Cardiovascular Services



Specializing Institutions

Cardiovascular medicine focuses on the treatment of acquired diseases affecting the heart and the great vessels. Conditions affecting the heart include coronary artery disease, arrhythmia, heart failure and stroke. Cardiovascular diseases claim approximately 17.1 million lives each year. Tobacco use, an unhealthy diet, and physical inactivity increase the risk of heart attacks and strokes. Cardiovascular risks are particularly higher for women after menopause. Prevention programs in which physicians, physical therapists, nurses and exercise consultants work together often help patients take control of their health. The healthcare industry has been making strides in the past two decades researching and creating innovative and comprehensive treatment, prevention and detection options for patients with complex diseases of the heart, blood vessels, and circulatory system.

Cardiovascular surgery is surgery performed on the heart, the aorta and other vessels. Procedures range from Open Heart Surgery to minimally invasive procedures performed with the da Vinci® Surgical System, an advanced technology that enables surgeons to perform delicate operations with the least intrusion to the patient and is available at the South Texas Medical Center.

Non-invasive cardiac monitoring includes Holter Monitoring, also known as Ambulatory EKG or Ambulatory ECG. The Holter Monitor is portable and allows for continuous heart monitoring without interrupting the patient’s daily activities. Invasive cardiac monitoring includes Cardiac Electrophysiology, a study that requires catheterization to record spontaneous cardiac activity and cardiac responses to programmed electrical stimulation. Cardiac catheterization is common and can be used to perform a number of procedures including angioplasty, PCI, angiography, balloon septostomy and Electrophysiology studies. Both non-invasive and invasive cardiac procedures are performed at the South Texas Medical Center.

Cardiac Implantations, such as Permanent Pacemaker Implantations, or pacemakers, are used to regulate cardiac rhythm through electrical impulses. These implantations help maintain an adequate heart rate for patients struggling with low heart rate or a block in their heart’s electrical conduction. Patients can get treated for irregular heart rate and get cardiac implantations at several institutions at the South Texas Medical Center.

Another device used to detect irregular cardiac activity, and also offered at the South Texas Medical Center, is the Implantable Cardioverter Defibrillator or ICD. This implantable battery-powered electrical impulse generator helps patients who are at risk of sudden cardiac death resulting from ventricular fibrillation and ventricular tachycardia.

Cardiovascular Articles

  • CORRECTED-For diabetics, losing weight may delay kidney problems

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

    About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study's lead author Dr. William C. Knowler.

    "This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight," said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona.

    He and his coauthors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

    For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

    People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

    The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

    At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

    Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

    The study's primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

    Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

    Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

    de Zeeuw, of the Department of Clinical Pharmacy and Pharmacology at the University of Groeningen in The Netherlands, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn't line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

    Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

    "In one sense it doesn't add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already," Knowler said. "But we don't really put a lot of force behind that recommendation."

    For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

    "Any approach that results in sustained weight loss should work just as well," Knowler said.

    SOURCE: http://bit.ly/1oRix03 The Lancet Diabetes and Endocrinology, online August 11, 2014.

  • For older women, working out may keep heart rates regular

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Physically active older women are less likely to suffer from atrial fibrillation, the most common form of irregular heartbeat, than less active women, according to a new U.S. study.

    Contrary to suggestions that exercise might raise the risk of abnormal heart rhythms, the analysis based on more than 80,000 postmenopausal women found the risk of atrial fibrillation was lowered by up to 44 percent with regular physical activity.

    "This is one of the reasons we ended up doing the study, we wanted to quell some of those concerns," said senior author Dr. Marco V. Perez of the Stanford Center for Inherited Cardiovascular Disease in California.

    "These are women not engaged in extreme forms of exercise, and what we found was that women who engaged in more exercise actually had a lower risk of AF," Perez told Reuters Health. "The more obese you were, the more you benefitted."

    Atrial fibrillation (AF), sometimes shortened to "AFib," affects more than 1 million U.S. women, and raises their risk of stroke and death even more than it does for men with the condition.

    Perez and his team analyzed data from the large, long-term Women's Health Initiative study. They focused on 81,317 postmenopausal women who had been followed over an average of 11 years.

    Using hospital records and Medicare claims, the researchers found that 9,792 of the women developed AF, at an average age of 63.

    Higher body mass index, a measure of weight relative to height, increased the risk for AF, as did lower levels of physical activity.

    Women who exercised an amount equivalent to five or six 30-minute walks per week or to more vigorous activity like biking twice a week, were 10 percent less likely to develop AF than sedentary women, the authors report in the Journal of the American Heart Association.

    "By the time you're 80, your risk of AFib is about 10 percent, so if you can decrease your risk by 10 percent that is significant," Perez said.

    Obese women were most likely to develop AF, but more physical activity reduced that risk. Obese, sedentary women's AF risk was 30 percent higher than that of a sedentary woman with normal BMI, and 44 percent higher than that of a normal-weight woman who exercised.

    But obese women who exercised had a 17 percent higher risk for AF than normal-weight women who exercised.

    There are other benefits as well, Perez said, since AF leads to hospitalizations and healthcare expenditures.

    Women who exercise more could also be doing other things that lower their risk of AF, but in the Women's Health Initiative data he and his team were able to account for education, income and other lifestyle factors, he said.

    "Physical activity in itself is known to help reduce cardiovascular risk factors, one of the most important of which is high blood pressure, a known mediator of risk of atrial fibrillation," said Dr. Usha B. Tedrow, director of the Clinical Cardiac Electrophysiology Program at Brigham and Women's Hospital in Boston.

    Exercise is also known to reduce inflammation, which may play a role, Tedrow told Reuters Health by email. She was not part of the new study.

    "Atrial fibrillation is a disease where many components of the condition are not under the patient's control," she said. "This study suggests one more piece of the puzzle that can allow patients slightly more control over this disease."

    Perez would recommend that postmenopausal women make time for exercise, within reason and under supervision of a doctor if starting a new and strenuous program, he said.

    High blood pressure and diabetes are also closely tied to AF, so treating those conditions is extremely important as well, he said.

    SOURCE: http://bit.ly/1nbvrQZ Journal of the American Heart Association, August 20, 2014.

  • REFILE-Travel with medications, medical devices can be daunting

    (Removes redundant attribution in 22nd paragraph)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    Travel health and traveling with medications is a "huge mess" and "supremely unsatisfactory," said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study.

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, he told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the county of destination to continue treatment and prescribe the medication," he said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," he said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • REFILE-Travel with medications, medical devices can be daunting

    (Removes redundant attribution in 22nd paragraph)

    By Kathryn Doyle

    NEW YORK (Reuters Health) - For international travelers who need to carry medical devices and medications with them, it's not easy to find out the travel requirements at their destinations, and embassies in general aren't much help, according to a new study.

    "The problem is known to exist but has not previously been published as we have," said lead author Moses Mutie of the Faculty of Health at the University of Canberra in Bruce, Australia.

    "Most embassies focus on trade and tourism," Mutie told Reuters Health by email. "Health issues are not often a priority."

    The Australian researchers considered the situation of a traveler from their own country going to one of 25 other countries popular with Australian tourists, including destinations in Africa, the Americas, Europe, Southeast Asia and the Western Pacific.

    The researchers explored embassy and consular websites looking for the quantities and different types of medication allowed in the country for personal use, required documentation, customs information and details about travelling with medical equipment.

    They also sent a standardized email to each embassy asking those same questions.

    Two weeks later, 11 embassies had responded, two of which forwarded the questions to the Pharmacy Board of the home country but did not respond further, the authors report in Travel Medicine and Infectious Disease.

    Of the eight countries that did respond, their recommendations varied widely, and tended to be much more strict than the recommendations of the International Narcotics Control Board (INCB), an independent body implementing United Nations Drug Control Conventions.

    According to the INCB recommendations for individual travelers, you should carry a copy of the prescription, but there are no other certifications or requirements for less than 20 doses of any medication, or less than a 30-day supply of narcotics or psychotropics, such as Ambien or Haldol.

    Many embassies, however, said all drugs required special certification of ownership and personal use, beyond a valid prescription. In some countries, a visitor is required to consult a local clinician to validate ongoing need for the medication.

    Some countries warn that if authorities are in doubt, they have the right to deny entry or confiscate the medications, the authors write.

    Drugs on Schedule I of the U.S. Controlled Substances Act, including hallucinogens or stimulants with no medical use, like THC or cocaine, can never be brought across national borders.

    Neither the embassy and consular websites nor the email responses addressed medical equipment.

    Travel health and traveling with medications is a "huge mess" and "supremely unsatisfactory," said Dr. Irmgard Bauer of the Division of Tropical Health and Medicine at James Cook University in Townsville, Australia, who was not part of the study.

    Patients should turn to their treating doctor and a travel clinic, with both having the obligation to find out what is required, he told Reuters Health by email.

    "Travellers on longer trips could also be referred to a colleague in the county of destination to continue treatment and prescribe the medication," he said. "In some cases, it may mean that travel cannot happen."

    Specific outcomes for a traveler with too much medication or not enough documentation depend on the country, its law, and the person working at customs that day, Bauer said.

    "With narcotics, an arrest is not unlikely," he said. "In some countries, this will not be pleasant."

    The situation can be toughest for last minute travelers, Mutie said, but ideally there will be sufficient time to search for information ahead of time and talk to your doctor, who should be the principal source of the required information.

    Dr. Natasha Hochberg, an infectious disease physician at Boston University School of Public Health, suggested "that international travelers with chronic medical conditions seek care at least 4 to 6 weeks in advance of travel at a travel clinic to address issues related to bringing medications overseas but also to address the need for immunizations and prophylactic medication and to discuss health-promoting topics."

    Hochberg, who was not involved in the new study, added, "Travelers bringing medication overseas should bring the medication in their carry-on luggage to prevent possible loss in checked baggage, keep it in the original bottle that the medication came in, take enough to last for their trip as well as some extra in case of changes to the itinerary, and have adequate documentation including the original prescription and possibly a signed letter on travel clinic letterhead."

    For medical devices, Mutie suggests planning ahead and checking with the airline. Airlines, he notes, have published clear medical clearance guidelines in this area.

    In future, embassy websites should be designed with the user in mind, since embassies are established to provide a service, he said.

    SOURCE: http://bit.ly/1lfNmeb Travel Medicine and Infectious Disease, August 6, 2014.

  • CORRECTED-For diabetics, losing weight may delay kidney problems

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Healthy eating, staying active and losing weight are already recommended for people with type 2 diabetes, and new research suggests these steps may also delay or prevent chronic kidney disease.

    About 35 percent of U.S. adults with diabetes have some degree of kidney disease, and diabetes is the major cause of kidney failure and dialysis, according to the study's lead author Dr. William C. Knowler.

    "This result along with many others tends to reinforce the value of weight loss interventions and hopefully motivates people with diabetes to lose weight," said Knowler, who is chief of the Diabetes Epidemiology and Clinical Research Section of the National Institute of Diabetes and Digestive and Kidney Diseases in Phoenix, Arizona.

    He and his coauthors reexamined data from an existing study of lifestyle modifications for people with type 2 diabetes.

    For the original study, more than 5,000 overweight or obese Americans with type 2 diabetes ages 45 to 76 were divided into two groups. Half received diabetes support and education and the other half aimed to lose seven percent of their body weight through reduced calorie diets and increased physical activity.

    People were recruited for the study between 2001 and 2004. For the first year or so, the weight-loss group met regularly with dieticians, case managers and physical activity experts to stay on track toward their calorie, activity and weight-loss goals.

    The study continued, with encouragement to stick to diet and exercise programs, through 2012. As with many weight loss programs, the first year is the critical period for weight loss and later years are spent maintaining it, which can be difficult, Knowler said.

    At the one-year mark, the diet and exercise group had lost an average of 8.6 percent of their body weight, compared to less than one percent lost in the support-and-education group.

    Over the entire study period, people in the diet and exercise group were 31 percent less likely to develop very high risk chronic kidney disease, according to urine tests.

    The study's primary aim was to investigate the power of weight loss to reduce the risk of heart problems or stroke, and as the researchers published previously, no benefit was seen there.

    Knowler emphasized, however, that the weight loss program did improve the outlook for kidney disease and many other aspects of health, including depression, knee pain, urinary incontinence and heart rate recovery after exercise.

    Dr. Dick de Zeeuw writes in an accompanying editorial in The Lancet Diabetes and Endocrinology that he found the kidney-health benefit with no heart benefit difficult to reconcile.

    de Zeeuw, of the Department of Clinical Pharmacy and Pharmacology at the University of Groeningen in The Netherlands, also writes that using very high risk chronic kidney disease as the marker of success or failure in the study doesn't line up with what most trials like this would do if a drug were being tested instead of a lifestyle change.

    Nevertheless, these results reinforce the existing recommendation that people with type 2 diabetes should maintain a healthy weight, he told Reuters Health.

    "In one sense it doesn't add anything to existing recommendations because for overweight people, weight loss and increased activity are recommended already," Knowler said. "But we don't really put a lot of force behind that recommendation."

    For most people, telling them to lose weight and handing out some pamphlets is not enough, he said. This study indicates that an intense program of major behavioral change, including counseling, group session and mutual reinforcement can work.

    "Any approach that results in sustained weight loss should work just as well," Knowler said.

    SOURCE: http://bit.ly/1oRix03 The Lancet Diabetes and Endocrinology, online August 11, 2014.