Thanks to revolutionary technology and innovative procedures, cardiac care has immensely improved in recent years. Learn how local hospitals are leaders when it comes to providing breakthrough cardiac health services.
As a single mother of three children, a high school business teacher, and the sole breadwinner of her family, Beth Marcello never thought about possibly having heart disease. Christmas was coming, and she had decorations to put up.
“I was 48 years old, and I can just remember this back pain I had while pushing a grocery cart through the snow,” she says. “Both my mother and father died of heart attacks at young ages, but I wasn’t really thinking about that for me. My two older siblings didn’t have any heart issues, and at this time [1994], women’s heart issues weren’t really discussed like they are today.”
Marcello assumed she sprained her back somehow. She asked her teenage son, Tony, to drive her to the emergency room.
The snow was getting worse as Marcello received an electrocardiogram (EKG) – a simple, painless test that measures the heart’s electrical activity.
Marcello’s world forever changed when she heard the results.
“That was my first time hearing I had heart disease, and it hit me like a hammer,” Marcello says. “I kept thinking ‘I have heart disease.’ I should have realized it with my family history, but we take so much for granted in life.”
That same night, Marcello had a heart attack. Thus began a long road of struggling with heart failure.
To date, Marcello has had two open-heart surgeries and five bypass surgeries. Every June, when school let out for summer break, she would get an angiogram to check on the status of her blood flow.
In 2015, Marcello decided to take control of her health in a new way.
“I went in for a routine angiogram and the pressure readings on my heart were sky-high,” she says. “I ended up staying in the hospital for about 20 days. When I left, I was motivated to go online and read more about my heart.”
That’s how Marcello discovered the CardioMEMS HF System. This system features a small pressure-sensing device that’s implanted directly into the pulmonary artery. It sends information wirelessly to a patient’s doctor.
“It helps us monitor a patient remotely,” says Linda Rood, a heart failure nurse practitioner at Centegra Health System, in McHenry County. She’s also one of the health providers responsible for Marcello’s care. “We can intervene early, before a patient even has symptoms, and modify their medications, if needed, before they have to go back into the hospital. It’s truly revolutionary technology.”
Marcello wrote a letter to Centegra’s board of directors, hoping they’d consider offering this technology. Her research showed that the CardioMEMS device had successful trials, was FDA-approved, and was already being inserted into heart failure patients in Chicago.
Her letter sparked a discussion and much more research.
“I thought ‘OK, I’m representing myself, my children, and all the other people I’ve met in cardiac rehabilitation who have heart failure,’” Marcello says. “Sometimes, you’ve got to take care of yourself. Doctors can take care of you, but sometimes their hands are tied and you’ve got to push for what you want.”
After two years, with lots of paperwork involved, Centegra was approved to implant CardioMEMS devices. On Sept. 9, 2017, Marcello became the first patient at Centegra to receive the device. She fit all of the necessary criteria: she had been admitted to the hospital for heart failure within one year of the operation, she presented heart failure symptoms, and she was able to take anticoagulant medications for one month after the device was inserted.
The procedure to insert the device was painless, and Marcello was able to go home the same day.
Now, she simply lies on a special pillow for about five minutes every morning to do a wireless scan of her heart.
“I get up, take my pills, brush my teeth, and then I lay on my pillow and relax,” Marcello says. “It scans me – I don’t feel a thing – and it sends my information to my cardiologist and nurse, Linda Rood. I’ve had it for six months and the tech support has already updated the software to send readings faster.”
For the first few weeks, Marcello’s doctors would call on a weekly to biweekly basis and instruct her on how to tweak her medications slightly. Now, her doctors have found a “sweet spot” with medications, and Marcello’s heart is functioning optimally.
“There are no more guessing games that a patient has too much fluid in their body,” Rood says. “This device is quantitative without question. And, it’s quite easy to use – patients don’t even need to have internet service since it works with cell towers. So far, we’ve implanted CardioMEMS in five patients at Centegra, and I’m happy to say none of them have gone back into the hospital for their heart conditions.”
Rood says CardioMEMS is also a great device for accountability. Heart failure patients aren’t supposed to consume high levels of sodium, but if they do, Rood can tell the next day when she gets a patient’s readings.
“I swear, our five CardioMEMS patients seem to behave a lot better because they know that we’re monitoring them,” Rood says. “If they eat too much salt, we see it. So I think that makes them more compliant, as well.”
At age 71, Marcello is now healthy enough to travel for the first time in years. She’s visited friends in Naples, Fla., vacationed in Daytona Beach, Fla., and Las Vegas, and visited her grandchildren in Baltimore, Md.
“Before, I could only see my grandchildren if they came to visit me,” Marcello says. “Life is back to how it used to be decades ago. The impact is unbelievable; I feel like a free woman.”
Not every patient is perfect for CardioMEMS, but Rood advises people to inquire.
“It’s really great that we’re able to provide this to our patients,” she says.
Atrial Fibrillation
According to the American Heart Association, at least 2.7 million Americans are living with atrial fibrillation (AFib), which means they have a quivering or irregular heartbeat (arrhythmia). If left untreated, AFib can lead to blood clots, stroke, heart failure and other heart-related complications.
“This is very common, and it’s growing in prevalence because of the aging of our population,” says Dr. John Onufer, medical director of arrhythmia service at Northwest Community Healthcare, in Arlington Heights. “What happens is the top chamber of your heart becomes disorganized, and now the cells are chaotically activated in no organized pattern, resulting in the top chamber failing to develop any forceful contractions.”
For a patient, this condition may present no symptoms, however, breathlessness, fatigue and nausea can occur. Onufer says people with high blood pressure, diabetes, obstructive sleep apnea and excessive weight are more at risk.
In order to treat patients, Onufer first calculates their CHADSVAS score. The mnemonic stands for congestive heart failure, hypertension, age, diabetes, stroke, vascular disease, age and sex.
“We evaluate a patient’s features and score them accordingly,” Onufer says. “If a patient has 2 points or greater, it’s standard treatment for them to be on blood thinners to reduce the risk of stroke by about 60 to 65 percent. The higher the CHADVAS score, the more likely you are to have a stroke.”
If medications are either ineffective or not tolerated, a procedure called catheter ablation is often employed to correct AFib.
“I think if more people know their CHADVAS score, they’ll be more interested in getting on the right blood thinner,” Onufer says. “I also think people will be interested in learning that catheter ablation is available to control atrial fibrillation.”
Treating AFib Without Radiation
Dr. Mansour Razminia is an expert at doing catheter ablation procedures. In fact, the director of cardiac electrophysiology at Presence Saint Joseph Hospital, in Elgin, is apparently the first person in the nation to perform every catheter ablation of cardiac arrhythmias without using radiation.
“I started doing radiation-free catheter ablations in 2010,” he says. “Presence Saint Joseph is perhaps the only hospital in the nation right now doing completely radiation-free procedures, but I go to many universities and hospitals in the United States and abroad to give presentations to other physicians. More people are starting to know about it, which is truly a great thing.”
Catheter ablations have been done for more than 30 years, Razminia says. Historically, physicians would insert catheters through the groin to reach the heart. In order to see the catheter, an X-ray was necessary for assistance.
The procedure would last about 30 minutes to several hours, which requires sometimes up to a few hours of radiation exposure. And oftentimes when treating AFib, patients need multiple catheter ablation procedures to get rid of the arrhythmia, Razminia adds.
“When you do 20 minutes of radiation, it’s like you have taken more than 160 chest X-rays,” Razminia says. “That increases the risk of cancer. With about 60 minutes of radiation, you may have one additional chance in every 300 people of getting cancer. And unfortunately, that risk remains with that patient for the rest of their life. Radiation exposure may also result in chromosomal abnormalities, which they may give to their offspring. Not only that, but the physicians and lab staff are also exposed to radiation and have to wear lead aid that’s about 15 to 20 pounds for their protection. So, the staff starts having back pain and knee pain because of these procedures. So, without radiation, you eliminate all of these issues.”
Razminia has performed radiation-free catheter ablations on more than 1,500 consecutive patients. He uses the EnSite (ESI) system, a catheter navigation and mapping system, as well as intracardiac ultrasound.
Razminia takes catheters that have platinum on the tip and inserts them through the groin to reach the heart. From there, he can freeze or burn (ablate) the area where there is a rhythm abnormality.
“I tell my patients it’s as if I have a metal detector and there’s metal somewhere in their heart, and there’s a beep when I find it,” Razminia says. “Then I can ablate the area. This is done in an outpatient procedure, and after about four hours they can go home.”
Razminia has even been called to hospitals where he doesn’t have privileges just so he can teach physicians how to do radiation-free ablations.
“About four years ago, I was called to a hospital in Chicago,” he says. “They had a patient who was supposed to get an ablation procedure. Well, they found out the patient was pregnant, and they called me and asked if it was possible for me to go and teach them how to do the procedure without radiation. Now, I didn’t have privileges at that hospital, but the patient was already on the table to have the procedure. So, I went there. I couldn’t do the procedure myself because I didn’t have privileges, but I taught them how to do the entire procedure without radiation by just talking them through it.”
Since AFib is becoming more and more prevalent, Razminia recommends people have an EKG when they see their physician, especially if there’s a family history of heart disease or a personal history of palpitation or passing out.
“I’m very passionate about this because I think this really improves the lives of so many people,” Razminia says. “I see patients feeling miserable because of their rapid heart rate, they have a lack of stamina, and then we take care of their rhythm abnormality and it’s like you gave their life back to them. The risks are so minimal, but there are so many benefits.