News from America's Leading Heart Center
The Cleveland Clinic
Volume Three, Number One, March 2003
Ever wonder where doctors go for their heart care?
Year after year, many choose the Cleveland Clinic Heart Center. The Cleveland Clinic is rated number one in America for heart care by U.S. News& World Report, and its physician staff includes many of the world's leading heart experts.
The Cleveland Clinic Heart Center is also America's largest and busiest heart center, and these physicians know that where doctors have the most experience, patients overall get better results. In this issue of Heart, we highlight a doctor from Albuquerque, New Mexico, who came to The Cleveland Clinic after discovering that she had a rare heart valve disease. You will also read interesting stories about new studies and technologies that are raising the state of heart care to new heights.
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When a Doctor Needs Heart Care
Her disease had no obvious symptoms. Elizabeth Cumby, M.D., 48, was able to fly an airplane, ski, snowboard and enjoy her family. She had no trouble caring for her patients at a New Mexico pueblo reservation, where she has practiced as a family physician for 15 years. But Dr. Cumby's heart was hiding a secret: an unusual valve disease called myxomatous degeneration, which, if left untreated, could lead to congestive heart failure and death.
Dr. Cumby would never have learned of the worsening of her condition if she hadn't needed to take a routine physical for her pilot's license. The examining physician had some concerns about the sound of her heart, and sent her to a cardiologist who diagnosed severe regurgitation due to myxomatous degeneration. The condition is hereditary. As it turned out, Dr. Cumby had inherited it from her father, who had died of complications from the illness.
Dr. Cumby learned that the usual treatment for myxomatous degeneration is open heart surgery to replace the defective valve — either with a pig valve or a mechanical valve. The pig valve would have to be replaced every 10 years, and the mechanical valve would require taking blood thinners for the rest of her life.
In March 2001, Dr. Cumby saw a local cardiovascular surgeon, who confirmed the diagnosis and said the valve needed to be replaced within six months.
As a doctor herself, Dr. Cumby knew that choosing the best doctor and hospital for her treatment was a crucial decision. Not all doctors and hospitals are alike. She asked questions and did research before making her choice. A cardiovascular surgeon friend told her that if she needed a valve procedure, she should see Delos M. Cosgrove, M.D., at the Cleveland Clinic Heart Center. Dr. Cosgrove is widely recognized as the world's leading expert on valve surgery.
"It was clear to me that The Cleveland Clinic was the best choice,"says Dr. Cumby.
Many physicians who have heart disease choose to come to the Cleveland Clinic Heart Center for their care. Doctors know that the Cleveland Clinic Heart Center's vast experience in all areas of heart care can be a factor affecting the quality of their outcomes.
Delos Cosgrove, M.D. (left foreground) was Dr. Cumby's surgeon
For Dr. Cumby's surgery, Dr. Cosgrove performed a valvuloplasty, a procedure that he pioneered, which allows him to repair rather than replace certain diseased heart valves. He also installed a Cosgrove-Edwards band, a device he developed to reshape the annulus, the ring of fibrous tissue that gives a valve its structural integrity.
"The people at the Clinic were very nice,"Dr. Cumby recalls. "When I was in the hospital, everyone knocked on the door and introduced themselves, even the person delivering the food."
Today, Dr. Cumby is feeling better than ever. Her stamina is back to normal, and she will probably need no further surgical treatment for her condition. "I always value the experience of being a patient myself,"says Dr. Cumby. "It deepens my sense of empathy."
Breakthrough Discoveries
Best Way to Clear a Carotid Blockage
A Cleveland Clinic Heart Center study recently made medical history. Cardiologist Jay S. Yadav, M.D., led the project, which tried to determine the best means of treating blockages of the carotid (neck) artery: a surgical procedure called an endarterectomy, or a minimally invasive catheterization procedure.
The catheterization procedure involves widening the blockage via balloon angioplasty — as is routinely done to clear blockages in the heart — followed by the insertion of a stent (a small wire mesh cylinder) to keep the artery open. In the past, the carotid- clearing version of this procedure has been associated with increased risk for strokes. The strokes were related to tiny blood clots, called emboli, that break off the blockage as it is being cleared. For the study, the stenting procedure also included the use of the AngioGuard, a device invented by Dr. Yadav, which opens like a small umbrella in the artery during the angioplasty and filters out the floating emboli before they can reach the brain and cause a stroke.
The results of Dr. Yadav's study were remarkable: Compared to the surgical procedure of endarterectomy, carotid stenting using the AngioGuard cut 30-day rates of death, heart attack and stroke by more than 50 percent. It made history because it was the first time that an interventional (minimally invasive catheter) procedure has been shown to be superior and not just equal to surgery in cardiovascular medicine.
Jay Yadav, M.D. Led the study
Breaking News!
The study has been named one of the Top Ten Research Advances of 2002 at the American Heart Association's (AHA) Scientific Sessions.
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Q&A
I’ve been diagnosed with atrial fibrillation. What are my treatment options?
Atrial fibrillation is an abnormal heart rhythm originating in the atria (top chambers of the heart). Instead of the impulse traveling in an orderly fashion through the heart, many impulses begin and spread through the atria, causing a rapid and disorganized heartbeat. This condition may be treated by:
Medication A variety of drugs are available to treat atrial fibrillation. These include drugs that convert arrhythmia to a normal rhythm, drugs that control the heart rate, and “blood thinning” drugs that help prevent the clots sometimes associated with atrial fibrillation.
Lifestyle changes These include limiting or stopping smoking, caffeine use, alcohol, or cough or cold remedies containing stimulants.
Electrical cardioversion While under a short-acting anesthesia, an electrical impulse is delivered to the chest wall, normalizing the rhythm.
Catheter ablation with pacemaker implantation High-frequency electrical energy is delivered through a catheter to the conduction system of the heart. This prevents the rapid heart rate caused by atrial fibrillation. A pacemaker is then implanted to control the heart rate.
Pulmonary vein isolation Using a catheter, bands of tissue inside the pulmonary vein (atop the heart) are rendered dysfunctional, blocking conduction of the abnormal rhythms.
Heart surgery The maze procedure uses a series of incisions in the right and left atria to confine the heart’s impulses to defined pathways.
Noninvasive alternatives to the maze Understanding that isolations of the pulmonary vein and portions of the left atrium can eliminate atrial fibrillation, Heart Center physicians now use radiofrequency, microwave and cryothermic (cold temperature) devices to scar the tissue and block abnormal impulses.
Your cardiologist will suggest which treatment is best for you after assessing your condition. Whatever treatment you may need, the Cleveland Clinic Heart Center offers alternatives that can’t be found at any other hospital. Call us to find out more. 800/545-7718.
Know Your CRP
Heart Center cardiologist Deepak Bhatt, M.D., says "CRP is a valuable way to gauge risk."
We all know that cholesterol screening can tell your doctor if you are at risk for heart attack or stroke. Now there’s a new, and possibly even better, marker. It’s called c-reactive protein (CRP). The presence of CRP is associated with inflammation, and inflammation is now believed to be a major factor in cardiovascular disease. Beyond that, CRP is also associated with increased risk of stroke and heart attack in individuals with normal cholesterol levels, no symptoms of heart disease, and none of the usual risk factors, like obesity, smoking, hypertension, etc. Testing for CRP levels in the blood is simple, and more and more physicians believe it should be a routine part of a patient’s physical examination, like cholesterol screening.
“Using CRP testing is a valuable way to gauge risk,” says Cleveland Clinic Heart Center cardiologist Deepak L. Bhatt, M.D.
“A high CRP level is a marker of arterial inflammation, and arterial inflammation correlates with atherosclerosis, including unstable plaque, which can precipitate heart attacks and strokes.”
CRP is a protein found in the blood. In studies involving large numbers of patients, CRP levels seem to be correlated with levels of cardiac risk. In fact, CRP seems to be at least as predictive of cardiac risk as cholesterol levels. Data from the Physicians Health Study, a clinical trial involving 18,000 apparently healthy physicians, found that elevated levels of CRP
were associated with a threefold increase in the risk of heart attack.
CRP is detected through a simple blood test that can be done at the same time as a cholesterol screening. Dr. Bhatt already tests for CRP along with cholesterol in his patients who have been diagnosed with heart disease, and he believes that it may be useful in the general population as well.
Eric Topol, M.D., co-chairman of the Cleveland Clinic Heart Center, told the Washington Post, “If I was allowed only one test, I would use CRP.”
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