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Cardiovascular news from the experts

Vascular Screening

Vascular Screening Could Save Lives

Quick and Painless Screening Can Identify Problems in Arteries

George Lee, MD and Purvi Dubal, Heart and Vascular Institute Operations Manager

Your vascular system carries your lifeblood, and problems can be virtually undetectable until they threaten life or health — but a quick, painless procedure can identify problems while they can still be treated effectively. Vascular screening at El Camino Health has no out-of-pocket cost, and it could save your life.

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Blood vessels — arteries carrying oxygen-rich blood and veins carrying blood back to the heart — are the expressways, streets and alleys of the circulatory system. Conditions such as blood clots or hardening of the arteries can create "traffic jams" in blood vessels, obstructing the flow of blood to or from any part of the body. Without oxygen, no part of the body can function.

As a vascular surgeon, I often see the effects of undiagnosed vascular issues. Because vascular conditions and diseases often have no early symptoms, you may not think about your vascular health until your life or well-being are at stake.

Cardiovascular disease is the top cause of death in the United States, and any problem with the vascular system needs to be evaluated and treated as promptly as possible. Early diagnosis often means some cardiovascular disease can be managed with lifestyle interventions and medications instead of invasive surgery. Other vascular conditions, such as aneurysms, may need surgical repair to prevent rupture or other life-threatening events.

Vascular Screening: 30 Minutes Well Spent

The 30-minute vascular screening offered through the El Camino Health Heart & Vascular program is a painless, noninvasive ultrasound of the neck, abdomen and legs to check for common vascular diseases. This screening is a vital tool to help us assess your risk of vascular health conditions, so that doctors can intervene early.

During a screening, we look for:

  • Carotid artery disease, which can lead to stroke
  • Abdominal aortic aneurysm, which can be deadly if the aneurysm bursts
  • Peripheral arterial disease, which can cause serious complications in the lower legs, pain with walking, or in severe cases, may lead to limb loss

We'll share the results with you and your physician and recommend any steps needed.

If you need more advanced, specialized treatment, our team is here for you. Our board-certified vascular surgeons offer a full spectrum of care, covering every possible treatment for circulatory disorders, from medical management, to endovascular procedures, to open surgical procedures.

To treat vascular problems, we use the least invasive options available. Innovations in surgery have made open surgeries less common. Endovascular procedures require only a tiny incision and usually have much shorter recovery times than open surgeries. Our vascular surgery team will make sure you understand all your options.

When to Get Screening

Vascular disease can occur at any age but is more common among older people. Most people under age 40 do not need vascular screening.

You are eligible for screening if you are:

  • Age 60 or older
  • Age 50 or older, with risk factors such as smoking, diabetes, high blood pressure, high cholesterol, family history of heart disease, lack of physical activity and obesity
  • Older than age 40 with diabetes

Family history of vascular disease — such as immediate family members who have had stroke, heart attack, high blood pressure, kidney failure, sudden cardiac death or abdominal aortic aneurysms — may also increase your risk. Talk to your doctor about your personal risk and whether you should get screened early.

El Camino Health provides screenings at the Advanced Care and Diagnostic Center on El Camino Health's Mountain View campus. The screening is noninvasive and takes about 30 minutes. Wear loose, comfortable clothing. No referral is required, and in most cases, there are no out-of-pocket costs.

Schedule a screening

Find out more about free vascular screening

Learn more about Heart and Vascular Care at El Camino Health.

Advanced care for women's hearts

Advanced care for women's hearts

Women's Heart Center and two new cardiology programs take aim at women's heart problems.
Jane Lombard, MD

We've known for decades that heart disease is the top cause of death and a threat to quality of life for women as well as men. Yet because most past cardiovascular research has focused on men, we're still learning how heart disease can affect men and women differently, and how to best approach its prevention and treatment in women.

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As a cardiologist and a woman, I have a personal and professional interest in improving heart care for everyone, especially women. That's why I'm excited to be leading El Camino Health's Women's Heart Center, as well as two new cardiology programs tackling heart risks that widely affect women. El Camino Health has long made women's health a priority, and I'm pleased to be part of that commitment.

Our Women's Heart Center — part of the Norma Melchor Heart and Vascular Institute — provides preventive care, treatment and management tailored for women and their needs. The center's specialists and other professionals are trained and experienced in helping women keep their hearts as healthy as possible for as long as possible.

Now, El Camino Health is taking aim at health conditions specific to women through two new cardiology programs. Our cardio-obstetrics program is designed for women who have heart risks or conditions related to a current or past pregnancy, and our cardio-oncology program helps people who are at risk for — or living with — heart problems related to cancer treatment.

Better care for women's hearts

Recent research has shown that women with heart problems fare better if their cardiologist is a woman. They're also more likely to survive a heart attack if their emergency room physician is a woman. These findings suggest that heart care for women is not as good as it could be — and El Camino Health is working to improve it for our own patients and all women.

At the Women's Heart Center, we take care of all kinds of women and all kinds of hearts. We work with healthy women who want to stay that way, and with women who already have cardiovascular disease or a serious heart condition. Some women come because they have a family history of heart disease. Some have health conditions or long-term habits that put them at high risk for heart problems. Others have no risk factors but want to find ways to stay healthy, live longer and enjoy healthier lifestyles.

Our approach to women's heart health includes proven lifestyle and wellness care, combined with the most advanced treatment options and technology. Every care plan is tailored specifically to the patients' needs, goals and preferences. Sometimes, women know what they need to be doing, but they’re so busy focusing on their work, families or passions that they don't always apply their knowledge about heart health. We help women find ways to enjoy taking care of themselves and making their heart health a priority.

Cardio-oncology: Combating the heart effects of cancer treatment

Cancer treatment has come a long way in the past few decades. More Americans are surviving cancer long-term — and in some cases, they're living with heart damage or increased risk of heart problems brought on by their cancer treatment.

We've always known that traditional cancer treatment, including chemotherapy and radiation therapy, can cause cardiac complications, sometimes up to 20 or 30 years later. It's important that women who have been treated for any kind of cancer, particularly breast cancer, have cardiological care and monitoring for heart problems as they grow older. Many of these cardiac complications can be catastrophic, so it's critical that they're caught as early as possible so that care and interventions can be provided before the problem becomes life-threatening.

With each new medicine or therapeutic agent against cancer, the heart risks change and must be reconsidered. Doxorubicin and Herceptin, for instance, have been game-changers in treating certain breast cancers. We now know these drugs can greatly increase a woman's risk of heart failure and other heart problems later in life.

By monitoring men and women for heart problems after cancer treatment, we can improve their outcomes and help them enjoy longer, healthier lives. Most will do very well with the right awareness and care.

Cardio-obstetrics: Reducing heart risks related to pregnancy and childbirth

Pregnancy and childbirth can take a toll on heart health for some women. For one thing, your blood volume increases by as much as 50% during pregnancy, putting a strain on your heart and circulatory system. The risk for related heart problems may not end when you give birth. Recent research has shown certain heart-related complications during pregnancy are associated with a much higher risk of heart problems later in life. A difficult pregnancy or childbirth may provide clues about your heart's future health.

Prenatal care is vital in improving all outcomes for mothers and their babies. Heart problems or other complications that are not effectively diagnosed and managed can be serious, even fatal. The damage might show up suddenly, immediately, gradually or even years later.

Women who have had gestational diabetes or any pregnancy-related high blood pressure disorder — such as gestational high blood pressure or preeclampsia — have a higher long-term risk of heart and blood vessel problems. A premature birth or other difficulties during pregnancy or childbirth have also been associated with an increase in the risk of heart problems later in life. Awareness and vigilance can greatly reduce these risks and help women get the care they need earlier in the game. A woman nearing menopause who has had a difficult pregnancy in years past may be an excellent candidate for early intervention.

Improving the future of heart care

Fortunately, awareness about women's heart health and heart risks has increased dramatically in recent years. The general public is learning that heart disease can affect anyone, and that in many cases it can be prevented. The medical community is recognizing that improving heart care for all adults must be a priority.

El Camino Health is a leader in these efforts, and lives are being improved and saved. With continued commitment, we can ensure that our children enjoy healthier hearts and futures.

To find out more about El Camino Health's heart care for women, contact us.

Preventing and managing heart disease

Preventing and managing heart disease: Lifestyle is key

For preventing and treating cardiovascular problems, the heart of your healthcare team is you.
Neal Scott, MD, Sheri Berger, RDN, CDCES, and Karen Román, BSN, RN, RN-BC

There's no getting around it. Eating right, staying as active as you can, and managing stress in healthy ways are all important for your physical and mental health — and your heart. Of course, most of us know that — but knowing and doing are two different things.

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So, what is a healthy lifestyle, and how do you create one? Healthy lifestyle choices include:

  • Not smoking. If you need help quitting, talk to your doctor or cardiologist.
  • Getting regular exercise, at least two and a half hours per week or whatever your doctor recommends.
  • Eating a well-balanced, plant-rich diet full of vegetables, fruit, whole grains and lean protein.
  • Managing stress with plenty of rest and self-care.

Healthy eating and staying active are critical. Also, while we can't always avoid stress, we can learn to manage it in healthy ways. Lifestyle medicine incorporates all these goals to help you live your best life while you take care of your health and heart. In fact, it's estimated that up to 80% of heart disease cases could be prevented with a healthy lifestyle.

Healthy eating

The idea of food as medicine isn't new — Hippocrates referred to food as medicine more than 2,000 years ago. Today, "food as medicine" refers to using food and nutrition to help prevent or treat chronic diseases, such as heart disease or diabetes.

Science and medicine have long stressed the benefits of healthy eating, as well as the possible consequences of an unbalanced diet high in fat, sugar, refined carbohydrates and "junk food." Keeping an eye on your lipid levels, particularly LDL (low-density lipoprotein) cholesterol, is one way your doctor can help. Blood glucose (sugar) levels are also important, especially if you are at risk of diabetes.

The core of food as medicine is selecting mostly plant-based whole foods, such as whole grains, legumes, fruits, vegetables, nuts and seeds. Enjoy meat and dairy less frequently and in smaller amounts than in a traditional American diet. For example, meat might be used as a garnish rather than the focus of a meal. Lentils or white beans can take the place of ground meat in a pasta dish or other recipe.

Variety is key to a balanced, enjoyable eating plan, and many heart-healthy foods can be used in new or nontraditional ways.

Oats, for example, are a fantastic choice. Oats contain a substance called beta-glucan, a soluble fiber, which helps reduce LDL (remember "L" for "lousy") cholesterol levels.

Fruits and vegetables are essential in a heart-healthy diet. They're rich in phytochemicals, soluble fiber and many other beneficial heart-healthy nutrients. To make sure you get a healthy mix, eat a variety of colorful produce.

Legumes, such as beans, lentils and peas, are an excellent source of protein, fiber, folate and iron. Research has shown that including legumes in the diet four times per week can reduced the risk of coronary artery disease by 14%.

Our heart-healthy cooking videos can provide inspiration in the kitchen.

Staying active

Just about any kind of exercise can be good for your heart, from walking to weight training. But aerobic exercise (sometimes called cardio) is the best type for your heart. Aerobic exercise uses the large muscles in your body and gets your heart pumping faster.

Experts recommend getting at least 30 minutes of moderate aerobic exercise on most days — about two and a half hours a week. You can also break this up into a few 10- or 15-minute sessions each day. Before you start an exercise program or increase your aerobic activity, talk to you doctor or primary care provider. Your doctor can help you choose activities that are best suited for your age, fitness level and overall health.

You don't have to go to a gym or count every step to gain the benefits. According to Medline Plus from the National Library of Medicine, moderate aerobic exercise can include:

  • Dancing
  • Gardening and light yard work
  • Bicycling at less than 10 miles per hour (mph)
  • Moderate walking (about 3.5 mph)
  • Swimming
  • Downhill skiing
  • Tennis (doubles), softball or golfing (without a cart)

For even more heart benefits, consider adding vigorous activity, such as stair climbing, jogging or heavy yard work. If all your exercise is vigorous, aim to get at least 75 minutes each week.

Managing stress

Everyone has to cope with stress. A survey conducted in 2017 by the American Psychological Association found that more than 70% of respondents reported having at least one symptom of stress over the past month. Stressors from the COVID-19 pandemic have only made matters worse.

Chronic stress can affect your mental and physical health, and we're still learning about the connection. But we've known for decades that long-term activation of your body's stress response system, along with prolonged exposure to cortisol and other stress hormones, may put you at risk for a wide range of health troubles — including high blood pressure, heart disease and stroke.

Severe or chronic stress can affect heart health in a variety of ways:

  • Depression and chronic stress contribute to heart disease.
  • Time or deadline pressure results in a continuous "fight or flight" response.
  • Anger and hostility can trigger a response that can cause arteries to clog faster.
  • Intense anxiety can trigger irregular heartbeat patterns.
  • Sudden emotional stress can trigger "broken heart syndrome" (Takotsubo cardiomyopathy) and also increases the risk of heart attack.

How you respond to stress is key. To reduce stress or cope with it more effectively:

  • Learn to say "No." Taking on too much or pretending to enjoy activities we’d rather skip can lead to time management problems, resentment and burnout.
  • Get enough sleep. Most experts recommend seven to nine hours each night, but everyone is different, and our sleep needs also change over time.
  • Declutter. Being in a cluttered or messy environment can increase stress and make life more complicated.
  • Focus on one thing at a time. Too much multitasking can be physically and mentally draining — and can increase the risk of mistakes and accidents.
  • Spend time with the people you care about and enjoy. Adjust your boundaries with people who tend to upset you or drain your energy.
  • Do something nice for someone. Focusing on someone else can help you feel more positive about your own life and situation.
  • Sit in the sunshine. Getting outside can help improve seasonal mood changes and reduce symptoms of stress.
  • Listen to music. Studies have shown that listening to music can help calm your nervous system and reduce cortisol levels.

Keep up with preventive care

Whether you're trying to stay healthy or already living with a heart condition, regular visits with your doctor or primary care provider are critical. Closely monitoring lipid levels, blood pressure and other health factors can help your doctor assess your heart risk and recommend steps to protect your heart health.

Learn about heart care at El Camino Health.

Beating arrhythmia: Electrophysiology

Beating arrhythmia: Electrophysiology leads to better, safer care

Technology helps regulate the heart's timing.
Shaun Cho, MD

An irregular heartbeat (arrhythmia) can be relatively harmless — or it could lead to serious complications, including stroke, cardiac arrest or heart failure. If you have an arrhythmia, you may not know it and feel fine. Or you may have symptoms such as a fluttering in the chest, chest pain, shortness of breath, sweating, dizziness and fainting.

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If you've been diagnosed with a benign arrhythmia and have no symptoms, your doctor might advise doing nothing. However, if you're having symptoms, or if you have an arrhythmia that puts you at high risk for heart problems, you need to be evaluated by a cardiologist — and you’re likely to hear the word "electrophysiology."

Electrophysiology may sound like a 21st century innovation, but its origins can be traced all the way back to the 18th century. An Italian physician named Luigi Galvani was dissecting a frog when he discovered what he called "animal electricity."

Now we know that all cells and tissues in our bodies have electrical properties. Today's electrophysiologists are specialists in the electrical activity of the heart — and how to treat the electrical problems that can cause the heart to beat irregularly.

As a cardiac electrophysiologist at El Camino Health, I have the privilege and satisfaction of using the most advanced procedures and products, and am able to quickly, safely and effectively treat arrhythmias to stop or ease symptoms and prevent further damage. Technology is constantly evolving and improving from major international companies, but also from smaller companies and startups, many based right here in Silicon Valley. Here at El Camino Health, we are constantly applying new knowledge and the latest tools to provide the best possible care for our patients.

Electrophysiologists are able to treat many types of arrhythmias, whether it is too fast (tachycardia) or too slow (bradycardia). These arrhythmias include such conditions as:

  • Atrial fibrillation (AFib) and atrial flutter: Irregular, often rapid arrhythmias where the upper and lower chambers (atria and ventricles) of the heart are not coordinated, causing the heart to beat too quickly, too slowly or irregularly.
  • Supraventricular tachycardia: A fast or erratic heartbeat in the upper part of the heart.
  • Ventricular arrhythmias: A fast heartbeat in the lower chambers of the heart.
  • Sinus node dysfunction (formerly called sick sinus syndrome): Abnormal heart rhythm of the sinus node, the heart's pacemaker.
  • Cardiac conduction abnormalities: An obstruction in one of the electrical branches of the ventricle blocks electrical signals, forcing them to take a different path.

After noninvasive testing is completed, an electrophysiology study may be advised. This minimally invasive procedure involves passing a very thin tube called a sheath through a vein in the leg. Thin wires with electrodes on the tip are advanced through this sheath to reach the heart, using moving X-ray imaging as a guide. Catheterization technology has evolved so that many arrhythmias can be quickly diagnosed and treated effectively, and the patient can sometimes even go home the same day.

Treating arrhythmia: Ablation, implantable devices, medications

Medications are often used to treat some arrhythmias or to prevent their possible complications. All these drugs have potential side effects, and some people cannot take them, or their arrhythmia may not respond well. Today's treatment options can often correct an arrhythmia so that medication is no longer needed.

Some arrhythmias may be amenable to treatment with cardiac ablation. Ablation uses energy (heat or cold) to make tiny scars in the heart, precisely placed to block electrical signals that are causing the arrhythmia. Ablation has a long record of safety and efficacy, especially at experienced centers such as El Camino Health. However, all procedures have some small degree of risk which include bleeding, clotting or collateral injury to adjacent structures.

Catheter ablation is often performed during the same procedure as an electrophysiology study, preventing the need for another procedure. Some patients are discharged the same day or the following morning.

An arrhythmia may require the placement of an implantable device, such as a pacemaker or an implantable cardioverter defibrillator (ICD). Some innovative devices can be placed through catheters, preventing the need for traditional surgery. Pacemakers use electrical pulses to regulate the heartbeat. ICDs can actually monitor the heart’s rhythm and deliver shocks as needed.

As technology improves, so does the treatment and management of arrhythmias. In some cases, an arrhythmia may not be life-threatening, but can cause troubling physical symptoms, as well as anxiety, discomfort or, in severe cases, disability. Some people have endured their symptoms for decades. With today's minimally invasive treatment options, treating these patients can greatly improve their quality of life without undue risk, possibly eliminating the need for medication.

If you have been diagnosed with an arrhythmia or think you may have one, it's important to talk to your doctor. If you're not having symptoms, you may not need immediate treatment. But if your arrhythmia is increasing your risk of severe heart problems or is causing symptoms, you need to be evaluated by a cardiologist as soon as possible. The electrophysiology team at El Camino Health offers complete arrhythmia care. We can track, treat or monitor your arrhythmia, to protect your heart, your life and your health.

Innovations in Cardiology

Innovations in Cardiology

Advances in imaging lead to innovation, new treatment options.
Deepu Nair, MD, FACC

Since the first electrocardiogram (EKG or ECG) was used to measure heartbeats in 1887, diagnosing and treating heart conditions has been through many revolutionary changes. Today, cardiologists at El Camino Health can view the heart and vascular system in a variety of ways, observe how it functions in real time and even perform complex procedures without the need for open-heart surgery.

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As a cardiologist and medical director of echocardiography at El Camino Health, I am fortunate to see firsthand how advances in imaging technology can lead not only to easier, more precise diagnosis but also to new, less invasive procedures — and ultimately better care.

New, more advanced imaging technology has dramatically changed cardiovascular care in recent years, and it's still evolving rapidly. At El Camino Health, we're not just keeping up; we're on the front line, advancing diagnosis, treatment and personalized heart care. Honestly it seems like we are constantly adapting our techniques to some new idea, and because we're here in Silicon Valley, we are often among the first to see some developments.

The two biggest gamechangers in cardiac imaging in recent years have been computed tomography angiography (CTA) and high-resolution, three-dimensional (3D) echocardiography. Though CT scans and echocardiograms aren't new, the technology in both cases has become much more sophisticated — and powerful.

A new kind of CT scan

Computed tomography, often called a CT scan or CAT scan, uses X-rays to create detailed images of areas inside the body. CT angiography, one of the gamechangers I've already mentioned, carries CT scanning much further, providing detailed pictures of the heart and blood vessels throughout the body.

CTA can identify narrow or blocked areas of a blood vessel, as well as the presence of arterial plaque, the fatty substance made of cholesterol and other materials from the blood stream. Being able to detect the presence of plaque is a huge advancement in diagnosis, because plaque is a bigger predictor of long-term heart attack risk than blood pressure, cholesterol levels or other traditional risk factors, so detecting it early can potentially be lifesaving.

This noninvasive test takes less than 10 minutes and presents modest radiation exposure, so it's quite safe. It allows us to get a complete picture of heart arteries. In fact, in many cases, we can use it to rule out coronary disease, which helps the patient avoid unnecessary procedures. If a patient has symptoms for heart disease, this can be a very useful test.

Echocardiography shows the heart working in real time

Echocardiography uses ultrasound to monitor heart function and has been in use for decades. But today's high-resolution, three-dimensional, real-time imaging of anatomy and function is not your grandfather's echocardiogram.

The development of high-resolution echo technology with 3D capability is another gamechanger. It allows us to visualize both anatomy and function of the heart. We can see the heart pumping, the valves in motion and other details so we can be very precise about what the problem is. It also helps us determine whether there are minimally invasive or surgical options that would solve the problem.

Better technology leads to innovation: Structural heart

As imaging technology has improved, research into new, less invasive or more effective treatment options has picked up speed. Being able to see the heart and vascular system in such detail sparks ideas and innovation.

Imaging to guide catheter-based procedures is one of my clinical interests, and what's happening today is very exciting. We're learning how to fix problems that previously had no good solution, and we're developing less invasive procedures for problems that once required open-heart surgery. Many of these less invasive treatment options are in the emerging area of structural heart disease, focusing on anatomical abnormalities of the heart itself, including valves, walls or chambers.

Two examples of recent innovation are the MitraClip and the Watchman device.

The MitraClip, now in use worldwide, was invented by El Camino Health's own Fred St. Goar, MD. El Camino Health's cardiology team was one of the first in California to use the MitraClip to treat mitral valve disease (also called mitral valve regurgitation) — a condition in which the heart valve doesn't close properly. The standard method of treatment is open-heart surgery, which isn't feasible for many patients because of age or overall health.

The MitraClip is placed using a catheter, a very thin tube, which is passed through a vein in the groin. Advanced imaging guides the placement in the heart and allows function to be assessed with the clip in place so that adjustments can be made right away. This device offers a treatment option for people who have severe symptoms and who are at too great a risk to have traditional surgery.

The Watchman device is a small implant placed in the heart that can reduce the risk of stroke in patients with atrial fibrillation (often called AFib). The balloon-like implant is inserted near the groin and placed inside the left atrial appendage of the heart to prevent blood from pooling there. With this device, we are often able to reduce the need for blood thinners for Afib, while also reducing stroke risk.

Then and now

Catheter-based (also called percutaneous) treatment options are evolving all the time. I started at El Camino Health in 2008, and since then many of the procedures that were strictly surgical can now also be done percutaneously.

These treatment options are less invasive, with tiny incisions, and may be lower risk than open surgery for some patients. Recovery is often much quicker. Patients can often go home after one or two days.

However, catheter-based solutions aren't for everyone. Surgical methods are tried and true, and we don't yet have long-term results from some catheter-based procedures.

Age, overall health, life expectancy, the patient's goals and preferences, and other factors must be considered when making the decision. For instance, in a younger patient, surgery may be the better choice for long-term outcomes, while an older patient is usually at higher risk of surgical complications.

Our team members work closely with patients and families so they can make informed decisions about their care. Everyone is unique, and every case is different. As we learn more, we'll continue to develop newer, safer and more reliable treatment options. Cardiology will always be rapidly evolving as new knowledge is applied, and El Camino Health will continue to be a leader in advancing heart care and saving lives.

Learn more about Heart and Vascular Care at El Camino Health.

 


 

El Camino Health is a nonprofit organization with campuses in Mountain View, California and Los Gatos, California. Our hospitals have served communities in the South San Francisco Bay Area for over 50 years.

Learn more at elcaminohealth.org