Orlando Health Choose Health (Heart Month Issue)

WINTER 2020

Unexpected Ways Pregnancy
to Improve Your and
Heart Health
Heart
Heart-Healthy Diets Conditions
Managing Stress
How Gender Affects Your
Heart Attack Symptoms
Blood Pressure Medication

OrlandoHealth.com/ChooseHealth

HEART AND VASCULAR SPECIAL EDITION

WINTER 2020

Unexpected Ways Pregnancy
to Improve Your and
Heart Health
Heart
Heart-Healthy Diets Conditions
Managing Stress
How Gender Affects Your
Heart Attack Symptoms
Blood Pressure Medication

OrlandoHealth.com/ChooseHealth

HEART AND VASCULAR SPECIAL EDITION

David Strong
President & CEO
Orlando Health
Andrew J. Snyder
Senior Vice President
Marketing & Communications

CHOOSE HEALTH CONTRIBUTORS
Larry Ferachi, MD
Roland Filart, MD
Kristin B. Ford
Rod James
Farhan Khawaja, MD
Swathy Kolli, MD
Sushma Koneru, MD
Amanda Maldonado
Kim Marcum
Sarah McLean, PA-C
Yahaira Ortiz Gonzalez, MD
Melissa Perry, Registered Dietitian
Shahid Qamar, MD
Raghav Sharma, MD
Mark Steiner, MD
Julie Vargo

Heart Institute Proud recipient
of the APEX 2019
Award of Excellence,

recognizing
excellence in

publishing

WELCOME

Welcome to the Heart
and Vascular special
edition of Orlando Health
Choose Health magazine.

This issue focuses on the lifestyle
strategies that will help you
avoid developing cardiovascular
problems, the heart and vascular
symptoms to watch out for and
lifesaving procedures that are
available if you need them.

INSIDE THIS ISSUE

Unexpected Ways to Keeping Your Heart’s
Improve Your Heart Health Support System Healthy

4&5 12 & 13

Eating Your Way to 5 Ways to Relieve Stress
a Healthier Heart and Help Your Heart

6&7 14 & 15

The Little-Known Test that How Gender Affects the Way
Can Prevent a Heart Attack You Experience a Heart Attack

8&9 18 & 19

How Pregnancy Affects ‘I Felt Like My Heart Could
a Mother’s Heart Quit at Any Minute’

10 & 11 20 & 21

3ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

PREVENTION

Unexpected Ways to Improve
Your Heart Health

By Julie Vargo, Editorial Contributor

Most of us know the basics for
creating a heart-healthy lifestyle
— exercise, a low-fat diet and
avoiding bad habits like smoking.
While these tried-and-true
methods help lower the risk for
heart disease, researchers have
recently discovered some other
simple, yet unexpected, ways to
boost heart health.

4ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

Going to the Dogs (and Cats) “We all know healthy lifestyle changes are habits worth
adopting,” says Dr. Sharma. “But if they don’t have a reason
When it comes to coronary well-being, several studies show to adopt them, most people won’t. You have to be interested
dogs may truly be man’s best friend. in your health to want to improve it, and having a purpose or
passion provides that motivation to watch your cholesterol, walk
“The companionship and unconditional love of a dog can every day and take your medicine.”
reduce the risk of heart disease and other cardiovascular
problems,” says Dr. Yahaira Ortiz Gonzalez, a cardiologist For some, a job or volunteer commitment gives them purpose.
with the Orlando Health Heart Institute Cardiology Group. For others, their passion might be family or friends.
“Studies show pet owners get almost 30 minutes more exercise
a day walking their dog than those without dogs, have better “I love to take care of my patients,” says Dr. Sharma. “To achieve
cholesterol levels and lower blood pressure.” this purpose most successfully and be a good doctor, I know I
have to be rested and happy. So I make sure I get eight hours of
Dog owners also have better health outcomes after suffering a sleep, eat well and stay active so I can be functional and ready to
major cardiac event. Heart attack survivors who own pooches help my patients. Purpose drives me.”
have a 33 percent lower risk of death compared to those without
one. Stroke survivors living with a dog saw their risk of death Hello, Nap Time
decrease 27 percent. One study found simply petting a dog
reduced blood pressure as much as some medication. Naps no longer rank as a privilege extended only to the
preschool set. According to a study published in the journal
While the biggest benefits come from housing a hound, cat Heart, adults should schedule a short snooze once or twice a
owners also receive heartfelt rewards. A study published in the week to lower their risk of coronary complications like heart
Archives of Internal Medicine discovered cat lovers were 40 percent disease and stroke.
less likely to suffer a heart attack and 30 percent less likely to die
of other cardiovascular diseases than those without a pet. “Sleep is important for your body,” says Dr. Ortiz Gonzalez.
“Inadequate sleep can result in high blood pressure, increased
“I’ve had patients desperate to leave the hospital because they cholesterol, stroke and cardiovascular disease.”
missed their pets, including one who Facetimed his cat every
day,” says Dr. Ortiz Gonzalez. “Owning an animal is definitely a About a third of Americans are sleep-deprived, getting less than
driving force to getting and staying healthy.” the recommended 7-8 hours of shut-eye nightly. An occasional
20-minute catnap offers a stress-relieving opportunity to replace
Having a Purpose lost nighttime sleep, thus protecting heart health.

A recent study on purposefulness, published in JAMA, the Just don’t go overboard. “The
Journal of the American Medical Association, showed having cardiovascular benefit disappears
a strong sense of life purpose improved physical and mental if you nap more than twice a
health, including better quality of life post-cardiac incident. week,” says Dr. Ortiz Gonzalez.
“Sleep is restorative, but napping
“I define purpose as your passion,” says Dr. Raghav Sharma, too much during the day is not
an interventional cardiologist with the Orlando Health Heart productive.”
Institute Cardiology Group. “Purpose is what gives meaning to
life, as well as joy. People lacking a passion, or reason for being,
may feel hopeless and unmotivated, especially when it comes to
their health.”

Those with a robust focus are more likely to engage in healthy
behaviors. According to the study, having purpose pushes positive
health outcomes for sleep disturbances, stroke, post-stroke quality
of life, depression, diabetes and cardiovascular events.

5ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

NUTRITION

By Kristin B. Ford,
Editorial Contributor

Effective weapons for fighting The Mediterranean diet blends healthy eating with the flavors and cooking
cardiovascular disease may methods of Italy and Greece. The main components are fruits, vegetables, whole
be as close as your kitchen. grains, fish, poultry, beans, nuts, seeds and olive oil. The Mediterranean diet also
Two popular food plans — allows dairy products and wine to be consumed in moderate amounts. Eating red
the Mediterranean and the meat is limited.
DASH (Dietary Approaches
to Stop Hypertension) — are The DASH diet is an eating plan aimed at lowering blood pressure, which can
recognized for keeping your reduce your risk of strokes and heart attacks. It is a diet rich in whole grains, fruits
heart well while promoting and vegetables and low in sodium, saturated fat and cholesterol. Instead of red
overall health. meat, it favors low-fat dairy, poultry, fish and beans as sources of protein. The
daily amount of sodium is limited to about a teaspoon of salt (2,300 mg). Those
with high blood pressure, diabetes or chronic kidney disease as well as anyone
older than 50 should aim for no more than 1,500 mg. Reducing sodium intake has
been shown to help lower blood pressure in adults with hypertension, according
to the American Heart Association.

When trying to decide which diet to follow, Orlando Health registered dietitian
Melissa Perry recommends first considering whether you have hypertension or
other health conditions. If not, look at which foods are more appealing long-term.

6ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

Avoiding Roadblocks Grocery List for Grocery List for
Mediterranean Diet DASH Diet
Two common complaints about following any specific diet are
that they are time-consuming and expensive to prepare. Perry’s Fruits and vegetables, Fruits and vegetables,
suggestions for avoiding these potential roadblocks include: fresh or frozen without fresh or frozen without
added salt or sauces added salt or sauces
• Plan your meals ahead of time.
Dairy products such Skinless poultry
• Keep unsalted nuts or seeds, fresh fruit or vegetables on hand as cheese and yogurt (chicken, turkey, duck)
as an easy grab-and-go snack.
Poultry (chicken, Fish and seafood
• Opt for whole grains in place of white or processed grains. turkey, duck) (tuna, salmon, trout,
mackerel, shrimp,
• Cook with salt-free herbs and spices instead of salt. Fish and seafood clams, crab)
(tuna, salmon, trout,
• Buy fresh fruits and vegetables that are in season or purchase mackerel, shrimp, Lean meats (ground
frozen fruits and vegetables (without added sauces) that will clams, crab) or sirloin cuts)
last longer.
Beans Legumes and nuts,
• When purchasing canned beans or legumes, choose unsalted unsalted (walnuts,
or low-sodium options. Nuts (walnuts, almonds, kidney
almonds, cashews, beans, chickpeas)
• Remember that beans and legumes are an affordable source macadamia nuts,
of fiber and protein. hazelnuts) Whole grains
(bread, bagels, cereal,
“Choosing heart-healthy options can be easy when you know what Seeds rice, pasta)
to look for,” Perry says. “The American Heart Association places (pumpkin, sunflower)
a heart checkmark on food packaging to symbolize heart-healthy Low-fat dairy
products that meet criteria for trans fat, saturated fat and sodium Olive oil products (milk,
in a single serving of food.” cheese, yogurt)
Red wine
An Added Benefit: Losing Weight (1 glass per day) Oil (extra virgin olive,
peanut)
Protecting your heart and losing weight don’t have to be Coffee and tea
mutually exclusive. Coffee and tea

“Heart-healthy diets may aid in weight loss, especially when 100% fruit juice
processed grains and sweets are replaced with a diet enriched in
fruits, vegetables and fiber. Since you can eat a variety of foods on 7 OrlandoHealth.com/ChooseHealth
each diet, weight management may be easier to sustain with long-
term compliance,” she says.

“The Mediterranean diet contains a relatively high amount of
calories from fat. The majority of the fat calories in this diet come
from monounsaturated fats, such as olive oil. Fat does contain
more calories, so if you are looking to lose weight, you will need
to monitor your intake. Portion control is recommended to avoid
excess calorie intake.”

ChooseHealth Special Edition

DIAGNOSIS

TeTshtaetHhLaeitattCrlteaA-nKttPnarocewkvennt
By Julie Vargo, Editorial Contributor

When it comes to tests, credit
and sports, high scores triumph.
But when it comes to your heart,

it’s low numbers for the win.
In general, the lower your blood
pressure, cholesterol and pulse
rates, the better your heart health.

8ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

The same holds true for the latest need- Keeping Score Who’s a
to-know number — your coronary artery Candidate?
calcium (CAC) score. Relatively new, the CAC scores range from 0 to more than 400.
CAC score is the number you need to know “You want the lowest score possible,” says The CAC scan is not for
but probably haven’t heard about. The CAC Dr. Steiner. “Higher scores translate to more everyone. “A healthy 20-year-
measures the amount of calcium deposited calcium, putting you at a greater risk of a old running 4 miles a day
with plaque in the walls of the heart’s arteries cardiac event. Above 400, there is danger of probably doesn’t need a CAC
and was considered significant enough to significant blockage.” test,” says Dr. Steiner. “But
include in the recently updated American a 45-year-old runner with a
Heart Association cholesterol management A score of zero means no calcium is seen in strong family history of heart
guidelines. the heart and the probability of having a heart disease and moderately high
attack in the next five years is low. Scores of cholesterol would be a great
Don’t confuse harmful coronary calcium 100 to 300 indicate moderate plaque deposits. candidate.”
with healthy dietary calcium found in food. Those already at risk for heart disease who
Coronary calcium builds up inside the fatty score between 100 and 400 or higher are more If you are 40 years old or
plaque that clogs arteries. Once there, it can likely to have a heart attack. older and have any of these
harden, further restricting or even cutting off risk factors, ask your doctor
blood flow to the heart. This simple, cost-effective scan allows doctors about scheduling a CAC scan.
to identify patients with coronary blockage
The CAC score is calculated using a earlier, especially those with no other visual • Family history of heart
specialized CT scan. Multiple images are symptoms. “It’s hard to look at someone and disease
captured, then combined into a view that tell if they have heart disease if they don’t
shows any tiny fragments of calcium in the have any symptoms but just risk factors,” says • High cholesterol levels
arteries supplying the heart. Dr. Steiner. “With this test, we can hone in
immediately on those who are at higher risk • High blood pressure
“Hardening of the arteries, or atherosclerosis, and more likely to benefit from interventional
refers to the buildup of this rigid calcium,” therapies.” • Diabetes
says Dr. Mark Steiner, an interventional
cardiologist with the Orlando Health Heart Taking the Test • Past or present smoker
Institute Cardiology Group. “A CAC scan
pinpoints where the calcium is and measures CAC scores are calculated by a quick, • Inactive lifestyle
the amount it sees in the arteries.” noninvasive test that doesn’t require dye
injection, removing all your clothes or even • Overweight
The resulting CAC score can be a crucial seeing a cardiologist. “Your primary care
indicator of coronary artery disease before physician can order this test for you,” says Dr. If you already have suffered
other symptoms occur. “If we can identify Steiner. “It takes about 30 seconds to perform, a heart attack, have coronary
plaque and calcium deposits before someone there is minimal radiation and the test stents or are pregnant,
has a heart attack, we can effectively begin provides a lot of good information quickly.” you are not considered
aggressive treatment with statins, aspirin and a candidate for a CAC
diet,” says Dr. Steiner. While early intervention can keep the CAC screening.
score from increasing, it can’t be lowered.
“Once calcium is deposited, it will be there
forever,” says Dr. Steiner. “If we do the test
and the results show calcium and plaque
buildup, we will work with the patient to
stabilize the plaque and treat the risk factors.”

9ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

DIAGNOSIS

HOW
PREGNANCY
AFFECTS A

MOTHER’S
HEART

By Julie Vargo, Editorial Contributor

When pregnant, a woman’s • Blood volume increases 40 to 50 percent.
body undergoes dramatic
changes. Some, like • The amount of blood pumped by the heart each minute
swollen feet and protruding jumps 30 to 40 percent.
stomachs, are obvious. But
changes to the heart and blood • Heart rate increases 10 to 15 beats per minute.
vessels? You can’t see them, but
they’re happening too. • And blood pressure drops.

While all normal, these changes put additional stress on the
body and require the heart to work harder, says Dr. Sushma
Koneru with the Orlando Health Heart Institute Cardiology
Group. They also can cause fatigue, shortness of breath and
light-headedness.

ChooseHealth Special Edition 10 OrlandoHealth.com/ChooseHealth

Heart of the Matter When cardiac complications are
managed, successful pregnancies
Typically, gestational stress on the heart clears up with the baby’s birth. By and births result. The key? A team
three months postpartum, a new mother’s cardiovascular system generally approach dependent on close
has snapped back to pre-pregnancy status. collaboration between the OB-GYN
and the cardiologist.
For some women, however, pregnancy introduces a bevy of abnormal cardiac
conditions demanding medical intervention. “Being pregnant can make other New Heart
cardiac problems worse, create new problems or help a woman discover Disease and
underlying heart issues not previously diagnosed,” says Dr. Koneru, a board- Pregnancy Program
certified noninvasive cardiologist and heart failure specialist.
To address cardiac conditions in
During pregnancy, women are more prone to blood clots due to hormonal mothers-to-be, Orlando Health
changes. Spontaneous tears in the aorta, high blood pressure, preeclampsia,
cardiomyopathy, heart failure, gestational diabetes, heart murmurs, preterm has created the Heart Disease and
labor and valve problems also can occur. Pregnancy Program. Designed to
provide specialized, appropriate
Cardiac disease during pregnancy can present challenges and potentially
increase the risk of complications. Only 6 percent of women who suffer care for pregnant women with heart
a pregnancy-related death due to heart disease, says Dr. Koneru, were disease, the innovative program
diagnosed with a previous heart condition.
takes a multidisciplinary approach to
What’s a Mother To Do? maternal heart health.

“When you suffer a cardiac disorder while pregnant, it is important to Specialists from maternal-
see both a high-risk OB-GYN and a cardiologist during your pregnancy fetal medicine, anesthesia,
and after you give birth,” says Dr. Koneru. obstetrics, cardiology and other
subspecialties collaborate to provide
Some conditions — like preeclampsia and gestational diabetes — clear up comprehensive care for pregnant
after birth. Unbeknownst to most new mothers, these issues may resurface women with heart disease.
later in life.
“This program was created to benefit
“Women who suffer these conditions during pregnancy are more prone to women born with heart disease,
developing stroke, high blood pressure and heart attacks in the future,” says those who acquire heart disease
Dr. Koneru. “The condition goes away after delivery, and the new mothers go prior to their childbearing years
home with their babies. Rarely does anyone talk to them about heart disease.” and those who develop heart
disease during pregnancy,”
They should. A mother who suffers gestational diabetes while pregnant may says Dr. Koneru. “The goal is
get diabetes later in life. Delivering a preterm baby puts a mother at increased a successful outcome for
risk for future heart attacks and stroke. Preeclampsia, or high blood pressure, both mother and baby.”
during pregnancy doubles a woman’s chance of developing heart disease five
to 15 years postpartum.

Women with an underlying or known cardiac condition need to take special
precautions before and during pregnancy. “If you have heart disease, it’s vital
to talk to a cardiologist before becoming pregnant to discuss the short- and
long-term risks,” says Dr. Koneru. “Not all heart medications are safe to take
during pregnancy. If new symptoms surface during pregnancy, a doctor needs
to know. “

11ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

VEINS AND ARTERIES:

Keeping Your Heart’s
Support System Healthy

By Julie Vargo, Editorial Contributor

The heart’s supporting cast of veins,
vessels and arteries often goes
overlooked. But its well-being is
essential to your well-being.

Ignoring even subtle symptoms like
leg pain, non-healing leg wounds and
exercise-induced or night cramps can

have serious consequences.

SCyommpmtoomn sPAD “These symptoms of vascular disease often go undiagnosed,” says Dr. Raghav Sharma, an interventional
cardiologist with the Orlando Health Heart Institute Cardiology Group. “Delaying diagnosis and
PAD symptoms treatment can increase risk of coronary artery disease, heart attack, stroke and possible amputation.”
commonly affect the
legs and include: PVD and PAD

Cramping and pain Any disease that affects the body’s circulatory system outside of the heart is considered peripheral
during activity vascular disease (PVD). The most common areas to develop PVD are in the legs and feet. About half of
those with PVD do not have symptoms.
Tingling or
numbness PVD includes several forms — such as deep vein thrombosis and varicose veins — but peripheral artery
disease (PAD) is the most common. This progressive circulation disorder affects one in 20 Americans
Slow-healing sores over the age of 50.

Thinning of skin

Skin color changes

Poor nail growth

12ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

The arteries are responsible for bringing blood from the heart to Expanding Vascular Surgery Options
the rest of your body. When plaque develops in arteries, it reduces in Seminole County
the flow of oxygen and nutrients to the body. With that buildup,
arteries become narrow or blocked and the legs are starved of By Kristin B. Ford, Editorial Contributor
blood and oxygen, resulting in pain. Plaque blockages also can
break off and cause lack of blood flow to the leg or travel up to the To make it easier for patients to receive the vascular care they
brain, causing a stroke. need, the Orlando Health Heart Institute Vascular Surgery
Group is expanding its locations in Central Florida. In addition
“We can diagnose PAD by a physical exam, a blood pressure to downtown Orlando and Ocoee, Orlando Health now offers
test, ultrasound, blood tests or angiography,” says Dr. Sharma. vascular surgery options in Maitland and Lake Mary.
“Treatment includes healthy lifestyle changes to reduce cholesterol
and weight as well as medications or possible surgery.” Two new vascular experts also

Critical Limb Ischemia have joined the vascular surgery

The final stage of PAD is critical limb ischemia (CLI). If left group. They are Dr. G. Kendrix
untreated, it can lead to amputation, says Sarah McLean, a
physician assistant at Orlando Health Heart Institute. Adcock and Dr. Robert P. Winter.

Treatment for CLI starts with controlling risk factors — “Both physicians specialize in
such as smoking, diabetes and an unhealthy diet — as well as
regulating high blood pressure and cholesterol. the diagnosis and treatment of G. Kendrix Robert P.
Other treatment options include: vascular conditions, and will add Adcock, MD Winter, MD

• Medications to slow progression of disease, valuable expertise and experience to the institute’s Vascular
fight infections and relieve pain
Surgery Group team,” says Dr. Farhan Khawaja, president of the
• Supervised exercise
Orlando Health Heart Institute.
• Endovascular procedures such as clot-busting
medicines, inserting balloons to widen the A board-certified surgeon, Dr. Adcock earned his medical degree
arteries or wire-reinforced stents from the University of Louisville (Kentucky) and completed
his residency at West Virginia University (Morgantown). His
• Surgical procedures such as a bypass fellowship in peripheral vascular surgery was completed at
of the affected artery Mercy St. Vincent Medical Center (Toledo, Ohio).

“The CLI program at Orlando Health coordinates patient care Board-certified in general and vascular surgery, Dr. Winter
among multiple specialties for a comprehensive approach that earned his medical degree from Emory University (Atlanta) and
prevents and treats ischemia in the lower extremities and provides completed his residency at the University of Texas Southwestern
our patients with the best resources,” McLean says. “From time of Medical Center (Dallas). His fellowship in vascular surgery was
referral to time of intervention is 21 days. This aggressive timeline completed at Eastern Virginia Medical School (Norfolk).
improves quality of life and reduces morbidity, mortality and
overall healthcare costs.” To make an appointment at their Maitland or Lake Mary
offices, call (407) 539-2100.

“Delaying diagnosis and treatment can increase
risk of coronary artery disease, heart attack,
stroke and possible amputation.” — Dr. Raghav Sharma

13ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

Ways to How you handle
Relieve Stress and stress can either
Help Your Heart help or hinder your
heart health.
By Julie Vargo, Editorial Contributor
“Stress causes some
Stress is a constant companion for many of us. people to act in unhealthy
Late for an appointment? Stuck on a clogged ways, which further
highway? Worried about money? Stressful moments increases their risk for
like these often result in a bout of muscle-tensing, heart disease,” says Dr.
heart-racing anxiety. Ferachi. “If you try to relax
by smoking, overeating,
Occasional stress is a part of life. But if unrelenting pressure becomes a daily demon, drinking too much alcohol
your heart can suffer damage. or becoming sedentary,
it actually makes matters
“It’s impossible to escape stress,” says Dr. Larry Ferachi, an invasive cardiologist with worse, adding more
the Orlando Health Heart Institute Cardiology Group. “But constant stress and anxiety stress to your life. These
can affect your heart health, resulting in chronic inflammation as well as chest pain, habits can increase blood
increased blood pressure and irregular heartbeat.” pressure and damage
artery walls.
When stress hits, your body releases the hormone cortisol to prep you for fight-or-flight
action. However, high levels of cortisol produced from long-term stress can increase “But if you choose positive
heart disease risk factors like cholesterol, triglycerides, blood sugar and blood pressure. options like exercise,
connecting with people
and staying upbeat
despite the stress, you can
make a difference in your
emotions – and body.”

When stress gets you
down, consider these
five anxiety-busting
ideas to take pressure
off your heart.

14ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

Laugh It Out: Quiet Down: Deep

Simply having a good laugh can help your heart. breathing and inward focus
Laughter has been found to lower levels of stress have been shown to lessen
hormones, reduce inflammation in the arteries and heart disease risk factors
increase the good HDL cholesterol. Tickle your funny such as high blood pressure.
bone by watching comedy shows, joking with friends or Meditation, yoga and prayer
listening to funny podcasts or radio programs. all help ease both the mind
and the body.
Get Creative: “Meditation is a good way
to relax, clear the mind and
Channel anxiety into refocus energy away from negativity,” says Dr. Ferachi.
art. Pull out the paints, “It’s important to improve one’s outlook to reduce stress
pens and paper. Try an and anxiety.”
adult coloring book.
Pick up the knitting Create Balance: Stress can knock a person off
needles. Dust off that
musical instrument. balance. Regain equilibrium by taking control of your life
Dance. Scrapbook a and being more organized.
photo album of good “I learned over time that to accomplish any goals, I
memories. Focusing on needed to be organized,” says Dr. Ferachi. “So I plan
creative processes relaxes the mind. ahead. Sounds simple, but if you get your clothes
out the night before, you can save 10 to 15 minutes
Move It: Exercise in the morning and you don’t rush. If traffic is usually
unpredictable, learn to leave early. Reduce stress by
helps your body holding yourself accountable and taking charge of your
release anxiety-melting own health.
hormones called “Often, we are so focused on our goals, we minimize
endorphins. In addition ourselves,” he adds. “Being organized can help you
to reducing stress, regain balance, which reduces stress.”
exercise lowers blood
pressure, strengthens
the heart muscle and may even peel off some pounds.

“All exercise is good for the heart,” says Dr. Ferachi,
who suggests swimming as a top-notch option.
“Waking up early and exercising first thing also will
lead to better, more natural sleep at night. Good sleep
helps reduce stress.”

15ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

A TEAM WITH HEART
TO CARE FOR YOURS

At Orlando Health Heart Institute, cardiac care is a team effort. Our comprehensive care
includes diagnostic services and consultations, and advanced surgical treatment options.

Orlando Health Heart Invasive Cardiology Cardio-Oncology
Institute Cardiology Group Imran Bawaney, MD Carolina Demori, MD
Arnold M. Einhorn, MD Swathy Kolli, MD
Electrophysiology Larry Ferachi, MD Suraj R. Kurup, MD
David Bello, MD Joel R. Garcia, MD Deven M. Patel, MD
Aurelio Duran, MD Lushantha S. Gunasekera, MD
Roland A. Filart, MD Mohit Gupta, MD Orlando Health Heart
Luis I. Garcia, MD Jose A. Lefran, MD Institute Cardiovascular
Pavel A. Guguchev, MD Pablo R. Lopez, MD and Thoracic Surgery Group
Parimal B. Maniar, MD (321) 841-7700
Peter D. Taylor, MD Israel J. Mantecon, MD
Sundeep Mediratta, MD Cardiovascular and
Interventional Cardiology Harendra Patel, MD Thoracic Surgery
Sumith Aleti, MD Chakravarthy Raghavan, MD Jeffrey Bott, MD
Robert Boswell, MD Jonathan Rodriguez, MD Michael Hanna, MD
Ronald R. Domescek, MD Khurram Shahzad, MD Steven Hoff, MD
Chandresh Duggal, MD Sanjeev K. Shroff, MD Mark Sand, MD
Joel A. Garcia Fernandez, MD Mouaz N. Tawam, MD Kalei (Karen) Walker, MD
Muhammad Ghumman, MD Adam J. Waldman, MD
Vijaykumar S. Kasi, MD Orlando Health Heart
Farhan Khawaja, MD Noninvasive Cardiology Institute Vascular
Caleb E. Mercado, MD Saba Ahmad, MD Surgery Group
Kiran K. Mogali, MD Kamran Akram, MD (321) 843-8655
Robert Rothbard, MD Illena Antonetti, MD
Raghav Sharma, MD Jorge A. Cusco, MD Vascular Surgery
Mark A. Steiner, MD Linda E. Jaffe, MD G. Kendrix Adcock, MD
Egerton van den Berg, MD Sushma Koneru, MD Jonathan Higgins, MD
Deepak P. Vivek, MD Salvador N. Lanza, MD Robert P. Winter, MD
Irwin R. Weinstein, MD Yahaira Ortiz Gonzalez, MD
Shahid Qamar, MD
Carlos Zayas-Torres, MD

OrlandoHealth.com/HealthyHeart
(321) 841-OHHI (6444) | Fax: (407) 650-1307

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SYMPTOMS

How Gender
Affects the
Way You
Experience a
Heart Attack

By Kristin B. Ford, Editorial Contributor

Heart disease is often thought of as a man’s disease, but
it is the leading cause of death in American women
too, with about one in five dying from the illness.

Nearly two-thirds of women who die suddenly from coronary heart disease
have no symptoms, according to the Centers for Disease Control and
Prevention (CDC). That’s why it is important for them to be aware of the
risks and take preventive steps. For those already diagnosed with heart
disease, it’s vital to take good care to minimize the progression of the
illness, says Dr. Swathy Kolli, a cardiologist with the Orlando Health
Heart Institute Cardiology Group.

Well-known risk factors for heart disease are diabetes,
hypertension, abnormal cholesterol levels, obesity, physical
inactivity and smoking. These are not different for men
and women.

18ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

Recognizing Heart Attack Symptoms in Women

Heart disease can take place in different forms, but the one most people are familiar
with is a heart attack, which occurs when the flow of blood that brings oxygen to the
heart gets reduced or cut off. That happens when the arteries bringing blood to the
heart narrow from an accumulation of fat or cholesterol.

Symptoms of a heart attack in women may be different from those in men. While

women may feel crushing pain in the chest, the symptoms also may be more subtle and

they may come and go. Symptoms include:

Shortness of breath Upper back pressure
Pain neck
or discomfort in the arm, back or

Vomiting Dizziness or lightheadedness

With the onset of symptoms, it is important to get treatment right away to limit the
damage that may be occurring to the heart from a lack of blood flow.

Recognizing Heart Attack Symptoms in Men

However, there are some For men and women, the most common symptom of a heart attack is chest pain.
risk factors that are Although women are more likely to experience a variety of symptoms, some men do,
unique to women: too. For both genders, the more symptoms an individual experiences, the greater the
likelihood a heart attack is occurring.
• Preterm delivery
Men should pay attention to these reactions:
• Hypertensive disorders
in pregnancy Pain, aprrmess—urcea,nsqspuereeazdintgoojarwa,cnheincgk in the chest heartburn Cold sweat
or and back abdominal pain
• Gestational diabetes
Shortness of breath Nausea, or
• Autoimmune diseases
such as rheumatoid Fatigue Dizziness or lightheadedness
arthritis and systemic
lupus erythematosus Most heart attacks start slowly with the onset of mild pain, but some can be sudden.
Quick action is vital to save a life if any of these symptoms are present.
• Radiation for left-sided
breast cancer Call 911 even if you are not sure it is a heart attack.

• Persistence of weight
gain after pregnancy

19ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

PATIENT STORY

Two years ago,
Don Schaus was
moping around
the house, wishing
he could attend his
grandson’s graduation. But
he had heart problems, and
that kept holding him back.

“I was living with a little fear in the back of
my head that my heart could go awry at any
moment, and I would be in trouble,”
says the retired Orlando businessman,
who had spent decades crisscrossing
the country while working in the
food industry.

ChooseHealth Special Edition 20 OrlandoHealth.com/ChooseHealth

Schaus suffered from atrial fibrillation Another Option? Zing, Zing, Zing and Done
(AFib), a common heart arrhythmia
affecting almost 3 million Americans. During a regular cardio checkup, his doctor Schaus decided to have the minimally
Patients with this condition have irregular suggested an option — a minimally invasive invasive outpatient procedure. Done under
heartbeats, which occur when the heart’s procedure for patients who cannot be on general anesthesia, the Watchman device
upper and lower chambers (the atria) blood thinner. The tiny device, called the takes about an hour to implant. While some
contract rapidly and erratically. Because Watchman™, is implanted in the heart to patients stay in the hospital overnight,
AFib can lead to the formation of blood close the left atrial appendage and minimize Schaus was able to leave the same day.
clots that increase the risk of stroke or heart the risk of blood-clot related strokes. The
attack, it’s critical to diagnose and treat any Watchman is a one-time implant that “The procedure was honestly a piece of cake
signs of it immediately. doesn’t need to be replaced. — zing, zing, zing and done!” says Schaus,
who attended his grandson’s graduation and
“I discovered I had AFib by a fluke,” says “The initial thought was frightening,” says hasn’t stopped moving since. “Best of all,
Schaus, who follows a regular schedule Schaus. “I didn’t want to mess with my I don’t have to constantly worry about my
of wellness exams with his primary care heart. I didn’t want to have another stroke. heart anymore.”
physician. “During a routine physical, my But with the Watchman, my doctor assured
family doctor didn’t like how my heart me I wouldn’t have to worry.” Schaus tips his hat to Dr. Filart. “He is a
sounded, so he sent me to a cardiologist great surgeon and a great man. Not just
right away.” Before Schaus agreed to the procedure, because of what he did for me, but because
he wanted more information. Dr. Roland he kept his word about that graduation,”
Dr. Adam J. Waldman at the Orlando Health A. Filart, a board-certified clinical cardiac says Schaus.
Heart Institute Cardiology Group diagnosed electrophysiologist at the Orlando Health
Schaus’s AFib immediately and placed him Heart Institute Cardiology Group, provided “He cares about his patients and he is smart
on the anticoagulant, warfarin. With time, the reassurance he needed. as a whip. He is my hero.”

however, the blood-thinning therapy “This state-of-the-art device has
became ineffective for him. demonstrated a successful track record for
patients just like Don,” says Dr. Filart. “He
Concerned about his “ticker,” the wanted to go to his grandson’s graduation.
active septuagenarian curtailed I told him, ‘If I put the Watchman in, I’ll get
his busy lifestyle and hobby of you there.’ ”
collecting signature hats from
every city he visited. “I was Is the Watchman Right for You?
scared to death. Your heart
keeps your motor running,” To be a candidate for the Watchman procedure, patients should have:
says Schaus. • AFib not caused by heart valve problems
• A doctor recommendation for blood-thinning medicines
“I just didn’t see how I • A history of bleeding or lifestyle with bleeding risks from long-term therapy
could travel with this AFib • A need for an alternative to blood thinners
situation,” he says. Orlando Health Orlando Regional Medical Center (ORMC) is the only hospital in Central
Florida, and one of only two hospitals in the state of Florida, to have full accreditation from
the Society of Cardiovascular Patient Care for its Atrial Fibrillation Program.

21ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

Taking Your Heart Pills
By Julie Vargo, Editorial Contributor

If you are among the 75 million Americans who routinely take blood
pressure medicine every morning, it’s time to consider switching
it up. Taking your pills before bedtime may actually be better for you,
according to new research published in the European Heart Journal.

The study, which followed more than 19,000 patients for six years, found taking medicine for high blood
pressure at night cut the risk of dying from heart problems nearly in half. The threat of stroke dropped by
49 percent. Myocardial infarction risk went down by 44 percent, heart failure fell 42 percent and coronary
revascularization by 40 percent.

“The idea of taking blood pressure medicine before bed makes sense,” says Dr. Farhan J. Khawaja, an
interventional cardiologist with the Orlando Health Heart Institute Cardiology Group. “Most heart
attacks take place in the morning. We already recommend taking statins at night for patients who need
them. This falls in line with those recommendations.”

ChooseHealth Special Edition 22 OrlandoHealth.com/ChooseHealth

Silent and Deadly Making the Move

High blood pressure, or Successfully shifting blood pressure medication from
hypertension, affects one in day to night — without forgetting — works best when
three Americans and causes the you can fit it into your existing routine. For example,
heart to work harder to pump keep your medication beside your toothbrush or
the blood through the body. combine taking it with putting on your pajamas.
Unless the pressure is very high,
the disease doesn’t manifest in Some other tips include:
a lot of symptoms, giving it the
nickname “silent killer.” • Put your medication in a weekly pillbox with a
compartment for each day, then set it on your
“Most people don’t check their blood pressure daily and don’t know if bedside table where you will see it each night. There
it’s high or not,” says Dr. Khawaja. are even pill dispensers with alarms that beep or
vibrate when it’s time to pop your pills.
“Hypertension can cause a host of problems like stroke, heart failure,
coronary artery disease, and renal and kidney disease. So it is vital to • For a more high-tech method
keep blood pressure in check to reduce the complications of those of medication management,
medical conditions.” go digital. Set up electronic
text or email dosage alerts on
Fortunately, a number of steps can be taken to help normalize blood your smart phone.
pressure. Borderline hypertension is first treated with lifestyle changes
like reducing caffeine, salt and alcohol intake, increasing sleep and • Pill reminder apps available
exercise and maintaining a healthy weight. When that doesn’t work, in the App Store or Google
doctors prescribe medicine, often two or more types. Play offer another option,
complete with alarms, weekly
Shift Change prescription tracking, notes
and reminders for refills.
Taking your medication consistently is key to therapy success. “If you are
hit-and-miss with any medication day or night, it’s not going to be very • Enlist a loved one to remind you to take your
effective,” says Dr. Khawaja. medicines with a nightly phone call or text message.

In the past, doctors recommended adhering to a morning medication
schedule. The new data suggests a night shift. If you are recently
diagnosed with hypertension, work with your doctor to start your dosing
regimen at bedtime. For those already in a morning routine, Dr. Khawaja
suggests transitioning in conjunction with your physician’s help.

“Most patients take more than one type of blood pressure medication,”
says the doctor, who suggests staggering your pill consumption to start.
“Following your doctor’s recommendations, take one pill in the morning
as you have been doing and move the other to the evening. Once you
have established that routine, you can consider moving the next to the
evening as well.”

If you take a diuretic as part of your regimen, you may find yourself getting
up to go to the bathroom in the middle of the night when you first move
the medication to bedtime. “This may affect patients just starting a blood
pressure regimen more so than those already on pills,” says Dr. Khawaja.
“But after a few weeks, this progressively becomes less of a problem.”

ChooseHealth Special Edition 23 OrlandoHealth.com/ChooseHealth

T R E AT M E N T S

New Program for

By Kristin B. Ford, Editorial Contributor

One of the most serious results of
cardiovascular disease is heart failure,
which is a condition when the heart

cannot pump enough blood to
the rest of the body. The
Orlando Health Heart Institute
has long treated heart-failure
patients with the most
up-to-date therapies. Now
Orlando Health is poised to
take advanced heart-failure
care to the next level.

“The idea is that we will offer everything within our
system from uncomplicated heart-failure (early-
stage) to advanced-stage care. We are with the
patients through each step of their journey, providing
comprehensive care under one roof,” says Dr. Shahid
Qamar, who, as the director of the new Advanced
Heart Failure Program, will help build it over the next
two years.

“We have a dire need for this program because of the
rapidly increasing population of heart failure patients in
Orlando who will require better treatment with advanced
therapies,” says Dr. Qamar.

To meet their needs, Orlando Health plans to offer:

• Implantation of left ventricular assist devices (LVADs)

• Pulmonary hypertension therapies

• Cardiac oncology treatments

• Heart transplantation

ChooseHealth Special Edition 24 OrlandoHealth.com/ChooseHealth

Failing Hearts

The goal of the Advanced Heart Failure Program is to have patients seen and treated early Meet Dr. Shahid Qamar
enough to help prevent them from developing advanced heart disease, says Dr. Qamar. To do
so, the clinic will offer same-day appointments and intravenous (IV) medications to improve A board-certified
symptoms, and a nurse will be available by phone for questions. It’s also important to help
these patients manage their chronic disease so they can avoid going to the emergency room cardiologist,
or being admitted to the hospital frequently, he says.
Dr. Qamar has

additional certifications

in echocardiography,

Offering LVAD Implants advanced heart failure Shahid
and transplant cardiology. Qamar, MD

A key component of Orlando Health’s plan for total heart-failure care is offering LVAD post- He specializes in advanced heart failure
operative care. Currently, Orlando Health treats patients who have had LVADs implanted.
Soon, Orlando Health will be able to offer the procedure itself. care, mechanical circulatory support and

An LVAD is a battery-operated, portable pump that is surgically attached to the left ventricle heart transplantation.
of the heart and helps the organ pump blood to the rest of the body. LVADs can be used
as the last therapy for end-stage heart failure, extending a patient’s life as long as 10 years, At Orlando Health, Dr. Qamar serves as
says Dr. Qamar. LVADs also are used as a bridge-to-transplant therapy for patients who are the director of the new Advanced Heart
candidates for heart transplants but cannot get them immediately. Failure Program, which he will help build
over the next two years.

“This is a survival method. Advanced heart failure patients have a very high mortality rate He completed his medical training at
Dow Medical College (Pakistan) and his
— as high as any type of advanced cancer — so LVAD therapy and heart transplants allow residency in internal medicine at the
University of Chicago. He performed
patients to live longer,” says Dr. Qamar. fellowships in general cardiology, and
advanced heart failure and transplant at
“We can use these therapies to improve Patients who can most benefit from the University of Chicago.
their quality of life, prolong survival, help these devices are ones who have:
them stay out of the hospital and have as A fellow of the American College of
close to a normal life as possible.” • Failed medical therapy alone Cardiology, Dr. Qamar has pursued
interests in cardiac oncology, pulmonary
Orlando Health cardiothoracic surgeons • Inadequate quality of life hypertension and infiltrative heart
will perform traditional and minimally disease. He actively participates in clinical
invasive surgeries to implant the LVADS. • Frequent hospital stays trials to provide his patients with the
most promising new therapies used to
• Activity tolerance that is getting manage advanced heart failure.
progressively worse

Cardiac Oncology

For Dr. Qamar, cardiac oncology is a field he is passionate about, as well. He helped develop
a cardiac oncology program in Tulsa, Oklahoma, and he looks forward to working with the
physicians in this specialty at Orlando Health.

“Cancer therapies have improved tremendously over time, and patients are surviving the
cancer,” he says. “One of the side effects of the chemotherapy is living with heart disease.
The idea behind cardiac oncology is to identify those patients and minimize — or avoid —
the toxicity of the chemotherapy.”

25ChooseHealth Special Edition OrlandoHealth.com/ChooseHealth

RECOVERY

CHaerldpisaRceRgeahinabSitlriteantgiothn

By Kristin B. Ford, Editorial Contributor

As serious as heart disease is, having it is not a death sentence, says
Dr. Sushma Koneru, a cardiologist with the Orlando Health Heart
Institute Cardiology Group. Cardiac rehabilitation can help you
maintain or improve your heart health, even if you have heart disease.

A medically supervised outpatient program of exercise and education, cardiac rehabilitation helps
relieve some of the symptoms of heart conditions, such as chest pain, shortness of breath and
fatigue. It also improves blood pressure, reduces lipid and blood sugar levels and increases exercise
performance. In addition, cardiac rehab helps with weight loss, the ability to perform activities of
daily living and the likelihood of returning to work or leisure activities.

Common conditions that warrant Types of Exercises
cardiac rehabilitation include:
Cardiac rehabilitation programs
• A recent heart attack generally last three months, with
sessions two or three times a week.
• Conditions such as congenital heart disease, During that time, your healthcare
stable angina (chest pain) and heart failure team will teach you proper exercise
techniques, such as warming up and cooling down. An exercise routine
• Procedures such as angioplasty or cardiac stenting usually includes both aerobic exercise (to get your heart rate up) and
muscle-strengthening activities. Typically the sessions last 30 to 45 minutes.
• Surgeries such as coronary artery bypass surgery
and heart valve repair or replacement With its multi-pronged approach, cardiac rehab gives you the tools and
knowledge to fight the progression of cardiovascular disease.
• Heart or heart–lung transplant

• Peripheral vascular disease

• Pulmonary hypertension

ChooseHealth Special Edition 26 OrlandoHealth.com/ChooseHealth

95

44
19

44 441 415
Mount Dora
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Sanford
75 rida Turnpi75 Apopka Oviedo
301 a Turnpike 436 Lake Mary 426
Ocala Winter
Springs 417
19
33 27 434

Altamonte
Springs

Flo Maitland 434
Winter Park
50 Winter
keGarden Ocoee 408
Orlando
50

Orlando Health Hospitals 33 435 Avalon Park 520
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Medical Pavilions W Gore St
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Heart Institute
Community Physicians 528 S Division Ave S Lucerne TerraceW Miller St E Miller St
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*Includes Imaging, Rehab, 417 417 Kaley St
Laboratory and Cancer Centers.
192 Downtown Orlando
Kissimmee
95
Celebration

17 192 192
Davenport St. Cloud
Melbourne

98

Lakeland 27

17
60

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