and stroke. These include advanced tests for more precisely measuring cholesterol, 24-hour blood pressure monitoring, genetic testing, and imaging tests of the heart and arteries.

If these tests and assessments determine you're at increased risk of heart and vascular disease, your healthcare team can make a personalized plan to treat your risk.

Ready to get the most comprehensive picture of your risk for heart disease?

Learn more about Penn's Preventive Cardiovascular Program.