Princess Health and Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

Princess Health and Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee. Princessiccia

cardiac care cardiovascular disease heart health narcotics pain pain management prescription drug abuse research

Gusty 07:28 Add Comment

"Accidental overdoses aren't the only deadly risk from using powerful prescription painkillers," The Associated Press reports. "The drugs may also contribute to heart-related deaths and other fatalities, new research suggests."

A study of of more than 45,000 Medicaid patients in Tennessee from 1999 to 2012 found that "those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine," AP reports. "Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients."

"As bad as people think the problem of opioid use is, it's probably worse," said Vanderbilt University professor Wayne Ray, the lead author of the study report. "They should be a last resort and particular care should be exercised for patients who are at cardiovascular risk."

The report in the Journal of the American Medical Association noted that opioids can slow breathing and worsen the disrupted breathing associated with sleep apnea, which could lead to irregular heartbeats, heart attacks or sudden death.

The patients in the study "were prescribed drugs for chronic pain not caused by cancer but from other ailments including persistent backaches and arthritis," AP reports. "Half received long-acting opioids including controlled-release oxycodone, methadone and fentanyl skin patches. . . . There were 185 deaths among opioid users, versus 87 among other patients. The researchers calculated that for every 145 patients on an opioid drug, there was one excess death versus deaths among those on other painkillers. The two groups were similar in age, medical conditions, risks for heart problems and other characteristics that could have contributed to the outcomes."

Princess Health and Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death.Princessiccia

Princess Health and Know the signs of a heart attack and don't ignore or dismiss them; quick action can be the difference between life and death.Princessiccia

cardiac care cardiovascular disease heart disease heart health

Gusty 10:00 Add Comment

Many people who have a heart attack initially ignore the symptoms or dismiss them. For the best chance of survival and preserving heart function, you should not ignore these symptoms, and should get help quickly.

Heart disease is the leading cause of death in the U.S. and Kentucky. Nationwide, it causes about one in four deaths. The age-adjusted death rate from heart disease in Kentucky is 208.2 per 100,000 per year, according to the federal Centers for Disease Control and Prevention.

Below are some questions and answers about the symptoms and treatment of heart attacks and narrowed aortic valves, as reported by Gina Kolata for the New York Times.

How do you know if you are having a heart attack? Most people feel pain, pressure or squeezing in their chest and about one-third of people have symptoms in addition to or instead of chest pain that include abdominal pain, heavy sweating, back pain, neck and jaw pain, nausea and vomiting, Kolata reports. WebMD adds pain that radiates down one arm, indigestion or a choking feeling, extreme weakness, anxiety or shortness of breath, and rapid or irregular heartbeats to the list.

How can you decide if symptoms other than chest pain are actually from a heart attack? If your symptoms come on suddenly, or if they worsen over a period of hours or days, call 911 and get to an emergency room. "The best time to treat a heart attack is within one to two hours of the first onset of symptoms," says WebMD. "Waiting longer increases the damage to your heart and reduces your chances of survival."

Do women have different symptoms than men? "Probably not," Dr. Mary Norine Walsh, vice president of the American College of Cardiology, told Kolata. Walsh noted that women, however, are more likely to delay seeking treatment and doctors are more likely to dismiss their symptoms, especially if the woman is younger.

The American Heart Association says women often attribute signs of a heart attack to the flu, acid reflux or the normal aging process, even though it is the number one killer of women. It also noted that symptoms in women can be subtler, like shortness of breath, upper back pressure that feels like squeezing, lightheadedness or actually fainting.

What should you do if you are having heart attack symptoms? Call 911 for an ambulance to take you to the emergency room immediately. Do not drive yourself and do not have a friend or family member drive you unless you have no other choice. Kolata notes that paramedics are trained to treat heart attacks and are less likely to get stuck in traffic.

How can you find out if your local hospital is able to treat heart attacks quickly? Don't waste time fighting with your paramedic when you are having a heart attack, they will know the best place to take you, Kolata writes.

That being said, some hospitals are faster than others in treating heart attacks, but the time to research this information is before you are in the throws of a heart attack, Kolata writes. To find out this information, she suggest you ask each hospital what its "door to balloon time" is, which will tell you how long it takes the hospital to open a blocked coronary artery with a balloon after you arrive at the emergency room. If they don't have this information, ask if they take certain steps to speed up treatment. For example ask: Do paramedics transmit a patient's electrocardiogram to the hospital en route?; Does the ER doctor read the EKG and send out a single call to summon the cardiology team?; And are the team members on call required to be within 30 minutes of the hospital?

What are the symptoms of a severely narrowed aortic valve? There are three classic symptoms of this disease of aging: shortness of breath, a feeling of heaviness and pain in the chest, and fainting, according to cardiologists. They also noted that these symptoms are often mistakenly attributed to the normal process of aging.

How can a doctor know if symptoms are caused by a narrowed aortic valve? The doctor will listen  for a heart murmur in the patient�s chest and can order an echocardiogram, which will reveal the narrowed artery and the extent of the damage.

Should everyone with a severely narrowed artery have it replaced? Not everyone should undergo treatment, Kolata reports, so ask your doctor if you are a good candidate. The latest treatment is a transcatheter aortic valve replacement, or TAVR, which allows doctors to replace valves without doing open-heart surgery. High risk patients who would have been considered at too great a risk of dying from open-heart surgery have a chance to have a valve replacement, but sometimes elderly patients whose health is compromised are not good candidates.

Princess Health andResearchers discover why common blood-pressure medicine doesn't work for some people: your kidneys don't want to lose salt.Princessiccia

Princess Health andResearchers discover why common blood-pressure medicine doesn't work for some people: your kidneys don't want to lose salt.Princessiccia

blood pressure heart health research

Gusty 11:40 Add Comment

Each year, more than 120 million prescriptions are written around the world for thiazide drugs, which lower salt to treat high blood pressure. High blood pressure affects 28 percent of Kentucky adults, according to the state Department for Public Health. Thiazide drugs often save lives but are ineffective in some patients and only work for a time in others. A study by University of Maryland School of Medicine researchers has found a key reason for the failure.

Thiazides prevent salt from moving through the kidney, causing it to expel salt and water. However, the researchers found that the kidney seems to know "that it's losing too much salt and activates mechanisms to retain salt in other ways," said Paul Welling, a professor of physiology at the University of Maryland.

The researchers studied an animal model designed to prevent salt retention, which imitated the thiazides' effects. They discovered almost 400 genes that alter their activity to assist regulation of the kidney's salt control. Eventually, it might be possible to make drugs that affect the body's mechanisms that control how the body interacts with thiazides.

Welling and his colleagues also may have discovered a "biomarker" that could allow doctors to easily find out in which patients thiazides will not work. When the kidney is working against the thiazides, a certain molecule increases in the urine. "Now that we know more about these novel pathways and processes, we can begin to find new ways to help patients with high blood pressure," said Dean E. Albert Reece, vice president for medical affairs at the University of Maryland.

Princess Health andHeart attacks are leading cause of death while on the job in Kentucky; being struck by objects is No. 2, and falling is No. 3.Princessiccia

Princess Health andHeart attacks are leading cause of death while on the job in Kentucky; being struck by objects is No. 2, and falling is No. 3.Princessiccia

accidents cardiovascular disease heart health safety workplace health

Gusty 15:03 Add Comment

Heart attacks are the number one killer of Kentuckians who die on the job, according to a study conducted by the state Labor Cabinet.

The study found that in the last three years, 87 Kentuckians had fatal heart attacks while on the job. Their average age was 52. Ten of them were truck drivers, seven were machine operators and six were maintenance workers.

The study found that 28 of the victims were struck by an object, 19 fell, 17 had transportation crashes, 13 were being caught in or between objects, seven were electrocuted, and one each suffered hyperthermia or suffocation. Eight deaths in the workplace were from natural causes, such as stroke, brain aneurysm and failure of the pancreas.

Kentucky ranks 48th in the nation in cardiovascular deaths, with more than 12,000 per year, a state press release said. �Employers should do everything they can to raise awareness about cardiovascular health, and everyone needs to keep an eye on their blood pressure and cholesterol levels while paying close attention to diet and exercise,� Labor Secretary Larry Roberts said.

The study includes workplaces under the jurisdiction of the Kentucky Occupational Safety and Health Program, and do not include those monitored under federal agencies, such as the Mine Safety and Health Administration or the Federal Railroad Administration.

Princess Health and Princess Health andUK's advanced ventricular-assist device program for heart patients saves and improves lives.Princessiccia

Princess Health and Princess Health andUK's advanced ventricular-assist device program for heart patients saves and improves lives.Princessiccia

heart disease heart health heart transplant hospitals pneumonia University of Kentucky

Gusty 07:13 Add Comment

Two years ago, John Doty was diagnosed with walking pneumonia, and though antibiotics originally helped, the pneumonia came back with a vengeance, and he went to see a cardiologist. He found out his heart was severely weakened with an ejection fraction of less than 10 percent. "The ejection fraction is a measure of how effectively the heart can pump blood volume into the body, and in a healthy heart, that number falls between 50-65 percent," Allison Perry writes for the University of Kentucky, where Doty received a left ventricular assist device (LVAD) because his heart was so weak.

UK Chandler Hospital is Lexington's only hospital, and one of two in the state, that can perform emergency VAD procedures. "When Mr. Doty was transferred to UK, he was very sick, on a ventilator and requiring two medications to support his blood pressure," said Dr. Navin Rajagopala, a heart failure cardiologist at the UK Gill Heart Institute. "He was going into kidney and liver failure. It was clear that he needed an assist device as soon as possible before the damage to his body was irreversible."

VADs partially take the place of the function of a failing heart. They're more often used for the left ventricle, but some patients need the device for the right ventricle or even two devices to help both ventricles (BiVAD). Because VADs can help the heart rest and heal, some patients receive them after a heart attack or a surgery. People suffering from congestive heart failure might need a VAD for the rest of their lives.

A viral infection damaged Andy Baker's heart, and though he originally resisted the idea of a VAD, now he says he's "happy to keep the device and has no interest in getting a heart transplant," Perry writes. "I had mixed feelings about it," Baker said about getting the VAD, "but it's given me life again."

VAD treatment can save money for the both the patient and the hospital and allow at-home recovery. VADs can allow people to return to their normal lives, participating in many of the same activities they did previously. in about 5 to 10 percent of cases, the VAD even helps the heart to heal to the point that the device can be removed. That was the situation for Doty, whose device was removed 16 weeks after he got it. "I almost feel like I never had it," Doty said. "It wasn't that great of an imposition, considering that it was keeping you alive."

UK performs about 20 to 30 VAD procedures per year, and recently received its third straight biannual Certificate of Distinction from The Joint Commission, the leading accreditor of U.S. health-care organizations. That "shows just what an outstanding job our physicians, nurses and support staff are doing when it comes to treating patients who require these assist devices," said Dr. Maya Guglin, director of UK's Mechanical Assisted Circulation Program. (Read more)

Princess Health and Attorney general says UK should hand over records on children's heart surgeries, which have been suspended pending review.Princessiccia

Princess Health and Attorney general says UK should hand over records on children's heart surgeries, which have been suspended pending review.Princessiccia

attorney general birth defects cardiac care children heart health medical school open government open records

Gusty 12:38 Add Comment

Attorney General Jack Conway has ruled that the University of Kentucky hospital violated the state Open Records Act by refusing to give a reporter for the university-owned radio station records relating to the work of the chief of cardiothoracic surgery, who has stopped doing surgery on children. UK refused to let Conway's staff examine the records to evaluate UK's claimed need for confidentiality.

After inquiries by Brenna Angel of WUKY, "UK announced that the hospital had stopped performing pediatric cardiothoracic surgeries pending an internal review," John Cheves writes for the Lexington Herald-Leader. Angel reports that she sought records on Dr. Mark Plunkett, left, who was also director of the pediatric and congenital heart program: "the date of Plunkett�s last surgery, the mortality rate of pediatric heart surgery cases, and documentation related to the program�s review." She sought no patient-specific information.

UK denied her request, citing the federal Health Insurance Portability and Accountability Act and arguing that release of the information could lead to the identification of one or more patients because Plunkett was doing so few surgeries on children. It also cited HIPAA in refusing to let Conway's staff review the records. Conway rejected that argument, noting that HIPAA does not supersede state laws and even make allowances for them.

Because it deals with the Open Records Act, Conway's decision has the force of law. UK can appeal the decision to circuit court within 30 days of March 27, the date of the decision. "UK spokesman Jay Blanton says officials are considering whether to file an appeal," Angel reports. The decision was publicly released Monday, the same day UK held a press conference about "the progress UK Healthcare has made in cardiology," she notes. "Yet the pediatric cardiothoracic surgery program remains under review, and patients from Central and Eastern Kentucky are being referred to hospitals out of state. Dr. Mark Plunkett remains on staff."

When Angel asked Dr. Michael Karpf, UK's executive vice president for health affairs, to comment, he replied, �We�ll have something to say about that in a little while.� Cheves notes, "UK recruited Plunkett, a noted surgeon at the University of California at Los Angeles, in 2007 to strengthen its pediatric heart program. He makes $700,000 a year, one of the highest salaries at UK." (Read more)

Read more here: http://www.kentucky.com/2013/04/01/2582150/uk-violated-open-records-law-in.html#storylink=cpy

Read more herehttp://www.kentucky.com/2013/04/01/2582150/uk-violated-open-records-law-in.html#storylink=cpy

Princess Health and U of L researcher gets $3.4 million to replicate studies of stem cells for heart treatment.Princessiccia

Princess Health and U of L researcher gets $3.4 million to replicate studies of stem cells for heart treatment.Princessiccia

cardiac care cardiovascular disease heart disease heart health research University of Louisville

Gusty 08:36 Add Comment

Dr. Roberto Bolli of the University of Louisville has received a $3.4 million grant from the National Institutes of Health to test the validity of several recent studies by replicating them. The studies examine whether certain types of stem cells are safe and effective in treating heart failure, heart attacks and other cardiovascular disorders.

"Replicating studies in several locations with a large number of patients is necessary for researchers to ultimately determine which ones can be submitted to the Food and Drug Administration for approval," Jill Scoggins reports in a U of L press release.

Bolli has received more than $100 million in grants for basic research for NIH. This is the first grant he has been awarded for clinical research. (Read more)

Princess Health and UK doctors first to perform triple ablation, a special form of cardiac catheterization.Princessiccia

Princess Health and UK doctors first to perform triple ablation, a special form of cardiac catheterization.Princessiccia

cardiac care heart health University of Kentucky

Gusty 11:00 Add Comment

Ollie Whitaker of Whitesburg is the first known patient to have undergone triple ablation surgery, in which a catheter is inserted through a patient's blood vessels to remove a faulty electrical pathway and tissue from the patient's heart. The procedure was performed at the University of Kentucky's Gill Heart Institute.  (UK photo of Whitaker, Dr. Sammy Claude Elayi and Dr. Gustavo Morales)

"Typically, the catheter is placed into the patient's femoral artery, internal jugular or subclavian vein. The catheter is guided toward the heart, and high-frequency electrical impulses are used to induce the arrhythmia and then destroy (or ablate) the abnormal tissue causing it," reports Jodi Whitaker for UK Public Relations.

"Performing two ablations during one procedure is commonly done, but three with this complexity is basically unheard of," said Dr. Sammy Claude Elayi, a UK cardiologist. "But in this patient's case, despite the risk, I believed that we could perform three ablations."

"I'm so very pleased," said Whitaker, who had a massive heart attack 30 years ago at age 42 and had been suffering severe after-effects ever since. "I can work in my flower bed outside and do more around the house." (Read more)

Princess Health and Jewish Hospital of Louisville becomes national leader in removing heart pumps from patients with heart failure.Princessiccia

Princess Health and Jewish Hospital of Louisville becomes national leader in removing heart pumps from patients with heart failure.Princessiccia

heart disease heart health

Gusty 22:05 Add Comment

Eleven patients with advanced heart failure were able to have their heart pumps removed thanks to a combination of medication administered at Louisville's Jewish Hospital.

Texas Heart Institute is the only other institution that has removed heart pumps, also known as left ventricular assist devices. Twenty of the devices have been removed in 10 years there. At Jewish, all 11 have been taken away in the past 18 months, Laura Ungar reports for The Courier-Journal.

The program at Jewish uses a cocktail of medicines, including ACE inhibitors, beta blockers and others, in combination with the heart pump. The medication helps strengthen the heart, allowing the pump to be eventually removed. "These patients have a very good quality of life, much better, in fact, than if they continued with the LVAD alone or received a heart transplant," said Dr. Emma Birks, director of the Jewish Hospital Heart Failure, Transplant and Mechanical Support Program.

The treatment could mean "some patients with advanced heart failure may be able to forgo a heart transplant, while others can delay having one," Ungar reports. "That could mean a longer life for younger heart failure patients with LVADs; life expectancy after a transplant averages 10 years."

Nationwide, about 5 million Americans have heart failure, which translates to 300,000 deaths a year, National Heart, Lung and Blood Institute figures show. (Read more)