Heart Health in San Joaquin

by NISSA HALLQUIST | photos by BRENDA HARTSHORN

Angela Jones isn’t the first person you’d think of when it comes to heart disease. She’s young, fit, active, and eats healthy. She works as a nurse at St. Joseph’s Medical Center in Interventional Radiology, which is often used in the diagnosis and treatment of heart issues. At first glance, no one would ever know that many of her lifestyle choices came about because she was born with congenital heart defects, an ailment that persists to this day.

There was never a time when Jones had a properly working heart. As such, she’s always been aware of her heart, and has always worked hard to take care of it. Most people don’t have the same keen awareness of heart health. Despite strides in treatments and preventative measures, heart disease remains the number one cause of death for people in the United States. The number one weapon against becoming a part of this statistic is keeping informed.

Risk Factors

According to the American Heart Association, common risk factors for heart disease can be broken down into two categories. The first are those items over which you have no control.

Heredity and family history: People with immediate relatives who have heart disease are more likely to develop it themselves. African Americans and other minorities have a greater tendency toward high blood pressure and heart disease than Caucasians.

Age: More than 80 percent of fatalities from coronary heart disease are over 65 years old.

Gender: The gap is narrowing somewhat, but men still have a greater chance of having a heart attack.
Then there are the factors over which, through lifestyle choice and/or medications, you do have a certain amount of control.

Smoking: People who smoke are at least twice as likely to develop heart disease than those who don’t.

Obesity: Excessive weight increases the heart’s workload to pump blood and oxygen through the body.

Lack of Exercise: Regular exercise keeps the blood flowing easier, while sitting still all the time does the opposite. 

High Blood Pressure: A consistently high blood pressure offers empirical evidence that your heart is working harder than it has to, and may soon lead to the muscle stiffening and malfunctioning (i.e. Congestive Heart Failure, or CHF).

High Cholesterol: Total cholesterol levels should not exceed 200 mg/dL. The appropriate split between good (HDL) versus bad (LDL) cholesterol is dependent on your other risk factors.

Diabetes: When a person’s body becomes unable to produce insulin or its cells to properly utilize it, glucose builds up in the blood, over time damaging the heart and other organs.

Knowing all your risk factors, and acting as proactively as possible to keep them under control is the best way to prevent significant problems from occurring. Dr. Gurinder Grewal of San Joaquin Cardiology is also the Medical Director of St. Joseph’s Medical Center’s Catheterization Lab and Cardiac Research Department. He is a great proponent of “risk factor modification.” Basically, the best way one can avoid heart disease, or at least minimize the risk, is to eat properly, exercise, stop smoking, and regularly monitor blood pressure and cholesterol levels. 

Of course, even if you do everything the right way and take the right precautions, those pesky factors you can’t control can still come into play. Like Jones, Al Murillo was not the stereotypical heart disease candidate, being an avid marathon runner and in good shape. Apart from slightly elevated cholesterol levels, he’d never had any issues with his heart. Then, in 2007, he began to feel pain in his chest, which he attributed at first to stress and anxiety.

Still, just to be safe, he went in for a routine physical at St. Joseph’s Medical Center, renowned in the San Joaquin area for their award-winning cardiac care. His cardiologist found three occluded arteries, and Murillo found himself headed in for an immediate triple bypass.

Needless to say, according to Murillo, “It was a shock. I’d never had any problems before. But fortunately, since it was caught in time, I haven’t had any problems since.

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Warning Signs

What was especially surprising about Murillo’s episode is that it didn’t feel how one assumes a heart attack to feel. Those having a heart attack often experience chest discomfort ranging anywhere from slight discomfort (indigestion-like) to full-fledged crushing pain. Pain may also present in other parts of the body, including the arms, jaw, back, or neck. Other signs are shortness of breath, lightheadedness, fatigue, and nausea.

The important thing to remember is that not all signs have to present with chest pain in order for it to be a heart attack. Even if you’re not sure it’s your heart that’s the cause, don’t take a chance. According to Theresa Weaver, a nurse who works with Dr. Grewal at St. Joseph’s Cardiac Research Department, the most important step in the process is to immediately call 911.

“A lot of times, people are in denial about the seriousness of their condition,” she states. “They try driving themselves to the hospital or ignore the symptoms altogether until they become serious. And by then, the damage is done."

Heart Tech: Diagnosis
Fortunately, new technologies are making the diagnosis and treatment of cardiac-related issues easier than ever. Some well-known techniques in the diagnosis of heart problems include PET, CT, and CAT scans. But there are many other effective methods.

Coronary Angiography/ Areteriography
According to Dr. Abbas Chothia, cardiologist and senior partner at Stockton Cardiology Medical Group, this is one of the least invasive and most effective tools currently available to diagnose heart problems. A catheter is inserted into a blood vessel in your groin area or arm. Then the tip is positioned in the heart or at the beginning of the arteries supplying the heart. A special contrast medium is then injected and photographed via X-ray to identify blockages.

EKG/ECG (Electrocardiograph)
The 12-lead EKG remains one of the most effective diagnostic tools. Through precisely placed leads on a person’s body, improper rhythms and rate can be quickly and easily discovered. It is often used in conjunction with stress tests to determine heart performance before, during, and after physical exertion.

New to the San Joaquin area, and designed to cut down on the time between an initial attack and treatment, are on-site EKGs. Responding paramedics are able to conduct an EKG and send the information to the emergency room electronically. That way, the emergency room doctor can then determine the severity of the case and contact a cardiologist as needed before the patient is even through the doors.

SPECT (Single Photon Emission Computed Tomography) MRI
As an improvement over planar, or two-dimensional, imaging, a radioactive tracer is placed into the blood, a series of pictures is taken of the heart and surrounding area, then computer graphics create 3-D images of slices of the heart.

Loop Recorder
In a case where heart problems occur, but the cause is not immediately evident to the cardiologist, a loop recorder can be implanted under the skin where it monitors and records heart performance over a set amount of time.

Heart Tech: Treatment
Once the diagnosis of heart trouble is made, then comes the need for treatment.

Implantable Pacemaker/Defibrillator
In the case of chronic arrhythmias and congestive heart failure, pacemakers and defibrillators implanted under the skin and attached to the heart muscle are still the norm, keeping the heart pumping, and regulating rhythm and rate through electrical impulses. While such devices are not new technology per se, technological advancements have improved how they work—they are becoming increasingly compact and have a longer battery life.

With an acute episode like a heart attack, the ideal situation is to maximize arterial blood flow as quickly as possible. Various medications can be given initially to try to improve the pumping of the heart, dissolve an artery-blocking clot, and/or enlarge the arteries. When that’s not enough, then surgical procedures are indicated.

Angioplasty
A catheter is fed into the damaged artery. For laser angioplasties, a laser at its tip is used to break-up the offending clot. With balloon angioplasties, a thin wire is threaded past the clot. A balloon in the wire is then inflated and the clot pulled out.

Stent Procedure
During an angioplasty, permanent stents made out of metal mesh are often inserted into the artery in order to keep the artery open and stable after removing the clot.

Bypass
When all else fails, the chest needs to be opened up to manually remove the clot and repair arteries. While still highly invasive, Dr. Chothia has noted an increased tendency for heart surgeons to opt for “off pump,” or beating heart surgeries. Rather than stopping the heart and pumping blood through machines, only the area needing repair is clamped off and held still, allowing the rest of the heart to continue to pump naturally. This reduces shock to the heart and damage to blood cells. [SJM]