Holy Cross Cardiovascular Blog

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.

Ask the Doc (Karan Munuswamy, MD, Cardiology): Checking Blood Pressure at Home

  • Posted Feb 02, 2015
  • Karan Munuswamy, MD

Q: Why is it important to check my blood pressure at home?

Dr. Munuswamy: Blood pressure (BP) can fluctuate, and home BP readings can provide your healthcare provider with valuable information to determine whether you really have high blood pressure. And if you do have high blood pressure, home BP readings can show if your BP is adequately controlled with your current treatment. It is also quite helpful in ruling out "white coat syndrome" (when the BP in the physician office may be high but not at home).

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.

What is the Most Common Cause of Death around the World?

  • Posted Nov 17, 2014
  • Claudio Smuclovisky, MD, FACC,...

Did you know that the lifetime risk of a person developing cancer is 22%? In contrast, 50% of males develop symptoms of a heart attack or other types of cardiovascular illnesses, and one third of all females develop heart disease.

How do I know if I have heart disease?
Some people undergo stress testing with their physician to check for coronary artery disease. The stress test, however, looks for later stages of disease, where there’s blockage and decreased oxygen in the muscle of the heart. Nowadays, there is technology available that can detect heart disease years before it’s detectable by stress tests: Cardiac CT.

What is Cardiac CT?
It is a highly specialized CT scan using a 256-slice CT scanner that provides very detailed 3D imaging of the heart and vessels. These images are captured rapidly in as little as two heart beats. It also involves 90% less radiation than current stress testing using radioactive isotopes that is given through the blood. It is very accurate in determining quickly whether or not a person has plaque and allows physicians to take active measures to prevent a heart attack.

Cardiac CT Video Thumbnail
Given that a person is more likely to develop a cardiovascular illness than cancer, it is important to ask your doctor about screening for cardiovascular diseases.

Dr. Smuclovisky is a diagnostic radiologist who practices in Fort Lauderdale, FL and specializes in cardiac imaging. For a physician referral or to inquire about scheduling an appointment for Holy Cross Hospital’s Harry T. Mangurian, Jr. Diagnostic Imaging Center, call 954-900-6659.

Holy Cross Hospital Honored by American Heart Association with Resuscitation Quality Achievement Award

  • Posted Nov 06, 2014
  • hchadmin

Holy Cross Hospital has received the Get With The Guidelines® - Resuscitation Bronze Quality Achievement Award for implementing specific quality improvement measures outlined by the American Heart Association for the treatment of patients who suffer cardiac arrests in the hospital.

More than 200,000 adults and children have an in-hospital cardiac arrest each year according to the American Heart Association.

Holy Cross Hospital is awarded for meeting specific measures in treating adult cardiac arrest patients. To qualify for the awards, hospitals must demonstrate compliance with these performance measures at a set level for a designated period.

Guidelines include following protocols for patient safety, medical emergency team response, effective and timely resuscitation (CPR) and post-emergency care.

“We adapt processes and implement proven models of care to ensure better patient outcomes and satisfaction” said Holy Cross Hospital President and CEO Patrick A. Taylor, M.D. “This award recognizes the commitment of the physicians and nurses at Holy Cross."

The Get With The Guidelines-Resuscitation program was developed with the goal to save lives of those who experience cardiac arrests through consistently following the most up-to-date research-based guidelines for treatment. 

The program builds on the work of the American Heart Association’s National Registry of CardioPulmonary Resuscitation originally launched in 1999 as a database of in-hospital resuscitation events from more than 500 hospitals. Data from the registry and the quality program gives participating hospitals feedback on their resuscitation practice and patient outcomes and help develop research-based guidelines for in-hospital resuscitation.

For more information on Holy Cross Hospital's cardiac services, visit HolyCrossHeart.com.

Transcatheter Aortic Valve Replacement (TAVR) Update: Two Years Later

  • Posted Aug 26, 2014
  • hchadmin

Holy Cross Hospital was the first facility in South Florida  to offer Transcatheter Aortic Valve Replacement (TAVR) for high risk patients and for those who suffer from severe symptomatic aortic stenosis. The TAVR program, along with the Valve and Structural Heart Disease Clinic launched in 2012. Two years later, Holy Cross' TAVR team has the most experience in South Florida in performing this minimally invasive procedure and has seen success rates higher than the national average. Originally, the procedure was done via a transfemoral approach (through the leg), and now there are four different approaches by which this procedure is performed, ensuring an available anatomical pathway for each patient.

Watch a video overview about this revolutionary procedure:
Transcatheter Aortic Valve Replacement at Holy Cross Hospital - An Overview

Learn more about this procedure and Holy Cross' TAVR team at HolyCrossHeart.com.

TAVR Team 2014
Photo (L-R):
Holy Cross Hospital TAVR Team
Alexander Llanos, MD, Interventional Structural Heart Disease Cardiologist
Alan Niederman, MD, Interventional Cardiologist
Alexander Justicz, MD, Cardiovascular and Thoracic Surgeon
Joshua Purow, MD, Interventional Cardiologist
Imad Tabry, MD, Cardiovascular and Thoracic Surgeon
Irving David, MD, Cardiovascular and Thoracic Surgeon
Vicente Font, MD, Echo Cardiologist
Elizabeth Graf, MSN, ACCNS-AG, CCRN, Valve and Structural Heart Disease Clinic Coordinator


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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