The Beat: A Bryan Heart Blog
The Beat is a monthly blog from Bryan Heart cardiologists to keep you informed on trending topics, advancements and news in heart care.
When should I start Entresto?
When a patient is hospitalized for heart failure (HF), it is a sentinel moment for many reasons, one of which is that their risk for subsequent events is significantly higher. Also, following hospitalization, patients are much more willing to accept changes in their medical regimen, including aggressive titration of medication or addition of new therapies.
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What is my target number? 2018 ACC/AHA Multisociety Guidelines on the Management of Blood Cholesterol
The 2018 American College of Cardiology (ACC) and American Heart Association (AHA) multisociety guidelines aim at reducing risk of atherosclerotic cardiovascular disease (ASCVD) through lipid management. Compared to the 2013 these guidelines emphasize a more intensive approach based on recent controlled studies and expert consensus.
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Mitra Clip: Treatment of Secondary Mitral Regurgitation
Written by John Steuter, MD
The MitraClip device is already approved in the U.S. for use in primary mirtal regurgitation (MR), a condition in which the mitral valve leaflets do not function properly due to a degenerative defect. Whether the device is useful for secondary MR, in which the valve structure is normal, but the ventricle is enlarged, has still been in question. The prognosis for heart failure patients who develop severe secondary mitral regurgitation is poor with limited treatment options.
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I have heart failure, should I keep walking?
Written by John Steuter, MD
Heart failure affects people of all ages, yet it is more prevalent among seniors over the age of 60. The American Heart Association (AHA) recommends people at risk should avoid smoking, exercise more, eat heart-healthy foods. But more specifically what can walking do to help heart failure?
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Is Valsartan Safe?
Written by John Steuter, MD
Last month the U.S. Food and Drug Administration (FDA) issued a recall on pharmaceuticals containing the active ingredient valsartan. Valsartan is used to treat high blood pressure and heart failure. An impurity that can cause cancer has been found in batches of the ingredient valsartan manufactured in China. The recall is due to changes in the way the active substance was manufactured. However, not all products containing valsartan are being recalled.
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How important is good sleep to my patient’s heart health?
Written by John Steuter, MD
For some time, we have known that insufficient sleep increases blood pressure, and, therefore, the risk of heart-related diseases. A recent study from Columbia University assessed whether or not less serious sleep issues could cause measurable cardiovascular effects. An estimated one third of people in the United States do not get enough sleep. And, women seem to be affected more often than men.
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Stent versus CABG to treat multivessel coronary artery disease
Written by John Steuter, MD
Cardiac revascularization in patients with significant coronary artery disease (CAD) is an important therapeutic intervention to improve symptoms and prognosis. Along with revascularization, patients should receive guideline direct medical therapy. The best current revascularization results achieved with percutaneous coronary intervention (PCI) are with new-generation drug-eluting stents (DES) and for coronary artery bypass grafting (CABG) with maximal use of arterial grafts. The best option is still a large question as many different patient characteristics exist.
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Does fish oil reduce my risk of heart disease?
Written by John Steuter, MD
Historically, ecologic studies found low rates of coronary heart disease (CHD) deaths among Greenland Eskimos consuming large amounts of seafood. Subsequent animal studies, observational studies and clinical trials examined the health effects of seafood consumption. These studies identified the long-chain n-3 polyunsaturated fatty acids (n-3 PUFA) in fish oil, eicosapentaenoic acid (EPA) and docosahexaenoic (DHA) acid as the likely active contributors to lowering heart disease.
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Treating Heart Failure and Atrial Fibrillation
Written by John Steuter, MD
Is the end of Digoxin nearing? Digitalis has been used for over 200 years to treat patients with heart failure and atrial fibrillation (afib). Digoxin is used for rate control of afib and in the treatment of heart failure, yet has recently come into question with concern for increased mortality.
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Understanding Advanced Heart Failure
Written by John Steuter, MD
A large spectrum of disease severity exists when it comes to patients with heart failure. Medical therapy, revascularization with stents or bypass, and defibrillator placement are some common tools utilized to treat a patient for heart failure.
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What is causing my chest pain?
Written by John Steuter, MD
Evaluating patients for coronary artery disease (CAD) is a common clinical scenario that providers face on a daily basis. A variety of tests exist that can be utilized to sort through the multitude of such patients from stress tests to heart catheterization. Tests can be categorized into either being functional assessments for significant CAD such as treadmill stress tests, nuclear stress tests or into anatomic, as in heart catheterization or cardiac CT. Each modality has strengths and limitations.
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What is my blood pressure goal?
Written by John Steuter, MD
Hypertension, the world’s most common and modifiable cardiovascular risk factor, has been the focus of multiple clinical practice guidelines. In hopes to address the ongoing controversies and to account for new evidence from recent trials that focused on hypertension, the American College of Cardiology and the American Heart Association (ACC/AHA) have now produced the 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults.
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The WATCHMAN Device: An Alternate Treatment to Blood Thinners
Written by Robert Percell, MD
Atrial fibrillation (AFib) is a chaotic rhythm of the upper chambers of the heart called the atria and is the most common heart rhythm disorder. More than 2.7 million people in the United States have AFib. The average person with AFib is five times more likely to suffer a devastating stroke than someone with a regular heartbeat. More than 90% of stroke-causing clots originating from the heart are formed in a small structure called the left atrial appendage. A stroke results when a blood clot escapes from the left atrial appendage and travels to the brain cutting off the blood supply.
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Why Did My Patient “Pass Out”?
Written by John Steuter, MD
Syncope is a clinical syndrome in which transient loss of consciousness (TLOC) is caused by a period of inadequate cerebral flow. Typically the period of time with inadequate cerebral flow is relatively brief and, by definition, self-limited. It is often the result of cerebral hypo-perfusion due to transient hypotension.
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New Diabetes Therapy Lowers Risk of Death from Cardiovascular Causes and Could Reduce Weight and Blood Pressure
Written by John Steuter, MD
Type 2 diabetes mellitus (T2DM) patients often suffer from obesity and hypertension, increasing their cardiovascular risk. To improve outcomes for patients with T2DM, empagliflozin (Jardiance) a sodium-glucose contransporter 2 inhibitor (SGLT2-I), was approved in 2015 as monotherapy or as an add-on therapy.
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Is it Safe to Participate in Sports? Cardiovascular Screenings for Athletes
Written by John Steuter, MD
Cardiovascular screening in athletes is universally supported, but the best model for accurate detection of athletes and children with potentially lethal heart disorders remains challenging and often controversial.Most athletes who suffer sudden cardiac arrest do not have warning signs or symptoms before their cardiac arrest. Some symptoms can be under-reported by athletes or go unrecognized by medical providers.
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For Afib Patients, to Bridge or not to Bridge? That is the Question.
Written by John Steuter, MD
To clarify questions and standardize patient care, in 2017, the American College of Cardiology (ACC) came forth with new guidelines and recommendations for which atrial fibrillation patients should be “bridged” during the perioperative period and which should not. The guidelines and recommendations apply to non-valvular atrial fibrillation (afib) patients undergoing surgery.
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Impella: A Novel Percutaneous Cardiac Assist Device
Written by Timothy Gardner, MD, FACC
A 68 year-old male experiences a massive anterolateral STEMI and cardiogenic shock. He requires a high dose of Dopamine and Levophed to maintain mean arterial BP of 65 mmhg. An emergent cardiac cath is performed and a 100% occluded proximal LAD culprit lesion is found and treated with a drug eluting stent with no residual stenosis and normal TIMI 3 flow. Revascularization is achieved within four hours of onset symptoms. Ejection fraction is 20% with anteroapical akinesis.
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PCSK9 Inhibitors: An Effective Option for Cholesterol Treatment
Written by Ryan Whitney, MD
Heart disease is a leading health problem in America. It affects over 92 million people and accounts for one of every four deaths each year. Aggressively treating cholesterol is a key component of managing cardiovascular disease and reducing the risk of future complications. A class of medications called the statins have been, and still are, the cornerstone of cholesterol lowering therapy. However, the PCSK9 inhibitors are a new class of medications approved to complement statin use in certain high risk individuals.
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Venous Disease
Written by Timothy Gardner, MD, FACC
40 percent of people in the United States suffer from chronic venous insufficiency (CVI). This common disease is twice as prevalent as coronary artery disease and ten times as rampant as peripheral arterial disease. CVI is caused when there is inadequate blood flow, yet abnormally high blood volume and pressure in the veins.
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Cardiac MRI: Powerfully Clear Imaging to Identify Heart Issues
Written by John Steuter, MD
In the last 10 years cardiac magnetic resonance imaging (MRI) has emerged as a tool to better visualize the heart and define abnormal disease states. This minimally invasive procedure does not involve radiation and delivers unparalleled image quality. Cardiac MRI offers new levels of specificity in the diagnosis and management of heart care.
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What is the Ideal Amount of Exercise?
Written by John Steuter, MD
With a new year upon us, resolutions to improve our physical fitness are plenty. Patients often ask how much should I exercise? Is it possible to exercise too much?
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Preventative Measures to Reduce Heart Disease
Written by John Steuter, MD
Heart disease is the leading cause of death in the United States and has carried the number one spot for many years. Yet, heart disease deaths are steadily decreasing in many states and cancer is gradually becoming the leading cause of death.
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New Coronary Stents Fully Absorb in Patients
Written by John Steuter, MD
Every day patients receive stents to keep their arteries open to supply blood to the heart. Interventional cardiologists at Bryan Heart now have a new approach to make this procedure easier and safer for patients.
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Revolutionary Pacemaker Lessens Patient Complications
Written by W. Michael Kutayli, MD
Micra is the newest and smallest pacemaker, approved for use in the United States by the FDA in April 2016. Bryan Heart is the first in Nebraska to offer this true revolution in pacing technology.
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Coronary Calcium Screening: A Simple Test to Prevent Heart Attack
Written by John Steuter, MD
A coronary calcium screening is a test that looks for areas of calcium in the walls of the coronary arteries, which could ultimately cause a heart attack. Calcifications in the coronary arteries are an early sign of atherosclerosis.
Mitraclip: A Minimally Invasive Procedure to Reduce Mitral Regurgitation
Written by John Steuter, MD
Mitral regurgitation develops when the heart's mitral valve leaflets fail to close tightly causing blood leak back through into the left atrium. As a result, the heart must then work harder to push the extra blood through the heart.
Preventing Readmissions for Heart Failure Patients
Written by John Steuter, MD
Heart failure is a major problem in the United States. Over five million people suffer from heart failure with over 650,000 new cases and over one million heart failure admissions a year.
