Seamless integration of services—over miles, across special- ties and through all stages of care. That’s the definition of a systemwide cardiovascular service line, and is what MHVI has been shaping for decades. Nowhere is this mantra more evident than in our Advanced Heart Failure program for patients in the Baltimore area. During the last several years, we have worked to create a seamless progression for patients who may ultimately need mechanical circulatory support or a transplant—complex procedures available only at MedStar Washington Hospital Center. Our cover story demonstrates how we are success- fully sharing expertise and technology across our 10 regional hospitals—while providing the comfort and convenience of before and after treatment closer to home.
The Blind Men and the Elephant
Treatment of heart failure and other cardiovascular diseases evolves over time as our knowledge expands. It calls to mind the very old story of the Blind Men and the Elephant. In this Indian parable, a group of blind men who had never crossed paths with an elephant are asked to describe the animal by touching it. Each feels a different part of the elephant and describes it based on this limited experience. Of course, their perceptions of the creature differ vastly.
At MedStar Union Memorial Hospital, a new hypertrophic cardiomyopathy clinic under the direction of Sandeep Jani, MD, demonstrates the modern relevance of this ancient tale. When physicians first identified hypertrophic cardiomyopathy, it was characterized by the limited tools at their disposal. They were only touching a part of the elephant.
In the early 1950s, Sir Russell Brock, a surgeon at Guy’s Hospital in London, reported on three patients with aortic outflow obstruction as a result of left ventricular hypertrophy. Donald Teare, a contemporary of Sir Brock’s, described many of the symptoms of the disease, and in post-mortem examination, he identified myocyte disarray. He also reported the sudden death of a 16-year-old brother of one of his original patients. On post-mortem, the heart’s appearance was nearly identical to his sister’s—a discovery that helped establish the genetic, and sometimes inherited, basis of hypertrophic cardiomyopathy.
But it was the advent of echocardiography that allowed physicians to measure left ventricular wall thickness and identify differing patterns of ventricular hypertrophy. Two dimensional echo, doppler techniques, and modern cardiac catheterization have expanded our understanding of the disease. Genomics and advanced imaging modalities, such as MRI, allowed us to see the “whole elephant” (although much work still needs to be done). Today we recognize that less than a quarter of patients with hypertrophic cardiomy- opathy have left ventricular outflow tract obstruction—despite the initial description.
Now Dr. Jani is caring for patients—and families—affected by the disease driven by our experience, extensive imaging capabilities, genetic counseling, as well as skilled interven- tional, EP, and surgical management services, when needed.
Nursing Excellence
Also in this issue, we highlight the remarkable team of specialist nurses who are key to our clinical success. Their knowledge of complex cardiac disease and their teamwork are critical to maintaining optimal patient outcomes. Much like in medicine, nurses with specific content knowledge, interest, and experience further elevate the overall level of patient care. In 2017, the nursing team at MedStar Washington Hospital Center received the prestigious Pathway to Excellence® designation from the American Nursing Credentialing Center—the first such designation of an acute care hospital in the D.C. area. In addition, the MHVI Nursing Residency Program is now certified by the Commission on Collegiate Nursing Education, a national accreditation agency. At MHVI, high tech and high touch go hand-in-hand.