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

  • Weekday heart attacks still getting quicker treatment at hospitals

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who arrive at the hospital with a heart attack during business hours are more likely to survive than those who show up on weeknights, weekends or holidays, according to a new study.

    Rates of death in the hospital are very low overall, at just over 4 percent, the researchers found. But some life-saving treatments can take longer to get to patients during off hours, which makes care less than optimal, they write.

    It was actually surprising how similar quality of care seemed to be for working hours and after hours in the hospital, and even for balloon angioplasty, there was only a difference of 16 minutes, said study author Dr. Jorge F. Saucedo of the NorthShore University Health System in Evanston, Illinois.

    In the most severe heart attacks, a blood vessel in the heart is completely blocked. Using a catheter to thread a balloon into the blocked artery can immediately restore blood flow.

    In the new study, which included more than 50,000 severe heart attacks between 2007 and 2010 in the U.S., patients who arrived at the hospital during work hours took an average of 56 minutes to have angioplasty, the balloon procedure. For those who arrived on nights or weekends, the average wait time was 72 minutes.

    Both times fall within the American Heart Association's recommendation of no more than 90 minutes wait for angioplasty. The time to patients getting imaging or medication was the same for both groups, according to the results in Circulation: Cardiovascular Quality and Outcomes.

    When the researchers adjusted for a variety of patient characteristics, they found those who arrived at the hospital during off hours were about 13 percent more likely to die from any cause.

    The proportion of patients who had angioplasty within the recommended 90 minutes was 89 percent during the weekdays and 79 percent during off hours.

    All in all, the numbers are better than in past studies, the authors note in their report, and in most categories there were no differences in treatment based on when patients arrived at the hospital.

    Management of these severe heart attacks seems to have improved greatly over the past several years, said Dr. Rodrigo Estévez-Loureiro of the interventional cardiology unit at Complejo Asistencial Universitario de León in Spain.

    "Differences observed in (door to balloon) times, although statistically significant, are not clinically relevant between off and on-hours," Estévez-Loureiro, who was not involved in the new study, told Reuters Health by email.

    A 16-minute delay likely will not influence overall mortality from the heart attacks he said.

    "Also surprising was the very low in- hospital mortality for both groups," Saucedo told Reuters Health.

    The hospital catheterization laboratory, where angioplasties are performed, is fully staffed during the day but most hospitals in the U.S. do not staff the lab after hours, he said. When a heart attack patient arrives on a night or weekend, staff members are paged and have to drive to the hospital from their homes.

    To make angioplasty wait times equal day and night, catheterization labs would have to be fully staffed 24-hours per day, but currently the financial and logistical costs would be too high to recommend that, Saucedo said by email.

    Patients may have waited longer to come to the hospital with heart attack symptoms in the middle of the night, which might have contributed to the increased risk of death, he noted. All things considered, the management and outcomes for people with severe heart attacks after hours was very good.

    One takeaway message for patients, he said, is to come to the hospital as soon as you have symptoms of a heart attack, including tightness of the chest, excess sweating, weakness and light-headedness.

    Estévez-Loureiro recommended calling an ambulance to get to the hospital, since medical personnel may be able to verify if you are having a heart attack on the way and start administering treatment and call the catheterization lab en route.

    SOURCE: Circulation: Cardiovascular Quality and Outcomes, online July 29, 2014.

  • Short jogs linked to lower risk of death from heart disease

    By Kathryn Doyle

    NEW YORK (Reuters Health) - People who run in their spare time, even if it's not very fast or very far, tend to have a lower risk of dying from heart disease or from any cause than non-runners, according to a new study.

    The study was large but was observational, meaning the researchers asked participants about their running habits rather than randomly assigning them to running and non-running groups. So they cannot conclude that running, and not other differences between participants, was responsible for the lower risks.

    It's difficult to use more rigorous randomized controlled trials to look at outcomes like death, because that takes so long to track, said lead author Duck-chul Lee, from the College of Human Sciences at Iowa State University in Ames.

    He said the current study is the largest on this topic, but it would still be useful to conduct randomized trials to look at the effects of running on blood pressure and cholesterol, for instance.

    The researchers studied more than 55,000 generally healthy adults between ages 18 and 100. Participants answered questions about their physical activity habits over the past three months, including running speed, duration and frequency. Some were not runners at all; the rest were divided into five groups based on how much they ran each week.

    The researchers then tracked the participants using their medical records for an average of 15 years.

    About 3,400 people died during that time, including roughly 1,200 from cardiovascular causes, including heart disease and stroke.

    At the start, runners were more often male, younger and leaner. Compared to non-runners, people who ran at all were 30 percent less likely to die during the study period and 45 percent less likely to die from cardiovascular disease.

    Runners had a reduced risk of death even if they ran for less than 51 minutes or less than six miles per week, and even if they ran at a pace slower than six miles per hour, according to results published in the Journal of the American College of Cardiology.

    "I think the findings are very encouraging since the study suggests that you don't necessarily have to aim for a marathon in order to obtain the health benefits of physical activity," said Dr. Kasper Andersen of Uppsala University Hospital in Sweden.

    Andersen was not involved in the new study.

    "I guess you can interpret this as every time you go running you are putting savings in your own health bank - an investment that gives you a longer life," he told Reuters Health by email.

    Running was linked to better health regardless of sex, age, smoking status or weight, the researchers found. Runners had life expectancies three years longer than non-runners, on average.

    "The (World Health Organization) guidelines recommend at least 75 minutes per week of vigorous aerobic activity such as running," Lee told Reuters Health in an email. "However, we found mortality benefits in runners who ran even as little as 30 to 60 minutes per week."

    There haven't been as many studies on the benefits of vigorous activity as there have been for moderate activity, he said.

    "As far as recommending that people go for short jogs everyday, I do think this is something we could recommend, although with a couple caveats," said Andrea Chomistek, from the School of Public Health at Indiana University Bloomington.

    "For individuals who are currently inactive, they should probably start with walking and ease into running," she told Reuters Health in an email. "For inactive individuals who are older or have medical issues, they may want to check in with their physician before starting a running program, although walking is just fine."

    Finding a running buddy can be good motivation, Chomistek said.

    "If you know that someone is counting on you to show up, you'll be more likely to go," she said. "And longer runs are definitely more fun if you have company."

    SOURCE: Journal of the American College of Cardiology, online July 28, 2014.

  • Dementia patients more likely to get pacemakers: study

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - People with dementia are more likely to get pacemakers than people without any cognitive impairment, according to a new study.

    The study can't explain why people with dementia are more likely to get the devices, which help control irregular heart rhythms, according to the lead author.

    "It may be completely appropriate," Nicole Fowler said. "There may be something that we haven't been able to measure that makes people with dementia need them more."

    Alternatively, she told Reuters Health that the difference could represent family members or doctors choosing more aggressive treatment for people with dementia.

    Fowler worked on the new study while at the University of Pittsburgh School of Medicine. She's now affiliated with the Indiana University Center for Aging Research in Indianapolis.

    She and her colleagues write in a research letter in JAMA Internal Medicine that people with dementia and a lesser form of thinking and memory trouble known as mild cognitive impairment can also have heart problems.

    People with dementia, their family members and their doctors should weigh the risks and benefits of using pacemakers, they add.

    For the new study, the researchers analyzed data on 16,245 people seen at 33 Alzheimer's Disease Centers from September 2005 through December 2011.

    At their first visit to the centers, about 46 percent of people had no evidence of dementia. Another 21 percent had mild cognitive impairment and 33 percent had dementia.

    Over the course of the study, four people out of every 1,000 who didn't have signs of dementia at their first visit received a pacemaker each year. The rate increased to 4.7 per 1,000 people among those with mild cognitive impairment and 6.5 per 1,000 people among those with dementia.

    The researchers found that people with dementia were 60 percent more likely to receive a pacemaker than those without dementia after taking into account their age, sex, race, location, heart health, blood pressure, stroke risk and cognitive decline during the study.

    They write that the findings are counter to expectations that people with serious and often fatal conditions might be treated less aggressively.

    Additional studies will be required to find out exactly why people with dementia are more likely to receive pacemakers, Fowler said.

    "Medical decisions for patients with dementia are really hard," she said. "We know from the data that families really struggle to make medical decisions . . . It's important to find out what are some of the things patients and families need to support their decision making."

    SOURCE: JAMA Internal Medicine, online July 28, 2014.

  • Drugs to increase "good" cholesterol may not cut deaths

    By Andrew M. Seaman

    NEW YORK (Reuters Health) - Drugs that have been investigated to increase so-called "good" cholesterol may not prevent deaths, heart attacks or strokes as many hoped, according to a new analysis.

    Due to limitations in existing studies and ongoing experiments involving these and other drugs, researchers not involved with the analysis caution that it's too early to give up on medications that increase high-density lipoprotein (HDL) cholesterol, however.

    "In the time before statins were available, there were several pieces of evidence that HDL-raising drugs reduce cardiovascular events, but since the time statins have been used there is now evidence that HDL-targeted therapies don't do anything to decrease mortality," said Dr. Darrel Francis, the study's senior author from Imperial College London.

    Unlike low-density lipoprotein (LDL), which is the so-called "bad" cholesterol that piles up in blood vessels, HDL is considered good because it's thought to chip away LDL cholesterol.

    People with low HDL levels and high LDL levels are known to be at an increased risk of death, the researchers write in the journal The BMJ.

    Drugs known as statins - such as Pfizer's Lipitor - that lower LDL have been found to be effective at reducing deaths. Attention has turned to the development of drugs that increase levels of HDL to achieve added benefits.

    Francis and his colleagues examined the results of 39 randomized controlled trials - the gold standard in medical research - that evaluated the use of three drugs known as niacin, fibrates and cholesterylester transfer protein (CETP) inhibitors.

    While the drugs differ in how they work, all three increase the amount of HDL cholesterol in the body.

    Overall, the drugs did not reduce the number of deaths from any cause or deaths from heart disease before or after statins became common.

    Before statins, fibrates reduced heart attacks and niacin reduced heart attacks and strokes. After statins, the benefit from the two HDL-increasing drugs disappeared.

    The researchers write that the simple idea that a drug that raises HDL levels should also decrease the number of heart attacks and strokes may not be correct.

    "Even if HDL is carrying cholesterol away from the coronary arteries, that doesn't mean that any therapy that raises HDL is automatically protective," Francis said. "After all, the therapy could just be blocking cholesterol traveling on HDL from exiting."

    But a closer look should be given to specific groups of patients before researchers abandon work on drugs targeting HDL cholesterol levels, cautioned Dr. Leonard Kritharides in an editorial accompanying the new study.

    Kritharides, the head of cardiology at Concord Repatriation General Hospital in Sydney, Australia, said other research has suggested there may be a benefit among people with low HDL cholesterol and high triglycerides, which is another type of fat in blood.

    "The possibility of important benefits for some patients should not be dismissed too lightly," he wrote.

    Dr. Steven Nissen, the chair of cardiovascular medicine at the Cleveland Clinic in Ohio, also said the studies included in the analysis had limitations and there are more studies on HDL-increasing drugs underway.

    "I think the science here hasn't been fully worked out and the only way to answer it is with randomized controlled trials and that's what a number of people are doing," said Nissen, who wasn't involved with the new study. He is the head of a trial for a CETP inhibitor from Eli Lilly.

    "If every study underway fails, we'll have to give up on HDL at some point," he said, adding that researchers aren't there yet.

    "What we don't need here is to prejudge ongoing research," Nissen said.

    SOURCE: and The BMJ, July 18, 2014.