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Harford’s Healthy Heart

April 2014

Strategic Partnership, Expertise, Experience Benefit Community

March 17, 11pm – Michael Drossner, M.D., director of the cardiac catheterization lab at the University of Maryland Upper Chesapeake Medical Center (UM UCMC), heads to the hospital after being notified that a Harford County woman has had a heart attack.

March 18, following morning – Three additional patients are treated by Dr. Drossner and his team with serious heart issues ranging from significant blockage in coronary arteries to excessive fluid around the heart.

Vivek Dhruva, D.O., (left) and Michael Drossner, M.D., are part of an innovative cardiology team at University of Maryland Upper Chesapeake Medical Center.

Vivek Dhruva, D.O., (left) and Michael Drossner, M.D., are part of an innovative cardiology team at University of Maryland Upper Chesapeake Medical Center.

“This is the kind of excitement in a 12-hour period that I have every day when I come to work. It’s all about doing things that are helpful to people, and I am fortunate to be in this position,” says Dr. Drossner, a cardiologist who is board certified in internal medicine, cardiovascular disease and interventional cardiology and specializes in an-gioplasty and cardiac catheterization.

Despite the whirlwind experience of the past 12 hours Dr. Drossner had experienced before our interview, his energy and enthusiasm for helping patients and the community give no indication just how intense and exhausting the last 12 hours have been. To show the breadth of heart issues he and his team at UM UCMC have tackled during this time, he shares further details.

The call at 11pm last night was in response to a 47-year-old woman presented with a heart attack. “It was the first cardiac event for her and involved an occlusion of one of her heart arteries. So, we opened up the artery with a balloon and stent. She will now have normal heart function and normal anticipated lifespan,” he says, adding that he sees a lot of patients in their 40s. “The first presentation in 40 percent of those with coronary artery disease is a heart attack or even sudden death, so we have to be in position to handle these emergencies. Fortunately we have been able to do so.”

The following morning, Dr. Drossner did a diagnostic cardiac catheterization on a man who had worsening symptoms of coronary disease and previously had bypass surgery. “We found a significant blockage, so we will have to open it up with angioplasty and a stent at the University of Maryland Medical Center in Baltimore, where I am two days a week to do elective coronary intervention, angioplasty and stents,” he says. Later that morning, a catheterization was done on a patient awaiting lung transplantation. “We do a lot of the evaluations for transplants for the University of Maryland Medical Center because these are patients in our community and we have established a good relationship with them. We measure the pressures around their heart and look at their heart arteries and heart function to determine whether they can be a candidate for a lung transplant and whether they can tolerate it.”

Finally that morning, a 73-year-old patient was transferred from University of Maryland Harford Memorial Hospital (UM HMH) due to a large amount of fluid around his heart. Once at UM UCMC, Dr. Drossner and his team drained almost a liter of fluid, and the man felt immediately better.

“The hospital has made it all possible for us to succeed and have all the facilities and all the equipment we need to do catheterization and clinical cardiology, as well as the support in the office, the echocardiogram lab and the stress test labs. Whatever we need, we get here so that our patients have the convenience of care closer to home,” says Dr. Drossner.

The catheterization lab at UM UCHC runs 24/7, backed by an experienced team of nurses and technologists. And thanks to a new innovative program developed and implemented by cardiologist Vivek Dhruva, D.O., the hospital is aptly prepared and ready to tackle any heart-related emergency before the patient even arrives at UM UCMC. Dr. Dhruva, who is board certified in cardiology, echocardiography and nuclear cardiology, did research as a fellow at UMDNJ School of Medicine in Newark, N.J., on early recognition of heart attacks and the use of wireless technology.

Dr. Dhruva has conducted research on the use of wireless technology for the early recognition of heart attacks.

Dr. Dhruva has conducted research on the use of wireless technology for the early recognition of heart attacks.

His research study was published in the Journal of the American College of Cardiology in 2007 and examined the “effects of implementing a fully automated wireless network to reduce door-to-intervention times (D2I) in ST-segment elevation myocardial infarction (STEMI) to allow for patient triage directly to the cardiac catheterization laboratory from the field.” Dr. Dhruva explains: “Say you are having a heart attack and the ambulance comes to your house. We now have the ability to take the EKG that is performed in your house and transmit it wirelessly to Dr. Drossner’s email or smartphone in less than five seconds. Dr. Drossner is able to look at that information before the patient is even en route to the hospital. Since he lives 10 minutes away, he and his team can have everything set up before the patient is transported to the catheterization lab.”

Dr. Dhruva, who lives in Bel Air with his wife and two children, stresses that “our door to balloon times are amongst the best in the nation, and that is due to the coordinated effort between cardiology, EMS and the Emergency Department. According to the American Heart Association, the time it takes for an individual to receive the cardiac intervention after setting foot in the hospital must be less than 90 minutes. At UM UCHC, that time is significantly less – between 30-35 minutes, which is especially impressive considering the large geographic area the hospital serves – all of Harford County and parts of Cecil County and even Baltimore County.

Dr. Drossner is the director of the cardiac catheterization lab, which runs on a 24/7 schedule.

Dr. Drossner is the director of the cardiac catheterization lab.

Dr. Drossner adds that in addition to time, the other crucial variables that may determine whether a patient survives is the expertise and experience of the physicians and staff at the hospital and the coordinated effort with all the key players. “The EMS staff stays and watches the procedures here, so they know exactly what we do. This knowledge makes them better at their jobs. Dr. Dhruva and I have met with them several times and done EKG classes so that they would know which patients to perform an EKG on and how to interpret the EKG. We all work together as a team and we feel more involved in the community we serve,” says Dr. Drossner, who adds that between he and the other three interventional cardiologists, they have over 100 years of experience. He notes that the collaboration between the four cardiologists is invaluable.

Ways you can reduce your risk of heart diseaseQuit smoking. Smokers have more than twice the risk for heart attack as nonsmokers and are much more likely to die if they suffer a heart attack.• Improve cholesterol levels. The risk for heart disease increases as your total amount of cholesterol increases. A total cholesterol level over 200, an HDL, or “good” cholesterol level under 40, or an LDL, or “bad” cholesterol level over 160 indicates an increased risk for heart disease.• Control high blood pressure. Over 50 million people in the U.S. have hypertension, or high blood pressure, making it the most common heart disease risk factor. One in four adults has systolic blood pressure (the upper number) over 140, and/or diastolic blood pressure (the lower number) over 90, which is the definition of hypertension.• Get active. Many of us lead sedentary lives, exercising infrequently or not at all. People who don’t exercise have higher rates of death and heart disease compared to people who perform even mild to moderate amounts of physical activity.

Eat right. Eat a heart-healthy diet low in fat and cholesterol. Try to increase the amounts of vitamins you eat, especially antioxidants, which have been proven to lower your risk for heart disease.

Achieve and maintain a healthy weight. Excess weight puts significant strain on your heart and worsens several other heart disease risk factors such as diabetes. By eating right and exercising, you can lose weight and reduce your risk of heart disease.

Manage stress and anger. Poorly controlled stress and anger can lead to heart attacks and strokes. Use stress and anger management techniques to lower your risk.

Control diabetes. If not properly controlled, diabetes can lead to significant heart damage, including heart attacks and death.

– Source: WebMD


Prevention is Key

Of course, the greatest weapon against heart disease is prevention. Despite the fact that heart disease is the nation’s single leading cause of death for both men and women – according to the American Heart Association at least 58.8 million people in the country suffer from some form of heart disease, and cardiovascular diseases kill some 950,000 Americans every year – there is still not enough awareness that most of the causes of heart disease are preventable. By following a few steps – eating a healthy diet, exercising, quitting smoking and maintaining a healthy body weight – nearly everyone can be more heart healthy.

“Prevention is huge, so we go out in the community to various functions – blood pressure screenings at IronBirds games, monthly cardiovascular screenings at the hospital, ‘Dining with the Docs’ events to cover such areas as sports cardiology, smoking cessation classes, etc.,” says Dr. Dhruva. Dr. Drossner stresses the importance of knowing your cholesterol and blood pressure numbers and having regular checkups with your physician.

“Traditionally, hospitals have been in the business of sick care, not healthcare. We are changing our focus toward healthcare by providing screenings to assist in early intervention as well as offering education on awareness and prevention, so that when someone needs to come to the hospital, they may not be quite so sick, which will result in improved outcomes. Today’s hospitals must take on both roles, as both healthcare and sick care will help improve the overall health of our communities,” says Mark Lewis, director of the Heart and Vascular Institute at University of Maryland Upper Chesapeake Health.

Another education battle facing physicians is the misconception that heart disease only affects those over age 65. Dr. Dhruva points out that he has seen two patients under age 40 who have coronary artery disease just in the past two weeks. According to the American Heart Association, almost 150,000 Americans killed by cardiovascular disease each year are under the age of 65, and one out of every 20 people below the age of 40 has heart disease. Another misconception is that the disease targets primarily men. While men and women are equally affected, Dr. Drossner says there is a “higher incidence of coronary disease in women over 65 than men. Risk factor mitigation after menopause is especially important for women. Women have smaller arteries that are less forgiving; it doesn’t take a lot of plaque to occlude them. Also, it’s harder to open their arteries with angioplasty and it’s harder to operate on women with bypass surgery.”

When In Doubt, Call 911
When most of us were growing up, our parents taught us how and when to call 911 and how to do so responsibly. So why is it that as adults, many of us are tentative to call 911 when we need help? Educating the community about the importance of calling 911 is a huge initiative for physicians and staff at UM UCMC. It’s literally a matter of life and death.

“If you are in trouble – call 911. We can get you to the hospital safer and quicker, but some people are still afraid to call 911 and instead drive themselves to the hospital,” says Dr. Drossner. According to UM UCMC, data shows that when 911 is called, the hospital can diagnose and treat individuals in the Cardiac Catheterization Lab at UM UCMC in an average of 60 minutes. That average goes up to 76 minutes if a patient drives to the emergency room.

“A 45-year-old man who has never had a problem in his life and has what he thinks is just indigestion may not think he’s having a heart attack, so he doesn’t call 911. There’s a high pre-hospital mortality rate for people who have heart attacks so it’s important to call 911,” adds Dr. Drossner.

Exercising Regularly … But Safely
The topic of childhood obesity has finally gotten the attention it so deserves, which is especially beneficial for those like Dr. Dhruva dedicated to the importance of being heart healthy. “I think the epidemic of obesity has really changed everything when it comes to heart disease. People used to be always outside working, outside playing, exercising whether they knew it or not. Now the average child is watching TV, on the computer, on their phones and only going outside to play sanctioned sports – lacrosse, soccer, etc.” Dr. Dhruva applauds such programs as the National Football League’s “PLAY 60,” a national youth health and fitness campaign focused on increasing the wellness of young fans by encouraging them to be active for at least 60 minutes a day.

And while exercising is a key element in mitigating your risk for heart disease, Dr. Dhruva, who has a special interest in sports cardiology, emphasizes that as we get older, it’s important to ensure that your heart is healthy enough for whatever physical activity you’re engaged in. Especially at risk is the so-called “Weekend Warrior.”

“These are people who are too busy to do anything during the week so when the weekend comes, they hit it hard. That works when you’re 18. When you are older and you are inactive all week and then work out hard on the weekend, it’s a stress on your heart,” says Dr. Dhruva. “Or it’s someone who is inactive and then goes out and shovels six inches of heavy snow and has a heart attack doing it. Exercising regularly is the key – 30 minutes, five days a week – instead of being inactive all week and then going to the gym and running on the treadmill for two hours. The Weekend Warrior is more likely to have a cardiac event than one who works out regularly.”

With this in mind, Dr. Dhruva is helping develop a comprehensive sports cardiology program at UM UCMC for those “Weekend Warrior” types, as well as those looking to either begin a new exercise regiment or increase their physical activity. Dr. Dhruva hopes those patients will come in and be screened for cardiovascular disease to make sure it’s OK for them to play intramural sports, go to the gym and coach sports. Dr. Dhruva stresses that even if you feel in shape, you still need to protect your heart. “I had a patient who ran five miles a day, had the runner’s build, passed a stress test, but a poor diet and a strong family history of coronary artery disease. A test called a calcium score was completed and showed a very high level of plaque. This is the type of patient we worry about. I want to help people like him in preventing a sudden cardiac event,” he says.

For those who have had a cardiac event, heart surgery, angioplasty or a diagnosis of coronary artery disease, the cardiac rehab programs at UM UCMC also can make a difference. “It’s scientifically proven to improve outcomes, but more than that – from a clinician’s perspective, I get so much data on how they are doing – blood pressure readings, symptom readings, telemetry readings. I know almost everything about them and because they are involved in the program, if they are having any symptoms, they can tell the physical therapist or rehab specialist and that information is translated to us,” Dr. Dhruva says. “Cardiac rehab works in building both the physician’s and the patient’s confidence that everything is OK. Furthermore, problems such as abnormal blood pressures, arrhythmias and symptoms are detected much earlier in this program.”

Know the Warning SignsCall 911 right away if you or someone you know is experiencing these symptoms:
• Sudden chest pain or pressure that worsens
• Discomfort, heaviness or pain felt in the chest, back, jaw, throat, arm or below the breastbone
• Tightening in the chest
• Pain that spreads from the center of your chest to your arms, shoulders, neck or jaw
• Sweating, nausea, vomiting, dizziness or shortness of breath
• A fullness, indigestion or choking feeling
• Rapid or irregular heartbeats
• Extreme weakness or anxiety
– University of Maryland Upper Chesapeake Health

A Partnership That Benefits All
Many times when two institutions merge or form a partnership, the public shrugs it off as simply a name change or a marketing tool. However, when Upper Chesapeake Health officially merged into the University of Maryland Medical System in late 2013 (the two institutions have had a strategic partnership since 2009), it was further evidence of the immense benefits that Harford County residents and those in the Baltimore metropolitan area would enjoy.

“The University of Maryland partnership has been vital to us professionally and to our patients. One example is the Advanced Heart Failure program where two UM faculty physicians – a cardiac surgeon and the director of heart transplantation – come here once a week to see our patients,” says Dr. Drossner. He adds that cardiac surgery follow-up appointments are also done at UM UCMC so that patients don’t have to leave the county again after having surgery at UM St. Joseph Medical Center or the University of Maryland Medical Center in downtown Baltimore.

UM UCMC patients also benefit by the numerous technological advancements through the partnership. One such example, Dr. Drossner points out, is the ability for surgeons at the University of Maryland Medical Center to perform transcatheter aortic valve replacements for patients who are deemed too high risk for traditional surgery. “We can also use genetic testing to determine whether patients are responding appropriately to the blood thinners prescribed after angioplasty. To be connected with the University of Maryland Medical Center is a major advantage for our patients,” says Dr. Drossner. “Patients who have their surgery at the University of Maryland Medical Center will be treated by highly trained cardiac surgeons who utilize the most advanced technologies and minimally invasive techniques to perform life-changing surgery. They provide the highest quality cardiac care to patients throughout Baltimore and all of Maryland.”

As an assistant professor at the University of Maryland School of Medicine, Dr. Drossner teaches board-certified cardiologists in their last few months of training to become interventional cardiologists. These senior fellows also gain experience by working in community-based medicine at UM UCMC. “Every year I have a cardiac surgery resident with me for at least three months. Their program believes it’s important for them to be exposed to cardiology and to community medicine, and we learn from each other,” says Dr. Drossner. I95