Geisinger Publishes Series for Heart Month—Signs of Heart Disease You Shouldn’t Ignore Signs of heart disease may show up unexpectedly. But these clues should lead you to your doctor’s office. By: Gregory Yost, D.O., interventional cardiology, Geisinger Bleeding gums may not seem like a serious issue. But if it becomes chronic, you might be surprised to hear that it can be a clear warning your heart isn’t working as it should. While pressure or tightness in the chest and a rapid, irregular heartbeat are primary signs of heart disease, there are other symptoms that can be less obvious — yet just as dangerous. And ignoring these subtle signs of heart disease can lead to serious heart trouble, like a heart attack or stroke. Identifying all signs of heart trouble and then responding to them is key to help prevent heart disease, which is the leading cause of death for both men and women. Even if you’re unsure, don’t hesitate to get a symptom checked out — especially if you have risk factors for heart disease. Preventing heart disease is an important step in living a long, healthy life. 6 subtle signs of heart disease Chest pain that may radiate to the neck, jar or arms, shortness of breath, heart palpitations and numbness set off alarm bells that will send most of us straight to the doctor’s office. But not all heart problems come with clear warning signs. If you have some of these lesser-known signs of heart disease, don’t wait to contact your provider. Waiting puts you at higher risk for a serious heart event to occur. Exhaustion and weakness While exhaustion alone isn’t a sign of heart disease, chronic exhaustion and weakness can be, especially if you’re getting sufficient rest. Your energy levels are directly related to blood flow and oxygen levels. A healthy heart constantly pumps oxygen-carrying blood through your body. But if there are underlying problems with your heart, it might not work as efficiently. As a result, you may begin to feel tired after routine activities — or even confused. Because oxygen isn’t reaching your muscles and brain as it normally does, weakness and fatigue become obvious. If you’re often feeling exhausted and weak, even with sufficient rest, consult with your healthcare provider to find a cause. Swollen feet Swollen feet are a more subtle sign of potential heart concerns. In fact, your socks and shoes can make it difficult to notice your feet are swollen in the first place. But why would your feet swell if you have heart problems? Because your heart regulates blood flow, and slow blood flow can cause pressure to build up in your legs, leading to edema. Edema is the buildup of fluid in the body’s tissues. Typically, edema related to heart problems can be seen in the legs and feet. Any sign of heart failure or reduced function is serious, so talk to your doctor if you notice swelling in your feet. Dizziness, light-headedness, and shortness of breath Slow blood flow and low oxygen levels in the brain and lungs can lead to feeling dizzy, light-headed and short of breath. And it’s especially important to notice if you have these symptoms without rigorous activity. If activities, like going up the stairs or going about your daily life, consistently make you dizzy or out of breath, don’t ignore them. Dizziness and being out of breath are both examples of your body telling you that you need more oxygen. Migraines Migraines are intense headaches that are bad enough on their own. Some research suggests migraines with auras may be linked to heart problems, but more studies are needed on the connection between these health issues. If you have migraines with auras, take note of any new changes in symptoms of your headache. Newly developed weakness in your arms during a migraine could be a sign of heart disease. Swollen and bleeding gums Swollen or bleeding gums may not be the biggest indicator of heart health, but studies show a possible correlation. Recent research has revealed that your mouth can show your heart health. In fact, some of the same bacteria found in your mouth can be found in your heart. So, if you have high levels of bacteria and swelling in your mouth, it’s wise to get your heart checked, too. While the relationship between heart health and oral health isn’t clearly understood, consistent swollen and bleeding gums could be a sign of heart issues. Sweating Sweating while exercising is normal. Breaking out in a sweat while watching TV is not. We sweat to keep our body temperature at a regular level. So, why would you sweat when you aren’t active or it’s not hot outside? Heart failure makes pumping blood more difficult, so your heart must work harder. When your heart struggles to pump blood consistently, it generates heat. To compensate, your body starts sweating to keep your body temperature normal. If you’re having serious episodes of sweating when you shouldn’t be, talk to your doctor. Many of these symptoms alone aren’t signs of heart disease, but chronic issues can be or at least a sign of an underlying condition. It’s a good idea to get regular checkups — and live a heart-healthy lifestyle — to take the pressure off. Heart disease risk factors All these subtle signs are even more important to report if they’re combined with other heart disease risk factors, such as if you: Are overweight or obese Smoke, use drugs and alcohol Have a high level of stress Eat a diet high in sodium and saturated fat Don’t exercise regularly Have a family history of heart disease Have high blood pressure or high cholesterol Have diabetes If any of these heart disease risk factors apply to you, talk to your doctor to create a heart health plan. Awareness is the first step in managing your heart health. While genetics do play a role in heart disease, there are risk factors that can be reversed by taking the proper steps and precautions. Left untreated, heart disease can cause a heart attack — when blood flow is severely reduced to the heart. Watch for the subtler symptoms that can indicate a possible heart condition. If you have them, be sure to tell your healthcare provider. When you bring these issues to their attention earlier, they can screen you for heart disease — and plan to keep your ticker going strong for the long haul. For the latest health and wellness tips and advice, visit geisinger.org/balance.
Geisinger Announces Chief of Structural Heart Disease Shikhar Agarwal, M.D., M.P.H., has been promoted to chief of structural heart disease at Geisinger. In his new role, Dr. Agarwal oversees the integration and growth of services across the health system for patients with diseases of the heart valves. Over the past decade, there has been a substantial increase in the number of patients with heart valve disorders, including aortic valve stenosis (narrowing of the aortic valve) and mitral valve regurgitation (leaking of the mitral valve). A Geisinger provider since 2016, Dr. Agarwal specializes in valve-related interventions and complex coronary interventions. He leads the structural heart disease program at Geisinger Medical Center (GMC), performing minimally invasive procedures, including transcatheter aortic valve replacement (TAVR), transcatheter mitral valve repair and replacement, paravalvular leak closure and coronary interventions that require only a skin puncture. In 2020, Dr. Agarwal was recognized as one of the Pennsylvania Medical Society’s Top Physicians Under 40 for significant successes early in his career. To date, he has performed more than 100 mitral valve repairs and more than 550 TAVR procedures and led the GMC structural heart team’s implantation of more than 1,000 replacement valves via TAVR. Dr. Agarwal’s leadership at GMC was integral to the hospital’s investment in its interventional hybrid suite, which has expanded availability to patients in the region and established the medical center as a destination for structural heart care. “As a system, we have witnessed tremendous growth in structural heart disease care in recent years,” Dr. Agarwal said. “I look forward to working with my colleagues in interventional cardiology and cardiac surgery to offer our patients in every community a full team of experts to consult on the best approach to their care.” As system chief of structural heart disease, Dr. Agarwal will work closely with regional chiefs of cardiology and the chair of the Department of Cardiology, George Ruiz, M.D., to coordinate care across the system, create new programs that complement clinical efforts, provide the communities Geisinger serves with expanded clinical expertise and review any clinical quality challenges that arise. “Our vision is to make better health easier for our patients and members regardless of where they live,” Dr. Ruiz said. “With Dr. Agarwal’s leadership, we’re bringing outstanding care for structural heart disease to every region in our service area.”
The Wright Center for Graduate Medical Education Resident Physicians Present Scholarly Works at 71st American College of Cardiology Scientific Session Internal medicine resident and cardiology fellow physicians at The Wright Center for Graduate Medical Education recently presented scholarly abstracts at the 71st Annual American College of Cardiology Scientific Session & Expo in Washington, D.C. The global conference enables the cardiology community to connect with peers and top experts in the field to learn about the latest practice-changing research and cutting-edge education that can transform cardiovascular care for doctors, health care team providers and patients. Dr. Sanskriti Shrivastava, the lead author, presented three research abstracts and a meta-analysis. His scholarly works included, “Long Story Short: Long-Term Outcomes in Alcohol Septal Ablation vs. Septal Myectomy in Patients with Hypertrophic Cardiomyopathy,” “Outracing Cancer: Analyzing Racial Differences in Clinical Characteristics and Outcomes in 270 Patients with Primary Malignant Cardiac Tumors from the Seer Database,” and “Characteristics and Survival Outcomes in Primary Malignant Cardiac Tumors Based on Histology: Insights from the Seer Database.” She also presented the meta-analysis, “Gender-Based Differences in Cardiovascular Outcomes Associated with COVID-19 Infection: A Systematic Review and Meta-Analysis.” The lead author on three abstracts, Dr. Chaitanya Rojulpote presented “Effects of Prednisone Use on Cardiac Function and Outcomes in Patients with Sarcoidosis,” “Temporal Trends of Acute Myocardial Infarction Complicating Atrial Fibrillation Hospitalizations in the United States,” and “Temporal Trends of Heart Failure Complicating Atrial Fibrillation in the United States.” Dr. Pooja Kharbanda was the lead author on the scholarly abstract, “Dynamic Assessment of Left Ventricular Outflow Tract Obstruction Using Cardiac Catheterization.” Dr. Raza Naseer offered, “Rate vs. Rhythm Control for Atrial Fibrillation in the Modern Era: A Systematic Review and Mata-Analysis.” “Monitored Anesthesia Care vs. General Anesthesia Outcomes in Transcatheter Aortic Valve Implantation: A Systematic Review and Meta-Analysis, was presented by Dr. Humza Hanif, the lead author. Co-authors included Drs. Muhammad Affan, Najam U. Saqib, Muhammad Siddique Pir, Shrivastava and Naseer. “Double Firing AV Node,” a case report, was presented by Dr. Sujithraj Dommaraju. Dr. Saqib presented his case reports, “The Bread and Butter and Beyond” and “Robotic PCI,” which he co-authored with Dr. Samir Pancholy. Overall, resident physicians in The Wright Center for Graduate Medical Education have had 115 scholarly abstracts, written on a wide array of topics in medicine, accepted for presentation at professional conferences since the beginning of the 2021-22 academic year.
Geisinger Welcomes New Chair of Cardiology Specialty-trained cardiologist accepts role as vice chair of Heart Institute George Ruiz, M.D., a seasoned clinical cardiologist and proven leader, has joined Geisinger as chair of Cardiology and vice chair of the Geisinger Heart Institute. As counterpart to John Conte, M.D., chair of Cardiothoracic Surgery and vice chair of the Heart Institute, Dr. Ruiz rounds out institute leadership under Alfred Casale, M.D., chief medical officer of surgical services and chair of the Heart Institute at Geisinger. With more than 20 years of clinical experience, Dr. Ruiz cares for adult cardiology and adult congenital heart disease patients in central and northeastern Pennsylvania in addition to serving in his leadership roles. A bilingual physician, Dr. Ruiz has treated and organized outreach to the Spanish-speaking community for more than two decades. Dr. Ruiz specializes in clinical cardiology with a subspecialty in adult congenital heart disease and pulmonary hypertension, and he has extensive experience in mechanical circulatory support and adult heart failure. As a leader, he focuses on improving quality of care within complex, progressive service programs. Dr. Ruiz earned his medical degree from Albert Einstein College of Medicine at Yeshiva University in the Bronx, New York. He completed his residency in internal medicine and fellowships in cardiovascular medicine and adult congenital heart disease at Harvard Medical School’s Brigham and Women’s Hospital in Boston. Before coming to Geisinger, Dr. Ruiz held academic and clinical leadership roles, including instructor of Medicine at Brigham and Women’s Hospital, director of Advanced Cardiac Support, Pulmonary Hypertension and Advanced Heart Failure at MedStar Washington Hospital Center in Washington, D.C., and chief of Cardiology at MedStar Union Memorial Hospital, Good Samaritan Hospital and Harbor Hospital in Baltimore. He also served as a White House Fellow and special assistant to United States Secretary of Veterans Affairs James Nicholson from 2005 to 2006 and consultant to Deputy Secretary of Veterans Affairs Gordon Mansfield from 2007 to 2008. Dr. Ruiz is board certified in cardiology, advanced heart failure, and adult congenital heart disease, and he is fluent in English and Spanish.
Geisinger South Wilkes-Barre Opens New Cardiology Clinic Geisinger has opened a new cardiology clinic on the campus of Geisinger South Wilkes-Barre to make heart-care services more accessible to the community and better health easier for patients in northeastern Pennsylvania. The newly renovated space at 50 Roosevelt Terrace offers pediatric and adult cardiology services, providing care for adult patients with congenital heart disease, and featuring noninvasive diagnostics like echocardiography and electrocardiography. Pediatric spaces were specifically designed to calm the youngest congenital-heart patients. Staffed daily with cardiologists, advanced practitioners, sonographers and technicians to accommodate both pediatric and adult patients, the refinished clinic features a new echocardiography bed, electrocardiography (ECG or EKG) machine, and high-end blanketwarmingcabinet. “We know patients have wanted a cardiology practice to come back to the South Wilkes-Barre community for some time, and we wanted to provide that service again,” said Kelly Austin, RN,operations manager for the clinic. “This practice will increase appointments available to cardiology patients in Luzerne County and bring cardiology services closer to home for patients in or near South Wilkes-Barre.” Pediatric cardiologist Dr. Karen Lurito will lead pediatric cardiology services at the clinic, and she is passionate about expanding heart care in the northeast. “In one place, you get a full spectrum of care. We have the ability to treat children with cardiovascular disease and continue that specialized care as they mature,” Lurito said, noting the importance of lifelong care for the growing number of patients who now live longer with congenital heart disease due to advancements in treatment. Patients who need additional heart-care services can take advantage of the robust cardiology and congenital heart disease programs at Geisinger. For example, services in interventional cardiology, electrophysiology, cardiac surgery, pediatric stress testing and metabolic stress testing are all available in the northeast at Geisinger Wyoming Valley Medical Center. And pediatric and congenital heart surgery services are offered at Geisinger Medical Center in Danville. Systemwide, the congenital heart team has been strengthened recently with the addition of a surgeon with 30 years of experience to lead pediatric and adult congenital heart surgery and a certified registered nurse practitioner well-versed in building adult congenital heart disease programs. The team also features cardiologists who have achieved Adult Congenital Heart Disease board certification and can care for patients throughout their lives. Care even extends to the maternal and fetal medicine clinic, where pediatric cardiologists will do echocardiography on fetuses. “We will care for you from your prenatal days all the way through adulthood,” Lurito said.
