Cardiology

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 MRIs 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.

NCMA Docs Make a Difference: Dr. Harendra Punatar and the NBIAA

DMADNorthern California Medical Associates (NCMA) Cardiologist Harendra Punatar, MD, FACC, gives back to the community through his volunteer work with the North Bay Indo-American Association (NBIAA). NBIAA is a non-profit organization founded in 1990 in the North Bay area by the local residents of Santa Rosa, Rohnert Park, Petaluma and Novato. Dr. Punatar’s brother Suresh was one of the original founding members. NBIAA’s mission is to “bring India to the North Bay” by organizing cultural, religious, and educational events that are of interest to the growing Indian community in the region.

DSC_1412 DSC_1428

NCMA's cardiologist Dr. Patrick Coleman with Dr. Punatar

NCMA’s cardiologist Dr. Patrick Coleman with Dr. Punatar

Soon after its founding, the NBIAA grew in popularity and became a primary avenue for connecting Indian community members. Events became well-attended and information about upcoming events spread quickly via word-of-mouth. In the late 90s, doctors began to notice a significantly higher propensity for heart disease and diabetes within the community. In fact, these diseases were almost twice as common in Indians in the North Bay than they were in other groups! Due to the disturbingly high prevalence of these diseases, Dr. Punatar began organizing free, annual NBIAA Health Fairs 15 years ago to spread awareness about disease prevention and treatment.

“The data on diabetes and heart disease made for a startling discovery. Members of the Indian community are on average more affluent than other groups in the area, and what we realized was that with that affluence came an increase of poor eating and exercise habits—both of which can be major health risks,” says Dr. Punatar.

He continues, “People in the community were worried and asking lots of questions about their health. The Health Fairs started as a way to meet the demand for health education. Originally, diabetes and heart disease have been the main topics of focus at the health fairs, but over the last five years we’ve really broadened the discussion to cover other prevalent health related subjects. The fairs have been extremely successful. We’ve come to expect about 100-2150 attendees every year!”

NBIAA Health Fairs are run entirely by volunteers with substantial support from NCMA and Medtronic. At the fairs, NCMA nurses and physicians offer free lipid health screenings with immediate results. In just a few minutes, these screenings reveal cholesterol and A1C hemoglobin levels in the bloodstream necessary to diagnose diabetes. During the health screenings, yoga and Tai Chi instructors offer free classes in other rooms to promote healthy exercise habits. At each fair, Dr. Punatar also arranges for two speakers to come and present for one hour each. Past presenters include NCMA Drs. Hopkins and Coleman and renowned physicians from all over the country.

The last NBIAA Health Fair took place on April 18th, 2015, at the Medtronic Cardiovascular at 3850 Brickway Blvd in Santa Rosa. The event focused on common food allergies, free lipid panel health screenings as well as yoga and Tai Chi classes.

Dr.-Punatar-PhotoDr. Punatar obtained his medical doctorate at Miraj Medical College in Miraj India and went on to complete his residency and fellowship training in cardiovascular disease from Coney Island Hospital in Brooklyn, NY. He has been a valued member of NCMA’s team of expert cardiologists for over 23 years, and he regularly sees patients in Santa Rosa and Petaluma. Dr. Punatar is also the proud father of two bright young women—one who is currently completing her residency training at UCSF Benioff Children’s Hospital in Oakland and the other is finishing her medical school at George Washington University in Washington, DC.

To schedule an appointment with Dr. Punatar, call (707) 573-6199, and visit northbayindia.org for more information on the NBIAA and upcoming events.

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NCMA Cardiologist Jaime Molden Explains Latest in Catheter Ablation Treatment for Atrial Fibrillation

 Jaime Molden, MD, FACC, FHRS Electrophysiologist


Jaime Molden, MD, FACC, FHRS
Electrophysiologist

Northern California Medical Associates (NCMA) Cardiology offers expert atrial fibrillation care from leading specialists in the North Bay region. Cardiac Electrophysiologist Jaime Molden explains the current guidelines for treating atrial fibrillation with catheter ablation—an invasive, nonsurgical procedure that may reduce patient reliance on toxic medications.

Atrial fibrillation (Afib) is a common, potentially life-threatening heart condition in which the upper heart chambers beat out of sync with the lower chambers, causing an irregular heartbeat. Although the arrhythmia causes only a small increase to one’s risk of early death, the condition can evolve when left untreated over time and become very serious. In addition to life-changing symptoms of fatigue, palpitations, shortness of breath, inability to exercise, chest pain, and syncope, patients with Afib live with increased risk for an array of serious life-threatening health problems including stroke, cardiomyopathy, and heart failure.

Cardiologists have been helping patients manage their Afib for decades primarily with anti-arrhythmic drugs (also known as AADs or “rhythm drugs”). While these drugs are proven effective, the degree of efficacy varies from patient to patient, and side effects from taking these medications over extended periods of time can cause serious complications. Catheter ablation for Afib first became a viable treatment option in the early 1990s, and researchers and cardiologists have studied its efficacy ever since, fine-tuning the procedure throughout the process. Today, catheter ablation is gaining traction in the treatment of Afib as it has shown to help certain patient groups return to healthy heart rhythms while reducing their reliance on medications, which can have significant side effects.

NCMA Cardiologist Jaime Molden, MD, studied cardiac electrophysiology during his fellowship at Cedars Sinai Medical Center in Los Angeles. Dr. Molden regularly treats patients with Afib and he is a leading specialist in the area of catheter ablation techniques.

Dr. Molden explains, “Treating Afib remains a challenge to cardiologists today. There are three types—paroxysmal, persistent, and permanent—and treatment varies depending on which type the patient has. Paroxysmal is generally described as lasting less than 48 hours at a time. Persistent Afib lasts more than a week or requires an intervention to terminate it. Permanent Afib lasts longer than a year. Paroxysmal Afib patients have better treatment prognoses than persistent and permanent patients, but both paroxysmal and persistent Afib can become more frequent over time if untreated or treated ineffectively. Since many treatments are available but none that will work the same for every patient, treating Afib demands cardiologists’ full attention to detail in each individual case.

Treatment of Afib is always individualized to the patient. Many patients want to get off of their anti-arrhythmic medications altogether, and others want to simply minimize symptoms. When symptoms persist, more catheter ablation procedures can often get patients to where they want to be, with the type of Afib playing a significant role in the efficacy of the treatment. Patients with paroxysmal Afib can achieve excellent results with a single ablation procedure.

In the procedure, we use several different diagnostic catheters and an ablation catheter to map out and treat the areas of the heart that are causing the abnormal rhythm. In the vast majority of patients, arrhythmia is triggered by pulmonary veins firing electrical signals in an irregular, chaotic pattern. With catheter ablation, lesions (‘burns’) are made around the opening of each pulmonary vein until there is no electrical conduction into the vein. What we are essentially doing is cutting off ‘communication’ between the misfiring vein (or veins) and the heart by modifying the tissue in a precise area. We can then test the results to ensure that there is no conduction between the heart and the misfiring vein. After catheter ablation, a patient’s pulmonary veins will still fire an electric signal that would normally cause arrhythmia, but the signal cannot pass through the ablated tissue, and sinus rhythm (normal rhythm) is maintained.

Catheter ablation for atrial fibrillation is becoming more widely used within the medical community for several reasons. It likely has a more favorable success rate than anti-arrhythmic drugs. Analysis of landmark Afib trials like AFFIRM, RACE and RACE II suggests that rhythm control with drugs and cardioversion benefit the patient by maintaining sinus rhythm, but the toxicities and adverse effects associated with AADs negate the positive effects. The subset of patients who responded well to the treatment, meaning that their normal rhythm was maintained with little adverse reactions to the drugs, had lower morbidity rates than the overall population of patients in the study. This suggested that non-pharmacologic therapies might allow us to achieve the larger benefits of maintaining sinus rhythm.

While studies into the efficacy of catheter ablation are ongoing, results from recent research demonstrate that approximately 60-70% of patients with paroxysmal Afib can enjoy freedom from arrhythmia after a single procedure. With two or more procedures, the efficacy increases further. The research also indicates a higher success rate for paroxysmal patients when compared to rates for persistent or permanent Afib patients. Patients with paroxysmal Afib, accordingly, are better candidates for the procedure than those living with the persistent types.

The risks associated with catheter ablation are serious, but the propensity for major complication is approximately 2% with the overall complication rate in the range of 5%. Compare that number with the propensity for complications associated with anti-arrhythmic drug treatment, and the risks of catheter ablation look even better. While rhythm drug treatment has a lower rate of life threatening side effects than ablation, almost a third of patients on these medications eventually experience an adverse event caused by their treatment, like severe heart rate slowing or the precipitation of other abnormal heart rhythms. Over 10% of patients either find the treatment too intolerable to continue or altogether ineffective.

This leads to the important question—‘When is the use of rhythm drugs warranted?’ New official Afib treatment guidelines in the US now include a treatment route for Afib that removes AADs from the process altogether, allowing patients to opt for ablation before they’ve tried AAD therapy. This is exciting progress, as the new guidelines demonstrate a trend towards replacing a standard treatment with a potentially better one. With that said, we do not have a curative treatment for Afib in 2014. The treatment for this disease will continue to be a combined approach utilizing the existing medicines in as safe a way as possible while applying catheter ablation techniques to the patients who prove to be good candidates.

A trial run with medications is still generally seen as the first option for Afib patients. Also, patients with persistent or permanent Afib may not be eligible for the ablation procedure depending on various cardiac and overall health factors. Catheter ablation for treating Afib has settled in as a viable treatment for patients that meet the right criteria, both without and in conjunction with medications. For some patients, catheter ablation may offer the best outcomes.”

Click here to view Dr. Molden’s complete presentation on Afib catheter ablation from NCMA’s annual symposium.

NCMA offers patients excellent quality and convenience in its comprehensive cardiac and vascular testing services. All procedures are performed by highly skilled and trained registered sonographers, registered nuclear technologists, and/or registered nurses and medical assistants, under the support of our physicians. NCMA’s nuclear and echocardiology laboratories are accredited by the Intersocietal Accreditation Commission. To learn more about NCMA Cardiology or Dr. Molden, please visit www.ncmahealth.com, or call (707) 573-6166 to schedule an appointment.

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NCMA Cardiology Launches “Be Heart Smart” Campaign During National Heart Month

February is American Heart Month, and Northern California Medical Associates (NCMA) Cardiology is kicking off its “Be Heart Smart” campaign to do its part to spread heart health awareness. Since 1975, NCMA Cardiology has focused on educational outreach in addition to providing a comprehensive range of cardiac services from highly trained, elite physicians. With the “Be Heart Smart” campaign, NCMA Cardiology aims to educate the public about various aspects of heart health in order to empower people to make the right choices and to live a heart healthy life.

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Heart disease has been the number-one killer of Americans for the past 80 years. In 2015, it isn’t news to most people that heart disease is the leading cause of premature death in the United States. It also isn’t news to most people that heart disease is preventable. The shocking news is that even though people know the risks of heart disease and that it is preventable, the incidence of heart disease and related deaths continues to grow. According to the American Heart Association, one in seven deaths is related to coronary heart disease, and one in nine is caused by heart failure. In light of the growing problem, February has been deemed “Heart Month” in America. NCMA Cardiology has launched its “Be Heart Smart” social media campaign this month as a means to help people realize the power of preventative healthy living to reverse the trend of rising heart disease.

While there are some risk factors you can’t control such as age, gender, heredity, and race, people can significantly mitigate their risk for heart disease by making healthy lifestyle choices. With its campaign, NCMA Cardiology hopes to reach as many people as possible and to cause them to stop and think about their hearts when making health-related choices. NCMA cardiologists have identified seven interrelated goals that will help people reduce their risk for heart disease. In essence, the “Be Heart Smart” campaign is about (1) managing diet and weight, (2) exercising regularly, (3) quitting smoking, (4) reducing stress, (5) keeping blood pressure in the healthy range, (6) managing cholesterol levels, and (7) controlling blood sugar.

First and foremost, managing diet and weight is the most important step towards minimizing one’s risk of heart disease. NCMA Cardiology strives to redefine the meaning of ‘diet’ in popular culture. One’s diet encompasses everything he or she ingests over a lifetime. Alternatively, when one ‘goes on a diet,’ this most likely means the dieter is resisting the foods that he or she prefers to eat for a set period of time for the sake of losing weight. This type of dieting is not an effective way to sustain weight loss, as once the diet ends, the person rewards themselves with the unhealthy foods they resisted while dieting. To truly have a healthy diet, NCMA cardiologists recommend eating smaller portions at meals, and snacking on vegetables and fiber-rich whole grains during the day. Allow yourself to indulge in high-fat, and high-sugar foods, but don’t overdo it. Your diet does not have an end-date.

While obesity poses one of the most serious threats to heart health, you don’t have to be obese to have an increased risk of heart disease due to a poor diet. Everyone’s body processes food differently. Although it is unlikely, some people can appear slim and fit while sustaining themselves on potato chips and soda pop. This does not change the fact that these people are increasing their risk for heart disease through their diets. What foods are really the best for your heart? Recent studies have shown that the “Mediterranean diet” can reduce the risk heart disease by about 20% in both men and women.

“Just taking a walk in the morning or the evening will put you on your way to better heart health.”

After maintaining a healthy diet, exercising regularly is the next most important step towards reducing hearth health. Not only will living a sedentary lifestyle reduce muscle strength and endurance, it will also contribute to metabolic problems such as high blood sugar and cholesterol. Much scientific research has gone into how much exercise is enough, and today’s leading experts recommend getting at least 60 minutes of continuous, moderate aerobic exercise each day of the week. NCMA cardiologists recognize that this recommendation is more than what many Americans are willing to do or have time for, so they level with patients and tell them the raw facts—true up until the extreme, the more cardiovascular exercise people get everyday, the more they reduce their risk for heart disease. While 60 minutes a day brings about excellent health benefits, even just 20 to 30 minutes of continuous, moderate aerobic exercise five days a week has been shown to reduce the risk for heart disease by 30-50%. Just taking a walk in the morning or the evening will put you on your way to better heart health.

It shouldn’t come as a surprise to anyone that smoking dramatically increases your risk of cardiovascular heart disease. Like it says on every cigarette box today, smoking causes heart disease. Smoking accelerates the progression of heart disease in people predisposed to having it, and drastically increases the chances of it developing in people who would otherwise be at a very low risk. In conjunction with the Northern California Center of Well-Being, NCMA offers smoking cessation classes. Even if you aren’t ready to quit, it is important to talk to your NCMA physician about your smoking habit so that he or she may provide you with all of the resources, clinics and classes offered through NCMA.

When it comes to reducing stress, it is important to clarify what kind of stress is most necessary to reduce for the sake of improving heart health. Reducing physical stress such as exercise, for example, should not be thought of as an effective means to reduce one’s risk of heart disease. Emotional stress, such as work-related, relationship, and financial stresses, has long been suspected and recently confirmed to increase one’s risk for heart disease. These types of stresses, however unpleasant or dangerous, cannot always be avoided. Reducing stress, therefore, is ultimately about finding ways to relax when confronted with stressful situations. No two people will ever react to the same type of stress the same way, so it is also important for individuals to determine the stresses that affect them most. Avoid them when you can, and find relief through deep breaths and communal support when you can’t. Include your doctor in conversations about your stress levels for further feedback and advice.

High blood pressure, high cholesterol, and off-balance, volatile blood sugar levels are all relatively common in our society and can significantly increase one’s risk of developing heart disease. While the best way to mitigate these risks is through exercise, healthy eating, and not smoking cigarettes, treatment may require management with drug therapy and careful monitoring by your physician. Other contributing factors other than lifestyle choices such as genetics and metabolic disorders are often unavoidable and may warrant even closer care with your doctor.

Improving your heart health and reducing your risk for heart disease doesn’t have to be overwhelming. Simply making an effort to be conscious of heart health in your day-to-day living can go a long way. To start, NCMA Cardiology encourages everyone to pick two or three goals on the “Be Heart Smart” list to go after. In addition, keeping regular appointments with your cardiologist before any serious heart issues arise is the best way to stay on top of your heart health.

NCMA Cardiology is comprised of 14 cardiologists, two cardiothoracic and vascular surgeons, and one electrophysiologist—all board-certified in their fields. 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. In accordance with its practice of providing comprehensive cardiovascular health care, NCMA offers HeartWorks, pacemaker and defibrillator clinics, anti-coagulation clinics, congestive heart failure clinics, pulmonary hypertension clinics, lipid clinics, and an adult congenital heart clinic in addition to general check-ups with cardiologists. NCMA’s HeartWorks Cardiac Rehabilitation Center provides each patient with a personal diet and exercise plan supervised by a team of physicians, nurses, and cardiac exercise specialists.

Be Heart Smart IconNCMA Cardiology provides cardiac care in three counties, with 11 offices, located in Santa Rosa, Petaluma, Sonoma, Healdsburg, Fort Bragg, Mendocino, Gualala, Ukiah, and Lakeport. Visit our website at www.ncmahealth.com for more information on NCMA health services and contacting NCMA offices. Please call (707) 573-6166 to schedule an appointment with NCMA Cardiology, and visit NCMA’s Facebook page to follow the “Be Heart Smart” campaign.

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Northern California Medical Associates (NCMA) Welcomes Jaime Molden, M.D. Cardiac Electrophysiologist to the NCMA Cardiovascular Services Team

Northern California Medical Associates’ (NCMA) Cardiovascular Services is delighted to welcome Dr. Jaime Molden to the elite Fountaingrove Cardiology team. Dr. Molden previously served as Medical Director of Electrophysiology at Dixie Regional Medical Center in St. George.

Background

Jaime Molden, M.D. Dr. Molden earned his medical degree from the University of Chicago’s Pritzker School of Medicine, where he was recognized with the Dylan Award in Medical Ethics. Returning to California, and following internship and residency in internal medicine at Harbor-UCLA Medical Center in Torrance, Dr. Molden joined Kaiser Permanente Southern California in Los Angeles as an internist. In 2009 he completed a fellowship in cardiovascular disease at Harbor-UCLA Medical Center during which time he also served as a clinical instructor. Dr. Molden went on to complete the Clinical Cardiac Electrophysiology Program at Los Angeles’s Cedars-Sinai Medical Center in 2010.

Dr. Molden currently holds board certifications in clinical cardiac electrophysiology, cardiovascular disease, nuclear cardiology and internal medicine, as well as, advanced cardiac life support and has authored numerous clinical publications.

Cardiology and More

Dr. Molden is trained to diagnose and treat a variety of heart and cardiovascular conditions including congenital heart defects, congestive heart failure, heart disease, coronary artery disease, heart attacks, arrhythmias, high cholesterol, high blood pressure and many other heart-related conditions. As an electrophysiologist, Dr. Molden is able to also provide advanced diagnosis, treatment and management of electrical- based diseases and disorders of the heart. His education and experience in electrophysiology allows him to perform specialized surgical procedures such as ablation and drug therapy to manage complex arrhythmias.

By joining Northern California Medical Associates’ (NCMA) Cardiovascular Services team Dr. Molden becomes an important part of a highly recognized team of dedicated professionals, all working together to deliver the highest quality care with the best patient results.  Providing treatment and services for everything from cardiac catheterization to open-heart surgery, from electrophysiology to rehabilitation and prevention, this highly  qualified staff not only maintains its commitment to patient health and well-being, they also follow a tradition of excellence and expertise to deliver the most current, innovative treatment in cardiovascular medicine.

Making an appointment

Dr. Molden is pleased to be accepting new patients at NCMA’s Fountaingrove Cardiology office in Santa Rosa. For more information about NCMA visit our site at ncmahealth.com, and to arrange for an appointment call (707) 573-6199.

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Northern California Medical Associates is Northern California’s premier provider of medical and surgical care north of the Golden Gate and has been serving individuals and families since 1975. Every highly skilled professional comprising the NCMA team shares a strong commitment to preventive programs and health screening designed to promote and maintain everyday health. NCMA has successfully built a legacy of excellence that is recognized nationwide.