• Keeping Your Heart Healthy
  
• Warning Signs of Heart Attack and Stroke
  
• Problems
  
• Diagnosis
  
• Cardiac Catheterization
  
• Surgery
  
• Rehabilitation

The normal heart is just a little larger than a fist. A muscle, it pumps about 2,000 gallons of blood each day.

The heart consists of four compartments: the right and left atria and right and left ventricles. The right atrium receives blood from the veins. This blood then enters the right ventricle and is pumped to the lungs. From the lungs, blood comes back into the left atrium, then goes into the left ventricle. Blood from the left ventricle is pumped out of the aorta to the rest of the body. 

Four valves in the heart ensure that blood moves in only one direction.

Coronary arteries surround the heart, supplying blood that nourishes the heart muscle.

Who is Responsible for a Healthy Heart?

Doctors can do wonders for an ailing heart. But only you can keep your heart healthy.

Most heart disease is preventable. Many of the patients we see at West Virginia University are here because years of unhealthy behavior have damaged their hearts. If you are a smoker, do not get much exercise, are overweight, or have high blood pressure, you can significantly reduce your risk of heart disease band improve your overall health by changing your lifestyle.

First, Stop Smoking

West Virginians have the highest rates of tobacco use of any state in the U.S. Tobacco is a part of our culture. But is also the cause of many of our health problems.

Smoking may be responsible for one-third or more of the deaths from cardiovascular disease in the United States. A pack-a-day smoker has double the heart attack risk of a non-smoker - and a smoker who has a heart attack is four times as likely to die within the first hour.

Quitting smoking is never easy. Nicotine is highly addictive. If you can't quit without help, see your physician. You may benefit from a medically supervised stop-smoking program like those offered by the Mary Babb Randolph Cancer Center at WVU.

Watch Your Blood Pressure

High blood pressure is a major contributing factor in heart disease. High blood pressure can result from a number of factors - being overweight is one of them - and is usually controlled by dietary changes, weight loss, or medication. 

If you have high blood pressure, your physician may suggest reducing salt use, a weight-loss program or regular doses of medicine.

It's important to follow these recommendations. Even if you feel no symptoms, high blood pressure puts a major strain on the cardiovascular system and makes you susceptible to heart disease.

Exercise Regularly

Most Americans lead lives that don't require much physical exertion. An aerobic exercise program that includes 20 minutes of activity three times a week may help to lower blood pressure, lower the average heartbeat, and strengthen the heart muscle. Aerobic exercise raises the heart rate and forces the body to take in more oxygen. Strength-building exercise like weight-lifting doesn't have the same effects.

Don't make a quick switch from an inactive life to an exercise program without checking with your physician. But don't delay. Exercise is easier, cheaper, and more fun than almost anything that's so good for you.

You may be more motivated to exercise if you join a group. Your local hospital, the mall, or the school system may sponsor fitness programs.

Eat Right

Nutrition plays an important part in keeping a heart healthy.

A heart-healthy diet is low in saturated fats and cholesterol. By cutting down on red meats and dairy products - substituting fish or vegetarian dishes a few times a week - you can substantially improve the quality of your diet.

People who eat a lot of fruits and vegetables simply take in less fat and fewer total calories. Have either a glass of juice or fruit for breakfast, a salad and/or vegetable soup for lunch, a potato and another vegetable with dinner, and fruit for a snack. Pasta dishes and casseroles are other easy places to increase vegetables. Fruits can be used in place of or added to desserts.

Your physician, or a dietician, can provide you with more tips on switching to a healthy diet.

Preventive Medicine

Some research shows that low doses of aspirin taken regularly can reduce the risk of heart attack. Other studies have shown that certain vitamins may help prevent heart disease.

Check with your physician before beginning regular use of aspirin or any other medicine. While aspirin is harmless for most people, it can have serious side effects for some, especially when used continuously over a long period of time. 

Because the physicians at WVU Hospitals are teachers as well as doctors, they are among the first to know about studies that can help you prevent diseases. 

• Uncomfortable pressure, fullness, squeezing, or pain in the center of the chest that lasts more than a few minutes.
• Pain spreading to the shoulders, neck, or arms.
• Lightheadedness, nausea, shortness of breath, fainting, sweating, accompanied by chest discomfort.

It is very important that you get to a hospital equipped to handle cardiac emergencies as soon as possible. New drugs that can stop or limit the damage of a heart attack are now available, but they MUST be administered very soon after an attack begins.

Warning Signs: Stoke:

The warning signs of a stroke are:

• The face, arm, or leg suddenly becomes weak or numb on one side of the body.
• Loss of vision, or dimming, in only one eye.
• Trouble talking, or understanding speech.
• A sudden, severe headache.
• Unexplained dizziness, particularly if combined with any of the above symptoms.
• Previous TIAs (transient ischemic attacks) or "little strokes." TIAs happen when the brain is deprived of oxygen by a blood clot temporarily clogging an artery. A TIA can last a very short time, but is an extremely important stroke warning sign.

Jon Michael Moore Trauma Center passed a rigorous inspection based on national standards to become the state's first Level I trauma center. State-of-the-art facilities and an experienced staff combine to provide the very best of care to emergency patients.

Because WVU is an academic medical center, cardiac and emergency care specialists and the latest medications are available around the clock.

West Virginia University Health Sciences Center has the most comprehensive heart diagnostic center in north central West Virginia.

Angiogram

An angiogram is an x-ray picture that shows the blood vessels or chambers of the heart. The test traces the course of a special fluid, visible by x-ray, that has been injected into the bloodstream.

Echocardiogram

An echocardiogram examines the heart's structure and function using sound waves transmitted from a transducer on the chest to a VCR tape and viewed on a television screen. (See Fetal Echocardiogram and Transesophageal Echocardiogram.)

Electrocardiogram (ECG or EKG)

The heart produces electrical impulses that can be graphically recorded by an ECG. WVU is one of the few centers equipped with a special, signal-averaging ECG that helps to predict a patient's likelihood of developing a life-threatening arrhythmia.

Event Monitor

A device, applied to the chest by the patient, that records heart activity. When patients experience symptoms, they call Cardio Care and play back the recorded event, which is then evaluated by the Cardio Care staff. Cardio Care contacts the hospital if any irregularities are noted.

Fetal Echocardiogram

By 19 to 20 weeks gestation, an echocardiogram (see earlier section) can be safely used in an unborn baby to diagnose most serious congenital heart defects.

Holter Monitor

A holter monitor is worn by a patient for 24 hours to capture cardiac abnormalities that cannot be detected on an ECG. The heart's activity is recorded and evaluated along with the patient's diary of activity.

Stress Test

This test evaluates the heart's ability to respond to exercise. Heart specialists will measure heart rate and blood pressure and administer an electrocardiogram while a person taking this test walks on a treadmill or performs a similar exercise.

Thallium Stress Test

Like the stress test explained before, a thallium stress test measures the heart's response to exercise. In this test, a small amount of radioactive material is injected into a vein. If you have a thallium stress test, you will have x-rays taken right after exercise and again three hours later. This test can "see" where blood flow is decreased.

Tilt Table

A tilt table is used in the workup of syncope (fainting), a condition that is often difficult to diagnose. On the tilt table, the patient's blood pressure and heart rate are monitored as the table changes position.

Transesophageal Echocardiogram

When a traditional echocardiogram (see previous section) does not produce an acceptable image, physicians obtain another image of the heart from a monitor in the esophagus. In infants and children, Transesophageal Echocardiogram is now commonly used in the operating room.

Transesophageal Electrophysiological Study

West Virginia University is the only medical center in the region to offer this special process that both evaluates and treats certain children's arrhythmias. To conduct a transesophageal "EP" study, a physician places a catheter in the esophagus behind the heart and obtains recordings of the heart's electrical activity. The physician can then pace the heart to treat the arrhythmia and/or determine its cause.

WVU's state-of-the-art cardiac catheterization laboratories are used for both diagnosis and treatment. By far, the largest number of patients who use the cardiac catheterization laboratories have coronary artery disease, or blocked arteries. WVU is one of the few medical centers in the country that performs other sophisticated procedures, such as ablation, the electronic correction of arrhythmia (irregular heartbeat), and the correction of congenital heart defects.

Cardiac catheterization is the process of examining or treating the heart by threading a thin tube (Catheter) into a vein or artery and passing it into the heart.

Arrhythmia (Irregular Heartbeat)

• Diagnosis
  In the diagnosis of arrhythmia, the catheter is used to locate the area of the heart that is causing an abnormal heart rhythm. A computer is used to map the electrical impulses in the heart.
  
• Treatment
  Irregular heartbeat is often treated in the same procedure that identifies the area of the heart that is causing the problem. When physicians pinpoint the location of the abnormal rhythm, they apply electrical current at that location. This heats and destroys the heart tissue causing the problem. The process is call ablation.

Congenital Heart Defects

• Diagnosis
  The diagnosis of almost all congenital heart problems in children is made by echocardiography; in some cases, even before the baby is born. If a defect is found, a cardiac catheterization may be performed in case interventional procedures are needed or if necessary information cannot be obtained by echocardiography alone.
  
• Treatment
  Certain forms of heart problems in children can be addressed by balloon angioplasty. The most common congenital heart defect treated in this way is narrowing of the pulmonary valve. Dilation of other heart valves or the branch pulmonary arteries is also performed in selected cases. Other procedures are performed to reduce the extent of intervention if surgery is required.
  
  The technique of transesophageal echocardiography and color Doppler evaluation allows physicians to immediately evaluate the success of surgical procedures before the child leaves the operating room.

Coronary Artery Disease

• Diagnosis
  When cardiac catheterization is used to diagnose coronary artery disease, a doctor will first guide a thin plastic tube (a catheter) through an artery in a leg and into the coronary arteries. The doctor will then inject a liquid dye visible in x-rays into the catheter. X-rays will trace the dye as it flows through the arteries.
  
  This test shows whether there are blockages in coronary arteries. A doctor will review the pictures and determine how many, if any, blockages there are, where each one is located, and how severe they are. This information will help doctors make decisions about treatment.
  
• Treatment
  Most of the time, the treatment for coronary artery disease is not done the same day as the diagnostic test. If a patient is diagnosed with coronary artery disease, his or her doctor will discuss several treatment options.
  
  One of those options is a process called angioplasty, or the remodeling of a blood vessel. Physicians at WVU offer a variety of angioplasty treatments.

Balloon Angioplasty

• A doctor will advance a tiny guidewire inside a coronary artery until it reaches the area that is blocked. A catheter with a deflated balloon on its tip is then guided over the wire to the blockage. Once in place, the balloon is inflated several times. This compresses the fatty material, or plaque, against the arterial walls and allows for greater blood flow.

Directional Atherectomy

• Using the same guidewire system explained above, the doctor introduces a tiny saw into the clogged artery. The saw then shaves off plaque into a built-in receptacle for removal. This "cleans' the artery and yields better blood flow.

Laser Atherectomy

• WVU is an investigational site under FDA protocol for this new technology in which a laser is guided to the site of the blockage through a catheter. The laser then vaporizes lesions which have blocked the arteries.

Valve Problems

• Diagnosis
  As in the diagnosis of coronary artery disease, the diagnosis of valve malfunction utilizes pictures obtained when a physician threads a catheter into a vein or artery and passes it into the heart.
  
• Treatment
  A physician threads a tiny balloon through a catheter until it reaches the diseased valve. The balloon is then inflated, which opens the valve. This process is called valvuloplasty.
  

WVU's cardiothoracic surgeons are recognized for their expertise in a wide range of procedures. They are supported by specialized cardiovascular nursing units, and a team of specialists on hand at Ruby Memorial Hospital, WVU Children's Hospital and Monongalia General Hospital.

Coronary Artery Bypass Surgery

Coronary artery bypass surgery increases the circulation and nourishment to the heart muscle by forming a new pathway for blood to reach the heart muscle.

In most cases, physicians remove a large vein (the saphenous vein) from the leg, attach one end to the aorta, and connect the other end to the coronary artery below the blockage. (Sometimes surgeons use either one or both of the internal mammary arteries as the bypass graft.)

This procedure relieves chest pain, but patients who undergo bypass surgery must modify their lifestyle to slow further development of coronary artery disease.

Correction of Congenital Defects

WVU has attained national recognition for its successful treatment of children with congenital heart defects.

It is one of the few centers in the world to repair a lethal congenital heart defect known as hypoplastic left heart syndrome. WVU's pediatric cardiac surgery program has a strong emphasis on infant cardiac surgery, with a team of nurses specially trained in pediatric intensive cardiac care.

Surgery can correct or improve most heart defects without serious risk. Most of the time, surgery is done as soon after birth as possible. More operations often are necessary as the child grows.

Some congenital heart defects are inherited. Physicians or genetic counselors on staff at WVU can discuss inheritance patterns and the risk of having another child with a heart defect.

Pacemaker

When the electrical conducting system of the heart is malfunctioning, a pacemaker may be inserted to regulate heartbeat.

The pacemaker has two parts - the pulse generator and the lead. The pulse generator is the timing mechanism and the battery. The lead carries current to the heart and carries the signals back from the heart.

A pulse generator may be implanted in one of two ways. In the transvenous approach, a miniature electrode is introduced to the inside of the heart through a vein. The pulse generator is placed under the skin in the chest.

The epicardial approach attaches the lead to the outside of the heart. The pulse generator is placed in the abdomen.

Physicians will continue to monitor the pacemaker.

Valve Repair

Heart valve repair utilizes a person's own tissues to relieve stenosis or leakage. A blockage caused when a valve can't open properly may be relieved by separating the parts of the valve to enhance movement.

Leakage may cause the entire valve to enlarge or dilate. Restoring the valve to normal functioning may require the removal of excess tissue. Sometimes prosthetic rings may be used to narrow a dilated valve and to reinforce valve repairs.

Valve Replacement

Serious deformation or destruction of tissue may rule out valve repair. In some cases, valves must be replaced.

The new valve can come from a human or animal or it can be manmade.
West Virginia University is one of the few centers in the world to use human graft implants for valve surgery. This technique provides valves that last longer, cause fewer complications, and require no anticoagulants.

WVU keeps a reserve of donor valves ready for transplant.

Other Surgical Specialties

West Virginia University's cardiothoracic surgeons also perform other procedures, including:

• Resection of left ventricle aneurysm
• Closure of ventricular septal defects
• Application of cardiac assist devices
• Treatment of cardiac and thoracic trauma

A Team That Puts the Patient First

At West Virginia University, cardiac rehabilitation has a mission: to help the patient resume as normal a lifestyle as possible following a cardiac problem, with an improved quality of life.

WVU takes a multidisciplinary team approach to rehabilitation. Members of the rehabilitation team can include a physician, nurse, physical therapist, dietician, social worker, exercise physiologist, psychologist, education specialist, pastor, occupational therapist, and vocational rehabilitation specialist.

This team takes an individualized approach to patient care. Each rehabilitation plan is customized to a patient's needs, and that plan is continuously evaluated.

The Components of Cardiac Rehabilitation

Cardiac rehabilitation at WVU integrates four components:

• Education
• Emotion
• Exercise
• Activity

These components are implemented in a three-phased program. In Phase I, the acute phase of recovery, nurses and therapists provide passive range of motion activities, progressing to limited walking. Patients learn the symptoms of heart disease and its risk factors. Self-care is emphasized.

Phase II treats patients on an outpatient basis and cares for the patient in the 12 weeks following a cardiac event. Patients are continuously monitored by electrocardiogram during graded exercise on a treadmill or stationary bicycle. The education component in Phase II works in eliminating risk factors, offering techniques for smoking cessation, menu selection, and medication routines.

Phase III, also outpatient, concentrates on health maintenance. It includes a supervised walking program and continued education support emphasizing a healthy lifestyle.

• Education

  West Virginia University is a teaching institution, and cardiac rehabilitation takes advantage of both the University's links to education experts and to up-to-date medical discoveries.

  Our cardiac rehabilitation team considers patient education of utmost importance. The patient's family, an integral part of the rehabilitation team, is included in the education process.

• Emotion

  It is normal for a cardiac patient to experience emotional upheaval. The patient may be anxious, fearful, depressed, or angry.
  
  WVU's cardiac rehabilitation team recognizes that the patient's emotional health is as important as his or her physical health.

• Exercise

  Regular exercise is an integral part of WVU's cardiac rehabilitation program. Patients' regimens are individualized according to their needs.
  
  A number of hospitals in the state - including West Virginia University - have supervised walking programs.

• Activity

  When should a patient return to everyday activities? What is a "normal" lifestyle following a cardiac event?
  
  The WVU rehabilitation team's individualized approach to patient care helps to answer questions like these. The patient is our first priority. Remember, our goal is to improve the patient's quality of life.