Penn Heart and Vascular

Penn Heart and Vascular Update

Tuesday, July 28, 2015

Join Penn Medicine's 2015 Heart Walk Team!

Walk alongside the Penn Medicine community, American Heart Association (AHA) and people of all ages at the 2015 Philadelphia Heart Walk on Saturday, November 7. This year, the Penn Medicine challenge is to raise $200,000!

Over 600,000 people in the U.S. die each year from heart disease; that's nearly 1 in every 4 deaths. By supporting the heart walk, you'll be making a difference in people's lives – including your own.


Saturday, November 7, 2015
8 am - Registration Opens
10 am - Opening Ceremonies
10:30 am - Heart Walk Begins!


Citizens Bank Park
1 Citizens Bank Way
Philadelphia, PA 19148

Help Penn raise funds and surpass last year's efforts by joining a Penn heart walk team, or starting your own team and participating in the 2015 Philly Heart Walk.

To become a team captain, register as a walker or make a donation, visit Penn's Team Page, or contact Cara Feldman at

Thursday, July 23, 2015

One Question Everyone Should Ask Themselves

What would you do if you saw someone collapse and stop breathing?

In the United States, over 500,000 people suffer a sudden cardiac arrest (SCA) each year, and the overwhelming majority of these occur outside a hospital where the chance of survival is less than 6%.

These were the stark findings last month, when the Institute of Medicine released a report on cardiac arrest.

The report examined opportunities to improve cardiac arrest treatment and outcomes, noting that the public plays a critical role in improving CPR survival, as bystander CPR and quick defibrillation with an AED are essential in improving survival rates.

According to the American Heart Association, effective bystander CPR can double or triple the chances of SCA survival, but only 32% of victims receive it.

In Philadelphia, just 4% of the population is trained in CPR. There is room for improvement — lots of room. Anyone and everyone can learn Hands-Only CPR and become a part of this change that can increase survival in cardiac arrest victims.

So, ask yourself this question: Do you know Hands Only CPR?

Once we've convinced you that Hands-Only CPR is worth learning, the only thing left is to learn it. Dr. Benjamin Abella, Associate Director of the Center for Resuscitation Science makes it easy for you in this short video: How to Save a Life in 90 Seconds. Arm yourself with a tool that allows you to do something, not just standby when someone's life is at stake.

Wednesday, July 22, 2015

3,400 Miles on a Bike, With a New Heart

Heart transplant recipient Derek Fitzgerald is happy to be home.

Pushing the limits of what any heart transplant recipient has gone on to do, Derek has reached the end of his 44-day ultra-distance bike ride.

As part of the Recycledman Foundation's Tour for a Cure, Derek and fellow athletes Dave Madden and Maire Reynolds traversed the continent from Santa Monica, California to Avalon, New Jersey. The purpose: to raise money for cancer research, promote heart health, and bring awareness to organ donation.

A brief sendoff event this morning at the Hospital of the University of Pennsylvania celebrated Derek's post-transplant accomplishments. Riding with Derek on the last leg of his journey were more than a dozen cyclists.


Derek has faced daunting health problems in his life. In 2003, he was diagnosed with Non-Hodgkin's Lymphoma. Derek beat the cancer, but the treatments damaged his heart – he went into severe heart failure that ultimately led to a transplant in 2011.

Hear Derek tell his story:

With multiple IRONMAN competitions already under his belt, Derek is gearing up for two more: IRONMAN Mont-Tremblant and the IRONMAN World Championship in October.

We wish Derek all the best in his upcoming competitions!

Learn more about Derek's Recycledman Foundation and follow them on Facebook.

Monday, July 20, 2015

5 Tips for Exercise with Heart Failure

Exercising has been shown to provide benefits to people with heart failure.
People with heart failure may find symptom relief with exercise

For many people with heart failure, shortness of breath and low energy during physical activity are hallmarks of their condition. In fact, these symptoms during exercise are often the first indicators of heart failure, and tend to be a primary reason that people seek medical care.

While exercise is good for the heart, many people with heart failure find it difficult to stick to a program. "When you are sick with heart failure, fatigue can be an overwhelming symptom, which makes exercise quite difficult," explains Amy Marzolf, MSN, CRNP, Heart Failure Clinical Practitioner at Penn Medicine. "The problem can then multiply because the less you do, the less you can do — and it becomes difficult to know if your disease is progressing or if you are becoming deconditioned."

It’s important to remember that exercise will not improve your ejection fraction (the percentage of blood your heart can push forward with each pump). However, it can help to improve the strength and efficiency of the rest of your body. It’s also been shown to boost quality of life for patients living with heart failure.

Trying to maintain some level of physical activity can be very helpful in the long run in both keeping the rest of your body as healthy as possible while also preventing weight gain.

Of course, exercise is easier said than done. Here are five tips to help you kick start your exercise program.

Know the Benefits

Over the past two decades, research has shown the positive impact of exercise training in patients with heart failure. Among the benefits are:

Start slowly and build up gradually

When starting or changing an exercise program, it's important to start slowly and to gradually increase the amount and intensity of the exercise. Everyone has a different starting point, and that’s just fine. Some people start with walking around the room a few times a day. The key is to very slowly increase your activity. Don't expect to go from 0 to being a marathon runner. Set realistic and reachable expectations. "We often tell patients that if you add two steps every day, that is progress. Slow and steady is exactly who wins when it comes to heart failure and exercise," says Amy.

Pick something you enjoy

If you're already walking regularly, try picking up a new activity like cycling or swimming. This can keep you interested, and motivated to continue. You'll feel better by doing something different, too!

Get an expert's opinion

Before starting any new exercise regimen, or if you want to increase the intensity of your current program, talk to your doctor first. As with any major change, there are risks that should only be assessed by an expert familiar with your circumstances. The doctor may be also able to point you in the direction of a good cardiac rehabilitation program and give you pointers about exercises to try and which to avoid. The good news is that cardiac rehabilitation is now covered by health insurance plans for many patients who suffer from heart failure.

Don't overdo it

It's important to manage the risks involved with any exercise program. A key component of managing risks is preventing overexertion. A good measure of intensity is that you should be able to talk while you are exercising. You should also pause or stop exercising completely if you experience breathing difficulties, lightheadedness, chest pain, nausea or vomiting. If the symptoms continue several hours after the exercise, contact your doctor or nurse.

Do you have questions about your heart failure or other cardiac condition?

Learn more about Penn's Heart Failure Program or Find a Penn Cardiologist today.

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.