Rehabbing your heart with MercyOne Siouxland Cardiac Rehab Center
Cardiac rehabilitation is an important step in recovery after almost any cardiac event. It doesn't change your past, but it can help prolong your future.
"If I didn't do any cardiac rehab, I would seriously doubt I'd have the life expectancy I have now." Mike Pesky has been through cardiac rehab four separate times.
"There's always a possibility you know, when you have heart problems," Pesky said after class. "I got nine stents in me and there's always a possibility of more down the line."
"You only get one heart and we have to take care of it from youth on up." ~ Ruth Ann McKeever, RN
Inside the Cardiac Rehab Center at MercyOne Siouxland, a team of medical specialists helps Siouxlanders through a cardiac rehabilitation program designed just for them.
"We look at lots of things, what their history is, what their ejection fraction is, how well their heart muscles able to pump blood out to their body, what their symptoms were if they had arrhythmias and if that caused their event what was going on?" Ruth Ann McKeever, a registered nurse in the cardiac rehab center said. "So each person is individualized and we look at them individually."
"They care about you as an individual. And it's not like oh, okay, do your workout and we'll see you next time. It's, Do you have questions? Is there anything bothering you? Kind of thing and if you have like depressed, you can feel free to talk to them. And sometimes that's all it takes," said Pesky.
Cardiac Rehabilitation is important for anyone who is recovering from heart surgery, had a heart attack, or is suffering from other heart conditions like coronary artery disease, angina or heart failure.
Because your heart is a muscle and needs to be taken care of. "And once you lose your heart muscle, if you drop your ejection fraction, there's no going back," McKeever said. "The older we get, the more likely we're going to have to have an event or to have something happen."
Exercise uses your entire cardiovascular system, but while the room may look like a gym, cardiac rehab involves more than a workout. "That heart muscle is weakened," McKeever said. "And so you need to start slow and gradually build that heart muscle back up again."
This is also a chance for participants to learn more about their heart and how heart health impacts every aspect of their life.
"Once a week they have education and so we go over a different topic of education with them once a week, so that they continue to learn about their heart and heart-healthy habits," said McKeever.
But while this room may look like a gym, cardiac rehab involves more than a workout. It's also a chance to learn.
"Heart is one thing but the heart and the mind go together. ~Mike Pesky" Changing the way a person thinks about their life, their stress, and other triggers is an important part of the process. "It's not just getting the heart. That's only a part of it," said Pesky. "You got to get the mind is well and that's one thing I have liked all the way through."
Because you only have one beating heart. "So we have to really take care of that heart muscle," McKeever said, "because you don't always get a second chance."
Pesky can't say enough about the team at MercyOne. "These gals care and it shines like the sun outside, it shines through," he said. "And you know I am been very, very blessed to have the nurses here and through my years of coming, to have them here and I can't say enough good things about them."
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Surviving a widow maker heart attack - Aurelio's story
I was 50 and this was October 13th I believe.
Aurelio Hernandez is counting his blessings. Just 5 months ago, at age 50, he had a heart attack. One with a scary name, the Widow Maker.
"So, heart attacks are all bad," said Dr. Mir Subla with MercyOne Siouxland Medical Center. "Usually, we talk about Widow Maker, we are talking about the artery that supplies the left ventricle. That's the chamber of the heart that pumps the blood."
There are three main arteries in the heart, one on the right and two on the left. The Widow Maker occurs in the left anterior descending artery which supplies blood to a large portion of the heart.
"In the Widow Maker, what happens is this artery gets blocked, there is a plaque in the wall and that ruptures and a clot forms in the artery and an artery gets blocked and there's no blood flow," said Dr. Subla.
A Widow Maker feels like any other heart attack, with symptoms like shortness of breath, chest pain and heaviness.
"It was actually during work, felt a little tired so I figured I'd go home while the texture was drying," Hernandez recalled about the day he had his heart attack. "I was gonna try to take a nap but then I felt pain across the chest. I actually started on one area and kind of gradually started moving. I didn't think anything of it until it started all the way across, and then my breathing kind of got a little difficult."
Hernandez went to a nearby ER and they sent him to MercyOne Siouxland. Because when it comes to matters of the heart, time is critical.
"Nowadays, it has improved a lot," said Dr. Subla. "Fatality rates have dropped if they receive care in what we call "door to balloon time", or "contact to balloon time".
Dr. Subla says the standard time from first medical contact to balloon time or the point where doctors open the artery, is 120 minutes, or 2 hours.
"It's usually fatal if not treated. People can develop heart failure because that portion of the heart doesn't get any blood and the part of the muscle dies. - Dr. Subla"
Hernandez got treatment in time, but he also knew what to look for.
"Just watching what happened to my brother, passing away at the same age of 50 and leaving four kids," Hernandez said. "I guess it wasn't actually surprising because of my family history of it. But at that time, you know, I was always active. I know my lifestyle of working all the time and not eating right and all had something to do with it but it was a to where I can't believe this is happening to me."
By the time Hernandez arrived at MercyOne last October 13th, the cardiology team was ready.
Dr. Subla recalls that day, "we took him immediately to the catheterization laboratory, his Widow Maker was 100% blocked and we opened up with a balloon and a stent and it had good flow at the end. He was symptom-free and his heart muscle did not suffer any damage."
READ MORE - HEART MONTH: Rehabbing your heart with MercyOne Siouxland Cardiac Rehab Center
He is one of the lucky ones, especially in a time when many are not seeking treatment because of COVID-19.
"It's what we call timeless muscle," said Dr. Subla. "So the more you delay, the more muscle will die.
And even if you survive, if you don't come to the hospital, you will have heart failure and we see a lot with those patients especially in COVID times, people didn't want to come to the hospital for obvious reasons. And we see a lot of heart failure patients."
When I met Hernandez, he was graduating MercyOne's cardiac rehab program. Leaving with a new lease on life and a vow to teach his kids and others around him that heart attacks aren't for the faint of heart.
"So you change your outlook on a lot of things. So there's not like what I don't care if it happens to me, now you got to what does it matter if it just happens to you, but everybody else behind you to it, you know, it affects them as well," Hernandez said after graduation.
His one tip for Siouxlanders?
"Just be careful. You know, know your signs, figure it out, you know, if you don't feel something right, you know, there are issues there and it's not fun. It's not fun at all."
Hernandez says he plans to keep up his workout routine and healthy eating habits, with a focus on overall heart health.
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Local cardiologists explain stents and how they are used
It's smaller than the tip of your finger but powerful enough to open the arteries of your heart.
Millions of Americans receive stents each year, but what are these tiny, life-saving devices?
If you have a blockage or narrowing of an artery around your heart, you may be told you need a balloon angioplasty and a stent placed.
"This is called balloon and stenting and this is a very common procedure that has been done in the entire world millions of times already," said Dr. Gary Chan with MercyOne Siouxland's cardiology team. "So actually the rest is pretty safe."
"Most of the times stents do a wonderful job and the patient doesn't have to go through a huge surgery," explained fellow cardiologist, Dr. Mir Subla.
Stents are common and a lot smaller than you may think, fitting on the tip of your finger.
It's typically a minimally invasive procedure where a tubing is inserted into the blocked artery.
"And this tubing has some special features to it. It has a little saucer-shaped balloon attached to it so that when it's inflated, it will push the cholesterol blockage up against the wall, opening it up temporarily," explained Dr. Chan. "But then this is only a short-term solution. To really prevent it from coming back in we have to deflate that balloon, withdraw the entire tubing, put another tubing across the lesion.
The next piece is the stent itself which looks a bit like chicken wire.
READ MORE: Surviving a widow maker heart attack - Aurelio's story
"But then in addition to the balloon, it has a metal scaffold attached to it so that when it's inflated, and then the balloon is deflated," said Dr. Chan. "The macro scaffolds stay behind keeping it up, keeping the arteries open for a long time."
Patients can have multiple stents and they are permanent.
"Patients can have multiple stents and they can be overlapping they can be the side branches," said Dr. Subla. "If a patient has stents and they decide to have bypass surgery as the disease progresses, they can still have bypass surgery down the road."
If you have a stent placed, it's typically managed with medication and a few lifestyle modifications and can help prevent a bigger heart surgery down the road.
"The stents remain open with the medications and little follow-ups with the cardiologist and it reduces the huge burden of surgery for the patient," said Dr. Subla. "And the stent just takes is one hour at least and they can go home the next day."
Once a stent is placed, tissue will begin to grow around the area, completely covering the device like a layer of skin.
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What is atrial fibrillation and how is it treated?
I just knew something was not right.
Stephen Lordemann had his wife take him to the hospital in 2008. He'd been helping his daughter move when he started to not feel well. His heart was racing. His wife, an EMT, couldn't count his heartbeats when feeling his pulse.
Lordemann was in AFIB or atrial fibrillation, which is an irregular and often rapid heart rhythm.
"So in atrial fibrillation, the top chambers of the heart are beating erratically, said Dr. Gary Chan with MercyOne Siouxland Medical Center. "And because of that, blood is not being moved efficiently from the top chamber to the bottom chamber."
AFIB is fairly common and some who experience it don't have any symptoms at all. So how can you tell if you could be in AFIB?
"For the patient, for the general population, the easiest way to tell will be to feel their pulse. And if they feel that from one pulse to the next one, and if the duration is different then they are in AFIB," said Dr. Chan.
While AFIB isn't usually life-threatening on its own, ignoring it could lead to more life-threatening issues like blood clots and increase the risk of heart failure or stroke.
"In atrial fibrillation, the top chamber is, instead of pumping effectively, is actually quivering," said Dr. Chan. "So blood stays there not moving well, and as a result, blood clots can form. And the end result is that if the blood clot flows down to the bottom chamber, and pump up to the brain, it can cause a stroke."
So how do doctors treat AFIB? There are a few ways. Medication might be enough to get the heart pumping in rhythm again and in some cases, shocking the heart might be needed.
"And we can either give them an electrical shock, that brings it back to that sort of reset the heart and then get it back to normal or give them medicine to bring them back to a regular rhythm," said Chan.
Many patients who experience AFIB end up on blood thinners, at least for some time. Age is a big factor in those who experience AFIB, other risk factors include obesity, high blood pressure, smoking and heavy drinking.
"If there are structural abnormalities such as the top chambers are dilated, they are at increased risk. If they have an issue with the valve, that could also increase the chance of having AFib in the first place," said Chan.
"I've experienced twice," Lordemann said, regarding AFIB. "Then had two heart attacks. Both of them had stents."
Lordemann credits his MercyOne cardiology team for getting him where he is today with a few lifestyle changes and a little cardiac rehab, he and his heart are doing great.
For Dr. Chan, his one piece of advice is if you feel something could be wrong don't wait to seek medical care. "But then sometimes times does matter," Chan said, "especially when it comes to matters of the heart."
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Mitral valve issues in women
"I had had a heart attack on July 6th and had been having some problems with passing out. And finally, Dr. Ciuffo said he was going to fix it." Gloria Lordemann had experienced issues with her heart before. "I'd had a bypass a couple of years before that. And then this was something new and different," she said.
She had a problem with her mitral valve, something fairly common for women.
"If you take a sample of the population between the age of 25 and 40, one woman out of six has what we call mitral valve prolapse," said Dr. Giovanni Ciuffo with MercyOne Siouxland Medical Center. "It's like sort of a redundant amount of tissue."
But what is a mitral valve and how does it work in your heart?
"The heart has four valves and they work as one-way valves. You have two on the right side which is the side of your heart that pumps into the lungs, oxygenates the blood and then it goes back to the left side of the heart," explained Dr. Ciuffo. "Mitral valve is in a pumping chamber, when the heart squeezes the mitral valve closes to make sure there's not backflow into the lungs and it flows into the main pipeline in the body that carries oxygenated blood all over the body."
There are two main problems a person can develop with their mitral valve; it can leak causing blood to flow backward into the lungs, or it can struggle to open properly leading to a buildup of blood and pressure in the lungs.
"In severe degrees, mitral regurgitation will really make your life miserable, swollen legs, very short of breath," said Dr. Ciuffo. "You can't even go to a supermarket and push a cart, it gets that bad."
The surgical procedure to fix a mitral valve used to mean open heart surgery. Now, it is a minimally invasive procedure.
"But for the last 20 years, I was able to implement a minimally invasive technique, such as the one I use in this patient, where you can actually make a small incision on under the skin fold of the right breast and you go between the fourth and the fifth rib. That's what we call minimally invasive," he explained. "You don't break any bones. It's minimal amounts of bleeding."
This also means a quicker recovery. But why do doctors see more mitral valve issues in women than men?
"They actually would tell you that probably one of the most common things is, that's sort of a far-fetched theory, there are moments in a woman's life where soft tissue becomes loose," explained Dr. Ciuffo. "One classic thing is when during pregnancy is a natural adaptation because you have to deliver a baby and having the extra loose stations it makes it easier. But other than that, I would say there are certain features that belong to one sex or the other the general."
For Gloria and her husband who also receives cardiac care here, making the drive to MercyOne for their heart health was a no-brainer.
"I've had the best of luck here with mercy. they've handled all my problems and taken great care of me," Gloria said.
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MercyOne cardiologists find lifesaving treatment for early COVID-19 patients
In the early days of the COVID-19 pandemic, doctors didn't know how to treat the sickest patients. Everything about the virus and how it interacted with the body was unknown. But when ICU specialists and the cardiology team at MercyOne Siouxland Medical Center came together in the fall of 2020, they discovered that a piece of equipment in their arsenal was just what they needed.
"We learned a lot about managing COVID patients. You know, our first wave was truly disheartening because it was sort of a new disease that we had to deal with. And our therapeutic options were pretty limited." Dr. Giovanni Ciuffo wasn't used to working with Intensive Care Unit staff. "Intensive Care Unit specialists don't interface much with a heart surgeon but that became a necessity," he recalled.
That necessity began when the first wave of COVID-19 hit Siouxland and doctors had to use everything at their disposal to save lives.
Doctors turned to an external oxygenation device, something cardiologists typically used for patients who suffered cardiac issues.
it's a modular cooler, heater-cooler, that circulates water through these pipes and it controls the temperature in the patient," Dr. Ciuffo explained. "You can hook it up to the machine and dial the machine and say bring the patient back to a normal body temperature 98-99."
This machine can essentially oxygenate your blood for you. Something many otherwise healthy people were struggling to do after testing positive for COVID-19 and ending up in the ICU fighting for their lives.
When the MercyOne team first began using this machine to treat COVID-19 positive patients, they were among the first in the nation to do so.
"You know, when we started doing this, we were among the first guys doing it in the country. Here was a brand new concept where, well let's try to bail these patients out," Ciuffo said.
But they worked in cooperation with hospitals nationwide in finding a new way to care for patients with an unknown virus.
"You can see there's an oxygen tank here. And in addition to that, there's an oxygen rate regulator, see the air oxygen mixer," Dr. Ciuffo said as he walked me through the large machine. "And we can basically modulate how much oxygen is put through the oxygenator while the machine flows so that I can control the patient's temperature, how much I'm flowing."
This machine takes your blood, oxygenates it, and gives it back, taking work away from your body and giving it a chance to heal.
"And what you do with his machines, you actually connect them to veins and arteries in the body and circulate the blood into an oxygenator something that basically is replacing your lungs," Dr. Ciuffo said. "You oxygenate the blood, give it back to them and that will give them the break they need to get through the COVID infection until the lungs recover their ability to oxygenate."
The oxygenator is used to help those who have suffered a massive heart attack, pulmonary embolism, or blood clots, and those whose heart has stopped because they got too cold. This machine can help bring their temperature back up and help bring them back to life.
"So this one is basically what will keep your patient alive and well. While they go into the next level of treatment if it's available to them." While the outcomes were initially unknown when treating COVID-positive patients, they saw positive results.
"In medicine, you always had to strike a balance between what's reasonable to help someone and what's just far fetched," Ciuffo explained. "In those patients that we use this machine on really he was not far fetched. They survived. So it was well worth all the effort we put on it."
For Dr. Ciuffo, and others in the fight to save lives, it's all about giving people a 2nd chance at life.
"Human Physiology, this complex beautiful machine we call the human body with lungs and kidneys and heart and brain and electrical system and all that is incredibly complex."
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A peek inside the Cath Lab at MercyOne Siouxland
A catheterization laboratory may look like a scary place with a big name, but it's a common stop for patients entering the hospital with possible cardiovascular problems.
"In the Cath Lab, what happens is patients will be brought into the cath lab such as this, and their heads will be up here near the imager and their feet down here," said Dr. Gary Chan, a cardiologist with MercyOne Siouxland Medical Center.
In the Cath Lab, cardiologists use diagnostic imaging equipment to visualize the arteries and chambers of the heart.
"Now there are two ways to do the cath. One is to the wrist and another one is through the groin." During the procedure, the patient will be moderately sedated to help calm the nerves and ensure they can lay still for 45 to 90 minutes.
"They will put a fine tube in a way very similar to an IV but then the tubing is way longer because it has to be long enough to go all the way up to your arms to your heart or from the groin so that they can inject some contrast to it," said Chan. "And then with that, they can visualize the three coronary arteries in the heart and see if there's any blockage."
Dr. Chan says there are generally four outcomes from a cath procedure. The first, nothing is wrong and the issues the patient is feeling are not related to a blockage in the heart.
"Outcome number two is the patient does indeed has some blockage and that can be fixed by a stent," said Chan.
The third outcome is when a stent doesn't work and the patient will be referred to a cardiothoracic surgeon to see if they qualify for bypass surgery.
"In a bypass surgery, what happens is they either use your own blood vessel in your chest wall area, or harvest a piece of veins in your legs, and then just sew it across the blockage, that's why it's called bypass," said Chan. "The earlier we open a blockage, blood vessels supply the heart the more recovery the heart can retain the functions we can prevent loss of functions of the heart."
The 4th outcome, if a stent or bypass is not an option, is medical management.
"The last outcome is then also not a candidate for this and that will be managed medical management," said Chan. "Only meaning that we keep them we give them the medicine that will help prevent further progression of the disease."
Dr. Chan says health risks in the cath lab are minimal, with possibly some minor bleeding at the insertion site or a drop in blood pressure.
"If this is an elective procedure is generally safer than someone coming in with a cardiac arrest or having an acute heart failure flown in from a rural area," said Chan. "So this is totally different. The risks are totally different."
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Cold weather and heart attacks
Winter weather typically means snow and ice which also means shoveling snow and bitterly cold temperatures, but did you know that combination could lead to a heart attack?
"It is comparable to if we got on one of these treadmills and we're running full speed." Bridget Hayes Beck is a Registered Nurse at Mercyone Siouxland's Cardiac Rehab Center, "it just shocks people that when they go out and shovel their walks in their driveways that how much stress that puts on their heart."
She's helped Siouxlanders recover after suffering a heart attack in the winter and has a word of warning for Siouxlanders.
"If we could get the word out to the public, that is very dangerous to just go out and start shoveling the walk and the driveway."
But why are heart attacks common in the winter months? Simple... the cold.
"It does really wear on the heart, that cold air coming into the lungs, into the heart can constrict down the coronary arteries and that's where people have problems," she said. "It will cause those coronary arteries that are smaller than drinking straw to constrict down. And at that point, some people do have a heart attack meaning that the heart cells do not get oxygen and do not get the blood that they need."
There are a few things you can do to stay a little safer while shoveling snow or working in the cold, like taking frequent breaks.
"It's very important to warm up. It's very important not to have a big meal beforehand," she said. "And then when you do go out there take small breaks."
And this is especially true for Siouxland farmers, who spend hours outside working at a time.
"Now if you try to tell that to a farmer who's going to be out there for three hours, no take your breaks," she said. "Especially let a family member know that you're out there."
When in doubt, take a break, and if something doesn't feel right, seek medical assistance right away.
"But the most important thing is to make that phone call or have your family member make the phone call for you."
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Preventing heart attacks with simple life changes
Heart attacks and heart disease can present differently in everybody.
"In women, in particular, especially older women, the symptoms are typically unusual," said Dr. Glynne Edwards. "It can be breathlessness and just shortness of breath, unusual sweating episodes, sometimes a toothache, even belching, unusual belching symptoms."
Signs and symptoms of heart attacks, heart disease or coronary artery disease can manifest with pain or pressure in the chest, which typically moves toward the left side of the body.
But what can cause these life-threatening events?
"A very common thing is high blood pressure and high blood pressure has a lot of effects on the heart that, if unchecked, you know, heart failure relationship," said Dr. Edwards.
Another common denominator? Genetics.
"Knowing your family history of heart disease is also important," said Dr. Edwards.
So how can you stay heart healthy?Regular exercise is a good place to start.
"The American College of Cardiology has a recommendation for 120 minutes of aerobic exercise in the seven-day period," said Dr. Edwards.
Watching what you eat is important, too, as well as staying away from tobacco use.
"Smoking is the number one modifiable risk factor for the use of hierarchy disease animalism formation, vascular disease in the legs and the stroke."
At the end of the day, staying active, eating a balanced diet and knowing your family medical history can be a good start in keeping your heart healthy each and every day.
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Smoking isn't just bad for your lungs, but your heart, too
"Smoking is probably the number one most important preventable risk factor when it comes to heart disease." We've all heard the warnings about smoking and your lungs, but did you know it's just as bad for your heart? Not only heart disease but coronary artery disease and many other life-threatening health issues.
"There is increased risk of strokes, increased risk of blockages in the leg arteries and damage to the major arteries of the heart and the body, in particular, the aorta which can become involved forming an aortic aneurysm," said Dr. Glynne Edwards. "And in these cases, these always require emergency surgery. So, an ounce of prevention is better in this in this instance."
Smoking and tobacco use can cause your arteries to shrink, "and what we call vasoconstriction, where the arteries actually shrink from this size to 1/3 of the size in response to these toxic chemicals," said Dr. Edwards.
Not only that smoking and tobacco can also cause plaque build-up in the arteries feeding your heart.
"In some instances, the narrowing may not be acute but so severe that it weakens the heart muscle to the extent that you develop what is called heart failure," said Dr. Edwards. "Overall, it triples or quadruples your risk of getting a heart attack. If you're under 50. That risk is increased sevenfold. more than doubled your risk of having a stroke."
And if keeping yourself healthy isn't motivation enough, think of the health damage it can cause to those around you.
"The only thing I want to mention is that secondhand smoke also tripled your risk of having heart disease and we've actually looked at data for folks who have been exposed to secondhand smoke over a lifetime 20-30 years, their risk of developing coronary disease even though they didn't smoke themselves, is three times higher than folks who are not exposed to secondhand smoke."
While this is probably something we've all heard before, the best thing you can do is put that cigarette down.
"So generally the advice in anyone who smokes and who has heart disease would be to find a way to try to quit."
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