ChooseHealth WINTER 2024 The Heart Disease You May Not Know You Have Orlando Health Heart and Vascular Institute Special Edition Foods Cardiologists Avoid Sneaky Signs of Heart Problems Heart Attack on the Highway What To Ask on Your First Visit The Risks of Caffeine-Packed Drinks Focus on Your Heart OrlandoHealth.com/ChooseHealth
ChooseHealth WINTER 2024 3 Women’s Health When It’s More Than a Heart Attack 4 Nutrition 6 Foods Cardiologists Avoid 6 Spotlight 9 Sneaky Signs of Heart Problems 8 Inspiring Stories Heart Attack on the Highway 10 Get Ready What To Ask on Your FIrst Visit 12 Get Ready What To Expect at a Stress Test 14 Spotlight The Heart Disease You May Not Know You Have 15 Technology Can a Fitness Tracker Help Your Heart? 16 New Doctors at Orlando Health 18 Risks Caffeine-Packed Drinks OrlandoHealth.com/ChooseHealth David Strong President and CEO Orlando Health Andrew J. Snyder Senior Vice President Marketing and Communications Choose Health Contributors Jeanne Adam Lauren Baldwin, PA-C Tim Barker Alexander Bolanos, MD Allan Chen, MD Lisa Cianci Mary Frances Emmons Imran Farooq, MD Kathy Halley Rod James Kim Marcum Ana Mercedes, MD Daniel Nguyen, MD Lisa Nickchen Maxim Olivier, MD Abid Shah, MD Khurram Shahzad, MD Chelsea Stevens ChooseHealth WINTER 2024 The Heart Disease You May Not Know You Have Orlando Health Heart and Vascular Institute Special Edition Foods Cardiologists Avoid Sneaky Signs of Heart Problems Heart Attack on the Highway What To Ask on Your First Visit The Risks of Caffeine-Packed Drinks Focus on Your Heart OrlandoHealth.com/ChooseHealth Proud recipient of the APEX 2023 Grand Award, recognizing excellence in publishing Inside This Issue 2
• Chest pain • Rapid heartbeat • Pain in the arms, shoulders, back or jaw • Shortness of breath • Unusual, extreme tiredness • Nausea • Dizziness SCAD Risk Factors While researchers have yet to determine a definitive cause for SCAD, they have identified numerous risk factors. They include: • Gender: SCAD tends to affect women more often. • Recent childbirth. • Hormone use: Oral contraceptives and infertility treatments have been associated with SCAD. • Severe high blood pressure. Treatment and Outlook The goal of treatment is to restore blood flow to the heart, alleviate chest pains and prevent a recurrence of the condition. In some instances, a series of smaller tears may be managed primarily through lifestyle modifications and medications. Other treatments include the placement of a stent (a small mesh tube) inside the artery to keep it open. Surgery also may be used to bypass a damaged blood vessel. Learn more about the many heart and vascular conditions we treat at OrlandoHealth.com/Heart. First Signs For many people, the first symptom is a heart attack. But if the affected coronary artery isn’t completely blocked, SCAD may initially feel like a severe case of heartburn. It also may mimic symptoms associated with heart attacks, such as: WOMEN’S HEALTH When It’s More Than a Heart Attack By Tim Barker | Editorial Contributor Severe heartburn and traditional heart attack symptoms — such as chest pains and shortness of breath — could be another dangerous condition, especially if you’re a woman in your 30s or 40s. Spontaneous coronary artery dissection (SCAD) is a rare but potentially fatal emergency condition that occurs when a tear forms suddenly in the inner lining of the arteries that supply blood to the heart. The tear allows blood to seep into the walls of the artery. “This causes the wall to bulge, narrowing or completely blocking blood flow through the artery, resulting in chest pain or a heart attack,” says Dr. Khurram Shahzad, a board-certified invasive cardiologist with Orlando Health Heart and Vascular Institute. OrlandoHealth.com/ChooseHealth 3
Cardiologists Avoid By Tim Barker | Editorial Contributor Among the many ways you can reduce your risk for heart disease, some of the easiest are simply watching what you eat. The key is knowing which foods to avoid. There’s no single diet that’s best for your heart health. The goal is to focus on fruits, vegetables, whole grains and foods brimming with antioxidants. At the same time, avoid foods high in sugar, salt, saturated fats and trans fats. “There may be no perfect diet, but there are certainly some foods that should not be a regular part of your menu,” says Lauren M. Baldwin, a certified physician assistant with Orlando Health Heart and Vascular Institute. If you want to look at foods to avoid, consider half a dozen options you won’t find in a cardiologist’s diet. Bacon, Sausage and Processed Meats These foods don’t have a lot going for them, health-wise. To start with, they are high in salt, which can be a major contributor to high blood pressure. These tasty foods also are high in saturated fats, which can increase your LDL cholesterol levels. Often referred to as “bad cholesterol,” this is the stuff that collects on the walls of your blood vessels, increasing your risk for heart attack and stroke. NUTRITION 4
Red Meat Red meat, including pork, is higher in saturated fats and cholesterol. Recent research also suggests that red meat carries nutrients that produce trimethylamine-N-oxide (TMAO), when broken down by your gut. TMAO has been linked to increased risk for hardened arteries, heart attack and stroke. If you have a craving that can’t be satisfied with chicken or fish, go for the leanest cut of red meat you can find and trim away any visible fat. Among the leanest cuts, according to the U.S. Department of Agriculture, are: Potato Chips and Other Processed Snacks These crispy snacks tend to be high in sodium and fat. But even worse is all the empty calories you are consuming. When eating healthy, you’re aiming to fuel your body. But when you eat chips and crackers, all you’re getting is calories without the vitamins, minerals and fiber your body needs. That’s a recipe for overeating, since you’ll still be hungry, even after finishing that bag. Fast Food This can be a tough one since we all find ourselves in situations from time to time where fast food is the easiest option. The key is to avoid having these foods as a regular part of your diet. Like some other items on this list, they are high in sodium. But even worse is that many fast-food restaurants are still using trans fats. These are the least healthy fats you can eat, since they raise your bad cholesterol levels, while lowering your good cholesterol levels. • Eye of round roast and steak • Sirloin tip side steak • Top round roast and steak • Bottom round roast and steak • Top sirloin steak Movie Theater Popcorn There are several reasons to avoid this snack during your next trip to the theater. Along with being covered in salt, the stuff is often popped in coconut oil, which is high in the saturated fats that can raise your bad cholesterol level. It’s even worse if you get it drenched in “butter,” which is usually something like butter-flavored palm oil, which gets you even more saturated fats. The large portion sizes don’t help, either. This isn’t to say that all popcorn is bad. You can make a healthy snack with air-popped popcorn. Just take it easy with the butter, salt and portion size. Find more food and nutrition tips for a healthier lifestyle at OrlandoHealth.com/Content-Hub. Sugary Drinks Sugary drinks increase your risk for metabolic disease as well as diabetes, which is a significant risk factor for cardiovascular disease. Like chips, these drinks also are full of empty calories. Energy drinks are a part of this group. They’re loaded with sugar and high amounts of caffeine, which can cause irregular heartbeats. (See related article on pages 18-19.) OrlandoHealth.com/ChooseHealth 5
SPOTLIGHT By Lisa Cianci | Editorial Contributor You’re probably familiar with the most common symptoms of heart disease. The one that gets the most attention is chest pain (or angina), which can feel like tightness, pressure, aching or pain in your chest. Other top symptoms include pain in your neck, jaw and back; pain, numbness or weakness in your legs or arms; and shortness of breath. “But heart disease can create a wide range of symptoms, some far less common than others,” says Dr. Ana Mercedes, a board-certified cardiologist with Orlando Health Heart and Vascular Institute. Let’s take a look at some of those lesser-known signs of heart disease. 1. Legs or Hips Hurt While Walking If your legs feel fine while resting, but then start hurting or cramping when you go for a walk, it could be a sign of congestion or blockage in your arteries. The pain (claudication) is often a symptom of peripheral artery disease (PAD), which is caused by the buildup of plaque (fats and cholesterol) on artery walls. The pain occurs when you become active and fades when you rest. People with PAD are at higher risk of congestive heart failure. 2. Struggling To Breathe While Lying Flat You may find yourself gasping for breath or otherwise struggling to breathe easily while lying down. You might only be able to sleep by propping yourself up with several pillows. This could be related to fluid buildup in your lungs. If your heart isn’t pumping as strongly as it should be, it will have difficulty keeping your blood flowing, allowing more of it to pool. For some people, this condition — known as orthopnea — may be the only symptom of congestive heart failure. 6
For wellness and prevention tips to keep you heart healthy, follow us on social media at Facebook.com/OHHeartInstitute. 3. Erectile Dysfunction Erectile dysfunction can be caused by several things, including diabetes and stress. But it also can be an indicator of heart disease. The root cause is endothelial dysfunction, a condition in which the blood vessels have difficulty expanding or contracting the way they’re supposed to. The condition reduces blood flow both to the penis and the heart. 4. Swollen Feet or Ankles There are several potential causes of swollen feet and ankles. But when your heart isn’t working as efficiently as it should be, it has difficulty pushing blood throughout your body. This can be problematic for your legs and feet, in particular. The blood moves into them, but your heart isn’t beating strongly enough to push the blood back through your veins. 5. Feeling Tired for No Reason Unexplained fatigue is one of the more common symptoms found in heart disease patients. Maybe you feel exhausted after unloading the dishwasher or walking to the mailbox. It may be related to an obstructed coronary artery, which restricts blood flow to the heart. For women, this is often the first sign of heart trouble. 6. Waking Up Often at Night To Urinate It’s not uncommon for aging men (enlarged prostates) and women (incontinence) to wake up more frequently at night to urinate. But it also can be a telltale symptom of heart problems. It’s somewhat related to swollen feet and ankles — when you rest at night, blood has an easier time making its way back to the heart. Similarly, your kidneys end up having more fluids to filter, increasing the frequency of urination at night. 7. Bad Breath Bad breath can be a sign that you have gum disease. And while that doesn’t cause heart disease, there is a wellknown correlation between periodontal disease and cardiovascular disease. People with gum disease have two to three times higher risk of a heart attack. 8. Feeling Nauseous Unexplained queasiness could be related to your heart’s struggles to pump blood, which causes fluid to build up in your lungs, abdomen and legs. Water retention and bloating may cause you to feel full, less hungry and nauseous. 9. Chronic Cough Yet another side effect of your heart’s diminished strength is fluid buildup in the lungs, a condition called pulmonary edema. This can cause a persistent cough as your body attempts to clear this excess fluid. OrlandoHealth.com/ChooseHealth 7
Cynthia Jones thought she was having a bad dream. Lying by the side of the highway, she was surrounded by strangers, confused and in pain. And so very, very cold. Try as she might, she could not wake up. But this was no nightmare: She was having a heart attack. INSPIRING STORIES Heart Attack on the Highway By Mary Frances Emmons | Editorial Contributor A Regular Day It was a Friday like any other, perhaps busier as it was the start of a holiday weekend. Jones had to drive from her Leesburg home to her Orlando office to pick up some files. She had not slept well, and her back had been bothering her for days. She navigated the Florida Turnpike as usual, eventually approaching I-4 and John Young Parkway, where she had to cross five lanes of traffic to make her turn. Suddenly, as she sat waiting at the light, she lost consciousness. Her foot came off the brake, and her car slowly drifted into the massive intersection. A good Samaritan had to break the car’s back window to get her out. When Jones, who was 61 at the time, came to, she was on the ground, with no idea how she got there. Then she noticed the firetrucks. “The EMS people asked, ‘Do you have a history of seizures?’ ” she recalls. “I said, ‘What? No! Someone hit me!’ They said, ‘You passed out at the wheel.’ ” The medics performed an EKG, and the results suggested a heart attack. That was just the first of many surprises that day. 8
Surprising Symptoms Because Jones had none of the classic indications, she struggled to process what was happening. In fact, she had been having symptoms for six months, Dr. Farooq says, but — like many women — simply did not connect them to her heart. Historically, heart attack studies have been done in men, who typically have the classic crushing pain and pressure in their chest or arm. Women can have that too, but often have very different symptoms that can be mistaken for fatigue, heartburn, asthma, menopause, anxiety and more. For some women, a heart attack can be the first obvious sign of heart disease. “When I told her we found this blockage, she was, like, ‘Oh my God, I’ve been having back pain all this time, and I couldn’t put two and two together,’ ” Dr. Farooq says. The ‘Widowmaker’ Admitted to Orlando Health Orlando Regional Medical Center, Jones immediately underwent more tests, which confirmed the worst: a 99% blockage of her left anterior descending artery, a condition sometimes called a “widowmaker” heart attack because that artery is the source of most of the heart’s blood flow. Jones was whisked into the cardiac catheterization lab, where Dr. Imran Farooq, a board-certified interventional cardiologist with Orlando Health Heart and Vascular Institute, placed a stent, reopening the closed artery. Much to her surprise, it was all over within about three hours. She was even more surprised to realize she felt instant relief. That reaction is common, Dr. Farooq says. “Typically there’s no blood flow when someone is having a heart attack — their heart is dying. The second you put a stent in, you’ve restored blood flow, and the muscle starts living again. Once that’s happened, the pain is gone.” Making Changes Reopening blocked arteries is lifesaving, but not a cure-all. Patients must commit to lifestyle changes. Today Jones is more intentional about getting regular exercise, and she’s working with her physician to better control her cholesterol. Just as important, she found a new and less stressful job in her field. That’s important, Dr. Farooq says. “Stress definitely has a major impact in terms of heart disease,” he says. Jones “is going to live longer not only because we fixed the artery but because she made lifestyle changes.” Jones still gets emotional when she thinks of that day. Dr. Farooq told her then, “If you didn’t believe in God before, you’d better believe in him now because he saved your life. Medically speaking, you should not be here.” “It was truly through Dr. Farooq’s hands and God’s work that I am here today,” she says. For more inspiring patient stories, follow us on social media at Facebook.com/OrlandoHealth. OrlandoHealth.com/ChooseHealth 9
10 Things To Ask Your Cardiologist at Your First Visit By Tim Barker | Editorial Contributor You’ve experienced heart discomfort, or your primary care doctor noticed something amiss during routine blood work. So now you’re headed to your first appointment with a cardiologist. GET READY What happens next? “The goal of the initial meeting is to launch a thorough evaluation of your heart,” says Dr. Abid Shah, an interventional cardiologist with Orlando Health Heart and Vascular Institute. You might be worried and alarmed before your first appointment. But to get the most out of the session, show up with a list of questions you’d like to ask. 10
As a starting point, consider these: 1. How does my family history affect my heart health? If coronary artery disease runs in your family, there’s a strong chance your genes make you more vulnerable. This is particularly important if you have a parent, brother or sister who developed heart disease. That link is further bolstered if they developed the disease before age 50. 2. What role does my blood pressure play? High blood pressure is one of the strongest risk factors for heart disease. And while it can be controlled by medication, the goal is to use lifestyle modifications as well. 3. What is my cholesterol level and how does it affect my heart? High levels of cholesterol increase the risk of heart disease by creating a buildup of fatty deposits in your blood vessels, forcing your heart to work harder than it should. While your doctor will look at your cholesterol numbers, there are other factors that could come into play when making decisions about treatment options. Patients with diabetes, for example, are at higher risk for heart disease. So a more aggressive strategy may be employed, even if cholesterol numbers are only modestly high. 4. Am I experiencing problems because of my age, gender or weight? In general, men are at slightly higher risk for heart disease than women. Being over the age of 50 also increases your risk. Of course, there’s nothing you can do about either of these risk factors. On the other hand, you can do something about your weight. Having a body mass index (BMI) of 25 or higher increases your risk. To find a cardiologist who fits your needs, go to OrlandoHealth.com/Heart. 5. How would I know if I’m having a heart attack? A key sign is chest pain that gets worse with exertion and doesn’t get better with rest. If you suspect you are having a heart attack, call 911 and don’t attempt to drive yourself to the hospital. Other symptoms include: • Feeling weak or light-headed • Pain in the jaw, neck or back • Pain in one or both arms or shoulders • Shortness of breath 6. Are my eating habits affecting my heart? Changing your diet is one of the most important things you can do to reduce your risk of heart disease. The American Heart Association recommends an emphasis on vegetables, fruits, whole grains and healthy proteins, including fish. You should cut back on red meat, sugars, alcohol and processed foods. 7. How does exercise affect my heart symptoms? Exercise is another lifestyle modification that can have a significant impact on your heart health. The key is finding an aerobic activity that gets your heart pumping. This should be done three to four times a week, for about 40 minutes per session. 8. Is my level of stress/anxiety increasing my risk of heart complications? A lot of attention is paid to measurable risk factors like cholesterol and blood pressure. But stress, anxiety and social factors also can aggravate your symptoms and accelerate heart disease. 9. What are my treatment options for the heart symptoms I’m having? Don’t expect your cardiologist to write a couple of prescriptions and call it a day. The best way to manage your risks for heart disease is a multifaceted approach with a heavy reliance on lifestyle changes. 10. What should I do if my symptoms don’t go away? If your symptoms are not going away, seek help immediately. And if a treatment plan developed by your cardiologist isn’t providing relief, let them know. That’s key to helping your doctor delve deeper into your health situation. OrlandoHealth.com/ChooseHealth 11
What To Expect at Your Cardiac Stress Test GET READY By Kim Marcum | Editorial Contributor 12
Why Do I Need This? The most common thing cardiologists look for are signs of coronary artery disease, which creates problems with what is essentially the plumbing system that supplies the heart. “As you age, these pipes can build up with cholesterol and become clogged, forcing your heart to work harder. If severe enough, this blockage can lead to a heart attack,” says Dr. Allan Chen, a fellowship-trained cardiologist with Orlando Health Heart and Vascular Institute. A test also may be recommended for reasons that include: • Diagnosing heart rhythm issues. Heart arrhythmias occur when electrical signals regulating your heartbeat don’t work correctly. This may cause your heart to beat too fast, too slowly or irregularly. • Guiding treatment of heart disorders. The test can be used to evaluate whether a current treatment plan is working if you’ve already been diagnosed with a heart condition. • Checking the heart before surgery. Your cardiologist may use the test as part of an evaluation to see if you can safely have surgery. Your test will evaluate several things, including how efficiently your heart pumps blood and whether your heart is getting enough blood. It also will measure how well you perform in a physical activity compared with your peers. And if you are having discomfort or some other symptom of heart trouble, the goal is to reproduce it during the test in a safe setting. Did you used to run a couple of miles a day, but now you’re exhausted running to the end of your street? Do you have shortness of breath or chest tightness? It might be time for a heart stress test. The test will examine how your heart works when it’s pumping during exercise or physical activity. And it’s done in a controlled environment — with a doctor at your side. To learn more about stress tests and other diagnostics, go to OrlandoHealth.com/Heart. Types of Tests There are several types of stress tests. The most common involves walking on a treadmill or riding a stationary bike while connected to an electrocardiogram (EKG) that measures your heart’s electrical activity. Other types of tests include: • Chemical stress test: This is a substitute for people who cannot exercise. The injection — through an IV — causes your heart and body to react as though you were exercising. • Exercise stress echocardiogram: Similar to the standard test, this one offers more detailed information. Your cardiology team will perform an echocardiogram (an ultrasound of your heart) before the test starts and after you reach peak exercise level. It evaluates valve functions and how well blood is flowing. • Nuclear stress test: This more advanced test adds a radioactive substance that’s injected into your bloodstream. Images are taken before and after you exercise. • Cardiac rehabilitation stress test: Testing may be done as part of a treatment plan if you already have been diagnosed with heart disease. The test helps your rehab team develop an effective exercise program. Testing Day On the day of your test (and depending on which test you are getting), you may be asked not to eat or drink anything for up to 12 hours before the test. You also may be asked to hold off on certain medications that could interfere with your heart rate and test data. During the test, you will have electrodes (like stickers with wires attached) placed on your chest to provide monitoring by the EKG. When you are exercising, your team also will monitor your blood pressure, heart rate and oxygen levels. Whether on a treadmill or exercise bike, you’ll start at a slow pace, which will be increased slightly every three minutes. This will continue until you reach the target heart rate determined by your cardiologist. At that point, your heart should be under enough stress to evaluate its function and potential problems. Depending on the test you are taking, it may take up to four hours to complete the process. Only a small portion of this time (8 to 12 minutes at a time) will be spent exercising. You’ll spend the rest of the time in imaging or resting between sessions. OrlandoHealth.com/ChooseHealth 13
SPOTLIGHT The Heart Disease You May Not Know You Have By Tim Barker | Editorial Contributor You probably haven’t heard of hypertrophic cardiomyopathy, but it’s the most common cause of sudden cardiac death in people younger than 35 years old. The condition, which causes your heart muscle to thicken for no apparent reason, is often inherited. Researchers are still learning about the causes of this disease. Most cases are passed down from a parent to a child, but it also is linked to high blood pressure and age. There are times, however, when the cause remains unknown. What To Watch For Hypertrophic cardiomyopathy can be difficult to diagnose because some people never have noticeable symptoms. “This is particularly troubling with young athletes, who appear to be in peak health – without realizing they have a potentially life-threatening disease,” says Dr. Alexander Bolanos, a board-certified interventional cardiologist with Orlando Health Heart and Vascular Institute. When symptoms do appear, they include: Find more information about healthy lifestyle changes you can make at OrlandoHealth.com/Content-Hub. • Chest pain • Shortness of breath and fatigue • Fainting or passing out • Heart palpitations • Abnormal heartbeat (arrhythmia) Treating the Condition With hypertrophic cardiomyopathy, your risk of sudden cardiac death is very low. Often, it’s treated with lifestyle changes and medications to help your heart muscle relax and work more efficiently. In severe cases, your doctor may recommend a more aggressive approach, including: Ethanol ablation: This minimally invasive procedure uses a tiny bit of pure alcohol to kill some of the muscle cells in your septal wall — the muscle tissue separating the right and left sides of your heart. Implantable cardioverter defibrillator: This small device is implanted under your skin, where it constantly monitors your heartbeat — ready to deliver a small shock to correct an abnormal heart rate. Septal myectomy: In this open-heart surgery, the thickened heart tissue is trimmed away by the surgeon. 14
T E C H N O L O G Y How a Fitness Tracker Can Help You Next time you’re in a large group, take a peek at what everyone is wearing on their wrists. Odds are, many of your companions are sporting fitness trackers or smart watches. These devices have shown success in boosting physical activity, with the potential for lower blood pressure, cholesterol and blood sugar. The Heart Benefits Having a device that keeps track of your movements can be a great motivator, particularly if you set goals for the number of steps you’ll take each day. “At first, you might be surprised to learn how little you actually move. But after the tracking starts, you may find yourself looking for ways to increase your step count,” says Dr. Daniel Nguyen, a board-certified cardiology and electrophysiology physician at Orlando Health Heart and Vascular Institute. By Lisa Cianci | Editorial Contributor Trackers also can serve as an early warning system for some potential heart rhythm problems. They are often equipped with an electrocardiogram, which can alert you if an abnormal heartbeat is detected. Getting Started To get the most out of a fitness tracker, here are some tips to get you started: Wear it every day. The more you wear it, the more data it can collect and help you accomplish your goals. Set goals. Be sure to set realistic goals so you don’t become discouraged. Recognize your achievements. When you meet your goals, reward yourself with a selfie on social media, a nap, new sneakers or a anything else that brings you joy. Build a social component. Use the tracker to join friends, family members or social media groups. Don’t obsess. As you use your tracker, be sure that you aren’t overly focused on it. You should be having fun. Find more health and wellness advice at OrlandoHealth.com/Content-Hub. OrlandoHealth.com/ChooseHealth 15
Welcome New Doctors* Electrophysiology Downtown Orlando Campus (321) 841-6444 Dr. Acevedo, a board-certified cardiologist specializing in electrophysiology, joined Orlando Health Heart and Vascular Institute in October. He received his medical training at Ross University (Dominica). He completed fellowships in cardiovascular disease at the VA Caribbean Healthcare System (Puerto Rico) and in clinical cardiac electrophysiology at the University of Florida (Gainesville). He is fluent in both English and Spanish. Javier Acevedo, MD Cardiology Clermont (321) 841-6444 In November, Dr. Anreddy joined Orlando Health Heart and Vascular Institute as a non-invasive cardiologist and advanced cardiac imager. Board certified in cardiology, he received his medical training at Gandhi Medical College (India) and earned a master’s degree in public health with a specialization in epidemiology from the University of Alabama (Birmingham). Dr. Anreddy completed his residency at Thomas Jefferson University Hospital (Philadelphia) and a fellowship in cardiovascular disease at Allegheny General Hospital (Pittsburgh). Sandeep Anreddy, MD Cardiology Dr. Phillips Area (321) 841-6444 A board-certified cardiologist, Dr. Bhuva joined Orlando Health Heart and Vascular Institute in November. He received his medical training at Surat Municipal Institute of Medical Education and Research (India) and completed his residency at Canton Medical Education Foundation (Ohio). His cardiology fellowship was performed at The Wright Center for Graduate Medical Education (Scranton, Pennsylvania). His board certifications include echocardiography, nuclear cardiology and cardiovascular computed tomography. Rushik Bhuva, MD Electrophysiology Longwood (321) 841-6444 In January, Dr. Elshazly joined Orlando Health Heart and Vascular Institute as a board-certified cardiac electrophysiologist, specializing in the evaluation and treatment of heart rhythm disorders. He received his medical degree from Weill Cornell Medicine (Qatar) and completed his residency at Johns Hopkins Hospital (Baltimore). His fellowships in cardiovascular medicine and cardiac electrophysiology were performed at Cleveland Clinic (Ohio). Mohamed Elshazly, MD Cardiology Downtown Orlando Campus (321) 841-6444 Dr. Izarnotegui, a board-certified cardiologist, joined Orlando Health Heart and Vascular Institute in September. She received her medical training at Instituto Tecnologico de Santo Domingo (Dominican Republic) and completed her residency at the University Virginia Health System (Charlottesville). Dr. Izarnotegui’s fellowships in interventional cardiology and cardiovascular medicine were performed at the University of Virginia Health System. She is fluent in both English and Spanish. Valerie Izarnotegui, MD Cardiology Downtown Orlando Campus (321) 841-6444 A board-certified cardiologist, Dr. Krishnarao joined Orlando Health Heart and Vascular Institute in December. She specializes in advanced heart failure, general cardiology, maternal-fetal medicine, cardio-obstetrics and peripartum cardiomyopathy. She received her medical training at Lake Erie College of Osteopathic Medicine (Pennsylvania) and completed her residency at Allegheny General Hospital (Pittsburgh). Fellowships in cardiovascular disease and advanced heart failure and transplantation were performed at the Mayo Clinic (Jacksonville). Krithika Krishnarao, DO 16
The doctors at Orlando Health are part of a collaborative network that works toward one common goal: your health. Cardiology East Orlando (321) 841-6444 Board certified in cardiology, Dr. Kumar joined Orlando Health Heart and Vascular Institute in December. He received his medical training at St. George’s University School of Medicine (Grenada) and completed his residency at Albany Medical College (New York). His fellowship in cardiovascular disease was performed at the University of South Dakota’s Sanford Medical Center (Sioux Falls). Vishesh Kumar, MD Cardiology Clermont (321) 841-6444 In October, Dr. Negrón joined Orlando Health Heart and Vascular Institute as a board-certified cardiologist. He earned his medical degree from the University of Puerto Rico Medical Sciences Campus (San Juan), where he also completed his residency and a fellowship in cardiology. Dr. Negrón is fluent in both English and Spanish. Roberto Negrón, MD Electrophysiology Downtown Orlando Campus (321) 841-6444 A board-certified electrophysiologist who specializes in heart rhythm issues, Dr. Nguyen joined Orlando Health Heart and Vascular Institute in October. He earned his medical degree from the University of Florida (Gainesville) then completed his residency at the University of Pittsburgh Medical Center (Pennsylvania). He performed fellowships in cardiovascular medicine and clinical cardiac electrophysiology at the University of Maryland Medical Center (Baltimore). A valedictorian of Winter Park (Florida) High School, Dr. Nguyen is fluent in both English and Vietnamese. Daniel Nguyen, MD Interventional Cardiology St. Cloud (321) 841-6444 Board certified in interventional cardiology, Dr. Patel joined Orlando Health Heart and Vascular Institute in September. Inspired by his grandfather who also was a physician, he received his medical training at Gujarat University (India) and completed his residency at Coney Island Hospital (New York). Dr. Patel performed fellowships in cardiovascular disease and interventional cardiology at Maimonides Medical Center (New York). Prakrut (PK) Patel, MD Interventional Cardiology West Orange County (321) 841-6444 In September, Dr. Patel joined Orlando Health Heart and Vascular Institute as a board-certified interventional cardiologist. He received his medical training at Maharaja Sayajirao University’s Medical College Baroda (India). His residency and fellowship in cardiovascular disease were completed at The Wright Center for Graduate Medical Education (Scranton, Pennsylvania). Another fellowship in interventional cardiology was performed at State University of New York (SUNY) Downstate Health Sciences University (Brooklyn). Saurabh Patel, MD Cardiology West Orange County (321) 841-6444 A board-certified cardiologist, Dr. Shashidharan joined Orlando Health Heart and Vascular Institute in January. He received his medical training at Vijayanagar Institute of Medical Sciences (India). His residency was completed at the University of Pittsburgh Medical Center (Pennsylvania). He performed a cardiology fellowship at the University of Illinois College of Medicine (Peoria). Shiva Shashidharan, MD *New doctors from September 2023 – January 2024 OrlandoHealth.com/ChooseHealth 17
CAFFEINERISKS Hidden Caffeine Poses Blood Pressure Threat By Kim Marcum | Editorial Contributor Energy drinks and other caffeine-packed beverages have become increasingly popular, particularly with teens and young adults. While most people can drink them safely, they can be a health threat if you have heart issues or high blood pressure. 18
It’s not uncommon to find energy drinks that contain 200 mg of caffeine — or roughly the equivalent of six cans of soda or two cups of coffee. The average person should drink no more than 400 mg of caffeine each day, according to the U.S. Food and Drug Administration (FDA). “Even more troubling is that it might not always be obvious when a beverage is highly caffeinated, making it important to read the labels,” says Dr. Maxim Olivier, a board-certified cardiologist with Orlando Health Heart and Vascular Institute. Not everyone can handle intense boosts of caffeine, which can wreak havoc with the heart’s ability to pump blood normally. Health Risks When consumed in moderation, caffeine is considered safe. In fact, some studies suggest that regular coffee drinkers are less likely to develop chronic illnesses, including heart disease, diabetes and Parkinson’s disease. For most people, drinking four to five cups a coffee a day should be fine. There is the potential for trouble, however, when that consumption skyrockets past the recommended levels. Among the more common side effects: • Headaches • Dizziness • Nausea • Dehydration • Irritability • Difficulty sleeping • Jitteriness Caffeine poses a bigger risk for people who have heart conditions that can trigger arrhythmia — a problem with the heart’s electrical system that causes an irregular heartbeat. Among the most common of those conditions is atrial fibrillation (AFib), which can lead to blood clots, stroke and heart failure. With AFib, the heart’s upper chambers beat irregularly and out of sync with the lower chambers. For some, there are no symptoms. But for others, there is a fast or pounding heartbeat, shortness of breath or lightheadedness. In general, those with AFib can consume caffeine, as long as they do so in moderation. But drinks with excessive caffeine content could trigger dangerous episodes of arrhythmia. In some rare cardiac conditions, arrhythmias can be triggered or worsened by stimulants that, depending on the condition, can be fatal. More Than Caffeine Caffeine content alone doesn’t always provide a clear picture of the effect a particular drink will have on your body. Energy drinks and other highly caffeinated beverages also are likely to contain several additional ingredients that can amplify the impact. Among them: Sugar: These drinks are often loaded with as much as 50 or 60 grams of sugar in a serving. That’s considerably more than the American Heart Association’s daily recommendations of 36 grams for men and 24 grams for women. Consuming too much sugar can increase your risk for heart disease, diabetes and some cancers. Guarana: This plant extract contains highly concentrated caffeine — two or three times higher than what’s found in coffee beans. Guarana also affects your body differently than the caffeine in coffee. It’s slower releasing and longer lasting, unlike coffee, which gives you a quicker, but more temporary boost. As a result, it’s easier to consume more caffeine than you realize. Take Precautions If you have a heart condition, talk with your cardiologist before considering a heavily caffeinated beverage. If you don’t have a heart condition, take some time to understand what’s in the drink you have chosen. You should know that these drinks — and their various additives — are not regulated or approved by any health or safety organizations. So, read the nutrition label to get a better sense of how much caffeine, sugar and other supplements you will be consuming. Remember that the average person should aim for 400 mg or less of caffeine each day. So, if your favorite energy beverage is loaded with 200 mg of caffeine, count that as half of your total for the day. And if you have any doubts about the safety of a drink, talk to your doctor. For wellness and prevention tips to keep you heart healthy, follow us on social media at Facebook.com/ OHHeartInstitute. OrlandoHealth.com/ChooseHealth 19
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