Our Passion, Your Health

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Heart Attack Victim Credits Quick Action With Saving His Life

It was a Sunday in August, and Robert Clay had just made a putt on the 15th green of the Rich Maiden Golf Course near Fleetwood.

From what he’s been told, as he reached down to retrieve the ball, he sank down onto one knee and said to his golf partners, “something isn’t right.”

Clay recalls none of that, nor much of what happened to him for the next 12 hours. What he does know, however, if not for the speedy and capable efforts of other golfers, the EMTs who treated him, and Penn State Health St. Joseph’s Emergency Department and Heart Institute staff, he would not be alive after suffering cardiac arrest.

“They told me when I woke up in the hospital that I was really lucky,” Clay said during a recent interview. “They said that most people who have the kind of heart attack I had don’t make it. I hate to think what would have happened if I had been home by myself, or out in the woods hunting.”

After Clay fell onto the golf course, one of his golfing buddies started CPR. No one in the foursome had a cell phone, so a player behind them called 911.

Northern Berks Emergency Medical Services was on the scene in less than 10 minutes, and paramedics treated Clay en route to Penn State Health St. Joseph. On two different occasions, they could detect neither a pulse nor a heartbeat.

“They told me that I flat-lined twice, but the EMTs used the paddles on me and brought me back,” Clay said. “Then, when I got to the hospital, they were all ready for me in the Emergency Department.”

After being treated and stabilized in the ED, Clay was moved to the St. Joseph’s Heart Institute, where a stent was placed to open a blocked artery. He was released three days later, grateful to be going home.

The Spring Township resident, who is 60, had very few symptoms before the cardiac arrest, which he was told was triggered by a blood clot caused by heart arrhythmia.

“I didn’t have any pain, or anything like that,” he explained. “The only thing I can think of is that for about a week before it happened, I felt really sluggish. Like, I’d wake up in the morning and feel still tired.”

Clay, whose father and two brothers died of heart disease, currently is in cardiac rehabilitation at Berks Cardiology, and says he is feeling well.

He is changing his diet to avoid fats and salts, and has stopped smoking cigarettes.

“I sent my son to my house while I was in the hospital to get rid of all the cigarettes,” Clay said. “I’m wearing a patch now. Every now and then I crave a little bit, but then I think about something else and it’s okay. I should have given them up a long time ago.”

Reading food labels is time consuming, said Clay, who lives alone, but he’s doing his best. Changing his eating habits won’t be easy, but he’s determined.

“I’m Pennsylvania Dutch, so I like some shleck,” he said. “And, what I’m really going to miss is my all-time favorite, fresh-cut French fries.”

Clay, however, who is the father of a son and a daughter and the grandfather of five, is determined to improve his health.

“I’ve got my family, and I just retired from Car Tech last year,” Clay said. “I’ve got a lot to live for, and I want to stick around for a while and enjoy it.”

Penn State Health St. Josephs Heart Institute and Emergency Department
have demonstrated expertise and commitment to quality patient care by meeting American Heart Association’s stringent criteria as a Heart Attack Receiving Center. If you’re having chest pain or other heart attack symptoms, call 9-1-1 and seek medical attention immediately. Any other questions, contact The Heart Institute at 610-378-2340.

Berks cardiologists weigh in on keeping your heart healthy

Excerpt from Reading Eagle story by Matthew Nojiri

February is American Heart Month, and it puts the spotlight on an important issue. About 34 percent of American adults have high blood pressure, and heart disease accounts for one in seven deaths, according to the American Heart Association.

Dr. Andrew Waxler, a cardiologist with Berks Cardiologists Ltd., Wyomissing, discussed heart disease and the ways to live a healthy life.

About heart disease

Coronary artery disease is the biggest heart issue, Waxler said.

The buildup of plaque and the hardening of the arteries around the heart can be an insidious problem as artery disease doesn’t always come with symptoms,” said Waxler, who also serves as president of the Berks County Medical Society. “Coronary artery disease is incredibly common.

“We’ve known the process of arteriosclerosis, the hardening of the arteries, starts early. People get to my age, 50, and they have a heart attack, but the process has been going on for years.”

Coronary artery disease makes up about 45 percent of all cardiovascular disease, but some people don’t know it’s an issue until later in life.

“In some people, their first warning is a heart attack,” Waxler said. Others will notice tightness or pressure in the middle of the chest or shortness of breath from doing everyday tasks, Waxler said. “I never ask about chest pain,” he said. “It’s about tightness, pressure and discomfort.”

Preventive steps

Some aspects of health cannot be changed.

Family history and genetics fall into that category. Ethnicity is another. Those factors can make you more likely to suffer from heart disease. Still, there are things that are within your reach. For one, you can decide to quit smoking, Waxler said.

“The whole world knows smoking can cause emphysema and lung cancer,” he said. “I don’t think the American public knows how detrimental it is to the heart. It causes injury to the lining of heart arteries, which promotes more blockages. It also causes constriction of blood vessels, which can lead to a heart attack.”

Penn State Health St. Josephs Heart Institute and Emergency Department
have demonstrated expertise and commitment to quality patient care by meeting American Heart Association’s stringent criteria as a Heart Attack Receiving Center. If you’re having chest pain or other heart attack symptoms, call 9-1-1 and seek medical attention immediately. Any other questions, contact The Heart Institute at 610-378-2340.

The Watchman is a Device That Can Help Certain Patients with Atrial Fibrillation

Charlotte Moyer had no fears about getting a new heart procedure at Penn State Health St. Joseph.
The 71-year-old St. Lawrence resident had bigger fears about having a stroke. “I decided to have it done just to be cautious,” Moyer said. “I don’t want to worry about having a blood clot in the head. It was nothing to have it done.”

watchman-lg

Moyer was one of the first patients in Berks County to have a new procedure to insert a device called the Watchman. The device from Boston Scientific Corp. was approved by the Food and Drug Administration in 2015.

The Watchman has been approved for certain patients with atrial fibrillation who are at a higher risk for a stroke and do not want to be on a blood thinner for the long term due to concerns about bleeding and other side effects.

Cardiologists at St. Joe’s say the new procedure fills an important niche. Many patients with an abnormal heartbeat are at a higher risk of stroke, but can’t take a blood-thinning medicine, such as Coumadin.

The Watchman could be emerging as an alternative for those patients, said Dr. Christopher Rogers, a cardiologist with Berks Cardiologists. “It kind of technically eliminates the part of the heart where clots form to eliminate the risk of having a stroke,” Rogers said.

Abnormal heartbeat

At St. Joe’s, Rogers and his colleague Dr. Troy Trayer have been performing the procedure since August, and it’s taken a bit of legwork to get ready.

The two doctors have been watching for nearly a decade as the device moved through the process of clinical trials and regulation. They said there has always been a need for such a device.

Patients who have an irregular heartbeat can be at higher risk for blood clots and strokes.

Most of those blood clots develop in the left atrial appendage in the heart and then travel through the bloodstream. That can ultimately lead to a stroke in the brain.

Blood thinners have been the gold standard for stroke prevention, but some patients have problems with bleeding while on those drugs. “There’s a population of patients who need to be protected from having stroke that are not good candidates to be on blood thinners,” Rogers said. “This is the only FDA-approved device that’s approved and available that shows it’s at least as protective as being on blood thinners.”

How it works

The device is implanted through a catheter that runs all the way up from a leg vein to the left side of the heart.
Rogers and Trayer work with a team of caregivers during the procedure, which can last between 45 minutes and three hours.

The device is pushed through the catheter and opens up like a flower once it reaches its destination in the heart. It’s made of a self-expanding, nickel-titanium frame with an attached woven plastic cap.

The key is to position the device in just the right spot, making sure it’s secure and there are no leakages, the doctors said. “It’s like putting an umbrella in this pouch, and that umbrella is catching and preventing blood from coming out there where that clot could form,” Trayer said.

Feedback

Patients are put under general anesthetic and only have to stay at the hospital for a day before being released. Moyer said the whole process could not have been simpler. She was a perfect candidate for the procedure because she has atrial fibrillation but couldn’t be on blood thinners for the long term due to the bleeding problems in her stomach.

“I feel fine, and I have no problems,” she said of her recovery. “I’m just glad I had it done. It’s one less worry I have.”
Moyer was on Coumadin for 45 days and now takes Plavix, but eventually she’ll just need to take a daily aspirin.

Rogers said it’s possible the device could be expanded to help more people one day, but that is likely years down the line.
For now, the doctors are happy to offer the service to the patients who need it in Berks County.

“They have an alternative to blood thinners if they have high risk of stroke and high risk of bleeding,” Trayer said. “They don’t have to go on living their life crossing their fingers and hoping they don’t have a stroke.”

About the Watchman

What: The device is implanted via a catheter into the left atrial appendage of the heart. It prevents blood clots from entering the bloodstream and causing a stroke.

How it works: The device is implanted through a catheter through a vein in the leg. The physician makes a small hole through the wall between the two upper chambers of the heart. The device is pushed in the left atrial appendage and then opens up like an umbrella.

When it’s used: The device is an option for patients who have atrial fibrillation not related to heart valve disease. Those abnormal heart beat patients should also be at increased risk for stroke, recommended for blood thinners and have appropriate reason to seek an alternative to those blood thinners.

Clinical results: The device was evaluated in four studies, comparing how it compared against blood-thinning medicines to prevent strokes caused by a blood clot in the brain. In two of the studies, the blood thinners were better than the Watchman in preventing strokes caused by a blocked blood vessel in the brain. However, the number of strokes caused by bleeding in the brain was lower in the device patients compared to the blood thinner patients. The rate of serious bleeding was similar in the device and blood-thinner patients.

In one study, 99 percent of patients were able to stop taking the blood thinner Coumadin after a year.

Approved: March 2015

Source: Food and Drug Administration

By Matthew Nojiri, Reading Eagle
Bern Township, PA

Troy Trayer, DO and Christopher Rogers, DO are cardiologists with Berks Cardiologists, Ltd. who perform the Watchman procedure. If you have any questions or would like more information, contact our Heart Institute at 610-378-2340 or email LShober@PennStateHealth.psu.edu

Penn State Health St. Joseph patient’s gain access to leading clinical trials

Cardiologists leading the way in various trials leading to innovative treatments

Cardiologists at Penn State Health St. Joseph are always looking for better and more effective methods of treating patients who have coronary disease. To that end, St. Joseph is participating in a cutting- edge clinical trial designed to compare the performance of a dissolvable heart stent with that of a non-dissolvable stent currently in use.

Depending on trial outcomes, the dissolvable stent could soon be approved by the U.S. Food and Drug Administration (FDA) for use in the United States. And that, said Dr. Guy N. Piegari, Jr., a cardiologist with Berks Cardiologists, Ltd. and Medical Director of the Cardiac Catheterization Laboratory at Penn State Health St. Joseph, could be significant.

“We’re always moving toward something better,” Piegari said. “The stents that we have are really very good, but we’re always in a continual state of improvement for our patients.”

St. Joseph and Berks Cardiologists have been participating as a team in the randomized control trial, sponsored by Abbot Vascular, a division of Abbott Laboratories, since 2013. The Abbot trial is designed to compare the performance of the company’s new dissolvable stent, Absorb™ Bioresorbable Vascular Scaffold (BVS), with its non-dissolvable stent, XIENCE.

A dissolvable stent could provide significant benefits to patients, Piegari said, because it enables an artery to return to its natural state once it has healed. Currently, some patients whose arteries have narrowed due to buildup of plaque are treated with metal stents containing a medicine that, when released into the artery, prevents the plaque from reforming.

The stent holds the artery open, which enables blood flow. Because it remains in the body, however, it prevents the artery from working as it naturally would. A dissolvable stent is designed to remain in place until the medicine to prevent the rebuild-up of plaque has been dispensed over time, and then gradually disappear. “Arteries are designed to dilate and constrict according to the needs of the body, but they can’t do that well when you’ve got a metal stent in,” Piegari explained. “If the stent dissolves, then there’s nothing left in the artery to interfere with its normal function.”

The clinical trial is required by the FDA before the Absorb stent can be approved in the United States. Absorbable stents are already in use in Europe. The Abbott trial is one of two in which the hospital is currently involved.

St. Joseph and Berks Cardiologists also are involved in a trial sponsored by Swiss-based Biosensors Europe, testing a drug coated, non-absorbable stent known as BioFreedom™. More patients were enrolled in that clinical trial at St. Joe’s than at any other trial site in the country – a significant achievement for the hospital.

“We are the leading contributor in that study,” Piegari said. “If it gets approved, it’s definitely due to our participation.”
These clinical trials involving heart stents are just two of many in which Penn State Health St. Joseph has participated during that past 16 years. “We’ve been conducting clinical research since 1999,” said Lori Shober, Director of Cardiovascular Services. “We’ve been involved in some very cutting-edge research.” Most of the clinical trials have occurred within the Heart Institute and Cancer Center, and have involved hundreds of patients.

Some trials conducted within the Heart Institute have directly contributed to approval by the FDA of devices used in angioplasty and stenting of the carotid, coronary, renal and leg arteries. Participating in clinical trials is time consuming and complex, but the effort that the hospital undertakes is well worth it, Shober said. Trial participation not only increases the profile of St. Joseph, it also helps with advances in the medical field. “It’s just awesome to be involved in research that results in life-saving medical advances,” Shober said. “It’s what we’re about.”

Guy N. Piegari Jr., MD, FACC, FSCAI, is a cardiologist with Berks Cardiologists, Ltd.
He is a Board Certified in Cardiovascular Diseases, Internal Medicine, Interventional Cardiology, and Critical Care Medicine. He can be reached at 610-685-8500.