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Page 1: Cacrdio Consultants
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www.cardiologyconsultants.com 3

Welcome to the inaugural issue of Pensacola HeartHealth. The mission of Cardiology Consultants, PA, is toexceed expectations while providing high-quality car-diovascular care for our patients and consultative serv-ices for referring physicians. We aim to practice in amanner that enhances the personal and professionallives of our employees, our families, and ourselves.We feel this goal is best accomplished through zealous

continuing education, planned practice responses to our community’schanging needs, and cost-conscious practice standards that do not com-promise quality.

We are proud of our history, having provided cardiology services to thePensacola community since 1977. Two key founding physicians are stillactive in the practice today. Since the 1970s, the group has practiced on theBaptist Hospital and the Sacred Heart Hospital campuses. In 2004, weadded a full-time office on the Gulf Breeze Hospital campus.

From its modest beginnings, the practice has grown manyfold, encom-passing cardiothoracic surgery and the subspecialties of interventionalcardiology and electrophysiology.

Cardiology Consultants physicians have participated in a number ofPensacola “firsts,” including the development of the first coronary care unit,the performance of the first balloon angioplasty (percutaneous translumi-nal coronary angioplasty, or PTCA), the introduction of electrophysiology,the first minimally invasive cardiac surgery, and more. Today, the physiciansremain on the cutting edge of each of their respective areas of interest.

We hope you enjoy our new magazine!

Sincerely,

Andrew Radoszewski, MBA, MPH, CMPEAdministrator

Opening Remarks

Baptist CampusBaptist Medical Towers1717 N. “E” St. Ste. 331Pensacola, FL 32501-6376(850) 444-1717

CARDIOLOGISTS:W. H. Langhorne Jr., MD, FACCWilliam S. Pickens, MD, FACCW. Daniel Doty, MD, FACC, FAHAEdwin W. Rogers, MD, MBA, FACCG. Ramon Aycock, MD, FACCF. James Fleischhauer, MD, FACCS. Marcus Borganelli, MD, FACCW. Henry Langhorne III, MD, FACCBrent D. Videau, MD, FACCAndrew Scott Kees, DO, FACCSafwan Jaalouk, MD, FACP, FACC, FSCAIElias G. Skoufis, MD, FACCThanh H. Duong-Wagner, MD, FACCThabet Alsheikh, MD, FACCMuthu Velusamy, MD, FACCSumit Verma, MD, FACCHani A. Razek, MD, FACCRoger E. Moraski, MD, FACCSteven J. Schang Jr., MD, FACP, FACCThomas D. Paine, MD, FACCMartha J. Stewart, MD, FACC, FSCAI

CARDIOTHORACIC SURGEONS:James L. Nielsen, MD, FACSJames L. Lonquist, MD, FACSWilliam F. Bailey, MD, FACS

NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS:Richard Clark, PA-CSara Hulme, PA-CTanya Duffey Warner, MSN, ARNP-CKevin Harris, PA-CTeresa Yates, MSN, ARNP-CMichael Sweet, MSN, ARNP-CDrew Watson, PA-CJennie Lowery, MNSc, ARNP-CElizabeth Berg, ARNP-CPatrick Pagan, ARNP-CRalph DeCapua, PA-CStarr Jacobus, MSN, ARNP-CKathleen Ouzts, ARNP-CRebecca Cower, PA-CErin Armstrong, PA-CDouglas S. Baker, PA-CWilliam Nate Taylor, PA-C

ADMINISTRATOR:Andrew Radoszewski, MBA, MPH, CMPE

MAGAZINE COORDINATOR:Frances Kahler-Ropp, LCSW

LOCATIONS:

Pensacola Heart HealthA publication from

4 And the Beat Goes OnCardiologists, Surgeons Join Forces to Provide Quality Care

6 Philanthropic EffortsLocal Physicians Extend Expertise to Health Care Overseas

8 Young at HeartWomen and Heart Disease: An Equal Opportunity Killer

10 Protect Your HeartRecognizing the Signs of Peripheral Vascular Disease

14 Directory

Pensacola Heart Health is published by QuestCorp Media Group, Inc., 885 E. Collins Blvd., Ste. 102,Richardson, TX 75081. Phone (972) 447-0910 or (888) 860-2442, fax (972) 447-0911, www.qcmedia.com.QuestCorp specializes in creating and publishing corporate magazines for businesses. Inquiries: VictorHorne, [email protected]. Editorial comments: Brandi Hatley, [email protected]. Please call or faxfor a new subscription, change of address, or single copy. Single copies: $5.95. This publication may not bereproduced in part or in whole without the express written permission of QuestCorp Media Group, Inc. QCCreative is a full-service graphic design firm, www.qccreative.com. Creative services inquiries: JalynnTurner, [email protected].

Gulf Breeze CampusMedical Office Building1118 Gulf Breeze Pkwy. Ste. 102Gulf Breeze, FL 32561-4836(850) 932-1775

Con

tent

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Sacred Heart CampusRegional Heart and Vascular Institute5151 N. 9th Ave. Ste. 200Pensacola, FL 32504-8721(850) 857-1700

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Written in every name, there is a rich storyof comings and goings, endeavors, and chal-lenges. It’s true of Cardiology Consultants,PA, which has made its home in Pensacola,Florida, since 1977. In that year, foundersW.H. (Henry) Langhorne Jr., MD; CharlesRiley, MD; and William Pickens, MD, estab-lished Cardiology Associates, PA. The namechanged to the current one in 1983 whenDr. Riley left the practice.

Today, the roster at Cardiology Consultantsincludes 21 cardiologists and three cardio-vascular surgeons who serve northwesternFlorida and southern Alabama. The prac-tice has more than 200,000 patient encoun-ters per year at its three offices and thethree hospitals that it serves.

The structure of Cardiology Consultantsenables patients to find the care they needin one setting. “To have both cardiologistsand surgeons in the same group is not thatcommon,” says Andrew Radoszewski,MBA, MPH, CMPE, and Administrator forCardiology Consultants. “I believe we arethe only one of our kind in the southeast-ern United States. With both cardiologistsand surgeons, we make the best medicaldecision for the patient’s treatment,whether it be stent placement by a cardiol-ogist or open heart surgery by a surgeon.”

Constancy and Clarity

“The group’s philosophy has always beento maintain quality care with the most

up-to-date knowledge, technology, andskills to best serve Pensacola and north-western Florida,” says Dr. Langhorne. “Westrive to provide a level of patient carecomparable to that in large metropolitanand academic centers.”

Keeping pace with advances in medicalresearch is a given for everyone atCardiology Consultants. It includes partic-ipation in research and clinical studies ledby three dedicated research coordinators.Clinical drug trials and thrombolytic stud-ies, as well as interventional, pacing, ICD(implantable cardioverter defibrillator),and electrophysiology (EP) trials and pro-tocols have ensued in recent years.

To ensure patients receive the best care in atimely way, Cardiology Consultants alsohas a full staff of nurse practitioners andphysician assistants.

To improve accessibility for patients,Cardiology Consultants has three Floridalocations — two in Pensacola and one inGulf Breeze. They are the Sacred Heart campus at the Regional Heart and VascularInstitute, the Baptist campus at BaptistMedical Towers, and the Gulf Breeze campus at the new Medical Office Building.

A full complement of diagnostic services isavailable in the campus setting, includingstress testing, an anticoagulant clinic,echocardiography, nuclear cardiology,heart catheterizations, and vascular stud-

ies. The anticoagulant clinic streamlinesthe focus of attention on individualstaking drugs such as warfarin (e.g.,Coumadin®) to lower the risk of thrombo-sis, or blood clots in the circulatorysystem. More than 100,000 diagnostic and

therapeutic procedures are performed bythe physicians and staff of CardiologyConsultants each year.

Of course, Cardiology Consultants is notjust about treatment. Prevention is of para-mount concern. The practice works withpatients to help them achieve healthydiets, whether for weight, sodium intake,or cholesterol management.

The physicians and clinical staff atCardiology Consultants can help patients

And the Beat Goes OnCardiologists, Surgeons JoinForces to Provide Quality Care By Diane M. Calabrese

The roster at Cardiology Consultants includes 21cardiologists and three cardiovascular surgeons.

1964: Dr. Langhorne introducesphonocardiography, vectorcardiog-raphy, the Master’s Two Step exer-cise test, apex cardiography, andthe photomotogram as a screeningprocedure for thyroid function.

1965: The first community coronary care unit in the South-east United States opens atBaptist Hospital.

1970: The Sacred Heart Hospitalcardiac catheterization laboratoryis started as a joint venture bythe medical community.

1972: Treadmill exercise testingand hemodynamic monitoring areintroduced at Baptist Hospital;first catheterization laboratoryopens at Baptist Hospital.

1977: Drs. Langhorne, Pickens,and Riley incorporate CardiologyAssociates, PA.

Important Dates in Cardiology Consultants, PA, History

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identify the best combination of lifestyle changes and medica-tions to keep blood pressure within an appropriate range.

Vigor and Vision

Cardiology Consultants attracts and retains talented health careprofessionals, as well as administrative staff. For instance, whenRadoszewski joined the group in 2002, he brought 20 years ofexperience to the position.

Radoszewski has served as an administrator in hospitals,ambulatory surgery centers, heart institutes, and medical grouppractices. This range of experience allows him to coordinate theactivities at Cardiology Consultants in a way that contributes toexcellence and efficiency.

“Consistent availability and continuity of care for patients is thesignature of Cardiology Consultants,” says Radoszewski.

The physicians of Cardiology Consultants are also passionateparticipants in continuing education. As the senior member ofthe practice, Dr. Langhorne sets the tone with which allthe physicians resonate. Starting in his earliest days as a physicianmore than four decades ago, he became a lifelong studentof medicine.

Heart disease prevention is a paramount concern at CardiologyConsultants.

While the printed words of Dr. W.H. (Henry)Langhorne Jr. appear in medical journals,they also fill the pages of other literaryworks — poetry books.

At work on his fourth book of poetry,Dr. Langhorne fits into the same physician-poet category as William Carlos Williams(1883-1963). He is the current Poet

Laureate of northwestern Florida.

Dr. Langhorne earned his undergraduate degree at TheUniversity of the South at Sewanee, Tennessee, an institutionimbued with a strong literary tradition. From there, he went tothe School of Medicine at Tulane University in New Orleans.

After completing an internship and residency at CharityHospital in New Orleans, Dr. Langhorne moved toPensacola, Florida. He has held a membership in the BaptistHospital medical staff since 1963, holding the titles ofChairman of the medical board, President of the medicalstaff, and Medical Director. He has also earned a HollingerAward for outstanding service as a physician.

“I came from a family of physicians and pharmacists,”says Dr. Langhorne. The heart and circulatory systemcaptured his attention early in his medical studies. One ofDr. Langhorne’s three children followed in his foot-steps; W.H. Langhorne III, MD, is also a member ofCardiology Consultants.

The elder Dr. Langhorne says his patients and the advancesin cardiac care are foremost on his mind. “Cardiology hasgrown in an explosive way since the mid-1960s,” he says.“There are constant new developments, medications,devices, and procedures that have benefited my cardiacpatients beyond expectation.”

1983: The practice is rein-corporated as CardiologyConsultants, PA; Dr. Tranthamis recruited as the firstelectrophysiologist inNorthwest Florida.

1994: Dr. Borganelli performs thefirst pectoral implant ICD in thestate of Florida.

2000: Outpatient catheterizationlaboratories are constructed atthe Sacred Heart and Baptistoffices; noninvasive studies,including echocardiography andnuclear stress testing, are under-taken at the Sacred Heart,Baptist, and Gulf Breeze offices.

“We are all committed to providing the best cardiac care to ourpatients,” Dr. Langhorne says. “Over the many years since itsinception, Cardiology Consultants has remained one of the mostsuccessful, longstanding, and largest cardiovascular practices inFlorida. Its evolution was unique — in fact, a rarity. And itsfuture looks bright because it has grown on the principle that themost talented will always attract and recruit the most talentedfuture associates.”

Meet W.H. Langhorne Jr., MD

1983-1992: A number of important procedures and programs areinitiated by the group, including intravenous and intracoronary throm-bolysis, dual-chamber and rate responsive pacemaker implantations,carotid and vascular ultrasound, Doppler echocardiography, stressechocardiography, transesophageal echocardiography, pharmacologicnuclear stress testing, balloon valvuloplasty, telemetry event monitor-ing, direct coronary atherectomy, and radio frequency catheter ablation.

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Philanthropy encompasses the ideal of giv-ing back — not only money but also timeand knowledge. Two Florida physicianshave embraced the philanthropic conceptof promoting human welfare by organizingthe Syrian American Medical Society, orSAMS. The purpose of SAMS is to giveback a portion of the medical educationthey received in the United States.

Five years ago, Mazen Daoud, MD, andCardiology Consultants CardiologistThabet Alsheikh, MD, among a dozenother physicians, decided to commit oneweek per year to medical education in Syriaand independently organized small confer-ences in Damascus.

When they later discussed their experi-ences, Dr. Daoud suggested forming anorganization of American-trained Syrianphysicians to initiate a larger, multispecial-ty conference. The following year, Dr.Alsheikh performed the first surgical pro-cedure during the conference in Syria byimplanting his first dual-chamber pace-maker, which was consistent with his visionof teaching not only cognitive skills butalso procedural skills to Syrian physicians.

As SAMS’s first President, Dr. Daoud sawhis brainchild become a reality whenSAMS organized its first official continuingmedical education (CME) conference inSyria. Dr. Alsheikh, Vice President of SAMSand Convention Chairman of next year’sconference, was Scientific Chairman of thisyear’s conference.

For five years, SAMS physicians have inde-pendently funded all conference activities,bringing in millions of dollars worth ofdonated supplies for use in treatment-indi-gent patients. Spurred by the success of theconference, SAMS has now grown to morethan 500 members in the United States.

This year’s conference provided 81 U.S.-accredited CME hours in 23 specialties.This training was done through 32 didacticsessions and 16 advanced workshop cours-es at 14 hospitals and teaching centers infour Syrian cities. More than 200 Syrian-American physicians traveled to Syria thisyear to provide 122 of the 150-memberconference faculty, accomplishing thelargest CME conference ever held in Syria.

Positive Impact

The impact of SAMS and the annual conference is truly profound. In cardiacelectrophysiology in Syria, for example,before these conferences, there were nodual chamber pacemaker implants, abla-tions, or ICD (implantable cardioverterdefibrillator) implants; no electrophysio-logy (EP) laboratories or training courses;and no standardized protocols for BLS(basic life support) or ACLS (advanced cardiac life support).

Dr. Alsheikh’s three-day advanced pacingworkshop this year was an eight-hour-per-day course, which he uniquely fully trans-lated into Arabic. The workshop includedhands-on participation for select partici-pants and live video monitoring for theaudience. This year, he added a trainingcourse in ICD implantation and hopesto offer North American Society forPacing and Electrophysiology (NASPE) cer-tification with the eventual goal of helpingto establish full EP fellowship trainingin Syria.

SAMS’s impact on Syrian health care ingeneral is much greater than new conceptsand procedures. Until now, there were noenforced physician CME requirements forprocedures or official implementation ofevidence-based guidelines.

SAMS’s larger impact on Syrian health careis reflected in the lectures given this yearin the opening plenary session by thatcountry’s Ministers of Health and ofHigher Education, with topics including“Physicians Training in Syria: Is It Time toUnify the Standards?” and “Can the HealthCare System Survive Without Account-ability, Clinical Guidelines, and QualityAssurance?” Several SAMS members wereinvited to attend the first ExpatriatesConvention in October 2005 to promoteSyrian health care reform.

Giving Back

Each year, the United States recruits andretains many of the brightest internationalphysicians from around the world, yet veryfew physicians “give back” through sharingtheir training with their native countries. Atremendous, largely untapped potentialexists for collaborative international edu-cation and research. Few individuals likeDr. Daoud and Dr. Alsheikh have the initia-tive to commit hundreds of personal hoursto originating such programs.

Many physicians, both international andthose born in the United States, however,are willing to share their time, ideas, andenergies if organizations such as SAMS andthe American College of Cardiology commit to sowing the seeds of such pro-grams. International bridges built throughthe sharing of medical knowledge and thecommonality of human values and aspira-tions can do nothing but good for medicineand, in a larger perspective, our world.

Philanthropic EffortsLocal Physicians ExtendExpertise to Health CareOverseas

Dr. Thabet Alsheikh with an award for hishumanitarian efforts

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Although there is widespread publicityregarding women and breast cancer,which is responsible for one in every 30female deaths, much less is said about awoman’s risk of heart disease and stroke.These diseases are implicated, in fact, inone out of every 2.5 female deaths. Whileheart disease is traditionally perceivedas a male problem, statistics indicate it isthe leading cause of death in women overthe age of 25 years.

The incidence of myocardial infarction(MI) is lower in premenopausal women,

but it increases rapidly after menopause. DoloresStrickland, a patient atCardiology Consultants, is74 years old. At the age of 61years, she had her first heartattack. “My family has nohistory of heart problems,”

the retired nurse says. “I am not a smoker. Ihave low blood pressure and low choles-terol. So I was very surprised when I wastold it was a heart attack.”

Ten years later, Ms. Strickland had asecond heart attack and eventuallyunderwent triple-bypass surgery. “After my triple bypass, I recovered very welland was able to have a regular home life,”says Strickland.

Understanding Gender Differences

Underrepresentation of women and lack ofgender-specific reporting in many clinicaltrials have limited the data availabilityneeded to devise optimal managementstrategies for women with coronary heartdisease (CHD). An example is seen inthe Framingham study, which reported agood prognosis for women with angina.Unfortunately, the study did not include asufficient number of women to addressgender-specific questions.

It is likely that this conclusion reflected ahigh prevalence of women with chest painoriginating from diseases other than thoseaffecting the coronary arteries. It is alsolikely that this lack of detailed gender-spe-cific results has led to incorrect decisionsconcerning investigation and treatmentalternatives, resulting in an inability toidentify the high-risk woman in time.

“I had no chest pain or early symptomsexcept jaw pain, which is a commonsymptom in women,” says Strickland. “Myadvice is to not ignore the symptoms.”

Clinical trial results are usually used toset standards for both sexes, despite thefact that most research is performedalmost exclusively on men. This bias com-pounds our inability to understand gender

differences in the diagnosis and treatmentof heart disease.

Examining the Risk Factors

Cardiovascular risk factors include previ-ous personal history of CHD, an age over55 years, dyslipidemia (high LDL and/orlow HDL cholesterol), diabetes, hyperten-sion, smoking, peripheral vascular disease,or a first-degree male relative (youngerthan 55 years) or female relative (youngerthan 65 years) with CHD. Elevated triglyc-erides, obesity, and a sedentary lifestyle,while not considered primary risk factors,are also commonly associated with highercoronary risk.

As women age, their risk equals and even-tually outpaces that of men. Postmeno-pause is an additional, gender-specific riskfactor for CHD. Essential hypertension alsopresents itself differently in men andwomen. While there are obvious hormonaldifferences between the sexes beforemenopause, the arterial tree ages different-ly after menopause. At all ages, the shorterstature in women and the obligatory short-er arterial tree that results induce fasterheart rates and earlier reflected arterialpulse waves. These factors operate to influ-ence systolic blood pressure (BP), pulsepressure (PP), PP amplification, diastolictime, and diastolic BP. The circulatory

Women and HeartDisease: An EqualOpportunity KillerBy Thanh Ha Duong-Wagner, MD

YOUNGAT HEART

Dolores Strickland

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effects of these variables during youth andwith aging help explain the time-depend-ent and aging differences in cardiovascularrisk between men and women.

Metabolic syndrome — a collection ofhealth risks that increase the chance ofdeveloping heart disease, stroke, and dia-betes — is also associated with subsequentCHD events and increased mortality. Mostresearchers believe it is caused by a combi-nation of genetic makeup and lifestylechoices, including the types of food we eatand physical activity levels.

Overall, women have a higher prevalenceof metabolic syndrome than men.Screening for metabolic syndrome inwomen with high risk for new vascularincidents may help identify patients witheven higher atherosclerotic vascular risk.

Confronting the Problem

Recommendations for women at risk forcardiovascular disease include regimentedexercise programs, smoking cessation,weight control, a low-fat diet, treatment forhypercholesterolemia (elevated LDL, orlow-density lipoprotein, cholesterol levels),control of hypertension and diabetes, andavoidance of contraceptives for womenwho smoke. Interventions recommendedfor high-risk women include more aggres-sive treatment of hypercholesterolemia andthe use of folic acid supplementationin presence of hyperhomocysteinemia. Inaddition, daily aspirin (75 to 162 mg),beta-blocker treatment in patients withknown coronary artery disease, and thereduction of BP to less than 130/80 mayhave added benefits.

Gender-difference ignorance on the part ofthe patient and health care worker limitsthe optimal management of women withheart disease. More thorough educationduring office visits, earlier and moreaggressive control of coronary risk factors,and a greater degree of suspicion and eval-uation regarding chest pain may helpreverse the trend of late referral and lateintervention. Research indicates thatbehavioral changes on the part of womenand reshaping of practice patterns by theirhealth care providers may dramaticallyreduce the number of women disabled andkilled by CHD each year.

In its second year, the Go Red forWomen campaign is intent on inform-ing women about the deadly conse-quences of ignoring coronary heartdisease (CHD) symptoms. “Men re-cover and women die,” says Thanh H.Duong-Wagner, MD, a cardiovasculardisease specialist, when asked whythis campaign is so important.

Of the total number of U.S. deathsin 2001 attributed to CHD, womenrepresented 53.6% of all deaths andmen represented 46.4%. A significantportion of these women had no previ-ous symptoms.

“Contrary to common belief, heart dis-ease is no longer a men-only condition;women also need to be aware of thewarning signs,” says Dr. Duong-Wagner. Most heart attacks start slowly,with mild pain and discomfort or pres-sure in the center of the chest. The painmay last for a few minutes or longer and

then retreats, only to return. Other signsinclude vague pain, discomfort, or pres-sure in other areas of the upper body,shortness of breath, cold sweats, nau-sea, or lightheadedness. Unfortunately,because they do not recognize thesymptoms, women often wait too longbefore seeking help.

According to Dr. Duong-Wagner,women are generally not aware of theirunique risks, often shrug off earlysymptoms, and tend to delay seekingtreatment, stating they do not want tobother others with their health prob-lems. They often feel they do not havethe time to seek medical attention. Bythe time women finally seek medicalattention for their symptoms, they areolder with concurrent diseases, andtheir heart disease may have pro-gressed to a more advanced stage. Atthis point, coronary revascularizationbecomes more complicated and canresult in higher mortality and morbidity.

For these reasons and many others,the grassroots campaign provides tipsand information to women on how theycan minimize their risk. In addition toGo Red spokesperson R&B vocalistToni Braxton, a number of celebritieshave lent their names to the cause. Theyinclude Bill Cosby, Antonio Banderas,Melanie Griffith, Jamie Lee Curtis, DaisyFuentes, Jane Pauley, Univision TV per-sonality Teresa Rodriguez, designerCarolina Herrera, and TV chefs RachelRay and Sara Moulton.

For more information, visit www.americanheart.org.

Thanh Ha Duong-Wagner,MD, received her undergradu-ate degree from the Universityof Wisconsin and her medicaldegree from the University ofWisconsin Medical School. Her

postgraduate training included a residencyin Internal Medicine at Hennepin CountyMedical Center in Minneapolis-Minnesota,a fellowship in cardiology, and advanced

training in echocardiography and vascularmedicine at the University of Michigan-AnnArbor. She is board certified in internal med-icine, cardiovascular diseases, and adultcomprehensive echocardiography. She is amember of the American College ofCardiology, American Society of Echocardi-ography, and Heart Failure Society ofAmerica. She joined Cardiology Consultantsin July 1999.

Go Red for Women By Phil Vinall

Frances Kahler-Ropp, LCSW, and CarolMoore, RN, (both from Cardiology Consul-tants) assisting with heart risk assessmentsduring the Go Red campaign

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The two basic types of PVD are functionaland organic. Functional PVDs do not haveunderlying organic causes and do notinvolve abnormalities or defects in theblood vessel structure. These are usuallyshort-term effects related to a spasm thatmay be intermittent. An example of thistype of PVD is Raynaud’s Syndrome, whichis triggered by cold temperatures, emotion-al stress, working with vibrating machin-ery, or smoking.

Organic PVDs result from structuralchanges in the blood vessels, includinginflammation and tissue damage. PVD isoften an indicator of occult cardiac disease.

A Sign of Heart Disease

PAD is a condition similar to coronaryartery disease. In these diseases, fattydeposits build up on the inner linings(endothelium) of the vessels and restrictcirculation. Myocardial infarction, orstroke, is often the result.

In PAD’s earliest stages, a common symptom is cramping or fatigue in thelegs or buttocks during physical activity.Such cramping subsides when the personstands still. This is known as intermit-tent claudication.

Nearly 75% of people with PAD, however,do not experience symptoms such as footpain, poor wound healing, and gangrene.

Diagnosis of PAD includes a completephysical examination, often including theankle-brachial index test that comparesblood pressure in the feet to blood pressurein the arms. (Normal ankle pressure ismore than 90% of arm pressure, but withsevere narrowing of the vessels, it maymeasure less than 50%.)

Doppler and ultrasound imaging is anoninvasive method used to visualize thearteries with sound waves to measureblood flow and detect any obstructions.Computed tomographic (CT) angiographyis another noninvasive test that visualizes

Protect Your Heart

Peripheral vascular disease (PVD) — especially peripheral arterialdisease (PAD) — is a relatively common form of atherosclerosis, orhardening of the arteries. It affects circulation primarily in the vesselsthat nourish the kidneys, stomach, arms, legs, and feet. It is estimatedthat some eight to 12 million Americans have PAD, and approximately20% of those older than 70 years of age have the disease.

Recognizing the Signs ofPeripheral Vascular DiseaseBy Safwan Jaalouk, MD

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Learn more at sjm.com

Mapping and navigation.

Therapeutic tools.

Ceaseless innovation.

Together we can.

In the advance against AF, we’re committedto reducing the effect it has on patients’ lives.

the arteries in the abdomen, pelvis, andlegs. This test is a useful diagnostic tool forpeople with pacemakers or stents.

Similar to CT angiography but without theuse of x-rays, magnetic resonance angiog-raphy is yet another noninvasive test usedto diagnose PAD.

PAD Treatment

PAD is often treated with lifestyle changesand/or medications. Lifestyle changes tolower the risk include:

• Smoking cessation. Smokers are two to25 times more likely to develop PAD.

• Diabetes management and control.This chronic disease can acceleratethe development of PAD. Managementinvolves regular testing for hemoglobinA1c, hypertension, insulin resistance,and diabetic retinopathy.

• Blood pressure control.

• A regular, medically supervised exerciseprogram. According to the American

Heart Association, the most effectivetreatment for PAD is regular exercise.Walking, leg, and treadmill exercisesare usually good ways to begin.

• Dietary changes to include a low-fat,low-cholesterol diet.

PAD may also require medications, such asan antiplatelet agent (cilostazol) to increasewalking distance and cholesterol-loweringagents (statins). When lifestyle modifica-tions and drug interventions are not suffi-cient to treat PAD, angioplasty (a nonsurgicalprocedure used to dilate narrowed orblocked peripheral arteries) or surgeryare sometimes required.

During angioplasty, a small balloon is intro-duced via the groin into the circulatorysystem and then inflated inside the blockedartery, resulting in the reestablishment ofnormal blood flow. Occasionally, a stent(like metal mesh) is deployed inside theartery to keep it open.

If a long portion of the artery is diseasedand narrowed, surgery is often necessary.

In this procedure, a vein from anotherpart of the body or a synthetic blood vesselis used to bypass the diseased part of thevessel. The graft is attached above andbelow the blocked area to detour bloodaround the blockage.

Safwan Jaalouk, MD, earnedhis medical degree at theUniversity of Aleppo, Syria,and completed an internship atLutheran Medical Center inCleveland, Ohio, where he also

completed a residency in internal medicine.He has held fellowships in cardiology at theCleveland Clinic Foundation and theOchsner Clinic in New Orleans. He is boardcertified in internal medicine, cardiovasculardisease, interventional cardiology, nuclearcardiology, and echocardiography. Dr.Jaalouk is a Fellow of the American Col-lege of Physicians, American College ofCardiology, and the Society for Cardio-vascular Angiography and Interventions.

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Pensacola Heart Health14

Directory

Attorneys

Clark Partington Hart

Larry Bond & Stackhouse ........................see page 12

Commercial Laundry

Crown Health Care

Laundry Services, Inc...............................see page 12

Health Care Technology and Management

Med3000 Group, Inc. .................................see page 14

Health Information Services

Gulfwave Communications, Inc..................see page 13

Hospice

Hospice of the Emerald Coast, Inc. ...........see page 12

Medical Imaging

Toshiba ........................................................see page 7

Medical Manufacturing and Distributing

St. Jude Medical, Inc..................................see page 11

TZ Medical Inc............................................see page 13

Medical Services

Baptist Health Care................................see back cover

Baptist Medical Park ..................................see page 13

Karanbir S. Gill, MD....................................see page 12

Medtronic, Inc. ............................see inside back cover

Sacred Heart Health System........see inside front cover

Nonprofit Organizations

American Heart Association, Inc. ...............see page 12

Office Products

Gulf Coast Office Products, Inc. ..................see page 7

Pharmaceuticals

Novartis ........................................................see page 7

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Cardiology Consultants, PA1717 N. “E” St. Ste. 331Pensacola, FL 32501-6376