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

  • Checking pulse could help detect risk of a second stroke

    By Kathryn Doyle

    NEW YORK (Reuters Health) - Stroke patients and their families can be taught to monitor the patient's pulse and detect irregular heartbeats that might lead to another stroke, according to a new study.

    Of people who have a stroke, 40 percent will suffer another one within the next 10 years, said lead author Dr. Bernd Kallmunzer of the Department of Neurology at Universitätsklinikum Erlangen in Germany.

    Taking a pulse reading can detect atrial fibrillation, a leading source of blood clots that travel to the brain and cause stroke. Detecting atrial fibrillation is important because the patient can be treated with anti-clotting medications to reduce the risk of another stroke or death, Kallmünzer told Reuters Health by email.

    Atrial fibrillation is when the two upper chambers of the heart contract very rapidly and irregularly. At first, this irregularity occurs in episodes, then the heartbeat returns to normal rhythm and may not cause any symptoms.

    There's no treatment for the fibrillation itself, but the longer a person's pulse is monitored, for example by an electronic sensor, the greater the odds of detecting fibrillation events and starting clot prevention, the authors write in the journal Neurology.

    However, not everyone has access to or can afford high-tech monitoring, so the study team tested how accurately patients and their families could detect fibrillation just by taking a pulse.

    The study included 256 patients who had suffered a first stroke and were treated at the authors' stroke unit in Germany in late 2012 or early 2013. While still hospitalized, the patients and in some cases also their relatives were taught to take pulse readings from the radial artery in the left wrist.

    The patients and families were also given printed instruction materials and a stopwatch.

    During the half-hour tutorial, patients were taught to use the stopwatch to measure pulse rate and to recognize a normal pulse sensation and an irregular sensation that may indicate atrial fibrillation.

    Atrial fibrillation feels like a 'stumbling' rhythm and may be faster than 100 beats per minute or slower than 50, Kallmünzer said. A normal heartbeat is rhythmic and regular and only changes slightly on inhale and exhale.

    The patients were then hooked up to an electrical heart monitor and the screen was covered. A healthcare professional, the patient and the patient's family all attempted to take a pulse reading.

    According to the electrical heart monitor, 172 of the patients had normal heart rhythms and 57 had atrial fibrillations - the rest had another kind of abnormal rhythm. The researchers analyzed how often wrist pulse readings achieved the same result as the electrical heart monitor.

    Almost 90 percent of the patients who were mentally able did complete a pulse reading on themselves, and correctly detected 54 percent of the atrial fibrillations. Health care providers detected 97 percent of atrial fibrillations.

    Only six patients who thought their heart rates were irregular were incorrect. A false-positive rate that low is encouraging, the authors write.

    Among patients with atrial fibrillation whose family members took the tutorial, relatives detected the irregular beats 77 percent of the time by taking the patient's pulse.

    When atrial fibrillation is detected, medication can reduce the risk of a second stroke by 60 to 70 percent in comparison to not treating patients, according to Rolf Wachter of Universitatsmedizin Gottingen in Germany.

    "This is, I would say, one of the most effective therapies in medicine," he told Reuters Health in an email.

    Wachter, who was not part of the new study, researches heart conditions like atrial fibrillation.

    "We do not specifically know whether the approach in this paper is really the best approach. Other methods, including using a machine to monitor heart rhythm, might be better at detecting fibrillations, but they haven't been compared to each other in a trial," he said.

    "In general, taking your pulse is easy, harmless and free from side effects. Therefore anyone can try to do it," Kallmünzer said. "In stroke patients with very severe disability, family members, friends or nurses can do the measurements for the patient."

    The risk of a second stroke is highest during the months after the first one, but currently researchers do not know exactly how long this kind of pulse monitoring should go on, he said.

    If you're not sure how to take your pulse or that of a family member or how often you should check, ask your doctor, he said.

    "Health care professionals, doctors and nurses have outstanding experience in this technique and will be glad to give instructions."

    SOURCE: Neurology, online July 23, 2014.

  • Hispanic Americans need tailored heart care: report

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Hispanic Americans make up the fastest growing minority group in the U.S. and healthcare professionals need to better understand their unique heart health risks in order to tailor their care, according to a new report from the American Heart Association.

    That's not to say the 53 million U.S. Hispanics are all the same, the authors emphasize in their review of research detailing health-related traits and trends among groups of people whose origins are in the Spanish-speaking countries of the Americas and Caribbean.

    "We hope that we can move into a new era when we can look at this population with a more nuanced perspective," said Dr. Carlos Rodriguez, the report's lead author and a cardiologist at Wake Forest Baptist Medical Center in Winston-Salem, North Carolina.

    Cardiovascular disease includes conditions that affect the heart and blood vessels, such as heart failure, strokes and high blood pressure.

    The size and growth of the U.S. Hispanic community makes the group's health vital to the nation and to reaching the American Heart Association's 2020 goals, Rodriguez and his co-authors write in the journal Circulation.

    The 2020 goals aim to improve the cardiovascular health of all Americans while reducing deaths from cardiovascular diseases by 20 percent between 2011 and 2020.

    "For us to meet those goals and for us to be a healthy population and a healthy country, all groups have to be accounted for," Rodriguez said.

    The working group that produced the new report combed through medical literature to summarize what is known about the health of Hispanic Americans, identify gaps in the research that need to be filled and come up with recommendations for healthcare providers. In total, they summarize findings from 400 studies and articles.

    Much of the information on cardiovascular disease, they found, is focused on Mexican Americans, which may give an inaccurate view of the health of other Hispanic populations, such as people from South America and Puerto Rico.

    The report notes that about a third of Mexican Americans have cardiovascular disease, which is slightly lower than non-Hispanic whites and considerably lower than non-Hispanic blacks.

    While heart disease appears to be less common overall among Hispanic Americans, the researchers found a number of specific risks that seem to afflict Hispanics more than other racial and ethnic groups.

    For example, Mexican Americans are twice as likely to have a stroke before age 60 and are more likely to be hospitalized for heart attacks than non-Hispanic Americans.

    "We found Hispanics have high rates of diabetes, high rates of high cholesterol and really very prevalent within this population is poor access to care and economic challenges that impact on healthcare," Rodriguez said.

    Hispanic American children are also more likely to be obese than non-Hispanic white children.

    And while Hispanics are less likely to smoke as a group, certain subpopulations including Mexican and Cuban men and Puerto Rican women have smoking rates much higher than the national average.

    Noting the racial diversity of certain Caribbean and Latin American countries, the researchers point out that some Hispanic Americans may also have risk factors associated with African, Asian or Amerindian roots.

    "The recognition that the Latin groups have become our largest minority group and recognizing the diversity within them and paying attention to some of the special issues that they bring is certainly a step in the right direction," Dr. Hal Strelnick said.

    Strelnick was not involved with the new report but is dean of community engagement at the Albert Einstein College of Medicine of Yeshiva University in Bronx, New York.

    "I think one could say that the study is long overdue but it's certainly welcomed," he said.

    The working group included lists of policy recommendations as well as dos and don'ts for healthcare providers in their report.

    Those recommendations include educating healthcare providers to tailor their care to language and cultural traits of Hispanic patients, better identifying subgroups by including countries of origin or descent in medical records and increasing the Hispanic healthcare workforce.

    The report authors also suggest that U.S. screenings for cardiovascular disease begin at a younger age for Hispanics, because the condition tends to start earlier in that population.

    The American Heart Association recommends that all Americans get active, control their cholesterol, eat better, manage blood pressure, lose weight, reduce blood sugar and stop smoking to improve their cardiovascular health.

    SOURCE: Circulation, July 14, 2014.

  • Probiotics might help lower blood pressure

    By Krystnell Storr

    NEW YORK (Reuters Health) - Regularly consuming probiotics, or the "good" bacteria found in yogurt, milk and cheese, may help control blood pressure, according to a new review of past studies.

    Researchers found that consuming the proper amount of probiotics over at least two months appeared to modestly lower blood pressure.

    "I do not think the general public understands how probiotics might be beneficial to health at this stage," said Jing Sun, who worked on the study at the Griffith University School of Medicine and Griffith Health Institute in Queensland, Australia.

    "The challenge to us is to convince patients and clinicians to accept the product in daily life," Sun said.

    Past studies have shown probiotics can have a positive effect on blood sugar, cholesterol and certain hormones - all of which can impact blood flow, she noted.

    The new findings do not mean people should replace their blood pressure medication with probiotics and it is still unclear which strain or combination of strains might work best.

    The American Heart Association considers normal blood pressure to be a systolic reading of less than 120 millimeters of mercury (mm Hg) and a diastolic reading of less than 80 mm Hg. High blood pressure starts at 140/90 mm Hg and increases a person's risk of heart disease, stroke, kidney disorders and other health problems.

    For some people with high blood pressure the only effective treatment has been medication, but that means costs and possible side effects.

    The new review, published in the journal Hypertension, combined the results of nine studies that randomly assigned participants to take probiotics or not. Seven of the trials were double-blind, meaning neither the participants nor the experimenters knew who received probiotics and who received a probiotic-free placebo until the end of the study. The different strains of probiotics were delivered in products like yogurt and milk.

    The studies included a total of almost 550 people.

    The researchers found that on average, probiotic consumption lowered systolic blood pressure (the top number) by 3.56 mm Hg and diastolic blood pressure (the bottom number) by 2.38 mm Hg, compared to a placebo or no treatment.

    Getting at least 100 billion colony-forming units of probiotics each day, the amount in a carton of some yogurts, seemed to be necessary for significant blood pressure improvements. And no change in blood pressure was seen among participants who were given probiotics for less than eight weeks.

    The researchers noted that the effect of probiotics was strongest among people who already had elevated blood pressure.

    Lori Hoolihan, a researcher at the Dairy Council of California in Irvine who was not involved in the analysis, called probiotics a "functional food."

    She said the review is a step in the right direction.

    "Randomized clinical trials are the gold standard in research and they had a strict criteria for choosing the studies and they actually looked at human trials which are stronger than animal trials," she said.

    "They used real foods that had probiotics at realistic levels, they didn't use supplements or wacky chemical concoctions that no one has heard of. They used foods on the market so you and I could go into the market and pick (them) up," she added.

    "Americans don't like to think about bacteria so it's hard for people to embrace it but there are good and bad bacteria and there is no avoiding them. Our gut is home to many bacteria and if bumping up the amount of good bacteria can optimize health and prevent chronic diseases then that's a good thing," Hoolihan said.

    The price of probiotic supplements varies, but a 30-day supply from the drugstore may cost about $30.

    Dr. Shira Doron, who has studied probiotics at Tufts Medical Center in Boston, said that because probiotics only seemed to have an effect under certain conditions in specific groups of patients, it's hard to know how to make recommendations to patients at this time.

    What's more, she said, "The fact that each study within this meta-analysis was done using a different probiotic or combination of probiotics means that I as a physician am completely unable to say to my patient, 'Go out and buy probiotic X. It was shown to be effective in clinical trials.'"

    "We know no two probiotics act alike," Doron explained. "One simply cannot extrapolate from a study of one probiotic that another strain or even another dose or another source - dairy product, capsule, sachet, etc. - will work."

    "I don't think this is 'ready for prime time' yet, as they say. That being said, probiotics might help, and generally don't hurt, except perhaps your wallet, so if someone with high blood pressure wants to try probiotics as an adjunct to their regular blood pressure medication, I say go for it," she said.

    SOURCE: Hypertension, online July 21, 2014.