Holy Cross Cardiovascular Blog

ABSORB III™ trial studying “dissolving” heart device

  • Posted Dec 04, 2013
  • hchadmin

The Jim Moran Heart and Vascular Research Institute at Holy Cross Hospital in Fort Lauderdale is one of the first in the region to enroll patients with coronary artery disease (CAD) in a clinical trial studying a “dissolving ” cardiac stent to treat heart disease.

The ABSORB III™ clinical trial recently started in the United States. Interventional cardiologists at Holy Cross implanted the Absorb™ cardiac stent, a small mesh tube that is designed to open a blocked heart vessel, restore blood flow to the heart and then dissolve into the blood vessel over time. 

Since the 1970s, physicians have treated patients with CAD with balloon angioplasty, metallic and drug eluting metallic cardiac stents, allowing many patients to avoid open heart surgery. Unlike a metallic stent that remains permanently in the body, Absorb™ dissolves over time.

“The goal of the Absorb cardiac stent is to restore the vessel to a more natural state and enable natural vessel function for improved long-term outcomes,” said Joshua Purow, MD, Principal Investigator.

Absorb™, is an investigational (not FDA approved) bioabsorbable vascular scaffold manufactured by the healthcare company Abbott. Absorb™ is referred to as a scaffold to indicate that it is a temporary structure. Abbott's Absorb™ BVS is made of polylactide, a naturally dissolvable material that is commonly used in medical implants such as dissolving sutures.

ABSORB III™ is the first U.S. clinical trial to evaluate the potential benefits and safety of Absorb™ in comparison to a medicated metallic cardiac stent, also called a drug eluting stent, in patients with CAD. Absorb BVS™ is approved for use outside of the US. More than 25,000 patients worldwide have received an Absorb BVS™. The clinical trial will enroll approximately 2,250 patients, the majority expected in the United States.

According to the Centers for Disease Control and Prevention, heart disease accounts for one of every six deaths in the nation. Patients with CAD can experience symptoms such as chest pain and shortness of breath when the demand for blood to the heart is more than the heart's ability to supply. These blockages are caused by the buildup of fat and cholesterol inside the vessel.

For more information, contact jmhvri@holy-cross.com, or  call 954-229-8400.

Inspiration (Part 1)

  • Posted Dec 03, 2013
  • Ricky M. Schneider MD

Thoughts from my first clinical role model,  Morris L. Jampol, MD:

Mahler and Me
November 30, 2013

The famous composer and conductor Gustave Mahler lived over a century ago.  He was considered one of the great geniuses of the time in Europe and the United States.  Despite the fact that I am not musical in any way except to enjoy listening to music, I have discovered that I have a slight tenuous connection with this illustrious man.  Here is my story:

 In the Year 1911 Mahler was invited to New York to conduct at the Metropolitan Opera House.  He had been feeling ill in Europe but his doctors there had not been able to find any cause for his symptoms of weight loss, fatigue and low grade fevers.  While in New York City he had been referred to the Mount Sinai Hospital, then known as a most excellent institution staffed by outstanding specialists.  A young intern named Dr. George Baehr was assigned to assist in Mahler’s care.  After his careful examination, Dr. Baehr suspected a blood stream infection and drew Mahler’s blood for bacteriologic culture.  This was a relatively new test and not universally available.  The blood culture came back strongly positive for Streptococcus viridans, a bacterium known to infect the heart valves and destroy them.  Mahler was known to have damaged heart valves as a result of childhood throat infections.  Dr. Baehr made the diagnosis of SBE- subacute bacterial endocarditis, a disease known to be uniformly fatal in three to six months. These were the days before antibiotics and there was no hope for patients with SBE.  Gustave Mahler returned to Europe and died several months later.

Some fifty years later I had been recommended as Chief of Medicine at a new hospital in Queens, N.Y.  This hospital was under the aegis of the Health Insurance Plan of Greater New York, a pioneer Health Maintenance Organization.  In the intervening years Dr.Baehr had risen through the ranks of the Mount Sinai Hospital eventually becoming the Director of Medicine He had achieved an outstanding reputation as one of the great clinicians, researchers, and teachers of the nation.  After fifty years at Mount Sinai, he had retired and now started a new career as the President of the Health Insurance Plan of Greater New York.  One of his duties was to approve the choice of Chief of Medicine of the Plan’s  newly acquired  hospital in Queens. And so I found myself being interviewed by the eminent Dr. Baehr.  He carefully reviewed my credentials, and asked many searching questions about my experience and my thoughts about developing a strong Department of Medicine.  Apparently I received his approval and subsequently enjoyed many fruitful years in my position.

After my retirement, I developed the hobby of writing short essays on the medical health of famous musician and composers.  To my surprise I learned that the Dr. Baehr who had approved my appointment was the famous clinician who made the striking diagnosis of Gustave Mahler. I now listen and enjoy the music of Mahler more intently as he and I have had a relationship with the famous Dr. George Baehr.

The Cardiology-Cancer Connection

  • Posted Nov 14, 2013
  • Jorge Arturo Flores, MD, FACC

Cancer is the second leading cause of death in the United States after cardiovascular disease; the survival rate of all types of cancer has improved in the last 25 years from 50 percent to 68 percent as a result of more successful anticancer therapies by oncologists. There are currently over 12 million cancer survivors. This, however, comes with a price, as cardiac toxicity stemming from oncology treatments is a common adverse effect. It has resulted in more interaction between cardiologists and oncologists.

Cardiac Toxicity

Adverse effects include direct toxicity to the cardiac muscle cells (myocytes) from chemotherapy, resulting in defects in contractility of the heart and ultimately leading to congestive heart failure of varying degrees. Another source of toxicity is radiation therapy, which can cause valvular problems and pericarditis. Other drugs used in cancer treatment can also cause blood pressure and lipid abnormalities. There are situations in which more than one agent is used, therefore increasing the possibility of cardiac toxicity.

Two Types of Cardiac Toxicity

One type of cardiac toxicity is caused by direct action on the heart's left ventricle, causing heart failure as a final result. This is a direct effect from drugs of the anthracycline type, like doxorubicin, and its effect is nonreversible and generally dose-related.

A mediated cardiac toxicity is caused by monoclonal antibodies, such as protein kinase inhibitors (KI) like Herceptin. This adverse effect is reversible and not dose-dependent; outcomes are more favorable than in the other type.

An integration between clinical oncology and cardiology is essential to detect early signs of toxicity. This collaboration involves cardiac testing, such as echocardiography or nuclear cardiology, which facilitates the decision to delay or modify treatment as needed. The use of cardiac protecting agents (i.e., beta blockers, ACE inhibitors or ARBs, or diuretics) becomes necessary as soon as any cardiac dysfunction is detected. These therapies are also useful once heart abnormalities are present.

Direct communication between oncologists and cardiologists is vital in reaching a common goal: a cancer-free, heart-healthy patient. Be sure to discuss cardiac toxicity with your physician.

Holy Cross Hospital in Fort Lauderdale, Florida is one of the few facilities in the nation dedicated to minimizing cardiac toxicity during cancer treatment and cardiovascular risks during cancer survival. Click to learn more about Holy Cross' Cardio-Oncology Clinic.

Women: Lower Your Risk, Not Just Your Weight

  • Posted Aug 20, 2013
  • Richard Goldman, MD, PhD, FACC...

Heart disease and stroke continue to be the number one killer of women both in the United States and worldwide.  Heart disease is the cause of one in three women’s deaths each year, and 43 million women in the United States are affected by heart disease.  There were over 400,000 heart disease deaths in 2007, which claimed more women’s live than all forms of cancer, respiratory disease, Alzheimer’s disease and accidents, combined.  The economic cost of heart disease in the Unites State is estimated at over 100 billion dollars each year.

Heart disease death rates in U.S. women ages 35 to 54 appear to be increasing over the past decade, at least partially related to the increase in obesity.  Forty seven percent of African-American women over the age of 20 have cardiovascular disease, most likely secondary to the prevalence of  hypertension.  Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women.  And finally, 55,000 more women than men suffer a stroke every year.

All women need to understand the major risk factors associated with cardiovascular disease and stroke, since it is estimated that 80% of these risk factors are modifiable with early screening methods, lifestyle modification and medications.  

Risk Factors

These risk factors include well-established Framingham criteria which include:  1. Age,  2. Total Cholesterol,  3. HDL cholesterol, 4. Systolic Blood Pressure, and 5. Smoking History.  Additional factors beyond the Framingham risk criteria include: 6. Medical, Lifestyle and Family History, 7. Markers of Preclinical Disease (coronary calcium score, carotid artery plaque) 8. Physical exam including  blood pressure, Body Mass Index (BMI) and waist size, 9. Obesity, Poor Diet, Physical Inactivity and Metablic Syndrome, 10. Systemic Autoimmune Disorder, 11. Laboratory markers includingGlucose & Kidney Function, 12. High Risk Factors which include documented cardiovascular disease or stroke, peripheral arterial disease, diabetes or end-stage or chronic kidney disease.

The role of new biomarkers of cardiovascular disease, such as advanced lipid testing, high sensitivity CRP, and coronary calcium score are not included in the initial assessment of CV risk, but may play an important role in refining the risk estimates of women who are at intermediate risk on the initial screening factors outlined above.

Lifestyle Recommendations

There are many Lifestyle recommendations, which have been shown to reduce cardiovascular disease and stroke risk in women.  These include the following:

1.    Complete Smoking Cessation—combination of office and formal cessation program, group counselling, nicotine replacement and pharmacotherapy.
2.    Physical Activity—150 minutes per week of moderate exercise (brisk walking) or 75 minutes per week vigorous exercise or combinations of the two, plus muscle strengthening exercise at least two days per week.
3.    Nutrition—diet rich in fruits and vegetables, whole grain, higher fiber foods, fish (oily fish such as salmon and mackerel), poultry, lean meats, dry beans, eggs, and nuts. Avoid saturated and trans fats (partially hydrogenated fats) such as deep fried foods, bakery products, crackers, margarine, packaged snack foods, red meats, dairy products, coconut and palm oils.
4.    Weight Maintenance/Reduction—maintenance or lose weight through a combination of physical activity, appropriate caloric intake and behavior modification goal for a BMI less than 25 kg/m2 or waist size less than 35 inches or other related weight metrics.  Weight reductions of 10% may decrease blood pressure, cholesterol levels and reduce risk of diabetes
5.    Health screenings for:
A.    Blood pressure—optimal BP reading less than 120/80—weight control, physical activity, sodium reduction (less than 2,000mg/day), alcohol reduction.
B.    Cholesterol levels—should be checked at least once every five years starting at age 20, or should be checked at a younger age in children with family history of heart disease, or more frequently in women with elevated cholesterol levels. (Optimal levels: Total Cholesterol less then 150, Triglycerides less than 150, HDL cholesterol greater then 50, LDL cholesterol less then 100).
C.    Diabetes screening—check fasting blood sugar (optimal glucose less then 100) usually between ages 30-40 and retest every 3-5 years.

Drug Therapies

1.    Aspirin (75-325 mg/daily) for women with heart disease or stroke or diabetes unless contraindicated.  May be useful in women over 65 at increased risk for heart disease/stroke.
2.    Lipid lowering medications—recommended for women with coronary disease/stroke/diabetes to reach goal LDL cholesterol less than 100 and may be less than 70 in high risk patients.
3.    Blood pressure medications---In addition to regular exercise, good nutrition, and low sodium (less then 2000 mg sodium/daily), pharmacotherapy is indicated for women with blood pressure readings over 140/90, or women with diabetes and blood pressure readings over 130/80.

Effective-based guidelines for prevention of cardiovascular disease in women. Circulation. 2011;123:1242-1262.
Managing heart disease risk at any age. www.goredforwomen.org.

Holy Cross Hospital is the First in Florida to Perform Specialized Heart Operation

  • Posted Jul 15, 2013
  • hchadmin

Paravalvular leak closure was performed using a transapical approach, which is a minimally invasive option for patients who are not suitable for open heart surgery
Surgeons at Holy Cross Hospital in Florida are the first in the state to use the minimally invasive transapical approach to repair a paravalvular leak (PVL), a complication of cardiac valve replacement resulting in blood escaping from around the valve which can cause anemia or congestive heart failure and may be life threatening. The hybrid cardiac repair surgical approach is an option for patients who are not suitable candidates for open heart surgery due to age or medical conditions.
Having undergone three previous open heart operations, Dorothy Hodyl, 74, was now becoming increasingly short of breath. Holy Cross physicians determined her mitral valve had become detached from the surrounding heart tissue leaving a gap of approximately 30 percent of the circumference of the valve, a paravalvular leak.
“Patients with paravalvular leaks have typically had at least one open heart surgery and may be older which adds to the risks of undergoing another open heart surgery to repair the leak,” explains Dr. Alexander Llanos who led the surgical team for the hybrid cardiac repair. “The transapical hybrid cardiac repair procedure offers a quicker recovery and better outcome possibilities for some high risk patients.”
The procedure, which took under three hours, involved gaining access to the heart through an incision made between the ribs which enabled the placement of a sheath that acted as an access port for the physicians to utilize guidewires and catheter techniques to deliver a device to close the PVL. Once the closure was confirmed, the sheath was removed and the incision surgically closed.
In addition to Llanos, the surgical team included cardiothoracic surgeon Irving David and Dr. Vincent Font, an expert in echocardiography, which was used to guide the procedure and confirm the repair. Director of Interventional Cardiology at Massachusetts General Hospital Dr. Igor F. Palacios also joined them building upon a collaborative agreement begun in 2010 between the Holy Cross and Massachusetts General Hospital, one of the world’s most distinguished academic medical centers.
The operation took place in Holy Cross Hospital’s new 2,000 square-foot hybrid interventional operating room which contains advanced technology enabling leading-edge procedures.

Watch a video of our physicians explaining paravalvular leak and how the minimally invasive procedure was successfully performed:

Learn more about the services offered at the Holy Cross Jim Moran Heart and Vascular Center in Fort Lauderdale, FL by visiting www.HolyCrossHeart.com.

Patient Story: Treatment of Severe Stroke

  • Posted Jul 02, 2013
  • hchadmin

A stroke is a medical emergency. Strokes happen when blood flow to your brain stops. Within minutes, brain cells begin to die. There are two kinds of stroke. The more common kind, called ischemic stroke, is caused by a blood clot that blocks or plugs a blood vessel in the brain. The other kind, called hemorrhagic stroke, is caused by a blood vessel that breaks and bleeds into the brain. "Mini-strokes" or transient ischemic attacks (TIAs), occur when the blood supply to the brain is briefly interrupted.

Symptoms of stroke are
    •    Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
    •    Sudden confusion, trouble speaking or understanding speech
    •    Sudden trouble seeing in one or both eyes
    •    Sudden trouble walking, dizziness, loss of balance or coordination
    •    Sudden severe headache with no known cause

If you have any of these symptoms, you must get to a hospital quickly to begin treatment. Acute stroke therapies try to stop a stroke while it is happening by quickly dissolving the blood clot or by stopping the bleeding.

NIH: National Institute of Neurological Disorders and Stroke

In the video below, one of our patients shares with us how she realized the importance of coming to Holy Cross Hospital in Fort Lauderdale, Florida to be treated for severe stroke and how our Comprehensive Stroke Center's Neuro Interventional Radiologist Laszlo Miskolczi, MD, was able to successfully treat her condition when another facility was unable to do so:


Prevalence of Heart Disease in Women

  • Posted May 20, 2013
  • Jorge Arturo Flores, MD, FACC

Older Woman on BeachWhen we hear the term “heart disease,” we often think of it as a man’s disease, but the fact is that heart disease is the number one killer of women in the United States. One in four women die of heart disease, whereas one in thirty die with breast cancer.

A Serious Matter
Once a woman has a heart attack, 20 percent die within a year and 50 percent die within six years; therefore, this is not to be taken lightly. Furthermore, it is a totally preventable problem. First we have to recognize the risk factors which exponentially add to the development and progression of the disease. These factors include heredity, diabetes, high blood pressure, high cholesterol, cigarette smoking and - to a lesser degree - obesity and lack of exercise. Only the genetic ones are non-modifiable; therefore, an effort to control risk factors is of capital importance through correct lifestyle adjustments like diet, exercise, control of blood pressure, cholesterol and diabetes (with medications if needed). It is extremely important to discuss this with your doctor.

Be Aware
A heart attack is a sign of advanced arterial disease, which commonly already exists in other arterial systems, but it is never too late to start the risk control management. More importantly, be able to recognize symptoms which are somewhat different than in men. The typical crushing chest pain is not as common, but it could be present on both sides of the chest, shoulders, arms (usually left), neck and the jaw and are typically accompanied with a sensation of severe weakness, indigestion, nausea, vomiting, profuse sweating and anxiety. These symptoms rarely happen all at once, but the presence of any of them requires immediate attention as it becomes a life and death situation. If these symptoms arise, call 9-1-1 to be taken to a hospital and be treated by a cardiologist. There is a chance that the artery will be opened and treated with a clot dissolving medicine or with a balloon and stent procedure, which could be life- saving.

Symptoms of chest discomfort provoked by exercise should prompt one to seek medical attention as it could be a life threatening situation.

Holy Cross Medical Group, Gallagher Adult Practice | 1900 E. Commercial Blvd., #101, Fort Lauderdale, FL 33308 | 954-351-5838 | HolyCrossHeart.com

Anticoagulation Medications and Stroke Following Surgery

  • Posted Apr 10, 2013
  • By Holy Cross Administrator

Patients with certain cardiac conditions who are taking anticoagulation medications face the dilemma of being taken off anticoagulants before undergoing any surgery to avoid bleeding and serious complications. From the few days before and after surgery that this type of patient is not taking anticoagulants, there becomes a serious risk of suffering a stroke.

One out of every 200 patients who have stopped taking anticoagulants in order to have surgery will have a stroke. Holy Cross Hospital's Comprehensive Stroke Center and has the technology, experience and expertise to help prevent dramatic loss of functions due to stroke. Our Stroke Team and internationally-acclaimed Interventional Neuroradiologist (Laszlo Miskolczi, MD) are on-call 24/7 ready to diagnose and treat strokes in case such a complication arises during your care.

In this video, you will hear from one of our stroke patients regarding the treatment he received from Dr. Miskolczi. For more information about Holy Cross Hospital's Comprehensive Stroke Center, contact Dr. Miskolczi at 954-492-5780 or visit the Holy Cross Hospital Comprehensive Stroke Center Webpage:


Holy Cross Hospital Receives UnitedHealth Premium® Cardiac Services Specialty Center Designation

  • Posted Apr 08, 2013
  • By Holy Cross Administrator

Holy Cross Hospital in Fort Lauderdale has received the UnitedHealth Premium® specialty center designation in recognition of quality care.

UnitedHealthcare® developed the UnitedHealth Premium specialty center program to give its members information and access to hospitals meeting rigorous quality criteria. Designed to help members make informed decisions should they need cardiac services care, the designation is based on detailed information about specialized training, practice capabilities, outcomes and cost efficiency of care.

To receive this designation, the non-profit hospital met extensive quality and outcomes criteria based on nationally recognized medical standards and expert advice. The criteria incorporate measurements of breadth and depth of care, staff experience, emergency care, quality and outcomes reporting.

“We are proud to be one of the leaders in cardiac care,” said Patrick A. Taylor, M.D., President and CEO of Holy Cross Hospital. “Our focus on clinical excellence, leading edge technology and state-of-the-art procedures continues to be recognized nationally.”

Holy Cross Hospital offers comprehensive cardiac services through the Jim Moran Heart and Vascular Center and progressive research at the Jim Moran Heart and Vascular Research Institute.

About Holy Cross Hospital
A member of Catholic Health East, Holy Cross Hospital in Fort Lauderdale, Fla. is a full-service, non-profit Catholic hospital, sponsored by the Sisters of Mercy. Since opening its doors in 1955, the 559-bed hospital has offered progressive services and programs to meet the evolving healthcare needs of Broward County. 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, visit holy-cross.com, “like” Holy Cross Hospital, Fort Lauderdale on Facebook, or follow @holycrossfl on Twitter.

Holy Cross Hospital  is a participating hospital in the UnitedHealthcare network but is not owned or otherwise affiliated in any way with UnitedHealthcare: a UnitedHealth Group company.


Electrical Disorders of the Heart

  • Posted Mar 11, 2013
  • Daniel Weitz, MD
american heart association heart arrhythmia photoPhoto from www.heart.org

Have you been told that you have difficult to control rapid heart rates?  Do you experience palpitations or lightheadedness? These symptoms may be all from a heart arrhythmia. There have been considerable advancements in diagnosing and treating arrhythmia in recent years.

Arrhythmia is a condition in which the electrical system of the heart malfunctions.  Because the heart is an electrical-mechanical pump, electrical disorders cause the heart to function irregularly. For example, if the heart’s electrical system has an interruption in the normal connections, then the heart beats too slowly. Luckily, implanting a pacemaker can restore the regular function of the heart. The heart’s electrical system can also have a malfunction that creates a “short-circuit” that causes very rapid heart rates. Palpitations, lightheadedness, inability to exercise and passing out can all be manifestations of a “short-circuit” in the heart.  Today, it is possible to cure such conditions with safe and effective procedures. In fact, many patients are able to go home the same day. 

Atrial Fibrillation
Atrial fibrillation is the most common electrical disorder of the heart, affecting over 5.1 million people in the United States. Disorganized electrical activity causes irregular heart beats that lead to blood pooling and clotting, which can cause stroke and other serious health issues. People who suffer from atrial fibrillation may have palpitations (a sudden pounding, fluttering or racing feeling in the chest), lack of energy, dizziness, chest discomfort, and difficulty breathing during normal activities or even at rest. High blood pressure, coronary artery disease, heart conditions, obesity, sleep apnea and age are all causes of atrial fibrillation.

Treatment of Atrial Fibrillation
At Holy Cross Hospital, we specialize in diagnosing and treating atrial fibrillation. If a physician suspects that you may have this condition, or if you have the symptoms mentioned above, an electrocardiogram (ECG) or a Holter (24-hour ECG) can assist in making the diagnosis.   Treatment options include medications, a cardioversion to shock the heart back into a normal rhythm and pacemakers to bring the heart back to a proper rate. For those who are very symptomatic, a catheter-based procedure may be the best option. Most importantly, if you are diagnosed with atrial fibrillation, ask your doctor how you can reduce the risk of stroke from atrial fibrillation.

Get Expert Help If you experience the above symptoms, it may be time to speak to a cardiac electrophysiologist. A cardiac electrophysiologist specializes in the electrical disorders of the heart. At Holy Cross Hospital, we can make the diagnosis and provide comprehensive treatment to bring your heart back to its regular beat.

Learn more about atrial fibrillation and available treatments at www.HolyCrossHeart.com.


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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