Cardiology

NCMA Sonoma Cardiology welcomes Sheryl A. Garrett, MD

More doctors. Better heart health in Sonoma.

Welcome, Dr. Sheryl Garrett, to Sonoma Cardiology

NCMA Cardiology in Sonoma, Calif., is pleased to announce Dr. Sheryl A. Garrett has joined our practice. Dr. Garrett, who already practices at Petaluma Cardiology, now joins NCMA’s Dr. Thomas E. Dunlap at our 377 Perkins Street offices.

Dr. Garrett was delighted to join NCMA Cardiology in Petaluma and now Sonoma Cardiology. As a cardiologist with years of experience at Georgetown University, Stanford University and Mt. Sinai School of Medicine in New York City, she believes in treating the whole person and looks forward to partnering with patients for their cardiac health throughout Sonoma County.

As part of NCMA Cardiology, Dr. Garrett and Dr. Dunlap are part of the North Bay’s leading team to offer comprehensive cardiovascular services, including:

  • nuclear cardiology,
  • electrophysiology,
  • prevention services,
  • interventional cardiovascular services,
  • thoracic surgery,
  • cardiac/peripheral vascular evaluations,
  • EKGs,
  • treadmill stress testing
  • echocardiography and
  • nuclear medicine studies.

Visit our cardiology services page to learn more about our expert physicians and heart health services. For scheduling at NCMA Cardiology in Sonoma please call 707-573-6199.

NCMA cardiologists Patrick Coleman and Keith Korver update TAVR progress in Sonoma County

Earlier this year, NCMA’s Patrick Coleman, MD, helped make Sonoma County healthcare history by participating in the area’s first transcatheter aortic valve replacement (TAVR) procedure with colleagues at Santa Rosa Memorial Hospital. TAVR is a less invasive option for patients with severe aortic stenosis who may otherwise not receive adequate treatment due to their high risk for open heart surgery.

As a leading expert in in TAVR procedures (also referred to as transcatheter aortic valve implantation [TAVI]), Coleman and Keith Korver, MD, spoke as part of a panel titled “Update on TAVR” at NCMA’s 2018 Physician Regional Symposium in Santa Rosa. Dr. Coleman’s presentation covered structural heart disease, valvular heart disease, structural modifications to minimize risk, and critical aortic stenosis factors.

Please view the embedded video above to learn more about TAVR from Drs. Coleman and Korver.

About the NCMA Physician Regional Symposium

Northern California Medical Associates, along with St. Joseph Health, held the annual Regional Primary Care Spring Symposium on March 24, 2018 in Santa Rosa. This well-attended conference plays a vital role in the local medical community, offering physicians and healthcare providers an opportunity to learn about cutting edge treatments, to collaborate, share research and gain fresh perspectives.

At this year’s event, physicians from a variety of backgrounds and fields of practice gave hot-topic educational lectures to an audience of healthcare providers that included; internal medicine and primary care physicians, emergency physicians, physician assistants, nurse practitioners, staff RNs, and medical assistants; all from the northern California region. This event gives doctors the opportunity to also earn continuing medical education credits (CMEs) for their attendance.

Programs highlighted during the symposium gave in-depth overviews of the current state of healthcare, and included advanced treatments and new technologies from the experts as they continue to improve patient outcomes and provide exceptional patient experience in the process.

See all of the videos on NCMA’s YouTube channel

Complete episodes of these timely lectures are available online via NCMA’s YouTube channel. All videos are free and open to the public. This educational program is provided by Northern California Medical Associates and St. Joseph Health, Santa Rosa Memorial.

Waist and hip size associated with heart attack risk in women

NCMA Cardiovascular Services offers patients a comprehensive range of cardiac services, interventional procedures and comprehensive care to meet the needs of our patient

Higher waist and hip size are more strongly associated with heart attack risk than overall obesity, especially among women, according to research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

In a study of nearly 500,000 adults (aged 40-69) from the United Kingdom, researchers found that while general obesity and obesity specifically around the abdomen each have profound harmful effects on heart attack risk in both sexes, women were more negatively impacted by higher waist circumference and waist-to-hip ratio than men.

This study suggests that the differences in the quantity and distribution of fat tissue not only results in differences in body shape between women and men, but may also have differential implications for the risk of heart attack in later life, researchers noted.

“Our findings support the notion that having proportionally more fat around the abdomen (a characteristic of the apple shape) appears to be more hazardous than more visceral fat which is generally stored around the hips (i.e., the pear shape),” said lead author Sanne Peters, Ph.D., Research Fellow in Epidemiology at the George Institute for Global Health at the University of Oxford in the United Kingdom.

Additional research on sex differences in obesity may yield insights into the biological mechanisms and could inform sex-specific interventions to treat and halt the obesity epidemic.

According to statistics in the AHA’s 2018 Statistical Update, 40 percent of American women age 20 and older and 35 percent of men were considered obese in 2013-14 national surveys. Being obese puts you at a higher risk for health problems such as heart disease, stroke, high blood pressure, diabetes and certain cancers.


Story Source: Read this article on Science Daily: American Heart Association. “Higher waist and hip measures may add up to greater risk for heart attack among women.” ScienceDaily. ScienceDaily, 28 February 2018. www.sciencedaily.com/releases/2018/02/180228085425.htm.


NCMA Cardiovascular Services team is comprised of highly skilled physicians, specialists, nurses, and other healthcare professionals dedicated to our patients’ health care needs. Since 1975, the group has focused on sub specialization within cardiovascular health to provide services by the most highly trained and experienced physicians and staff.  We provide cardiac care in three counties, with 11 offices, located in Santa Rosa, Petaluma, Sonoma, Fort Bragg, Mendocino, Ukiah, and Lakeport.

Who Needs a Cardiac Electrophysiologist?

A clinical cardiac electrophysiologist, or cardiac EP, specializes in treating rhythm problems of the heart. A cardiac EP is a cardiologist who completes 3 years of extra training beyond that required for board certification in cardiology to specialize in problems of the heart and blood vessels.

NCMA Bedi photo

Dr. Ashwani Bedi is board certified in cardiac electrophysiology, cardiovascular disease and internal medicine. He brings specialty expertise in all aspects of cardiac electrophysiology including SVT and VT ablations, atrial fibrillation ablations, pacing (including BiV pacing) and defibrillation as well as intracardiac echocardiography. Dr. Bedi was the recipient of the Health Care Hero Award and received multiple WOW designations at Deaconess Hospital in Evansville, Indiana. He has a professional interest in cardiac ablations, prevention and awareness of sudden cardiac death in communities and has been actively involved in cardiac screening for college athletes.

Common reasons to see an electrophysiologist

A cardiac EP can diagnose and treat conditions such as Atrial fibrillation (an irregular, fast heart rhythm in the upper chambers of the heart), Bradycardia (a heartbeat that is too slow), Tachycardia (a heartbeat that is too fast), Ventricular tachycardia ( a particularly dangerous type of very fast heartbeat), Supraventricular tachycardia (characterized by a sudden, very fast heartbeat), Ventricular fibrillation (dangerous fluttering of the heart muscle that doesn’t let it pump blood and can be fatal), sudden cardiac arrest (the heart suddenly stops beating), Long QT syndrome  (a disorder of the heart that can cause sudden arrhythmias) Wolff-Parkinson-White (WPW) syndrome (a condition that causes episodes of a fast heartbeat  caused by an extra electrical pathway in the heart), other arrhythmias (Arrhythmias can be caused by pregnancy, medicine interactions, or metabolic problems)

What is Arrhythmia

In a normal, healthy heart, the upper chambers (the atria) and lower chambers (the ventricles) work together, alternately contracting and relaxing to pump blood. Sometimes the rhythm changes, resulting in an irregular heartbeat — it may becomes too fast (more than 100 beats per minute) or too slow (fewer than 60 beats per minute). Sometimes arrhythmia is caused by an injury from a heart attack. It can also happen in patients who are recovering from heart surgery, have coronary artery disease or valve disorders.

Arrhythmia can also be caused by an imbalance of sodium or potassium, or be the result of  stress. An electrophysiologist can order special tests to confirm arrhythmia and to determine its cause. Once identified, arrhythmia can be treated in a number of way including;

  • lifestyle changes
  • medications
  • invasive therapies if necessary

If medications and lifestyle changes don’t correct the problem, an electrophysiologist may consider catheter ablation. With this procedure a thin tube is inserted into a blood vessel in the groin. A wire is put through this catheter and sent up to the heart. A small part of the heart that is causing arrhythmia is destroyed with radiofrequency energy, restoring normal heart function.

Electrophysiologists work to understand what is causing the disease and and using their vast knowledge and available resources, they work to develop new strategies for treating the condition. They help people with irregular heartbeats manage their condition, and work as a team with other physicians and healthcare providers so patients receive the best care possible.

For more information about the full range of services offered by Northern California Medical Associates, visit the NCMA Health website. To make an appointment with Dr. Bedi, call (707) 573-6199


FountainGrove Cardiology
3536 Mendocino Ave. Suite 200
Santa Rosa, CA 95403
(707) 573-6166 Main Number
(707) 573-6199 Scheduling
Fax: (707) 573-6165

NCMA cardiologist shares insight on a new study linking high blood pressure to common heart valve disorder

NCMA cardiologist Dr. Noel Santo Domino discusses the latest findings pointing to a clear link between high blood pressure and a life-threatening condition that may be preventable in some cases.

Mitral regurgitation is a term that describes a medical situation where blood backflows into the heart resulting in symptoms such as shortness of breath, tiredness, dizziness and chest pain. “It is generally more common in older adults and can lead to death,” explains Dr. Noel Santo Domingo, MD NCMA cardiologist.

A new study, published in the journal PLOS Medicine, detailed the heart history of 5.5 million adults over 10 years. Researchers discovered that those who were diagnosed with higher blood pressure in early life have a significantly greater risk of developing mitral regurgitation later in life. Mitral regurgitation is a condition which makes the heart less efficient at pumping blood throughout the body and can lead to heart failure in severe cases.

Dr. Noel Santo-Domingo

Mitral regurgitation is a term that describes a medical situation where blood backflows into the heart resulting in symptoms such as shortness of breath, tiredness, dizziness and chest pain. “It is generally more common in older adults and can lead to death,” explains Dr. Noel Santo Domingo, MD NCMA cardiologist.

The crux of this study indicates that mitral regurgitation may in fact, be preventable in patients who are diagnosed early with high blood pressure. “If this is the case, then as cardiologists it becomes our task to encourage those patients that are presenting with high blood pressure to take measures to adopt healthier lifestyle habits – thereby greatly reducing the chance that they will ever develop this deadly and debilitating disease.”

The deadly consequences of mitral valve regurgitation

Mitral valve regurgitation often progresses slowly and is accompanied in the early stages by very mild symptoms. A patient may have no symptoms for years, even decades. Depending on how advanced the disease is when diagnosed, signs and symptoms of mitral valve regurgitation can include:

  • Heart murmur
  • Shortness of breath (dyspnea), especially with exertion or when at rest
  • Fatigue, especially during times of increased activity
  • Heart palpitations (experienced as rapid, fluttering heartbeat)
  • Swollen feet or ankles

A diagnosis of mitral valve regurgitation sometimes happens only after a doctor discovers a heart murmur. In other patients the problem develops quickly and in these cases, the patient may experience a sudden onset and exhibit severe signs and symptoms. In the medical community, mitral regurgitation has been largely considered a degenerative disorder, viewed as resulting from a weakening of the valve over time due to ‘wear and tear’. When viewed as a degenerative disorder doctors generally focus on treatment such as surgery to repair or replace the valve — rather than prevention.

“This new study is exciting and provides hope for many of our patients,” said Dr. Santo Domingo. “It also suggests additional research is needed to determine whether lowering blood pressure — through exercise, diet or blood pressure-lowering drugs – will in fact reduce the risk of the disorder occurring. In the meantime, advising patients who already exhibit signs of high blood pressure to take measures to improve their health will only lead to better outcomes in the long run.”

The deadly ramifications of HBP

High blood pressure (HBP or hypertension) is often called the “silent killer” in that symptoms are very subtle and not always detectible in an otherwise healthy person. In this way it quietly damages blood vessels and leads to chronic health conditions. While there is no absolute cure, medications prescribed by a cardiologist can help, and choosing to pursue healthier lifestyle changes can not only enhance quality of life, it will help to reduce the overall risk of developing heart disease and related symptoms such as stroke, kidney disease and more.

The American Heart Association recommends taking these steps to manage high blood pressure naturally:

  • Eat a well-balanced, low-salt diet
  • Limit alcohol consumption
  • Adopt a routine that includes regular physical activity
  • Maintain a healthy weight
  • Take prescription medications properly
  • Monitor your heart health and know your blood pressure

The best way to find out if a person’s blood pressure is in a healthy or unhealthy range is to get it checked.

About the NCMA Cardiology Team

From cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, the Northern California Medical Associates (NCMA) Cardiovascular Services team is dedicated to delivering the highest quality care and the best patient results. The NCMA Cardiology staff not only maintains its commitment to patients’ health and well-being but also maintains a tradition of excellence and expertise in its practice of the most current, innovative treatments in cardiovascular medicine. To learn more, visit the cardiology section of the NCMA website.

 

 

Just a few extra pounds has big consequences on heart health

NCMA Cardiology expert Dr. Thomas Dunlap on the importance of maintaining healthy weight over time as new study reveals hazards associated with heart health and minimal weight gain.

NCMA Cardiology expert Dr. Thomas Dunlap on the importance of maintaining healthy weight over time as new study reveals hazards associated with heart health and minimal weight gain.Researchers now say that gaining just a small amount of weight can have a negative impact on the structure and function of the heart muscle over time, increasing long-term risk of heart failure. The study tracked a group of 1,262 adults (average age 44) who were originally free from heart disease and other conditions that put them at high risk for heart disease for seven years. Participants underwent MRI scans of their hearts and multiple body fat measurements at the start of the study and then again seven years later. Scientists discovered that even a five-percent weight gain led to an increased risk of thickening and enlargement of the left ventricle.

“We’ve known for some time now that patients who carry extra pounds are much more likely to develop heart disease,” says NCMA cardiologist Dr. Thomas Dunlap. “This study helps to stress the importance of maintaining optimal weight and points out the need to be persistent with an exercise program that will help keep the pounds off.”

One bit of good news from the study was revealed by those who actually lost weight. The participants of that group were more likely to exhibit decreases in heart muscle thickness, resulting in lower risk of heart disease.

“It’s important to take steps to improve heart health before a problem arises,” says Dr. Dunlap. “If maintaining weight at optimal levels can decrease a person’s chances of developing heart disease over time, then making lifestyle choices to improve cardiovascular health will also improve quality of life, while lowering the risk for heart disease. Once symptoms begin to manifest, walking back the clock to earlier levels of cardio health is not always easy, or in some cases; even possible.”

Heart disease is serious business

According to the American Heart Association more than 5 million people in the United States suffer from heart failure, less than 50 percent of those with heart failure live a full five years following diagnosis. The deadly duo of heart disease and stroke are among the most prevalent and costly health complications today. Heart disease or stroke wreak havoc on people’s lives measured in increased medical bills, lost wages and decreased quality of living.

  • 1.5 million heart attacks and strokes occur every year in the United States.
  • 800,000 deaths occur from heart disease each year, a total of 1 in every 3 deaths – about the same number as die from cancer, respiratory disease and accidents – combined.
  • 150,000 of deaths from heart disease occur in people under age 65.
  • $320 billion in health care costs and lost productivity were attributed to heart disease and stroke in 2011.

The top five ways to get a handle on heart disease include; managing high blood pressure (talk to your doctor), take up a daily routine of physical activity (at least 20 minutes per day), make an effort to eat whole foods (avoid processed alternatives), avoid excess salt and quit smoking. 

About NCMA Cardiology Services

From cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, the NCMA’s Cardiovascular Services team is dedicated to delivering the highest quality care and the best patient results. The professional staff not only maintains its commitment to patients’ health and well-being but maintains a tradition of excellence and expertise in the practice of the most current, innovative treatments in cardiovascular medicine. For more information, visit the NCMA website.

 

Dr. Ashwani Bedi on Heart Health for Life and the Results of Decades of Research

Northern California Medical Associates (NCMA) Dr. Ashwani Bedi discusses the results of this month’s study on heart disease.

Earlier this month researchers from the Chicago Heart Association Detection Project released results of a study focused on 25,800 people who had turned 65 by 2010. Pulling data from the same participants who also made up a study from 1967 to 1973, researchers looked at heart health during younger years and how that played out over time.

They found that people with favorable heart health at younger ages lived about four years longer altogether, survived about five years longer before developing a chronic illness such as cancer or heart failure and spent 22 percent less of their senior years with a chronic disease compared to people with two or more heart risk factors earlier in life. This group also saved almost $18,000 in Medicare costs.

“Cardiovascular health is a lifetime concern,” says Dr. Ashwani Bedi, NCMA Cardiologist. “The American Heart Association says that about 41 percent of the U.S. population will have cardiovascular disease by 2030. That is a shocking statistic. This study clearly demonstrates that life-long heart health can be achieved, if patients make it a priority early in life. It’s hard to imagine a simpler solution than that.”

Cardiovascular disease includes conditions that affect the structures or function of the heart. It is the leading cause of death in the U.S. causing more than 800,000 deaths per year and $300 billion in direct medical expenditures. “The best way to prevent cardiovascular disease is to learn about it early and to take steps to prevent it from occurring,” says Dr. Bedi.

As a practicing Cardiac Electrophysiologist who specializes in the diagnosis and treatment of abnormal heart rhythms, Dr. Bedi understands the importance of prevention and the need to make lifestyle changes early in life to help ensure a healthy heart for life. “It’s human nature to not focus on our cardiovascular health until later in life when it becomes a problem. This study shows the importance of making lifestyle changes to support heart health earlier in life.”

How to prevent heart disease

Heart failure is a major health problem for both men and women in the U.S., affecting nearly 5 million Americans. About 550,000 people are diagnosed with it each year. It is the leading cause of hospitalization in people older than 65. The hallmarks of prevention for heart disease include:

  • Eating healthy
  • Getting active
  • Maintain a healthy weight
  • Quit smoking and avoid secondhand smoke
  • Manage cholesterol and blood pressure
  • Drink alcohol in moderation
  • Take steps to manage stress

“Ultimately, it’s never too early or too late to learn about heart disease. The earlier in life a person can take steps to prevent cardiovascular disease, the better the chances that person has for staying healthy for life,” Dr. Bedi said.

About Dr. Bedi

Dr. Bedi is board certified in cardiac electrophysiology, cardiovascular disease and internal medicine. He brings specialty expertise in all aspects of cardiac electrophysiology including SVT and VT ablations, atrial fibrillation ablations, pacing (including BiV pacing) and defibrillation as well as intracardiac echocardiography. Dr. Bedi was the recipient of the Health Care Hero Award and received multiple WOW designations at Deaconess Hospital in Evansville, Indiana. He has a professional interest in cardiac ablations, prevention and awareness of sudden cardiac death in communities and has been actively involved in cardiac screening for college athletes.

For more information about the full range of services offered by Northern California Medical Associates, visit the NCMA Health website. To make an appointment with Dr. Bedi, call (707) 573-6199

NCMA News: Dr. Kimberly Brayton, M.D. – Advocate for Women’s Heart Health

Throughout her life, cardiologist Dr. Kimberly Brayton has always strived to make a significant impact in the field of health. She has been with NCMA for a year and is advocating for the awareness of women’s heart health.

During Dr. Brayton’s first week at NCMA, she was a guest speaker at a Women
and Heart Disease event for WHAM (Women’s Health at Memorial), a women’s
philanthropy group. “It’s going to be an important part of my practice,” she says.
“Community events like this are especially important for women’s groups, as well as
on-going provider education, and especially emergency room front line providers and
primary care physicians.”

Originally from Petaluma, Dr. Brayton began studying health policy in law school.
“It felt like health policy would have more of an impact than treating individual patients’s, a more global impact is what I had envisioned.” But while she found that good in theory, “I really didn’t find it so satisfying on the ground.”

Dr. Brayton discovered that what she really wanted was patient contact. “It turned out that on a day to day basis what’s more interesting for me is to feel like I’m making a difference in individual’s lives. I derive more joy from face to face interaction. It feels much
more meaningful.”

While in medical school, Dr. Brayton maintained an interest in public health in general. And because heart disease is the number one killer in the U.S., for men and for women, it made sense that to impact a greater number of patients, she would focus on cardiology.
“It would be interesting to me medically, but I would also be treating a population where
there was potential for a greater impact.”

Dr. Brayton finished her fellowship in 2013, and continued with a post-doctoral fellowship
in health services research at Stanford University, which she finished in 2014. For the next
two years she was intermittently practicing medicine while doing clinical research in cardiovascular drug development. But again, something was missing. “I found the research and drug development interesting and thought it would have an impact; but, I had the same problem I always had, there was not enough patient contact. For me,
it was pretty clear I needed to get back into the clinic. Here at NCMA, this is exactly what I want to be doing.”

Dr. Brayton’s husband is also a cardiologist with NCMA, Dr. Vishal Patel. They have a one-year old son, Aash and recently had a little girl, Laana. When Dr. Brayton is not pursuing one of her many interests, she is “chasing her son around.” The family also enjoys hiking adventures to see the countryside.

NCMA FountainGrove Cardiology Welcomes Vishal Patel, M.D.

Dr. Vishal Patel

Dr. Vishal Patel

Dr. Vishal Patel, M.D. is joining NCMA’s Fountaingrove Cardiology, an elite team of cardiologists who practice the most current, innovative treatments in cardiovascular medicine. Dr. Patel is board certified in interventional cardiology, cardiovascular disease, and endovascular medicine. He is certified board eligible in nuclear cardiology and certified
with the American Registry for Diagnostic Medical Sonography Physicians’ Vascular Interpretation. Dr. Patel is a recipient of the JoAnn McWhoter Award for Excellence in Clinical Cardiology and also received the St. Mary’s Medical Center
Outstanding Teaching Award.

Dr. Patel received his medical degree at Baylor College of Medicine in Houston,
Texas, and completed his residency in internal medicine at the University of
California at San Francisco, San Francisco, CA. Dr. Patel also pursued subspecialty
fellowship training in interventional cardiology and cardiovascular disease from the
University of Texas Southwestern Medical Center in Dallas, Texas.

When Dr. Patel is not working he enjoys spending time on outdoor adventures
with his wife, son, and new puppy. He loves to garden, cook, and explore the
Sonoma County food and wine scene.

FOUNTAINGROVE CARDIOLOGY
3536 Mendocino Ave. Suite 200
Santa Rosa, CA 95403
To make an appointment with Dr. Patel call (707) 573-6199

NCMA
Northern California’s premier provider of medical and surgical care since 1975
employing the most highly respected primary care physicians and specialists in
Sonoma, Lake and Mendocino Counties.

Northern California Cardiologists and Emergency Medicine Expert Provide an Update On STEMI (Severe Heart Attacks) and Sepsis Protocols

New developments to aid in the diagnosis and timely treatment of severe heart attacks and related infectious conditions were the topics discussed recently at the Regional STEMI Program and Sepsis meeting at the John Ash Restaurant at the Vintner’s Inn Event Center.

Drs. Patrick Coleman, Thomas Dunlap and Tucker Bierbaum

Drs. Patrick Coleman, Thomas Dunlap and Tucker Bierbaum

Dr. Thomas Dunlap and Dr. Patrick Coleman, cardiologist with Northern California Medical Associates, Inc. and Dr. Tucker Bierbaum with Emergency Medicine at St., Joseph Health System’s Santa Rosa Memorial Hospital, co-hosted the biannual dinner meeting. They observed that both STEMI and Sepsis conditions present in similar ways and require time-critical intervention to avoid large area heart damage and progressive infections that can result in mortality.

According to Drs. Coleman and Dunlap, the medical community has come a long way in implementing timely procedures to treat patients with STEMI. “Cardiologists in the late 1990’s and early 2000’s began treating heart attack patients with intravenous stents, catheterization and balloon angioplasty – as well as drug-covered stents and balloons — for faster, more effective intervention — as opposed to just prescribing drugs to open clogged arteries which can take longer to do their job. The heart continues to suffer damage as long as the arterial occlusion remains. This new treatment strategy yields remarkable benefits in terms of less heart damage and improved patient prognoses.”

Dr. Dunlap said, “The STEMI Program has instilled a pervasive sense of urgency in people involved in administering the heart attack response protocol, and our efforts are paying off. The new STEMI treatment approach has been so successful that it’s not uncommon for patients that get picked up by EMS personnel at referral hospitals in Petaluma or Healdsburg to have their lifesaving device implanted within the next 90 minutes. There is still plenty of work to be done to increase STEMI response efficiency even further.

Dr. Coleman addressed the necessity of adhearing a standardized response protocol. “The urgency of any heart attack situation requires that all caregivers involved, including the paramedics, firemen, ED triage nurses, ED physicians, and cardiologists, perform precise tasks with efficient command and expertise.”

full table

All of the presenters at the meeting emphasized the vital importance of education and teamwork in an era marked by new techniques, technology and procedures. “It’s our job as cardiologists to educate everyone involved about their essential roles in saving heart attack patients’ lives,” Dr. Coleman added. “We know what needs to happen for STEMI patients to be treated effectively. Only through unified countywide planning and optimal utilization of local emergency facilities can we give patients their best chance for survival.”

A key barrier to the proper diagnosis of STEMI (ST-segment elevation myocardial infarction, or a severe heart attack) is that while EMS personnel and paramedics in the field can take EKG readings on site, or as they transfer the patient in an ambulance, they do not have the expertise or authority to read the tape and determine whether a STEMI incident has occurred. Only a cardiologist seeing the tape can make this assessment.

When a suspected heart attack victim is received by EMS personnel, they immediately call ahead to the nearest regional center emergency department (ED) to alert the cardiologist on duty so cath lab team members can be assembled in advance to save time.

“Without proper diagnosis, paramedics cannot know with certainty how to proceed and implement the correct treatment protocol unless a cardiologist miles away at a regional emergency department catheterization lab reviews the EKG tape,” Dr. Coleman continued. “So the quest has been to find a way to transmit EKGs to the cardiologist for precise interpretation while the patient is still in transit.”

Most facsimile machines are only capable of transmitting relatively low-resolution images. However, today’s cell phones have high-resolution cameras that can produce detailed images fine enough for an accurate STEMI diagnosis. Now a picture can be taken of the EKG tape in the field and transmitted to a physician in seconds, cutting the time interval for obtaining a diagnosis and treatment authorization during the journey from the field to the hospital, while also enabling the EMS to start appropriate medication therapy enroute.

The ability to transmit the photo image depends upon physical access to the nearest cellular signal relay tower. But even in remote areas beyond cell reception a moving vehicle often will enter an active cell zone within a few miles and be in a position to relay the picture before arriving at a hospital. HIPPA patient security and privacy considerations are avoided by asking the patient for permission to send the photo via a cell call prior to transmitting it.

In another innovative example, a Cotati-based medical transport company (ProTransport-1) has introduced ambulance technology that uses Google Glass camera-equipped spectacles worn by emergency technicians that transmit what they’re seeing to awaiting hospital staff.

The Google Glass system in the ambulances will allow EMTs, paramedics and nurses to transmit live video to receiving health care facilities during transports. In addition to mobile, visual evaluations, this versatile technology can improve the efficiency of patient care, documentation, navigation, dispatch communication and many more operational processes in the health care, ambulance and EMS industries.

“We’ve learned how to do many things well and still want to find ways to do them better, by focusing on a single process with ramifications based on how what you do will save lives, time and reduce costs,” Dr. Dunlap explained. “New communications technology is helping us expedite patient care before they arrive at the ED.”

Dr. Dunlap said the incidence of STEMI has decreased over the years, while the incidence of non-STEMI MI’s has gone up (1.6 cases per 1,000). Delays in treatment for STEMI come with a human cost per hour. Studies show that up to 40 lives can be saved for each hour medical personnel do better at identifying causes and administering proper treatment. For example, in door-to-balloon angioplasty therapy to unblock arteries, any time saved below 90 minutes makes a big difference in the 30-day mortality rate.

He said referral hospitals are good at processing patients quickly for transfer, and all regional medical centers have a reputation for rapid assessment of a patient’s condition, reducing the time required to implement treatment in receiving hospitals.
In an ideal scenario, ambulances equipped with EKGs would transmit the tape to the ED at the receiving hospital while adhering to standard protocols for drug stabilization and transfer from referral hospitals. The majority of the work will be done at the STEMI receiving hospital based on a single call from the field. This enables a classification of the case by level of evidence and severity.

The treatment ladder protocol for regional programs has been developed in consultation with Dr. David Lee at Stanford University with the goal of identifying a patient with ST elevation MI and directing the transport team to a STEMI-designated receiving hospital with a cath lab within 1.5 hours or less.

Dr Tucker Bierbaum

Dr. Tucker Bierbaum (R) of St., Joseph Health System’s Santa Rosa Memorial Hospital

Also presenting was Dr. Tucker Bierbaum, with St., Joseph Health System’s Santa Rosa Memorial Hospital. Dr. Tucker contends that Sepsis is an issue with increase prevalence and diagnosis. From 2012-13 there was an 11% increase in Sepsis in the region affecting 122 per 10,000 of population with those in the 65+ age group most severely affected, as well as those with weakened immune systems. During this time frame, Sepsis accounted for 40% of intensive care unit (ICU) costs and involved longer hospital stays. Those with Sepsis have a high recidivism rate. When not treated in time, the condition can lead to permanent renal disease.

Sepsis is one of four pathologically similar and progressive conditions beginning with SIRS (systemic inflammatory response syndrome), Sepsis (a potentially life threatening complication of infection due to the presence of bacteria or other infectious organisms in the blood stream that can spread throughout the body), Severe Sepsis (Sepsis with organ failure) and Septic Shock (Sepsis with multiple organ dysfunction or death).

For STEMI cases, two sets of protocols were discussed, including what to do during the first three-hours utilizing the initial bundle of treatment procedures, and what to do during the next three-hour period, as well as what medications have proven to be most effective in addressing this condition.

Regular meetings such as this and the quality of information provided are the keys to continuous improvement through education, as representatives from referral and regional hospitals come together to learn about new developments that can make the health care system better and improve patient outcomes.