Recognize the Signs

Many people think a heart attack is sudden and intense, like a “movie” heart attack, where a person clutches his or her chest and falls over. The truth is that many heart attacks start slowly, as a mild pain or discomfort. Your symptoms can even come and go.

“If you feel such a symptom, you might not be sure what’s wrong. Even people who have had a previous heart attack sometimes don’t recognize it if it happens again, because the next attack can have entirely different symptoms,” said Cooper University Hospital cardiologist Elias A. Iliadis, MD, Medical Director of Noninvasive Vascular Intervention at the Cooper Heart Institute.

Also, if you’re a woman, you may not believe you’re as vulnerable to a heart attack as men, but you are. Women account for nearly half of all heart attack deaths. Heart disease is the number one killer of both women and men.

It’s vital that everyone learn the warning signs of a heart attack. They are:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. The discomfort can feel like uncomfortable pressure, squeezing, fullness, or pain.
• Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
• Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.
• Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

As with men, women’s most common heart attack symptom is chest pain or discomfort. But women are somewhat more likely than men to experience some of the other common symptoms, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Act Fast

If you or a family member feels heart attack symptoms, call 9-1-1 immediately. Do not delay. Seek fast treatment. Minutes matter. “Heart attack deaths and heart damage can often be avoided when treatment begins within an hour of when the symptoms started. Most studies show a large reduction in death rates and in heart damage in patients treated within 1 hour of the start of symptoms,” said Dr. Iliadis.

There are differences in how women and men respond to a heart attack. “Women are less likely than men to believe they’re having a heart attack and more likely to delay seeking emergency treatment,” Dr. Iliadis said.

Further, women are more likely to have other conditions, such as diabetes, high blood pressure, and congestive heart failure–making it all the more vital that they get proper treatment fast.

Heart disease is the number one killer of American women, and nearly half of all heart attack deaths each year happen to women. Furthermore, women are less likely to survive a heart attack than men.

Be Safe, Not Sorry

Some people who are experiencing the symptoms of a heart attack might wait hours or even days before seeking needed medical care because they do not recognize their symptoms as life-threatening. That’s why it’s important to know the signs and take action quickly.

“Even if you’re not sure it’s a heart attack, you should still have it checked out. It’s better to be safe than sorry, and sometimes chest pain — even mild chest pain — is the only indicator of the beginning of a heart attack,” Dr. Iliadis said.

Emergency medical personnel, or mobile EMS teams, can diagnose a heart attack and begin treatment on the spot. They can even revive a heart that has stopped or is beating erratically.

“Emergency medical personnel want you to call to get your symptoms checked out. Even if the call turns out to be a false alarm, running the risk of feeling a little embarrassed is better than running the risk of dying or having a permanently damaged heart,” Dr. Iliadis said.

Help Yourself and Others

The time it takes for an individual to decide to ask for help is the most significant portion of time delay in getting needed medical treatment for heart attack. Sometimes heart attack sufferers dismiss the seriousness of their symptoms or they fail to recognize their symptoms as life-threatening.

Studies show that family members should expect lack of awareness or denial of the seriousness of the symptoms from those suffering a heart attack, and resistance to calling for help. Many heart attack sufferers will reject calling 9-1-1, thus delaying the arrival of help. That’s why it’s best to enlist family, friends, and co-workers now. Discuss the symptoms. Talk to your doctors about risk for a heart attack. Make a survival plan, before you need one. And remember, while most heart attacks occur in people over 65 years of age, 45 percent, or nearly half, of all heart attacks occur in people under age 65, and five percent occur in people under age 40.

“Whenever a heart attack is suspected, everyone should know to call 9-1-1 immediately. Don’t wait for the person having symptoms to agree. Take charge to make sure the person gets checked out sooner rather than later,” Dr. Iliadis said.

When You’re Having a Heart Attack, Every Minute Counts.

Cooper cardiologists open blocked arteries without surgery, using angioplasty, which restores blood flow and saves vital heart muscle. On average, Cooper doctors perform emergency angioplasty 32 minutes faster than the national average of 90 minutes, saving lives and reducing complications. Many hospitals in the community provide heart care, but few can mobilize a team available 24/7 to provide the skilled emergency care to open blocked coronary arteries. The Cooper Cardiac Catheterization Lab has the physicians, staff, and technology to provide the best heart-attack care in the region.

Related Links

• Cooper Heart Institute
• 46 Minutes to Save a Life (Video)

In observance of National Cholesterol Education Month, the Cooper Heart Institute reminds you to keep your cholesterol levels in check.

The following information is offered to help you understand the importance of cholesterol testing, and how maintaining healthy cholesterol levels can protect your heart and arteries.

What is cholesterol?

Cholesterol is a soft, waxy, fat-like substance naturally produced by the body. The body needs and uses cholesterol to make hormones, Vitamin D, and substances that help with food digestion. Cholesterol also is in some of the foods we eat. Too much cholesterol in the body, however, can build up in the arteries and narrow them, slowing or blocking blood flow to the heart.

What is meant by “good” and “bad” cholesterol?

Cholesterol travels through the blood in different types of bundles called lipoproteins. Low-density lipoprotein – LDL, the so-called bad cholesterol, delivers cholesterol to the body. High-density lipoprotein – HDL, the so-called good cholesterol, removes cholesterol from the bloodstream. This explains why too much LDL cholesterol is bad for the body and why a high level of HDL cholesterol is good. The balance between the types of cholesterol tells you what your cholesterol level means. For example, if your total cholesterol level is high because of a high LDL level, you may be at higher risk of heart disease or stroke. If your total level is high only because of a high HDL level, you’re probably not at higher risk.

When and how should cholesterol levels be tested?

Cholesterol levels should be measured at least once every five years for everyone over the age of 20. (Tests should be done more regularly for people with higher risk for heart disease [see below].)

The test that is frequently used to measure cholesterol levels is called a lipoprotein profile – a simple blood test that requires fasting for eight hours before the test. A lipoprotein profile also measures triglycerides. Triglycerides are fats carried in the blood from the food we eat. A high triglyceride level has been linked to coronary artery disease in some people. Experts recommend that men age 35 and older and women age 45 and older be routinely screened for lipid disorders (high blood cholesterol and triglycerides).

What are the healthy and unhealthy lipoprotein levels?

Total cholesterol levels:

• Less than 200 is best.
• 200 to 239 is borderline high.
• 240 or more means you are at increased risk for heart disease.

LDL cholesterol levels:

• Below 100 is ideal for people who have a higher risk of heart disease. Higher risks include obesity, high blood pressure, diabetes, family history of heart disease, smoking, etc. Some experts recommend that people with heart disease or blood vessel disease should try to get their LDL cholesterol below 70.
• 100 to 129 is near optimal.
• 130 to 159 is borderline high.
• 160 or more means you are at a higher risk for heart disease.

HDL cholesterol levels:

• 60 or higher greatly reduces your risk of heart disease.
• Less than 40 means you are at higher risk for heart disease.

Triglyceride levels:

• Less than 150 is normal.
• 150 to 199 is borderline high.
• 200 to 499 is high.
• 500 or higher is very high.

Remember, a lipid profile can help determine your risk for heart disease and guide you and your doctor in deciding what treatment might be best for you if your levels are borderline or high. Depending on your results and other risk factors, treatment options can involve lifestyle changes, such as diet and exercise, and/or lipid-lowering medications and therapies.

Diagnosing and treating complex lipid disorders

The Cooper Heart Institute offers special expertise in diagnosing and treating complex lipid disorders. Cooper cardiologist Perry J. Weinstock, MD, Head of the Division of Cardiovascular Disease and Director of Clinical Cardiology at Cooper University Hospital, is one of only a few hundred physicians nationwide certified by the American Board of Clinical Lipidology (ABCL). He also is distinguished as an ABCL Diplomate, a status recognizing his successful completion of advanced education and rigorous examination in the field of clinical lipidology. Dr. Weinstock serves on the Board of the American Heart Association and is an officer on the Board of Directors of the Northeast Lipid Association. He also is a member of the editorial board of the Journal of Clinical Lipidology.

Read more about cholesterol and the advanced lipid testing available at the Cooper Heart Institute from these eHealth Connection articles on this topic:

• “Concerned About Cholesterol? Learn How Advanced Screening Can Determine Whether You Need Treatment,” May 19, 2009
• “Understanding Cholesterol and Blood Lipid Profiles,” February 1, 2008

Related Links

• Cooper Heart Institute
• Perry J. Weinstock, MD

In many patients, the leads are simply left in place, and pose few risks. However, in patients where the leads must be removed, serious complications can develop when scar tissue has formed around sites along the surface of the lead.

To provide a safe and effective removal option for these patients, electrophysiologists at the Cooper Heart Institute are now performing laser-assisted lead extraction utilizing a system from Spectranetics®.

The technology uses low-temperature ultraviolet light to safely and effectively break down the scar tissue holding the leads in place, permitting the leads to be safely removed.

“Lead extraction is a delicate and complex procedure, and Cooper is one of only a handful of centers in the Delaware Valley with the expertise required,” said John A. Andriulli, DO, Director of the Arrhythmia Device Program at Cooper University Hospital.

“Cooper also is one of the few heart centers in the region that can perform this type of procedure because it requires on-site cardiac surgery specialists,” Dr. Andriulli said.

For more information about laser lead extraction or other programs and services of the Cooper Heart Institute, call 1.800.8.COOPER (1.800.826.6737).

Related Links

• Cooper Heart Institute
• John A. Andriulli, DO

In standard cardiac catheterization procedures, patients must lie flat for hours while a needle and thin catheter are introduced into the artery in their groin. The catheter is then threaded up through the body into the vessels of the heart. After the procedure, patients must remain horizontal and immobile for hours, and may have some pain and bruising at the puncture site for several days.

At Cooper, skilled practitioners offer appropriate candidates the option of having their cardiac catheterization performed with access through the wrist, via the radial artery, eliminating the need for lying flat and motionless for long periods.

“There are multiple benefits for the patient in addition to lifting the restriction on remaining flat and immobile,” said cardiologist Elias A. Iliadis, M.D., Medical Director of Noninvasive Vascular Intervention, at the Cooper Heart Institute.

“There is a lower risk of bleeding with the wrist access, as only a small bandage at the wrist is required post-procedure. Patients can move about immediately after the catheterization, with no required bed rest. Many patients actually return to driving and work the following day,” Dr. Iliadis said.

Radial artery access requires a high level of practitioner skill. Less than 5 percent of cardiac catheterizations are performed with a wrist access nationwide. At Cooper, however, the rate is nearly three times the national average.

“I believe we have a higher rate of radial/wrist access because of the depth of expertise and experience of Cooper cardiologists,” Dr. Iliadis said.

If you would like to find out more about radial artery access or would like to make an appointment with a Cooper cardiologist, call our Physician Referral Service at 1.800.826.6737.

Related Links

• Cooper Heart Institute

This year, that search can be easily met at Cooper’s expanded physician practices in the suburban tri-county area.

From family medicine to obstetrics and gynecology, and from orthopaedics to medical specialties, Cooper University Hospital’s University Physicians have begun to see patients at new and improved locations in Burlington, Camden and Gloucester counties.

This expansion represents Cooper’s commitment to quality, patient- and family-centered care by offering academic medical services at convenient, state-of-the-art facilities in Voorhees, Washington Township and Willingboro.

With a new office complex at 900 Centennial Boulevard, Building 2, in Voorhees (in the former Village Shoppes Plaza), Chief of Orthopaedic Surgery Lawrence S. Miller, M.D., said, “We are excited to be one of several specialties that have moved into this beautiful complex. This new office complex will allow increased communication among all physicians and staff, improving the way we deliver care to our patients.”

While Cooper Bone & Joint Institute and its Sports Medicine and Rehabilitation Services, along with several medical practices, have already moved to the new and larger quarters in Voorhees, others are set for relocation in April (see list below).

New to 6117 Main Street in Voorhees are Cooper Obstetrics/Gynecology Practices. They provide women with clinical services, joining with the health education and resources of The Ripa Center for Women’s Health & Wellness, located at 1011 Main Street.

Cooper Rheumatology Practices also are new to Voorhees, having moved into the new complex at 900 Centennial Boulevard, Building 2. Cooper’s Surgical Specialty and Hematology/Oncology Practices are scheduled to expand at 900 Centennial Boulevard, Building 1, in 2010.

The Department of Family Medicine also has opened a beautiful 2,400-square-foot outpatient facility in Washington Township, at 123 Egg Harbor Road, Tower Commons, in Sewell.

“The new location in Washington Township now offers our patients better access in a more convenient, comfortable and newly constructed office setting,” said Dyanne P. Westerberg, D.O., Chief of the Department of Family Medicine at Cooper University Hospital.

In Willingboro, expansion will occur this spring. Cooper Specialists and Cooper Primary Care will add a second site, which will be located on JFK Parkway.

Cooper on the Move

These Cooper Physician Practices Are Growing to Serve You Better

In Voorhees:

• Bone & Joint Institute
  From: 6117 Main Street
  To: 900 Centennial Boulevard, Building 2, Suite 203
  View directions & map with Google Maps
• Bone & Joint Institute – Physical Medicine and Rehabilitation
  From: 6225 Main Street
  To: 900 Centennial Boulevard, Building 2, Suite 203
  View directions & map with Google Maps
• Heart Institute
  From: 900 Centennial Boulevard, Building 1, Suite H
  To: 900 Centennial Boulevard, Building 2, Suite 202
  View directions & map with Google Maps
• Internal Medicine
  From: 900 Centennial Boulevard, Building 1, Suite L
  To: 900 Centennial Boulevard, Building 2, Suite 201
  View directions & map with Google Maps
• Obstetrics and Gynecology
  From: 1210 Brace Road, Cherry Hill
  To: 6117 Main Street
  View directions & map with Google Maps
• Rheumatology
  From: 1103 North Kings Highway, Cherry Hill
  To: 900 Centennial Boulevard, Building 2, Suite 201
  View directions & map with Google Maps

In Washington Township:

• Family Medicine
  From: 603 N. Broad Street, Woodbury and 141 South Black Horse Pike, Blackwood
  To: 123 Egg Harbor Road, Tower Commons, Building 600, Suite 604, Sewell
  View directions & map with Google Maps

In Willingboro:

• Primary Care
  (Additional office opening Spring of 2010)
  From: 218 Sunset Boulevard
  To: 651 JFK Parkway
  View directions & map with Google Maps

A Cooper cardiologist explains: “Heart disease is an umbrella term for a number of complex problems affecting the heart muscle, the blood vessels in the heart, and the veins and arteries leading to and from the heart. While all of the many types of heart disease differ, one can think of them in a simplified way as conditions that affect the rhythm and blood-flow of the heart,” said Perry J. Weinstock, M.D., Head of the Division of Cardiovascular Disease at Cooper University Hospital.

Heart Attack vs. Cardiac Arrest

Perhaps the most misunderstood terms related to heart problems is the difference between heart attack and cardiac arrest.

“Heart attack, which is caused by a circulatory problem in the heart, is quite different from cardiac arrest, which is caused by a rhythm problem in the heart,” Dr. Weinstock said. “A heart attack occurs when a coronary artery is blocked and the heart does not get the blood supply it needs, causing permanent damage to a portion of the heart muscle. All heart attacks are due to to circulatory problems; however, not all heart attacks cause the heart to stop beating.

“Approximately one-third of all heart attacks result in cardiac arrest or sudden death. In cardiac arrest, however, the heart does suddenly stop beating. The heart stops because a chaotic, irregular heart rhythm causes the heart to suddenly stop pumping blood. Cardiac arrest, also known as sudden cardiac death, results in a medical emergency, and may or may not be related to a heart attack. Sudden cardiac death is the number one killer among adults in the United States accounting for approximately 300,000 deaths per year,” Weinstock said.

Types of Heart Disease include:

Coronary Artery Disease (CAD) — the most common type and the leading cause of heart attacks. CAD is a narrowing and hardening of the arteries caused by the build up of plaque within the walls of the arteries that supply the myocardium—the muscular tissue of the heart. Angina pectoris (chest pain) is a frequent symptom of CAD. Myocardial infarction is the medical term for a heart attack.

Heart Failure — Heart failure, also known as congestive heart failure (CHF), is an umbrella term for different types of disorders marked by the inability of the heart muscle to pump enough blood throughout the body. This inability restricts the blood supply to other organs, resulting in damage to the organs or poor functioning of the organs. Heart failure has many causes, including untreated high blood pressure. Symptoms of heart failure include shortness of breath; swelling in the feet, ankles, and legs; and extreme tiredness. Heart failure does not mean that the heart stops beating.

Heart Arrhythmias — a group of conditions characterized by irregular heartbeat or abnormal heart rhythm due to a malfunctioning of the heart’s “electrical system”—or impulses that drive the beating/pumping action of the heart. Symptoms may include palpitations, dizziness, fainting, and shortness of breath and chest discomfort. Many different factors can cause arrhythmias, including CAD, electrolyte imbalances in the blood (such as sodium or potassium), changes in the heart muscle, and injury from a heart attack. Atrial fibrillation (A-Fib) is an irregular and often rapid heart rate that commonly causes poor blood flow to the body and symptoms of heart palpitations, shortness of breath and weakness. It is a common arrhythmia that requires close monitoring and treatment with medication or a corrective procedure. Ventricular fibrillation (V-Fib), on the other hand, is always a medical emergency. When V-Fib occurs, effective pumping of the blood stops. V-fib is considered a form of cardiac arrest, and an individual suffering from it will not survive unless CPR (cardiopulmonary resuscitation) and defibrillation treatment are provided immediately.

Cardiomyopathy — the deterioration of the function of the myocardium—the heart muscle. People with cardiomyopathy are often at risk of arrhythmia and/or sudden cardiac death. Many times, the cause of cardiomyopathy is unknown; however, the most common cause is CAD, heart attacks, or myocarditis (a viral infection that causes the heart muscle to become inflamed). Some people with cardiomyopathy never have symptoms, and others have no symptoms in the early stages of the disease; however, as it progresses, the symptoms are similar to heart failure.

Heart Disease Prevention

“Remember, many types of heart disease can be improved, or even prevented, by making certain lifestyle changes, such as not smoking, maintaining a healthy weight, staying physically active, eating healthful foods, managing stress, and controlling such conditions as high blood pressure, high cholesterol and diabetes,” said Dr. Weinstock.

“Also, don’t ignore the importance of regular medical check-ups. Early detection and treatment can set the stage for a lifetime of better heart health,” Dr. Weinstock said.