Penn Heart and Vascular

Penn Heart and Vascular Update

Tuesday, October 21, 2014

Preparing for a Doctor's Appointment

Do these 6 things before your next doctor's appointment
Whether it's going for a regular check up or seeing someone for a second opinion, doctor's appointments can often feel overwhelming. You may worry about getting bad news or feel concerned about the tests that may need to be performed. However, getting ready prior to the appointment can help decrease your anxiety.

Here are 6 things you can do to prepare for your next doctor's appointment:
  1. Create a list of current medications. Include the name of the medication, dosage, and how often you take it. It is a good idea to print this list off and keep it inside your wallet; as well as give a copy to a close friend or relative. Make a note of any concerns or questions you have about the medications you are taking.

  2. Remember your allergies or sensitivities. Include medications, foods and body care products. Often a food allergy can be associated with a medication so those are just as important to note.

  3. Document your family history. Be prepared to answer many questions about family history. If there are things that are very specific or you think you may forget, make sure to write them down.

  4. Bring your medical records. Your primary physician likely already has access to your full medical record, but make sure you communicate any changes or concerns since your last visit. If you are seeing a new doctor, call their office ahead of time to coordinate the delivery of your records. Prepare to communicate key issues from your medical history and be proactive about sharing issues you think are important. Finally, bring copies of films and test results that were performed since last seeing this doctor.

  5. Write down your questions. Due to the stress and anxiety that you may feel at the doctor's office, sometimes it is difficult to remember all the health questions you have had leading up to the appointment. To make sure you ask them, write your questions down ahead of time.

  6. Bring a family member or friend. Having support at your appointments can be helpful for a number of reasons. Your partner can help you remember what the doctor said during the appointment, they can help ask questions you may not think of, and of course, the extra moral support comes in handy too.
Think about or write down these six things and bring them to your next appointment. That way, you'll feel more relaxed and be more likely to cover what's important in your visit.

Wednesday, October 15, 2014

Ejection Fraction: What the Numbers Mean

Ejection fraction is a measurement that can gauge how healthy the heart is.

A low ejection fraction number can be an indicator of heart failure and can lead to a variety of symptoms, including:

  • Shortness of breath
  • Fatigue
  • Irregular heartbeat
  • Abdominal discomfort
  • Swelling in the legs and feet

There are two types of ejection fraction: left ventricular and right ventricular. Left ventricular measures how much blood gets pumped from the left ventricle with each contraction. Typically, ejection fraction refers to left ventricular. Right ventricular ejection fraction measures how much blood is pumped out of the right side of the heart, to the lungs.

What are the tests used to determine ejection fraction?

  • Echocardiography – the most common test used to measure ejection fraction.
  • Cardiac catheterization
  • MRI (magnetic resonance imaging)
  • Nuclear medicine scan
  • CT (computerized tomography)

What do ejection fraction numbers mean?

  • 55 to 70% – Normal heart function.
  • 40 to 55% – Below normal heart function. Can indicate previous heart damage from heart attack or cardiomyopathy.
  • Higher than 75% – Can indicate a heart condition like hypertrophic cardiomyopathy, a common cause of sudden cardiac arrest.
  • Less than 40% – May confirm the diagnosis of heart failure.

How can you improve ejection fraction?

  • Limit salt – the average American eats nearly 3,400mg of sodium a day – more than double the recommended amount.
  • Watch your fluid intake – talk with your cardiologist about how much fluid to consume each day.
  • Exercise – try some type of physical activity 30 minutes each day, three days a week.

After the initial ejection fraction measurement, your doctor will check the number as needed, depending on your condition. Because ejection fraction is just one measure of how well the heart is working, even when this number is normal, the heart may not be functioning properly.

Heart failure is a complex disease, but it is manageable – especially when you are armed with the right information.

Our heart failure team is "certified and advanced" by the Joint Commission, meaning we specialize in treating patients with heart failure. We also take the time to answer all of your questions, including how to find a heart failure specialist near you.

Thursday, October 9, 2014

7 Heart Healthy Apple Recipes


We're in the thick of apple season here in the Northeast. Whether you pick your own, purchase them from your local farmers' market or at the local store, there isn't anything much better in early fall than a crisp apple or the smell of apples cooking. It's a lucky coincidence that apples happen to rank high on the healthy fruit meter with a powerful store of nutrients in each bite.

One medium size apple offers:
  • Up to 4 grams of soluble fiber which is known to lower LDL (bad) cholesterol
  • Up to 8 grams of Vitamin C - an immune boosting nutrient
  • Antioxidants such as anthocyanins which have been know to decrease the risk of developing type 2 diabetes
Below are recipes to help you boost your health and please your senses. 

What are your favorite ways to eat apples? 


Photo credit: Million Hearts


Photo credit: Go Red For Women


Photo credit: Eating Well


Photo credit: American Heart Association


Photo credit: Real Food Real Deals


Photo credit: Health.com


Photo credit: Eating Well






Wednesday, October 8, 2014

How My Priorities Changed After Heart Transplant

Image of Bob GoodmanBob Goodman, heart transplant recipient, reminisces on how a drastic illness caused him to question his priorities in life. Bob is joining Penn Medicine in the 2014 Philadelphia Heart Walk.


I received my new heart on November 24, 2013, but it took a couple of months for it to dawn on me that I almost died before receiving it. In fact, I had been walking around near death for a few months and didn't know it – no one did. Once that realization finally reached the forefront of my brain, I was already setting new priorities.

The Saturday after my transplant, I said to my wife Patti that we needed to take advantage of my new heart and we needed to share our experience with others. I must have been given this heart, especially so quickly, for some reason. (Just three days after being placed on the transplant list, I was told a heart was available).

I realized very quickly that I had to take care of myself and my family. That was most important and, quite frankly, it never occurred to me that it wasn't my first priority – and that it will always be my first priority.

As we started to think about how we take advantage of my new heart, it became clear that my second priority was an entirely an altruistic effort. It started with talking with a few other heart transplant patients, notably the incredibly inspirational Derek Fitzgerald, and doing a lot of reading through web searches and websites; as well as organizations that Derek referred me to. Several staff members at the Penn Medicine Heart & Vascular Center were very helpful as well. I'm now participating in activities on behalf of Penn Medicine's Heart & Vascular Center; am on two committees of the New Jersey chapter of the American Heart Association; and I'm involved with efforts associated with the Gift of Life.

My third priority revolves around business and ties together my 40 plus years of business experience in the healthcare industry and my patient experience of the last year. I am now actively seeking opportunities to become a board member of a company focused on life sciences, medical devices or a provider of services. I feel this will allow me to contribute my insights, my experience and just to give back.

Lastly, I am in the process of re-starting my 15-year-old healthcare consulting firm and similar to my board participation efforts, I am in the midst of networking to re-establish myself with current, former and new colleagues to secure a client base.

Always number one though will be my family. Their support and perseverance through the past few years motivates me to be the best husband and father I can be. And if I'm not well, I won't feel secure that my family is truly taken care of. These are my new priorities, which I have taken to...heart.

Monday, September 15, 2014

Dine Out with us to Support the American Heart Association

View flyer for Dine Out and
support the Philadelphia Heart Walk

Help us fight heart disease by choosing healthy meals at two award winning Philadelphia restaurants!

Doc Magrogan’s and Harvest Seasonal Grill and Wine Bar are teaming up with Penn Medicine to raise money for the Philadelphia Heart Walk.

Show your server your Penn Medicine ID or the flyer in this blog post any time between September 15 and November 8, and 10% of your bill will be donated to the American Heart Association.

In addition, eligible items that have been deemed heart healthy by registered dieticians will be marked on the menu with the Penn Medicine logo.

There is no doubt that fresh, healthy foods are essential to being healthy. Both Doc Magrogan’s and Harvest share a mission of providing fresh, seasonal and healthy options for eating out.

Come dine out with us to help fight heart disease!

Tuesday, September 2, 2014

Learning More about Heart Failure —
Commonly Used Heart Failure Classifications

Doctors often describe the severity of heart failure by how much the patient’s physical activity is limited.

One of the most frequently used heart failure classification systems that doctors use is the New York Heart Association (NYHA) Functional Classification. Each class in this system describes a patient’s symptoms while performing physical activities. Classifying heart failure based on how a person functions during exertion is a strong indicator of the patient’s outcome.

Here is a description of the NYHA Functional Classification:

NYHA Class Symptoms
I Cardiac disease, but no symptoms and no limitation in ordinary physical activity, e.g. shortness of breath when walking, climbing stairs etc.
II Mild symptoms (mild shortness of breath and/or angina) and slight limitation during ordinary activity.
III Marked limitation in activity due to symptoms, even during less-than-ordinary activity, e.g. walking short distances (20–100 m). Comfortable only at rest.
IV Severe limitations. Experiences symptoms even while at rest. Mostly bedbound patients.
The American College of Cardiology (ACC) and the American Heart Association (AHA) developed a different classification system for heart failure. The ACC/AHA system does not replace, but complements, the NYHA system, and identifies a patient class not present in the NYHA Classification – those patients who don’t have heart failure, but are at high risk for developing the condition.

Here are the ACC/AHA Stages of Heart Failure:

ACC/AHA Stage Symptoms
A At high risk for heart failure but without structural heart disease or symptoms of heart failure.
B Structural heart disease but without signs or symptoms of heart failure.
C Structural heart disease with prior or current symptoms of heart failure.
D Refractory heart failure requiring specialized interventions.

The Most Common Treatments for Each Stage of Heart Failure:

Receiving the proper treatment at the right stage during heart failure is important to stop or slow down the progression of heart failure. The most common treatments for heart failure are:
ACC/AHA Stage Treatment

A

(At high risk for heart failure)
- Quit smoking.
- Exercise regularly
- Treat high blood pressure
- Treat lipid disorders
- Discontinue alcohol or illegal drug use
- If you have coronary artery disease, diabetes, high blood pressure, or other vascular or cardiac conditions, taking medications as prescribed

B

(Heart disease, without signs of heart failure)
- All patients should take an ACE inhibitor or ARB
- Beta-blockers should be prescribed for patients after a heart attack
- Surgery options should be discussed for coronary artery or valve disease

C

(Heart disease, with signs of heart failure)
- African-American patients may be prescribed a hydralazine/nitrate combination if symptoms persist
- Diuretics (water pills) and digoxin may be prescribed if symptoms persist
- An aldosterone inhibitor may be prescribed when symptoms remain severe with other therapies
- Restrict dietary sodium (salt)
- Monitor weight
- Restrict fluids (as appropriate)
- Pacemaker or ICD may be recommended

D

(Heart failure not responding to treatments)

- Patient should be evaluated to determine if the following treatments are available options:
  • Heart transplant
  • Ventricular assist devices
  • Surgery options
  • Research therapies
  • Continuous infusion of intravenous inotropic drugs
  • End-of-life (palliative or hospice) care

We can help you get the right heart failure treatment. The heart failure program at Penn Medicine is the largest on the East Coast with specialized cardiologists that are solely dedicated to treating you, or your loved ones living with heart failure, or its affects. To learn more about how the program can help, schedule a consultation today.



Thursday, August 28, 2014

It Takes a Village to Heal a Heart

A heart transplant is not just an eight-hour surgery. It is also the coming together of doctors, nurses and support staff to prepare the patient before surgery and also be there for the patient and family throughout the recovery. And for Bob Goodman, all of these people take up a large part of his new heart.

Bob was placed on the transplant list the Tuesday before Thanksgiving with his wife Patti by his side. They remember the moment that their nurse, Mia, came to tell them that a heart was available. At first, a feeling of disbelief ran through them, but that was quickly followed by reserved excitement. High-fiving friends as he headed down to surgery, Bob was ready for what was ahead: a long road to recovery, but a road leading to a newfound life.
Bob and his wife Patti visit the hospital room where Bob was told his new heart was ready for transplant.
That recovery began the moment he left the operating room and headed to the Surgical Intensive Care Unit (SICU). Heavily sedated, this is a time that Bob does not remember, but one that his wife Patti and daughter Stephanie remember well. "The SICU staff was prepared. The nurses in the unit were the most competent, caring, professional individuals that I have ever met," Patti says. "Day in and day out they educated us on every single thing that was happening."

Not only did the nursing staff take care of his physical ailments, but they also educated, encouraged, and in many ways, became a constant in Bob's life. Friendly faces such as Rachael Cress and Stephanie Barlow, nurses on the Silverstein 10 floor at the Hospital of the University of Pennsylvania , will forever be engrained in Bob's memory. As Bob says, "Their care from the moment I woke up and throughout my days in the hospital was more than just clinical. They were prepared for the journey that a transplant patient was on, they had done this before. The education they provided, their encouragement, knowledge and passion is something I will take with me."
Stephanie Barlow and Rachael Cress  – Penn nurses who cared for Bob after his heart transplant.

What goes into our bodies makes a difference, especially in transplant patients.

After discharge from the hospital Bob was having trouble gaining weight. He had become a diabetic secondary to the steroid treatments needed during heart failure. Enter registered dietician Kathleen King. Her knowledge of this subset of patients was crucial in Bob's recovery. A personalized plan was put together and Bob was able to gain weight and energy.
Bob with heart transplant nurse practitioner Mieke Maslanek and patient services coordinator Ashley Wetherell.

A heart transplant patient receives care from over 20 different disciplines while in the hospital.

Bob with cardiac electrophysiologist
David Callans, MD
The medications of a transplant patient can be overwhelming. It is important that patients and their caregivers know the roles of each medication. Bob's education began during his post-transplant hospital stay, but that education continued with Mieke Maslanek, heart transplant nurse practitioner and Bob's post-transplant coordinator.

Continuity of Care is Important

Throughout Bob's journey, he never felt alone. There were people with him at every turn to offer guidance, support and wisdom.
Nearly one year later, Bob continues to have follow-up appointments with physicians Dr. David Callans, Dr. Lee Goldberg and Dr. Jessica Dine, and Mieke is always available when a question arises or to coordinate care.

They were with him in the beginning and continue to be there every step of the way.