Time to Test Your Heart

Chest pains, also called angina, are scary, but are often triggered by non-cardiac causes such as underlying stress or anxiety. However, they can also be a symptom of life-threatening coronary artery disease, narrowing or blockages of the blood vessels that supply oxygen-rich blood to your heart.

            That’s why the first step your cardiologist might take to diagnose your angina is a cardiac stress test. This non-invasive examination evaluates your heart’s electrical system and how well it works when physically taxed by exercise or medications.

            The most common kind of stress test involves walking on a treadmill while your heart’s activity is monitored by an electrocardiogram (ECG or EKG). Your cardiologist will first study your heart while it is resting to obtain a baseline measurement. Then, every three minutes or so, the speed of the treadmill will be increased.

            When stressed during exercise, a heart beats faster and blood supply to the organ increases. Blood supply to specific parts of the heart muscle may lag due to a blockage in one of the arteries, which could lead to symptoms of chest pain or shortness of breath and/or EKG changes.

            A cumulative score called the Duke treadmill score, can be calculated from the time on the treadmill, EKG changes and symptoms of chest pain. This score will give your cardiologist the information he or she needs to determine whether or not you have a heart problem.

            Other forms of stress testing involve imaging. These include:

• a stress echocardiogram, a non-invasive test that uses sound waves to visualize your heart’s structure and function before and after a stress test;
• a nuclear stress test, which uses a radioisotope tracer (usually thallium) to image a specific area of the heart muscle.

            Patients who are unable to exercise on a treadmill due to other medical conditions—such a respiratory illness, hip/knee problem, or back pain—may undergo a pharmacological stress test. 

            This kind of test, explains Holy Name interventional cardiologist Tariqshah Syed, MD, requires the patient to lie down while the physician evokes the same kinds of responses from the heart with medication, as with treadmill exercise. “The patient is continuously monitored by a cardiologist and a nurse during all types of stress tests,” assures Dr. Syed.

            Dr. Syed notes that when the blood supply to the heart increases during exercise or because of medications, it should increase to every part of the heart.  “If not, then we suspect a blockage,” he says, “and portions of heart muscle might be in jeopardy.”

            If these blockages are in small arteries or are not severe, medication and lifestyle changes, such as amping up exercise or quitting smoking, might be prescribed. If a large portion of the heart muscle is not receiving adequate blood, an angiogram using cardiac catheterization would be the next step, says Dr. Syed.

            During an angiogram, a cardiologist threads thin catheters through the wrist or groin up to the heart to assess blood flow to the organ. If there is a blockage, an interventional procedure, such as angioplasty and stenting, may be used to open the blockage and keep it from recurring.

            Depending on the patient’s diagnosis and prognosis, Dr. Syed says a cardiologist may recommend a follow-up exercise stress test and outpatient cardiac rehabilitation.

For a referral to a Holy Name Medical Center cardiologist please call 1-877-HOLY-NAME (1-877-465-9626).

Holy Name Medical Center Establishes Headache Treatment Program for Migraine Sufferers

Holy Name Medical Center has established a Headache Treatment Program for the care of adults, adolescents and children who suffer from intractable migraine headaches, and for whom conventional methods of therapy have failed. Holy Name neurologist James Charles,  MD, FAAN, FAHS, is medical director of the Headache Treatment Program, and is certified in headache medicine by the United Council of Neurologic Subspecialties.

Under the direction of staff neurologists, intravenous medications are administered on an outpatient basis by nursing staff specially trained in the field of headache medicine to ensure maximum safety and effectiveness. Children and teens are treated on the Medical Center’s pediatric and young adult floor; adults are treated in the adult infusion center. Most patients require one visit; others may need repetitive, daily treatment for up to three days. Holy Name is the only facility in New Jersey offering infusion therapies to intractable headache patients of all ages.
 

Early intervention can re-set the brain’s headache mechanism

“Studies have demonstrated that, with early intervention, as soon as the patient is identified and that patient is placed onto an appropriate treatment program, the transformation to the malignant, disabling forms of migraine can be prevented,” explains Dr. Charles.  “This is a biological disease that is often genetic. A migraine attack lowers the threshold for more brain attacks. More brain attacks cause anatomic and functional alterations of the brain, setting the stage for more frequent and debilitating migraine headaches.”

According to Dr. Charles, infusion therapy is highly effective for patients with:

Ø       chronic migraines with and without medication overuse, who have failed multiple treatments to prevent or stop migraine symptoms, and who are disabled by their headaches but do not require or desire inpatient treatment

Ø       migraine headaches lasting longer than 72 hours and that do not respond to conventional medications

Ø       acute migraine attacks that last fewer than 72 hours, are debilitating, and not responsive to self-administered medications

Ø       prolonged aura

Ø       cluster headache exacerbation

Ø       new, daily persistent headache

“While most patients experience relief after an outpatient treatment, continues Dr. Charles, “there are those whose headache attack will not terminate after days and weeks, and there are some chronic migraine patients whose headaches do not respond to oral medications.  The Headache Treatment Program at Holy Name is designed for such patients. Children, teenagers, and adults are treated with the appropriate medications to break the vicious headache cycle, and leave our infusion center feeling better. The long- term goal is to reset the brain 's neurochemistry so that, in conjunction with targeted outpatient treatment, patients can go from frequent severe headaches to minimal headaches. “

“Lowering the burden of migraine starts with educating the public, especially parents and teachers,” notes Dr. Charles. “It is a misconception that an acute headache with nausea, vomiting, and the need for bed rest is due to conditions such as sinusitis, eyestrain or dental problems. “

Facts & Stats About Migraine Headache

Ø      The World Health Organization has placed migraine in the top 20 group of most disabling diseases of the world. 

Ø      In the United States, there are 28 million people over the age of 12 who suffer with migraines.

Ø      In the US, there are eight million children under the age of 12 who suffer with migraines.

Ø      Thirty percent of migraine sufferers never see a doctor because they have low-frequency intermittent headaches, experience occasional headaches, and do not require medical assistance.

Ø      Seventy percent of migraine sufferers fall into one of two categories: About 40% will have intermediate to high-frequency migraine attacks. The remaining 30% will transform to chronic migraine which is defined as more than 15 headache days per month.

Ø      Chronic migraine patients (adults and children) have decreased academic performance, impaired work productivity, and can become socially withdrawn.  

For more information about migraine headache or the Headache Treatment Program at Holy Name Medical Center, patients may contact Holy Name’s Call Center at 1-877-HOLY-NAME.

Colonoscopies save Lives… Just Do It!

For years, the healthcare community has known that colonoscopies reduce the incidence of colon and rectal cancer, but a recent study published in The New England Journal of Medicine provides convincing evidence that colonoscopies actually reduce mortality. The death rate in patients whose precancerous polyps had been removed who were tracked for 20 years was reduced by 53 percent – a significant reduction in cancer-related mortality.
            Holy Name Medical Center gastroenterologist Susan Fishbein, MD, commenting on the results of the research, noted that “This is very important data. It’s the first time a study has shown conclusively that colonoscopies and removal of cancerous polyps reduce mortality.   It’s proof that we all really must have colonoscopies!”
            Colorectal cancer is one of the few cancers that can be prevented by regular screening, yet it is the second most common cause of cancer-related death in the United States. Fewer than 60% of Americans over the age of 50 have had a screening colonoscopy or sigmoidoscopy in the past 10 years. Dr. Fishbein laments the statistic.  “Colon cancer is a terrible disease. But it is so preventable.”
            She recommends that individuals with no family or personal history of colon cancer have a screening colonoscopy when they reach the age of 50. If the results are good, Dr. Fishbein believes it is prudent to have a second screening in seven or eight years, rather than the usually recommended 10 years, since it takes about 10 years for a normal colon to develop cancer.  If a polyp is found in the initial screening, a second colonoscopy is recommended in one to five years, depending on the pathologist’s report.  If there is a family history of colon cancer, the initial screening should occur by age 40 or 10 years earlier than the age when the family member developed cancer – whichever is younger, according to Dr. Fishbein, who has been screening patients in Holy Name’s Endoscopy Suite for more than 12 years and praises the staff as “top-notch.”
             Colonoscopy preparation requires colon-cleansing, and nourishment during prep is usually limited to clear liquids – gelatin, clear broth or black coffee. Dr. Fishbein agrees that nothing fibrous may be consumed before a colonoscopy, but she does permit consumption of anything that can melt: milk in the coffee, even ice cream or milk shakes! (A sip of milk shake would certainly make colon prep a bit more palatable for me!)
            Although we can’t change our genetic makeup or reduce all the health risks we face, it makes sense to commit to regular colon screenings. A colonoscopy can save your life. Just do it!

For a referral to Dr. Fishbein or another Holy Name physician, call 1-877-HOLY-NAME (1-877-465-9626) or visit www.holyname.org.