Patients able to pass a cardiac exercise test have a 98 percent chance of not having a heart attack the next year, says Dr. Jerrold Glassman, chief of cardiology at Scripps Mercy.

Heart attacks are preventable, says Dr. Jerrold Glassman, chief of cardiology at Scripps Mercy. People can lower their risk through lifestyle changes and by understanding nonmodifiable factors such as gender and family history. By working with their doctors, people can modify many risk factors with drugs, diet and behavior. “If you have high blood pressure and you treat it successfully, make it normal blood pressure, you drastically reduce the risk of heart attack,” says Glassman. “Smoking is, of course, clearly the most modifiable.”

Scripps Mercy in Hillcrest is one of five Scripps hospitals in the region with programs devoted to the education, prevention, diagnosis, research and treatment of cardiac disease. In 2004, its center was named one of the Top 100 Hospitals for Cardiovascular Care in the nation by Solucient, a medical database company. It was one of only two in the state to make that list.

When it comes to heart health, Glassman says it is pretty easy to determine who is at risk. Here are the factors: overweight, lack of exercise, poor diet and a tendency toward high blood pressure, diabetes and high cholesterol.

Just getting physically fit reduces the chance of a heart attack. But how at risk is your body? When should you see the doctor?

For those with a family history of heart disease, it is a good idea to see a physician before starting an exercise program. An easy treadmill test measures stress on a body during exercise. “Even in the population of people with heart disease, if you are able to do the exercise test without problems, you have a 98 percent chance next year of not having a heart problem,” Glassman says.

Heart attacks also can be stopped. “If you have any thought that it might be a heart attack,” Glassman says, “the sooner you get to a medical facility, the chance of you having a good outcome is dramatically increased. If you get there in 90 minutes or less, you have a 98 percent chance of success. If you are in doubt, go to the hospital. They can stop a heart attack.”

Mercy’s Heart Care Center conducts clinical research on investigational medicines and procedures. Current efforts include a study on individuals who fail to tolerate cholesterol-lowering medicines (statins) and the potential damage to their muscle tissue; one that employs special software to measure patients’ breathing when using or not using a given drug therapy and to lower their cholesterol when they cannot tolerate statins; a medication study for patients receiving a drug stent to find the best combination of medications for the stent; a national database of stent patients and outcomes; and a study comparing a clot-busting drug with a standard treatment for heart attack patients.

Mercy Hospital’s Cardiac Rehabilitation Program helps most patients return to full, productive lives. It provides exercise, cardiac monitoring, educational classes to change lifestyles, emotional support and dietary counseling. The center teaches patients how to get control of their lives and strengthen their bodies.

Scripps Memorial in La Jolla touts its Heart Center as the largest cardiovascular program in San Diego. Here, Scripps provides the latest in diagnostic, intervention, arrhythmia management and surgical procedures, as well as cardiac rehab. The cardiovascular center will undergo expansion this month to increase its space by 15,000 square feet. This will add two new cath labs, one electrophysiology lab and a 17-bed recovery area. “All cardiac services within the hospital will be centralized to one area,” says Chris Messick, manager of the Cardiac and Pulmonary Rehabilitation Center. “The current cardiac cath lab is at capacity and further growth is projected in this area. The cardiac rehab program is also at max capacity and needs more room.”

The new rehab center will offer comprehensive cardiac and pulmonary rehab programs. Patients can benefit from nutrition and stress counseling, support and educational groups, tai chi, yoga, pilates, fitball classes and massage therapy. The rehab center will be located on the second floor of the Schaetzel Center. Expansion cost is about $21 million. Funding is through donors and capital funding from the Scripps system.

At the Scripps Center for Integrative Medicine and Healing Hearts Program in La Jolla, the focus is on aggressive detection and prevention with emphasis on changing lifestyles. Treatment regimes include acupuncture, biofeedback, guided imagery and hypnosis, herbal pharmacy, herbal and nutritional supplement consultation, healing touch treatment and professional training, massage, nutrition consultation, cooking classes, stress reduction, yoga and meditation, kundalini yoga and watsu water massage. The center is run by Dr. Erminia Guarneri who leads by example with her own active and healthy lifestyle. Guarneri, who appeared on the cover of San Diego Metropolitan in February 2004, has penned and released her book, “The Heart Speaks: A Cardiologist Reveals the Secret Language of Healing.” Within the pages, Guarneri uses new scientific research and personal stories “to explore the emotional, spiritual and mental landscape of the heart — and why it so often breaks down.”

Education At Kaiser

Kaiser strives to engage its cardiac patients as partners in providing education, support, information and encouragement.

At Kaiser Permanente, education is the most important part of recovery. “It’s not enough to perform life-saving procedures,” says Dr. William Keen, cardiologist. “We have to engage the patient as partners in their health concerns. That includes providing education, support, information, encouragement and excellent communication from all of us.”

Kaiser’s health education department offers classes on eating healthy, exercise, weight control, stress management, medication compliance and accessing the hospital system’s resources. A healthier living class covers how to deal with issues that face people with chronic conditions such as medications, depression/stress, pain control, starting an exercise program, relaxation techniques, better communication and problem solving techniques.

The cardiology department also provides access to a post-cardiac surgery class for patients and their family or caregivers. The class covers what to expect during recovery, how defibrillators and pacemakers work, the signs of setbacks, how to measure progress and specific guidance on appropriate physical exercise. A post-coronary interventions class covers all aspects of recovery from congestive heart failure, including follow-up medical care and medications.

A wellness center offers a variety of weight management programs, nutritional counseling and exercise programs while the psychiatry department provides counseling and support groups. With multiple health lines and centers, patients and their families have support groups available to aid in recovery and prevent future complications.

UCSD’s Research Expertise

The UCSD Cardiovascular Center operates UCSD Medical Center, Hillcrest; UCSD Medical Center, Thornton Hospital in La Jolla; and the VA Medical Center. Examples of research and clinical successes that have come from its efforts include:

• The Electrophysiology Program to treat electrical anomalies of the heart, founded 19 years ago and the region’s largest. The procedures treat atrial fibrillation, atrial flutter and other electrophysiological problems.
  
  
• A new test to detect oxidized phospholipids in the bloodstream developed by Dr. Sotirios Tsimikas and Dr. Joseph Witztum. This predicts the presence and extent of coronary blockages, especially in patients younger than 60 years old who also have elevated cholesterol levels.
  
  
• Pulmonary thromboendarterectomy surgery, the surgical removal of lethal blood clots from the pulmonary arteries, which UCSD developed more than 30 years ago. In early 2006, UCSD will perform the 2,000th surgery at Thornton Hospital. UCSD performs about 150 of these per year.

The structure of a recovery program depends on the patient and severity of the attack. “If the patient’s had a mild heart attack and we fix the problem, we send them home and back to regular life rather quickly,” says Dr. Anthony DeMaria, director of the Anthony DeMaria cardiovascular center and Metropolitan cover boy for a February 2003 feature on cardiac care. “Somebody with a large heart attack would go home to convalesce. We restrict their activity.”

For those who have suffered an “in- between” heart attack, their recovery is based upon the stress exercise test. A rehabilitation program of exercise, training and conditioning and a modification of coronary risk factors is prescribed. UCSD does not provide structured programs. Instead, its doctors refer patients to classes and support groups within the community. “Rather than us reinvent the wheel, we turn them to the community,” DeMaria says.

‘We fix the problem and send them home and back to regular life rather quickly,’ says UCSD Dr. Anthony DeMaria of patients who have had a mild heart attack.

Just approved by the University of California Board of Regents is construction of a new cardiovascular center and expansion of critical care services at the John M. and Sally B. Thornton Hospital. This will construct a state-of-the-art cardiovascular center on UCSD’s East Campus medical complex and bring together UCSD’s patient care, clinical research and teaching activities in heart and vascular disease and stroke management. DeMaria will head the new center. Emergency cardiovascular and stroke services will remain at the UCSD Medical Center in Hillcrest. The $136.5 million project will be funded by $30 million raised by the center board. The center has been named the Sulpizio Family Cardiovascular Center in recognition of a $10 million leadership gift from San Diegans Richard and Maria Sulpizio.

The Sulpizio Family Cardiovascular Center will include 16 to 20 examination rooms, and related diagnostic and treatment services along with cardiac catheterization labs, four operating rooms and expanded emergency room services. Construction is expected to begin in December 2007, with completion in December 2009.

Making History At Sharp

At Sharp Memorial, physicians are making medical history in treating the first patient in California with a next-generation ventricular assist device, the HeartMate II heart pump, which is still in clinical trials. A ventricular assist device is a mechanical pump that helps a heart too weak to pump blood through the body. It is sometimes referred to as “a bridge to transplant” since it can help a patient survive until a heart transplant can be performed.

This is one of many medical device therapy options for heart failure. The AHA and the American College of Cardiology recently issued guidelines recommending the use of the ventricular assist device to treat patients with late-stage heart failure.

Patients who do not qualify for a heart transplant due to illness or age can be supported by Left Ventricular Assist Devices permanently. More than 100,000 congestive heart failure patients could be helped by a device like this.

Although a heart attack or heart surgery can be the most frightening experience of a patient’s life, San Diego’s medical community says patients are in good hands before, during and after a procedure. By following health guidelines, making lifestyle changes and listening and responding to the body, most people have the ability to eliminate a heart attack or rapidly recover after one and go on to live a better life.