Category: Heart & Vascular

By: Angie Smith, Director, Fisher-Titus Foundation

Fisher-Titus is an independent, non-profit, community hospital that is small enough to put the needs and care of our community at the center of everything we do. Yet we are big enough to enjoy a breadth and quality in services that is rare for a rural health system.

Proximity to skilled care is vital, especially during a serious cardiac event like a heart attack. You may have heard the phrase “time is muscle” in relation to a heart attack. Because a heart attack is caused by a blockage in an artery or several arteries within your heart, heart muscle tissue may start to die from a lack of blood circulation, causing irreversible damage. “Time is muscle” because the more time it takes to receive care, the more you are at risk for permanent heart muscle damage, which can lead to limited recovery of heart function, and even death. The closer you are to high quality cardiac care that includes a catherization (cath) lab to open blockages, the better your chances of survival and of minimizing the damage to your heart muscle.

Receiving a skilled and rapid response requires a well-coordinated team of paramedics/EMTs, emergency room personnel, doctors, nurses, technicians, and support staff to save time. The Fisher-Titus health system provides us, our loved ones, and neighbors just that—access to care from a sophisticated, coordinated team of emergency and cardiac professionals.

From February 14, 2019 when we opened the Level II Adult Cardiac Catheterization Laboratory to January 2022, the Fisher-Titus Interventional Cardiology Program has performed 140 emergency and 289 nonemergent interventional cardiac procedures. That is over 300 procedures that patients would have previously had to travel outside our community to have done. Additionally, we have performed 730 diagnostic caths in that timespan.

Fisher-Titus continues to invest in the full continuum of heart care—from equipment in the field for North Central EMS to the latest cath lab technology to restore blood flow to the heart. Recent upgrades include:

A new ambulance for North Central EMS equipped with the latest heart monitoring technology to transmit data to the hospital from the scene, which allows care planning to start before the patient arrives, saving valuable time.
Completed renovation of one of our two existing cardiac cath labs with renovation for the second coming soon. The upgrades include the addition of state-of-the-art equipment with technology advancement to support the next decade of excellence in cardiovascular care.
Installation of the ScottCare system with lightweight vitals monitors and integrated technology to improve comfort, safety and progress monitoring.
These upgrades would not be possible without the support we have received from our community. Through Fisher-Titus Foundation events like the Golf Tournament, Cork & Kegs, the $10,000 Blooming Cash Raffle, and through individual donations, we raised over $130,000 for the renovation of the cardiac cath labs in 2021.

We invite our community to again support local heart and vascular care through the 2022 Fisher-Titus Foundation $10,000 Blooming Cash Raffle. When you purchase tickets for your chance to win the $1,000 Early Bird Prize and the $10,000 Grand Prize , you are supporting quality local heart and vascular care through the cath lab renovation project.

Tickets for the Blooming Cash Raffle are $20 per ticket or 3 tickets for $50. The Early Bird Drawing will take place on Thursday, March 10 at 11:30 a.m. Tickets purchased by 4 p.m. on March 7 will be included in the Early Bird Drawing (the Early Bird winner will be re-entered for the Grand Prize Drawing). The Grand Prize Drawing will take place on Thursday, March 31 and tickets must be purchased by 4 p.m. on March 28. Only 3,200 tickets will be sold.

Ticket can be purchase online at fishertitus.org/donate, at all Fisher-Titus Medical Offices, Sheri’s Coffee House’s Downtown Norwalk location, or by calling the Foundation office at (419) 660-2920. For more information visit, fishertitus.org/raffle.

In celebration of Pulmonary Rehabilitation Week, March 14-20

The Fisher-Titus Pulmonary Rehabilitation Program will be celebrating its eighth anniversary this year! Our pulmonary rehab program began caring for patients in the spring of 2013. Our staff is dedicated to helping individuals with lung disease breathe easier. If you have been diagnosed with a chronic lung disease such as COPD, you may qualify for our program.

The program’s goal is to improve the quality of life for those living with chronic lung disease. This is accomplished through individualized strength and endurance building. Our Pulmonary rehabilitation program also provides participants with the skills and education to better manage their symptoms of lung disease.

Our program is accredited by the American Association of Cardiovascular and Pulmonary Rehabilitation. Dr. Basem Haddad, M.D., a Fisher-Titus Pulmonologist, is the medical director and guides our program.

If you are interested in learning more about the Pulmonary Rehabilitation Program offered at Fisher-Titus and how it could benefit you or someone you know, please call (419) 660-2600. We look forward to helping you BREATH EASIER.

By: Dr. Mohamed Osman, Vascular Surgeon

During heart month, we become more aware of the health of our heart, symptoms of heart attacks, and more. However, our body is full of veins and arteries that can become clogged over time just like the arteries near your heart. Some of the most important of these are the carotid arteries.

About Carotid Stenosis

Carotid stenosis, also known as carotid artery disease, is the narrowing of the arteries that carry oxygen-rich blood from the heart to the brain. Carotid stenosis can develop slowly over time with little to no symptoms, but it can eventually have serious complications. Carotid stenosis is estimated to cause 20-30% of strokes in the United States.

Normal, healthy arteries are flexible with smooth inner walls. Over time, plaque—a sticky substance made of fat, cholesterol, calcium, and other fibrous material—can build up on the inner walls of arteries causing them to narrow and become rigid. This process is also known as atherosclerosis.

Causes and risk factors for Carotid Stenosis

Carotid stenosis is most often caused by atherosclerosis in the carotid arteries. It can begin as early as your 30s but it usually takes decades to cause symptoms. Some things that can contribute to an increased risk for damage in the arteries are:

• High blood pressure
• Diabetes
• High cholesterol (LDL cholesterol)
• Obesity
• Coronary artery disease
• A family history of carotid stenosis
• Advanced age
• Smoking

Symptoms

Symptoms of carotid stenosis do not typically develop until the artery is severely narrowed or a clot has formed. For many people, the first sign of carotid stenosis is a mini stroke, also known as a transient ischemic attack (TIA). A TIA happens when blood flow to the brain is temporarily interrupted and then restored so, the symptoms usually last a couple minutes and then resolve completely. However, these symptoms shouldn’t be ignored. A TIA can be a warning that a major stroke and/or brain injury could be down the road.

The symptoms of a TIA are similar to those of a stroke. These can be remembered with the acronym, BE FAST:

• Balance – sudden loss of balance
• Eyes – lost or blurry vision in one or both eyes
• Face – unevenness in the face
• Arms – weakness or numbness in one arm
• Speech – slurred speech, trouble speaking, or confusion when speaking
• Time – time is of the utmost importance when experience a TIA or stroke so you should call 911 or go to the nearest emergency room

Diagnosis and treatment

If you experience any signs or symptoms of stroke—even if they don’t last very long—you should talk to your doctor. Additionally, you should talk to them if you have any risk factors for carotid stenosis. They can recommend management and treatment of these factors. Talking to a doctor early can also increase your chances that carotid stenosis will be found and treated early.

A doctor can use any symptoms you’ve experienced, medical history, family history, and risk factors to help determine if you have carotid stenosis. They can also perform a physical exam where they may listen to your carotid artery with a stethoscope. This can help them detect a swishing noise called a “bruit” that can be a sign of turbulent blood flow caused by atherosclerosis.

Depending on the results of this exam and your personal history, additional tests may be recommended such as doppler ultrasound of the neck, a CT angiogram of the neck, magnetic resonance angiography (MRA), or cerebral angiogram. A diagnosis of carotid stenosis can be reached if tests show diminished blood flow in one or both carotid arteries.

In treating carotid stenosis, the goal is to reduce the risk of stroke. There are various treatment options depending on the severity. These include:

• Medications (antiplatelet, cholesterol-lowering statins, and antihypertensive)
• Carotid endarectomy, an open surgery to remove the plaque
• Carotid angioplasty/stenting, a minimally invasive procedure that compresses the plaque and widens the artery
• Carotid artery bypass, a surgery that reroutes the blood supply around the blocked area

About Dr. Osman

Dr. Mohamed Osman is a vascular surgeon with Fisher-Titus Heart & Vascular. Dr. Osman specializes in aortic aneurysm repair, complex aortic dissection, blockage in the aorta or iliac arteries, carotid artery disease, dialysis access surgery, treatment of varicose veins and vein ablation, limb salvage, and more. In 2020, Dr. Osman led the Fisher-Titus Vascular team in the addition of two innovative, vascular procedures. For more information on Fisher-Titus Heart & Vascular, visit fishertitus.org/heart.

Cardiovascular is probably a word you’ve heard but you may not know exactly what it means. Cardiovascular disease describes the many different diseases affecting the heart and blood vessels. “Cardio” refers to the heart and “vascular” refers to the blood vessels. There are many types of cardiovascular diseases ranging from high blood pressure and coronary artery disease to heart failure and stroke. It is the leading cause of death among men and women, taking more lives than all cancers combined. Fortunately, there are ways to reduce your risk of developing these diseases.

February is heart month so it is the perfect time to learn about cardiovascular disease and ways you can prevent it.

The term cardiovascular disease is most commonly used to describe arthrosclerosis. Arthrosclerosis is the build-up of plaque in the arteries. Too much build-up can restrict blood flow to organs and tissues. It causes chest pain and can eventually lead to cardiovascular diseases.

Arthrosclerosis is caused by many factors. It can be silent for many years and may not present symptoms until the build-up becomes so severe that it blocks the blood supply entirely. Some common warning signs that this has happened are chest pain, dizziness, and swelling or pain in the arms or legs.

How to Reduce Your Risk for Cardiovascular Disease

You can ensure the health of your heart by maintaining a healthy lifestyle. While some risk factors are out of your control, most risk factors are lifestyle changes you can make. These guidelines will not only help you prevent cardiovascular disease, but many other diseases and conditions as well.

• Quit smoking. Smoking can damage the heart and blood vessels making them more susceptible to arthrosclerosis.
• Exercise. 30 minutes of moderate intensity aerobic exercise daily can help blood flow more easily.
• Eat healthy. A diet rich in fruits, vegetables, whole grains, and low-fat dairy products supports a healthy heart. Avoid foods high in saturated fat as they contribute to higher cholesterol. Foods high in trans-fat raise bad cholesterol and lower good cholesterol.
• Healthy weight. By maintaining a healthy weight, you reduce your risk of high blood pressure, high cholesterol, and diabetes all of which can contribute to cardiovascular diseases.
• Regular checkups. Visiting your doctor regularly gives you a better picture of your own heart health. Your doctor can measure blood pressure and cholesterol and help you make choices that are best for you.

Efforts to prevent cardiovascular disease can begin as early as childhood. Parents can teach their children healthy eating habits and the value of exercise to help them make the healthiest choices throughout their lives.

Managing cardiovascular disease close to home

The Snyder/White Heart & Vascular Center at Fisher-Titus is equipped with state-of-the-art technology to provide the latest cardiovascular diagnostic and interventional procedures. Non-invasive tests such as stress tests, CT scans, and echocardiograms are all common in detecting and treating cardiovascular disease.

Our highly experienced cardiovascular team is able to provide patients with the most current heart and vascular procedures right here at Fisher-Titus. They offer wellness and prevention, high-tech diagnostics, critical emergency services, a variety of interventional procedures, and personalized rehabilitation programs. We are able to provide all of these cardiology services in the same location, close to home.

About Jason Gahring MSN, MBA, RN

Jason is Vice President of Ambulatory Nursing. He has been a Registered Nurse at Fisher-Titus Medical Center for nearly 20 years with extensive experience in cardiology care. For more information about the Fisher-Titus Heart & Vascular Center, visit fishertitus.org/heart; to make an appointment with a cardiologist, call 419-660-4707.

Peripheral Artery Disease (PAD) is a circulatory problem where narrowing in the arteries reduce the blood flow to your limbs. This means that your limbs, usually your legs, aren’t receiving enough blood flow. An important component in heart health are the blood vessels that carry blood throughout your body. It’s important to show them the same love you do for your heart.

Peripheral Artery Disease increases a person’s risk for heart attack or stroke as it may be an indication of a more widespread accumulation of plaque in the arteries causing reduced blood flow to your heart or brain. If left untreated, it can worsen over time and even lead to a complete blockage of blood flow causing permanent damage to that part of the body. It can also lead to gangrene (death of tissue) in that part of the body or require amputation.

What are the Most Common Symptom of Peripheral Artery Disease

PAD is most common in those age 50-64. However, those under 50 can also have increased risk for developing PAD. You may be at increased risk if they you any of the following risk factors.

Risk Factors for Peripheral Artery Disease

• Smoking
• High cholesterol
• High blood pressure
• Diabetes
• Family history of PAD
• History of atherosclerosis (hardening of the blood vessels) such as the coronary arteries (blood vessels to the heart), carotid artery (the main blood-carrying vessel from the heart to the brain), and blood vessels of the abdomen or kidneys
• Obesity

Many people with PAD may have mild or no symptoms and may not even know they have PAD. While other people may have more significant symptoms.

The most common indication of PAD is leg pain when walking also known as claudication. This may feel like muscle pain or cramping in your legs or arms that is triggered by activity but subsides after a few minutes of rest. Calf pain is the most common but the location of the pain depends on the location of the clogged artery. Claudication can vary in severity ranging from mild discomfort to debilitating pain.

Other signs and symptoms of PAD can include:

Other Signs and Symptoms of PAD Peripheral Artery Disease Can Include:

• Leg pain, tightness, or cramping sensation with walking
• Leg numbness or weakness
• Leg or foot feels cold to the touch compared to the opposite side
• Dry and scaly skin on your leg
• Sores on your toes, feet, or legs that won’t heal
• Poor toenail growth or hair loss on your feet or toes
• Weak or no pulse in your legs or feet

PAD Diagnosis and Treatment

If you are at increased risk for PAD or you have symptoms, there are several tests your doctor may recommend to determine if you have PAD. These may include

• Physical exam
• Ankle-brachial index
• Doppler ultrasound
• Treadmill test
• Magnetic Resonance Angiogram (MRA)
• Arteriogram

If you do have PAD, there are many things you can do to manage your symptoms and stop the progression of blockage throughout your body. Many of the treatments your doctor suggests will likely involve lifestyle changes which can be very effective especially if you are in the early stages of PAD. Some recommended treatments and lifestyle changes include:

• Quit smoking
• Heart-healthy eating plan
• Regular walking and activity
• Exercise
• Medications
• Surgery and other procedures to open blocked blood vessels

Beginning this month, Fisher-Titus Cardiac Rehab will be offering a specially-designed exercise program for those diagnosed with PAD. For more information, call419-660-2600.

Although PAD can be serious, there are lots of things you can do to reduce your risk, prevent PAD, and manage it if you are diagnosed. Learn more about PAD and talk to your doctor if you have any concerns about your risk for Peripheral Artery Disease.

About Dr. Osman

Mohamed Osman, MD is a Vascular and Endovascular surgeon with Fisher-Titus Heart & Vascular. He is board-certified in Vascular Surgery, General Surgery, and Surgical Critical Care. For more information about Fisher-Titus Heart & Vascular, visit fishertitus.org/heart-and-vascular-services.

Part 1: Heart Disease Prevention with Exercise & Diet

Researchers in the area of heart care have been busy lately getting treatment options once considered futuristic ready for clinical use. So, today, a renewed sense of hope and enthusiasm exists for many different heart-related conditions, including new approaches for heart attacks and diagnostic imaging.

However, before I shed light on a few of the treatments coming down the pike—including advanced diagnostic tests—I want to talk about the importance of preventative care in part one of this series.

The Importance of Prevention

When patients ask me about heart disease or have questions about their health in general, the first thing I do is mention the importance of controlling blood pressure. You can’t always see heart disease, but you can see numbers. An excellent way to manage blood pressure is by exercising and eating a low salt diet. “Exercise is medicine,” and by simply exercising “low and slow” you can reap the benefits. In fact, it’s fairly typical after exercising to have a 12-point drop in the systolic number (the top number of your blood pressure) and a 7-point drop in the diastolic number (the bottom number). These exercise-induced effects on blood pressure will last over a few hours, and over time those hours add up.

Exercise also lowers bad cholesterol, raises good cholesterol, and lowers triglycerides. It’s this combination that helps reduce, or even reverse, plaque build-up in your arteries. And that’s what heart disease is –the build-up of plaque in the arteries, specifically, the coronary arteries. In fact, the specific role of the coronary arteries is to provide a path to deliver the vital oxygen demanded by your heart for all the work it does. Incidentally, the word coronary refers to a crown or a coronation, which certainly suits the name of these arteries since their location crowns the heart.

When the question, “just how much exercise should I be doing?” comes up, I explain that exercise gives you energy. Exercising for three 10-minute rounds or two 15-minute rounds has the same benefits as doing a straight 30 minutes of exercise. So, the take-home message is, three 10-minute rounds of exercise, such as walking in your neighborhood or moving around the house, can be just as good as one 30-minute round. The most important thing is to use good judgment and adjust your routine based on your schedule and your condition.

Evidence shows, however, that the benefits of exercise are dose dependent. This means more is better when it comes to exercise. The guidelines from the American College of Sports Medicine say that when it comes to heart care, 150 minutes/week of steady-state, continuous activity which elevates your heart rate is important. This goal can be achieved simply by walking – or even by moving your arms and legs while seated on a good exercise machine. As for our experiences with exercise equipment in the cardiac rehab gym, we get a lot of great use out of our NuStep machines. NuSteps are seated-exercise machines that can challenge the fitness of patients who don’t walk very as well those who consider themselves avid walkers. Furthermore, easy resistance-type exercises with light dumbbells are quite beneficial and shouldn’t be over-looked. In fact, our cardiac rehab team enjoys helping patients reach their goals as much as we appreciate working with their doctors to customize the best plan possible for somebody who’s coming in. It’s a team effort – and that team includes you.

I also like to point out that while exercise plays an important part in controlling body weight, diet is perhaps more important. For many people, proper portions, a reasonable intake of calories, and smart food choices serve as excellent ways to manage weight. But, a low salt diet helps reduce water retention while keeping blood vessels pliable, offering benefits for blood pressure management. Even though some salt is needed for basic body functions, one of the side-effects is that salt stiffens arteries. Basically, I tell patients that common sense prevails when diet is one of their concerns.

The final aspect of preventative care I’ll mention is the timely and proper taking of medications. With this in mind, another advantage of having the cardiac rehab staff nearby is that we can track your progress and update your doctor if a need should arise for medication adjustments. We can also teach you how to track your own progress.

Tune in next week to learn more about recent innovations in the diagnosis and treatment of heart disease.

In the January/February 2020 issue of Radiologic Technology, Kevin Wininger, an exercise physiologist and radiology technologist with Fisher-Titus Heart & Vascular, wrote about the innovative treatments that researchers are pioneering in heart care. He works in Cardiopulmonary Rehabilitation and the Pacemaker / ICD Clinic. For a closer look at Kevin’s article, “Biomimicry and Bioengineering in Cardiovascular Care,” visit: www.radiologictechnology.org. Visit fishertitus.org/heart for more information about our Heart & Vascular services.