New technology helps diagnose hidden heart disease, says UK cardiologist

Dr. Gretchen Wells

Written by Dr. Gretchen Wells, director of the Women’s Heart Health Program at the UK Gill Heart & Vascular Institute.

Today’s technology has made tremendous strides in the diagnosis and treatment of heart disease, but until recently it was tricky to diagnose a heart condition called Microvascular Coronary Dysfunction (MCD).

The most common type of heart disease is caused by plaques that begin to clog one or more of the large arteries that carry blood to the heart. When the heart gets too little blood to meet its needs, people have chest pain (called angina). If blood flow is restricted even further – usually due to a clot that lodges in the narrowed artery – a heart attack and death may occur.

Plaque is often involved in MCD, too. But instead of accumulating in the larger coronary arteries, MCD occurs when the tiny blood vessels that branch off from the larger coronary arteries are blocked or damaged.

For unknown reasons, MCD occurs more frequently in women. In fact, it’s estimated that almost 50 percent of women who have persistent chest pain and low blood flow to the heart but no blockage of major arteries have undiagnosed MCD.

Unfortunately, standard tests for heart disease, such as stress tests and cardiac catheterizations, aren’t designed to detect MCD. These tests look for blockages in the large coronary arteries, but MCD affects the tiny coronary arteries. That means that you can have a cardiac catheterization that finds no blockages yet still be at high risk for a heart attack.

Sadly, people who have been reassured that “everything was OK” because their cardiac catheterization was clear might not feel the need to make lifestyle changes that would reduce their coronary risk and/or ignore warning signs that a heart attack is imminent.

If you have persistent chest pain, see a doctor right away. Your doctor may give you a stress test, which compares coronary circulation while you are at rest with your circulation during exercise. He or she may also recommend a cardiac catheterization, which involves threading a long thin tube from a small incision in your groin, neck or arm up into the heart to look for blockages in your arteries.

If your catheterization shows no sign of blockages and you are still experiencing chest pain, ask for a coronary reactivity test which can identify blockages in the smaller coronary arteries – the hallmarks of MCD.  Available at specialized centers around the U.S., coronary reactivity testing is the gold standard for diagnosing coronary microvascular disease.

And always, if you experience severe chest pain, if that pain radiates down your arm or to your back or jaw, and/or you are short of breath, call 911 right away.

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family health history

This holiday season, find out about your family’s health history

Did your grandfather have a heart attack? Did your aunt have a stroke? Did any of your family members have diabetes? How old were they when this happened?

The answers to these questions can help you understand your own disease risk.

And if you don’t know the answers, the holidays are a perfect time to find out. If you’re reuniting with parents, grandparents, aunts and uncles, and other relatives during the holiday season, take some time to learn more about your family health history.

Why your health history matters

Your family history gives you and your doctor crucial information that will guide your healthcare plan.

While you can’t counteract your genetics, if you have a family history of heart disease, for example, you can change your behavior to reduce your risk. By committing to healthier habits for yourself – such as improving your diet, exercising more and quitting smoking – you also become a role model for family members who share your genetic traits.

A family history can be helpful for more than just heart disease, since genetics can play a role in many other diseases, such as Alzheimer’s, some cancers and osteoporosis.

Knowledge is power

Even if your family has a clean bill of health, there are other factors, such as race or ethnicity, that can increase your risk for heart disease. For example, African-Americans have higher risks for diabetes, high blood pressure and stroke. One in three Hispanics will suffer from high blood pressure, and nearly half will have high cholesterol levels.

Knowing your family’s health history is one important step to help you avoid these health concerns. Talk to your relatives this holiday season and then then share this information with your healthcare provider, who can tailor a plan to help you counteract the potential negative effects of your genetics.

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Making the Rounds with Dr. Andrew Kolodziej

The best part of this cardiologist’s job? Giving patients a second chance.

Making the RoundsFor our latest installment of Making the Rounds, we chatted with Dr. Andrew Kolodziej, a cardiologist at the UK Gill Heart & Vascular Institute who specializes in advanced heart failure, heart transplant and pulmonary hypertension.

What kinds of conditions do you treat?

I usually see patients who have heart failure and who require additional medicines to keep them going. Oftentimes, patients are referred to me after their doctors have exhausted all their means of treatment.

I also see pulmonary hypertension patients – patients with elevated pressures in the vessels of the lungs. Blood vessels in your lungs have a separate physiology and respond to different stresses in their own way. And ultimately that condition can result in heart failure. Hence my interest in both conditions, because they often go hand-in-hand.

When did you decide to pursue a career in medicine?

This really goes back to my junior high school years. There was a dramatic moment in my life where I was hit by a car crossing the street. I ended up in the emergency room, and luckily, nothing major happened to me. But the paramedics that literally picked me up off the ground made an impact on my life going forward.

That experience really interested me in taking care of patients, specifically in emergency medicine and critical-care situations – really sick patients. I became an emergency medical technician and then graduated to a paramedic position, which was always a stepping stone to something more. Ultimately, that was medical school.

When I went to medical school, I went toward cardiology. Heart doctors always get asked why we picked cardiology specifically. It’s partly the heart being the core and the soul of any human being, as well as the fact that the patient population is generally really sick. That really interested me.

How would you describe your patient-care philosophy?

Being a patient myself sort of put things in perspective for me. Approaching patients, I see myself in their position. I see my family in their position. And ultimately, it goes for all of my colleagues in the cardiology department: We approach our patients as part of our family.

Our patient population is very sick, and they stay with us for a long time. Hopefully we get to do something for their heart, either with a left ventricular assist device (LVAD) – which is a device that replaces the function of a failing heart – or through heart transplant. Our patients stay with us for a long time, and I really get a chance to be a part of their family. I think that’s what makes me who I am.

What’s the best part of your job?

The best part of my job is to take somebody who is essentially dying and giving them a second chance at life. When a patient gets an LVAD or a transplant and they’re discharged home, and then they get to walk their daughter down the aisle – that’s what makes me move forward. It’s the best part of what I do.

How do you spend your time away from work?

I do a lot of endurance sports. I’m actually a triathlete. I haven’t done too many official events, but that is really my hobby.

Living in Lexington, if you get out running, and if you run for two or three hours, it’s just so beautiful out there. Same thing goes for bike riding. You can go up to Richmond and back and make that 60-mile ride. It’s so beautiful, and it passes by so quickly. I was on a ride once, and there were a couple of young horses that just started racing with us. It was great.

What’s your favorite food?

I’m vegan, so I’ll try anything that is vegan. You can explore lots of different foods, and it’s as healthy as it can get. And there’s so many vegan options now and so much interest in it that people will make vegan food that tastes like meat. It literally looks and tastes look “regular food.” But it’s so much healthier, so you don’t feel guilty.

Check out our video interview with Dr. Kolodziej, where he tells us more about what makes the care teams at UK HealthCare so special.

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Pain from PAD? Exercise is best, says UK expert

If you have peripheral artery disease, or PAD, even a short walk can cause pain. This pain, called intermittent claudication, or IC, is caused when arteries in your legs become blocked with plaque. PAD is a serious disease, but the good news is that treatment is usually simple.

Exercise is generally the most effective treatment for PAD. Your doctor can recommend a program of Supervised Exercise Training, also known as cardiac rehabilitation.

What to expect from supervised exercise training:

  • A personalized exercise plan that works for you.
  • An assessment of your risk factors for heart and blood vessel disease.
  • Counseling and psychological/stress assessment.
  • Education and support to help you avoid tobacco and maintain a healthy weight and diet.
  • The opportunity to meet and share stories with other patients like you.

Benefits of supervised exercise training:

  • Reduce your risk of heart disease, heart attack and stroke.
  • Control other heart disease symptoms like chest pain or shortness of breath.
  • Stop or reverse damage to blood vessels in your heart and legs.
  • Improve your stamina and strength so you can enjoy work, hobbies and exercise.
  • Improve your confidence and well-being.
  • Monitor and control your blood pressure, cholesterol and diabetes.
  • Improve communication with your doctor and other healthcare providers about your progress.

Dr. Nathan Orr, a vascular surgeon at UK HealthCare, says that an exercise program not only helps patients walk longer distances, but can also help them avoid the need for complex surgery.

“A regular, directed exercise program will result in an improvement in your quality of life, an improvement in your overall health, and a lower risk of vascular disease progressing to limb loss,” Orr said.

Exercise training can work as well as medications and other more invasive treatments for PAD and IC, and it may be covered by your insurance. Contact UK Cardiac Rehabilitation at 859-323-5424 for more information.

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Making the Rounds with Dr. Aaron Hesselson

Meet Dr. Aaron Hesselson: engineering healthier heartbeats

Making the RoundsWe caught up with Dr. Aaron Hesselson for our latest Making the Rounds interview. Dr. Hesselson started at UK HealthCare this fall, bringing with him nearly 30 years of experience in cardiac electrophysiology. He now serves as the director of electrophysiologic services at UK. 

What types of conditions do you treat?

Electrophysiology covers all of the electrical aspects of the heart. That means I treat patients with abnormal heart rhythms. These can vary from slow heart rhythms to very rapid heart rhythms. Treatments for these conditions can range from simple monitoring and reassurance to medication and sometimes surgical procedures that can help manage or cure a certain problem.

How did your career in medicine begin?

I left college as a biomedical engineer and I was very interested in maintaining my medical background for my first job. I came across a job listing in the local newspaper that asked for a biomedical engineer to do research at a hospital in Newark, N.J.

So, rather than just sending my resume in, I decided I would show up in person. I just said, “Hey, I just happened to be in the area and I’m interested in this.” I had an initial interview and then a few more interviews, and then I got the job.

What’s the best part about being a doctor?

As an engineer, the technical aspects of the job are very appealing. But more important is the gratification we get from taking care of our patients.

Very few doctors can say that they can cure a medical issue, but in some cases we are able to do that as cardiac electrophysiologists. And that, to me, is very big. To see the appreciation of the family, patient – that makes it all worth it.

Is there an experience that has shaped your patient-care philosophy?

Yes – being a heart patient myself. When I was in college, even before I had any inkling that I wanted to go into medicine, I ended up in an intensive care unit with a fractured sternum and a bruised heart.

My experience then as a patient very much influences how I approach my patients now. I approach it from the standpoint that I’m that patient lying in the bed. The patient doesn’t know what’s going on or know the technology. They don’t know the technical terms and they don’t know what that end point is: When is my time here in the hospital going to end?

I try to anticipate what they’re thinking lying in bed because I was there. Hopefully I can anticipate their needs and their questions and make them that much more comfortable and reassured so that they know, “OK, we’ve got a plan and I feel good about it.”

Watch our video interview with Dr. Hesselson, where he explains why patients should feel confident coming to him for their care.

Next steps:

  • The UK Gill Heart & Vascular Institute is a leader in diagnosing and treating abnormal heart rhythms. Learn more about Gill’s Heart Rhythm Program.
  • A new study about heart stents is in the news. Two of our experts explain what the study means and what patients and their loved ones should know.
added sugar

Easy ways to cut back on added sugar

Added sugar is sugar or syrup that has been added to foods or beverages when they’re processed or prepared. And if you’re like most Americans, you’re probably consuming way too much of it every day.

Examples of products that contain added sugar include:

  • Beverages such as regular soft drinks and fruit drinks.
  • Candy.
  • Grain-based desserts such as cakes, cookies and pies.
  • Dairy desserts and milk products, including ice cream, sweetened yogurt and sweetened milk.
  • Other grain-based foods such as cinnamon toast and honey-nut waffles.

These kinds of foods have long been cited for contributing to obesity, high blood pressure and high cholesterol, but recent research has shown that their added sugars can also lead to heart disease.

How much is too much?

The American Heart Association daily recommendations for sugar consumption are no more than 6 teaspoons or 100 calories for women and no more than 9 teaspoons or 150 calories for men.

Unfortunately, many of us have a lot more than that. In fact, the average American consumes nearly 20 teaspoons of sugar each day.

Tips to cut sugar

November is the Eat Smart Month, and the American Heart Association offers the following tips to help you reign in your sweet tooth:

  • Replace a few of your beverages during the week with water.
  • Always check nutrition labels before you buy food and drinks, and pay attention to the sugar content. Keep in mind that added sugars go by many names, including sucrose, glucose, maltose, dextrose, high fructose corn syrup, concentrated fruit juice, agave nectar and honey.
  • Choose simple foods over heavily processed ones.
  • Rinse fruits if they are canned in syrup.
  • Swap out a regular soda for a diet soda.
  • Add fruit slices or a splash of fruit juice to your water for added flavor.
  • If you like fizzy drinks, try sparkling water.
  • Reduce the amount of sugar in your coffee and tea.

Check out the AHA’s Eat Smart Month infographic below to learn more!

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UK transplant patient shares emotional bond with family of donor

By early 2016, Conrad Webster was battling to stay alive.

Cardiomyopathy and polycystic kidney disease had destroyed his heart and kidneys, and his health had been deteriorating for nearly a decade. A combined heart-kidney transplant was his only remaining option.

After being turned away by multiple regional transplant centers, he came to the UK Transplant Center, where he was admitted right away and listed for transplant.

In April 2016, West Virginian Tim Maris suffered from pneumonia and a brain hemorrhage that ultimately took his life. Before passing, Tim told his family that he wished to be an organ donor.

Tim’s request saved three lives: One patient received his liver, another received a kidney and Conrad received both his heart and a kidney.

‘I was just so happy to know Tim is still out there’

Working through Kentucky Organ Donor Affiliates, Tim’s mother, Evelyn, sent a card to Conrad expressing her desire to meet. They began corresponding via letters and phone calls, and made plans for their families to meet in person at KODA’s Donor Family Recognition Ceremony in Lexington.

Conrad, his wife Leticia, and two of their children drove down from Ohio to meet members of Tim’s family: Evelyn, his sister Penny and brother-in-law Howie, and his nephew, Caleb.

“I couldn’t really get any sleep [the night before],” Conrad said. “My nerves were just built up so much.”

The two families spent several hours chatting before the ceremony, sharing stories and pictures from their lives. Representatives from KODA provided a stethoscope to allow Evelyn, Penny and Howie the chance to hear Tim’s heart beating in Conrad’s chest.

Evelyn says that meeting Conrad and his family provided her with some much-needed closure.

“My heart was about to burst, we were so excited,” she said. “It was a joy. I was just so happy to know Tim is still out there.”

A life-changing experience

For Conrad, Tim’s gift completely changed his life. After years of chronic illness, he’s able to do things he never thought he’d have the chance to do again, like travel, prepare his youngest daughters for college and meet his grandchild.

And last October – just six months after receiving his transplant – Conrad and Leticia got married in Florida after 11 years together.

Because of their experiences, members of both families have decided to become organ donors themselves.

“Someone saved my husband, and kids’ father,” Leticia said. “Why not join Donate Life to help another family or multiple families in need?”

Becoming an organ donor

Although hospitals are obligated by law to identify potential donors and inform families of their right to donate, anyone can sign up to become an organ donor by joining the Kentucky Organ Donor Registry. The registry is a safe and secure electronic database where a person’s wishes regarding donation will be carried out as requested.

To join the registry, visit or sign up when you renew your driver’s license. The donor registry enables family members to know that you chose to save and enhance lives through donation. Kentucky’s “First Person Consent” laws mean that the wishes of an individual on the registry will be carried out as requested.

UK Transplant Patient Thankful to Meet Donor Family from University of Kentucky on Vimeo.

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Listen: UK at the Half discusses exciting KCH partnership

Dr. James Quintessenza, chief of pediatric cardiothoracic surgery at UK HealthCare, and Dr. Scottie Day, interim chair of the UK Department of Pediatrics and physician in chief at Kentucky Children’s Hospital, were featured during “UK at the Half,” which aired during the UK vs. Utah Valley basketball game radio broadcast on Nov. 10.

The doctors talked about UK’s new partnership with Cincinnati Children’s Hospital that will offer the best pediatric heart care in the area.

“UK at the Half” airs during the halftime of each UK football and basketball game broadcast and is hosted by Carl Nathe of UK Public Relations and Marketing.

To hear the latest episode, click on the play button below.

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UK dean’s outstanding research recognized by the American Heart Association

The American Heart Association (AHA) awarded its Population Research Prize for 2017 to Donna K. Arnett, dean of the UK College of Public Health and professor of epidemiology, “for insightful research successfully blending the basic molecular sciences with population studies to produce a highly relevant new understanding of major aspects of cardiovascular disease including risk prediction, hypertension and heart failure.”

Arnett received the prize during Sunday’s opening of the American Heart Association Scientific Sessions 2017, a premier global exchange of the latest advances in cardiovascular science for researchers and clinicians, which was held at the Anaheim Convention Center in California. The annual prize honors important studies of cardiovascular disease patterns in populations.

“Throughout her praise-worthy career, Dr. Arnett has worked to integrate molecular science with population studies, using her extensive training in both disciplines, to produce broadly relevant results for the health of the public,” said Dr. John Warner, president of the AHA.

“Her personal success is evident in both her publication record and her funding,” he noted. “She has published more than 500 peer-reviewed reports in high-impact journals in multiple fields, including seminal work she has led identifying genetic biomarkers and in risk prediction, hypertension, heart failure, imaging and methods development.”

Arnett also has played a key role in the development of the population research portfolio of the AHA, where she served as a bridge between the population and molecular research communities.

“Her many years of service have included time as a high-profile role model for population research during her presidency of this association, in 2012-2013,” Warner said.

An NIH-funded researcher for 20 years, Arnett studies genes related to hypertensive disorders and organ damage that results from hypertension. She has published more than 450 peer-reviewed papers and two books.

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heart stents study

Don’t overreact to new study on heart stents, say UK cardiologists

Dr. Adrian Messerli

Dr. Adrian Messerli

Written by Dr. Adrian Messerli and Dr. Khaled Ziada, interventional cardiologists at the UK Gill Heart & Vascular Institute.

A recently released study once again shines the spotlight on heart stents, a procedure performed more than 600,000 times per year in the United States.

In effect, the study raises real concerns that stent placement for the treatment of activity-related chest pain (angina) is no better than treatment with medications alone.

Dr. Khaled Ziada

Dr. Khaled Ziada

Given the relatively high prevalence of heart disease in our society, this study is understandably getting a lot of attention. Already, we have received quite a few inquiries from patients and their loved ones who are concerned and perhaps somewhat confused.

Here’s what it all means:

What the study said

A group of respected British cardiologists conducted the study on 200 patients with angina and who had a severe blockage in one of their coronary arteries.

All patients were on high-quality medication treatment. The researchers then compared stent placement in one-half of these patients with a simulated sham procedure in the other half of the patients.

After six weeks, there were no significant differences in patient-reported improvement of symptoms or exercise ability in either group.

This study is receiving considerable scrutiny. It was rigorously designed and undertaken with great care. Even so, it has very important limitations.

Understanding the study’s limitations

First, and perhaps most importantly, this study does not pertain to patients who have suffered a heart attack. We know for a fact, based on the findings of numerous studies, that when someone is having or has recently had a heart attack, placing a stent to open up a blocked artery is clearly the treatment of choice.

In these situations, a stent is frequently lifesaving and may improve longstanding quality of life.

Second, this study was conducted in a small sample of lower-risk patients with good heart function, mild symptoms and blockages in one artery only.

So the results do not necessarily apply to higher-risk individuals with more severe angina, those with blockages in multiple arteries or those whose heart function was abnormal to begin with.

In these patients, stenting or even bypass surgery can reduce symptoms considerably, and possibly even protect against future heart attacks or worsening heart failure.

Third, the study followed patients for six weeks.

In a larger study published in 2007 on similar patients with activity-related angina who were treated with medications only, most patients did well, but about one-third of them eventually required a stenting procedure or surgery when followed for four to five years.

What do patients need to know?

If you have already had a stent placed, know that you are not in any new danger. In fact, current-generation stents are remarkably safe and durable. If you or your loved ones happen to suffer a heart attack, you should be aware that in this circumstance, stents are ideal.

If you experience new symptoms of angina, you should consult your primary care doctor or a cardiologist. If the symptoms are not severe or very frequent, your doctor will likely prescribe a number of medications, possibly order additional testing and then monitor the situation.

Frequently, the medication regimen will reduce or eliminate angina. If a heart catheterization or stent placement is recommended, it is entirely reasonable to ask careful questions, ensure you are on appropriate medications and get a second opinion.

Finally, it is important to remember that chest pain is a symptom, not a condition.

The underlying disease, coronary atherosclerosis, is best treated with aggressive risk-factor modification, including tobacco cessation, a healthy diet, regular exercise and stress management.

We have known for many years that, in a stable patient, stents do not reduce future risk of heart attacks or death. Rather the emphasis should be medication therapy and, even more importantly, lifestyle measures.

The problem of overuse of stents in stable patients with angina has improved significantly over the last decade, but there is no doubt that there is room for further improvement.

When used appropriately, this procedure has a validated and critical role in the treatment of heart disease. We have placed several thousand stents over our careers, and have seen firsthand the benefits for many of our patients in Kentucky.

So for now, let us not overreact to the results of this small trial, and accidentally throw out the proverbial baby with the bathwater.

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