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  1. 1. Fort Wayne Cardiology Presents Matters of the Heart • Vol. 1 No. 1 Helping Hands From seminars to pedometer programs, taking care of the community is Fort Wayne Cardiology’s first priority Drug eluting stents: Boost your heart with controversy or cure? functional foods
  2. 2. Welcome On behalf of the physicians and staff of Fort Wayne Cardiology, I would like to encourage Vol. 1 No. 1 In this issue 4 Helping hands From seminars to pedometer programs, taking care of the you to browse through Matters of the Heart, an educational resource for physicians, patients, and the general community is Fort Wayne public. We value this opportunity to share stories about important community activities and events in which Cardiology’s first priority our organization is involved, as well as timely articles about the prevention, diagnosis, and treatment of heart and cardiovascular diseases. As one of the leading cardiology practices in Northern Indiana, the physicians and employees of Fort Wayne 7 Eat and be Cardiology are dedicated to providing a center of excellence for comprehensive cardiovascular care to our patients. healthy Through the relationships we develop and the state-of-the-art medical care that we provide to our patients, our Functional foods will give your heart the boost it goal is to create a better quality of life for people in the Fort Wayne area and surrounding communities. might need In our premiere issue, the first article, “Helping hands,” highlights prevention of heart disease and discusses a number of local, state, and national initiatives our organization has been involved with to make a healthier community. This issue will also discuss the importance of knowing your EF (Ejection-Fraction) as well as a 8 Controversy timely discussion about the recent controversy raised in the media about drug eluting stents, an important or cure? and effective treatment for coronary artery disease. Another article, “Eat and be healthy,” gives practical tips Drug eluting stents are about eating smarter for a healthier heart. just one stop on the road to better coronary care If you have any ideas or suggestions of topics for future publications, we invite you to call or leave a voice mail at (260) 481-4868. We also encourage you to visit our Web site at to learn more about the services and locations offered at Fort Wayne Cardiology and additional educational informa- tion about your heart and cardiovascular disease. 10 An important number to We appreciate you taking the time to read and share our newest publication. know Educating patients about Sincerely, their Ejection-Fraction William W. Wilson, MD, FACC Indiana Satellite Offices: Raymond E. Dusman, MD Angola, Auburn, Charles F. Presti, MD Columbia City, Huntington, Stephen E. Brown, MD Kendallville, LaGrange, On the cover: Fort Wayne Mark A. O’Shaughnessy, MD Portland, Wabash, Warsaw Cardiology conducts health Roy W. Robertson, MD awareness events and programs Carew Medical Park to encourage heart healthy Ohio Satellite Offices: William C. Collis, MD 1819 Carew Street behavior among its patients and Hicksville, Paulding T. Eric White, MD the community. Fort Wayne, IN 46805 David E. Schleinkofer, MD (260) 481-4700 Physicians Kevin K. Hart, MD (800) 637-6505 – for Indiana Basil C. Genetos, MD (800) 334-4371 – for Ohio Hollace D. Chastain II, MD Matters of the Heart is an Robert W. Godley, MD and Michigan Ronald J. Landin, MD educational and informative Michael J. Mirro, MD Linda M. Landin, MD resource for physicians, health Kevin J. Kelly, MD care professionals, our patients, Lutheran Medical Park Mark D. Cohen, MD and the general public. This Lutheran Heart Pavilion Fred Doloresco, MD publication features news and 7910 West Jefferson Blvd., Suite 112 Patrick J. Daley, MD Nurse Practitioners trends involving cardiovascular- Fort Wayne, IN 46804 William W. Wilson, MD Joyce Fisher, RN, MSN, FNP-C related diseases, injuries, and treatments, and other related (260) 432-5613 James J. Heger, MD Ann Rademaker, RN, MSN, ANP-C topics of interest. Information contained in this publication Matters of the Heart is published by QuestCorp Media Group, Inc., 885 E. Collins Blvd., Ste. 102, Richardson, TX 75081. Phone (972) 447-0910 is not intended to replace or (888) 860-2442, fax (972) 447-0911, QuestCorp specializes in creating and publishing corporate magazines for businesses. a physician’s professional con- Inquiries: Victor Horne, Editorial comments: Darren Nielsen, Please call or fax for a new subscrip- sultation and assessment. tion, change of address, or single copy. Single copies: $5.95. This publication may not be reproduced in part or in whole without the express written Please consult your physician on permission of QuestCorp Media Group, Inc. To advertise in an upcoming issue of this publication, please contact us at (888) 860-2442, or visit us matters related to your personal on the Web at March 2008 health. Matters of the Heart 3
  3. 3. Helping hands From seminars to pedometer programs, taking care of the community is Fort Wayne Cardiology’s first priority By Mark A. O’Shaugnessy, MD “An ounce of prevention” … at Fort Wayne Most of our patients who have coronary artery Cardiology we take this adage seriously, understand- disease — fat build up inside the arteries that ing that the majority of the cardiovascular disease results in heart attack — are suffering because of poor we encounter daily is largely preventable. lifestyle choices, specifically, tobacco use, sedentary lifestyles, poor dietary choices, and obesity. Through our active wellness program, headed by Marsha Worthington and Sarah Mohrman, we have The number one cause of this disease is cigarette worked diligently to spread the message of good smoking. Although controversial in its stance, the health through prevention. Along with these efforts, Fort Wayne City Council joined cities and states the physicians of Fort Wayne Cardiology offer more across the country enacting clean air acts by banning than 100 lectures every year to health care profes- cigarette smoking inside public buildings within city sionals and the community covering topics such as limits. While this law pits personal freedom against basic cardiovascular research, cutting-edge treatment, public health issues, there is no controversy in the and prevention. scientific literature as to the causal relationship be- tween cigarette smoke, firsthand or secondhand, Cardiovascular disease is the leading and the development of cardiovascular and respira- cause of death of both men and women tory disease. The City Council looked to members in the United States. The vast major- of the health care community for their knowledge ity of this disease is preventable with and support on this sensitive issue. Initiatives such modest lifestyle changes that are at- as this one, while controversial, will serve to im- tainable even on limited budgets. prove the health of the Fort Wayne community and ultimately make it a more competitive market 4 Matters of the Heart
  4. 4. PHOTOS: Clockwise, from left: Fort Wayne Cardiology physicians, medical staff, and patients work together to maximize heart health. Many of our doctors and members of the wellness department actively participate in local community events, such as Science Central Doctors Day. Sarah Mohrman, Fort Wayne Cardiology’s registered dietitian, presents information on the importance of meal planning at the Fueling Your Family Fair. Participants in the Fort Wayne Walks One Million Miles program, which Fort Wayne Car- diology helped organize, celebrate their efforts by walking in the Three Rivers Festival Parade. One of many children who enjoyed hands-on activities during the Fueling Your Family Fair in August. for future employers. Through various community Motivation through education has been a mainstay affiliations and educational initiatives, Fort Wayne of our community wellness initiative with the ul- Cardiology has been instrumental in bringing lo- timate goal of making Fort Wayne a healthier and cal and national programs that stress prevention to more productive city. the Fort Wayne area. With the generous support of many organizations, national speakers such as Rob- America On the Move (AOM), a program developed ert Sweetgall (pedometer walking), Anne Fletcher by James Hill at the University of Colorado Health (diet success), and James Hill (America On the Move) Sciences Center (Colorado is the least obese state have come to Fort Wayne to present programs to in the Union), stresses energy balance through small both health care professionals and the commu- changes that reap huge benefits. Simply cutting nity. Each of these free programs has stressed small 100 calories from our daily food consumption attainable lifestyle changes that will lead to large and burning an additional 100 calories through health benefits. exercise will have a huge impact on weight gain >> Matters of the Heart 5
  5. 5. In addition to these community collaborations, Pio- neering Healthier Communities, an initiative spon- sored by the YMCA of the USA, selected Fort Wayne as a pilot community to develop programs stressing family health. This collaboration has also been instru- mental in educational opportunities for more than 5,000 children who participate in the Fort Wayne Parks & Recreation summer program. With the gener- ous support of local dietitians, this program teaches children how to make healthy food choices. Fort Wayne Cardiology’s partnership with the Fort Wayne Track Club, Fort Wayne Parks & Recre- ation, Greenway Consortium, restaurants, univer- sities, schools, corporations, churches, and many oth- and overall health. Small at- er businesses have assisted in promoting healthy life- tainable changes that can reap huge benefits are styles. Restaurants have been willing to offer healthy available on its Web site (www.americaonthemove. portions along with healthy option substitutions Dr. Mark A. O’Shaugnessy of Fort org). AOM lists programs and information on how a for sides at no additional cost. Waitstaffs have been Wayne Cardiology participated in the few simple lifestyle modifications can help a person educated on these healthy options and offer advice Science Central Doctors Day, which get on the road to overall health improvements. to diners who wish to make healthier meal choices. helped families to learn about healthy The Fort Wayne Track Club ( and foods and activity choices. The Web site also lists all the local Fort Wayne area Greenway Consortium (www.greenwayconsortium. initiatives, accessed by clicking on the Indiana pages. com) offer safe and enjoyable opportunities to ex- The local AOM board, with representatives from ercise in both competitive and noncompetitive en- business, churches, hospitals, and schools, continues vironments. With health care costs sky-rocketing to spread the message of small attainable lifestyle and obesity rates growing at epidemic levels, pre- changes with large health benefits. vention through healthy lifestyle choices is essential for our community to be able to compete in the Members of AOM’s board went one step further by global economy. Multiple businesses have adopted linking up with the Fort Wayne Sports Corporation wellness programs modeled after AOM principles and Fort Wayne Cardiology to develop a program — have taken advantage of the knowledge and expertise Fort Wayne Walks One Million Miles — in response of the Fort Wayne Cardiology wellness staff to begin to Fort Wayne being named one of the fattest cities in wellness and prevention initiatives within their organi- America. This 12-week program tracked activity levels zations. Each of these organizations is committed to of participants using pedometers with a goal of collec- the improvement of health and prevention of disease tively walking 1 million miles in 12 weeks. More than in the broader Fort Wayne community. 10,000 participants logged more than 1.3 million miles. At approximately 100 calories per mile that equates The vast majority of the heart disease we encounter to 130 million calories burned or almost 400 pounds on a daily basis is preventable with a few simple and lost from the waistlines of our participants. This suc- attainable lifestyle modifications. With the commit- cessful program has led to the formation of multiple ment of our community partners, we will be able to pedometer walking programs in schools, business, and realize the dream of a model city where health is not churches; and it spurred the development of a half just a lofty goal, but a reality. Fort Wayne Cardiology marathon scheduled for September 2008. remains committed to the prevention of cardiovas- cular disease, and we will continue to work with our Fort Wayne Cardiology with help from community many community partners to disseminate the message organizations also assisted in developing the Fuel- of prevention through attainable lifestyle choices. ■ Mark A. O’Shaughnessy, MD, spe- ing Your Family health fair, which allowed families to cializes in congestive heart failure, learn about healthy food and activity choices in a fun For more information on programs sponsored by noninvasive cardiac evaluation, and and interactive manner. More than 200 participants Fort Wayne Cardiology or in the community at large, prevention. He is actively involved in community education regarding the gained valuable insight into simple and cost-effective please contact Marsha Worthington, Wellness Director, prevention of cardiovascular disease. ways to improve the health of the entire family. at (260) 481-4868 or at 6 Matters of the Heart
  6. 6. Eat and be healthy Functional foods can give your heart a needed boost By Sarah L. Mohrman, RD, MA A heart-healthy diet recommendation magnesium, copper, folic acid, from your physician does not indicate a diet solely potassium, and vitamin E; some of fruits and vegetables. Following a heart healthy contain omega-3 fatty acids. One diet may include trimming the unhealthy fats ounce of nuts is equivalent to 3 to 4 Pomegranates are rich (saturated and trans fats) from your diet, but it also tablespoons of walnuts, 23 almonds, or 20 in potassium, vitamin includes adding functional foods to your everyday mixed nuts. C, and antioxidants. eating. Functional foods can be whole, fortified, or enhanced foods that provide health benefits be- Plant sterols are found naturally in fruits, vegetables, yond their nutrient composition. The following func- nuts, and grain products. These plant sterols help tional food suggestions may help boost your heart’s to lower bad (LDL) cholesterol and triglycerides overall health. naturally. The goal should be to consume 2 grams of these plant sterols per day to help lower cholesterol Plant sterols Juice derived from a pomegranate, a Middle East- levels (see sidebar). ern fruit that contains crunchy seeds surrounded by some foods with added juicy pulp, is rich in potassium, vitamin C, and anti- Fish, in particular salmon, mackerel, lake trout, her- plant sterols include Kroger oxidants. Recent studies indicate that pomegran- ring, sardines, and albacore tuna, are rich in omega-3 active lifestyle Fat Free ate juice should be the beverage of choice to fight fatty acids, which have been shown to provide sig- Milk (0.4g per 8 oz), nature hardening of the arteries. Not only does the juice ap- nificant benefits for the heart including decreased Valley Heart Healthy Chewy pear to prevent hardening of the arteries by reduc- risk of sudden death, improved arterial health, and ing blood vessel damage, but the antioxidant-rich decreased plaque development. Try incorporating Granola Bars (0.4g per bar), juice may also reverse the progression of this disease. fish, especially those listed above, at least twice per Minute Maid Heart Wise Studies suggest pomegranate juice contains three to week. For those who are not fish lovers, there are orange juice (1g per 8 oz), five times more antioxidants than green tea or red alternatives for omega-3 benefits; food products Benecol spreads or take wine. In order to reap the benefits of this juice, try such as ground flaxseed, canola oil, walnuts, and soy- Control margarines (1g per consuming 2 to 4 ounces of the juice daily. beans provide the heart with benefits, as well. tablespoon), and Promise Did you know that eating one ounce of nuts five or As you can see, there are many healthy foods you activ supershots (2g/3 oz). more times per week can reduce your risk of heart can add to your diet and enjoy, knowing you are disease by 25 to 39 percent? Although nuts are high improving your heart health. If you have more ques- in fat, the fat is primarily unsaturated fat that has tions about heart healthy eating or functional foods a beneficial effect on heart health. for your heart, please do not hesitate to contact Nuts are also good sources the Fort Wayne Cardiology Registered Dietitian of protein, fiber, at (260) 481-4858. ■ Sarah L. Mohrman, RD, MA, is the Registered Dietitian at Fort Wayne Cardiology, who educates patients on nutrition for disease management Eating one ounce of nuts and prevention. She is also active five or more times per week in promoting nutrition and wellness can reduce your risk of heart for heart disease prevention in the disease by 25 to 39 percent. community. Matters of the Heart 7
  7. 7. Controversy or cure? Drug eluting stents are just one stop on the road to better coronary care By Mark D. Cohen, MD Last year was the 30th anniversary of the caught by the press and exaggerated, which led first coronary balloon angioplasty. This procedure to a more cautious approach of DES use by some was the first type of percutaneous coronary inter- cardiologists, as well as much anxiety in our patients. vention (PCI), marking the beginning of the modern era of invasive, nonsurgical treatments for coronary In order to understand the risks related to stenting artery disease. During this time, many advances have and DES, it is necessary to start from the beginning pushed invasive treatment forward, but possibly one and understand the advances that have occurred of the greatest advances in nonsurgical coronary in- during the past 30 years in treating blocked coro- tervention since PCI is the drug eluting stent (DES). nary arteries, beginning with coronary artery bypass graft (CABG). Since the release of medicated coronary stents, DES has generated great excitement, intense utilization, Developed in the 1960s, CABG has gained a great and close scrutiny mainly because its effectiveness at measure of success and patient acceptance. Coronary keeping the artery open has been much greater than artery bypass surgery procedures in the early era, as the success of bare metal stents (BMS) that don’t use well as into the mid-to-late 1980s, were accompanied drugs. Initial studies of DES established a 70 percent by a 3 to 5 percent mortality rate. Some procedures reduction in restenosis (renarrowing), along with were associated with mortality rates as high as 10 per- increased safety. Since its approval in 2002, clinical cent, but this was accompanied with a 3 to 5 percent research studies have shown striking and profound risk of stroke and other significant complications. reductions in the need for repeat PCI procedures (due to renarrowing) as compared with standard Nonetheless, coronary artery surgical methods to Problems with early coronary angio- plasty led researchers to develop bare BMS. As a result, the use of DES rose rapidly to 80 to improve blood flow to the heart, known as revascu- metal stents (below), which were made 85 percent of coronary procedures performed. larization, began an era of nonmedical treatment of out of surgical steel. These then led to the development of drug eluting stents. advanced coronary disease. During the past 25 years, However, during 2005 to 2006, studies in the U.S. CABG has evolved and developed as a safe and pro- and Europe suggested the possible potential for ficient procedure with a dramatic reduction in the greater late risks (one year or more after stent- risk of stroke. Despite advances, CABG is a major ing) of cardiac events with DES, including surgery and risks of death, heart attack, and stroke an increased risk of death from remain a concern. myocardial infarction or heart attack. These Investigation of other treatment options were also reports were being explored and in 1977, Andreas Gruentzig, MD, published articles about patients being treated with coronary artery balloon dilatation known as per- cutaneous transluminal coronary angioplasty (PTCA). This entailed the inflation of small plas- tic balloons after they were inserted into the narrowed coronary artery to crack (tear) un- derlying blockages, expand the arteries, and improve blood flow. These early PTCA ap- proaches were limited both by the size of the artery and by the location of the blockage. Throughout the 1980s there were marked improvements in PTCA equipment resulting in 8 Matters of the Heart
  8. 8. significant competition to CABG. Early coronary angioplasty, however, was limited by its own mecha- nism of action — inflating a balloon within the artery led to large uncontrolled tears and the recurrence of the blockages or restenosis. These two problems prompted intensive investigation and research, which eventually produced small metal meshes made of surgical steel known as coronary stents. These stents were initially made of bare metal and offered a mod- est reduction in restenosis or renarrowing. However, stents did lead to a marked reduction in the need for urgent coronary artery bypass surgery and death, and thus improved patient safety. However, the greatest weakness of coronary inter- ventional techniques, and its most difficult challenge, was restenosis. Restenosis was caused by a response to injury from the balloon or stent and was associ- clotting (stents becoming blocked due to clots de- Drug eluting stents are coated with veloping from scar tissue). To date, data is limited, drugs designed to limit the exagger- ated with extensive new tissue growth within the ated tissue growth associated with artery, similar to a scar developing after cutting your but early research may suggest that with the dra- restenosis (renarrowing of the arteries). skin. Even with enhanced utilization and improve- matic reduction in repeat revascularization and The arrival of the drug eluting stents ment in BMS, restenosis was still a common prob- restenosis, there may be accompanied by a higher, (DES) conquered the problem of lem. It also should be noted that stents initially were but very low risk of late stent blockage due to restenosis, reducing the rates from 25 to designed as an emergency “back up” for failed PTCA. clot formation. 30 percent for bare metal stents to 7 to 9 percent for DES. These stents, which Restenosis of BMS thus led to further research and were initially developed between 1997 the eventual development of DES, a stent that was In 2007, more data became available from the and 2000, underwent extensive investi- coated with drugs to help keep blood vessels from National Heart Lung and Blood Institute and other gation and clinical trials and showed a reclosing (restenosis). investigators showing that, although there may be a restenosis reduction in all patient set- slightly greater risk of late stent closure by clotting, tings, vessel sizes, and vessel lengths. Des has generated great the risks for death and heart attack is identical to excitement, intense utilization, BMS the first four years following stenting. Several and close scrutiny mainly studies have shown DES to have about the same rate of death and heart attack as BMS patients. Further- because of its effectiveness at more, the initial trials investigating the results of DES keeping the artery open. have shown slowed progression of cardiovascular disease for at least five years with dramatic reduction The arrival of the DES seemingly conquered this in the need for repeat PCI procedures. problem of restenosis. Developed between 1997 and 2000, DES underwent extensive clinical trials showing Thus, it is important to remember that DES have a marked reduction in restenosis of approximately 50 been viewed not as a destination treatment, but as a to 70 percent compared to BMS. stop along a long and extensive road of patient-care techniques that have evolved during the past 30 years This effect was present across all patient settings, ves- to improve the health and well-being of patients. sel sizes, and vessel lengths. This dramatic reduction in restenosis and need for repeat procedures or coro- The next step in this ongoing process is the devel- nary bypass led to an increased usage of DES, essen- opment of new dissolvable stents. Further develop- tially dominating PCI, with 85 percent of procedures ments in drugs to prevent restenosis and newer utilizing a DES by the year 2005 to 2006. However, medical therapies to prevent clotting and reduce as with all other procedures, some questions were inflammation will hopefully lead to lower rates of Mark D. Cohen, MD, specializes in raised with respect to safety and long-term outcome. recurrences and long-term improvements in the the fields of interventional cardiol- care we deliver to our patients. The future seems ogy, peripheral vascular disease, and general cardiology. He is an active In 2005 and 2006, research in the U.S. and Europe bright with even more impressive advances yet clinical investigator on new device raised concerns about the possibility of stent-closure to come. ■ therapy for coronary artery disease. Matters of the Heart 9
  9. 9. Most people can tell you what their blood an EF of 45 to 50% to represent a mildly damaged pressure or cholesterol is. But how many of us know heart muscle; an EF of 35 to 45% to represent moder- what our EF is? ate damage; and an EF of less than 35% to represent a severely weakened heart muscle. EF stands for Ejection-Fraction, and it is arguably the single most important factor (among many) in deter- When a patient has damage to the heart muscle, mining prognosis in patients who have heart disease. the condition is known as a cardiomyopathy. There The EF is usually conveyed as a percentage, such are many possible causes for cardiomyopathy. In the as 30% or 32%; and it is the most widely accepted United States and other developed countries, the measure of the strength or vigor with which the most common cause is atherosclerotic coronary main pumping chamber of the heart, the left ven- artery disease. In atherosclerotic disease, fat and tricle, pumps. It is also commonly known as the left other deposits form in the walls of the coro- ventricular ejection-fraction (LV EF). nary arteries, the arteries that feed the heart muscle. This build up is called plaque. Eventu- It is important to point out that the normal EF is not ally the plaque can rupture, resulting in a sud- 100% — in fact, not even close to that. A normal den obstruction of blood flow. This occurrence EF ranges from approximately 50 to 55% up to 75 causes a heart attack, or acute myocardial infarc- to 80%. This number represents the amount of the tion, which leads to death or damage to areas of blood in the heart that is ejected with each contrac- the heart muscle. Myocardial infarctions can be tion of the heart muscle. If the heart muscle, specifi- large or small, singular or multiple, mild or severe; cally the left ventricle, becomes damaged or weak- and consequently, they can result in different de- ened in some manner, then the less power the heart grees of heart muscle damage and thus, different EFs. has to pump blood. Therefore, less blood is ejected Cardiomyopathy may also be caused by other con- from the heart with each contraction and the lower ditions, including valvular heart disease, uncon- the EF. By convention, cardiologists usually consider trolled hypertension, viral infections, and a host of An important other disease or medical problems. Not infrequently, the specific cause of a cardiomyopathy is unknown and is referred to as an idiopathic cardiomyopathy. Whatever the cause, cardiomyopathy frequently number to know Educating patients about their ejection-fraction By William W. Wilson, MD Dr. Ronald Landin of Fort Wayne Cardiol- ogy explains the importance of Ejection- Fraction (EF) to a patient. EF can be measured by different techniques, such as an echocardiogram (an ultrasound of the heart) or nuclear scans. 10 Matters of the Heart
  10. 10. results in a weakened heart muscle, causing a decrease in the EF. The EF is an important measurement to deter- mine when investigating any potential heart problem. It can be measured by different tech- niques, but the most common way is with an echocardiogram, or ultrasound of the heart. An echocardiogram is a safe, noninvasive test that can be performed quickly and can give an ac- curate EF. Nuclear cardiac scans also measure EFs accurately. Finally, cardiac catheterizations, while usually performed to visualize the coro- nary arteries, can also provide the patient with an EF value. A low EF means the pumping power of the heart is weak. As one might surmise, a person with a low EF is prone to develop heart failure, which if left untreated, can be fatal. Thus, once a cardiologist identifies a patient with a low EF, an aggressive medical regimen is initiated to help strengthen the heart and prevent heart failure. Another problem associated with a low EF is that the patient is prone to develop irregular rapid abnormal heart rhythms without warning. These abnormal heart rhythms, if not terminated by an electrical shock, can cause death. Patients with very low EFs have been shown to be at risk for sudden cardiac death due to arrhythmias. These lethal rhythm disturbances are effectively treated with a device called an implantable cardioverter defibrillator (ICD). ICDs function to automati- cally detect the rhythm disturbance promptly at any time and terminate the arrhythmia with ei- ther pacing or, if necessary, a programmed shock. Because these arrhythmias occur unpredictably and without warning, and are much more com- mon in those patients with low EFs, ICD devices are now recommended for patients with low EFs, even if they feel fine. In this manner, cardiologists hope to reduce the incidence of sudden cardiac death due to arrhythmias. ■ William W. Wilson, MD, specializes in the fields of nucle- ar cardiology, interventional cardiology, and hemostasis/ thrombosis. He is the founder and director of the Parkview Anticoagulation Therapy Unit and continues active clini- cal research through the Parkview Research Center. Matters of the Heart 11
  11. 11. ADVERTISER DIRECTORY Astellas .................................................. see back cover Barrett & McNagny ....... see inside back cover Bracco Diagnostics, Inc. for all of your contrast media needs (800) 447-6883 x7566 CBRE-Sturges....................... see inside back cover Ciocca Executive Cleaning ............. see page 13 CME Corporation ................................. see page 11 The Imaging Center ..............................see page 14 Medical Informatics Engineering ............................................ see page 12 Medtronic .................................................. see page 14 MSKTD ........................................................ see page 12 National City............................................ see page 12 Open View ................................................ see page 13 Parkview Hospital .......... see inside front cover Praxair.............................................................see page 11 Terumo Medical ......................................see page 13 Votaw Electric, Inc. ................................see page 13 Wells Fargo ..................................................see page 13 12 Matters of the Heart
  12. 12. Matters of the Heart 13
  13. 13. 14 Matters of the Heart
  14. 14. Fort Wayne Cardiology 1819 Carew Street Fort Wayne, IN 46805