Pensacola Heart Health                                                                                        Opening Rema...
And the Beat Goes On
Cardiologists, Surgeons Join
Forces to Provide Quality Care                                          ...
Meet W.H. Langhorne Jr., MD

Philanthropic Efforts
                                                                                             Dr. Als...   7
      AT HEART
      Women and Heart
      Disease: An Equal
      Opportunity Killer
      By Thanh Ha Duong-Wagner...
effects of these variables during youth and                 Thanh Ha Duong-Wagner,                training in echocardiogr...
Protect Your Heart
                                                                             The two basic types of PVD...
the arteries in the abdomen, pelvis, and           Heart Association, the most effective    In this procedure, a vein from...
               Surgery Centers
               Doctors’ Offices
               Rental Linens
               Full ... 13
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1717 N. “E” St. Ste. 331
Pensacola, FL 32501-6376
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  1. 1. Pensacola Heart Health Opening Remarks A publication from Welcome to the inaugural issue of Pensacola Heart Health. The mission of Cardiology Consultants, PA, is to exceed expectations while providing high-quality car- diovascular care for our patients and consultative serv- CARDIOLOGISTS: ices for referring physicians. We aim to practice in a W. H. Langhorne Jr., MD, FACC manner that enhances the personal and professional William S. Pickens, MD, FACC lives of our employees, our families, and ourselves. W. Daniel Doty, MD, FACC, FAHA Edwin W. Rogers, MD, MBA, FACC We feel this goal is best accomplished through zealous G. Ramon Aycock, MD, FACC continuing education, planned practice responses to our community’s F. James Fleischhauer, MD, FACC changing needs, and cost-conscious practice standards that do not com- S. Marcus Borganelli, MD, FACC promise quality. W. Henry Langhorne III, MD, FACC Brent D. Videau, MD, FACC We are proud of our history, having provided cardiology services to the Andrew Scott Kees, DO, FACC Safwan Jaalouk, MD, FACP FACC, FSCAI , Pensacola community since 1977. Two key founding physicians are still Elias G. Skoufis, MD, FACC active in the practice today. Since the 1970s, the group has practiced on the Thanh H. Duong-Wagner, MD, FACC Baptist Hospital and the Sacred Heart Hospital campuses. In 2004, we Thabet Alsheikh, MD, FACC added a full-time office on the Gulf Breeze Hospital campus. Muthu Velusamy, MD, FACC Sumit Verma, MD, FACC From its modest beginnings, the practice has grown manyfold, encom- Hani A. Razek, MD, FACC Roger E. Moraski, MD, FACC passing cardiothoracic surgery and the subspecialties of interventional Steven J. Schang Jr., MD, FACP FACC , cardiology and electrophysiology. Thomas D. Paine, MD, FACC Martha J. Stewart, MD, FACC, FSCAI Cardiology Consultants physicians have participated in a number of CARDIOTHORACIC SURGEONS: Pensacola “firsts,” including the development of the first coronary care unit, James L. Nielsen, MD, FACS the performance of the first balloon angioplasty (percutaneous translumi- James L. Lonquist, MD, FACS nal coronary angioplasty, or PTCA), the introduction of electrophysiology, William F. Bailey, MD, FACS the first minimally invasive cardiac surgery, and more. Today, the physicians NURSE PRACTITIONERS AND PHYSICIAN ASSISTANTS: remain on the cutting edge of each of their respective areas of interest. Richard Clark, PA-C Sara Hulme, PA-C We hope you enjoy our new magazine! Tanya Duffey Warner, MSN, ARNP-C Kevin Harris, PA-C Sincerely, Teresa Yates, MSN, ARNP-C Michael Sweet, MSN, ARNP-C Drew Watson, PA-C Jennie Lowery, MNSc, ARNP-C Elizabeth Berg, ARNP-C Patrick Pagan, ARNP-C Andrew Radoszewski, MBA, MPH, CMPE Ralph DeCapua, PA-C Administrator Starr Jacobus, MSN, ARNP-C Kathleen Ouzts, ARNP-C Rebecca Cower, PA-C 4 And the Beat Goes On Erin Armstrong, PA-C Douglas S. Baker, PA-C Cardiologists, Surgeons Join Forces to Provide Quality Care William Nate Taylor, PA-C Contents 6 Philanthropic Efforts ADMINISTRATOR: Local Physicians Extend Expertise to Health Care Overseas Andrew Radoszewski, MBA, MPH, CMPE 8 Young at Heart MAGAZINE COORDINATOR: Women and Heart Disease: An Equal Opportunity Killer Frances Kahler-Ropp, LCSW 10 Protect Your Heart LOCATIONS: Recognizing the Signs of Peripheral Vascular Disease Baptist Campus Gulf Breeze Campus Baptist Medical Towers Medical Office Building 14 Directory 1717 N. “E” St. Ste. 331 1118 Gulf Breeze Pkwy. Ste. 102 Pensacola, FL 32501-6376 Gulf Breeze, FL 32561-4836 (850) 444-1717 (850) 932-1775 Pensacola Heart Health is published by QuestCorp Media Group, Inc., 885 E. Collins Blvd., Ste. 102, Richardson, TX 75081. Phone (972) 447-0910 or (888) 860-2442, fax (972) 447-0911, Sacred Heart Campus QuestCorp specializes in creating and publishing corporate magazines for businesses. Inquiries: Victor Regional Heart and Vascular Institute Horne, Editorial comments: Brandi Hatley, Please call or fax 5151 N. 9th Ave. Ste. 200 for a new subscription, change of address, or single copy. Single copies: $5.95. This publication may not be Pensacola, FL 32504-8721 reproduced in part or in whole without the express written permission of QuestCorp Media Group, Inc. QC (850) 857-1700 Creative is a full-service graphic design firm, Creative services inquiries: Jalynn Turner, 3
  2. 2. And the Beat Goes On Cardiologists, Surgeons Join Forces to Provide Quality Care By Diane M. Calabrese Written in every name, there is a rich story up-to-date knowledge, technology, and ies. The anticoagulant clinic streamlines of comings and goings, endeavors, and chal- skills to best serve Pensacola and north- the focus of attention on individuals lenges. It’s true of Cardiology Consultants, western Florida,” says Dr. Langhorne. “We taking drugs such as warfarin (e.g., PA, which has made its home in Pensacola, strive to provide a level of patient care Coumadin ) to lower the risk of thrombo- ® Florida, since 1977. In that year, founders comparable to that in large metropolitan sis, or blood clots in the circulatory W.H. (Henry) Langhorne Jr., MD; Charles and academic centers.” system. More than 100,000 diagnostic and Riley, MD; and William Pickens, MD, estab- lished Cardiology Associates, PA. The name Keeping pace with advances in medical changed to the current one in 1983 when research is a given for everyone at Dr. Riley left the practice. Cardiology Consultants. It includes partic- ipation in research and clinical studies led Today, the roster at Cardiology Consultants by three dedicated research coordinators. includes 21 cardiologists and three cardio- Clinical drug trials and thrombolytic stud- vascular surgeons who serve northwestern ies, as well as interventional, pacing, ICD Florida and southern Alabama. The prac- (implantable cardioverter defibrillator), tice has more than 200,000 patient encoun- and electrophysiology (EP) trials and pro- ters per year at its three offices and the tocols have ensued in recent years. three hospitals that it serves. To ensure patients receive the best care in a The structure of Cardiology Consultants timely way, Cardiology Consultants also enables patients to find the care they need has a full staff of nurse practitioners and in one setting. “To have both cardiologists physician assistants. The roster at Cardiology Consultants includes 21 and surgeons in the same group is not that cardiologists and three cardiovascular surgeons. common,” says Andrew Radoszewski, To improve accessibility for patients, MBA, MPH, CMPE, and Administrator for Cardiology Consultants has three Florida therapeutic procedures are performed by Cardiology Consultants. “I believe we are locations — two in Pensacola and one in the physicians and staff of Cardiology the only one of our kind in the southeast- Gulf Breeze. They are the Sacred Heart Consultants each year. ern United States. With both cardiologists campus at the Regional Heart and Vascular Of course, Cardiology Consultants is not Institute, the Baptist campus at Baptist and surgeons, we make the best medical just about treatment. Prevention is of para- Medical Towers, and the Gulf Breeze decision for the patient’s treatment, mount concern. The practice works with campus at the new Medical Office Building. whether it be stent placement by a cardiol- patients to help them achieve healthy ogist or open heart surgery by a surgeon.” A full complement of diagnostic services is diets, whether for weight, sodium intake, Constancy and Clarity available in the campus setting, including or cholesterol management. stress testing, an anticoagulant clinic, “The group’s philosophy has always been echocardiography, nuclear cardiology, The physicians and clinical staff at to maintain quality care with the most heart catheterizations, and vascular stud- Cardiology Consultants can help patients Important Dates in Cardiology Consultants, PA, History 1964: Dr. Langhorne introduces 1965: The first community 1970: The Sacred Heart Hospital 1972: Treadmill exercise testing 1977: Drs. Langhorne, Pickens, phonocardiography, vectorcardiog- coronary care unit in the South- cardiac catheterization laboratory and hemodynamic monitoring are and Riley incorporate Cardiology raphy, the Master’s Two Step exer- east United States opens at is started as a joint venture by introduced at Baptist Hospital; Associates, PA. cise test, apex cardiography, and Baptist Hospital. the medical community. first catheterization laboratory the photomotogram as a screening opens at Baptist Hospital. procedure for thyroid function. 4 Pensacola Heart Health
  3. 3. Meet W.H. Langhorne Jr., MD While the printed words of Dr. W.H. (Henry) Langhorne Jr. appear in medical journals, they also fill the pages of other literary works — poetry books. At work on his fourth book of poetry, Dr. Langhorne fits into the same physician- poet category as William Carlos Williams (1883-1963). He is the current Poet Laureate of northwestern Florida. Dr. Langhorne earned his undergraduate degree at The University of the South at Sewanee, Tennessee, an institution imbued with a strong literary tradition. From there, he went to the School of Medicine at Tulane University in New Orleans. After completing an internship and residency at Charity Hospital in New Orleans, Dr. Langhorne moved to Pensacola, Florida. He has held a membership in the Baptist Hospital medical staff since 1963, holding the titles of Chairman of the medical board, President of the medical staff, and Medical Director. He has also earned a Hollinger Heart disease prevention is a paramount concern at Cardiology Award for outstanding service as a physician. Consultants. “I came from a family of physicians and pharmacists,” identify the best combination of lifestyle changes and medica- says Dr. Langhorne. The heart and circulatory system tions to keep blood pressure within an appropriate range. captured his attention early in his medical studies. One of Dr. Langhorne’s three children followed in his foot- Vigor and Vision steps; W.H. Langhorne III, MD, is also a member of Cardiology Consultants attracts and retains talented health care Cardiology Consultants. professionals, as well as administrative staff. For instance, when The elder Dr. Langhorne says his patients and the advances Radoszewski joined the group in 2002, he brought 20 years of in cardiac care are foremost on his mind. “Cardiology has experience to the position. grown in an explosive way since the mid-1960s,” he says. “There are constant new developments, medications, Radoszewski has served as an administrator in hospitals, devices, and procedures that have benefited my cardiac ambulatory surgery centers, heart institutes, and medical group patients beyond expectation.” practices. This range of experience allows him to coordinate the activities at Cardiology Consultants in a way that contributes to excellence and efficiency. “Consistent availability and continuity of care for patients is the “We are all committed to providing the best cardiac care to our signature of Cardiology Consultants,” says Radoszewski. patients,” Dr. Langhorne says. “Over the many years since its The physicians of Cardiology Consultants are also passionate inception, Cardiology Consultants has remained one of the most participants in continuing education. As the senior member of successful, longstanding, and largest cardiovascular practices in the practice, Dr. Langhorne sets the tone with which all Florida. Its evolution was unique — in fact, a rarity. And its the physicians resonate. Starting in his earliest days as a physician future looks bright because it has grown on the principle that the more than four decades ago, he became a lifelong student most talented will always attract and recruit the most talented of medicine. future associates.” 1983: The practice is rein- 1983-1992: A number of important procedures and programs are 1994: Dr. Borganelli performs the 2000: Outpatient catheterization corporated as Cardiology initiated by the group, including intravenous and intracoronary throm- first pectoral implant ICD in the laboratories are constructed at Consultants, PA; Dr. Trantham bolysis, dual-chamber and rate responsive pacemaker implantations, state of Florida. the Sacred Heart and Baptist is recruited as the first carotid and vascular ultrasound, Doppler echocardiography, stress offices; noninvasive studies, electrophysiologist in echocardiography, transesophageal echocardiography, pharmacologic including echocardiography and Northwest Florida. nuclear stress testing, balloon valvuloplasty, telemetry event monitor- nuclear stress testing, are under- ing, direct coronary atherectomy, and radio frequency catheter ablation. taken at the Sacred Heart, Baptist, and Gulf Breeze offices. 5
  4. 4. Philanthropic Efforts Dr. Alsheikh’s three-day advanced pacing workshop this year was an eight-hour-per- day course, which he uniquely fully trans- lated into Arabic. The workshop included Local Physicians Extend hands-on participation for select partici- pants and live video monitoring for the audience. This year, he added a training Expertise to Health Care course in ICD implantation and hopes to offer North American Society for Overseas Pacing and Electrophysiology (NASPE) cer- tification with the eventual goal of helping to establish full EP fellowship training Philanthropy encompasses the ideal of giv- in Syria. ing back — not only money but also time SAMS’s impact on Syrian health care in and knowledge. Two Florida physicians general is much greater than new concepts have embraced the philanthropic concept and procedures. Until now, there were no of promoting human welfare by organizing enforced physician CME requirements for the Syrian American Medical Society, or procedures or official implementation of SAMS. The purpose of SAMS is to give evidence-based guidelines. back a portion of the medical education they received in the United States. SAMS’s larger impact on Syrian health care is reflected in the lectures given this year Five years ago, Mazen Daoud, MD, and in the opening plenary session by that Cardiology Consultants Cardiologist country’s Ministers of Health and of Thabet Alsheikh, MD, among a dozen Higher Education, with topics including other physicians, decided to commit one “Physicians Training in Syria: Is It Time to week per year to medical education in Syria Unify the Standards?” and “Can the Health and independently organized small confer- Care System Survive Without Account- ences in Damascus. ability, Clinical Guidelines, and Quality Assurance?” Several SAMS members were When they later discussed their experi- invited to attend the first Expatriates ences, Dr. Daoud suggested forming an Convention in October 2005 to promote organization of American-trained Syrian Dr. Thabet Alsheikh with an award for his Syrian health care reform. physicians to initiate a larger, multispecial- humanitarian efforts ty conference. The following year, Dr. Giving Back Alsheikh performed the first surgical pro- This year’s conference provided 81 U.S.- accredited CME hours in 23 specialties. Each year, the United States recruits and cedure during the conference in Syria by retains many of the brightest international implanting his first dual-chamber pace- This training was done through 32 didactic sessions and 16 advanced workshop cours- physicians from around the world, yet very maker, which was consistent with his vision few physicians “give back” through sharing es at 14 hospitals and teaching centers in of teaching not only cognitive skills but their training with their native countries. A four Syrian cities. More than 200 Syrian- also procedural skills to Syrian physicians. tremendous, largely untapped potential American physicians traveled to Syria this exists for collaborative international edu- As SAMS’s first President, Dr. Daoud saw year to provide 122 of the 150-member cation and research. Few individuals like his brainchild become a reality when conference faculty, accomplishing the Dr. Daoud and Dr. Alsheikh have the initia- SAMS organized its first official continuing largest CME conference ever held in Syria. tive to commit hundreds of personal hours medical education (CME) conference in Positive Impact to originating such programs. Syria. Dr. Alsheikh, Vice President of SAMS and Convention Chairman of next year’s The impact of SAMS and the annual Many physicians, both international and conference, was Scientific Chairman of this conference is truly profound. In cardiac those born in the United States, however, year’s conference. electrophysiology in Syria, for example, are willing to share their time, ideas, and before these conferences, there were no energies if organizations such as SAMS and For five years, SAMS physicians have inde- dual chamber pacemaker implants, abla- the American College of Cardiology pendently funded all conference activities, tions, or ICD (implantable cardioverter commit to sowing the seeds of such pro- bringing in millions of dollars worth of defibrillator) implants; no electrophysio- grams. International bridges built through donated supplies for use in treatment-indi- logy (EP) laboratories or training courses; the sharing of medical knowledge and the gent patients. Spurred by the success of the and no standardized protocols for BLS commonality of human values and aspira- conference, SAMS has now grown to more (basic life support) or ACLS (advanced tions can do nothing but good for medicine than 500 members in the United States. cardiac life support). and, in a larger perspective, our world. 6 Pensacola Heart Health
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  6. 6. YOUNG AT HEART Women and Heart Disease: An Equal Opportunity Killer By Thanh Ha Duong-Wagner, MD Although there is widespread publicity Understanding Gender Differences differences in the diagnosis and treatment regarding women and breast cancer, of heart disease. which is responsible for one in every 30 Underrepresentation of women and lack of female deaths, much less is said about a gender-specific reporting in many clinical Examining the Risk Factors woman’s risk of heart disease and stroke. trials have limited the data availability Cardiovascular risk factors include previ- These diseases are implicated, in fact, in needed to devise optimal management ous personal history of CHD, an age over one out of every 2.5 female deaths. While strategies for women with coronary heart 55 years, dyslipidemia (high LDL and/or heart disease is traditionally perceived disease (CHD). An example is seen in low HDL cholesterol), diabetes, hyperten- as a male problem, statistics indicate it is the Framingham study, which reported a sion, smoking, peripheral vascular disease, the leading cause of death in women over good prognosis for women with angina. or a first-degree male relative (younger the age of 25 years. Unfortunately, the study did not include a than 55 years) or female relative (younger sufficient number of women to address than 65 years) with CHD. Elevated triglyc- The incidence of myocardial infarction gender-specific questions. erides, obesity, and a sedentary lifestyle, (MI) is lower in premenopausal women, while not considered primary risk factors, but it increases rapidly It is likely that this conclusion reflected a are also commonly associated with higher after menopause. Dolores high prevalence of women with chest pain coronary risk. Strickland, a patient at originating from diseases other than those Cardiology Consultants, is affecting the coronary arteries. It is also As women age, their risk equals and even- 74 years old. At the age of 61 likely that this lack of detailed gender-spe- tually outpaces that of men. Postmeno- years, she had her first heart cific results has led to incorrect decisions pause is an additional, gender-specific risk attack. “My family has no concerning investigation and treatment factor for CHD. Essential hypertension also Dolores Strickland history of heart problems,” alternatives, resulting in an inability to presents itself differently in men and the retired nurse says. “I am not a smoker. I identify the high-risk woman in time. women. While there are obvious hormonal have low blood pressure and low choles- “I had no chest pain or early symptoms differences between the sexes before terol. So I was very surprised when I was except jaw pain, which is a common menopause, the arterial tree ages different- told it was a heart attack.” ly after menopause. At all ages, the shorter symptom in women,” says Strickland. “My stature in women and the obligatory short- advice is to not ignore the symptoms.” Ten years later, Ms. Strickland had a er arterial tree that results induce faster second heart attack and eventually Clinical trial results are usually used to heart rates and earlier reflected arterial underwent triple-bypass surgery. “After set standards for both sexes, despite the pulse waves. These factors operate to influ- my triple bypass, I recovered very well fact that most research is performed ence systolic blood pressure (BP), pulse and was able to have a regular home life,” almost exclusively on men. This bias com- pressure (PP), PP amplification, diastolic says Strickland. pounds our inability to understand gender time, and diastolic BP. The circulatory 8 Pensacola Heart Health
  7. 7. effects of these variables during youth and Thanh Ha Duong-Wagner, training in echocardiography and vascular with aging help explain the time-depend- MD, received her undergradu- medicine at the University of Michigan-Ann ent and aging differences in cardiovascular ate degree from the University Arbor. She is board certified in internal med- risk between men and women. of Wisconsin and her medical icine, cardiovascular diseases, and adult degree from the University of comprehensive echocardiography. She is a Metabolic syndrome — a collection of Wisconsin Medical School. Her member of the American College of health risks that increase the chance of postgraduate training included a residency Cardiology, American Society of Echocardi- developing heart disease, stroke, and dia- in Internal Medicine at Hennepin County ography, and Heart Failure Society of betes — is also associated with subsequent Medical Center in Minneapolis-Minnesota, America. She joined Cardiology Consultants CHD events and increased mortality. Most a fellowship in cardiology, and advanced in July 1999. researchers believe it is caused by a combi- nation of genetic makeup and lifestyle choices, including the types of food we eat Go Red for Women By Phil Vinall and physical activity levels. In its second year, the Go Red for then retreats, only to return. Other signs Overall, women have a higher prevalence Women campaign is intent on inform- include vague pain, discomfort, or pres- of metabolic syndrome than men. ing women about the deadly conse- sure in other areas of the upper body, Screening for metabolic syndrome in quences of ignoring coronary heart shortness of breath, cold sweats, nau- women with high risk for new vascular disease (CHD) symptoms. “Men re- sea, or lightheadedness. Unfortunately, incidents may help identify patients with cover and women die,” says Thanh H. because they do not recognize the even higher atherosclerotic vascular risk. Duong-Wagner, MD, a cardiovascular symptoms, women often wait too long Confronting the Problem disease specialist, when asked why before seeking help. this campaign is so important. Recommendations for women at risk for According to Dr. Duong-Wagner, cardiovascular disease include regimented Of the total number of U.S. deaths women are generally not aware of their in 2001 attributed to CHD, women exercise programs, smoking cessation, unique risks, often shrug off early represented 53.6% of all deaths and weight control, a low-fat diet, treatment for symptoms, and tend to delay seeking men represented 46.4%. A significant hypercholesterolemia (elevated LDL, or treatment, stating they do not want to portion of these women had no previ- low-density lipoprotein, cholesterol levels), bother others with their health prob- ous symptoms. control of hypertension and diabetes, and lems. They often feel they do not have avoidance of contraceptives for women the time to seek medical attention. By who smoke. Interventions recommended the time women finally seek medical for high-risk women include more aggres- attention for their symptoms, they are sive treatment of hypercholesterolemia and older with concurrent diseases, and the use of folic acid supplementation their heart disease may have pro- in presence of hyperhomocysteinemia. In gressed to a more advanced stage. At addition, daily aspirin (75 to 162 mg), this point, coronary revascularization beta-blocker treatment in patients with becomes more complicated and can known coronary artery disease, and the result in higher mortality and morbidity. reduction of BP to less than 130/80 may have added benefits. For these reasons and many others, the grassroots campaign provides tips Gender-difference ignorance on the part of and information to women on how they the patient and health care worker limits can minimize their risk. In addition to the optimal management of women with Frances Kahler-Ropp, LCSW, and Carol Moore, RN, (both from Cardiology Consul- Go Red spokesperson R&B vocalist heart disease. More thorough education tants) assisting with heart risk assessments Toni Braxton, a number of celebrities during office visits, earlier and more during the Go Red campaign have lent their names to the cause. They aggressive control of coronary risk factors, include Bill Cosby, Antonio Banderas, and a greater degree of suspicion and eval- “Contrary to common belief, heart dis- Melanie Griffith, Jamie Lee Curtis, Daisy uation regarding chest pain may help ease is no longer a men-only condition; Fuentes, Jane Pauley, Univision TV per- reverse the trend of late referral and late women also need to be aware of the sonality Teresa Rodriguez, designer intervention. Research indicates that warning signs,” says Dr. Duong- Carolina Herrera, and TV chefs Rachel behavioral changes on the part of women Wagner. Most heart attacks start slowly, Ray and Sara Moulton. and reshaping of practice patterns by their with mild pain and discomfort or pres- health care providers may dramatically sure in the center of the chest. The pain For more information, visit reduce the number of women disabled and may last for a few minutes or longer and killed by CHD each year. 9
  8. 8. Protect Your Heart The two basic types of PVD are functional and organic. Functional PVDs do not have underlying organic causes and do not involve abnormalities or defects in the blood vessel structure. These are usually short-term effects related to a spasm that may be intermittent. An example of this type of PVD is Raynaud’s Syndrome, which is triggered by cold temperatures, emotion- al stress, working with vibrating machin- ery, or smoking. Organic PVDs result from structural changes in the blood vessels, including inflammation and tissue damage. PVD is often an indicator of occult cardiac disease. A Sign of Heart Disease PAD is a condition similar to coronary artery disease. In these diseases, fatty deposits build up on the inner linings (endothelium) of the vessels and restrict circulation. Myocardial infarction, or stroke, is often the result. In PAD’s earliest stages, a common symptom is cramping or fatigue in the legs or buttocks during physical activity. Such cramping subsides when the person stands still. This is known as intermit- tent claudication. Nearly 75% of people with PAD, however, do not experience symptoms such as foot pain, poor wound healing, and gangrene. Recognizing the Signs of Diagnosis of PAD includes a complete physical examination, often including the ankle-brachial index test that compares Peripheral Vascular Disease blood pressure in the feet to blood pressure in the arms. (Normal ankle pressure is By Safwan Jaalouk, MD more than 90% of arm pressure, but with severe narrowing of the vessels, it may measure less than 50%.) Peripheral vascular disease (PVD) — especially peripheral arterial disease (PAD) — is a relatively common form of atherosclerosis, or Doppler and ultrasound imaging is a hardening of the arteries. It affects circulation primarily in the vessels noninvasive method used to visualize the arteries with sound waves to measure that nourish the kidneys, stomach, arms, legs, and feet. It is estimated blood flow and detect any obstructions. that some eight to 12 million Americans have PAD, and approximately Computed tomographic (CT) angiography 20% of those older than 70 years of age have the disease. is another noninvasive test that visualizes 10 Pensacola Heart Health
  9. 9. the arteries in the abdomen, pelvis, and Heart Association, the most effective In this procedure, a vein from another legs. This test is a useful diagnostic tool for treatment for PAD is regular exercise. part of the body or a synthetic blood vessel people with pacemakers or stents. Walking, leg, and treadmill exercises is used to bypass the diseased part of the are usually good ways to begin. vessel. The graft is attached above and Similar to CT angiography but without the below the blocked area to detour blood use of x-rays, magnetic resonance angiog- • Dietary changes to include a low-fat, around the blockage. raphy is yet another noninvasive test used low-cholesterol diet. to diagnose PAD. PAD may also require medications, such as Safwan Jaalouk, MD, earned PAD Treatment an antiplatelet agent (cilostazol) to increase his medical degree at the walking distance and cholesterol-lowering University of Aleppo, Syria, PAD is often treated with lifestyle changes agents (statins). When lifestyle modifica- and/or medications. Lifestyle changes to tions and drug interventions are not suffi- and completed an internship at lower the risk include: Lutheran Medical Center in cient to treat PAD, angioplasty (a nonsurgical Cleveland, Ohio, where he also • Smoking cessation. Smokers are two to procedure used to dilate narrowed or completed a residency in internal medicine. 25 times more likely to develop PAD. blocked peripheral arteries) or surgery He has held fellowships in cardiology at the are sometimes required. Cleveland Clinic Foundation and the • Diabetes management and control. This chronic disease can accelerate During angioplasty, a small balloon is intro- Ochsner Clinic in New Orleans. He is board certified in internal medicine, cardiovascular the development of PAD. Management duced via the groin into the circulatory disease, interventional cardiology, nuclear involves regular testing for hemoglobin system and then inflated inside the blocked cardiology, and echocardiography. Dr. A1c, hypertension, insulin resistance, artery, resulting in the reestablishment of and diabetic retinopathy. normal blood flow. Occasionally, a stent Jaalouk is a Fellow of the American Col- (like metal mesh) is deployed inside the lege of Physicians, American College of • Blood pressure control. artery to keep it open. Cardiology, and the Society for Cardio- vascular Angiography and Interventions. • A regular, medically supervised exercise If a long portion of the artery is diseased program. According to the American and narrowed, surgery is often necessary. Mapping and navigation. Therapeutic tools. Ceaseless innovation. Together we can. In the advance against AF, we’re committed to reducing the effect it has on patients’ lives. Learn more at 11
  10. 10. Hospitals Surgery Centers Doctors’ Offices Rental Linens Full Service Locally Owned 1501 N. Guillemard Street Pensacola, FL 32501 (850) 438-7578 (800) 844-5280 Toll Free (850) 438-9395 Fax Living with Comfort, Compassion, & dignity when it matters most (850) 474-7288 • Superior Home Care for patients with life limiting illnesses • Medicare/Medicaid certified • Patients are admitted based on individual health needs and not their ability or inability to pay for services • Nursing care and services are available 24-hours/day, 7 days a week • Providing Physical, Social, Emotional and Spiritual support 12 Pensacola Heart Health
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  12. 12. Directory Cardiology Consultants, PA, thanks the following advertisers for helping make this publication possible. Attorneys Clark Partington Hart Larry Bond & Stackhouse ........................see page 12 Commercial Laundry Crown Health Care Laundry Services, Inc...............................see page 12 Health Care Technology and Management Med3000 Group, Inc. .................................see page 14 Health Information Services Gulfwave Communications, Inc..................see page 13 Hospice Hospice of the Emerald Coast, Inc. ...........see page 12 Medical Imaging Toshiba ........................................................see page 7 Medical Manufacturing and Distributing St. Jude Medical, Inc..................................see page 11 TZ Medical Inc............................................see page 13 Medical Services Baptist Health Care................................see back cover Baptist Medical Park ..................................see page 13 Karanbir S. Gill, MD....................................see page 12 Medtronic, Inc. ............................see inside back cover Sacred Heart Health System........see inside front cover Nonprofit Organizations American Heart Association, Inc. ...............see page 12 Office Products Gulf Coast Office Products, Inc. ..................see page 7 Pharmaceuticals Novartis ........................................................see page 7 14 Pensacola Heart Health
  13. 13. Cardiology Consultants, PA 1717 N. “E” St. Ste. 331 Pensacola, FL 32501-6376