Cardiology Appointment Request

Making an appointment with your MedStar Health cardiologist just got easier

Your MedStar Health cardiologist is an important member of your healthcare team. We make it a priority to schedule your appointment and get you in quickly. Getting your appointment scheduled quickly doesn't mean you're rushed. You'll have time to get your questions answered. You'll leave knowing your trust was well placed.

Easy Scheduling

 

 

Once you complete and submit the form, a representative will contact you within one business day to schedule your appointment.

MedStar Health cardiologists are part of MedStar Heart & Vascular Institute, the region’s leaders in cardiovascular care and research, offering a unique clinical and research alliance with the Cleveland Clinic Heart and Vascular Institute, the nation’s #1 heart program. We provide the individualized attention you need. Working closely with your primary care provider, we make your health our top priority.

Make an Appointment

To schedule an appointment with a specialist, use our online request form below.

Our Locations

Structural Heart and Valve Disease Program

The Structural Heart and Valve Program brings cutting-edge therapies to patients with valve and congenital heart diseases.
Below is a diagram of procedures currently being done at our center as the standard of care or clinical trial.


Contact the Structural Heart and Valve Disease Program at:

202-877-5975

For Physicians - Upload patient images at:

Congestive Heart Failure

Heart failure is a very common condition, affecting more than 5 million Americans. Your cardiologists can help you manage the condition with lifestyle changes and medications, leading to a longer, fuller life.

Our Advanced Heart Failure Program can also help with more serious cases of heart failure, with renowned doctors who specialize in the condition and use the latest surgeries, devices and other treatments. Learn more about our Advanced Heart Failure Program.

What is Congestive Heart Failure?

The heart squeezes blood through the circulatory system and also relaxes to accept blood returning from the body and lungs. 

Any disruption in this squeezing (systolic dysfunction) or relaxing (diastolic dysfunction) can lead to a failure of the heart to pump enough blood for your body or fill with enough blood. This condition is called heart failure, or congestive heart failure (CHF).

Heart failure is different than cardiac arrest, during which the heart actually stops beating. Still, heart failure requires medical attention. Two kinds exist:      

  • Heart failure with preserved ejection fraction (HFpEF): The heart cannot provide sufficient blood even though it squeezes normally.
  • Heart failure with reduced ejection fraction (HFrEF): The heart muscle is weak, so it has difficulty pumping blood to the rest of the body. 

Heart Failure Risk Factors

Certain factors make it more likely than you will develop heart failure:

  • Age: You have a greater risk if you are 65 or older. The heart weakens with age, and many patients have also endured diseases that lead to heart failure.
  • African-Americans: Heart failure is more common in African-Americans, as is the early onset of symptoms.
  • Weight: Too much weight strains the heart and also contributes to heart disease and diabetes, two heart failure causes.
  • Heart attack: A previous heart attack increases your risk.
  • Gender: Men are more likely to experience heart failure than women.

Heart Failure Causes

Most heart failure cases are caused by an underlying medical condition, such as:

Heart Failure Symptoms

Heart failure can produce a range of symptoms, including:

  • Fatigue
  • Shortness of breath
  • Swelling of the legs and feet
  • Swelling of the abdomen
  • Irregular heartbeat
  • Chest pain

Other conditions can cause similar symptoms. Please see one of our cardiologists for a proper diagnosis. Patients with more severe heart failure often feel symptoms even when resting. Learn more about our Advanced Heart Failure Program.

Heart Failure Classification

Functional capacity refers to the way heart failure patients feel when they engage in physical activity. This measure is used to classify heart failure into different stages:

  • Class I: No limits on activity; no shortness of breath, fatigue or chest pain with ordinary physical exertion
  • Class II: Slight limits on activity; mild symptoms when walking or performing other normal physical activity
  • Class III: Substantial limits on activity; shortness of breath and other symptoms occur with less-than-ordinary physical exertion
  • Class IV: Major limits on activity; unable to perform any ordinary physical activity without experiencing symptoms, or symptoms may occur at rest

Heart Failure Diagnosis

Early diagnosis of heart failure is the key to helping patients live longer, more active lives. We offer the latest tools and tests to provide for a prompt and accurate diagnosis. Learn more about our:

Heart Failure Treatment

The goals of heart failure treatment are to relieve symptoms and improve both the quality and length of life. In the earlier stages of the condition, treatment involves:

  • Lifestyle changes: Taking certain steps can help you feel better:
    • Eating a heart-healthy, low-salt diet (our dieticians can help)
    • Limiting the amount of daily fluid intake
    • Losing weight
    • Giving up smoking
    • Exercising
  • Medications: Medications can improve the heart’s function and your ability to live a normal life. Possible medications include:
    • Diuretics (water pills) to reduce fluid buildup
    • ACE inhibitors and ARBs to lower blood pressure
    • Beta blockers to slow your heart rate and lower your blood pressure
    • Aldosterone blockers to help prevent your body from holding onto fluids
    • Hydralazine/isosorbide to relax your blood vessels
  • Implantable cardioverter defibrillator (ICD): ICDs correct irregular heart rhythms, called arrhythmias.
  • Heart surgery: Possible surgeries for related heart problems can include coronary artery bypass graft (CABG) surgery or heart valve surgery.

More severe heart failure may require intervention from our cardiologists or surgeons specializing in advanced heart failure. Learn more about our Advanced Heart Failure Program.

For information or appointments, please call 855-463-3320.

Heart Transplants

In some cases, heart failure progresses to the point where the heart is no longer able to pump an adequate amount of blood, and heart transplantation may prove the best treatment option.

At MedStar’s Advanced Heart Failure Program, our expert heart transplant team offers you comprehensive care and support throughout the entire heart transplant journey. Our program features:

  • Experience: Our center performed the first heart transplant in the region in 1987. We have since performed more than 250 heart transplants.
  • Expert doctors: Our cardiologists are board-certified in heart transplantation. Our surgeons have years of experience performing heart transplants.
  • Multidisciplinary team: Our large team includes many dedicated clinicians and health care workers who have particular expertise in the specialized needs of transplant patients, such as coordinators, infectious disease specialists, pharmacists, social workers, physical therapists, occupational therapists, etc.
  • Quality of life: Our experienced transplant coordinators work with you and your family ever step of the way to help prepare you for a heart transplant. Our goal is to allow you to get back to the kid of life that you want to live, where you can return to work, spend quality time with your family and friends, resume the activities that you enjoy, etc.

Heart Transplant: Steps

Receiving a donor heart to replace your own requires many steps. Your heart transplant journey begins with expert doctors and a multidisciplinary team to support you through each stage of the process. In general, you can expect the process to unfold like this:

Step 1: Pre-Surgery

  • Initial evaluation: To help make sure you will benefit from a heart transplant, we perform a thorough medical and psychosocial evaluation, including blood tests and imaging studies, and we arrange for you to meet with several members of the transplant team.
  • Pre-surgical consultations: Before receiving a heart, you will meet with a transplant coordinator who will educate you about a heart transplant. You also will meet with a social worker to help you identify your social support systems and discuss what it is like to live with a transplanted heart. A financial counselor will meet with you to coordinate your insurance benefits and ensure you have adequate coverage for the special medications needed to live with a transplanted heart.
  • Transplant list: If the evaluation suggests that heart transplantation is a good option for you, your name will be placed on the national waiting list for a suitable donor heart. The wait time to receive a heart can be lengthy. When a suitable heart becomes available, a heart transplant coordinator will notify you and you will be asked to come to the hospital right away.
  • Clinical management: Patients may require a combination of therapies to support them while waiting for a new heart. These may include inotrope medications or LVADs. Some patients wait at home for their transplant, while others may require admission to the hospital. Learn more about left ventricular assist devices (LVADs).

 Surgery

  • Surgery day: The heart transplant surgery requires 4-8 hours. The transplant team will keep your family members informed of your progress.
  • Post-surgery: After surgery, you will wake up in a special cardiac intensive care unit. Our nurses have special training and expertise in caring for heart transplant patients. Our expert cardiac intensivist physicians and their team will closely monitor you and oversee your care in close collaboration with the transplant surgeons and cardiologists.
  • Progressive Care Unit: When you no longer need intensive care, you will be transferred to a specialized unit. During the course of your recovery, you will receive information about your transplant medications from a transplant pharmacist, physical therapy services, nutrition consultation and specialized education from one of the transplant coordinators. Your entire team will help prepare you and your loved ones for life after discharge.

After discharge:

  • Follow-up: We follow all of our heart transplant patients very closely. We will ask you to come in for follow-up visits after you receive your new heart, initially at least once a week. These checkups will be gradually spread out so that by year three you will only need to make annual visits. Testing to accompany these visits may include heart biopsies, echocardiograms and lab tests. Your Transplant Coordinator will help you arrange all of these visits.
  • Living with a donor heart: Life after a heart transplant can be an adjustment. For some it is a very emotional experience. That is why we offer a unique Patient Support Program that can assist you and your family in a number of ways, including an on-call nurse coordinator, patient support groups and referral to therapists if necessary. There is also a pharmacist and registered dietician to help answer any questions you may have at any time about medications and diet.

 

For information or appointments,
please call 855-463-3320.

Left Ventricular Assist Devices (LVAD)

Heart failure can progress to a point where it becomes end-stage heart failure. At this time, your heart becomes so weak it needs mechanical assistance to help do its job.

Our expert surgeons can give your heart a boost by implanting a pump called a left ventricular assist device, or LVAD. This device helps your heart pump blood to the rest of the body.

Why Choose MedStar Heart & Vascular Institute for LVAD Treatment

At the MedStar Advanced Heart Failure Program, our doctors are world-renowned for pioneering left ventricular assist device (LVAD) technology. Our expertise includes:

  • Pioneers: One of our heart surgeons, Steven M. Boyce, MD, helped design one of the first third-generation, continuous flow LVADs, and is pioneering novel surgical techniques for implanting LVADs.
  • Excellent outcomes: We currently care for more than 100 people with LVADs, many of whom have been living successfully with this technology for many years.
  • Highly specialized care: Our team includes experienced LVAD coordinators, along with dedicated pharmacists, physical therapists, nutritionists and others with special training and expertise in working with advanced heart failure patients.
  • Dedication to quality of life: Many of our patients return to work full-time and maintain active lifestyles.
  • High patient volume: We are among the busiest sites in the U.S. for LVAD surgeries.
  • Deep experience: The very first implantation of an LVAD pump took place at a MedStar hospital in 1988. At that time, we were one of just four hospitals in the world to perform this pioneering surgery.
  • Expert surgeons: Our highly experienced doctors have been involved with the development of LVAD technology since its beginning. Newer programs seek them out for assistance and advice, both nationally and internationally.
  • Patient support: Our patients receive the benefit and counseling of a number of team members who are experts at managing their care. Team members include nutritionists, social workers and transplant coordinators. Learn more about patient support.

What is a Left Ventricular Assist Device (LVAD)?

A left ventricular assist device is a small pump that helps circulate your blood when your heart becomes too weak to do its job effectively. The pump enables your heart to pump more blood with less work. An LVAD does not replace your heart and is not an artificial heart.

An LVAD is surgically attached to your left ventricle, your heart’s bottom left chamber. The pump continuously moves oxygen-rich blood from the left ventricle into the aorta, where it is delivered to the rest of your organs.

 A left ventricular assist device consists of several parts:

  • Pump: Resides inside or near your chest, and is attached to your heart.
  • Driveline: A small cable that attaches the pump to an external controller. The driveline exits your body through the skin.
  • Controller: A small computer, this machine alerts you when batteries need to be changed or if your device requires other attention. The controller usually is worn in a pack around the waist.
  • Batteries: Your LVAD needs an electrical source at all times, so it is usually attached to rechargeable batteries.
  • Power plug: You usually connect to an electrical source to recharge batteries.

When will your doctor recommend a LVAD?

Your doctor may recommend a left ventricular assist device when medications are no longer enough to help your heart pump adequate amounts of blood to the rest of your body.

LVADs can be used in two different situations:

  • Bridge-to-transplant: For patients who are awaiting a heart transplant, an LVAD can serve as a temporary assistive therapy until a suitable donor heart becomes available.
  • Destination therapy: For patients who do not qualify for a heart transplant, or simply do not want one, an LVAD can be implanted as a long-lasting treatment. The pumps are designed to last for many years.

Left Ventricular Assist Device Surgery: Steps

LVADs are implanted through open-heart surgery. Your LVAD journey begins with expert doctors and a multidisciplinary team to support you through each stage of the process. There are several possible steps:

  1. Initial evaluation: To help make sure you will benefit from receiving an LVAD, we perform a thorough medical and psychosocial evaluation, including blood tests, imaging studies and meetings with several members of the team.
  2. Pre-surgical consultations: Before receiving a pump, you will meet with an LVAD coordinator who will educate you about how your LVAD works and answer your questions about the technology. You also will meet with a social worker to help you identify your social support systems and discuss what it is like to live with an LVAD. A financial counselor will meet with you to coordinate your insurance benefits and talk about the ongoing expenses of maintaining a left ventricular assist device.
  3. Surgery day: The open-heart surgery performed to implant an LVAD takes about four to six hours.
  4. Post-surgical recovery: After surgery, you will wake up in a cardiac intensive care unit. Our nurses have special training and expertise in caring for LVAD patients. Our expert cardiac intensivist physicians and their team will closely monitor you and oversee your care, in close collaboration with the surgeon and advanced heart failure cardiologist.
  5. Progressive Care unit: When you no longer need intensive care, you will be transferred to a specialized heart failure unit. As you continue to recover from surgery, you will learn how to get around with your LVAD and take care of it before being discharged.
  6. Going home: You may have many questions about living with your new left ventricular assist device. Your personal LVAD coordinator can talk you through these issues.
  7. Follow-up: We will follow you closely after surgery to help you stay safe and healthy. At first, you will see our team in clinic on a weekly basis. These visits will gradually become less frequent as you continue to improve.

Life with a Left Ventricular Assist Device (LVAD)

After the LVAD is implanted, it is our hope that patients resume an active lifestyle. 

Receiving an LVAD may make you feel more energetic because your body is receiving an adequate amount of oxygen-rich blood again. You should be able to enjoy:

  • Moderate exercise
  • Intimacy with your partner
  • Returning to work or school

Activities you may need to avoid include:

  • Bathing in a tub or swimming: Your LVAD controller cannot be submerged in water. Your LVAD coordinator will help teach you how to adjust your personal hygiene.
  • Contact sports: These activities could damage your device.
  • Sleeping on your stomach: You will need to sleep on your back or side to avoid damaging any of the lines attached to the pump.
  • Having an MRI scan: It is safe to undergo a CT scan or X-ray, but not an MRI. 

Learn more about:

For information or appointments,
please call 855-463-3320.

WATCHMAN Device

For people who have atrial fibrillation, or A-fib, blood clots that cause strokes are a danger. The WATCHMAN™ device permanently seals off the left atrial appendage, a section of the heart that is the site of almost all stroke-causing blood clots in people who have A-fib.

It’s the only FDA-approved device of its kind designed to prevent blood clots that form in the left atrial area from entering the bloodstream and causing strokes.

 Our heart rhythm experts (electrophysiologists) and cardiologists at MedStar Heart & Vascular Institute were the first in the Washington metropolitan region to successfully use the WATCHMAN™ device to treat patients with atrial fibrillation (A-fib).

Facts at a glance: The WATCHMAN™

Here’s a look at important facts about the WATCHMAN™:WATCHMAN_ProductShot_with_Access_Sheath

  • The device has a mesh membrane that is spring-loaded to expand to about the size of a quarter once a doctor places it in the left atrial area.
  • This meshing acts as a filter: It allows blood to pass through while stopping clots.
  • The WATCHMAN™ is permanent. Heart tissue eventually grows over the device.
  • The device has no batteries or wires.
  • Most patients who get the WATCHMAN™ can stop taking blood-thinning medications within 45 days.

When will your doctor recommend the WATCHMAN™?

People who have A-fib often must take blood-thinning medication to prevent clots and strokes from happening. If you cannot take blood thinners due to side effects or bleeding problems, your doctor may recommend the WATCHMAN™ device.

Why choose MedStar for the WATCHMAN™?

Our heart specialists spent eight years testing the WATCHMAN™ device in clinical trials before it received FDA approval. While the procedure is new to others, it’s not new to us. Our doctors have more experience with the WATCHMAN™ device than anyone else in the Washington metropolitan region. 

We’re experts at performing medical procedures within the delicate structure of the left atrium. We’ve been performing complex ablation procedures within this fragile heart chamber for decades. Our doctors have the expertise and confidence you want when undergoing a heart procedure.

What is the WATCHMAN™?

The WATCHMAN™ is a self-expanding device that seals off the left atrial appendage, which is located at the top left chamber of your heart. In a normally-functioning heart, blood fills and then leaves the left atrial area with each heartbeat.

If you have an arrhythmia like A-fib, blood can remain in this area. This increases your risk for blood clots and strokes. The WATCHMAN™ creates a permanent barrier that prevents blood clots that may form in the left atrial area from entering the bloodstream and causing a stroke.

The WATCHMAN™ procedure: Steps

Our team of cardiologists and electrophysiologists implant the WATCHMAN™ device using a nonsurgical procedure performed in our specialized electrophysiology (EP) or cardiac catheterization labs. EP labs feature special equipment that allow our doctors to test the electrical activity of your heart.

The nonsurgical procedure lasts about an hour and involves several steps:

  1. You will receive anesthesia.
  2. Your doctor inserts a catheter (plastic tube) into a vein in your groin area.
  3. Your doctor guides the WATCHMAN™ device through the catheter to the opening of your left atrial area.
  4. Once the device is in place, it expands to create a mesh barrier of the left atrial area.
  5. You will most likely stay overnight in the hospital following the procedure.
  6. You should be able to discontinue the use of blood thinners after 45 days.
  7. The WATCHMAN™ is intended to be left in place permanently. Heart tissue eventually grows over the device.

Learn more about:

 

For information or appointments,
please call 855-463-3320.

AFib Treatment

Atrial fibrillation, or AFib, is the most common type of cardiac arrhythmia. It causes your heart to beat irregularly and increases your risk of blood clots, stroke and other heart-related complications. Learn more about atrial fibrillation.

Heart Rhythm Treatment

Our heart rhythm experts (electrophysiologists) at MedStar Heart & Vascular Institute’s Center for Comprehensive Atrial Fibrillation Management are nationally sought after to treat all forms of AFib—from routine cases to the most complex. Meet our doctors.

Some of our team’s pioneering achievements include being the first in the Washington metropolitan region to apply cutting-edge technologies to patients with AFib. These include:

Why Choose MedStar for A-fib Management

Our doctors are leading the way in researching and implementing new treatments for A-fib. At the Center for Comprehensive Atrial Fibrillation Management you benefit from:

  • Unsurpassed expertise: Our doctors have pioneered many heart treatments. We were the first in the region to offer new A-fib treatments, such as the WATCHMAN™ Device.
  • Comprehensive care: We provide a full spectrum of A-fib management—from diagnosis to individualized treatment plans. We also provide ongoing stroke prevention support and follow-up care for implantable devices like pacemakers.
  • Team approach: Our heart rhythm experts and cardiac surgeons work collaboratively to tailor individualized treatment plans that take into account your unique conditions and needs.
  • Clinical Research: Our team leads the way in clinical research to remedy heart arrhythmias like A-fib. Our doctors design and lead multiple research trials, giving patients early access to cutting-edge therapies.
  • Convenience: Our electrophysiology (EP) program is the largest in the Washington metropolitan region. We make it easy to get the care you need with 10 outpatient clinics located throughout the mid-Atlantic region.

Diagnosis and Treatment of A-fib

Our experts test the electrical activity of your heart in our dedicated EP labs. Highly-specialized equipment enables our team of experts to accurately diagnose your condition. Learn more about A-fib treatment options at MedStar Heart & Vascular Institute. 

Comprehensive A-fib Management

The Institute is part of large network. Many of our services can be obtained at our locations throughout the mid-Atlantic region. Inpatient services are currently available at:

For information or appointments,
please call 855-463-3320.

Aneurysm Repair

If our doctors find a dangerous aneurysm in time, they can save your life with urgent aortic repair. For cases that are less urgent, but still troubling, we work with you to find the best treatment plan, whether that is careful monitoring, medication or a procedure that reinforces the aorta. 

At the MedStar Heart & Vascular Institute, our world-renowned team offers the approaches you need for successful aortic care:

  • Open Surgery
  • Complex Repairs: Doctors around the region often refer patients to us.
  • Minimally Invasive Endovascular Repair: Other programs use stent-grafts in the descending aorta, but we also place them in the ascending aorta.
  • Hybrid Repairs Combining Surgery and Endovascular Techniques: We take this specialized approach more than any other heart and vascular program in the D.C. area.

 Complex Aortic Aneurysms

While our team members provide top care for all types of aneurysms, they offer particular expertise for challenging cases. Our expertise with complex procedures leads many outside doctors to refer these patients to us — sometimes from more than a hundred miles away. 

Complex cases can involve aneurysms that:

  • Run across both the chest and abdomen (thoracoabdominal) and can interfere with blood vessels branching off the aorta
  • Involve the aortic root, ascending aorta and/or aortic arch
  • Involve other areas of the body and require a careful watch over blood supply
  • Require multiple steps to fix

Aneurysms: Surveillance and Medical Therapy

Smaller aneurysms that do not cause pain may not need treatment. Instead, your doctor may recommend that you avoid heavy lifting, intense exercise and emotional stress and come in for regular monitoring. 

Other aneurysm may pose somewhat greater risk but are manageable with medications that:

  • Lower blood pressure
  • Relax blood vessels
  • Reduce the potential for rupturing 

Traditional Aneurysm Surgery

Surgical repair is often the best treatment for aneurysms that are causing symptoms or have grown larger, generally 2 inches across or greater. There are two categories of surgery, though our doctors perform both similarly:

  • Emergency Surgery: The aneurysm has already ruptured, or could soon, as indicated by symptoms like abdominal, chest or back pain.
  • Elective Surgery: While there is more time to plan, the aneurysm’s size, rate of growth or interference with blood flow makes a repair necessary. 

Aneurysm Surgery: Steps

Traditional aneurysm surgery replaces the damaged aorta and takes out at least part of the bulge, though complete removal is often unnecessary. Our doctors perform several steps:

  1. Some aneurysm repairs require cardiopulmonary bypass. Our surgical team uses a heart-lung machine to slow the heart and access the aorta, while still providing blood and oxygen to the brain and body. The body is cooled so it consumes less oxygen. Bypass is needed for:
    • Aneurysms in the aortic root and ascending aorta
    • Aneurysms in the aortic arch, unless a hybrid approach is taken (learn more about hybrid aneurysm repair)
    • Some aneurysms that traverse the chest and abdomen (thoracoabdominal aortic aneurysms)

Other aneurysms do not require this step — the enlarged section is simply clamped while maintaining the most critical blood flow.

  1. After anesthesia, surgeons make an incision above the aneurysm and open the aorta.
  2. At least part of the aneurysm is removed and a long-lasting synthetic graft is placed to reinforce the damaged aorta.
  3. Bypass is ended, if it was needed. Otherwise, the clamps are removed and incision is closed.
  4. Hospital recovery typically takes 7 to 10 days. 

Endovascular Aneurysm Repair

We also offer an alternative to surgery — a minimally invasive approach called thoracic endovascular aortic repair (TEVAR or EVAR) that uses a metallic scaffold and a synthetic fabric (stent-graft) to reinforce the aorta and avoid a rupture. While an endovascular approach is not appropriate for every patient, it can provide benefits over surgery, especially since it is minimally invasive. 

We are one of the few heart and vascular centers in the greater D.C. area using stent-grafts throughout the aorta, helping to refine and expand their use. We are also one of the few programs in the area combining endovascular repair with open surgery to help patients with particular aneurysms. Learn more about our hybrid aneurysm repair. 

Minimally Invasive Aneurysm Repair: Benefits and Challenges

Endovascular aneurysm repair can provide several advantages over traditional, open surgery:

  • Provides an option for patients too frail or sick for surgery
  • Smaller incision(s)
  • Less pain
  • Shorter hospital stay and recovery
  • Less chance of complications 

Endovascular Aneurysm Repair: Steps

Successful endovascular aneurysm repair requires several steps:

  1. Our team runs additional tests to make sure you are a good candidate for this type of repair, as well as to choose the best stent-graft.
  2. A team member administers local anesthesia and a sedative, or general anesthesia.
  3. Using X-rays and special dye for guidance, a guide wire and then a catheter are threaded through the arteries to the aneurysm.
  4. The collapsible stent-graft is put into the catheter and positioned over the aneurysm. It is then fixed in place and opened to reinforce the aorta’s wall.
  5. Hospital recovery typically takes 2 to 3 days. 

Aneurysm Follow-Up Care

Following discharge from the hospital, you are asked to come back within a certain amount of time for a checkup and ultrasound or CT scan. We are also likely to recommend some lifestyle changes:

  • Watch your blood pressure and weight
  • Eat foods lower in fat, cholesterol and calories
  • Exercise
  • Quit smoking (if applicable)

Transradial Catheterization

For many patients, cardiac catheterization can be performed through the radial artery in the wrist, instead of using an artery in the groin. The femoral artery in the groin has been traditionally used because it is a larger artery that allows for a larger, more easily maneuvered catheter.

Your physician will conduct a non-invasive test in the catheterization lab to be sure that there is sufficient collateral blood flow to the hand. If this test is normal, the physician can then access the same coronary arteries through the wrist as during a femoral catheterization procedure. If the patient's condition indicates a need for a stent, this can be done through the wrist as well.

A transradial catheterization has several advantages, including:

  • It is a more comfortable procedure for patients.
  • There is virtually no risk of bleeding complications where the catheter is inserted. This is especially important for patients who have other medical conditions, such as bleeding disorders, obesity or peripheral arterial disease.
  • Recovery time is much faster. Following the procedure, a simple wristband is used to compress the artery. The patient can sit up and walk around immediately, as compared to a patient undergoing a femoral artery procedure who must lie flat for four to six hours following the procedure.
  • Patients can often eat within an hour of their procedure.

 

Patient Steve Sindler’s Story

Hear from grateful patient and successful Annapolis attorney Steve Sindler about how the transradial approach to cardiac catheterization—and the experts at MedStar Heart & Vascular Institute at MedStar Union Memorial Hospital made a difference in his recovery.

The Transradial Approach to Cardiac Catheterization

Interventional cardiologist Dr. John Wang, chief of the Cardiac Catheterization Lab at MedStar Union Memorial Hospital, performs a transradial cardiac catheterization. This newer approach to catheterization, performed through the wrist instead of the groin, can mean less pain and a faster recovery for patients.

Dr. John Wang Discusses the Benefits of Transradial Cardiac Catheterization

“We’ve done thousands of procedures safely through the transradial approach.” Dr. John Wang, chief of the Cardiac Catheterization Lab at MedStar Union Memorial Hospital, describes the benefits of a newer approach to cardiac catheterization, performed through the patient’s wrist. The transradial approach is much more comfortable for patients and allows for faster healing and recovery.

Find out more about Transradial Cardiac Catheterization at MedStar Union Memorial Hospital.

Aortic Dissection Symptoms

A dissection is a tear in the lining of your aorta, the candy cane-shaped artery that delivers oxygen-rich blood from your heart. That allows the blood to leak from the inner layer (the intima) into the middle layer (the media). A new pathway (false lumen) is created for the blood, interfering with the aorta’s function. 

Dissections require medical attention — while blood pressure medication is enough to treat some, others can threaten your life and need repair. Early diagnosis and treatment is crucial, with our team providing expert care. Learn more about the renowned team at our Complex Aortic Center, or about our dissection treatment

Aortic Dissection Types: A and B

Some dissections are more dangerous than others, depending on the type:

  • Type A: These dissections often prove fatal in a day or two if not treated. They can involve the part of the aorta that leaves the heart (the ascending aorta), including the curve that turns back toward the chest and abdomen (the aortic arch). About two-thirds also go beyond the arch, into the descending aorta.
  • Type B: These dissections are found in the descending aorta in the chest, past the artery’s downward curve (the aortic arch). 

More dangerous dissections can:

  • Spread to other blood vessels, heart valves or the sac surrounding the heart
  • Rupture
  • Lead to additional aortic tears
  • Deprive organs of oxygen and vital nutrients 

Aortic Dissection Symptoms

There are several possible symptoms of an aortic dissection; some are classic and intense, while others lead to a more vague sense of feeling unwell:

  • Sudden and severe “knifelike” pain in the chest or upper back: the classic symptom, and the most common
  • Other pain, elsewhere in the back or in the limbs, neck, jaw, groin or abdomen
  • Fainting
  • Numbness, coolness or weakness in the limbs
  • Shortness of breath
  • Anxiety 

While you should still see a doctor, please keep in mind that other conditions can cause these symptoms, too — including abdominal diseases and heart problems. 

Aortic Dissection: Aneurysm and Other Causes

Many dissections are caused by an aneurysm, a bulge in the aorta (learn more about aortic aneurysms). There are other potential causes and risk factors, too:

  • Gender and age: Dissections mainly occur in men ages 60 to 80 — though women and other younger people can get the condition, too, especially those with risk factors.
  • High blood pressure (hypertension): the most important risk factor, tied to more than 70 percent of patients
  • Connective tissue disorders:
    • Marfan syndrome
    • Ehlers-Danlos syndrome
    • Turner syndrome
  • Inflammatory diseases that can damage blood vessels:
    • Giant cell arteritis
    • Takayasu arteritis
    • Rheumatoid arthritis
    • Syphilitic aortitis
  • Bicuspid aortic valve: two flaps (leaflets) instead of three
  • High-intensity weightlifting
  • Family history
  • Use of crack cocaine 

Aortic Dissection Diagnosis

Our doctors take several steps to diagnose an aortic dissection:

  • Medical history and physical exam:
    • Severity of pain and when it started
    • Other symptoms
    • Possible risk factors
    • Blood pressure evaluation
  • Imaging tests
    • X-ray: X-ray is usually the first test.
    • Computed Tomography (CT) Scan: This is typically the most used and reliable means of making a diagnosis. If the suspected dissection is not an emergency, the doctor is likely to use a CT as the second step.
    • Transesophageal Echocardiogram (TEE): In cases where a CT scan cannot be done (e.g., in the case of severe kidney disease) a TEE is often used to identify a dissection. This is done by placing an ultrasound probe down the esophagus.

Learn more about aortic dissection treatment.

Aortic Aneurysm Types

An aneurysm is a balloon-like bulge that forms in your aorta, the large artery that is shaped like a candy cane and delivers oxygen-rich blood from your heart. 

While smaller aneurysms are often monitored or treated with medication, larger bulges can rupture and threaten your life. Our doctors specialize in all types of aortic cases and can provide the care you need, whether through traditional, open surgery or a minimally invasive procedure. Learn more about the renowned team at our Complex Aortic Center, or about our aneurysm repair. 

We also have the tools to diagnose aneurysms before they become dangerous, and to screen those at greater risk. 

Thoracic and Abdominal Aneurysm Types

After leaving the top of your heart, your aorta curves back down, running through your chest and abdomen. Aneurysms are divided into three types, based on their location:

  • Thoracic Aortic Aneurysms (TAA): These bulges form in the part of the aorta that runs through the chest, above the diaphragm muscle that helps you breathe. They are further categorized by the specific section they are found:
  • Aortic Root: the point where the aorta leaves the heart, and where the aortic valve and coronary arteries are located
  • Ascending Aorta: after the root, but before the aorta makes its first turn and before the first blood-distributing branch
  • Aortic Arch: the curved part of the aorta, with three major branches supplying blood to the brain and arms
  • Descending Aorta: the part after the aortic arch that heads toward the abdomen
  • Abdominal Aortic Aneurysms (AAA): These bulges are found in the abdomen. They are the most common type, often found in men older than 60.
  • Thoracoabdominal Aortic Aneurysms: These bulges cross both the chest and the abdomen. 

In addition to internal bleeding from rupturing, aneurysms can:

  • Cause the aorta to split, another serious complication (learn more about aortic dissection)
  • Form blood clots
  • Press on nearby body parts
  • Block blood flow
  • Sometimes stop the aortic valve from closing properly (thoracic aneurysm only) 

Aneurysm Symptoms

Aneurysms can develop and then grow slowly for years without causing noticeable changes. They are often discovered during medical visits for different conditions. Other patients may experience certain symptoms, depending on the state of the aneurysm and its location. 

Ruptured Aneurysms

If you experience signs of a ruptured aneurysm, call 911. 

Ruptured thoracic aneurysms can cause:

  • Pain that is sudden, severe, sharp or stabbing and that starts in your chest or upper back and moves down toward your abdomen
  • Chest, arm and neck pain
  • Shock — a steep drop in blood pressure that interferes with the function of vital organs like the brain and kidneys and is marked by:
    • Clammy, sweaty skin
    • Light-headedness
    • Rapid heart rate 

Ruptured abdominal aneurysms can cause:

  • Sudden, severe pain in your lower abdomen and back
  • Nausea
  • Constipation and urination problems
  • Clammy, sweaty skin
  • Light-headedness
  • Rapid heart rate upon standing
  • Shock 

Thoracic Aneurysm Symptoms

Before rupturing, thoracic aneurysms can cause:

  • Pain in your jaw, neck, back or chest 
  • Coughing and/or hoarseness
  • Trouble breathing or swallowing
  • Neck swelling
  • Clammy skin
  • Nausea and vomiting
  • Rapid heart rate
  • General sense that something is wrong 

Abdominal Aneurysm Symptoms

Before rupturing, abdominal aneurysms can cause:

  • A throbbing feeling in your abdomen
  • Pain deep in your back or on your side
  • Steady, gnawing abdominal pain that lasts for hours or days 

Aneurysm Causes and Risk Factors

Aneurysms can develop when normal blood flow pushes on a spot of the aortic wall that is weakened or injured. While some reasons for this damage remain a mystery, other potential causes and risk factors include: 

  • Gender (men are more susceptible than women)
  • Smoking and emphysema
  • High blood pressure (hypertension)
  • High cholesterol
  • Obesity
  • Atherosclerosis (hardening and narrowing of the arteries from plaque buildup)
  • Aging
  • Vasculitis and other diseases that inflame the arteries
  • Car accident or other chest trauma (less common, and thoracic aneurysms only)
  • Family history of aneurysms
  • Personal history of aneurysms in leg arteries
  • Certain genetic conditions that weaken the body’s connective tissue, cause thoracic aneurysms at a younger age and put patients at a greater risk for rupture and dissection:
  • Marfan syndrome
  • Loeys-Dietz syndrome
  • Ehlers-Danlos syndrome (the vascular type)
  • Turner syndrome

Learn more about congenital defects and disease.

  • Having an aortic valve with two flaps (leaflets) instead of three (bicuspid valve) 

Our doctors and other researchers continue to look for additional causes of aortic weakening, including genetic mutations. If you have any of these known risk factors, ask one of our doctors if you should be screened for an aneurysm. 

Aneurysm Screening and Diagnosis

Early diagnosis of aneurysms can help prevent ruptures and other complications. Since aneurysms might not cause symptoms right away, people at greater risk may benefit from routine screening. 

Aneurysm Screening

If you are on Medicare, you can get coverage for a one-time abdominal aneurysm ultrasound screening if you meet one of two conditions:

  • You have a family history of the condition
  • You are man age 65 to 75 who has smoked more than 100 cigarettes in your life 

If you do not meet these requirements but feel you are at risk, talk to your doctor and your insurance company.

Aneurysm Diagnosis

Diagnosing an aneurysm takes several steps:

  • Taking your medical history
  • Physical exam: If you have an abdominal aneurysm, your doctor may feel a throbbing mass or hear a rushing blood flow rather than the normal whooshing sound.
  • One or more imaging tests to determine the aneurysm’s size and location:
  • Ultrasound
  • Computed Tomography (CT) scan
  • Magnetic Resonance Imaging (MRI)
  • Angiography using dye and X-rays to look inside your aorta 

Learn more about aortic aneurysm treatment.

For information or appointments, please call 855-463-3320.

Learn about aortic aneurysm repair at MedStar Washington Hospital Center.

Complex Aortic Center

Your aorta is the largest blood vessel and is responsible for carrying oxygen-rich blood to the rest of the body. The aorta receives all of the heart’s output under high pressure, making repairs to this crucial artery challenging. 

That is why our Complex Aortic Center brings together two specialties that traditionally have worked apart — the doctors who operate on the heart and its major arteries (cardiac surgeons) and those who operate on the other veins and arteries (vascular surgeons). 

Their combined skill and close partnership provides top care for the aortic tears known as dissections and the bulges called aneurysms. The aortic program at our MedStar Heart & Vascular Institute is one of the select few in the Greater D.C. area offering:

  • Complex Procedures: While our experienced team treats all types of aneurysms and dissections, they offer special expertise for complex repairs. Often, these are cases other doctors refer to us, sometimes from more than a hundred miles away. Our doctors treat several of these patients each week.

  • Minimally Invasive Aneurysm Repair throughout the Aorta: We can often find a minimally invasive, endovascular alternative for aortic repair, even when patients are told by other doctors that they cannot have surgery. We make small incisions and use special tools to reach the aorta. We can repair aneurysms throughout the aorta this way.

  • Hybrid Techniques: Certain patients benefit from procedures that combine traditional, open surgery with an endovascular repair, providing optimal treatment for you or your loved one. We perform more of these procedures than any other heart and vascular program in the area.

We design a treatment plan just for you, with the most advanced imaging and the latest stents and stent-grafts — the materials used to make successful repairs. 

Learn more about:

Top Aortic Care at MedStar

Aortic care at our Heart & Vascular Institute stands apart for several reasons:

  • Leading Doctors: The success of our aortic center hinges on top cardiologists and the expertise and experience of our surgeons:

    • Vascular: Board-certified in general and vascular surgery, Edward Woo, MD, directs MedStar’s Regional Vascular Surgery Program and leads a team that treats aortic disease. He is recognized around the world for complex, minimally invasive procedures to treat dissections and aneurysms. Dr. Woo is particularly acclaimed for combining this endovascular approach with traditional surgery, a hybrid technique he has performed hundreds of times and taught to other doctors around the globe. Learn more about hybrid aneurysm repair, or about the aortic center’s vascular team.

    • Cardiac: Well-versed in aneurysm and dissection repair, Christian Shults, MD, is our attending cardiac surgeon, is co-director of the Complex Aortic Center and leads its cardiac team. In addition to being fellowship-trained and board-certified in both surgery and thoracic/cardiac surgery, Dr. Shults has extensive domestic and international training in complex open and endovascular aortic surgery. Learn more about the aortic center’s cardiac team.

  • Team Approach: The vascular and cardiac teams often take a joint approach to challenging cases. They also consult closely beforehand on every patient, reviewing diagnoses and combining their knowledge and judgment to come up with the best recommendation.

  • Clinical Trials and Research: We take part in clinical trials to improve aortic care. Our doctors often create and lead these trials, giving patients even earlier access.

  • Support Services: In addition to all aspects of vascular and cardiac surgical care, MedStar’s Heart and Vascular Institute provides genetic testing, state-of-the-art surgical intensive care (if needed), access to additional specialists and other crucial services. Learn more about our:

Aortic Center Vascular Team

Read the profiles of our vascular team members:

Aortic Center Cardiac Team

Read the profiles of our cardiac team members:

For information or appointments,
please call 855-463-3320.

Aortic Dissection Treatment

While aortic dissections are a serious and sometimes fatal condition, more patients than ever are living long and healthy lives after undergoing a repair or using medication to manage the problem. 

At the MedStar Heart & Vascular Institute, our surgeons have the experience and skill to perform the challenging surgeries needed to repair aortic dissections. They specialize in complex cases, with other doctors often referring patients to them. And they have specialized expertise in a minimally invasive approach called endovascular repair. 

Learn more about aortic dissections or the team at our Complex Aortic Center

Complex Dissection Cases

We specialize in complex dissection repairs, thanks to the combined skills and partnership of our vascular and cardiac surgeons. Other doctors often refer challenging cases to us — sometimes from more than a hundred miles away. 

Complex dissections often require repair and are frequently marked by:

  • Patients who are especially ill
  • Multiple tears, and several new blood passageways (lumens)
  • Particular challenges in using equipment for repair
  • Skill needed to determine when the dissection is properly repaired and the surgery or procedure is finished
  • An even greater need for precision and accuracy 

Aortic Dissections and Medications

Medications are important for treating dissections, to lower blood pressure and relieve strain on the damaged aorta. We prescribe medication to all our dissection patients, and also recommend repair for many of them. Learn more about the types of aortic dissections

We start most patients with a beta-blocker such as metoprolol or labetalol, which:

  • Blocks adrenaline
  • Widens arteries
  • Decreases the force of the heart’s contraction 

We may also use:

  • Nitroprusside (to relax blood vessels)
  • ACE inhibitors
  • Calcium channel blockers 

Aortic Dissection Surgery

Surgery is the standard treatment for Type A dissections (ascending aorta), though some patients are too sick to undergo an operation and may rely on medication. Patients with Type B dissections (descending aorta) may also need surgery if:

  • The dissection is interfering with the major arteries branching off the aorta, with problems in the limbs or organs
  • The aorta has expanded too much or is at risk of rupturing
  • Medication cannot relieve the pain
  • Internal bleeding is causing problems
  • A large aneurysm has formed (learn more about aortic aneurysms

Learn more about the types of aortic dissections

Dissection Surgery: Steps

Surgically repairing an aortic dissection involves a number of steps:

  1. Patients with Type A dissections are placed on a heart-lung machine (cardiopulmonary bypass). This allows the surgical team to slow the heart and clear the aorta of blood, while still providing blood and oxygen to the brain and body. The brain and body are also cooled so they consume less oxygen.
  2. After a team member administers general anesthesia, and the patient has been placed on the heart lung machine, surgeons make an incision into the aorta to inspect the extent of the tear. They also determine if other vessels or body parts also require repair.
  3. The damaged aorta is replaced with a long-lasting synthetic graft and reconnected.
  4. A Type A dissection may also damage the aortic root. In most cases, this damage can be repaired, but at other times the aortic root may need to be replaced. This involves removing the aortic tissue and replacing it with a long-lasting synthetic graft, reattaching the coronary arteries and either repairing or replacing the aortic valve. Learn more about our heart valve surgery.
  5. The body is re-warmed, bypass is ended and the incision is closed.
  6. Hospital recovery typically takes 7 to 10 days. 

Learn more about the types of aortic dissections.

Endovascular Dissection Repair

While surgery remains an important tool for treating ascending aortic dissections (Type A), our team is among those advancing minimally invasive repair for patients with descending aortic dissections (Type B). 

Called endovascular repair, these procedures involve threading catheters through the femoral artery to your aorta. A stent-graft is sent through one of the catheters, then positioned to reinforce your aorta. An endovascular approach requires a high degree of expertise but offers several advantages:

  • Minimally invasive
  • Faster recovery
  • Fewer complications — less chance of rupturing, better blood flow to organs and less pain 

Learn more about the types of aortic dissections.

Aortic Dissection Follow-Up Care

Many patients follow a post-treatment plan, particularly if they are managing their dissection with medication. Your doctor may ask you to maintain a certain weight or limit yourself to light or moderate exercise.

For information or appointments,
please call 855-463-3320.

Hybrid Aneurysm Repair

Our aortic team is unique in treating aneurysms with a hybrid procedure when necessary: making part of the aortic repair with conventional open surgery and the rest with an endovascular approach. The minimally endovascular approach uses small incisions and special tools to reach the aorta. 

Not every patient needs a hybrid procedure, but it can provide a less-invasive solution for more complex cases. At the MedStar Heart & Vascular Institute, we complete more of these procedures than any other program in the D.C. area. 

Learn more about:

Hybrid Aneurysm Repair for Aortic Arch

After your aorta leaves your heart, it curves back toward your chest and abdomen — an area called the aortic arch. This area is challenging to repair because of the crucial arteries that branch off it to supply the brain and arms with blood. 

In the past, open surgery represented the only option for repairing aneurysms in the arch. This involved putting the patient on a heart-lung machine, cooling the body and stopping the normal circulation. But, a hybrid approach offers an alternative, with two main steps:

  1. Surgery: Our doctors perform open surgery to graft new blood-supplying arteries to the brain and arms, closer to where the aorta leaves the heart.
  2. Endovascular: A catheter is threaded toward the aneurysm and a stent-graft is positioned over the aneurysm, then released to treat the aneurysm. 

Learn more about aortic aneurysms and the parts of the aorta. 

Hybrid Aneurysm Repair Benefits

Using a hybrid approach to repair aortic arch aneurysms offers several benefits:

  • No heart-lung machine used
  • No need to cut into the sensitive aortic arch, resulting in less intense treatment with fewer complications 

While we may also use a hybrid approach for aneurysms that cross both the chest and abdomen (thoracoabdominal aneurysms), we can often treat these with a purely endovascular repair. Learn more about the types of aortic aneurysms

Hybrid Elephant Trunk Procedure

A hybrid procedure can often help patients with extensive aneurysms that involve both the ascending aorta (including the aortic arch) and the descending aorta. The procedure is performed in two stages, usually staggered so the patient can recover in between:

  1. Surgery: The ascending aorta and arch are replaced with a long-lasting synthetic graft. A second graft is left in the descending aorta but not attached at its far end, leaving it looking like an elephant’s trunk and giving the procedure its name.
  2. Endovascular: Using a catheter, a stent-graft is placed in the descending aorta, where it joins the earlier elephant trunk graft and completes the repair. 

By using an endovascular approach in the second step, the patient avoids a second surgery and a second large incision. Learn more about aortic aneurysms and the parts of the aorta. 

Complex Aortic Center

Your aorta is the largest blood vessel and is responsible for carrying oxygen-rich blood to the rest of the body. The aorta receives all of the heart’s output under high pressure, making repairs to this crucial artery challenging. 

That is why our Complex Aortic Center brings together two specialties that traditionally have worked apart — the doctors who operate on the heart and its major arteries (cardiac surgeons) and those who operate on the other veins and arteries (vascular surgeons). 

Their combined skill and close partnership provides top care for the aortic tears known as dissections and the bulges called aneurysms. The aortic program at our MedStar Heart & Vascular Institute is one of the select few in the Greater D.C. area offering:

  • Complex Procedures: While our experienced team treats all types of aneurysms and dissections, they offer special expertise for complex repairs. Often, these are cases other doctors refer to us, sometimes from more than a hundred miles away. Our doctors treat several of these patients each week.

  • Minimally Invasive Aneurysm Repair throughout the Aorta: We can often find a minimally invasive, endovascular alternative for aortic repair, even when patients are told by other doctors that they cannot have surgery. We make small incisions and use special tools to reach the aorta. We can repair aneurysms throughout the aorta this way.

  • Hybrid Techniques: Certain patients benefit from procedures that combine traditional, open surgery with an endovascular repair, providing optimal treatment for you or your loved one. We perform more of these procedures than any other heart and vascular program in the area.

We design a treatment plan just for you, with the most advanced imaging and the latest stents and stent-grafts — the materials used to make successful repairs. 

Learn more about:

  • Aortic aneurysms
  • Aortic dissections
  • Our aneurysm repair
  • Our aortic dissection treatment

Top Aortic Care at MedStar

Aortic care at our Heart & Vascular Institute stands apart for several reasons:

  • Leading Doctors: The success of our aortic center hinges on top cardiologists and the expertise and experience of our surgeons:

    • Vascular: Board-certified in general and vascular surgery, Edward Woo, MD, directs MedStar’s Regional Vascular Surgery Program and leads a team that treats aortic disease. He is recognized around the world for complex, minimally invasive procedures to treat dissections and aneurysms. Dr. Woo is particularly acclaimed for combining this endovascular approach with traditional surgery, a hybrid technique he has performed hundreds of times and taught to other doctors around the globe. Learn more about hybrid aneurysm repair, or about the aortic center’s vascular team.

    • Cardiac: Well-versed in aneurysm and dissection repair, Christian Shults, MD, is our attending cardiac surgeon, is co-director of the Complex Aortic Center and leads its cardiac team. In addition to being fellowship-trained and board-certified in both surgery and thoracic/cardiac surgery, Dr. Shults has extensive domestic and international training in complex open and endovascular aortic surgery. Learn more about the aortic center’s cardiac team.

  • Team Approach: The vascular and cardiac teams often take a joint approach to challenging cases. They also consult closely beforehand on every patient, reviewing diagnoses and combining their knowledge and judgment to come up with the best recommendation.

  • Clinical Trials and Research: We take part in clinical trials to improve aortic care. Our doctors often create and lead these trials, giving patients even earlier access.

  • Support Services: In addition to all aspects of vascular and cardiac surgical care, MedStar’s Heart and Vascular Institute provides genetic testing, state-of-the-art surgical intensive care (if needed), access to additional specialists and other crucial services. Learn more about our:

Aortic Center Vascular Team

Read the profiles of our vascular team members:

Aortic Center Cardiac Team

Read the profiles of our cardiac team members:

Our New Heart Hospital

newhospital

First Dedicated Heart and Vascular Hospital in the Nation’s Capital

The Nancy and Harold Zirkin Heart & Vascular Hospital opened July 2016 on the campus of MedStar Washington Hospital Center.

State-of-the-Art Facility for a Nationally Recognized Cardiovascular Program

The Nancy and Harold Zirkin Heart & Vascular Hospital is a 164-bed state-of-the-art facility, which is the cornerstone of the MedStar Heart & Vascular Institute and will advance cardiovascular care for patients throughout the Washington and mid-Atlantic regions.

The four-story, 160,000-square-foot facility centralized all cardiovascular services in the Hospital Center’s North Addition. The new space ushers in a new model of care and patient experience. Patients with similar medical conditions are cared for on designated specialty-care units that have dedicated teams of cardiologists, cardiac and vascular surgeons, nurse practitioners and nurses, to collaboratively deliver the highest quality cardiovascular care and achieve the best patient outcomes.

surgeonIncreased critical care capacity was an important linchpin in the new design of the heart and vascular hospital. The 44-bed cardiac intensive care unit on the second floor was built to meet the increasingly complex needs of patients from all over the region. The ICU rooms are much larger, with wider doorways facilitating access for team members and advanced equipment to the bedside. Each ICU room is equipped with ceiling-mounted booms carrying medical gases, and electric and data outlets, offering greater flexibility and providing clinicians unrestricted access to the patient from all four sides of the bed.

Construction of the Nancy and Harold Zirkin Heart & Vascular Hospital took three years to complete and was divided into four phases. In January 2015, a 60-bed inpatient unit opened to patients on the fourth floor of the hospital, followed by the third floor inpatient unit. The first floor, with a separate entrance and lobby, opened in December and is solely dedicated to outpatient care. The second floor cardiac ICU, the final phase of construction, opened July 2016.

The Nancy and Harold Zirkin Heart & Vascular Hospital was named to recognize long-time Washingtonians Nancy and Harold Zirkin for their generosity and extraordinary philanthropic support to the heart and vascular hospital. Their $10 million leadership gift is the largest single contribution in the history of MedStar Washington Hospital Center and MedStar Health.

Nationally Recognized Patient Care

MedStar Washington Hospital Center’s heart and vascular program is recognized as one of the most prominent in the country and it receives the highest rating for its cardiac surgery program by the Society of Thoracic Surgeons.

MedStar Heart & Vascular Institute was founded at the MedStar Washington Hospital Center, and its physicians have a record of nationally ranked excellence. They are known for their research and innovation that advances heart care, ensuring the latest treatment options are available for our patients. Our physicians specialize in treating a wide range of heart and vascular conditions, and they have extensive experience diagnosing and treating advanced and complex cases.

heartgroupYour personalized treatment plan may include a state-of-the-art procedure, and our specialists are often the first in the region to implement this new technology. Our physicians were pioneers in the development of the left ventricular assist device (LVAD) that supports diseased or damaged heart muscle and can be used as a bridge to heart transplantation; transcatheter aortic valve replacement (TAVR), a minimally invasive option for patients too ill to undergo open surgery; and more recently, the Watchman™ procedure, a minimally invasive surgical treatment for atrial fibrillation.

Vascular and cardiac surgeons work side by side as a team on complex aortic cases, thus providing patients the best possible outcomes. As a leading cardiovascular research center, MedStar Heart & Vascular Institute participates in many regional and national clinical trials, so we can provide you with the most advanced treatment choices.

Network of Partnership

MedStar Heart & Vascular Institute is an integral part of MedStar Health, a health system that includes 6,000 affiliated physicians. Our cardiac specialists are located at 10 MedStar Health hospitals, as well as physicians' offices throughout the greater Washington, D.C. and Central Maryland regions.

This network of cardiac specialists will work together, as well as with other specialists throughout MedStar Health, to ensure they provide you with the care that will produce the best possible outcome. Working together as a team, our physicians are dedicated to providing the right level of care, at the right place and at the right time for all of our patients.

Cleveland Clinic Alliance

medstar-heart-vascular-cleveland-clinicMedStar Heart & Vascular Institute has developed a strong clinical and research alliance with the world-renowned Sydell and Arnold Miller Family Heart & Vascular Institute at Cleveland Clinic, the nation’s #1 heart program.

What does this alliance mean for you? "It means even better heart care," says Cardiac Surgeon Paul J. Corso, MD. "We treat more patients in almost every category of cardiac care than anyone else in the region. Together we have seen it all—we have experienced it all. And research shows that more experience yields better outcomes."

Cardiac Surgery at MedStar Heart Institute

For Patients: 202-877-DOCS (3627) | For Physicians: 202-877-7777

Request an appointment

Our cardiac surgeons have a reputation as the best in the region and among the finest in the nation.

Team approach to cardiac care

There are many different aspects to consider when treating patients with cardiac disease. Our cardiac surgeons work in teams with other cardiac experts, including cardiac imaging specialists, interventional cardiologists, pulmonologists, radiologists and nurses to complete the entire picture for each patient. We are committed to a team approach to care.

The advantage of experience in cardiac surgery

We are one of the highest volume cardiac surgery centers in the Washington metropolitan area. Volume and experience also translate into best practices based on outcomes. Our entire team sees a large number of patients per year. We continually refine surgical techniques, so you receive the least invasive surgical option that will also bring the best long-term results.

Cardiac surgery database for better patient care

We have compiled a cardiac surgery database containing data on more than 60,000 cases from the past 30 years. This unique resource helps us continually improve patient care. It gives our physicians a direct window on the practices and approaches that produce the most successful outcomes for our patients. Few cardiac centers have anything like it.

Sophisticated communication and electronic medical records

Our sophisticated information management and communications capabilities are powerful resources for integrating MedStar Heart Institute services and locations, from enabling real-time sharing of patient images and data to supporting electronic medical records. This means you can receive advanced cardiac care no matter your location-at one of our sister hospitals, or at one of our satellite locations. If you are looking for experienced heart surgeons with advanced surgical expertise, who treat large numbers of patients every year, you have come to the right place. Our heart surgeons treat complex heart conditions using a variety of techniques—including minimally invasive surgery—with outstanding outcomes. They also work as part of a larger team of heart specialists to provide patient-focused care both before and after surgery.

Advanced heart surgical care in Washington, D.C.

Our history of innovation and research is not the only reason you should choose us for your heart surgery. Consider these facts:
  • The Society for Thoracic Surgeons awarded us three stars, its highest rating, based on quality and outcomes.
  • Nearly half of our CABG (Coronary Artery Bypass Graft) procedures are performed off-pump (without using a heart and lung machine), which speeds recovery and reduces bleeding, neurologic impairment and other complications.
  • We are the only hospital in the Washington, D.C., region to offer the Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure performed for severe aortic stenosis.
  • Our doctors and researchers have a database of more than 60,000 cardiac surgical cases from the past 30 years. This rich data helps us continually improve patient care.
  • Our patients have access to clinical trials in better methods to prevent and treat cardiac and vascular disease.

Cardiac surgical services

We offer the following surgical services for the treatment of heart conditions:

Heart conditions we treat

We offer the above heart surgeries for treatment of:
If you are a patient, call our referral and appointment line: 202-877-DOCS (3627)
If you are a physician, call our consultation line: 202-877-7777

Make a Gift to MedStar Washington’s Vascular Surgery Program

Some 15 million Americans have vascular disorders, which affect the arteries and veins throughout the body. Vascular disorders are often thought of as “hardening of the arteries” or “poor circulation.” At least half of those with vascular disorders have no symptoms.

Quick and Effective Diagnosis Leads to Better Outcomes

However, it is important to diagnose these conditions accurately and early, because they can lead to progressive discomfort, long-term disability or even sudden death. Vascular disease can reduce your life expectancy by causing heart attacks, strokes, ruptured blood vessels, blood clots or kidney failure. Blood vessel disease in your legs can lead to amputation if left untreated; in fact, it leads to about 100,000 amputations each year. Also, if you have vascular disease, your risk for developing heart disease is six times greater.

Our vascular surgery team can determine the nature and extent of your condition by performing a complete range of diagnostic tests, and then implement the most sophisticated treatment strategies to return you to good health. As a Level I trauma center and an advanced surgical center staffed by board-certified surgeons, the Hospital Center serves more than 300,000 patients a year in the Washington metropolitan area.

We Depend on the Support of Our Generous Donors

We are a not-for-profit organization, and depend on the support of our generous donors. Since 2000, we have provided more than $220 million in charity care to our community.   Please help us as we work to effectively treat and cure vascular disease.

Donate now

Vascular Health Quiz

  1. Do you feel pain, tightness, tiredness or weakness in your legs when you walk?
  2. Do your legs feel better when you stop walking?
  3. Has a physician ever told you that your have poor circulation in your legs?
  4. Have you ever been told that you have blockage in your carotid arteries?
  5. Have you recently experienced TEMPORARY:
    1. Loss of vision in one eye?
    2. Slurred speech?
    3. Difficulty understanding what is being said to you?
    4. Weakness or numbness of an arm or leg on one side of your body?
  6. Do you have high blood pressure?
    1. If yes, for how long? ___Years
    2. Has it been difficult to get your blood pressure under control?
    3. Are you taking more than two blood pressure medications now?
  7. Do your legs swell?
  8. Have you had problems with blood clotting or phlebitis?
  9. Have you had or do you have an open sore on your legs, feet or toes that doesn't heal?
  10. Do you have a family history for enlarged arteries or aneurysms?

If you answered "Yes" to any of the questions above, you should consider seeing your doctor or a vascular specialist for further evaluation.

 

MedStar Washington Hospital Center offers the most comprehensive service in diagnosing and treating vascular disorders. A team of specialists thoroughly reviews each case to determine the best treatment for each patient. MedStar Washington Hospital Center has a complete range of diagnostic tests to determine the nature and extent of vascular conditions and implement the most sophisticated treatment strategies to return patients to good health.

 

Minimally Invasive Vascular Surgery Suite

vascularsurgerysuite

The Lawrence B. Taishoff Center for Endovascular Surgery

Vascular surgeons at the Hospital Center perform approximately 1,800 operations every year, nearly four times more than any other hospital in the area. The Taishoff Center was made possible through a $1 million gift from the Taishoff Family Foundation, in appreciation of the care given to Lawrence Taishoff by Dr. Cameron Akbari, senior vascular surgeon at the MedStar Washington Hospital Center.

About the hybrid suite: the only one of its kind in the Washington, D.C. area

A hybrid suite has all the functional capabilities of the most advanced, state of the art traditional operating room. Vascular surgeons can perform open surgery and endovascular surgery, which uses small tubes and wires to treat disease from within the blood vessels.

Most operating rooms in the country will have a portable radiologic (imaging) unit to use during vascular operations; however, the imaging and processing and capabilities are vastly inferior to one in which the imaging equipment is built into the operating room.

 

Take a virtual tour of the minimally invasive surgery suite. 

 

Benefits of the hybrid suite

As a result of this advanced technology, our vascular surgeons are able to perform the most advanced endovascular and hybrid procedures, incorporating the latest technology, such as three-dimensional imaging and rotational imaging. This allows precise and accurate endovascular treatment with faster recovery for complicated diseases, which in the past had required extensive invasive operations with prolonged recovery.

Another added benefit of the hybrid suite is that post processing is more advanced, compared to a portable vascular surgery unit. Surgeons can get better visualization and more accurate measurements for the conditions they treat. For example, our surgeons can now incorporate intravascular ultrasound directly in the endovascular suite without any added machinery. They can place an ultrasound probe inside a blood vessel, and look inside any blood vessel prior to delivery of a stent. In the case of hybrid procedures, all of these advanced techniques can be performed at the same time as traditional, open surgery, if necessary, due to the advantages of having all the technology in one operating suite.

About vascular surgery at the Hospital Center

Our board-certified vascular surgeons have the most experience in the Washington metropolitan area in treating complex vascular problems. The wide variety of surgical cases evaluated and treated by our surgeons provides them with a depth of experience unparalleled by other physicians in the area.

What is a Vascular Surgeon?

A vascular surgeon is a specialist who evaluates and treats diseases of the blood vessels. Treatment can include traditional open surgery and endovascular approaches. Some of these surgeries may include:

  • Removing the plaque from an artery
  • Bypassing the area of obstruction with a graft
  • Performing endovascular procedures

Because of their training, vascular surgeons are uniquely qualified to diagnose all vascular diseases and interpret a wide variety of diagnostic tests.

Vascular Surgery Locations

Our expert vascular surgeons are available at the following locations:

MedStar Washington Hospital Center
106 Irving Street, POB North 3150
Washington, DC 20010
202-877-0275
www.medstarwashington.org/maps
www.medstarwashington.org/parking

MedStar Georgetown University Hospital
3800 Reservoir Road NW
Washington, DC 20007
202-444-2255

MedStar Good Samaritan Hospital
5601 Loch Raven Blvd.
Smyth Building, Suite 303
Baltimore, MD 21239
443-444-3434

MedStar Harbor Hospital
3001 S. Hanover Street
Outpatient Center, Suite 216
Baltimore, MD 21225
410-350-2106

MedStar Montgomery Medical Center
18109 Prince Philip Dr. Suite B-100
Olney, MD 20832
301-774-8962

MedStar Southern Maryland Hospital Center
7501 Surratts Rd.
Clinton, MD 20735
301-877-7353

MedStar St. Mary’s Hospital
25500 Point Lookout Rd.
Leonardtown, MD 20650
240-434-4072

MedStar Union Memorial Hospital
Johnston Professional Buidling
3333 N. Calvert Street, Suite 325
Baltimore, MD 21218
410-554-2950

MedStar Health at Lafayette Centre
Building 2
1133 21st St., NW
Washington, DC
202-416-2000

MedStar Health at Chevy Chase
Barlow Building
5454 Wisconsin Avenue, 11th Floor
Chevy Chase, MD 20815
301-215-9420

MedStar Health at McLean
6862 Elm St  Suite 800A
McLean VA 22101
(703) 288-7070

Medstar Health Bel Air Medical Campus 
12 Medstar Blvd
Bel Air, MD 21015
(410) 877-8088

Medstar Franklin Square Medical Center 
9101 Franklin Square Drive, Suite 210
Baltimore, MD 21237
(443) 444-3431

For more information or to make an appointment, call 202-877-DOCS (3627)

Why Choose Us

 vascular-surgery-team-mwhc

Our vascular surgery program was established in order to provide the region with a service dedicated to the thorough evaluation and treatment of vascular disorders. Our physicians work together to offer patients the most sophisticated diagnostic and treatment options. 

Team of Specialists

Our team of specialists includes:

  • Vascular medicine specialists
  • Vascular surgeons

These specialists work together to ensure a well-rounded approach to your care. When their expertise is needed, the team also has access to other specialists throughout the MedStar network, including:

  • Heart specialists
  • Diabetes specialists
  • Kidney specialists

Comprehensive Services

The program offers the most advanced evaluation options to achieve a precise diagnosis of your condition. Whenever possible our physicians use noninvasive diagnostic testing and treatments. The program also has access to the most sophisticated forms of treatments and procedures, including new catheter-based and surgical approaches.

Convenient Access

Usually, you will see one doctor during your initial evaluation. This physician will then discuss your case with our other specialists, to confirm a diagnosis and decide on the best treatment plan. The team works closely with your primary care physician to manage your care.

We offer the most comprehensive approach to your health care. We strive to combine the finest clinical capabilities with compassionate care and an unyielding commitment to our "Patient First" philosophy.

Vascular Surgery

WOO-SHULTS-IN-SURGERY-Feature-vascular-surgery

MedStar Heart & Vascular Institute's vascular surgery program is the largest, most experienced diagnostic and treatment center for vascular problems in the metropolitan area. Our specialists treat the most critical vascular patients, resulting in excellent outcomes. Our team includes vascular medicine specialists, vascular surgeons, interventional cardiologists and radiologists who work together to ensure a well-rounded approach to your care.

Experience and Expertise

Our vascular medicine specialists and vascular surgeons evaluate and treat the widest spectrum of vascular disease. Our vascular lab is accredited by the Intersocietal Commission for the Accreditation of Vascular Laboratories, and members of our staff are registered vascular technologists, ensuring the highest quality of care and sophisticated diagnostic testing available. Learn more about one of our vascular surgeons, Frederick Beavers, MD.

Referrals from Vascular Specialists

As home base for the most complex helicopter system in the area—patients are flown here from hundreds of miles away—our physicians are among the most experienced at quickly and effectively evaluating and treating the signs and symptoms of vascular disease. Our physicians are so widely respected, other vascular surgeons refer to our center.

Think You Have Symptoms of Vascular Disease?

Take our quiz to find out if you need to see one of our experienced vascular specialists.

Vascular Conditions Treated

Vascular Diagnosis

  • Abdominal aortic ultrasound
  • Angiography
  • Ankle-brachial Index
  • Arterial duplex scan
  • Arteriogram
  • Computerized tomographic angiography (CTA)
  • Doppler
  • Ultrasound
  • Magnetic Resonance Angiography (MRA)
  • Pulse Volume Recordings

Vascular Treatments

Electrophysiology Lab

Electrophysiology Lab at MedStar Heart & Vascular Institute

Our electrophysiologists manage one of the largest and busiest electrophysiology (EP) labs in the country. This is a major referral center for the entire mid-Atlantic region, and our physicians perform more than 5,000 EP procedures each year. 

About the electrophysiology lab

EPlab2MedStar Washington Hospital Center opened the area's first Cardiac Arrhythmia Center in 1985 and since then has remained in the forefront of new techniques to evaluate and manage patients with a wide variety of arrhythmias. A recent major renovation and expansion has created an eight-laboratory EP suite. It features state-of-the-art equipment and technology as well as a dedicated EP patient care suite that is unique and unrivaled in the region. Together with the adjoining outpatient Cardiac Arrhythmia Center, this facility is a fully integrated arrhythmia care center for patients.

Their clinical scope of work encompasses all areas of arrhythmia management, including:

  • Pacemakers
  • Implantable cardioverter defibrillators (ICDs)
  • Biventricular pacing
  • All types of ablation, including ablation for:
    • Supraventricular tachycardia (SVT)
    • Ventricular tachycardia
    • Atrial fibrillation

Cardiac Catheterization Research & Clinical Trials

From the most effective new cardiac treatments to staying ahead of the latest scientific advances, innovation is at the heart of MedStar Heart & Vascular Institute. The Heart Institute is a pipeline to the most important new research and developments for its physicians, which translates into state-of-the-art care for patients.

Through our Cardiovascular Research Institute, we bring the benefits of pioneering research and clinical trials to patients from throughout the region. At any time, we are involved in 30 to 50 investigational trials for the treatment of heart disease, and our cardiologists and cardiac surgeons publish their findings widely.

Here are just a few of the highlights from our research and clinical trials:

  • The TAVR procedure (transcutaneous aortic valve replacement) is a clinical trial, examining a minimally invasive procedure to treat patients with aortic stenosis who are too ill to undergo traditional surgery. We added more than 200 patients into the national clinical trial, and we are considered one of the international leaders in this area. TAVR is not offered anywhere else in our region.
  • Our interventional cardiologists have pioneered the testing and development of ventricular assist devices (VADs) since 1988. Today, VADs are routinely used as bridges to transplantation and, for some patients, a long-term solution for advanced heart failure.
  • We are assessing the MitraClip—a catheter-based therapy—for percutaneous repair of mitral valve regurgitation. We are the only center in the region to do this.
  • We are assessing a treatment for coronary arteries that uses completely biodegradable stents that dissolve once treatment is complete. 

Cardiac Catheterization Treatments

You may have heard the term “cardiac cath,” but may not know exactly what it means. Cardiac catheterization is a minimally invasive diagnostic and treatment option that involves passing a catheter (a thin, flexible tube) through the vessels supplying blood to the heart. Your doctor uses this procedure to tell how well your heart is functioning, and to diagnose any possible cardiac disease.

Cardiac Cath Care in Washington, D.C.

The Cardiac Catheterization Lab at MedStar Heart & Vascular Institute has 11 labs dedicated to interventional procedures, so treating patients is fast, leading to the best possible outcomes. All of our catheterization labs use the latest digital technology, which offers highly detailed images.

Interventional cardiologists perform cardiac catheterizations. These physicians have up to eight years of clinical training following medical school. 

Cardiac catheterization allows our cardiologists to treat certain types of heart conditions. For example, they can:

  • Open up a narrowed or blocked blood vessel in the heart or elsewhere in the body
  • Open a blocked heart valve
  • Dilate obstructed arteries in the heart
  • Repair holes in a blood vessel or other types of heart defects

Other diagnostic tests and procedures performed at the Heart & Vascular Institute:

Minimally Invasive Heart Procedures

Cardiac catheterization is a minimally invasive diagnostic and treatment option. Because it doesn't require surgery, you recover faster, with less pain and fewer complications. Patients who have an interventional treatment, such as placement of a stent, can usually go home the next day.

About 10 percent of patients who undergo cardiac catheterization need open heart surgery. At MedStar Heart & Vascular Institute, we have world renowned surgeons able to manage even the most complex cases.  Our cath labs are fully equipped operating rooms, so if cardiac surgery is necessary, we never have to move patients in the middle of a procedure. 

Learn more about cardiac catheterization and the many other diagnostic tests and procedures we perform for:

Radial Approach for Cardiac Catheterization

Based on the needs of each individual patient, our physicians assess each situation and may opt to perform angioplasty and cardiac catheterization procedures through the wrist instead of the groin. Traditionally, doctors performed cardiac catheterizations by threading a catheter through the groin.

Coronary Artery Disease

Valvular Heart Disease

Structural Heart Problems

Cardiac Electrophysiology Treatments

Restoring the Rhythm of Life:

Advanced AFIB Treatment

Welcome to the Section of Cardiac Electrophysiology at MedStar Heart & Vascular Institute—one of the nation’s most advanced programs for the treatment of heart rhythm disorders.

We offer:

  • The most sophisticated diagnostic tools and advanced treatment options—with more in our research pipeline.
  • A team of 16-board-certified, nationally recognized arrhythmia specialists.
  • Locations throughout the region.
  • A state-of-the-art patient care and procedure suite as its centerpiece.
  • And a new heart alliance with Cleveland Clinic – the nation’s #1 heart program.

We balance the best of technological expertise with the compassion of patient-centered care for all types of cardiac arrhythmias.  Our experts are leaders in developing and testing the most advanced medical, surgical and minimally invasive treatment techniques available today.  And they are caregivers who share a philosophy of medicine that puts patient comfort, privacy and individual attention first.

MedStar Heart & Vascular Institute is headquartered at MedStar Washington Hospital Center and is consistently recognized by U.S.News & World Report and The Society of Thoracic Surgeons for preeminent cardiac care.  MedStar Heart Institute is comprised of more than 100 cardiac physician specialists throughout the Washington region, as well as the nationally recognized expertise of the Hospital Center, the academic depth of MedStar Georgetown University Hospital, and the cardiac services of MedStar Montgomery Medical Center, MedStar Southern Maryland Hospital Center and MedStar St. Mary’s Hospital.

The Section of Cardiac Electrophysiology offers services in nine convenient locations:

Washington, D.C.

Maryland

Virginia

Take a Virtual Tour

Cardiac Electrophysiology Suite at MedStar Heart & Vascular Institute

afib-virtual-tour

Cardio-Oncology Research

Our cardiologists are conducting important research about why certain types of cancer treatments compromise heart function. There may be ways to prevent damage to the heart while still undergoing these cancer treatments.  However, there is not a lot of data in this field, and so clinical research is critical.

Our Cardio-Oncology Program is building a database of patients, their cancer treatments and their heart complications, so we can help future patients and design better cancer drugs. This database also helps our current patients, because as we build a clinical practice model, we are making very informed decisions about your cardiac health as it relates to your cancer treatment.

Please contact us by calling 202-877-2162. You may also send an email to [email protected]

For Referring Physicians

The MedStar Heart Institute’s Cardio-Oncology Program is the first of its kind in our Greater Baltimore/Washington, D.C., metropolitan area. We are dedicated to the prevention and early detection of cardiac complications from chemotherapy or other cancer treatments.

Combining sophisticated and advanced cardiac testing with the skills of our specialized cardiologists, our program offers:

  •       Earlier diagnosis of heart problems
  •       Special monitoring of your patients with cancer who also have existing or potential cardiac issues

If you have a patient with cancer and these other conditions that may affect their care:

  •       History of cardiomyopathy or heart failure Hypertension
  •       High cholesterol
  •       Diabetes
  •       Other heart-related issues

Please contact us by calling 202-877-2162. You may also send an email to [email protected]

You can see one of our cardiologists with expertise in cancer treatment at MedStar Georgetown University Hospital by calling 202-444-5111.

Our experienced team maintains communication with you while we are caring for your patient.

Treatment and Management: Cardio-oncology

Some patients with  heart trouble or who are at risk for developing heart conditions because of certain types of cancer treatment, need specialized care.

At our Cardio-Oncology Program, our physicians are cardiologists who use advanced imaging to diagnose and evaluate a patient’s risk of developing a heart condition due to  certain types of cancer treatments. Our cardiologists also treat patients who are undergoing cancer treatment, but have developed heart conditions, in the hope of protecting their heart function as much as possible.

Evaluation of cardiac risk and heart conditions during cancer treatment

We use the latest tests and diagnostic criteria to help patients understand their risk factors for heart failure and other associated conditions. These include:

  • Echocardiography
  • Echo strain imaging
  • Cardiac biomarkers
  • Cardiac MRI

This state-of-the-art imaging allows our cardiologists a full view of the heart’s function, giving them critical real time information that helps them evaluate your potential risk for developing a cardiac condition while undergoing cancer treatment.  Your diagnosis also reveals if there is a way to receive these drugs safely, without damaging your heart.

If you already have a heart condition, these advanced images provide important information for the best possible treatment.

Treatment

If you have heart damage due to certain types of cancer drugs, or radiation treatment to the chest, we develop a specialized plan for you. Side by side with your oncologists, our cardiologists discuss your heart function and possible treatments, including other types of medication that may help and not interfere with your cancer treatment. We may also discuss other alternatives to your cancer treatment, including the use of drugs that may not affect your heart.

As an academic medical center, we are training tomorrow’s leaders in this field. The top experts in cardiology and oncology are doing cutting-edge cardio-oncology research, to build better ways to evaluate, protect and treat cancer patients who are at risk for cardiac conditions.

Our Physicians: Cardio-Oncology

Our cardiologists have a special interest in the prevention and early detection of cardiac complications from chemotherapy or other cancer treatments, like radiation therapy to the chest.

Cardiologists and cancer physicians working together

Our oncologists and cardiologists work together, using state-of-the-art imaging technology to determine the potential risks and provide the best treatment options for patients.

Our physicians are fellowship-trained and work at an academic medical center, and  have been exposed to the widest range of patient situations and the latest research in their field. Their goal is to diagnose and treat patients, and  also learn effective methods for fighting cancer without damaging or compromising heart function. Learn more about treatment and management and our cardio-oncology research.

Ana Barac, MD, who leads the program, has specialized expertise in this field, and an interest in building better paths for evaluating and treating these unusual patients. Together, she works with oncologists at our sister institutions, including Washington Cancer Institute and the Lombardi Cancer Center.

Meet our cardio-oncology team

 

What is Cardio-Oncology?

Cardio-oncology is the intersection of heart conditions in patients who have been treated for cancer. Cardiologists can assess patients for potential risk of developing heart conditions if patients  take certain types of cancer drugs, or following radiation treatment to the chest. They also help oncologists protect their patients during treatment by closely watching the heart and recognizing heart trouble early in treatment.

Cardio-Oncology Program at MHVI

At the MedStar Heart & Vascular Institute (MHVI) Cardio-Oncology Program, our physicians are cardiologists who use advanced imaging to diagnose and evaluate a patient’s risk of developing a heart condition due to  certain types of cancer treatments. Our cardiologists also treat patients who are undergoing cancer treatment, but have developed heart conditions, in the hope of protecting their heart function as much as possible.

Certain cancer drugs can weaken the heart or cause abnormal rhythms. We designed our Cardio-Oncology Program to provide cancer patients with excellent, multidisciplinary care. We combine advanced imaging and treatment protocols with a knowledgeable team of oncologists and cardiologists working together.

Goals of our Cardio-Oncology Program

Our cardiologists have developed a comprehensive program that aims to:

  •       Ensure better outcomes for  patients with cancer and cardiac issues
  •       Provide earlier detection of cardiac toxic side effects from  cancer treatments
  •       Prevent or reduce further cardiac damage—and when possible reverse it
  •       Monitor patients with potential cardiac issues who are receiving cancer treatments
  •       Better understand cardiac issues in patients with cancer by participating in research studies
  •       Eliminate cardiac disease as a barrier to effective cancer therapy

For more information or to schedule an appointment, please call 855-463-3320.

Related Information

For more information or to schedule an appointment, please call 855-463-3320.

Patent Foramen Ovales and Atrial Septal Defects

While most congenital defects of the heart require surgery, our doctors perform some procedures in the catheterization lab. These include patent foramen ovales and atrial septal defects.

Patent Foramen Ovales (PFO)

A (PFO) is a small opening in the dividing wall between the heart's upper two chambers. To close this hole, our cardiologists use a special PFO closure device, which opens like an umbrella to permanently close the hole in the heart. Once your doctor inserts the balloon-tipped catheter into an artery and places it at the defect, the catheter is inflated. The inflation produces an indent, which measures the size and shape of the defect. The umbrella device tightly seals the surrounding normal septal tissue to create a permanent closure of the defect.

Atrial Septal Defects (ASD)

In a patient with an ASD the atrial septum—the wall between the left and right atria (upper chambers of the heart)—fails to close. To repair it, our cardiologists use two small umbrella-shaped clamshell devices placed on the right and left side of the septum. The two devices, once attached, close the hole in the heart.

Learn more about structural heart disease.

For information or appointments, please call 855-463-3320.

New Imaging Technologies

The doctors at the MedStar Heart & Vascular Institute are leaders in state-of-the-art cardiac care and innovation. We offer the most advanced imaging technologies which include:

Optical coherence tomography (OCT)

This new imaging technology is a lot like an ultrasound, but it uses fast-traveling light waves instead of sound waves to produce detailed pictures of your organs. It helps your doctors evaluate the health of your coronary artery and can clearly show the positioning and state of your coronary stents. OCT can also provide doctors with highly detailed information about the plaque in your arteries.

Fractional flow reserve (FFR)

This technology uses a thin wire to measure the blood pressure and blood flow through particular areas in your coronary artery. The wire helps doctors locate blockages even in the tightest areas in your artery.

Intravascular ultrasound (IVUS)

Ultrasound uses sound waves to create detailed pictures of your organs. In IVUS technology, your doctor threads a tiny ultrasound camera into the coronary arteries. This allows doctors to see the inside of blood vessels and arteries. It helps your doctors determine what size stent or balloon you may need. It also helps them make sure your stents are working properly. Some doctors may refer to it as the physiological analysis of lesions.

Learn more about IVUS.

For information or appointments,
please call 855-463-3320.

Heart Biopsies

Heart biopsies help your doctors determine how well you are adjusting to a heart transplant. They can also show if you suffer from certain heart conditions.

What are heart biopsies?

In a heart biopsy, doctors remove a small sample of heart muscle and send it to a lab for analysis.

We perform a cardiac catheterization procedure to access the tissue needed for the biopsy. We guide a catheter through your groin to one side of your heart and remove three heart muscle tissue samples. Then, we send them to the lab for examination.

Why do I need a heart biopsy?

Generally, we perform a heart biopsy to make sure your body is not rejecting a newly transplanted heart. We also perform a heart biopsy if we suspect you may have cardiac carcinoma or signs of other heart conditions, such as:

  • Cardiomyopathy
  • Myocarditis

Learn more about the diagnostic procedures we perform at the MedStar Heart & Vascular Institute.

For information or appointments,
please call 855-463-3320.

Diagnostic Procedures

Diagnosing the trouble with your heart is the first step to getting you better. The MedStar Heart & Vascular Institute uses state-of-the-art technology to give your expert physicians the information they need to create a personalized treatment plan right for you.

Common Heart Tests

There are some common tests your doctor can use to assess the health of your heart. These include:

  •         Cardiac Angiograph
  •         Electrocardiogram (EKG)
  •         Cardiac Echocardiogram (ECHO)

Interventional Cardiac Procedures

Interventional heart procedures involve using small incisions and wires so your doctors can get a better picture of how your heart is working. These may include:

Cardiac Imaging Studies

Your doctor may want to perform an imaging study on your heart to diagnose any conditions or possible disease. We offer some of the most advanced cardiac imaging in the region, including cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI). These sophisticated tests provide valuable information about your cardiac health.

  • Cardiac Computed Tomography
  • Cardiac MRI
  • Intravascular Ultrasound (IVUS)
  • New Imaging Technologies 

 

For information or appointments,
please call 855-463-3320.

Syncope

Syncope is a temporary loss of consciousness, commonly called fainting.

What causes syncope?

Syncope is caused by reduced blood flow to the brain, which results in loss of consciousness. When adequate blood flow resumes, you regain consciousness. Common causes of syncope are low blood pressure (hypotension) or slow heart rates. The brain simply does not receive adequate oxygen and glucose from the blood stream, causing you to pass  out.

While syncope alone is generally not life threatening, it may be a symptom of a more serious condition, and you should receive a prompt evaluation. Learn more about our treatments for arrhythmias.

Symptoms of syncope

Symptoms include:

  • Dizziness, sometimes after exercising
  • Feeling lightheaded
  • Irregular heartbeat (described as a fluttering in the chest)

Syncope diagnosis

Your doctor will want to investigate why you are experiencing syncope. Some diagnostic tests used to determine the cause include:

  • Blood tests: Your doctor will examine your sugar levels and make sure you are not dehydrated.
  • Electrocardiogram: An ECG or EKG records the electrical activity of the heart and shows abnormal rhythms (arrhythmias or dysrhythmias). Learn more about ECGs.
  • Tilt table test: During this test, you lie on a table that moves from side to side. We record your blood pressure and pulse as the table is tilted. This test will sometimes show an arrhythmia that contributes to the syncope.
  • Echocardiogram: This is an ultrasound of the heart as it beats. It may help to determine if there is an unusual cardiac rhythm. Learn more about echocardiograms.
  • Electrophysiology study: This is a catheter-based test of the heart’s electrical system.

Syncope treatment

Syncope is usually treatable. The cause of the syncope will determine the treatment. If you have cardiac arrhythmias, your cardiologist may recommend:

  • A pacemaker to treat slow heart beats
  • An implantable cardioverter defibrillator (ICD) to monitor and correct life-threatening rapid rhythms. Learn more about our arrhythmia treatments, including ICDs.

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.



 

 

For information or appointments, please call 855-463-3320.

Palpitations

Palpitations are usually felt as an unusual pattern of heart beating, such as heart skipping, thumping or hard beats. This sensation can be very mild or quite uncomfortable.

Often, it is not a harmful condition. Usually the only treatment necessary is reassurance from our doctors or in some cases, medical therapy to relieve symptoms. Learn more about our treatments for arrhythmias.

In other cases, palpitations may signal the presence of a heart problem in need of treatment. The best approach to this condition is a thorough evaluation by an experienced cardiologist, who has expertise in evaluating and treating palpitations. Meet our electrophysiologists.

What causes palpitations?

Palpitations can be caused by any sustained cardiac arrhythmia, but they can also be caused by normal heart rhythm or extra heart beats that are not necessarily abnormal. Examples of causes of palpitations include:

  • Premature atrial complexes (PACs)
  • Premature ventricular complexes (PVCs)
  • Atrial fibrillation
  • Atrial flutter
  • Supraventricular tachycardia (SVT)
  • Ventricular tachycardia

Palpitations symptoms

Symptoms include:

  • Feeling that the heart is running or skipping
  • Chest pain
  • Shortness of breath
  • Dizzy spells
  • Fainting spells

Palpitations diagnosis

Your doctor will want to investigate why you are having palpitations. Some diagnostic tests used to determine the cause include:

  • Blood tests. Your doctor will examine your chemistry levels, blood counts and thyroid functions, as well as ensure that you are not dehydrated.
  • Electrocardiogram. An ECG or EKG records the electrical activity of the heart and shows abnormal rhythms (arrhythmias or dysrhythmias). Learn more about EKGs.

Palpitations treatment

If your palpitations are caused by abnormal heart rhythms, your doctor may recommend the following strategies:

  • Heart monitoring or electrophysiology study to identify the cause of the palpitations
  • Medications to control the palpitations
  • Lifestyle modifications to control stress
  • Catheter ablation, if necessary, to eliminate the source of the abnormal electrical rhythm

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.



 

 

For information or appointments, please call 855-463-3320.

Laser Lead Extractions

The leads (wires) that lead from the implantable device to the heart may become fractured or infected.  

Your electrophysiologists can replace or remove these leads by using an extraction device wrapped in laser fiberoptics. 

By guiding the device, your doctor can deliver a controlled dose of laser energy to remove any scar tissue and free the lead.  The lead is then pulled out.  

This procedure can be performed on an outpatient basis.

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

 

For information or appointments,
please call 855-463-3320.

Pacemakers

Pacemakers are small—weighing about an ounce—sources of electrical stimulation implanted in the heart to maintain a healthy rhythm.  

Pacemakers are used to treat bradycardia; when the heart rate is slow, as well as atrial fibrillation, heart failure and syncope.  They work by delivering an electrical shock to the heart to retrigger a healthy rhythm.  Pacemakers rest just under the collarbone and are implanted during an outpatient procedure.


Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

For information or appointments,
please call 855-463-3320.

Implantable cardioverter defibrillators (ICDs)

Implantable cardioverter defibrillators (ICDs) are invaluable for protecting a patient from sudden cardiac arrest.  

How does an ICD work?

These small devices, about the size of a pager, are implanted below the collarbone.  Wires from the device are led to the heart to continuously monitor the heart’s rhythm.  If a dangerous arrhythmia begins, the heart is shocked back into the correct rhythm.  These devices also keep a record of the heart’s rhythms which can be wirelessly transmitted for analysis by the cardiologist.

Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

For information or appointments,
please call 855-463-3320.

Center for Complex Arrhythmias

The Center for Complex Arrhythmias is a specialized center for arrhythmias that are challenging to treat, such as:

The MedStar Heart and Vascular Institute physicians who staff our Center for Complex Arrhythmia Therapy have proven expertise in tough arrhythmias. They routinely receive cases transferred from other physicians and healthcare facilities.Your heart health is critical: Make an appointment with a cardiologist at the MedStar Heart and Vascular Institute today.

 

For information or appointments,
please call 855-463-3320.

Video Gallery

Advanced Heart Failure

Many patients find they can manage their heart failure and maintain their quality of life with lifestyle changes and basic medicines prescribed by our doctors.

But if the condition worsens, we also offer powerful medications, sophisticated devices to help the heart and even transplants. The cardiologists and surgeons in our Advanced Heart Failure Program have the expertise and experience needed to successfully offer these complex treatments.    

Our team will help you decide on the treatment plan that makes the most sense for you. We also work closely with family members and other caregivers. Learn more about the renowned team at our Advanced Heart Failure Program.

Advanced Heart Failure Symptoms

Advanced heart failure symptoms are similar to those experienced by patients with less serious disease. The difference is that symptoms can be felt with minimal exertion or even at rest. These include:

  • Fatigue
  • Shortness of breath
  • Swelling of the legs and feet
  • Swelling of the abdomen
  • Irregular heartbeat (learn more about cardiac arrhythmia)
  • Weight loss
  • Chest pain

 The severity of symptoms can still vary from day-to-day, or even within the same day.

 Learn more about heart failure

Advanced Heart Failure Treatment

Our doctors usually treat less-severe heart failure with lifestyle changes and more common medications. But more advanced heart failure often requires a deeper approach. Possible options include:

  • Inotropes: Medications that increase your heart’s squeezing capacity (only select centers like ours can send patients home on these powerful medications)
  • Cardiac resynchronization therapy (CRT) device: Ensures the right and left side of your heart contract at the same time (learn more about pacemakers)
  • Percutaneous valves: Repair or replacement of heart valves with a minimally invasive approach that avoids open-heart surgery
  • Left ventricular assist devices (LVAD): Devices that help the heart, either as permanent treatment or as a temporary measure before transplant
  • Heart transplant: Replacement of the heart with a donor organ 

For information or appointments, please call 855-463-3320.

Heart Conditions

Find a Doctor

Find a physician who can help answer your questions.

Call Us Today

Call today to speak to one of our health experts.

855-463-3320

Transcatheter Aortic Valve Replacement (TAVR)

TAVR is a treatment procedure for patients with aortic stenosis who are too ill to undergo traditional open-heart aortic valve replacement surgery.

During a TAVR procedure, your doctor replaces your diseased aortic valve with a new valve. Instead of opening your chest, your doctor uses a catheter (small tube) to thread the valve through a small incision in the groin or the chest wall. During this procedure, your heart remains beating the entire time.

Studies have shown that patients achieve better outcomes when they undergo a TAVR procedure than they do with medication alone.

Evaluation for TAVR

The first step is to complete a TAVR Assessment, so we can gather information about your heart health. Once the TAVR Assessment is complete, the TAVR team will be able to review your case and make a recommendation. You will not receive a new valve during the TAVR assessment.

We will call to schedule you for either an office visit or a cardiac catheterization. During this visit, you should bring a list of your medications. Your assessment will include:

  • Questions for you about your everyday life, what you can and cannot do for yourself, your living situation, and your heart symptoms.
  • Medical checkup during which a doctor or nurse practitioner will ask you questions about your heart and your health.
  • Cardiac surgeon consultation to review your chart and examine you to determine a best recommendation for conventional aortic valve replacement, TAVR or medications.
  • Questions from you and your family about your treatment options.

Making a decision

Once your TAVR Assessment is complete, the team will discuss all the information we have about you, your heart and your general health, to make a recommendation about the best treatment option for your severe aortic stenosis. If you and your physician decide you will have a TAVR procedure, you will need the following tests:

  • Cardiac Echocardiogram (Echo): This ultrasound of your heart provides information about your heart valves and how well your heart functions.
  • Cardiac Catheterization (Angiogram): A cardiologist will perform this test to study the function of your heart and heart valves and to measure pressures within the chambers of the heart.
  • Transesophageal Echocardiogram (TEE): If the doctors need more information after your cardiac echocardiogram, you will be scheduled for a TEE, a more detailed echocardiogram that uses the esophagus to look at your heart.
  • Computed Tomography (CT) Scan: This painless 30-minute test uses X-ray technology and computers to give your doctors information they need about your heart and/or your leg arteries.

The TAVR Team

If you are considering a TAVR procedure, be assured you are in the best possible hands. The MedStar Heart & Vascular Institute was the fourth cardiac center in the country to perform clinical trials on the TAVR procedure. We perform 70 TAVR procedures each year, making us one of the top five cardiac centers in the nation for this procedure. Our TAVR team—including cardiologists, cardiac surgeons and interventional cardiologists—have worked closely together to improve our overall heart valve program, based on what we've learned from the TAVR clinical trials.

The principal investigators in our TAVR trials include:

Request an evaluation for the TAVR procedure. If you have any questions about TAVR, or if your heart condition changes a lot while you are waiting for the procedure, please call MedStar Heart & Vascular Institute's TAVR Team at 202-877-5975.

Minimally Invasive Heart Surgery

Traditional heart surgery requires the surgeon to cut open the patient’s chest and cut through the breastbone. Minimally invasive heart surgery allows our cardiac surgeons to work through small incisions only three to four inches long, using elongated instruments and scopes.

What are the benefits of minimally invasive heart surgery?

  • Less pain
  • Shorter recovery time
  • Smaller scars
  • Shorter hospital stay
  • Lower risk of infection
  • Lower risk of bleeding and blood transfusion

What minimally invasive heart procedures do our surgeons perform?

Our heart surgeons treat complex heart conditions using a variety of techniques—including minimally invasive surgery—with outstanding outcomes. They also work as part of a larger team of heart specialists to provide patient-focused care both before and after surgery. Our specialists are trained in a full range of minimally invasive procedures, for the safety, healing and comfort of our patients.

At MedStar Heart & Vascular Institute, we offer the following procedures for the treatment of heart conditions:

ANEURYSM REPAIR

The aorta, the body’s largest artery, delivers blood from the heart to the rest of the body. When disease is present, the aorta can tear (dissect) or dilate to form an abnormal widening or ballooning called an aneurysm.

LEARN MORE

BEATING HEART BYPASS

During beating heart bypass surgery, the heart is able to continue beating naturally, eliminating the need for a heart/lung machine, or pump.

LEARN MORE

CORONARY ARTERY BYPASS

Coronary artery bypass graft surgery (CABG, or bypass surgery) is one of the most common heart surgeries our cardiac surgeons perform.

LEARN MORE

HEART VALVE SURGERY

During heart valve surgery, one or more unhealthy valves are repaired or replaced, to help reduce the strain on the heart and restore a healthy blood flow throughout the body.

LEARN MORE

TRANSCATHETER AORTIC VALVE REPLACEMENT

A transcatheter aortic valve replacement (TAVR) procedure is an advanced treatment option for patients with severe aortic stenosis, or abnormal narrowing of the aortic valve.

LEARN MORE

MINIMALLY INVASIVE SURGICAL ABLATION

Most patients with atrial fibrillation are candidates for minimally invasive surgical ablation. 

Leadless Defibrillator: Subcutaneous Implantable Defibrillator

Approximately 450,000 people in the U.S. succumb to sudden cardiac arrest (SCA)—an abrupt loss of heart function—each year. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation.

For patients who are at risk of SCA, MedStar Heart & Vascular Institute now offers a new, innovative, leadless defibrillator—the world’s first and only subcutaneous implantable defibrillator (S-ICD).

In cases of life-threatening arrhythmias, a leadless defibrillator shocks the heart to restore normal rhythm. The S-ICD is the first heart defibrillator implanted beneath the skin that does not require wires placed within the heart. It provides reliable defibrillation while leaving the heart’s blood vessels untouched. Since leads (wires) do not have to be inserted into the heart, the S-ICD procedure is much simpler. In addition, the removal or replacement of the device is much easier, and reduces the potential risk for vascular injury and infection.

Patients who might be good candidates for the new leadless defibrillator include:

  • Young patients who want to preserve their blood vessels (or vasculature) for future procedures
  • Patients who are very overweight and will have better outcomes with a defibrillator that sits right below the skin
  • Those patients who have already had prior vascular procedures, making their blood vessels no longer suitable to place leads within them.
  • Patients who are at particularly high risk for blood infections (for example, patients on dialysis or who have indwelling catheters)

Heart Valve Surgery

Your cardiologist may refer you to a MedStar Health cardiac surgeon to repair or replace your heart valve if medication has failed to reduce the strain on your heart and has not alleviated symptoms.

Your cardiac surgeon may recommend one of the following surgeries, depending on your pathology and what is causing the problem:

  • Heart valve repair is the preferred treatment option, because using your own tissue is better than replacing a heart valve.
  • Heart valve replacement can be performed using a variety of valves, including mechanical and biological tissue valves (those from pig or cow tissue). Mechanical valves require the use of blood thinners but have good long-term durability. Biological valves do not require use of long-term blood thinner.
  • Valve sparing is a relatively new technique used to treat aortic disease. Your heart surgeon can preserve your own valve while repairing the aorta.

Heart valve surgery (whether valves are repaired or replaced) is open-heart surgery that is done while you are under general anesthesia. A cut is made through the breastbone (sternum). Your blood is routed away from your heart to a heart/lung bypass machine. This machine keeps the blood circulating during your heart surgery.


Meet Heart Valve Patient Joanna Zimmerman

“To have a heart that allows me to live my life in all the ways I wanted to live my life…that feels like a tremendous blessing.” - photo caption

Joanna Zimmerman and her husband wanted to start a family, but Joanna was born with a heart valve problem and was told by multiple doctors that she should not have a child before the valve was fixed. Eager to start her family sooner rather than later, she sought out the experts at MedStar Heart & Vascular Institute. After evaluating Joanna, the current state of her valve, reviewing the literature on similar cases and in consultation with her high risk obstetrician, it was determined that Joanna could proceed with a pregnancy. They were thrilled to welcome a healthy daughter.

A happy ending indeed, but there’s more. Wanting a big family, Joanna and her husband once again sought the advice of Dr. Ruiz and Dr. Corso at MedStar Heart & Vascular Institute. At this point, though, her valve had narrowed to the point where having more children without intervention was not advised. Joanna had a successful surgery to replace her aortic valve and grew her family by two more!

Endarterectomy

Although it may be performed on any artery, this procedure most commonly treats carotid artery disease (carotid endarterectomy). In an endarterectomy, the surgeon opens the artery and removes the blockage. This type of open surgery is best for short blockages.

Coronary Artery Bypass Surgery

Coronary artery bypass graft surgery (CABG surgery) is one of the most common heart surgeries MedStar Heart & Vascular cardiac surgeons perform. You may have heard people call this bypass surgery. Your doctor will recommend a CABG (pronounced like the vegetable cabbage) when blood does not flow easily through the arteries of the heart and/or blood vessels narrow, reducing the flow of blood to the heart.

Coronary artery bypass surgery creates alternate routes for blood to flow to the heart, bypassing the natural arteries. Instead of removing the blockages in the coronary arteries, your heart surgeon will use a vein from your chest or leg to construct detours around the blockages and into the heart. These grafts allow the flow of oxygen-rich blood to the heart muscle.

At MedStar hospitals, our heart surgeons perform half of these surgeries as beating-heart surgeries, meaning they do not need to use the heart/lung bypass machine.

Hear from Jennifer Ellis, MD, about coronary artery bypass surgery.

Beating Heart Bypass

In beating-heart bypass surgery, the heart continues to beat naturally, eliminating the need for a heart/lung machine or pump. Prongs are placed on a specific area of the heart, stabilizing that area while allowing the heart to continue beating.

This process avoids many of the complications that can arise from the use of the heart/lung machine, such as stroke, increased need for blood transfusions, kidney and lung complications, and lengthy hospital stays. Also, stopping the heart is too traumatic and dangerous for some patients to endure. The beating-heart procedure enables a larger, more diverse population to undergo bypass surgery.

Recovery from this procedure is also faster and most patients return to normal activities sooner.

At MedStar Health, anyone requiring heart bypass surgery is a candidate for beating-heart surgery. You and your doctor will discuss whether beating-heart surgery is appropriate for you. The decision depends on your overall health, the severity of your coronary artery disease, the number of arteries requiring bypass and other factors.

Cardiac Surgery

MedStar Heart & Vascular Institute’s cardiac surgery team is the best in the region and among the finest in the nation—that has a lot to do with our commitment to a team approach to care. Our cardiac surgeons work in teams with other cardiac experts, including cardiac imaging specialists, interventional cardiologists, pulmonologists, radiologists, and nurses to complete the entire picture for each patient.

The advantage of experience

We are one of the highest volume cardiac surgery centers in the central Maryland and Washington regions. Our entire team sees a large number of patients per year; volume and experience also translate into best practices based on outcomes. We continually refine surgical techniques, so you receive the least invasive surgical option that will also bring the best long-term results. Learn more about cardiac surgery at MedStar Washington Hospital Center.

Better patient care

We have compiled a cardiac surgery database containing data on more than 60,000 cases from the past 30 years. This unique resource helps us continually improve patient care. It gives our physicians a direct window on the practices and approaches that produce the most successful outcomes for our patients. Few cardiac centers have anything like it.

Sophisticated communication

Our information management and communications capabilities are powerful resources for integrating MedStar Heart & Vascular Institute services and locations, from enabling real-time sharing of patient images and data to supporting electronic medical records. This means you can receive advanced cardiac care no matter your location-at one of our sister hospitals, or at one of our satellite locations.

Advanced heart surgical care

Consider these facts:

  • The Society of Thoracic Surgeons awarded us three stars, its highest rating, based on quality and outcomes.
  • Nearly half of our CABG (Coronary Artery Bypass Graft) procedures are performed off-pump (without using a heart and lung machine), which speeds recovery and reduces bleeding, neurologic impairment and other complications.
  • We are the only hospital in the region to offer the Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure performed for severe aortic stenosis.
  • Our patients have access to clinical trials in better methods to prevent and treat cardiac and vascular disease.
     

Stenting

A stent is a small metal wire tube used to prop up weak arteries. A doctor may also insert a stent to improve blood flow or prevent an artery from bursting.

  • Carotid stents treat arteries delivering blood to the brain.
  • Coronary stents treat the arteries of the heart.
  • Drug-eluting stents release medication over time to prevent further blockages.

For information or appointments,
please call 855-463-3320.

Septal Alcohol Ablation

This surgical procedure is less invasive than traditional open heart surgery. Doctors apply a little bit of alcohol to the problematic muscle tissue. The alcohol burns away the tissue, removes the obstruction and eases blood flow.

Septal alcohol ablation includes several steps:

  • Sedation keeps you comfortable during the procedure.
  • Cardiac catheterization creates a detailed picture of your heart.
  • Transesophageal echocardiogram insertion by probe creates a sonogram, or picture, of your heart and allows doctors to secure a catheter in place.
  • Alcohol infusion causes the tissue to shrink over time.
  • Temporary pacemaker insertion to regulate a slowed heartbeat for the first few days after the procedure.

For information or appointments,
please call 855-463-3320.

Rheolytic Thrombectomy

A rheolytic thrombectomy is a procedure designed to remove clots. A special pump delivers high-pressure saline to the tip of the catheter. This creates a vacuum that breaks the clot into fragments and suctions the fragments out of the artery. Your doctor may recommend the procedure if you have extensive clots, such as in the case of a heart attack or have vein graft disease.

For information or appointments,
please call 855-463-3320.

Percutaneous Valves

Generally, open heart surgery can repair or replace a damaged heart valve. Percutaneous valve replacement is a nonsurgical approach designed for people who are very weak and may not be able to tolerate open-heart surgery.

During this procedure, the physician will secure a catheter in your groin and direct it into the chambers of your heart. A new valve is inserted through a tube (through the groin and into the heart) and secured.

For information or appointments,
please call 855-463-3320.

Patent Foramen Ovales and Atrial Septal Defects

While most congenital defects of the heart require surgery, our doctors perform some procedures in the catheterization lab. These include patent foramen ovales and atrial septal defects.

Patent Foramen Ovales (PFO)

A (PFO) is a small opening in the dividing wall between the heart's upper two chambers. To close this hole, our cardiologists use a special PFO closure device, which opens like an umbrella to permanently close the hole in the heart. Once your doctor inserts the balloon-tipped catheter into an artery and places it at the defect, the catheter is inflated. The inflation produces an indent, which measures the size and shape of the defect. The umbrella device tightly seals the surrounding normal septal tissue to create a permanent closure of the defect.

Atrial Septal Defects (ASD)

In a patient with an ASD the atrial septum—the wall between the left and right atria (upper chambers of the heart)—fails to close. To repair it, our cardiologists use two small umbrella-shaped clamshell devices placed on the right and left side of the septum. The two devices, once attached, close the hole in the heart.

Medications

Because most vascular disease is associated with atherosclerosis, medications may be prescribed to reduce the overall risks of atherosclerosis, such as heart attack or stroke. These might include medications to

  • Lower cholesterol
  • Lower blood pressure
  • Control diabetes
  • Prevent blood clots

Other medications may be specifically for the vascular disease for which you are being treated. These might include symptom-relief medications or stronger medications for blood clots.

If a blood clot is blocking an artery, your doctor can administer thrombolytic therapy in which a clot-dissolving drug is injected into the artery at the point of the clot.

For information or appointments,
please call 855-463-3320.

Intracoronary Radiation Therapy

Intracoronary radiation therapy prevents the arteries from re-narrowing. Physicians use it to treat certain types of blockages in the coronary arteries, which may have narrowed due to an overgrowth of scar tissue at an angioplasty site.

Small doses of radiation therapy are directly applied to the angioplasty site to slow down or stop rapid scar tissue growth. Your doctor may deliver radiation treatment to the angioplasty site using a wire, balloon, or catheter. He or she inserts one of those devices into the newly opened artery for five to 25 minutes to administer the radiation therapy. You may be eligible for the radiation therapy procedure if a re-narrowing has occurred within a previously implanted stent.

Cutting Balloon

A cutting balloon is similar to the device used in conventional balloon angioplasty. The cutting device activates when the balloon inflates. The blades cut through plaque to open up blockages. The cutting balloon is particularly useful in hardened blockages that have narrowed. Your doctor may use this procedure with stents to open the blockage.

For information or appointments,
please call 855-463-3320.

Cardiac Rehabilitation

Cardiac rehabilitation is an important step in your recovery from heart disease. Our programs—monitored by exercise physiologist, physical therapists, and a physician—ensure that you exercise safely, without placing too much stress on your heart.

All MedStar Health Cardiac Rehabilitation programs are certified by the American Association of Cardiovascular & Pulmonary Rehabilitation.

Getting Started

To join MedStar Health’s Cardiac Rehabilitation program, you must:

  • Get a referral from your doctor
  • Undergo a post-event/procedure exercise stress test (unless your doctor indicates otherwise)

Once you begin the program, you will:

  • Talk to the physician, who will ask you about your medical history and review the results of your stress tests
  • Complete a six-minute walk test around a track, while your cardiac rehabilitation team monitors your heart rate and electrocardiogram (ECG)
  • Receive your individual exercise prescription, which our team develops for you

We use the information obtained at the start of the program to create a personalized exercise program for you. We will evaluate your prescription throughout the program, so you can continue to progress appropriately toward recovery and independent fitness activities.

Sessions

Our staff will teach you how the machines work and how to use them. We encourage you to attend the program for one hour of exercise training three times per week. The exact number of supervised exercise sessions depends on your individual needs as well as your insurance coverage. We will help you determine your benefits before you begin the program.

Communication with Your Cardiologist

Our physician and staff communicate closely with your cardiologist and your referring physician while you are a part of our program. We will notify them if there are any concerns about your heart rate and blood pressure, and if there is a reason to adjust your medication or if there are any other medical concerns.

Heart Health Education

In addition to exercise training, our program staff will provide you with educational information about various risk factors and lifestyle issues related to heart disease.

Wellness Program

You may want to attend MedStar Washington Hospital Center's Wellness Program because you:

  • Want to exercise in a medically supervised environment due to uncontrolled blood pressure or other medical conditions
  • Have recently completed our cardiac rehabilitation program
  • Want to be active, but feel more comfortable with a supervised program

We will create a personalized exercise program that is right for you. Our staff includes an exercise physiologist and physical therapists who will supervise you while you exercise and check your blood pressure and heart rate. They will also guide you while you work out on the various machines.

Please note: The Wellness Program is a self-pay program, and is not covered by health insurance.

Location

Cardiac Rehabilitation Program
125 Michigan Avenue, NE
Washington, D.C.
7:30 – 11:30 a.m., Monday, Tuesday, Thursday

Wellness Program
125 Michigan Avenue, NE
Washington, D.C.
7:30 – 10:30 a.m., Wednesday and Friday

Inpatient Rehabilitation

In addition to any cardiac services, your heart may require inpatient rehabilitation. MedStar National Rehabilitation Network's cardiac rehabilitation program is designed for patients who need assistance in getting back to their former level of physical endurance and self-sufficiency after an acute care stay for medical and/or surgical treatment of cardiac disease.

Program Highlights

  • Therapy in our cardiac gym five days a week
  • Specialized ECG-monitored exercise therapy under the supervision of doctors, nurses, and an exercise physiologist
  • Heart function and rhythm monitoring as patient’s move through a series of progressively more-intense activities
  • Therapy sessions that address bathing, dressing, walking, using stairs, and getting out of bed
  • Education on ways to prevent the progression of heart disease and manage the psychological impact on health
  • Weekly cardiac support group

Specialists

  • Sandeep Simlote, MD, clinical director, Cardiac Rehabilitation Program
  • Cynthia McDonald, RN, co-clinical director, Cardiac Rehabilitation Program

Before discharging a patient, our team will recommend services that will ease a patient’s transition to the next level of care. This might include outpatient services, skilled nursing facilities, or home care through the MedStar Visiting Nurse Association. Our job is to build a roadmap for your recovery — and to support you along the journey as you rebuild your life.

Location

MedStar National Rehabilitation Hospital
102 Irving Street, NW
Washington, DC 20010

For more information about Cardiac Rehabilitation at MedStar National Rehabilitation Hospital, please call 202-877-1152.

Cardiac Catheterization Lab

800xtechnology_Satler at monitor

MedStar Heart & Vascular Institute's Cardiac Catheterization (Cath) Lab features 11 individual labs with 24/7 staffing. The cath lab uses sophisticated imaging technology and implements best practices for patient care before, during and after procedures.

We Put Patients First

Patients are our first priority in everything we do. You can expect the best medical treatment delivered with care, compassion, clear communication and responsive service. Every member of our cardiovascular team treats each patient with the understanding and support we would give to our own families.

The Heart Team Approach

As part of our ongoing commitment to patient care quality and safety, we use an advanced “Heart Team” approach which brings together cardiology, cardiac surgery, intensive care medicine, nursing, ancillary care and administration in a collaborative patient care model based on diagnostic and therapeutic guidelines. Focusing on the total patient’s needs in a collaborative way has led to significant improvement in patient satisfaction as well as outcomes.

Our unique alliance with Cleveland Clinic Heart and Vascular Institute has further enhanced our focus on quality and safety across all cardiovascular services, and is reflected in the national and international recognition of many of our highly-trained cardiovascular specialists.

State-of-the-Art Facilities

Innovation is at the heart of the Heart & Vascular Institute's cath lab, which uses leading-edge imaging technology and implements the best practices in patient care. We also participate in nationally-recognized clinical trials not available at other facilities.

Dedicated Cath Labs

We have 11 dedicated catheterization labs, more than any other hospital in the Washington, D.C., area. We manage our patients with the most technologically advanced diagnostic tests and treatments, including angioplasty, stents, lasers, intravascular ultrasound (IVUS), brachytherapy, angiogenesis and other novel medical therapies. We also offer three state-of-the-art cardiac computed tomography (CT) scanners.

Our catheterization labs offer every cardiac service, including open heart surgery and heart transplantation. However, if interventional therapies are not appropriate for a particular patient, advanced options to help support the heart’s function can be pursued.

New Hybrid Labs

Hybrid labs are operating rooms that support complex procedures involving both cardiac catheterization and cardiac surgery. These specialized labs enable our heart teams, including anesthesiologists, interventional cardiologists, cardiovascular surgeons, and cardiac imaging specialists to work as together to perform complex valvular procedures in a minimally invasive fashion to improve patient outcomes and quality of life.

The Latest Technology

The latest technology is incorporated to help our physicians rapidly evaluate patient information, whether from the Emergency Department or referring physicians to help establish the best course of therapy for our patients. This helps coordinate real-time patient care.

Cath lab physicians use this technology to work in close coordination with other Heart & Vascular Institute facilities, physician and emergency transport teams. Our labs allow for the transmission of real-time data from the field to the doctors, so they are prepared to make treatment decisions before the patient even enters the facility. This technology helps coordinate rapid transfer to our institution from anywhere in the region.

Emergency Transport Available

We planned our facilities around patient needs, so you don't need to wait for care and treatment. We can admit patients to our cath lab from the Emergency Department in fewer than 60 minutes. We have four helicopter transport teams available to move patients around the region.

Balloon Valvuloplasty

Valvuloplasty is a procedure that uses a large balloon catheter to stretch open scarred valves that are blocking blood flow to the lungs, chambers of the heart or the body.

During this procedure, your doctor inserts a small catheter into the blood vessel and uses it to guide a wire to the problem valve. Leaving the wire in place, he or she then removes the smaller catheter and guides a larger one with a balloon attached. Your doctor may inject a contrast dye into the balloon so that it shows up on X-rays. This may be necessary to make sure the balloon is in the right place. Once in position, the doctor inflates the balloon, which stretches and widens the valve.

For information or appointments,
please call 855-463-3320.

Atherectomy

An atherectomy cuts away the plaque responsible for blocking or narrowing an artery. Your doctor can use a few different devices depending on the location and severity of the blockage.

  • Directional atherectomy uses a catheter with a small, mechanically driven cutter that shaves the plaque and stores it in a collection chamber. This device is effective in large arteries with soft blockages.
  • Extraction atherectomy uses a special catheter, called a transluminal extraction catheter (TEC), which has a rotating cutter. The device removes plaque particles through a vacuum suction system while it cuts.
  • Rotational atherectomy uses a high-speed rotating diamond chip burr, called a Rotablator®, which mashes plaque into very small particles. These particles can usually pass harmlessly through the coronary arteries. This device works best on hardened calcified blockages.

For information or appointments,
please call 855-463-3320.

Arrhythmia Treatment

Depending on your diagnosis, your cardiologist will create a comprehensive treatment program to treat your arrhythmia. Treatment for arrhythmias may include:

  • Ablation
    In some cases, when the electrical flow of the heart gets blocked or experiences a short circuit disturbs normal heart rhythms, the most effective treatment is to destroy the tissue housing the short circuit. This procedure is called cardiac ablation. It is a relatively non-invasive procedure that involves inserting catheters—narrow, flexible wires—into a blood vessel to locate the site of damage and restore electrical flow. For many types of arrhythmias, catheter ablation is successful in 90-98 percent of cases—eliminating the need for open-heart surgeries or long-term drug therapies.
  • Implantable Cardioverter Defibrillators (ICDs)
    ICDs are invaluable for protecting a patient from sudden cardiac arrest. These small devices, about the size of a pager, are implanted below the collarbone. Wires from the device are led to the heart to continuously monitor the heart's rhythm. If a dangerous arrhythmia begins, the heart is shocked back into the correct rhythm. These devices also keep a record of the heart's rhythms which can be wirelessly transmitted for analysis by the cardiologist.
  • Medical Management
    Depending on the nature and severity of your arrhythmias, your physicians may prescribe medicine to help regulate your heart. Or, they may use medicine in combination with one of these other treatments.
  • Pacemakers
    Pacemakers are small sources of electrical stimulation implanted in the heart to maintain a healthy rhythm. Pacemakers are used to treat bradycardia (slow heart rate), as well as atrial fibrillation, heart failure, and syncope. They work by delivering an electrical shock to the heart to retrigger a healthy rhythm.
  • Implantable Loop Recorders
    Sometimes, a patient's arrhythmia may not show up while the ECG is being recorded. Your physician may suggest loop recording. A small recordable device is placed underneath the skin, close to the heart, and records the heart's rhythms during a period of time. The test results are sent to the cardiologist, so he or she can analyze the patterns for cardiac arrhythmias.
  • Laser Lead Extractions
    The leads (wires) that lead from the implantable device to the heart may become fractured or infected. Your electrophysiologists can replace or remove these leads by using an extraction device wrapped in laser fiberoptics.

For information or appointments,
please call 855-463-3320.

Angiogenesis

Angiogenesis, a form of gene therapy, helps heart patients grow, repair, and restore new blood vessels.

Angiogenesis grows new blood vessels using substances called growth factors, which deliver instructions to the patient's affected cells so they grow. This type of gene therapy allows the body to heal itself.

Your doctor injects the growth factors directly into the heart or leg muscles. Or, he or she can administer them intravenously through catheters into the arteries of the heart.

Angiogenesis is ideal for patients who have a blockage in a major coronary artery and have developed collaterals. Collaterals are smaller blood vessels the body grows over time to help compensate for the loss of circulation.

For information or appointments,
please call 855-463-3320.

Angioplasty

Angioplasty is a procedure to improve blood flow through narrowed or blocked arteries of the heart. If tests show that you have narrowed arteries, angioplasty can relieve your chest pain and keep your arteries from narrowing further. It also can help prevent heart attack and improve your overall quality of life. Sometimes, doctors use angioplasty as an emergency treatment for heart attack. This procedure can, in some cases, restore blood flow better than clot-busting drugs. An angioplasty also can limit damage to the heart muscle and improve survival after a heart attack.

Your doctor has two options for this procedure:

Balloon Angioplasty

Using a catheter with a balloon attached, your doctor threads it to where the coronary arteries branch off to the heart. Once the catheter is positioned over the blockage, your interventional cardiologist inflates the tiny balloon. The pressure causes the plaque blocking the artery to split and compress, molding it against the artery wall and restoring blood flow. Once the blockage is cleared, the physician deflates the balloon and removes the catheter.
Often, a mesh tube called a stent is placed in the artery during the procedure. When the balloon inflates, the stent expands, supporting the artery wall and reducing the chances of the artery becoming blocked again. Sometimes a drug-eluting stent is used to release medications into your artery and prevent your artery from becoming blocked with scar tissue.

Laser Angioplasty

Some blockages are too long or too complicated for the balloon technique to be effective. In this case, your doctor may opt to use laser angioplasty. The laser directs a cool beam toward the blockage through a catheter in the coronary artery. The laser beam vaporizes the plaque causing the blockage, changing it to gases and water. A balloon angioplasty may follow laser angioplasty.

For information or appointments,
please call 855-463-3320.

Diagnosis

Many times, cardiac and vascular symptoms are misdiagnosed, or thought to point to other health conditions. When this happens, the disease progresses, putting patients at risk. It is critical to diagnose cardiac and vascular disease accurately to lead to the most effective and swiftest treatment.

Diagnostic tests like the following help your doctor identify any condition you may have and determine the best treatment plan and course of action for your particular situation:

Arteriogram

In this test, dye is injected into the arteries while X-rays are taken. The dye highlights the arteries, allowing the area of blockage to be accurately pinpointed.

Cardiac Catheterization

Cardiac catheterization is a minimally invasive diagnostic and treatment option that involves passing a catheter (a thin, flexible tube) through the vessels supplying blood to the heart. Interventional cardiologists use this procedure to tell how well your heart is functioning, and to diagnose any possible cardiac disease. With catheterization, MedStar Health cardiologists can:

  • Determine the pressure and blood flow in the heart's chambers
  • Collect blood samples from the heart
  • Examine the valves and arteries of the heart
  • Identify heart abnormalities

The procedure is performed in a catheterization laboratory (also called a cath lab).

Cardiovascular Imaging

MedStar Heart & Vascular Institute has one of the most advanced imaging programs in the region, including state-of-the-art equipment and expert staff to interpret these complex tests. We are one of the busiest imaging labs in the country—in 2012, we performed close to 25,000 cath lab procedures. Many of our cardiac imaging experts are internationally known for their research and contributions to the field of cardiac imaging.

MedStar Health hospitals offer advanced imaging technologies, including:

  • Optical Coherence Tomography (OCT) uses fast-traveling light waves instead of sound waves to produce detailed pictures of your organs.
  • Fractional Flow Reserve (FFR) uses a thin wire to measure the blood pressure and blood flow through particular areas in your coronary arteries. The wire helps doctors locate blockages even in the tightest areas in your arteries.
  • Intravascular Ultrasound (IVUS) lets your doctor thread a tiny ultrasound camera into the coronary arteries. This allows doctors to see the inside of blood vessels and arteries.

Computed Tomography (CT) Scan

A CT scan is a non-surgical procedure that provides physicians with detailed three-dimensional views of the heart and blood vessels. For patients, the experience is similar to having an X-ray; however, for physicians, this procedure provides detailed information about the inner workings of the heart and can be used in diagnosing abdominal and thoracic aneurismal disease.

Coronary Calcium Scanning

This test provides a measurement of arterial buildups (atherosclerosis) in the arteries of the heart.

Calcium scoring is a safe and simple test that takes only 15 minutes to complete and uses only a small amount of radiation (similar to the amount in two or three mammogram tests). Your doctor will receive a detailed report, including your calcium score and a comparison of your score to normal values, and will discuss the results with you.

Duplex Scan

A duplex scan is an ultrasound study used to assess blockages, narrowing, or other abnormalities in the abdominal vessels, the veins and arteries of the legs and arms, and the carotid arteries of the neck.

Electrocardiogram (ECG)

Electrocardiogram (ECG) records the electrical activity of the heart. The test measures damage to your heart, determines if your heart is beating normally, and checks the size and position of your heart chambers. It is useful in determining whether someone has heart disease. An ECG can be done as part of a routine health examination, or your doctor may order it if you exhibit symptoms of heart problem, such as chest pain or breathing problems.

Electrophysiology Studies

An electrophysiology study, or EPS, is a diagnostic procedure to look more closely at the electrical function of your heart. It is the most accurate and reliable method of evaluating your heart rhythms and will help your physician determine the treatment option that is most appropriate for you.

Certain conditions can cause the electrical system to make the heart beat too slowly, too fast or in an uncoordinated manner. These irregular patterns are called arrhythmias and they can occur in any of the four chambers of the heart. An electrophysiology study will help your physician determine the best treatment for you by showing where the arrhythmias are occurring.

Genetic Testing

There are certain conditions that are known to run in families. Genetic counselors are available to explain genetic testing for your family. By identifying an inherited genetic trait, individuals can take preventative steps to protect their heart health.

Heart Biopsy

At MedStar, our team generally performs heart biopsies to ensure your body is not rejecting a newly transplanted heart. We also perform a heart biopsy if we suspect you may have cardiac carcinoma (cancer) or signs of other heart conditions, such as cardiomyopathy or myocarditis.

During a heart biopsy, your physician performs a cardiac catheterization to access the heart muscle and remove three tissue samples to be sent to a lab for analysis.

Heart Scan Screenings

Each year, more than 500,000 Americans have a fatal heart attack and almost 300,000 of them have no prior warning. The good news is that 85 percent of heart disease can be halted or prevented if your risk is identified early enough. Even if you have no symptoms of heart disease, you should consider a heart scan if you are a man over age 40, or a woman over age 45, and:

  • Have a family history of heart disease
  • Have high cholesterol
  • Have high blood pressure
  • Are overweight
  • Are physically inactive
  • Are a smoker
  • Have a high level of stress

A heart scan uses an ultrafast spiral computed tomography (CT) scanner to detect the presence of calcified (hard) plaque in your coronary arteries. When calcified plaque builds up in your arteries, they narrow, reducing the flow of blood and oxygen to your heart. This is known as coronary artery disease or hardening of the arteries. When a coronary artery becomes completely blocked, a heart attack occurs. Knowing the amount of calcified plaque in your arteries will help you make the right decisions about your health care.

Holter/Event Monitor

Event and Holter monitors are worn for a period of several months or 24-72 hours, respectively. They measure and record the heart's rhythms and send a these signals by phone so the results can be interpreted.

Intravascular Ultrasound (IVUS)

A small catheter with an ultrasound transducer at the tip is inserted into a vessel to get a scan from inside the vessel.

Loop Recording

Sometimes, a patient's arrhythmia may not show up while the ECG is being recorded. Your physician may suggest loop recording. A small recordable device is placed underneath the skin close to the heart and records the heart's rhythms during a period of time. The test results are sent to the cardiologist so he or she can analyze the patterns for cardiac arrhythmias.

Magnetic Resonance Imaging (Cardiovascular MRI)

A Cardiovascular MRI is a sophisticated technique for the assessment of cardiac and vascular disease. This technique allows physicians to visualize cardiac and vascular structure and function and aid understanding of complex valve disease.

Nuclear Cardiology

Nuclear Cardiology uses nuclear medicine technology to study the heart. By using a tiny amount of radioactive material (radioactive tracer), pictures of the heart are taken with a special camera that shows both blood flow to the heart muscle and pumping function of the heart.

Positron Emission Tomography (PET) Scan

PET imaging is a very advanced, non-invasive test that allows your cardiologist gain more information about the function of the heart.

Stress Test

Stress testing includes a variety of diagnostic exercise tests to evaluate patients for coronary artery disease, congestive heart failure, and cardiac arrhythmias. MedStar Health performs standard and thallium tests and echocardiography exercise tests (either treadmill or bicycle exercise). We use state-of-the-art oxygen consumption techniques to determine how much exercise your heart can safely handle.

Tilt Table Test

During this test, you will lie on a table that moves from side to side. Your blood pressure and pulse will be recorded as the table is tilted. This test will sometimes show an arrhythmia that contributes to the syncope.

T Wave Alternans

This is a test used to discover if a patient has a risk of having ventricular tachyarrhythmias. By reading your ECG, your cardiologist can determine if you are at risk for cardiac arrhythmias by analyzing this pattern in your heart's rhythm.

Venous/Arterial Doppler

This sound-wave test measures blood pressure and blood flow in the arms and legs.

Information on other imaging technologies is available through the Radiology pages.

For information or appointments,
please call 855-463-3320.

Vascular Insufficiency

Venous insufficiency occurs when the veins do not efficiently return blood from the legs back to the heart, usually due to malfunctioning valves or a chronic blockage, both of which can occur after a deep vein thrombosis. Chronic venous insufficiency is one of the most common chronic conditions in the United States and worldwide.

Symptoms

  • Varicose veins
  • Swelling of the legs and pain in the extremities (dull aching, heaviness, or cramping)
  • Discoloration of the legs (often a brown discoloration)
  • Hard, thickened skin around the ankles
  • Ulceration of the skin around the ankle

Diagnosis

Chronic venous insufficiency is usually diagnosed by a history and physical examination. Duplex ultrasound is also commonly used for assessment of the veins.

Treatment

There are several treatment options for chronic venous insufficiency. In most cases, the initial treatment is conservative and nonoperative. This typically includes:

  • Compression garments or stockings
  • Unna's boots, which are gauze bandages coated with zinc oxide to create a semi-rigid boot
  • If conservative treatment is unsuccessful, a more invasive surgical treatment is pursued. This treatment is focused toward eliminating or lessening the effects of the damaged valve function in the veins. Options may include:
  • Sclerotherapy
  • Vein stripping
  • Valve replacement surgery
  • Endoscopic perforator ligation
  • Laser vein ablation

For information or appointments, please call 855-463-3320.

Vascular Malformations

The abnormal formation or development of blood vessels is generally referred to as vascular malformation. Abnormal blood vessel structure is usually congenital, meaning it is present at birth.

Abnormal blood vessels can prevent enough oxygenated blood from filling capillaries, the tiny blood vessels that connect the body's arteries and veins. In some people with vascular malformations, blood travels directly from the arteries into the veins without ever having reached the capillary system. When blood does not fill the capillaries, the blood tissues that would normally receive blood from them experience a lack of oxygen, as well as a buildup of waste products.

Types

The severity of these malformations varies greatly both within and among the following clinical groups:

  • Arteriovenous malformations
  • Capillary malformations (portwine stains)
  • Combined vascular malformations
  • Lymphatic malformations
  • Venous malformations

Vascular malformations are categorized as either slow flow or fast flow. These terms refer to the rapidity of blood flowing through the lesion.

  • Fast-flow lesions can lead to high output heart failure and may require specific treatment. Arteriovenous malformations are fast-flow lesions.
  • Capillary, lymphatic, and venous malformations are considered slow-flow lesions. Combined malformations may be either slow or fast flow.

Symptoms

When located in an extremity, vascular malformations might show as a birthmark, may stimulate the development of collateral blood vessels in the form of varicose veins, or can produce an enlargement of the limb or a lengthening of the limb by stimulating its bony growth centers.

The localized masses may be of various size, from small to huge, and at their surface the vessels may be vulnerable to injury and bleed or may break down and ulcerate.

Diagnosis

These lesions are diagnosed by both physical examination and by using a number of imaging techniques, including magnetic resonance imaging (Cardiovascular MRI) and ultrasonography. In some cases, an angiogram is needed to assist in detailed treatment planning.

Treatment

Vascular malformations posses a highly individual nature and, therefore, treatment is decided case-by-case, based on the exact location of any malformation and the specific symptoms and risks posed by the malformation. Some vascular malformations may only require monitoring or compression garments and drug therapy.

For lesions that are only superficial, laser therapy is commonly used. Lesions that are deep may, however, require surgical removal and other therapies such as sclerotherapy.

Vascular malformations that cause persistent pain, ulceration, bleeding, blood clots, obstruction of major vessels, progressive limb asymmetry by overgrowth, or that interfere with limb function should be treated, often with the following:

  • Surgery
    The surgeon ties off and removes the arteries that feed blood into the malformation and removes the malformation.
  • Embolization
    Catheters are advanced into the lesions, and the malformed vessels are blocked, or embolized, with a variety of injectable particles, substances, or devices such as polyvinyl foam, biological glues, and absolute alcohol.
  • Radiosurgery
    Highly focused radiation is aimed directly at the blood vessels that comprise the malformation and cause them to close.

For information or appointments, please call 855-463-3320.

Vascular Disease

Your vascular system is your network of blood vessels that includes your arteries and veins. When your vascular system is healthy, blood travels freely through blood vessels, carrying oxygen and nutrients to every cell in the body.

Any condition that affects your blood’s circulation is considered vascular disease—whether your vessels harden and narrow from a buildup of plaque, a condition called atherosclerosis, or they swell and their walls become thin and rupture.

Slowed, interrupted, or decreased blood flow can reduce life expectancy by causing a host of problems, including:

  • Heart attacks
  • Stroke
  • Ruptured blood vessels, secondary to aneurysm formation
  • Kidney failure due to restricted blood flow
  • Limb loss

Symptoms

An estimated eight million to 15 million Americans have vascular disease, and at least half do not experience symptoms. Symptoms, such as leg pain, may be mistaken for other conditions, such as arthritis. In many cases, vascular disease has no symptoms until it results in a stroke, mini-stroke, or ruptured aneurysm.

Risk Factors

Several conditions and lifestyle factors increase a person's risk, including:

  • High cholesterol and lipid levels
  • High blood pressure
  • Diabetes
  • Family history of atherosclerosis
  • Smoking
  • Being overweight
  • Sedentary (inactive) lifestyle
  • High-stress lifestyle
  • Over age 50 or post-menopausal (though it can occur at any age)

Read more about conditions considered vascular disease:

For information or appointments, please call 855-463-3320.

Varicose Veins

Varicose veins are recognized as the blue, enlarged veins seen near the surface of the skin. These superficial veins work with deeper veins in aiding blood flow. Blood normally moves from the superficial to the deep veins with a series of valves to keep the flow going in one direction. But when the valves weaken, the blood flow reverses, moving back to the superficial veins. With time, pressure on the superficial veins increases and they engorge with blood. Varicose veins can be painful and can make legs feel swollen, achy, itchy, or heavy. Legs also may tire easily or get cramps or sores. Left untreated, varicose veins can result in chronic swelling and leg ulcers.

Signs and Symptoms

Varicose veins are recognized often as the blue, enlarged veins seen near the surface of the skin. These superficial veins work with deeper veins in aiding blood flow. Blood normally moves from the superficial to the deep veins with a series of valves to keep the flow going in one direction. But when the valves weaken, the blood flow reverses, moving back to the superficial veins. With time, pressure on these veins increases and they engorge with blood. Signs and symptoms you may experience include:
  • Aching pain, especially after long periods of standing or sitting
  • Throbbing or cramping in the thigh or calf
  • A feeling of heaviness in the leg(s)
  • Swelling in the lower leg or ankle
  • Itching in the affected limb
Left untreated, vein disease often progresses. Learn more:

Treatment

  • Endoluminal vein surgery is a minimally invasive procedure in which your vascular surgeon inserts a needle into the affected vein and closes the weak area using high frequency doses of light.
  • In a mini-incisional varicectomy, all the prominent varicosities are removed through several tiny (2.0-mm) incisions. The procedure is performed under local anesthesia and intravenous sedation on an outpatient basis. Patients can usually resume normal activities within 3-6 days depending on the extent of their varicose vein problem.

Other Treatment Options

At our Chevy Chase and Lafayette Centre locations, you will benefit from comprehensive treatment in a single visit. Importantly, you will have the personal attention, care and oversight of our experienced board-certified vascular surgeons who are part of the MedStar Heart & Vascular Institute. Misaki Kiguchi, MD, is a board-certified vascular specialist and Maria Litzendorf, MD, is a board-certified vascular specialist, both with a special interest and experience in treating vein disorders. As part of your evaluation and treatment plan, you’ll receive:
  • A comprehensive assessment through an ultrasound performed by a registered vascular technologist
  • One-on-one examination and consultation to discuss your specific condition and a proposed treatment plan that may include one or more of the following options.
  • Treatment Options:
    • Compression therapy—Prescription-strength hose for extra support and pressure to eliminate symptoms
    • Sclerotherapy—Chemical injections into the spider and varicose veins
    • Radiofrequency ablation—Heat, administered through a small catheter, to eliminate damaged veins
  • Follow-up appointments and post-procedure ultrasound

Risk and Prevention

Varicose veins generally run in the family. Pregnancy and weight gain also can lead to this problem. But there are ways to prevent varicose veins or to relieve the pressure. If you suffer from or are worried about varicose veins, try these tips:
  • Change positions often when standing or sitting.
  • Keep legs propped up while sitting and don't cross your legs.
  • Sleep with the foot of the bed elevated, with your feet higher than your head.
  • Avoid high heels and clothes that are tight around the waist and hips.
  • Keep a healthy weight.
  • Stretch your calves by going up on your toes.
  • Wear support stockings or pantyhose.
  • Exercise regularly. Walking is especially good.

For information or appointments, please call 855-546-0883 or:


Locations:

MedStar Washington Hospital Center
110 Irving Street, NW
Washington, DC 20010
Get Directions

MedStar Georgetown University Hospital
3800 Reservoir Rd NW
Washington, DC 20007
Get Directions

MedStar Health in Chevy Chase
5454 Wisconsin Avenue, Suite 1100
The Barlow Building, Chevy Chase, MD 20815
Get Directions

MedStar Health at Lafayette Centre
Building 2
1133 21st Street, NW
Floor 7
Washington, DC 20036
Use parking garage entrance on 21st Street
Get Directions

Thoracic Aortic Aneurysm

A thoracic aortic aneurysm is an abnormal widening or ballooning of a portion of the aorta caused by weakness in the wall of the artery. Atherosclerosis is by far the most common cause, although it may be caused by a variety of conditions, including high blood pressure, congenital disorders (such as Marfan's syndrome), trauma, or, less commonly, syphilis.

Symptoms

Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests, such as a chest X-ray or a chest computed tomography (CT) scan that are being run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.

Diagnostic Tools

  • Aortic Angiography
  • CT Scan
  • X-ray
  • Echocardiogram

Treatment

  • Ascending aorta or aortic arch surgery
  • Descending thoracic aorta surgery

Learn more about heart surgery at MedStar Heart & Vascular Institute.

For information or appointments, please call 855-463-3320.

Structural Heart and Valve Disease

If you have structural heart disease, abnormalities exist in your heart muscles, valves, or major blood vessels. These defects can affect heart function and blood flow. Some structural heart disease is congenital (present at birth), while other cases develop later in life, due to injury, infection, or aging.

The specialists at the MedStar Heart & Vascular Institute are leaders in the field. We focus on routine and complex structural heart defects to offer you the full range of surgical and nonsurgical procedures that will help you best manage your condition.

Structural Heart Defects

  • Septal defects - The septum is the critical muscle wall separating the four chambers of your heart. It functions as a barrier that prevents blood from passing from one side of your heart to the other. Occasionally, holes or other abnormalities occur in the septum. These septal defects can be ventricular (located between the lower two chambers) or atrial (located between the upper two chambers).
  • Patent foramen ovale (PFO) - PFO is a common septal defect that happens when a naturally occurring opening between atria does not close after birth. It has been associated with stroke and migraine headache.
  • Valvular defects - Normal blood flow depends upon fully functioning heart valves. The mitral, aortic, tricuspid and pulmonary valves play a key role in the flow of blood through the heart. When the valves become hardened and narrow (stenotic), they cannot open fully, and blood flow is restricted. If the valves are unable to close completely (incompetent), blood flows in the opposite direction. In its most severe form, valvular disease can lead to congestive heart failure.

Major Blood Vessel Defects

The major blood vessels pump blood from the heart to the body and return the blood from the body back to the heart. Defects in these critical arteries and veins can prevent oxygen-rich blood from reaching the rest of the body. Conversely, these abnormalities can sometimes cause too much blood flow to the lungs. Major blood vessel defects can seriously affect heart function and overall health.

Treatment

  • Closure Procedures - Our physicians perform atrial and ventricular septal defect closures and have vast expertise in performing patent foramen ovale (PFO) closures, when clinically indicated.
  • Valve Repair or Valve Replacement - Valve repair reduces complications and the need for future medication. Our physicians perform the highest percentage of valve repair procedures in the area and can replace valves that cannot be repaired.
  • Aortic Disease Management - Our physicians are skilled in both surgical and endovascular management of aortic disease. We treat the largest volume of patients with aortic disease in the area and strive to bring you the most minimally invasive procedures whenever possible.

Contact Us

To contact the Structural Heart and Valve Disease Center, call us at 855-463-3320.

Structural Heart Specialists

Find a physician who can help answer your questions.

Learn More

Meet Heart Valve Surgery Patient, Joanna Zimmerman:

Renal Artery Disease

Also called renal artery stenosis, renal artery disease occurs when the artery that supplies blood to the kidneys is narrowed or blocked, most commonly by atherosclerosis. Atherosclerotic renal artery stenosis is usually seen in older individuals who may have vascular disease in other areas as well (such as the heart or legs). It may also be caused by medial fibroplasia, also called fibromuscular dysplasia, which occurs with abnormal development of the artery wall.

Renal artery disease can cause hypertension, though it is a much less common cause than primary (no underlying cause) hypertension, and treating it can improve or even cure the hypertension. In other cases, renal artery stenosis may cause poor kidney function and correcting the narrowing may improve kidney function.

Treatment

While traditional surgical methods (renal artery bypass) are sometimes still used to treat this condition, a newer, less invasive procedure called renal artery stenting has become more common. This is done by threading a tiny, balloon-tipped catheter through a small puncture in the groin to the site of the arterial narrowing. The balloon is expanded to enlarge the artery and a stent (a small, balloon-expandable metal tube or scaffold) is put in place to optimize the angioplasty result and minimize recurrences.

For information or appointments, please call 855-463-3320.

Peripheral Vascular Disease (PVD)

Peripheral Vascular Disease (Peripheral Arterial Disease)

Peripheral vascular disease (PVD), also known as peripheral arterial disease (PAD), refers to diseases of any of the blood vessels outside of the heart and brain. PAD is a range of disorders that can affect the blood vessels in the legs, feet, arms, or hands, or body. PAD can include any vascular condition including aortic aneurysms.

Artherosclerosis

The most common form of PAD is atherosclerosis (hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build up to form a substance called plaque that clogs the inside of the artery.

This buildup causes a gradual narrowing of the artery, which will decrease the amount of blood flow. When the flow of blood decreases, it results in a decrease of oxygen supply to the body's tissues, which in turn causes pain or ulceration. When the arteries to the legs are affected, the most common symptom is pain, weakness, or cramping in the thigh, calf, foot, hip, or buttock especially when walking. In addition, ulcers can form in the toes and feet.

Diagnostic Tools

There are some relatively simple tests that can be done to determine if the arterial blood flow in your legs is normal.

  • Segmental pressure test - In this test, the blood pressure at several points in your arm or leg is checked using a blood pressure cuff and a Doppler. This will help determine if there is a difference in blood flow in the affected limb.
  • Ultrasound scan - The scan produces images of arteries on a screen and is used to visualize the blood flow and locate blockages.
  • Arteriogram - In this test, dye is injected into the arteries while X-rays are taken. The dye "lights up" the arteries, allowing the area of blockage to be accurately pinpointed.

Treatment

The best treatment for PAD depends on a number of factors, including your overall health and the location, size and cause of the blockage. In some cases, lifestyle changes can be enough to slow the progress and manage PAD. Others will need intervention to restore the blood flow to their legs. For that reason, your physician may recommend seeing a doctor who specializes in this condition to discuss methods of rechanneling blood flow around the obstructed arteries. Most of these methods are minimally invasive and do not require surgery or an incision. Find a vascular surgeon to discuss PAD.

For information or appointments, please call 855-463-3320.

WTOP Medical Intel

The Silent Killer: Peripheral Vascular Disease

Mesenteric Artery Disease

The mesenteric arteries supply blood to the small and large intestines; when these narrow or are blocked, blood flow is restricted and can cause abdominal pain, vomiting, and diarrhea. Two types exist:

  • Acute mesenteric artery ischemia is an emergency. Surgery is usually performed to remove the clot. In some cases, the surgeon must also create a bypass around the blockage.
  • Chronic mesenteric artery ischemia is treated by removing the blockage and reconnecting the arteries to the aorta. A bypass around the blockage can be created with a plastic tube graft.

Mesenteric artery ischemia is often seen in conjunction with hardened arteries in other parts of the body (for example, those with coronary artery disease or peripheral vascular disease). The condition is more common in smokers and in patients with high blood pressure or blood cholesterol.

For information or appointments, please call 855-463-3320.

Long QT Syndrome

In a properly functioning cardiovascular system, certain proteins control the flow of potassium, sodium, magnesium, and other molecules through the heart’s cells. These molecules contribute to proper electrical activity in the heart and keep it beating in a steady pattern.

The QT interval is a way to measure the heart’s electrical recovery after each beat. Any problems—including genetic mutations to these proteins or medications that lengthen the QT interval—can disrupt this electrical activity and cause heart arrhythmia.

In Long QT Syndrome (LQTS), the heart takes longer to recover from each beat because its electrical activity is disrupted. If undiagnosed and untreated, LQTS can lead to fainting spells or torsades de pointes, a type of heart rhythm disturbance that causes sudden cardiac death.

Types

  • Inherited LQTS occurs in approximately 1 in 2,000 people.
    Medical experts have identified mutations in 13 different genes that cause LQTS. Each type of inherited LQTS has certain triggers that may be associated with arrhythmias. The most common types are:
    • LQTS 1: Exercise (especially swimming) or emotional stress
    • LQTS 2: Extreme emotions including fright, anger, pain, or surprise
    • LQTS 3: Arrhythmias triggered by a slow heart rate while asleep
  • Acquired LQTS is much less common and does not often cause serious arrhythmias, except in people with a genetic predisposition.

Symptoms

For some people, their first symptom is a sudden cardiac arrest. Others have symptoms that begin in childhood or early teens, including:

  • Fainting caused by torsades de pointes, especially during physical activity or emotional stress
  • Sudden, rapid heart arrhythmia that feels like fluttering in your chest       
  • Gasping or difficulty breathing during sleep
  • Accidents caused by fainting
  • Sudden cardiac arrest (heart stoppage because of arrhythmias caused by electrical problems) or death

Diagnosis and Treatment

If you have symptoms of LQTS, physicians can diagnose it with an ECG. But, it can be difficult to diagnose because the QT interval may not always be prolonged in affected people.

Testing tools that can detect LQTS include:

  • Standard electrocardiogram (ECG) to check for a prolonged QT interval in your heartbeat
  • Exercise ECG (or stress test) to detect heartbeat problems that may not appear on a standard ECG
  • Event monitor to record your heart’s electrical activity over days or weeks to detect heart arrhythmia
  • Genetic testing to look for the condition

Your physician may also diagnose LQTS after you have experienced a cardiac event. A family history of sudden death may signal the need for further evaluation.  If you or a family member are diagnosed with LQTS, it’s very important for other family members to be screened for the syndrome. Contact MedStar Health for more information on genetic screening for heart conditions.

Treatment goals for LQTS focus on preventing heart arrhythmia and sudden cardiac arrest. Our cardiac specialists may recommend any of these treatment options:

  • Lifestyle changes
    • Avoiding strenuous activity, especially swimming
    • Avoiding medications that can trigger heart arrhythmia
    • Controlling stressful situations
  • Medications such as beta blockers to help regulate heart arrhythmia
  • Surgery to implant a defibrillator that uses electric shocks to correct heart arrhythmia

For information or appointments, please call 855-463-3320.

Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a genetic condition (occurring in about 1 of 500 people) that causes heart muscle tissue to thicken. If the muscle tissue thickens too much, it can block blood flow from the heart to the rest of the body.

HCM can also cause you to have arrhythmia, an irregular heartbeat. If your arrhythmia is potentially life threatening, your doctor may implant a defibrillator to protect your heart.

If medication does not reduce your symptoms, you may need to have open heart surgery. This procedure will cut out the thickened tissue and improve your blood flow. 

Other conditions, such as high blood pressure (hypertension) or extreme athletic conditioning, can cause heart muscle thickening. This abnormal tissue may resemble HCM, making a diagnosis more challenging.

Symptoms

Many people who have HCM may not realize it because they often have no symptoms. During a routine medical exam, your physician may discover a heart murmur or suspect HCM after an abnormal electrocardiogram (ECG). But sometimes, the first symptom is a sudden collapse or cardiac arrest.

Other symptoms that people with HCM may experience include:

  • Shortness of breath, most commonly during activity
  • Dizziness, light-headedness or fainting during or after physical activity
  • Chest pain
  • Fatigue
  • Heart palpitations (fluttering or pounding in your chest)

Diagnosis and Treatment

Your physician will perform a complete physical exam and listen for abnormal sounds in the heart. These sounds include an abnormal heartbeat or a heart murmur. At MedStar Heart & Vascular Institute, our cardiac team looks for thickened heart muscle and problems with blood flow or heart valves using the following tests:

  • Echocardiogram (most common) to diagnose and monitor HCM
  • Electrocardiogram (ECG)
  • Diagnostic imaging, including Cardiovascular MRI
  • Cardiac catheterization to evaluate the function of your heart's arteries, chambers and valves
  • Event monitor to record your heart rhythm over time
  • Genetic testing to detect mutations known to cause HCM

If your physician diagnoses you or a family member with HCM, screening of other family members is very important. We offer genetic screening for heart conditions.

For people with HCM, our treatment goals focus on controlling symptoms, managing related conditions and preventing sudden cardiac arrest. Our cardiac specialists may recommend one or more of these treatment options:

  • Medications such as beta blockers, calcium channel blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a pacemaker to regulate your heartbeat or a defibrillator to correct dangerous heart arrhythmia
  • Open-heart surgery to remove parts of the thickened muscle or replace heart valves
  • Cardiac catheterization for septal alcohol ablation to remove excess muscle tissue in the heart
  • Lifestyle changes, including avoiding very strenuous activity

For information or appointments, please call 855-463-3320.

Hypertension

High blood pressure, also called hypertension, occurs when the systolic pressure is consistently over 140 mm Hg, or the diastolic blood pressure is consistently over 90 mm Hg.

There are two categories of hypertension: essential and secondary. The majority of cases of high blood pressure are essential hypertension, a type of hypertension without specific reason, but caused because the body cannot regulate the blood pressure within normal range. Secondary hypertension is commonly caused by stenosis, or narrowing, of the renal (kidney) arteries.

Risk Factors

Most of the time, there is no identifiable cause for essential high blood pressure. Risk factors for high blood pressure (secondary hypertension) that results from a specific condition, habit, or medication may include:

  • Anxiety
  • Arteriosclerosis
  • Coarctation of the aorta
  • Diabetes
  • Drugs such as alcohol toxicity or cocaine
  • Excess sodium (salt) in the diet
  • Habitual alcohol use
  • Obesity
  • Pain
  • Renal artery stenosis
  • Renal disease
  • Stress

Symptoms

Patients with high blood pressure generally have no symptoms. If patients experience a mild headache along with any of the following systems, it may be a sign of dangerously high blood pressure (malignant hypertension) or a complication from high blood pressure:

  • Blood in urine
  • Chest pain
  • Confusion
  • Ear noise or buzzing
  • Headache
  • Heart failure
  • Irregular heartbeat
  • Nosebleed
  • Tiredness
  • Vision changes

Treatment

Changes in lifestyle such as weight loss, increased exercise, and a low fat diet with limited sodium intake may reduce hypertension. If these lifestyle changes do not work, medications for hypertension may include:

  • ACE inhibitors or angiotensin receptor blockers
  • Beta-blockers
  • Calcium channel blockers
  • Diuretics
  • Alpha receptor blockers

Prevention

Steps to prevent or to reduce the risk of high blood pressure include:

  • Eating a low fat diet rich in fruits and vegetables and low in animal fat
  • Exercising at least 30-60 minutes on most days of the week
  • Maintaining a healthy weight
  • Maintaining a proper diet
  • Modifying salt intake
  • Reducing alcohol consumption
  • Quitting smoking

Renovascular Hypertension

Renovascular hypertension, a form of secondary hypertension, occurs when the arteries that carry blood to the kidneys become narrow, usually because of a blockage.

For symptoms, treatment, and prevention see Hypertension above.

When medications and lifestyle changes do not work, surgical reconstruction of a damaged artery may be performed. Procedures, such as balloon angioplasty or stenting of the damaged artery may be used instead of surgery.

For information or appointments, please call 855-463-3320.

Mitral Insufficiency

Mitral/mitral regurgitation (acute mitral regurgitation) is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to leak (back-flow) into the left atrium (upper heart chamber) when the left ventricle (lower heart chamber) contracts.

Mitral Insufficiency Symptoms

  • Chest pain, unrelated to coronary artery disease or a heart attack
  • Cough
  • Palpitations
  • Rapid breathing
  • Shortness of breath

For information or appointments, please call 855-463-3320.

Tricuspid Insufficiency

Tricuspid insufficiency/tricuspid regurgitation is a disorder involving backward flow of blood across the tricuspid valve, which separates the right ventricle (lower heart chamber) from the right atrium (upper heart chamber). This occurs during contraction of the right ventricle and is caused by damage to the tricuspid heart valve or enlargement of the right ventricle.

Risk Factors

The most common cause of tricuspid regurgitation is not damage to the valve itself, but enlargement of the right ventricle, which may be a complication of any disorder that causes failure of the right ventricle.

Rheumatic fever, diet medications such as Phen-fen (phentermine and fenfluramine) or dexfenfluramine, and a congenital heart disease (Ebstein anomaly) are also risk factors for tricuspid regurgitation.

Rarely, tricuspid regurgitation is caused by an unusual tumor called carcinoid, which secretes a hormone that damages the valve. Other infrequent causes of tricuspid regurgitation include endocarditis, rheumatoid arthritis, radiation therapy, Marfan syndrome, and injury.

Symptoms

In the absence of high blood pressure in the lungs (pulmonary hypertension), tricuspid regurgitation is usually asymptomatic. If pulmonary hypertension and moderate-to-severe tricuspid regurgitation coexist, symptoms may include:

  • Active neck vein pulsations
  • Decreased urine output
  • Fatigue, tiredness
  • Generalized swelling
  • Swelling of the abdomen
  • Swelling of the feet and ankles
  • Weakness

For information or appointments, please call 855-463-3320.

Tricuspid Stenosis

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • ECG
  • Echocardiogram

Treatment

  • Tricuspid valve repair surgery corrects tricuspid insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly.
  • Tricuspid valve replacement surgery corrects both tricuspid stenosis and insufficiency
  • Valve replacement with mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
  • Valve replacement with biological (tissue) valves. Learn more about heart valve surgery.

For information or appointments, please call 855-463-3320.

Mitral Stenosis

Risk factors for mitral valve stenosis include rheumatic fever. Since rheumatic fever rates are declining in the United States, the incidence of mitral stenosis is also decreasing. Only rarely do other disorders cause this condition.

Symptoms

  • Chest discomfort
  • Cough
  • Difficulty breathing
  • Fatigue
  • Frequent respiratory infections
  • Palpitations
  • Swelling of feet or ankles

Diagnostic Tools

Treatment

  • Mitral valve repair surgery corrects mitral valve insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly
  • Mitral valve replacement surgery corrects both mitral stenosis and insufficiency
  • Valve replacement with mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
  • Valve replacement with biological (tissue) valves

For information or appointments, please call 855-463-3320.

Heart Murmurs

The sound of your heart beating is the sound of the closure of your heart valves. When there is a problem with a valve (stenosis or regurgitation), the blood flow across the valves becomes turbulent. This causes a sound, which is heard as a murmur during an examination. Your doctor can usually hear the murmur while listening to your heartbeat using a stethoscope.

There are two types of heart murmurs: diastolic, when the heart muscle relaxes between beats, and systolic, when the heart muscle contracts to squeeze the blood through the chambers.

Diagnosis

Treatment

  • Medication
    • Valve surgery
    • Heart valve repair: May be preferable, as keeping your own tissue may be better than replacing a heart valve. This is most commonly performed in cases of mitral valve regurgitation (leakage) but may be possible in other situations, as well. Heart valve repair of the mitral valve is now possible using percutaneous (through the skin) treatments in certain cases. 
    • Heart valve replacement: Can be done using a variety of valves, including mechanical and tissue valves (pig or cow tissue). Learn more about heart valve disease and heart valve surgery

For information or appointments, please call 855-463-3320.

Aortic Insufficiency

Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Risk Factors

In the past, rheumatic fever was the primary cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen, including

  • Ankylosing Spondylitis
  • Aortic Dissection
  • Endocarditis
  • High Blood Pressure
  • Marfan's Syndrome
  • Reiter's Syndrome
  • Syphilis
  • Systemic Lupus Erythematosus
  • Valve problems that are present at birth

Symptoms

  • Chest pain under the sternum may radiate; crushing, squeezing, pressure, tightness; pain increases with exercise, relieves with rest.
  • Shortness of breath and fainting
  • Fatigue
  • Irregular, rapid, racing, pounding, or fluttering pulse
  • Palpitations

For information or appointments, please call 855-463-3320.

Aortic Stenosis

Aortic stenosis is the narrowing or obstruction of the heart's aortic valve, which prevents it from opening properly and blocks the flow of blood from the left ventricle to the aorta.

Risk Factors

Aortic stenosis may be present from birth (congenital) or it may develop later in life (acquired). Other risk factors include valve calcification, being male, and rheumatic fever.

Symptoms

  • Breathlessness with activity
  • Chest pain, angina-type under the sternum, may radiate; crushing, squeezing, pressure, tightness; increased with exercise, relieved with rest
  • Dizziness
  • Fainting or weakness with activity
  • Palpitations

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • ECG
  • Echocardiogram

Treatment

Surgeons may consider replacing the original valve with either:

  • Mechanical valves, created from man-made materials, which require long-term blood thinning with warfarin medication.
  • Biological (tissue) valves

For information or appointments, please call 855-463-3320.

Heart Valve Disease

Dysfunction in one of the four heart valves—mitral, aortic, tricuspid, or pulmonary—leads to heart valve disease. Normally functioning valves ensure that blood flows in one direction. When dysfunction of the heart valves occurs, the valves may become narrow (valvular stenosis) or may leak (valvular regurgitation). This can lead to chronic heart problems including heart failure, shortness of breath and chest pain, or enlargement of the heart chambers.

Learn more about the types of heart valve diseases:

For information or appointments, please call 855-463-3320.

Deep Vein Thrombosis

Deep vein thrombosis (DVT) is a blood clot that forms in the large veins of the arms or legs. These clots can travel through the bloodstream to the brain or heart, and can cause a stroke or pulmonary embolism (PE).

Causes

  • Trauma to the vein's inner lining. These may include surgery, serious injury, inflammation or an immune response.
  • Blood flow is sluggish or slow. This can be caused by lack of movement for long periods of time, such as sitting on an airplane or in a car for many hours, or after surgery.
  • Thicker-than-normal blood. Certain genetic conditions can increase blood's tendency to clot.

Symptoms

  • Pain, tenderness, swelling, warmth, or discoloration of the leg
  • Dilation of the superficial veins in the affected limb
  • Shortness of breath or chest pain

Post-thrombotic Syndrome

Post-thrombotic syndrome (PTS) is a late-complication that occurs in 25-33 percent of patients with DVT. It typically occurs within two years of diagnosis, despite appropriate treatment with blood thinners. PTS consists of chronic leg pain (aching or cramping), leg heaviness, itching or tingling, swelling, redness, varicose veins and leg discoloration. These symptoms are typically more pronounced upon standing or walking for long periods and relieved upon rest. PTS can lead to venous stasis ulcers in some patients.

Treatment

Treatment options for acute DVT include anticoagulation with blood thinners (like heparin or warfarin) and pharmacomechanical thrombolysis, in which clot-busting drugs are delivered through a small catheter placed inside the blocked vein, followed by mechanical removal of the clot itself.

All patients with DVT should be treated with three to six months (or longer) of anticoagulation and wear elastic compression stockings, which have been shown to reduce the incidence of PTS.

For information or appointments, please call 855-463-3320.

Congenital Defects and Disease

Congenital heart disease is a term that describes a number of different conditions caused by abnormal or disordered heart development before birth. Although congenital heart disease, by definition, is present at birth, its effects may not be obvious nor may present for many years.

A congenital heart defect most often occurs as an isolated incidence and is generally not associated with other diseases, there are a few genetic and chromosomal syndromes that can also cause heart defects, including:

  • Down syndrome
  • Ellis-van Creveld syndrome
  • Marfan syndrome
  • Noonan syndrome
  • Trisomy 13
  • Turner's syndrome

Drugs, chemicals, and infections during pregnancy may also cause congenital heart abnormalities. In infants, fetal rubella, maternal alcohol use (fetal alcohol syndrome), and use of retinoic acid (for acne), may also cause of congenital heart disease. In addition, if a pregnant woman has congenital heart disease, she should notify her doctor so her fetus may be checked during the pregnancy.

Treatment

Surgical treatments are tailored to correct the specific congenital abnormality. The most common include closing a patent foramen ovale and/or an atrial septal defect (ASD).

 

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

In a properly functioning cardiovascular system, certain proteins operate ion channels, which control the flow of sodium, potassium, and calcium through the heart’s cells. These molecules are essential in the regulating the heart’s electrical activity.

CPVT is an inherited genetic condition that mutates these proteins, which disrupts this flow and the heart’s electrical activity, leading to arrhythmia during physical activity or emotional stress.

These ventricular arrhythmias may return to a normal heartbeat on their own. But sometimes, arrhythmias can worsen into a more dangerous heart arrhythmia called ventricular fibrillation. Without immediate medical treatment, this problem can lead to sudden cardiac death, especially in children and young athletes who are otherwise healthy.

Symptoms

CPVT usually starts in childhood, but may go undetected. The first sign of the disease may be sudden cardiac death. Signs and symptoms usually occur during physical activity or emotional stress and include:

  • Light-headedness, dizziness or fainting
  • Seizures
  • Heart palpitations (fluttering or pounding in your chest)
  • Sudden cardiac arrest (heart stoppage because of arrhythmias caused by electrical problems) or death

Diagnosis and Treatment

A standard electrocardiogram (ECG) generally will not detect CPVT. If your physician suspects the disease based on family history or symptoms, you will need further testing. Some diagnostic tools we use at MedStar Heart & Vascular Institute include:

  • Exercise ECG (or stress test) to detect heart arrhythmia that may not appear on a standard ECG
  • Event monitor to record your heart’s electrical activity over time to detect heart arrhythmia
  • Diagnostic imaging, including cardiovascular MRI and echocardiogram, to evaluate your heart’s structure for any other abnormalities
  • Genetic testing to look for defective genes associated with CPVT

If your physician diagnoses you or a family member with CPVT, screening for other family members is very important. We offer genetic screening for heart conditions.

At MedStar Heart & Vascular Institute, our cardiac specialists work to reduce the risks of dangerous heart arrhythmia and sudden cardiac arrest. Among the treatment options we offer are:

  • Medications such as beta blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a defibrillator to correct dangerous heart arrhythmia with electric shocks
  • Lifestyle changes including avoiding very strenuous activity

For information or appointments, please call 855-463-3320.

Carotid Artery Disease

Your carotid arteries extend from your aorta to your brain and supply your brain with blood. If the internal carotid artery is blocked (by plaque buildup as a result of atherosclerosis) blood supply to your brain is reduced and can cause a stroke. In fact, carotid blockages are responsible for more than half of all strokes.

Symptoms

Most patients do not know they have carotid artery disease because it is often asymptomatic, but even without symptoms, a stroke can occur. If symptoms or warning signs of a stroke are present, they are called transient ischemic attacks, and they include:

  • Weakness, numbness, or a tingling sensation on one side of the body
  • Loss of control or the movement of an arm or a leg
  • Vision loss in one eye (many people describe this sensation as a window shade coming down)
  • Losing the ability to speak clearly

Diagnosis

X-ray studies using special dyes, called carotid angiograms, can show the degree of blockage of the carotid arteries. Other tests, such as ultrasound and magnetic resonance angiography can visualize blockages in the carotid arteries.

Treatment

  • For less severe stenosis, treatment includes lifestyle modification, such as smoking cessation and medication, including aspirin and anti-cholesterol medications.
  • Carotid artery surgery (also known as carotid artery endarterectomy), is a surgical procedure to manually remove fat and cholesterol build-up from inside the carotid artery and restore adequate blood flow to the brain to help prevent a stroke.
  • Angioplasty with stenting is a less invasive procedure in which a catheter is inserted through a nick in the skin (usually in the groin) and threaded under X-ray guidance to the carotid artery. A balloon is inflated to compress the plaque against the wall of the blood vessel and open up the artery.

For information or appointments, please call 855-463-3320.

Cardiopulmonary Disease

Cardiac and pulmonary diseases are conditions that affect the lungs and heart. Cardiac rehabilitation may benefit those who have experienced a recent heart attack or cardiac surgery, as well as other heart-related health problems. Pulmonary rehabilitation may be beneficial to individuals with asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema, or other lung conditions.

For information or appointments, please call 855-463-3320.

Cardiomyopathy

Cardiomyopathy is a weakening of the heart muscle or a change in heart muscle structure. It is often associated with inadequate heart pumping or relaxation or filling with blood. Cardiomyopathy can be caused by viral infections, heart attacks, valve disease, alcoholism, long-term severe high blood pressure, and sleep disorders that affect breathing.

Symptoms

  • Fatigue
  • Shortness of breath with exertion or at rest
  • Edema of feet and legs or abdominal swelling
  • Decreasing ability to tolerate physical exertion
  • Cough
  • Palpitations, rapid heartbeat, or irregular heartbeat
  • Loss of appetite or getting full easily

Diagnostic Tools

Treatment Options

  • ACE inhibitors
  • Beta blockers
  • Diuretics
  • Digoxin
  • Medicines that help the heart contract, such as hydralazine and nitrates.
  • Vasodilators

If medications alone do not work, physicians may consider the following treatment options:

In severe cases, surgeons may also consider the following procedures to sustain life until a transplant donor becomes available:

  • Coronary bypass surgery
  • Repair or replacement of heart valves
  • Left ventricular assist device (LVAD)

For information or appointments, please call 855-463-3320.

Cardiac Arrhythmia

Cardiac arrhythmias are disturbances in the normal rhythm of the heartbeat. Arrhythmias may be a sign of heart disease and can lead to other cardiac symptoms. Because arrhythmias can be life threatening, it is critical to have your heart evaluated by an expert cardiologist. Cardiologists who diagnose and treat patients for cardiac arrhythmias are known as electrophysiologists.

Watch the video to learn about Bill's experience with A-Fib:

 

 

Symptoms

  • Changes in the rate, rhythm or pattern of the pulse
  • Chest pain
  • Fainting
  • Fast or slow heart beat (palpitations)
  • Light-headedness, dizziness
  • Paleness
  • Shortness of breath
  • Skipping beats
  • Sweating

Risk Factors

  • Anti-arrhythmic medications
  • Blood chemistry imbalances
  • Caffeine
  • Illicit drug use
  • Endocrine abnormalities
  • Inappropriate use of amphetamines or other stimulants
  • Prior heart attack
  • Use of certain prescription medications

Types

Fast Heart Rhythms

A typical heart beats 60 to 100 times a minute. Faster than this is a fast heart rhythm, known as supraventricular tachycardia (SVT). This rapid, erratic beat can cause the body to receive an inadequate blood supply.

SVT Types

  • Atrial fibrillation keeps the heart from pumping blood efficiently, causing blood to pool inside the heart. Eventually this blood forms clots, setting up a dangerous situation where stroke, pulmonary embolism, or heart attacks can occur.
  • Paroxysmal Supraventricular Tachycardia (PSVT) is an abnormal heart rate that occurs sometimes. This form of SVT is caused by too many electrical signals in the heart at once. This causes overload, and the heart begins to beat too quickly.
  • Atrial Flutter occurs when the top two chambers of the heart beat too quickly and the lower two chambers-the ventricles-beat too slowly. This condition most often occurs in the elderly and is dangerous because it can cause a stroke.
  • Atrial Tachycardia is caused by too many electrical signals in the heart, specifically the atria; the two upper chambers of the heart. These signals cause the heart to beat too quickly, causing palpitations, breathlessness and possible anxiety.

Slow Heart Rhythms

Each day, a normal heart contracts 60 to 100 times a minute. Abnormally slow heart rates are typically those fewer than 60 beats a minute. These slow heart rhythms, referred to as bradycardias, can be life threatening.

Bradycardia is usually treated with an implantable cardiac device known as a pacemaker.

Palpitations

Palpitations are usually felt as an unusual pattern to a person's heartbeat, like skips or jumps. This sensation is usually uncomfortable for people and can sometimes signal that there is a heart problem. It is critical to be examined by a cardiologist with experience in evaluating and treating palpitations. Learn more about palpitations.

Syncope

Syncope is caused by a temporary loss of consciousness, known commonly as fainting. It is caused by low blood pressure—the heart cannot effectively pump enough blood to the brain, affecting the oxygen supply and causing the person to pass out.

While syncope alone is not life threatening, it may sometimes be a symptom of a more serious condition and should be evaluated as soon as possible. Learn more about syncope.

Diagnostic Tools

Treatments

  • Medical management
  • Implantable cardioverter defibrillators (ICDs)
  • Pacemakers
  • Implantable loop recorders

Catheter ablations, including:

  • Atrial fibrillation (A-Fib) ablation
  • Percutaneous epicardial ablation program
  • Ventricular tachycardia ablation
  • Intra-operative ablations
  • Laser lead extractions
  • Arrhythmia management in congenital heart disease

For information or appointments, please call 855-463-3320.

Brugada Syndrome

In a properly functioning cardiovascular system, certain proteins operate ion channels, which control the flow of sodium, potassium, and calcium through the heart’s cells. These molecules are essential in the regulating the heart’s electrical activity. If this flow is disrupted, the heart’s electrical activity is also disrupted, leading to arrhythmia.

Medical experts have identified genetic mutations in some of these proteins, which can lead to Brugada Syndrome, an inherited disorder of the heart’s electrical system that causes heart arrhythmia (erratic heartbeat).

If left untreated, Brugada syndrome can lead to:

  • Ventricular fibrillation: a rapid, uncoordinated heartbeat
  • Sudden cardiac death: heart stoppage because of severe arrhythmia

Symptoms

Brugada syndrome often shows no warning signs. Your physician may first find it during an electrocardiogram (ECG). Unfortunately, the first sign may be sudden cardiac arrest (heart stoppage because of severe arrhythmia) or death.

Other symptoms of Brugada syndrome include:

  • Fainting (most common symptom)
  • Seizure during rest or sleep
  • Disturbed sleep, including nightmares
  • Difficulty breathing, especially during rest or sleep
  • Heart palpitations (fluttering or pounding in your chest)

Diagnosis and Treatment

MedStar Health cardiac experts usually find Brugada syndrome during an electrocardiogram (ECG). However, people with the syndrome may sometimes have normal ECGs. If your physician suspects Brugada syndrome, further tests to confirm a diagnosis include:

  • Drug challenge using an intravenous sodium channel blocker to see whether the Brugada ECG pattern can be brought out
  • Genetic testing to look for defective genes
  • Diagnostic imaging, including Cardiovascular MRI and echocardiogram, to rule out other conditions
  • Electrophysiologic (EP) study, a cardiac catheterization procedure, to evaluate susceptibility to arrhythmias

If you or a family member are diagnosed with Brugada syndrome, screening of other family members is very important. We offer genetic screening for heart conditions.

At MedStar Heart & Vascular Institute, our cardiac team focuses on controlling heart arrhythmia and preventing sudden cardiac arrest. Currently, the only effective treatment for Brugada Syndrome is surgery to implant a defibrillator to correct dangerous heart arrhythmias with electric shocks.

Your physician may also recommend you avoid certain medications, as well as promptly treat any fevers.

For information or appointments, please call 855-463-3320.

Atrial Fibrillation Symptoms

Atrial fibrillation, or A-fib, is a type of sustained arrhythmia in which the heart beats irregularly or fast. It is often described to feel like "fish jumping in my chest," although many people feel no symptoms. A-fib affects nearly three million people in the U.S. There are four types of A-fib:

  • Paroxysmal, for which the irregular heartbeat lasts less than seven days, usually less than 24 hours and has recurred at least twice
  • Persistent, for which the irregular heartbeat lasts longer than seven days, but the abnormal rhythm can be stopped with treatment
  • Permanent, as defined when the arrhythmia lasts longer than one year and does not respond to treatment or treatment has not been attempted.
  • Lone, for which the irregular heartbeat is paroxysmal or persistent and occurs without another form of heart disease.

Although A-fib itself is not life threatening, it can have serious consequences. People with A-fib are at a much higher risk of stroke. Left untreated, A-fib can lead to heart failure.

MedStar Heart & Vascular Institute physicians achieve consistently high rates of success at controlling this highly challenging heart rhythm disorder that affects about one percent of the entire population and about 10 percent of people older than 80.

Risk Factors

  • High blood pressure
  • Coronary heart disease
  • Previous heart attack
  • Sleep apnea
  • Heart valve problems
  • Congenital heart defects
  • Diabetes
  • Other arrhythmias, including atrial flutter and ventricular fibrillation
  • Inflammation, such as after heart surgery (CABG)
  • Lung diseases, including pulmonary embolism
  • Excessive alcohol use
  • Viral infections
  • Obesity
  • Age: three to five percent of people over age 65 have A-Fib and up to 10 percent of people over age 80 have A-Fib

Diagnostic Tools

  • CG
  • Holter/Event Monitor
  • Loop Recorder

Treatment

  • Medicines: aspirin, warfarin, beta blockers, calcium channel blockers and anti-arrhythmic medicines to control heart rate and prevent stroke
  • Cardioversion: a procedure for people who are having A-Fib for the first time or need treatment right away
  • Ablation: for people with symptoms who have failed or not tolerated medicines
  • Surgery: for people who do not respond to medical therapy or ablation, often performed with other heart surgery
  • WATCHMAN device
  • Learn about treatment options at MedStar Washington Hospital Center

Convergent Atrial Fibrillation Ablation

  • Convergent Atrial Fibrillation Ablation is a minimally invasive hybrid procedure that aggressively treats this frequently frustrating heart rhythm disorder. It involves the teamwork of an interventional cardiac electrophysiologist and a cardiac surgeon.
  • Cardiac specialists at the Heart Institute are specially trained in performing this complex procedure. An interdisciplinary medical team will plan every step of your procedure and answer any questions you may have. The benefits of convergent A-Fib ablation include:
  • Minimally invasive—provides both endocardial and epicardial ablation without the need for chest incision or bypass
  • Intra-operative testing—we are able to ascertain the effectiveness of the therapy during the procedure itself.
  • Multidisciplinary care—experts in many areas of cardiac care are involved in your treatment.
  • Shorter hospital stay—less pain, a shorter hospital stay, and faster recovery times than traditional surgical methods.

For information or appointments, please call 855-463-3320.

Learn more about the Center for Comprehensive Atrial Fibrillation Management at the MedStar Heart & Vascular Institute.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

ARVC is an inherited genetic disorder caused by mutations in genes responsible for certain proteins that connect heart cells. It caused heart muscle tissue—usually in the right ventricle (lower chamber)—to break down, replacing it with scar tissue and fat.

ARVC disrupts the heart’s normal electrical activity and causes heart arrhythmia (irregular heartbeat) in the ventricles. Arrhythmias are life threatening and can lead to sudden cardiac arrest and death, especially in young people and athletes who are otherwise healthy.

Symptoms

ARVC may not cause symptoms, especially in the early stages of the disease. In many people, the first signs are:

  • Heart palpitations (fluttering or pounding in your chest)
  • Fainting
  • Sudden cardiac death (heart stoppage caused by arrhythmia), usually during strenuous activity

Diagnosis and Treatment

Diagnosing ARVC can be problematic because symptoms are often difficult to detect. If your medical or family history suggests that you may have ARVC, your physician will confirm a diagnosis with further tests, which may include:

  • Standard electrocardiogram (ECG) to check for problems with your heartbeat
  • Exercise ECG (or stress test) to detect heartbeat problems that may not appear on a standard ECG
  • Event monitor to record your heart’s electrical activity over time to detect heart arrhythmia
  • Diagnostic imaging, including Cardiovascular MRI and echocardiogram, to evaluate your heart’s structure for any abnormalities
  • Electrophysiology (EP) study through cardiac catheterization to assess susceptibility to arrhythmia
  • Genetic testing to look for defective genes associated with ARVC. If you or a family member are diagnosed with ARVC, it’s very important for other family members to be screened for the syndrome.  We offer genetic testing for heart conditions.

At MedStar Heart & Vascular Institute, our treatment goals for ARVC focus on preventing sudden cardiac arrest by controlling heart arrhythmia. Treatment options we may recommend include:

  • Medications such as beta blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a defibrillator to correct dangerous heart arrhythmia with electric shocks

Lifestyle changes such as:

  • Avoiding very strenuous activity
  • Avoiding stimulants including caffeine, nicotine and certain decongestants

Angina

Angina is a specific type of chest discomfort caused by inadequate blood flow through the blood vessels of the heart muscle. The discomfort or pain is felt anywhere along the front of the body between the neck and upper abdomen and is relieved by rest or medication within a short period of time (usually 15 minutes). Chest pain of a longer duration or pain appearing with a lower level of effort than before, even at rest, should be considered unstable angina.

Diagnostic Tools

Treatments

AspirinBeta-blockersCalcium Channel BlockersEnhanced External Counterpulsation (EECP)NitroglycerinOral nitratesOther medications to control high cholesterol, high blood pressure, or abnormal heart rhythms.

If medications fail or in more severe cases, physicians may recommend one of the following treatment options:

Long QT Syndrome

In a properly functioning cardiovascular system, certain proteins control the flow of potassium, sodium, magnesium, and other molecules through the heart’s cells. These molecules contribute to proper electrical activity in the heart and keep it beating in a steady pattern.

The QT interval is a way to measure the heart’s electrical recovery after each beat. Any problems—including genetic mutations to these proteins or medications that lengthen the QT interval—can disrupt this electrical activity and cause heart arrhythmia.

In Long QT Syndrome (LQTS), the heart takes longer to recover from each beat because its electrical activity is disrupted. If undiagnosed and untreated, LQTS can lead to fainting spells or torsades de pointes, a type of heart rhythm disturbance that causes sudden cardiac death.

Types

  • Inherited LQTS occurs in approximately 1 in 2,000 people.
    Medical experts have identified mutations in 13 different genes that cause LQTS. Each type of inherited LQTS has certain triggers that may be associated with arrhythmias. The most common types are:
    • LQTS 1: Exercise (especially swimming) or emotional stress
    • LQTS 2: Extreme emotions including fright, anger, pain, or surprise
    • LQTS 3: Arrhythmias triggered by a slow heart rate while asleep
  • Acquired LQTS is much less common and does not often cause serious arrhythmias, except in people with a genetic predisposition.

Symptoms

For some people, their first symptom is a sudden cardiac arrest. Others have symptoms that begin in childhood or early teens, including:

  • Fainting caused by torsades de pointes, especially during physical activity or emotional stress
  • Sudden, rapid heart arrhythmia that feels like fluttering in your chest       
  • Gasping or difficulty breathing during sleep
  • Accidents caused by fainting
  • Sudden cardiac arrest (heart stoppage because of arrhythmias caused by electrical problems) or death

 

Diagnosis and Treatment

If you have symptoms of LQTS, physicians can diagnose it with an EKG. But, it can be difficult to diagnose because the QT interval may not always be prolonged in affected people.

Testing tools that can detect LQTS include:

  • Standard electrocardiogram (EKG) to check for a prolonged QT interval in your heartbeat
  • Exercise EKG (or stress test) to detect heartbeat problems that may not appear on a standard EKG
  • Event monitor to record your heart’s electrical activity over days or weeks to detect heart arrhythmia
  • Genetic testing to look for the condition

Your physician may also diagnose LQTS after you have experienced a cardiac event. A family history of sudden death may signal the need for further evaluation.  If you or a family member are diagnosed with LQTS, it’s very important for other family members to be screened for the syndrome. Contact MedStar Health for more information on genetic screening for heart conditions.

 

Treatment goals for LQTS focus on preventing heart arrhythmia and sudden cardiac arrest. Our cardiac specialists may recommend any of these treatment options:

  • Lifestyle changes
    • Avoiding strenuous activity, especially swimming
    • Avoiding medications that can trigger heart arrhythmia
    • Controlling stressful situations
  • Medications such as beta blockers to help regulate heart arrhythmia
  • Surgery to implant a defibrillator that uses electric shocks to correct heart arrhythmia

Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT)

In a properly functioning cardiovascular system, certain proteins operate ion channels, which control the flow of sodium, potassium, and calcium through the heart’s cells. These molecules are essential in the regulating the heart’s electrical activity.

CPVT is an inherited genetic condition that mutates these proteins, which disrupts this flow and the heart’s electrical activity, leading to arrhythmia during physical activity or emotional stress.

These ventricular arrhythmias may return to a normal heartbeat on their own. But sometimes, arrhythmias can worsen into a more dangerous heart arrhythmia called ventricular fibrillation. Without immediate medical treatment, this problem can lead to sudden cardiac death, especially in children and young athletes who are otherwise healthy.

Symptoms

CPVT usually starts in childhood, but may go undetected. The first sign of the disease may be sudden cardiac death. Signs and symptoms usually occur during physical activity or emotional stress and include:

  • Light-headedness, dizziness or fainting
  • Seizures
  • Heart palpitations (fluttering or pounding in your chest)
  • Sudden cardiac arrest (heart stoppage because of arrhythmias caused by electrical problems) or death

Diagnosis and Treatment

A standard electrocardiogram (EKG) generally will not detect CPVT. If your physician suspects the disease based on family history or symptoms, you will need further testing. Some diagnostic tools we use at MedStar Heart Institute include:

  • Exercise EKG (or stress test) to detect heart arrhythmia that may not appear on a standard EKG
  • Event monitor to record your heart’s electrical activity over time to detect heart arrhythmia
  • Diagnostic imaging, including cardiac MRI and echocardiogram, to evaluate your heart’s structure for any other abnormalities
  • Genetic testing to look for defective genes associated with CPVT

If your physician diagnoses you or a family member with CPVT, screening for other family members is very important. We offer genetic screening for heart conditions.

At MedStar Heart Institute, our cardiac specialists work to reduce the risks of dangerous heart arrhythmia and sudden cardiac arrest. Among the treatment options we offer are:

  • Medications such as beta blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a defibrillator to correct dangerous heart arrhythmia with electric shocks
  • Lifestyle changes including avoiding very strenuous activity

Brugada Syndrome

In a properly functioning cardiovascular system, certain proteins operate ion channels, which control the flow of sodium, potassium, and calcium through the heart’s cells. These molecules are essential in the regulating the heart’s electrical activity. If this flow is disrupted, the heart’s electrical activity is also disrupted, leading to arrhythmia.

Medical experts have identified genetic mutations in some of these proteins, which can lead to Brugada Syndrome, an inherited disorder of the heart’s electrical system that causes heart arrhythmia (erratic heartbeat).

If left untreated, Brugada syndrome can lead to:

  • Ventricular fibrillation: a rapid, uncoordinated heartbeat
  • Sudden cardiac death: heart stoppage because of severe arrhythmia

Symptoms

Brugada syndrome often shows no warning signs. Your physician may first find it during an electrocardiogram (EKG). Unfortunately, the first sign may be sudden cardiac arrest (heart stoppage because of severe arrhythmia) or death.

Other symptoms of Brugada syndrome include:

  • Fainting (most common symptom)
  • Seizure during rest or sleep
  • Disturbed sleep, including nightmares
  • Difficulty breathing, especially during rest or sleep
  • Heart palpitations (fluttering or pounding in your chest)

Diagnosis and Treatment

MedStar Health cardiac experts usually find Brugada syndrome during an electrocardiogram (EKG). However, people with the syndrome may sometimes have normal EKGs. If your physician suspects Brugada syndrome, further tests to confirm a diagnosis include:

  • Drug challenge using an intravenous sodium channel blocker to see whether the Brugada EKG pattern can be brought out
  • Genetic testing to look for defective genes
  • Diagnostic imaging, including cardiac MRI and echocardiogram, to rule out other conditions
  • Electrophysiologic (EP) study, a cardiac catheterization procedure, to evaluate susceptibility  to arrhythmias

If you or a family member are diagnosed with Brugada syndrome, screening of other family members is very important. We offer genetic screening for heart conditions.

At MedStar Heart and Vascular Institute, our cardiac team focuses on controlling heart arrhythmia and preventing sudden cardiac arrest. Currently, the only effective treatment for Brugada Syndrome is surgery to implant a defibrillator to correct dangerous heart arrhythmias with electric shocks.

Your physician may also recommend you avoid certain medications, as well as promptly treat any fevers.

Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC)

ARVC is an inherited genetic disorder caused by mutations in genes responsible for certain proteins that connect heart cells. It caused heart muscle tissue—usually in the right ventricle (lower chamber)—to break down, replacing it with scar tissue and fat.  

ARVC disrupts the heart’s normal electrical activity and causes heart arrhythmia (irregular heartbeat) in the ventricles. Arrhythmias are life threatening and can lead to sudden cardiac arrest and death, especially in young people and athletes who are otherwise healthy.

Symptoms

ARVC may not cause symptoms, especially in the early stages of the disease. In many people, the first signs are:

  • Heart palpitations (fluttering or pounding in your chest)
  • Fainting
  • Sudden cardiac death (heart stoppage caused by arrhythmia), usually during strenuous activity

Diagnosis and Treatment

Diagnosing ARVC can be problematic because symptoms are often difficult to detect. If your medical or family history suggests that you may have ARVC, your physician will confirm a diagnosis with further tests, which may include:

  • Standard electrocardiogram (EKG) to check for problems with your heartbeat
  • Exercise EKG (or stress test) to detect heartbeat problems that may not appear on a standard EKG
  • Event monitor to record your heart’s electrical activity over time to detect heart arrhythmia
  • Diagnostic imaging, including cardiac MRI and echocardiogram, to evaluate your heart’s structure for any abnormalities
  • Electrophysiology (EP) study through cardiac catheterization to assess susceptibility to arrhythmia
  • Genetic testing to look for defective genes associated with ARVC

If you or a family member are diagnosed with ARVC, it’s very important for other family members to be screened for the syndrome.  We offer genetic screening for heart conditions.

At MedStar Heart Institute, our treatment goals for ARVC focus on preventing sudden cardiac arrest by controlling heart arrhythmia. Treatment options we may recommend include:

  • Medications such as beta blockers or anti-arrhythmic drugs to help regulate heart contractions
  • Surgery to implant a defibrillator to correct dangerous heart arrhythmia with electric shocks
  • Lifestyle changes such as:
    • Avoiding very strenuous activity
    • Avoiding stimulants including caffeine, nicotine and certain decongestants

Coronary Artery Disease

In coronary artery disease, the coronary arteries narrow from plaque, a substance made up of fatty deposit, building up on the coronary artery walls. Narrowing of the coronary arteries may cause the following symptoms:

  • Chest pain (angina)
  • Shortness of breath
  • Pain in the left arm or neck
  • Plaque can also rupture, causing a complete blockage of the artery and a heart attack.

Treatment

  • Medical, including a daily drug regimen
  • Percutaneous intervention, including the placement of stents to open any blockages
  • Surgical, including bypass surgery
  • Lifestyle modification, including a healthy diet, exercise and quitting smoking

MedStar Heart & Vascular Institute is a national leader in treating patients using the off-pump approach— heart surgeries done on beating hearts, as opposed to surgery while on cardiac bypass—and approximately half of coronary artery disease patients are operate d on this way. By using this technique, we may reduce potential adverse effects of cardio-pulmonary bypass.

Our cardiologists also use the latest technological advances in stents and catheter-based devices to treat coronary artery and valvular heart disease. Our advanced imaging techniques allow us to diagnose and treat a wide range of vascular and structural heart issues.

For information or appointments, please call 855-463-3320.

Heart Attack Symptoms

A heart attack, also known as a myocardial infarction, occurs when an area of heart muscle dies or is permanently damaged due to an inadequate supply of oxygen to that area.

Heart Attack Symptoms

  • Chest pain or other pain, which radiates from the chest to the arms or shoulder; neck, teeth, or jaw; abdomen or back. The pain can be intense and severe or quite subtle and confusing and can feel like:
    • Squeezing or heavy pressure
    • A tight band on the chest
    • An elephant sitting on your chest
    • Bad indigestion
    • Anxiety
  • Cough
  • Fainting
  • Feeling of impending doom
  • Lightheadedness or dizziness
  • Nausea or vomiting
  • Shortness of breath
  • Sweating, which may be profuse

Diagnostic Tools

  • Angiography
  • ECG
  • Echocardiogram
  • Stress Test

Treatment Options

Both medication and surgery are options for treating heart attack patients.

Contact Information

For information or appointments, please call 855-463-3320.

Related Information

Women may experience different symptoms than men. Read more about our Women’s Heart Program.

Aortic Disease (Dissection and Aneurysm)

The aorta, the body's largest artery, delivers blood from the heart to the rest of the body. When disease is present, the aorta can tear (dissect) or dilate to form an abnormal widening or ballooning called an aneurysm. These conditions may lead to rupture of the aorta, which may be life threatening.

Treating acute aortic disease requires the proper integration of surgical, interventional (stents), and medical techniques to achieve the best outcome possible for patients. MedStar Heart & Vascular Institute physicians are expertly trained, and have experience managing the most difficult cases of aortic dissection and aneurysm. We treat our patients with

  • A multidisciplinary approach with cardiologists, cardiovascular surgeons, and vascular surgeons
  • Surgical, endovascular, and medical management treatments, decided upon by a combined team on a case by case basis
  • Endovascular (minimally-invasive procedure that reduces recovery times and reduces the rates of infection) techniques with excellent outcomes

Aortic Aneurysm

Aortic aneurysms occur when the aorta wall, thinned and weakened from atherosclerosis, swells and balloons. The following types exist:

  • Thoracic aortic aneurysms are located in the upper aorta, in the chest, and are usually repaired with stent-grafts.
  • Abdominal aortic aneurysms (AAA) occur in the abdominal section of the aorta and often enlarge over time. Most do not cause symptoms and may be discovered during a routine examination or as part of a test performed for another condition. Occasionally, patients may feel abdominal or back pain. AAA in the thirteenth leading cause of death in the United States and is more common in males. Patients over the age of 65 who are prior or current smokers are particularly at risk. 
  • Peripheral aneurysms refer to those aneurysms that affect arteries other than the aorta. These are most commonly located in the legs. Most patients have no symptoms. Peripheral aneurysms generally do not rupture but may embolize (send) a clot from within the aneurysms to the arteries downstream. Occasionally, this is a limb-threatening condition.

Aortic Dissection

Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart).

There are two types of aortic dissections, depending on where the tear begins and ends:

  • Type A: This type is more common and more dangerous. In these cases, the tear occurs in the ascending aorta where it exits the heart and extends down through the descending aorta. The tear may extend into the abdomen. Type A cases usually require emergency surgery.
  • Type B: This type involves a tear in the descending aorta only, which may also extend into the abdomen. Depending on where the tear develops, our doctors may recommend medication or surgery.

Risk Factors

  • Chronic high blood pressure
  • Genetic conditions such as Marfan syndrome
  • Chest trauma
  • Aortic aneurysm

Symptoms

  • Back or chest pain
  • Changes in thinking ability, confusion, disorientation
  • Clammy skin, sweating
  • Cough
  • Decreased movement or sensation, any location
  • Dizziness, fainting, nausea, and vomiting
  • Dry skin/mouth, thirst
  • Excessive yawning
  • High blood pressure
  • Intense anxiety, anguish
  • Pallor (paleness)
  • Rapid pulse or weak/absent pulse
  • Shortness of breath

Diagnostic Tools

  • Angiography
  • Cardiovascular MRI
  • CT Scan
  • X-ray
  • Echocardiogram

Treatment Options

  • Medications, such as antihypertensives, drugs to lower blood pressure or cardiac medications such as beta-blockers
  • Surgery, including: 

Learn more about aortic dissection treatment.

Cardio-Oncology

If you are a patient with cancer and have heart problems , or you are a physician who needs to refer a patient for cardiac care, then you may know that help for these conditions is hard to find. Make an appointment or refer a patient.

MedStar Heart & Vascular Institute offers the first cardio-oncology program in the Greater Baltimore/Washington, D.C., metropolitan area.

Care for cancer and cardiac patients

Some chemotherapy and cancer treatments can worsen, or even cause heart problems in patients with cancer. Some patients also experience heart conditions after radiation treatment to the chest.

We offer a program designed to evaluate, diagnose and manage heart problems for patients who are being treated for cancer or who have already completed treatment. Our physicians can also determine if a patient with cancer may be at risk for developing a heart condition before or during cancer treatment. Further, we are doing important research in order to avoid drug complications in the future.

Learn more about cardio-oncology and our treatment and management.

Learn more about MedStar Heart & Vascular Institute's cardio-oncology program

Specially trained cardiologists with an interest in cancer treatment

Our cardiologists have a special interest in how cancer treatments may affect the heart. Our program includes a multidisciplinary approach where our cardiologists and oncologists (cancer physicians) work together to provide comprehensive care. Meet our physicians.

For referring physicians

If you have a cancer patient with cardiac issues, then please visit our For Referring Physicians page.

Make an appointment

Please contact us by calling 202-877-2162. You may also send an email to [email protected]

Learn more about cardio-oncology treatment at MedStar Washington Hospital Center.

Washington Adult Congenital Heart Center

AAcouple

If you were treated for congenital heart disease as a child, you know that pediatric cardiology is a robust field. However, it may not always be clear where you should turn for the continued, lifelong care you require.

MedStar Heart Institute and Children's National Medical Center have joined forces to fill that gap. Our partnership—the Washington Adult Congenital Heart Center (WACH)—is one of the few programs in the nation that caters to the complex needs of adult congenital heart patients. Locally, we are the only program in the Washington, D.C.-area dedicated to your care.

WACH merges the expertise of specialists at both the Heart Institute and Children's Hospital, building on the collective experience and innovations of adult and pediatric cardiology. Every member of our team has special training with congenital heart disease patients.

Procedures and Treatments

We regularly perform complex procedures, such as

  • Atrial septal defect closures,
  • Ventricular septal defect closures,
  • Patent foramen ovale (PFO) closures,
  • Complex hemodynamic and angiographic evaluations, and
  • Cardiac ablations and pacemaker/ICD insertions,

and treat conditions such as

  • Coarctation of the aorta,
  • Connective tissue disorders, such as Marfan syndrome and Loeys-Dietz,
  • Single ventricles (the Fontan procedure),
  • Tansposition of the great arteries,
  • Unrepaired heart disease (Eisenmenger's syndrome),
  • Epstein's anomaly, and
  • Tetralogy of Fallot.

Broad and diverse network

If you are an adult with congenital heart disease, you must constantly consider your unique medical history in your daily life and when undergoing even minor procedures. The experts at WACH make those decisions easier, by providing access to specialists in other fields, trained to understand your medical challenges. WACH has developed a broad network of health professionals in related subspecialties, including:

  • Cardiac surgery
  • Critical care
  • High-risk obstetrics
  • Gastroenterology
  • Pulmonology
  • General surgery
  • Psychiatry

Research

Ongoing research is vital to the advancement of this specialized field. We are constantly perfecting our understanding of congenital heart disease in adults, many of whom face an increased risk of cardiac conditions years after corrective surgery.

If you have a patient who has been diagnosed with a congenital heart defect, please refer them to us. We are collecting data on these patients so we can improve outcomes and share data among cardiac subspecialties.

Specialized medical training in congenital heart disease

Our doctors undergo in-depth training to understand the complex anatomy of congenital heart patients. This level of specialized training is unusual in the medical field. However, for our patients, it is critical to ensure our experts know exactly how to manage complex cases and anticipate future complications.

Our adult congenital heart disease physicians complete an extra one to two years of cardiology training in heart congenital disease. Across the country, there are fewer than 75 doctors with this specialized training.

  • Karen Kuehl, MD, MPH, director
  • Anitha John, MD, PhD
  • George Ruiz, MD

Follow My Heart: Empowering Patients

A key element in successfully transitioning our pediatric patients to the adult congenital heart program is the ability to manage their own care. Developed by doctors at Children's National Medical Center, the Follow My Heart program provides each patient with an online medical record that details his or her congenital heart disease. The patient owns the information and can control who has access to it.

The Follow My Heart program helps patient by:

  • Preventing unnecessary testing
  • Improving the follow-up rate of adolescent and adult patients
  • Reducing health care costs
  • Achieving better outcomes

Locations

MedStar Heart Institute
110 Irving Street, NW
Washington, DC 20010

Children's National Medical Center
11 Michigan Avenue, NW
Washington, DC 20010

If you are a patient, call our referral and appointment line: 202-877-DOCS (3627)
If you are a physician, call our consultation line: 202-877-7777

MedStar Rapid Transportation

460C9201Final

Just one call to MedStar Rapid Transportation connects our cardiac patients to critical ground and air transport services and to the experts that make up our heart care teams.

Air Transportation

MedSTAR Transport is accredited by the Commission on Accreditation of Medical Transport Systems and consists of four helicopters with bases strategically located throughout the Mid-Atlantic region to transport any critical care cardiac patients, as well as heart and hand trauma patients.

The standard flight crew consists of a pilot, critical care nurse, and a critical care paramedic, all of whom are trained to handle the full spectrum of adult and pediatric critical care patients. The medical crews are required to maintain the following certifications

  • DC, VA, MD, DE state licensure
  • National Registry for paramedics
  • ACLS, PALS, CPR, NRP, BTLS

Our pilots are required to be helicopter-instrument rated, and have a Class 2 medical certificate, and a minimum of 2,000 total flight hours/1,500 helicopter flight hours/1,000 helicopter hours as pilot in command /100 hours of unaided night-flight time as PIC/500 hours of turbine time.

Ground Transportation

MedStar Health partners with All American Ambulance whose ambulance and medical transportation services include basic and advanced life support and specialty care transports into or out of any MedStar Health facility.

The ambulance units are staffed by state-certified emergency medical technicians, nationally registered or state-certified paramedics, and registered nurses. A wheelchair-van service is available for clients who require assisted transportation but not an ambulance.

The fully-equipped fleet meets applicable industry and regulatory standards and is maintained in accordance with industry guidelines and replaced/updated regularly.

Specialists

With our highly qualified air and ground transportation teams, no one is far from MedStar Health’s interventional and medical cardiologists, cardiothoracic surgeons, and multi-specialty teams that include nurses, technologists, therapists, educators, and dietitians.

Communications Center

Our 24/7 communications center is always prepared to facilitate arrangements in moving patients from outlying facilities into the MedStar Health system: from expediting the referral and coordinating the transport to locating an admitting physician and making bed assignments.

Vascular Insufficiency

Venous insufficiency occurs when the veins do not efficiently return blood from the legs back to the heart, usually due to malfunctioning valves or a chronic blockage, both of which can occur after a deep vein thrombosis. Chronic venous insufficiency is one of the most common chronic conditions in the United States and worldwide.

Symptoms

  • Varicose veins
  • Swelling of the legs and pain in the extremities (dull aching, heaviness, or cramping)
  • Discoloration of the legs (often a brown discoloration)
  • Hard, thickened skin around the ankles
  • Ulceration of the skin around the ankle

Diagnosis

Chronic venous insufficiency is usually diagnosed by a history and physical examination. Duplex ultrasound is also commonly used for assessment of the veins.

Treatment

There are several treatment options for chronic venous insufficiency. In most cases, the initial treatment is conservative and nonoperative. This typically includes:

  • Compression garments or stockings
  • Unna's boots, which are gauze bandages coated with zinc oxide to create a semi-rigid boot
  • If conservative treatment is unsuccessful, a more invasive surgical treatment is pursued. This treatment is focused toward eliminating or lessening the effects of the damaged valve function in the veins. Options may include:
  • Sclerotherapy
  • Vein stripping
  • Valve replacement surgery
  • Endoscopic perforator ligation
  • Laser vein ablation

Vascular Malformations

The abnormal formation or development of blood vessels is generally referred to as vascular malformation. Abnormal blood vessel structure is usually congenital, meaning it is present at birth.

Abnormal blood vessels can prevent enough oxygenated blood from filling capillaries, the tiny blood vessels that connect the body's arteries and veins. In some people with vascular malformations, blood travels directly from the arteries into the veins without ever having reached the capillary system. When blood does not fill the capillaries, the blood tissues that would normally receive blood from them experience a lack of oxygen, as well as a buildup of waste products.

Types

The severity of these malformations varies greatly both within and among the following clinical groups:

  • Arteriovenous malformations
  • Capillary malformations (portwine stains)
  • Combined vascular malformations
  • Lymphatic malformations
  • Venous malformations

Vascular malformations are categorized as either slow flow or fast flow. These terms refer to the rapidity of blood flowing through the lesion.

  • Fast-flow lesions can lead to high output heart failure and may require specific treatment. Arteriovenous malformations are fast-flow lesions.
  • Capillary, lymphatic, and venous malformations are considered slow-flow lesions. Combined malformations may be either slow or fast flow.

Symptoms

When located in an extremity, vascular malformations might show as a birthmark, may stimulate the development of collateral blood vessels in the form of varicose veins, or can produce an enlargement of the limb or a lengthening of the limb by stimulating its bony growth centers.

The localized masses may be of various size, from small to huge, and at their surface the vessels may be vulnerable to injury and bleed or may break down and ulcerate.

Diagnosis

These lesions are diagnosed by both physical examination and by using a number of imaging techniques, including magnetic resonance imaging (MRI) and ultrasonography. In some cases, an angiogram is needed to assist in detailed treatment planning.

Treatment

Vascular malformations posses a highly individual nature and, therefore, treatment is decided case-by-case, based on the exact location of any malformation and the specific symptoms and risks posed by the malformation. Some vascular malformations may only require monitoring or compression garments and drug therapy.

For lesions that are only superficial, laser therapy is commonly used. Lesions that are deep may, however, require surgical removal and other therapies such as sclerotherapy.

Vascular malformations that cause persistent pain, ulceration, bleeding, blood clots, obstruction of major vessels, progressive limb asymmetry by overgrowth, or that interfere with limb function should be treated, often with the following:

  • Surgery
    The surgeon ties off and removes the arteries that feed blood into the malformation and removes the malformation.
  • Embolization
    Catheters are advanced into the lesions, and the malformed vessels are blocked, or embolized, with a variety of injectable particles, substances, or devices such as polyvinyl foam, biological glues, and absolute alcohol.
  • Radiosurgery
    Highly focused radiation is aimed directly at the blood vessels that comprise the malformation and cause them to close.

Vascular Disease

Your vascular system is your network of blood vessels that includes your arteries and veins. When your vascular system is healthy, blood travels freely through blood vessels, carrying oxygen and nutrients to every cell in the body.

Any condition that affects your blood’s circulation is considered vascular disease—whether your vessels harden and narrow from a buildup of plaque, a condition called atherosclerosis, or they swell and their walls become thin and rupture.

Slowed, interrupted, or decreased blood flow can reduce life expectancy by causing a host of problems, including:

  • Heart attacks
  • Stroke
  • Ruptured blood vessels, secondary to aneurysm formation
  • Kidney failure due to restricted blood flow
  • Limb loss

Symptoms

An estimated eight million to 15 million Americans have vascular disease, and at least half do not experience symptoms. Symptoms, such as leg pain, may be mistaken for other conditions, such as arthritis. In many cases, vascular disease has no symptoms until it results in a stroke, mini-stroke, or ruptured aneurysm.

Risk Factors

Several conditions and lifestyle factors increase a person's risk, including:

  • High cholesterol and lipid levels
  • High blood pressure
  • Diabetes
  • Family history of atherosclerosis
  • Smoking
  • Being overweight
  • Sedentary (inactive) lifestyle
  • High-stress lifestyle
  • Over age 50 or post-menopausal (though it can occur at any age)

Read more about conditions considered vascular disease:

Varicose Veins

Varicose veins are recognized as the blue, enlarged veins seen near the surface of the skin. These superficial veins work with deeper veins in aiding blood flow. Blood normally moves from the superficial to the deep veins with a series of valves to keep the flow going in one direction. But when the valves weaken, the blood flow reverses, moving back to the superficial veins. With time, pressure on the superficial veins increases and they engorge with blood.

Varicose veins can be painful and can make legs feel swollen, achy, itchy, or heavy. Legs also may tire easily or get cramps or sores. Left untreated, varicose veins can result in chronic swelling and leg ulcers.

Treatment

  • Endoluminal vein surgery is a minimally invasive procedure in which your vascular surgeon inserts a needle into the affected vein and closes the weak area using high frequency doses of light.
  • In a mini-incisional varicectomy, all the prominent varicosities are removed through several tiny (2.0-mm) incisions. The procedure is performed under local anesthesia and intravenous sedation on an outpatient basis. Patients can usually resume normal activities within 3-6 days depending on the extent of their varicose vein problem.

Risk and Prevention

Varicose veins generally run in the family. Pregnancy and weight gain also can lead to this problem. But there are ways to prevent varicose veins or to relieve the pressure. If you suffer from or are worried about varicose veins, try these tips:

  • Change positions often when standing or sitting.
  • Keep legs propped up while sitting and don't cross your legs.
  • Sleep with the foot of the bed elevated, with your feet higher than your head.
  • Avoid high heels and clothes that are tight around the waist and hips.
  • Keep a healthy weight.
  • Stretch your calves by going up on your toes.
  • Wear support stockings or pantyhose.
  • Exercise regularly. Walking is especially good.

Thoracic Aortic Anyeurism

A thoracic aortic aneurysm is an abnormal widening or ballooning of a portion of the aorta caused by weakness in the wall of the artery. Atherosclerosis is by far the most common cause, although it may be caused by a variety of conditions, including high blood pressure, congenital disorders (such as Marfan's syndrome), trauma, or, less commonly, syphilis.

Symptoms

Most patients have no symptoms until the aneurysm begins to leak or expand. Most non-leaking thoracic aortic aneurysms are detected by tests, such as a chest X-ray or a chest computed tomography (CT) scan that are being run for other reasons. Chest or back pain may indicate acute expansion or leakage of the aneurysm.

Diagnostic Tools

  • Aortic Angiography
  • CT Scan
  • X-ray
  • Echocardiogram

Treatment

  • Ascending aorta or aortic arch surgery
  • Descending thoracic aorta surgery

Structural Heart Disease

If you have structural heart disease, abnormalities exist in your heart muscles, valves, or major blood vessels. These defects can affect heart function and blood flow. Some structural heart disease is congenital (present at birth), while other cases develop later in life, due to injury, infection, or aging.

The specialists at the MedStar Heart and Vascular Institute are leaders in the field. We focus on routine and complex structural heart defects to offer you the full range of surgical and nonsurgical procedures that will help you best manage your condition.

Structural Heart Defects

  • Septal defects - The septum is the critical muscle wall separating the four chambers of your heart. It functions as a barrier that prevents blood from passing from one side of your heart to the other. Occasionally, holes or other abnormalities occur in the septum. These septal defects can be ventricular (located between the lower two chambers) or atrial (located between the upper two chambers).
  • Patent foramen ovale (PFO) - PFO is a common septal defect that happens when a naturally occurring opening between atria does not close after birth. It has been associated with stroke and migraine headache.
  • Valvular defects - Normal blood flow depends upon fully functioning heart valves. The mitral, aortic, tricuspid and pulmonary valves play a key role in the flow of blood through the heart. When the valves become hardened and narrow (stenotic), they cannot open fully, and blood flow is restricted. If the valves are unable to close completely (incompetent), blood flows in the opposite direction. In its most severe form, valvular disease can lead to congestive heart failure.

Major Blood Vessel Defects

The major blood vessels pump blood from the heart to the body and return the blood from the body back to the heart. Defects in these critical arteries and veins can prevent oxygen-rich blood from reaching the rest of the body. Conversely, these abnormalities can sometimes cause too much blood flow to the lungs. Major blood vessel defects can seriously affect heart function and overall health.

Treatment

  • Closure Procedures - Our physicians perform atrial and ventricular septal defect closures and have vast expertise in performing patent foramen ovale (PFO) closures, when clinically indicated. Learn more about adult congenital heart disease.
  • Valve Repair or Valve Replacement - Valve repair reduces complications and the need for future medication. Our physicians perform the highest percentage of valve repair procedures in the area and can replace valves that cannot be repaired. Learn more about Heart Valve Disease Treatments.
  • Aortic Disease Management - Our physicians are skilled in both surgical and endovascular management of aortic disease. We treat the largest volume of patients with aortic disease in the area and strive to bring you the most minimally invasive procedures whenever possible.

Renal Artery Disease

Also called renal artery stenosis, renal artery disease occurs when the artery that supplies blood to the kidneys is narrowed or blocked, most commonly by atherosclerosis. Atherosclerotic renal artery stenosis is usually seen in older individuals who may have vascular disease in other areas as well (such as the heart or legs). It may also be caused by medial fibroplasia, also called fibromuscular dysplasia, which occurs with abnormal development of the artery wall.

Renal artery disease can cause hypertension, though it is a much less common cause than primary (no underlying cause) hypertension, and treating it can improve or even cure the hypertension. In other cases, renal artery stenosis may cause poor kidney function and correcting the narrowing may improve kidney function.

Treatment

While traditional surgical methods (renal artery bypass) are sometimes still used to treat this condition, a newer, less invasive procedure called renal artery stenting has become more common. This is done by threading a tiny, balloon-tipped catheter through a small puncture in the groin to the site of the arterial narrowing. The balloon is expanded to enlarge the artery and a stent (a small, balloon-expandable metal tube or scaffold) is put in place to optimize the angioplasty result and minimize recurrences.

Peripheral Artery Disease

Peripheral arterial disease (PAD) refers to diseases of any of the blood vessels outside of the heart. PAD is a range of disorders that can affect the blood vessels in the legs, feet, arms, or hands.

The most common form of PAD is atherosclerosis (hardening of the arteries). Atherosclerosis is a gradual process in which cholesterol and scar tissue build-up to form a substance called plaque that clogs the inside of the artery. This build-up causes a gradual narrowing of the artery, which will decrease the amount of blood flow. When the flow of blood decreases, it results in a decrease of oxygen supply to the body's tissues, which in turn causes pain. When the arteries to the legs are affected, the most common symptom is pain, weakness, or cramping in the thigh, calf, foot, hip, or buttock when walking.

Diagnostic Tools

There are some relatively simple tests that can be done to determine if the arterial blood flow in your legs is normal.

  • Segmental pressure test - In this test, the blood pressure at several points in your leg is checked using a blood pressure cuff and a Doppler. Then you are asked to walk on a treadmill, followed by another check of your ankle pressure to determine if the pressure changed when you walked.
  • <li.Ultrasound scan - The scan produces images of arteries on a screen and is used to visualize the blood flow and locate blockages.
  • Arteriogram - In this test, dye is injected into the arteries while X-rays are taken. The dye "lights up" the arteries, allowing the area of blockage to be accurately pinpointed.

Treatment

The best treatment for PAD depends on a number of factors, including your overall health and the location, size and cause of the blockage. In some cases, lifestyle changes can be enough to slow the progress and manage PAD. Others will need surgical intervention to restore the blood flow to their legs. For that reason, your physician may recommend bypass surgery, a method of rechanneling blood flow around the obstructed artery. In this procedure, either a vein or a graft made from synthetic material is attached to the obstructed artery above and below the blockage to create a detour and increase flow to the legs.

Hypertension

High blood pressure, also called hypertension, occurs when the systolic pressure is consistently over 140 mm Hg, or the diastolic blood pressure is consistently over 90 mm Hg.

There are two categories of hypertension: essential and secondary. The majority of cases of high blood pressure are essential hypertension, a type of hypertension without specific reason, but caused because the body cannot regulate the blood pressure within normal range. Secondary hypertension is commonly caused by stenosis, or narrowing, of the renal (kidney) arteries.

Risk Factors

Most of the time, there is no identifiable cause for essential high blood pressure. Risk factors for high blood pressure (secondary hypertension) that results from a specific condition, habit, or medication may include:

  • Anxiety
  • Arteriosclerosis
  • Coarctation of the aorta
  • Diabetes
  • Drugs such as alcohol toxicity or cocaine
  • Excess sodium (salt) in the diet
  • Habitual alcohol use
  • Obesity
  • Pain
  • Renal artery stenosis
  • Renal disease
  • Stress

Symptoms

Patients with high blood pressure generally have no symptoms. If patients experience a mild headache along with any of the following systems, it may be a sign of dangerously high blood pressure (malignant hypertension) or a complication from high blood pressure:

  • Blood in urine
  • Chest pain
  • Confusion
  • Ear noise or buzzing
  • Headache
  • Heart failure
  • Irregular heartbeat
  • Nosebleed
  • Tiredness
  • Vision changes

Treatment

Changes in lifestyle such as weight loss, increased exercise, and a low fat diet with limited sodium intake may reduce hypertension. If these lifestyle changes do not work, medications for hypertension may include:

  • ACE inhibitors
  • Beta-blockers
  • Calcium channel blockers
  • Diuretics

Prevention

Steps to prevent or to reduce the risk of high blood pressure include:

  • Eating a low fat diet rich in fruits and vegetables and low in animal fat
  • Increasing exercising (as recommended)
  • Maintaining a healthy weight
  • Maintaining a proper diet
  • Modifying salt intake
  • Reducing alcohol consumption
  • Quitting smoking

Renovascular Hypertension

Renovascular hypertension, a form of secondary hypertension, occurs when the arteries that carry blood to the kidneys become narrow, usually because of a blockage.

For symptoms, treatment, and prevention see Hypertension above.

When medications and lifestyle changes do not work, surgical reconstruction of a damaged artery may be performed. Procedures, such as balloon angioplasty or stenting of the damaged artery may be used instead of surgery.

Tricuspid Insufficiency

Tricuspid insufficiency/tricuspid regurgitation is a disorder involving backward flow of blood across the tricuspid valve, which separates the right ventricle (lower heart chamber) from the right atrium (upper heart chamber). This occurs during contraction of the right ventricle and is caused by damage to the tricuspid heart valve or enlargement of the right ventricle.

Risk Factors

The most common cause of tricuspid regurgitation is not damage to the valve itself, but enlargement of the right ventricle, which may be a complication of any disorder that causes failure of the right ventricle.

Rheumatic fever, diet medications such as Phen-fen (phentermine and fenfluramine) or dexfenfluramine, and a congenital heart disease (Ebstein anomaly) are also risk factors for tricuspid regurgitation.

Rarely, tricuspid regurgitation is caused by an unusual tumor called carcinoid, which secretes a hormone that damages the valve. Other infrequent causes of tricuspid regurgitation include endocarditis, rheumatoid arthritis, radiation therapy, Marfan syndrome, and injury.

Symptoms

In the absence of high blood pressure in the lungs (pulmonary hypertension), tricuspid regurgitation is usually asymptomatic. If pulmonary hypertension and moderate-to-severe tricuspid regurgitation coexist, symptoms may include:

  • Active neck vein pulsations
  • Decreased urine output
  • Fatigue, tiredness
  • Generalized swelling
  • Swelling of the abdomen
  • Swelling of the feet and ankles
  • Weakness

Tricuspid Stenosis

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • EKG
  • Echocardiogram

Treatment

  • Tricuspid valve repair surgery corrects tricuspid insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly.
  • Tricuspid valve replacement surgery corrects both tricuspid stenosis and insufficiency
  • Valve replacement with mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
  • Valve replacement with biological (tissue) valves

Mitral Insufficiency

Mitral/mitral regurgitation (acute mitral regurgitation) is a disorder in which the heart's mitral valve suddenly does not close properly, causing blood to leak (back-flow) into the left atrium (upper heart chamber) when the left ventricle (lower heart chamber) contracts.

Symptoms

  • Chest pain, unrelated to coronary artery disease or a heart attack
  • Cough
  • Palpitations
  • Rapid breathing
  • Shortness of breath

Mitral Stenosis

Risk factors for mitral valve stenosis include rheumatic fever. Since rheumatic fever rates are declining in the United States, the incidence of mitral stenosis is also decreasing. Only rarely do other disorders cause this condition.

Symptoms

  • Chest discomfort
  • Cough
  • Difficulty breathing
  • Fatigue
  • Frequent respiratory infections
  • Palpitations
  • Swelling of feet or ankles

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • EKG
  • Echocardiogram

Treatment

  • Mitral valve repair surgery corrects mitral valve insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly
  • Mitral valve replacement surgery corrects both mitral stenosis and insufficiency
  • Valve replacement with mechanical valves created from manmade materials, which require long-term blood thinning with warfarin medication
  • Valve replacement with biological (tissue) valves

Heart Murmurs

The sound of your heart beating is the sound of the closure of your heart valves. When there is a problem with a valve (stenosis or regurgitation), the blood flow across the valves becomes turbulent. This causes a sound, which is heard as a murmur during an examination. Your doctor can usually hear the murmur while listening to your heartbeat using a stethoscope.

There are two types of heart murmurs: diastolic, when the heart muscle relaxes between beats, and systolic, when the heart muscle contracts to squeeze the blood through the chambers.

Diagnosis

  • Echocardiogram
  • CT Scan
  • MRI

Treatment

  • Medication
    • Valve surgery
    • Heart valve repair: Preferable, as keeping your own tissue is better than replacing a heart valve. This is most commonly performed in cases of mitral valve regurgitation (leakage) but may be possible in other situations, as well.
    • Heart valve replacement: Can be done using a variety of valves, including mechanical and tissue valves (pig or cow tissue). Learn more about heart valve disease and heart valve surgery

Aortic Insufficiency

Aortic insufficiency is a heart valve disease in which the aortic valve weakens or balloons, preventing the valve from closing tightly. This leads to backward flow of blood from the aorta (the largest blood vessel) into the left ventricle (the left lower chamber of the heart).

Risk Factors

In the past, rheumatic fever was the primary cause of aortic insufficiency. Now that antibiotics are used to treat rheumatic fever, other causes are more commonly seen, including

  • Ankylosing Spondylitis
  • Aortic Dissection
  • Endocarditis
  • High Blood Pressure
  • Marfan's Syndrome
  • Reiter's Syndrome
  • Syphilis
  • Systemic Lupus Erythematosus
  • Valve problems that are present at birth

Symptoms

  • Chest pain under the sternum may radiate; crushing, squeezing, pressure, tightness; pain increases with exercise, relieves with rest.
  • Shortness of breath and fainting
  • Fatigue
  • Irregular, rapid, racing, pounding, or fluttering pulse
  • Palpitations

Aortic Stenosis

Aortic stenosis is the narrowing or obstruction of the heart's aortic valve, which prevents it from opening properly and blocks the flow of blood from the left ventricle to the aorta.

Risk Factors

Aortic stenosis may be present from birth (congenital) or it may develop later in life (acquired). Other risk factors include valve calcification, being male, and rheumatic fever.

Symptoms

  • Breathlessness with activity
  • Chest pain, angina-type under the sternum, may radiate; crushing, squeezing, pressure, tightness; increased with exercise, relieved with rest
  • Dizziness
  • Fainting or weakness with activity
  • Palpitations

Diagnostic Tools

  • Cardiac Catheterization
  • X-ray
  • EKG
  • Echocardiogram

Treatment

  • Aortic valve repair surgery corrects aortic insufficiency; the damaged valve is strengthened and shortened to help the valve close more tightly.
  • Aortic valve replacement surgery corrects both aortic stenosis and insufficiency.
  • Patients who cannot undergo surgery—due to other conditions or because they are ill—may be candidates for a TAVR procedure.

Surgeons may consider replacing the original valve with either:

  • Mechanical valves, created from man-made materials, which require long-term blood thinning with warfarin medication.
  • Biological (tissue) valves

Heart Valve Disease

Dysfunction in one of the four heart valves—mitral, aortic, tricuspid, or pulmonary—leads to heart valve disease. Normally functioning valves ensure that blood flows in one direction. When dysfunction of the heart valves occurs, the valves may become narrow (valvular stenosis) or may leak (valvular regurgitation). This can lead to chronic heart problems including heart failure, shortness of breath and chest pain, or enlargement of the heart chambers.

To learn more about the types of heart valve diseases, follow the links below

Heart Failure

Congestive Heart Failure

The heart squeezes blood through the circulatory system and also relaxes to accept blood as it returns from the body and the lungs. Any disruption in the heart's ability to either squeeze (systolic dysfunction) or relax (diastolic dysfunction) can lead to failure of the heart to adequately pump blood, which is a disorder called congestive heart failure (CHF). This is different from a cardiac arrest, in which the heart actually stops beating.

Two kinds of congestive heart failure exist:

  • right-side heart failure, in which the heart cannot fill with enough blood
  • left-side heart failure, in which the heart does not have enough force to pump blood to the rest of the body

Often, heart failure is caused by coronary artery disease, in which a substance called plaque builds up in the arteries and makes it hard for blood to flow through the vessels to the heart muscle. As a result, the heart compensates by working at a higher pressure within its chambers. Higher pressures inside the heart can lead to substantial symptoms.

Risk Factors

  • Ischemia, heart attacks or poor blood flow to the heart
  • Valve leakage or valve obstruction
  • Viral or bacterial infection
  • Family history of heart failure
  • Alcohol abuse
  • Drug use, including cocaine
  • Idiopathic, meaning an unknown cause

Symptoms

  • Decline in exercise capacity
  • Shortness of breath
  • Chest discomfort
  • Fatigue
  • Swelling

Treatment

Medications are often considered the first line of therapy for patients with CHF. Medications used to improve the heart's function and the patient's ability to function normally include:

  • Ace inhibitors
  • Beta blockers
  • Aldactone
  • Hydralazine/isordil
  • Diuretics
  • Inotropic medication (medications that increase the squeezing capacity of the heart), as well as ultrafiltration for fluid removal.

As our physicians manage patients through various treatment strategies, we depend heavily on integrating our CHF team of specialists, which includes:

  • Cardiologists who cover the fields of heart failure transplantation, imaging, congenital heart disease, vascular disease and pulmonary hypertension.
  • Cardiac surgeons with experience in revascularization, valve repair and replacement, as well as advanced mechanical support (VADs) and transplantation.
  • Heart failure nurses and nurse practitioners
  • Dieticians
  • Physical therapists
  • Research coordinators
  • Social workers
  • Learn more about congestive heart failure treatments.
  • Ventricular Assist Devices

    In some cases, despite aggressive therapies, the heart muscle cannot adequately sustain the body's circulation. In those situations, advanced cardiac support, in the form of ventricular assist devices (VADs) or transplantation, may be considered in appropriate candidates.

    VADs can be used as a bridge to support patients awaiting heart transplantation or as destination therapy for some select patients who are not candidates for cardiac transplantation. VADs often allow patients to regain much of the functional capacity that they have lost to heart failure.

    Surgical Treatment

    If coronary artery disease is contributing to the heart's dysfunction, the team may consider coronary bypass surgery (CABG). If prior heart attacks have damaged key walls of the heart, surgical reconstruction or new devices may be also be used to improve heart function. If one or several of four heart valves are exacerbating the heart's dysfunction, surgical or percutaneous valve repair or replacement may be considered.

  • Hear George Ruiz, MD, talk about congestive heart disease diagnosis
  • Learn about congestive heart failure treatment at MedStar Washington Hospital Center
  • Heart Attack

    A heart attack, also known as a myocardial infarction, occurs when an area of heart muscle dies or is permanently damaged due to an inadequate supply of oxygen to that area.

    Symptoms

    • Chest pain or other pain, which radiates from the chest to the arms or shoulder; neck, teeth, or jaw; abdomen or back. The pain can be intense and severe or quite subtle and confusing and can feel like:
      • Squeezing or heavy pressure
      • A tight band on the chest
      • An elephant sitting on your chest
      • Bad indigestion
      • Anxiety
    • Cough
    • Fainting
    • Feeling of impending doom
    • Lightheadedness or dizziness
    • Nausea or vomiting
    • Shortness of breath
    • Sweating, which may be profuse

    Note: Women may experience different symptoms than men; read more about our Women’s Heart Program.

    Diagnostic Tools

    • Angiography
    • EKG
    • Echocardiogram
    • Stress Test

    Treatment Options

    Both medication and surgery are options for treating heart attack patients.

    • ACE Inhibitors
    • Beta Blockers
    • Thrombolytic Therapy (drugs used to break up or dissolve blood clots)
    • Angioplasty
    • Coronary Artery Bypass Surgery (CABG)

    Deep Vein Thrombosis

    Deep vein thrombosis (DVT) is a blood clot that forms in the large veins of the arms or legs. These clots can travel through the bloodstream to the brain or heart, and can cause a stroke or pulmonary embolism (PE).

    Causes

    • Trauma to the vein's inner lining. These may include surgery, serious injury, inflammation or an immune response.
    • Blood flow is sluggish or slow. This can be caused by lack of movement for long periods of time, such as sitting on an airplane or in a car for many hours, or after surgery .
    • Thicker-than-normal blood. Certain genetic conditions can increase blood's tendency to clot.

    Symptoms

    • Pain, tenderness, swelling, warmth, or discoloration of the leg
    • Dilation of the superficial veins in the affected limb
    • Shortness of breath or chest pain

    Post-thrombotic Syndrome

    Post-thrombotic syndrome (PTS) is a late-complication that occurs in 25-33% of patients with DVT. It typically occurs within two years of diagnosis, despite appropriate treatment with blood thinners. PTS consists of chronic leg pain (aching or cramping), leg heaviness, itching or tingling, swelling, redness, varicose veins and leg discoloration. These symptoms are typically more pronounced upon standing or walking for long periods and relieved upon rest. PTS can lead to venous stasis ulcers in some patients.

    Treatment

    Treatment options for acute DVT include anticoagulation with blood thinners (like heparin or warfarin) and pharmacomechanical thrombolysis, in which clot-busting drugs are delivered through a small catheter placed inside the blocked vein, followed by mechanical removal of the clot itself.

    All patients with DVT should be treated with 3-6 months (or longer) of anticoagulation and wear elastic compression stockings, which have been shown to reduce the incidence of PTS.

    Coronary Artery Disease

    In coronary artery disease, the coronary arteries narrow from plaque, a substance made up of fatty deposit, building up on the coronary artery walls. Narrowing of the coronary arteries may cause the following symptoms:

    • Chest pain (angina)
    • Shortness of breath
    • Pain in the left arm or neck
    • Plaque can also rupture, causing a complete blockage of the artery and a heart attack.

    Treatment

    • Medical, including a daily drug regimen
    • Percutaneous intervention, including the placement of stents to open any blockages
    • Surgical, including bypass surgery
    • Lifestyle modification, including a healthy diet, exercise and quitting smoking

    MedStar Heart Institute is a national leader in treating patients using the off-pump approach— heart surgeries done on beating hearts, as opposed to surgery while on cardiac bypass—and approximately half of coronary artery disease patients are operate d on this way. By using this technique, we may reduce potential adverse effects of cardio-pulmonary bypass.

    Our cardiologists also use the latest technological advances in stents and catheter-based devices to treat coronary artery and valvular heart disease. Our advanced imaging techniques allow us to diagnose and treat a wide range of vascular and structural heart issues.

    Congenital Defects and Disease

    Congenital heart disease is a term that describes a number of different conditions caused by abnormal or disordered heart development before birth. Although congenital heart disease, by definition, is present at birth, its effects may not be obvious nor may present for many years.

    A congenital heart defect most often occurs as an isolated incidence and is generally not associated with other diseases, there are a few genetic and chromosomal syndromes that can also cause heart defects, including:

    • Down syndrome
    • Ellis-van Creveld syndrome
    • Marfan syndrome
    • Noonan syndrome
    • Trisomy 13
    • Turner's syndrome

    Drugs, chemicals, and infections during pregnancy may also cause congenital heart abnormalities. In infants, fetal rubella, maternal alcohol use (fetal alcohol syndrome), and use of retinoic acid (for acne), may also cause of congenital heart disease. In addition, if a pregnant woman has congenital heart disease, she should notify her doctor so her fetus may be checked during the pregnancy.

    Treatment

    Surgical treatments are tailored to correct the specific congenital abnormality. The most common include closing a patent foramen ovale and/or an atrial septal defect (ASD).

    Learn more here about the Washington Adult Congenital Heart Center

    Carotid Artery Disease

    Your carotid arteries extend from your aorta to your brain and supply your brain with blood. If the internal carotid artery is blocked (by plaque buildup as a result of atherosclerosis) blood supply to your brain is reduced and can cause a stroke. In fact, carotid blockages are responsible for more than half of all strokes.

    Symptoms

    Most patients do not know they have carotid artery disease because it is often asymptomatic, but even without symptoms, a stroke can occur. If symptoms or warning signs of a stroke are present, they are called transient ischemic attacks, and they include:

    • Weakness, numbness, or a tingling sensation on one side of the body
    • Loss of control or the movement of an arm or a leg
    • Vision loss in one eye (many people describe this sensation as a window shade coming down)
    • Losing the ability to speak clearly

    Diagnosis

    X-ray studies using special dyes, called carotid angiograms, can show the degree of blockage of the carotid arteries. Other tests, such as ultrasound and magnetic resonance angiography can visualize blockages in the carotid arteries.

    Treatment

    • For less severe stenosis, treatment includes lifestyle modification, such as smoking cessation and medication, including aspirin and anti-cholesterol medications.
    • Carotid artery surgery (also known as carotid artery endarterectomy), is a surgical procedure to manually remove fat and cholesterol build-up from inside the carotid artery and restore adequate blood flow to the brain to help prevent a stroke.
    • Angioplasty with stenting is a less invasive procedure in which a catheter is inserted through a nick in the skin (usually in the groin) and threaded under X-ray guidance to the carotid artery. A balloon is inflated to compress the plaque against the wall of the blood vessel and open up the artery.

    Cardio-Oncology

    Some chemotherapy and cancer treatments can worsen or cause heart problems in patients with cancer. Some patients also experience heart conditions after radiation treatment to the chest.

    To that end, MedStar Heart Institute offers their cardio-oncology program to evaluate, diagnose, and manage heart problems in patients being treated for or who have already completed treatment for cancer.

    This program includes a multidisciplinary approach where our cardiologists and oncologists (cancer physicians) work together to provide comprehensive care. We use the latest tests and diagnostic criteria to help patients understand their risk factors for heart failure and other associated conditions. These include

    • Echocardiography
    • Echo strain imaging
    • Cardiac biomarkers
    • Cardiac MRI

    This state-of-the-art imaging allows our cardiologists a full view of the heart's function, giving them critical real time information that helps them evaluate your potential risk for developing a cardiac condition while undergoing cancer treatment. Your diagnosis also reveals if there is a way to receive these drugs safely, without damaging your heart. If you already have a heart condition, these advanced images provide important information for the best possible treatment.

    Program Goals

    • Ensure better outcomes for patients with cancer and cardiac issues
    • Provide earlier detection of cardiac toxic side effects from cancer treatments
    • Prevent or reduce further cardiac damage—and, when possible, reverse it
    • Monitor patients with potential cardiac issues who are receiving cancer treatments
    • Better understand cardiac issues in patients with cancer by participating in research studies
    • Eliminate cardiac disease as a barrier to effective cancer therapy

    Research

    Our cardiologists are conducting important research about why certain types of cancer treatments compromise heart function and searching for ways to prevent damage to the heart while still undergoing these cancer treatments. Because not a lot of data exists in this field, clinical research is critical. This is why the Cardio-Oncology Program is building a database of patients, their cancer treatments, and their heart complications, so we can help future patients and design better cancer drugs.

    For appointments and more information, please contact us by calling 202-877-2162.
    You may also use our online form to request an appointment.

    Cardiopulmonary Disease

    Cardiac and pulmonary diseases are conditions that affect the lungs and heart. Cardiac rehabilitation may benefit those who have experienced a recent heart attack or cardiac surgery, as well as other heart-related health problems. Pulmonary rehabilitation may be beneficial to individuals with asthma, chronic bronchitis, chronic obstructive pulmonary disease (COPD), emphysema, or other lung conditions.

    Cardiomyopathy

    Cardiomyopathy is a weakening of the heart muscle or a change in heart muscle structure. It is often associated with inadequate heart pumping or relaxation or filling with blood. Cardiomyopathy can be caused by viral infections, heart attacks, valve disease, alcoholism, long-term severe high blood pressure, and sleep disorders that affect breathing.

    Symptoms

    • Fatigue
    • Shortness of breath with exertion or at rest
    • Edema of feet and legs or abdominal swelling
    • Decreasing ability to tolerate physical exertion
    • Cough
    • Palpitations, rapid heartbeat, or irregular heartbeat
    • Loss of appetite or getting full easily

    Diagnostic Tools

    • Echocardiogram
    • X-ray
    • ECG
    • Exercise Stress Test
    • Angiography
    • MRI
    • Heart Biopsy

    Treatment Options

    • ACE inhibitors
    • Beta blockers
    • Diuretics
    • Digoxin
    • Medicines that help the heart contract, such as hydralazine and nitrates.
    • Vasodilators

    If medications alone do not work, physicians may consider the following treatment options:

    • Biventricular pacemaker/defibrillator (cardiac resynchronization therapy).
    • Pacemakers with defibrillation functions
    • Internal (implantable cardioverter defibrillator) defibrillator (ICD)

    In severe cases, surgeons may also consider the following procedures to sustain life until a transplant donor becomes available:

    • Coronary bypass surgery
    • Repair or replacement of heart valves
    • Left ventricular assist device (LVAD)

    Cardiac Arrhythmia

    Cardiac arrhythmias are disturbances in the normal rhythm of the heartbeat. Arrhythmias may be a sign of heart disease and can lead to other cardiac symptoms. Because arrhythmias can be life threatening, it is critical to have your heart evaluated by an expert cardiologist. Cardiologists who diagnose and treat patients for cardiac arrhythmias are known as electrophysiologists.

    Watch the video to learn about Bill's experience with A-Fib:

    VIDEO

    Symptoms

    • Changes in the rate, rhythm or pattern of the pulse
    • Chest pain
    • Fainting
    • Fast or slow heart beat (palpitations)
    • Light-headedness, dizziness
    • Paleness
    • Shortness of breath
    • Skipping beats
    • Sweating

    Risk Factors

    • Anti-arrhythmic medications
    • Blood chemistry imbalances
    • Caffeine
    • Illicit drug use
    • Endocrine abnormalities
    • Inappropriate use of amphetamines or other stimulants
    • Prior heart attack
    • Use of certain prescription medications

    Types

    Fast Heart Rhythms

    A typical heart beats 60 to 100 times a minute. Faster than this is a fast heart rhythm, known as supraventricular tachycardia (SVT). This rapid, erratic beat can cause the body to receive an inadequate blood supply.

    SVT Types

    • <strong.Atrial fibrillation keeps the heart from pumping blood efficiently, causing blood to pool inside the heart. Eventually this blood forms clots, setting up a dangerous situation where stroke, pulmonary embolism, or heart attacks can occur.
    • Paroxysmal Supraventricular Tachycardia (PSVT) is an abnormal heart rate that occurs sometimes. This form of SVT is caused by too many electrical signals in the heart at once. This causes overload, and the heart begins to beat too quickly.
    • Atrial Flutter occurs when the top two chambers of the heart beat too quickly and the lower two chambers-the ventricles-beat too slowly. This condition most often occurs in the elderly and is dangerous because it can cause a stroke.
    • Atrial Tachycardia is caused by too many electrical signals in the heart, specifically the atria; the two upper chambers of the heart. These signals cause the heart to beat too quickly, causing palpitations, breathlessness and possible anxiety.

    Slow Heart Rhythms

    Each day, a normal heart contracts 60 to 100 times a minute. Abnormally slow heart rates are typically those fewer than 60 beats a minute. These slow heart rhythms, referred to as bradycardias, can be life threatening. Bradycardia is usually treated with an implantable cardiac device known as a pacemaker.

    Palpitations

    Palpitations are usually felt as an unusual pattern to a person's heartbeat, like skips or jumps. This sensation is usually uncomfortable for people and can sometimes signal that there is a heart problem. It is critical to be examined by a cardiologist with experience in evaluating and treating palpitations.

    Syncope

    Syncope is caused by a temporary loss of consciousness, known commonly as fainting. It is caused by low blood pressure—the heart cannot effectively pump enough blood to the brain, affecting the oxygen supply and causing the person to pass out. While syncope alone is not life threatening, it may sometimes be a symptom of a more serious condition and should be evaluated as soon as possible.

    Diagnostic Tools

    • EKG
    • Holter/Event Monitor
    • Tilt Table Test
    • Electrophysiology (EP) Study
    • T Wave Alternans
    • Genetic testing
    • Echocardiogram
    • CT Scan
    • MRI
    • PET Scan
    • Loop Recording

    Treatments

    • Medical management
    • Implantable cardioverter defibrillators (ICDs)
    • Pacemakers
    • Implantable loop recorders
    • Catheter ablations, including:
    • Atrial fibrillation ablation
    • Percutaneous epicardial ablation program
    • Ventricular tachycardia ablation
    • Intra-operative ablations
    • Laser lead extractions
    • Arrhythmia management in congenital heart disease

    Cardiac Arrhythmia Center

    MedStar Washington Hospital Center opened the area's first Cardiac Arrhythmia Center in 1985 and has remained in the forefront of new techniques to evaluate and manage patients with a wide variety of arrhythmias.

    Our electrophysiologists (cardiologists who diagnose and treat cardiac arrhythmias) perform more than 4,500 procedures annually, using advanced diagnostic tools. These procedures include:

    • Approximately 1,500 electrophysiology studies
    • Approximately 500 ablations
    • More than 1,000 pacemaker and defibrillator implantations
    • More than 500 additional procedures, including tilt table tests, cardioversions, and other diagnostic and therapeutic procedures

    Our sophisticated electrophysiology lab is a new, state-of-the-art, eight-laboratory facility that offers the latest in high technology fluoroscopy and advanced heart mapping equipment. We regularly participate in clinical trials and are one of the first institutions in the nation to offer leadless defibrillators for the treatment of life-threatening arrhythmias.

    Center for Complex Arrhythmia Therapy

    The Center for Complex Arrhythmias is a specialized center for arrhythmias that are challenging to treat, such as:

    • Atrial fibrillation (AF)
    • Atrial tachycardia
    • Ventricular tachycardia
    • Other uniquely difficult rhythm problems

    MedStar Heart and Vascular Institute physicians who staff our Center for Complex Arrhythmia Therapy have proven expertise in tough arrhythmias. They routinely receive cases transferred from other physicians and health care facilities.

    Aortic Disease (Dissection and Aneurysm)

    The aorta, the body's largest artery, delivers blood from the heart to the rest of the body. When disease is present, the aorta can tear (dissect) or dilate to form an abnormal widening or ballooning called an aneurysm. These conditions may lead to rupture of the aorta, which may be life threatening.

    Treating acute aortic disease requires the proper integration of surgical, interventional (stents), and medical techniques to achieve the best outcome possible for patients. MedStar Heart & Vascular Institute physicians are expertly trained, and have experience managing the most difficult cases of aortic dissection and aneurysm. We treat our patients with

    • A multidisciplinary approach with cardiologists, cardiovascular surgeons, and vascular surgeons
    • Surgical, endovascular, and medical management treatments, decided upon by a combined team on a case by case basis
    • Endovascular (minimally-invasive procedure that reduces recovery times and reduces the rates of infection) techniques with excellent outcomes

    Aortic Aneurysm

    Aortic aneurysms occur when the aorta wall, thinned and weakened from atherosclerosis, swells and balloons. The following types exist:

    • Thoracic aortic aneurysms are located in the upper aorta, in the chest, and are usually repaired with stent-grafts.
    • Abdominal aortic aneurysms (AAA) occur in the abdominal section of the aorta and often enlarge over time. Most do not cause symptoms and may be discovered during a routine examination or as part of a test performed for another condition. Occasionally, patients may feel abdominal or back pain. AAA in the thirteenth leading cause of death in the United States and is more common in males.
    • Peripheral aneurysms refer to those aneurysms that affect arteries other than the aorta. These are most commonly located in the legs. Most patients have no symptoms. Peripheral aneurysms generally do not rupture but may embolize (send) a clot from within the aneurysms to the arteries downstream. Occasionally, this is a limb-threatening condition.

    Aortic Dissection

    Aortic dissection is a condition in which there is bleeding into and along the wall of the aorta (the major artery from the heart).

    There are two types of aortic dissections, depending on where the tear begins and ends:

    • Type A: This type is more common and more dangerous. In these cases, the tear occurs in the ascending aorta where it exits the heart and extends down through the descending aorta. The tear may extend into the abdomen. Type A cases usually require emergency surgery.
    • Type B: This type involves a tear in the descending aorta only, which may also extend into the abdomen. Depending on where the tear develops, our doctors may recommend medication or surgery.

    Risk Factors

    • Chronic high blood pressure
    • Genetic conditions such as Marfan syndrome
    • Chest trauma
    • Aortic aneurysm

    Symptoms

    • Back or chest pain
    • Changes in thinking ability, confusion, disorientation
    • Clammy skin, sweating
    • Cough
    • Decreased movement or sensation, any location
    • Dizziness, fainting, nausea, and vomiting
    • Dry skin/mouth, thirst
    • Excessive yawning
    • High blood pressure
    • Intense anxiety, anguish
    • Pallor (paleness)
    • Rapid pulse or weak/absent pulse
    • Shortness of breath

    Diagnostic Tools

    • Angiography
    • MRI
    • CT Scan
    • X-ray
    • Echocardiogram

    Treatment Options

    • Medications, such as anti-hypertensives, drugs to lower blood pressure or cardiac medications such as beta-blockers
    • Surgery
    • Coronary Artery Bypass Graft (CABG)
    • Heart valve surgery (aortic valve replacement)
    • Repair or replacement of the section of the aorta
    • Learn about aortic disease.
  • Learn more about MedStar Washington Hospital Center's cardiac care offered.
  • Angina

    Angina is a specific type of chest discomfort caused by inadequate blood flow through the blood vessels of the heart muscle. The discomfort or pain is felt anywhere along the front of the body between the neck and upper abdomen and is relieved by rest or medication within a short period of time (usually 15 minutes). Chest pain of a longer duration or pain appearing with a lower level of effort than before, even at rest, should be considered unstable angina.

    Diagnostic Tools

    • CT Scan
    • Angiography
    • EKG
    • Stress Test

    Treatments

    • Aspirin
    • Beta-blockers
    • Calcium Channel Blockers
    • Enhanced External Counterpulsation (EECP)
    • Nitroglycerin
    • Oral nitrates
    • Other medications to control high cholesterol, high blood pressure, or abnormal heart rhythms.

    If medications fail or in more severe cases, physicians may recommend one of the following treatment options:

    • Angioplasty and Stenting
    • Coronary Artery Bypass Grafting (CABG)

    Transcatheter Aortic Valve Replacement (TAVR)

    TAVR is a treatment procedure for patients with aortic stenosis who are too ill to undergo traditional open-heart aortic valve replacement surgery.

    During a TAVR procedure, your doctor replaces your diseased aortic valve with a new valve. Instead of opening your chest, your doctor uses a catheter (small tube) to thread the valve through a small incision in the groin or the chest wall. During this procedure, your heart remains beating the entire time.

    Studies have shown that patients achieve better outcomes when they undergo a TAVR procedure than they do with medication alone.

    Evaluation for TAVR

    The first step is to complete a TAVR Assessment, so we can gather information about your heart health. Once the TAVR Assessment is complete, the TAVR team will be able to review your case and make a recommendation. You will not receive a new valve during the TAVR assessment.

    We will call you to schedule you for either an office visit or a cardiac catheterization. During this visit, you should bring a list of your medications. Your assessment will include:

    • Questions for you about your everyday life, what you can and cannot do for yourself, your living situation, and your heart symptoms.
    • Medical checkup during which a doctor or nurse practitioner will ask you questions about your heart and your health.
    • Cardiac surgeon consultation to review your chart and examine you to determine a best recommendation for conventional aortic valve replacement, TAVR or medications.
    • Questions from you and your family about your treatment options.

    Making a decision

    Once your TAVR Assessment is complete, the team will discuss all the information we have about you, your heart and your general health, to make a recommendation about the best treatment option for your severe aortic stenosis. If you and your physician decide you will have a TAVR procedure, you will need the following tests:

    • Cardiac Echocardiogram (Echo): This ultrasound of your heart provides information about your heart valves and how well your heart functions.
    • Cardiac Catheterization (Angiogram): A cardiologist will perform this test to study the function of your heart and heart valves and to measure pressures within the chambers of the heart.
    • Transesophageal Echocardiogram (TEE): If the doctors need more information after your cardiac echocardiogram, you will be scheduled for a TEE, a more detailed echocardiogram that uses the esophagus to look at your heart.
    • Computed Tomography (CT) Scan: This painless 30-minute test uses X-ray technology and computers to give your doctors information they need about your heart and/or your leg arteries.

    The TAVR Team

    If you are considering a TAVR procedure, be assured you are in the best possible hands. The MedStar Heart Institute was the fourth cardiac center in the country to perform clinical trials on the TAVR procedure. We perform 70 TAVR procedures each year, making us one of the top five cardiac centers in the nation for this procedure. Our TAVR team—including cardiologists, cardiac surgeons and interventional cardiologists—have worked closely together to improve our overall heart valve program, based on what we've learned from the TAVR clinical trials.

    The principal investigators in our TAVR trials include:

    • Paul Joseph Corso, MD, team leader for cardiac surgery
    • Augusto D. Pichard, MD and Lowell F. Satler, MD, team leaders for cardiology
    • Petros Okubagzi, MD, director, clinical trials

    VIDEO

    Request an evaluation for the TAVR procedure. If you have any questions about TAVR, or if your heart condition changes a lot while you are waiting for the procedure, please call MedStar Heart Institute's TAVR Team at 202-877-5975.

    Minimally Invasive Heart Surgery

    Traditional heart surgery requires the surgeon to cut open the patient's chest and through the breastbone. Minimally invasive heart surgery allows MedStar Health cardiac surgeons to work through small incisions only three to four inches long, using elongated instruments and scopes. This kind of surgery leads to less pain; shorter hospital stay and recovery time; smaller scars; and lower risk of infection, bleeding, and blood transfusion.

    MedStar Health heart surgeons perform minimally invasive heart valve surgery and Coronary Artery Bypass Graft (CABG) surgery.

    Left Ventricular Assist Devices (LVAD)

    Because healthy hearts that are appropriate for transplantation are rare, the medical community has turned to advanced technology to find different ways to treat patients with heart failure. An LVAD is a mechanical circulatory assist device that helps pump blood from the failing heart into the aorta. It often helps reduce the number of repeat hospitalizations for patients with serious heart disease.

    MedStar Health heart surgeons implant LVADs while the patient waits for a transplant, allowing the patient to strengthen the heart and body through physical therapy. These devices may also be used for short-term purposes, allowing the heart to rest long enough so that it can recuperate and return to normal, independent function.

    Consistent Innovation

    At MedStar Heart Institute at MedStar Washington Hospital Center, one of our heart surgeons, Steven W. Boyce, MD, was the first surgeon in the United States to implant a new battery-sized artificial assist device into a patient. Always on the cutting-edge of advanced heart technology, the hospital is currently participating in a clinical trial to examine patients’ health while using these devices.

    Leadless Defibrillator: Subcutaneous Implantable Defibrillator

    Approximately 450,000 people in the U.S. succumb to sudden cardiac arrest (SCA)—an abrupt loss of heart function—each year. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation.

    For patients who are at risk of SCA, MedStar Heart Institute now offers a new, innovative, leadless defibrillator—the world’s first and only subcutaneous implantable defibrillator (S-ICD).

    In cases of life-threatening arrhythmias, a leadless defibrillator shocks the heart to restore normal rhythm. The S-CID is the first heart defibrillator implanted beneath the skin that does not require wires placed within the heart. It provides reliable defibrillation while leaving the heart’s blood vessels untouched. Since leads (wires) do not have to be inserted into the heart, the S-ICD procedure is much simpler. In addition, the removal or replacement of the device is much easier, and reduces the potential risk for vascular injury and infection.

    Patients who might be good candidates for the new leadless defibrillator include:

    • Young patients who want to preserve their blood vessels (or vasculature) for future procedures
    • Patients who are very overweight and will have better outcomes with a defibrillator that sits right below the skin
    • Those patients who have already had prior vascular procedures, making their blood vessels no longer suitable to place leads within them.
    • Patients who are at particularly high risk for blood infections (for example, patients on dialysis or who have indwelling catheters)

    Heart Transplant

    Heart transplantation continues to be the gold standard for selected individuals suffering from severe heart failure. However, due to the shortage of donor organs and the significant engineering advances in the field of mini-portable circulatory assist devices, known as LVADs, the actual number of heart transplants done in the United States slowly continues to decline.

    Heart Valve Surgery

    Your cardiologist may refer you to a MedStar Health cardiac surgeon to repair or replace your heart valve if medication has failed to reduce the strain on your heart and has not alleviated symptoms.

    Your cardiac surgeon may recommend one of the following surgeries, depending on your pathology and what is causing the problem:

    • Heart valve repair is the preferred treatment option, because using your own tissue is better than replacing a heart valve.
    • Heart valve replacement can be performed using a variety of valves, including mechanical and biological tissue valves (those from pig or cow tissue). Mechanical valves require the use of blood thinners but have good long-term durability. Biological valves do not require use of long-term blood thinner.
    • Valve sparing is a relatively new technique used to treat aortic disease. Your heart surgeon can preserve your own valve while repairing the aorta.
    • Heart valve surgery (whether valves are repaired or replaced) is open-heart surgery that is done while you are under general anesthesia. A cut is made through the breastbone (sternum). Your blood is routed away from your heart to a heart/lung bypass machine. This machine keeps the blood circulating during your heart surgery.

    Endarterectomy

    Although it may be performed on any artery, this procedure most commonly treats carotid artery disease (carotid endarterectomy). In an endarterectomy, the surgeon opens the artery and removes the blockage. This type of open surgery is best for short blockages.

    Coronary Artery Bypass Graft (CABG) Surgery

    Coronary artery bypass graft surgery (CABG surgery) is one of the most common heart surgeries MedStar Health cardiac surgeons perform. You may have heard people call this bypass surgery. Your doctor will recommend a CABG (pronounced like the vegetable cabbage) when blood does not flow easily through the arteries of the heart and/or blood vessels narrow, reducing the flow of blood to the heart.

    CABG surgery creates alternate routes for blood to flow to the heart, bypassing the natural arteries. Instead of removing the blockages in the coronary arteries, your heart surgeon will use a vein from your chest or leg to construct detours around the blockages and into the heart. These grafts allow the flow of oxygen-rich blood to the heart muscle.

    At MedStar hospitals, our heart surgeons perform half of these surgeries as beating-heart surgeries, meaning they do not need to use the heart/lung bypass machine.

    Beating Heart Bypass

    In beating-heart bypass surgery, the heart continues to beat naturally, eliminating the need for a heart/lung machine or pump. Prongs are placed on a specific area of the heart, stabilizing that area while allowing the heart to continue beating.

    This process avoids many of the complications that can arise from the use of the heart/lung machine, such as stroke, increased need for blood transfusions, kidney and lung complications, and lengthy hospital stays. Also, stopping the heart is too traumatic and dangerous for some patients to endure. The beating-heart procedure enables a larger, more diverse population to undergo bypass surgery.

    Recovery from this procedure is also faster and most patients return to normal activities sooner.

    At MedStar Health, anyone requiring heart bypass surgery is a candidate for beating-heart surgery. You and your doctor will discuss whether beating-heart surgery is appropriate for you. The decision depends on your overall health, the severity of your coronary artery disease, the number of arteries requiring bypass and other factors.

    Aneurysm Repair

    An aneurysm is a blood-filled, balloon-like bulge in a weakened artery caused by the pressure from blood flow. Aortic aneurysms occur in the aorta, the main artery of the heart. There are three types, depending on the location in the body:

    • Abdominal aortic aneurysms occur in the section of the aorta that passes through the abdomen.
    • Thoracic aortic aneurysms occur in the chest area. They may involve the aortic root, ascending aorta, aortic arch, or descending aorta.
    • Thoracoabdominal aortic aneurysms occur in the aorta as it passes through both the abdomen and chest.

    Surgery often is required to treat aneurysms. If left untreated, aneurysms could burst, a potentially fatal situation, or cause an aortic dissection or tear.

    • Endovascular aneurysm repair (EVAR)
      An endovascular treatment takes place inside your arteries. EVAR is a minimally invasive procedure using long, thin tubes called catheters that your surgeon threads through your blood vessels.
    • Open aortic aneurysm repair
      Open surgery in an operating room under general anesthetic is necessary when there is bleeding inside your body from an aneurysm, or when you are at risk for an aneurysm bursting.
    • Complex arch replacement and the elephant trunk
      Patients with extensive aortic aneurysms involving the artery around and including the aortic arch may require this more complex surgical procedure. This procedure takes place in an operating room and involves general anesthesia.

    Surgery

    MedStar Heart & Vascular Institute’s cardiac surgeons have a reputation as the best in the region and among the finest in the nation—that has a lot to do with our commitment to a team approach to care. Our cardiac surgeons work in teams with other cardiac experts, including cardiac imaging specialists, interventional cardiologists, pulmonologists, radiologists, and nurses to complete the entire picture for each patient.

    The advantage of experience

    We are one of the highest volume cardiac surgery centers in the central Maryland and Washington regions. Volume and experience also translate into best practices based on outcomes. Our entire team sees a large number of patients per year. We continually refine surgical techniques, so you receive the least invasive surgical option that will also bring the best long-term results.

    Better patient care

    We have compiled a cardiac surgery database containing data on more than 60,000 cases from the past 30 years. This unique resource helps us continually improve patient care. It gives our physicians a direct window on the practices and approaches that produce the most successful outcomes for our patients. Few cardiac centers have anything like it.

    Sophisticated communication

    Our information management and communications capabilities are powerful resources for integrating MedStar Heart & Vascular Institute services and locations, from enabling real-time sharing of patient images and data to supporting electronic medical records. This means you can receive advanced cardiac care no matter your location-at one of our sister hospitals, or at one of our satellite locations.

    Advanced heart surgical care

    Consider these facts:

    • The Society for Thoracic Surgeons awarded us three stars, its highest rating, based on quality and outcomes.
    • Nearly half of our CABG (Coronary Artery Bypass Graft) procedures are performed off-pump (without using a heart and lung machine), which speeds recovery and reduces bleeding, neurologic impairment and other complications.
    • We are the only hospital in the region to offer the Transcatheter Aortic Valve Replacement (TAVR), a minimally invasive procedure performed for severe aortic stenosis.
    • Our patients have access to clinical trials in better methods to prevent and treat cardiac and vascular disease.

    Read more about the ways in which MedStar Heart & Vascular Institute cares for your heart.

    Stenting