Holy Cross Cardiovascular Blog

For the Atrial Fibrillation Patient: Preparing for Any Type of Surgery

  • Posted Oct 16, 2015
  • Rishi Anand, MD

Over 27 million Americans undergo noncardiac surgery annually. However, despite having noncardiac surgery, cardiac complications can still be a major source of morbidity and mortality in the perioperative period if you suffer from atrial fibrillation.

Patients who are taking anticoagulants – including patients with afib - undergoing any surgery is taken off these blood thinning medications prior to the procedure to avoid bleeding and serious complications. The focus of preoperative evaluation if you have afib is to:
(1) assess your rate and/or rhythm control;
(2) identify patients with valvular disease or heart failure;
(3) determine if you have experienced prior thromboembolic events; and
(4) take a thorough history of previous management plans you used when cessation of anticoagulation was required.

Your physician will also perform a thorough cardiovascular examination, including a review of your ECG and prior echocardiograms. It is also important for your physician to know about prior factors that induced afib episodes, including any episodes occurring with prior surgical procedures.

Preoperative management includes optimizing the heart rate, which is individualized according to your needs. AV nodal blockers are typically continued around the time of surgery, and a post-op plan should be made for continuing these agents, taking into account whether or not oral food and fluids will be withheld from you after the procedure (if you are "NPO"). Your preoperative management should generally include a discussion with your cardiologist if you are receiving antiarrhythmic medications, such as sotalol, propafenone, and amiodarone.

The use of anticoagulation around the time of your surgery requires complex decision making.  A plan should be developed prior to surgery whenever possible. This plan should include anticipating the postoperative conditions affecting the resumption of anticoagulation. 

The management of anticoagulation when you are undergoing surgical procedures is challenging because interrupting anticoagulation for a procedure increases your risk of forming blood clots that can be carried to other vessels in your body (thromboembolism), which can lead to a more serious condition or death. At the same time, surgery and invasive procedures have associated bleeding risks that are increased by the anticoagulant(s) you take for thromboembolism prevention. A balance between reducing the risk of thromboembolism and preventing excessive bleeding must be reached.

If you are being treated for atrial fibrillation and will be undergoing any type of surgery, talk your doctor about management of your afib and blood thinners around the time of surgery.

Dr. Rishi Anand is a cardiac electrophysiologist with the Holy Cross Medical Group in Fort Lauderdale, FL and serves as medical director of Holy Cross Hospital's Electrophysiology Lab. For physician referral information, call 954-900-6659.

Ask the Doc - Karan Munuswamy, MD, Cardiologist: Uncontrolled Blood Pressure

  • Posted Aug 24, 2015
  • Karan Munuswamy, MD

Q: What are the complications of uncontrolled Blood Pressure?

Dr. Munuswamy: Uncontrolled BP can lead to heart attack, stroke, aneurysm, heart failure, kidney failure, memory disorder or blindness.

Dr. Munuswamy is a cardiologist and hypertension specialist who practices with the Holy Cross Medical Group in Fort Lauderdale, FL. For referral information, call 954-900-6659.

Holy Cross Hospital’s Jim Moran Heart and Vascular Research Institute Selected for American College of Cardiology SMARTCare Program

  • Posted Jul 30, 2015
  • hchadmin

Cardiology program designed to engage stable ischemic heart disease patients in decisions

Physicians at Holy Cross Hospital will have access to a unique set of tools to help them communicate and collaborate with their patients with heart disease through an innovative pilot program at selected health facilities in Florida and Wisconsin.

Holy Cross Hospital is among the first sites selected to participate in the American College of Cardiology SMARTCare Program, which stands for Smarter Management And Resource use for Today’s complex cardiac Care Program. The  program is designed to support physicians and stable ischemic heart disease patients in making decisions together about care based on the patient’s unique history and the latest treatment criteria.

“This is yet another exciting first for cardiovascular services at Holy Cross Hospital,” said Joshua Purow, MD, of Cardiology Associates of Fort Lauderdale, the Holy Cross Medical Group practice piloting the program. “Any time we can personalize care and fully engage healthcare consumers, we all benefit.”

More often than not, there is no “one-size-fits-all” answer for patient care. Using SMARTCare, which brings together five decision-making tools, physicians will access appropriate use criteria and other resources based on the patient’s history and symptoms. These tools include individualized patient cardiac risk profiles and electronic databases that allow the physician to readily access related treatment information at the right time. The SMARTCare tools are designed to further empower patients to become actively involved in the management of their care.

The Jim Moran Heart and Vascular Research Institute is participating in this innovative project, which will allow patients in Holy Cross Medical Group cardiology practices to learn more about their health choices and to become involved in decision making that may affect their health and quality of life. Participation is voluntary and patient  care will not change in any way if patients decide not to participate. There is no additional cost to the patient, nor is there a payment for participation.

The ACC’s Florida and Wisconsin chapters designed the SMARTCare program to reduce health care costs by providing tools for doctors and patients to communicate about options for their care. These tools help physicians apply the latest guidelines to the decision-making process and find a treatment that works for the patient. The program was made possible by a $15.8 million grant from the Center for Medicare & Medicaid Innovation. The SMARTCare model is expected to save participating sites $42.2 million over the three-year pilot program, while also improving the decision-making process to benefit patients.

“A physician’s best ally is a well-informed patient. The ACC SMARTCare Program offers physicians an opportunity to align their real-world experiences with the best evidence-based recommendations,” said ACC President Kim Allan Williams , MD, FACC. “This will reduce unnecessary procedures and provide a mechanism for physicians and patients to partner in decisions on care.”

“SMARTCare sites represent a variety of practices across Florida and Wisconsin and were selected based on their commitment to providing quality care. Holy Cross Hospital’s dedication to supporting the doctor-patient relationship and commitment to quality improvement through participation in registry programs will help make this program successful.”


Holy Cross Hospital, a part of Trinity Health, is a full-service, non-profit Catholic hospital operating in the spirit of the Sisters of Mercy. Holy Cross Hospital has a proud tradition of providing clinical excellence and research leadership in Cardiology, Cardiovascular Surgery as well as Cancer Treatments, Orthopedic Surgery and Pain Management.  Since opening its doors in 1955, the 557-bed hospital has offered progressive services and programs to meet the evolving healthcare needs of individuals and families we serve.   Today, Holy Cross has more than 600 physicians on staff representing more than 40 specialties and more than 3,000 employees. To learn more about Holy Cross Hospital, visit holy-cross.com, “like” Holy Cross Hospital, Fort Lauderdale on Facebook or follow @holycrossfl on Twitter.

The American College of Cardiology is a 49,000-member medical society that serves  as the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and improve heart health. The ACC leads in the formation of health policy, standards and guidelines. The College operates national registries to measure and improve care, provides professional medical education, promotes cardiovascular research and bestows credentials on cardiovascular specialists who meet stringent qualifications. For more information, visit acc.org.

The project described was supported by Grant Number 1C1CMS331322 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services.

The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the US Department of Health and Human Services or any of its agencies.

Ask the Doc - Karan Munuswamy, MD, Cardiologist: Optimal Blood Pressure

  • Posted Jul 23, 2015
  • Karan Munuswamy, MD

Q: What is the optimal blood pressure?

Dr. Munuswamy:

Although 120/80 mm of Hg or lower is the ideal blood pressure goal, presently there is no evidence that lowering blood pressure with medications to that level has any benefit in lowering the risk of heart attack or stroke. Therefore, present BP treatment goals are:

• Less than 150/90 mm of Hg if you are a healthy adult, age 60 or older. 
• Less than 140/90 mm of Hg If you are a healthy adult, younger than age 60. 
• Less than 140/90 mm of Hg with chronic kidney disease, diabetes or with underlying blocked arteries to the heart, irrespective of age.     

Dr. Munuswamy is a cardiologist and hypertension specialist who practices with the Holy Cross Medical Group in Fort Lauderdale, FL. For referral information, call 954-900-6659. 

Mitral Valve Prolapse and Mitral Regurgitation

  • Posted Apr 22, 2015
  • Vicente Font, MD, FACP, FCCP, FACC

A fairly common condition, Mitral Valve Prolapse (MVP) occurs when one or more leaflets of a mitral valve becomes abnormal and can sometimes lead to leakage of the valve (mitral regurgitation).

The mitral valve works like a one-way door system which allows blood to go in only one direction. After which, the valve is supposed to seal shut and not allow for any back flow of blood into the left atrium of the heart. When the valve becomes diseased, degenerative or becomes too loose, the valve loses the ability to close tightly, allowing for mitral regurgitation.

For most patients with MVP, if they experience mitral regurgitation at all, it is usually trivial, or mild. However, sometimes, the defect in the valve may be significant enough to cause a much greater amount of mitral regurgitation. In these instances, the condition would require surgery.

Most patients with Mitral Valve Prolapse have no symptoms, but when symptoms do manifest, they may include atypical chest pains, dizzy spells and some anxiety.

For patients whose MVP is significant enough to require surgery, there are various options between mitral valve repair and replacement. The video below offers an overview of this condition, along with more information about mitral valve prolapse repair and replacement:

Cardiologist Dr. Font i Procedure Room Discussing Mitral Valve Prolapse
To inquire about diagnosis, management and/or treatment of Mitral Valve Prolapse, contact Holy Cross Hospital's Valve Clinic in Fort Lauderdale, FL by calling 954-229-7974.

Dr. Vicente Font is a clinical cardiologist who practices at Holy Cross Medical Group's Cardiology Associates of Fort Lauderdale practice and is one of Holy Cross Hospitals' cardiac specialists in its Valve Clinic. For referral information to Dr. Font, call 954-900-6659.

The Road to Bio-Absorbable Stents

  • Posted Apr 20, 2015
  • Joshua Purow, MD, FACC

Coronary Artery Disease

A coronary artery supplies oxygenated blood to the heart muscle. When fat, cholesterol, calcium and other deposits accumulate on the inner wall of the artery, it builds plaque, which causes coronary arteries to become narrowed and limits the supply of oxygen-rich blood to the heart. Areas of plaque can also rupture, causing blood clots to form on the surface of the plaque. When blood flow to the heart is reduced or blocked, angina (chest pain) or a heart attack can occur. According to the Centers for Disease Control and Prevention, coronary artery disease accounts for one of every six deaths in the United States.

Treatments over the Years

The old-fashioned way of treating a blocked or clogged coronary artery is Coronary Artery Bypass Surgery. Then in the early 1980s, a less invasive procedure called angioplasty was introduced. During angioplasty, specialized medical balloons are inserted and inflated to unclog a blocked or narrowed artery to restore the blood flow to the heart. This procedure is sometimes followed by the implantation of a stent or scaffold (metal framework) to hold the artery open and allow the vessel to heal without the formation of clots or recoiling of the artery. When combined with the insertion of a stent or scaffold, the procedure is referred to as Percutaneous Coronary Intervention (PCI).

The advent of new technology brings new problems. One of the first new problems with stents was a process called restenosis where the stent itself would cause a re-blockage or re-narrowing of the artery (25% risk of re-blockage). Much of this problem was cured with the introduction of drug-eluting stents. Currently the standard of care, these are medicated stents that release medication into the wall of the artery, allowing for the vessel and the blockage to heal. This innovation has greatly advanced the catheter-based treatments for coronary artery disease.

Problems with Current Standard of Care

However advanced, there are still some problems with drug-eluting stents. Some patients continue to experience angina after the placement of the drug-eluting stent, and there remains long-term need for blood thinners. Also, a stent’s framework is necessary for the first 6 months while the vessel wall heals itself. After that time, the structural framework of the stent may no longer be necessary and may even restrict the function of the vessel. These are the challenges that a landmark U.S. pivotal study aims to address with the introduction of bioabsorbable (disappearing) stents called “Absorb.”

Disappearing Stents

The theory behind the bioabsorbable stent is to provide the necessary structural framework of the stent for the first 6 months, and then it will disappear. Studies have shown that without that framework for the rest of the patient’s life, those vessels remain uncaged and have the potential to resume uninhibited function. Potential benefits which are attributed to bioabsorbable stents in general, and are currently being investigated, include:
•The vessel is able to move in response to changes in blood flow
•Lower likelihood of retreatment of the vessel that received a bioabsorbable stent
•Ability to capture CT imaging of coronary vessels after the stents are placed
•Less angina

ABSORB IV Clinical Trial

Holy Cross Hospital is one of the sites participating in the ABSORB IV clinical trial, which will enroll patients with coronary artery disease in a first-of-its-kind trial that will  measure the effectiveness of these bioabsorbable stents in reducing chest pain, or angina, and keeping blood vessels open.
The device used in this study is investigational. An investigational device is one that is not approved by the U.S. Food and Drug Administration (FDA).

For more information on the ABSORB IV trial or the Holy Cross Jim Moran Heart and Vascular Research Institute, call 954-229-8400 or visit HolyCrossHeartResearch.com.

Ask the Doc (Karan Munuswamy, MD, Cardiology): Hypertension Risks

  • Posted Mar 09, 2015
  • Karan Munuswamy, MD

Q: Who is at risk for having high blood pressure (hypertension)?

Dr. Munuswamy: You are more likely to have high blood pressure if you are over 50 years old, overweight or obese, a smoker, have diabetes, African American, Hispanic or Latino, drink excessive amounts of alcohol, or have a family member with high blood pressure (mother, father or siblings).

Dr. Munuswamy is a clinical cardiologist and hypertension specialist who practices in Fort Lauderdale, FL. For physician referral information, call 954-900-6659. 

Ask the Doc (Karan Munuswamy, MD, Cardiology): How to Take Your Blood Pressure

  • Posted Feb 27, 2015
  • Karan Munuswamy, MD

Q: How do I take my blood pressure?

Dr. Munuswamy: Sit down with both feet on the floor and your back against the chair. Wrap proper size blood pressure monitor cuff above the elbow and rest your arm on a table, at your heart level. Do not talk while you take your blood pressure. Follow the instructions that came with your monitor. Take your blood pressure, then take it again after a few moments and write down the results. It is improtant that you record the BP at the same time each day.

Dr. Munuswamy is a clinical cardiologist and hypertension specialist who practices in Fort Lauderdale, FL. For physician referral information, call 954-900-6659.

Ask the Doc (Karan Munuswamy, MD, Cardiology): Symptoms of High Blood Pressure

  • Posted Feb 16, 2015
  • Karan Munuswamy, MD

Q: Can I tell - based on how I feel - if my blood pressure is elevated?

Dr. Munuswamy: High blood pressure is a silent killer and usually does not cause any symptoms unless it is extremely high. A common misconception is that high blood pressure causes symptoms such as headache, nervousness, facial flushing, difficulty sleeping or nosebleeds. In fact, studies have shown that only 17% of the patients treated for high blood pressure emergencies had nose bleeds, and those with high blood pressure are 40% less likely to experience headaches as compared to those with normal blood pressure.

Dr. Munuswamy is a board certified cardiologist and is a hypertension specialist who practices with the Holy Cross Medical Group in Fort Lauderdale, FL. For more informatio on Dr. Munuswamy, incuding referral information, call 954-900-6659.


This blog was archived on June 14, 2016. New blogs are being posted to The Medical Insider Blog

About the Center

The Jim Moran Heart and Vascular Center at Holy Cross offers the latest in high-tech cardiac care. Holy Cross was the first in Broward County to offer Induced Hypothermia, which has shown to increase the odds of surviving cardiac arrest, and has been shown to improve neurological outcomes after such an event. We were also the first in Florida to use the Prime ECG Vest which, in select patients, may give physicians additional data beyond a traditional electrocardiogram. Our outstanding cardiovascular team, utilizing cutting-edge technology, can treat any heart and vascular situation especially in an emergency.

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