Page 36 – Englewood Health

Bloodless Medicine Options for Cardiac Surgery Patients

Posted on September 18, 2017January 24, 2024 by John Williams

Patients for whom blood transfusion is not an option can still receive comprehensive care at Englewood Hospital and Medical Center, thanks to its pioneering Institute for Patient Blood Management & Bloodless Medicine and Surgery.

The bloodless medicine and surgery program dates to the 1990s, when the institution was approached by Jehovah’s Witnesses who were often denied medical care due to their religious objections to blood transfusions.

Jehovah's Witness blood table — Jehovah’s Witnesses make personal decisions on what they can accept in good conscience. It is important to discuss in advance what products or procedures are acceptable to each patient.

Richard Goldweit, MD — Richard S. Goldweit, MD, Section Chief of Interventional Cardiology and Medical Director of Cardiac Catheterization Laboratory

“Because we felt that this was such a compelling issue, we assembled key medical and administrative leaders to clearly define clinical, ethical and legal fundamentals for structuring such a program,” said Richard S. Goldweit, MD, section chief of interventional cardiology and medical director of cardiac catheterization laboratory at Englewood Hospital and Medical Center. “We’ve now developed an entire multidisciplinary science to support that effort and manage patients without transfusion.”

Although blood transfusion remains a common part of medical practice in many institutions, it carries a host of clinical and infection-related risks. In addition, transfusions can have negative costs and outcome implications.

“If you look back historically at the literature, the data on blood transfusion are not very good. Transfusions are overused, and there is only a relatively small number of cases where it is actually clinically indicated; most transfusions could be avoided,” Dr. Goldweit said.

In 2000, after observing the early benefits of reducing transfusions, the state of New Jersey partnered with Englewood Hospital to launch an innovative project designed to demonstrate the clinical and public health benefits of bloodless medicine and surgery in patients needing cardiac surgery. Within a few years, Dr. Goldweit and his colleagues published research showing that lowering the transfusion rate in open-heart surgery to 10% improved outcomes by reducing complications and improving survival.

“That 10% transfusion rate is sort of a landmark,” Dr. Goldweit said. “Year after year for more than a decade, Englewood Hospital had a zero mortality rate in cardiac bypass surgery.”

According to evidence documented in the surgical literature, excessive bleeding and vascular complications contribute to poorer outcomes and mortality. Because of this, Dr. Goldweit and his colleagues made the best use of all available technology and developed innovative techniques to avoid transfusions and minimize bleeding whenever possible.

For instance, Dr. Goldweit has developed a bloodless puncture, which consists of routinely working through the radial artery instead of the femoral artery. “Even in patients with myocardial infarction, I can perform a diagnostic angiogram and appropriate stenting procedure through the wrist, which has less bleeding risk.”

He also uses smaller devices to minimize bleeding and is judicious with the use of blood-thinning agents. “We use an intravenous agent that is like Plavix [clopidogrel] but that can be turned off during a procedure if you run into a problem,” Dr. Goldweit explained.

The ongoing success at Englewood Hospital in treating even the most challenging cardiac patients, such as those undergoing high-risk interventional procedures or chronic total occlusion, hinges on the dedication of everyone involved: a collaborative heart team approach.

“The patient blood management program at Englewood is very multidisciplinary. Interventional cardiology is only a small part of it,” Dr. Goldweit said. “We have everybody on the same page, whether they are vascular surgeons or hematologists or gastroenterologists, all trying to limit bleeding, and aggressively treat anemia. Thanks to this approach, we’ve seen many benefits, including improved patient outcomes, shorter hospital stays, less postoperative infections and greater patient satisfaction.”

In addition to publishing research on blood management in cardiac surgery, Englewood Hospital has been extensively involved in the investigation of various devices and therapeutic approaches for treating cardiac patients.

Englewood Hospital is now a participating site in the national ISCHEMIA trial, which is investigating how to best manage people with stable coronary disease, to determine whether medication or more invasive approaches would offer an advantage. “For a community hospital, we’ve enrolled quite a few patients into that trial,” Dr. Goldweit said.

The medical center has also been involved in trials investigating the use of antiplatelet agents in certain stenting platforms. “We’re very much engaged in research, and are now collating our data on TAVR [transcatheter aortic valve replacement] to compare our experience with other sites in New Jersey and nationally,” Dr. Goldweit said.

“Being engaged in research keeps you on the cutting edge,” he added. “It allows you to answer questions you may not have previously had the answers to, especially in situations where you have equipoise and you don’t know which way to go. However, with patient blood management, the benefits are clear.”

Posted September 2017

Prolonged Ambulatory Electrocardiography Monitoring Advances Stroke Care

Posted on September 18, 2017May 17, 2023 by John Williams

Medtronic Reveal size comparison — Insertable cardiac monitors enable physicians to continuously and wirelessly monitor a patient’s heartbeat for up to three years.

Long-term monitoring for atrial fibrillation with implantable cardiac monitors is a cutting-edge tactic for managing patients who have suffered a stroke, and it is an approach that neurologists and cardiologists at Englewood Hospital and Medical Center now regularly employ.

“We have been on the front line of advocating prolonged ambulatory electrocardiography [ECG] monitoring after stroke,” said Dennis Katechis, DO, a cardiologist at Englewood Hospital.

Patients admitted with an ischemic stroke are routinely placed on a heart monitor for the first 24 to 48 hours. In many cases, atrial fibrillation is difficult to detect within this short time period and the patient is discharged with a diagnosis of cryptogenic stroke (i.e., no cause is identified). Approximately 20% of ischemic strokes are considered cardioembolic, and atrial fibrillation is by far the most common cause of cardioembolic strokes.

Englewood Hospital was one of the first community hospitals to start using implantable cardiac monitoring after two major trials— EMBRACE (N Engl J Med 2014;370:2467-2477) and CRYSTAL AF (N Engl J Med 2014;370:2478-2486)— showed that prolonged ambulatory ECG monitoring was superior to conventional outpatient follow-up for detecting atrial fibrillation.

The EMBRACE trial demonstrated that atrial fibrillation was more readily identified in patients with cryptogenic stroke using an implantable cardiac monitor than with the conventional method of 24-hour Holter monitoring, specifically, 16.1% of patients at 30 days compared with 3.2%, respectively. In the CRYSTAL AF trial, an insertable cardiac monitor (Reveal XT, Medtronic) increased the rate of atrial fibrillation detection at six months from 1.4% to 8.9% for a control group that had received ECG monitoring.

Informed by these two studies, Englewood Hospital has taken a leadership role in the use of insertable cardiac monitors and has taken part in other trials involving implantable loop recorders.

Looped Recording

The latest monitoring technology, approved in March 2017, is the Reveal LINQ Insertable Cardiac Monitor with TruRhythm Detection (Medtronic), which enables physicians to continuously and wirelessly monitor a patient’s heartbeat for up to three years. The loop-recording device, smaller than a pen cap, can be inserted into subcutaneous tissue in the chest in a simple procedure that can be performed in an ambulatory setting. The device features a self-learning atrial fibrillation algorithm, which adapts to the patient’s heart rhythm over time. The cardiologist managing the patient is notified if a symptom is detected.

“The implant requires just a small incision and heals quickly,” said Lauren DeNiro, MD, medical director, stroke program at Englewood Hospital.

While many medical centers implant the device at a follow-up visit, Englewood Hospital does the procedure the day before a patient goes home from the hospital, so that no opportunity for early monitoring is missed. “A significant proportion of these patients—at least 15%— end up having atrial fibrillation,” Dr. DeNiro said. “This is important because it involves a different kind of treatment to prevent the next stroke. Prompt initiation of systemic anticoagulation is needed in most of these patients, as the presence of permanent or paroxysmal atrial fibrillation carries a cumulative risk of stroke that can be calculated based on a devised risk score.”

In addition to prolonged ECG monitoring, Englewood Hospital also has been on the forefront of nonpharmacologic therapy to prevent cardioembolic stroke. Grant Simons, MD, section chief, heart rhythm services, is responsible for the development and growth of the WATCHMAN program at Englewood Hospital.

The hospital participated in PROTECT AF, one of the trials that led to the approval of the WATCHMAN Left Atrial Appendage Closure Implant in 2015. This device, a self-expanding cage made of nitinol, provides an option for high-risk patients with nonvalvular atrial fibrillation who are seeking an alternative to warfarin or for those unable to take warfarin. Deploying the device in the left atrial appendage prevents a thrombus from forming and causing a stroke.

“The WATCHMAN device is truly revolutionary, a completely new standard of care in patients with atrial fibrillation to reduce their risk of stroke,” Dr. Katechis said. “It takes away the long-term risk of systemic anticoagulation for life.”

Posted September 2017

Cardiac Rehabilitation Center’s Care Is Key

Posted on September 18, 2017May 17, 2023 by John Williams

Although it’s impossible to rewrite the past, patients who have suffered from myocardial infarction, angioplasty, heart surgery or heart failure have the opportunity to improve the future. The key is cardiac rehabilitation. Medicare and all major insurance carriers cover a 12-week cardiac rehab program for patients with coronary artery disease, congestive heart disease with a low ejection fraction, or after bypass or valve surgery.

“It’s enormously beneficial and terribly underutilized,” said Samuel Suede, MD, section chief of cardiology and medical director of cardiac rehabilitation at Englewood Hospital and Medical Center. In fact, Dr. Suede cited numbers that the five-year mortality rate drops between 20% and 30% for patients who follow a prescribed cardiac rehabilitation program, yet only 20% to 30% of the eligible population enrolls in one.

“There’s a combination of factors that keeps the numbers low: from physicians who are unaware, so they don’t make a recommendation for cardiac rehabilitation, to patients who are resistant to starting an exercise regimen,” Dr. Suede said.

The Englewood Hospital cardiac rehabilitation center addresses patient apathy and maintains long working hours that can accommodate most patients’ schedules. The center’s staff works with patients one-on-one and coaches patients on every aspect of their well-being, including nutrition, stress management, and physical activity. The center also offers a comprehensive program with state-of-the-art exercise equipment.

“We really want to get a patient in as soon as they’re discharged,” Dr. Suede said. “So we’ve set up a comfortable and inviting atmosphere. We have experienced nurses and exercise physiologists who work closely with the patients. The staff is there for them and keeps them motivated and focused.”

The one-on-one setting allows the staff to educate patients in an intimate setting about their disease, risk factors, and lifestyle. “The program is customized for every single patient,” Dr. Suede said. “We customize the exercise program for anyone who has a neurological or orthopedic limitation.”

The care the staff puts into each patient leads to a very low dropout rate, Dr. Suede said. In fact, the program that the cardiac rehabilitation center created is so effective at stabilizing and reversing risk factors for heart disease and improving endurance and mobility that many patients choose to continue participating in the maintenance program after their insurance coverage lapses.

Dr. Suede reiterates the benefits of cardiac rehabilitation: Patients can return to their normal activity level sooner; their disease state is managed better; and with continuous exercise, their sense of wellness and mortality is improved.

Dr. Suede said he wishes more physicians referred their patients to cardiac rehab programs and more patients found the time and discipline to participate in cardiac rehab programs, given all of the benefits seen with Englewood Hospital’s cardiac rehabilitation center. “What could be better than a fully covered program that improves wellness and mortality?” he asked.

Posted September 2017

Cardio-Oncology Monitors the Challenges of Chemotherapy That Is Toxic to the Heart

Posted on September 18, 2017February 12, 2019 by John Williams

Echocardiology Lab — Cancer patients receiving potentially cardiotoxic drugs are seen in the echocardiology laboratory, which uses echo machines to ensure consistent results.

Expertise in cardio-oncology can be a decisive factor for patients challenged by the cardiotoxicity of cancer treatment who nonetheless need the therapeutic benefit of the medications.

Jay Erlebacher, MD, FACC, medical director, echocardiology laboratory at Englewood Hospital and Medical Center, has set up a cardio-oncology subsection in his lab and serves as the resident expert. “We have developed methodology to train our technical staff to do specialized heart function testing in patients who are getting chemotherapy, so we can follow their response to chemotherapeutic agents that are toxic to the heart,” he said.

Many cancer treatments can damage the heart, and patients with cardiac conditions treated with chemotherapy often have plans of care that differ from those who don’t. The top two cardiotoxic cancer drugs, doxorubicin (Adriamycin; others) and trastuzumab (Herceptin, Genentech), which typically are used in breast cancer patients, can cause chemotherapy-related cardiac dysfunction or weakening of the heart. Clinicians evaluate the heart function of patients receiving these drugs primarily by measuring left ventricular ejection fraction—the horsepower of the heart. A normal ejection fraction ranges from 55% to 65%, according to Dr. Erlebacher.

“The definition of chemotherapy-related heart dysfunction is when the ejection fraction drops by more than 10% and the final ejection fraction is under 50%. This happens in an unpredictable way in patients receiving Adriamycin and Herceptin,” Dr. Erlebacher said. “It is more common in people who have a history of heart attacks, valvular heart disease or other kinds of cardiomyopathy, as well as individuals with hypertension or diabetes, but this heart dysfunction can happen to young, healthy people, too. If clinicians keep pushing these drugs in someone whose heart has already become weak, they almost guarantee their heart function will be impaired and it can lead to congestive heart failure.”

Women treated for breast cancer with chemotherapeutic agents are at increased risk for developing congestive heart failure over the following five years, according to Dr. Erlebacher. Most doxorubicin toxicity occurs within six months of completing therapy and is dose-related, which is why patients taking doxorubicin receive an echocardiogram at baseline, at the end of chemotherapy, and then again six months later. Trastuzumab toxicity is not dose-related and can occur at any time, and thus, patients on this HER2-targeted therapy are evaluated every three months with an echocardiogram. Whereas damage from doxorubicin is often permanent, much of the damage from trastuzumab is reversible by holding or stopping use.

All cancer patients receiving potentially cardiotoxic drugs at Englewood Hospital are seen in the special subsection of the echo lab, which uses echo machines and employs two highly trained technicians to ensure consistent results. In addition to doxorubicin and trastuzumab, other drugs used routinely in oncology cause other problems, including clotting, atherosclerosis and severe hypertension. Tyrosine kinase inhibitors have adverse effects in a small percentage of patients and some new immunotherapies have been linked to rare lethal arrhythmias and reduced heart function.

Left Ventricular Global Longitudinal Strain

Recently, Englewood Hospital has started evaluating cancer patients for earlier signs of heart dysfunction using a newer measurement called left ventricular global longitudinal strain (GLS). GLS is assessed using automated speckle-tracking echocardiography to detect and quantify subtle disturbances in left ventricular systolic function. “The echocardiogram strain function looks at the relative motion of tiny speckles in the heart muscle,” Dr. Erlebacher explained. “In doing that, you can evaluate individual small segments of the heart in multiple planes.”

Alterations in GLS often precede any change in ejection fraction. If clinicians can detect subtle changes in heart function before they affect the overall ejection fraction, clinicians can provide standard treatments, such as ACE inhibitors or beta blockers, and reverse the course of many patients who would have developed heart dysfunction from chemotherapy. “The earlier you detect left ventricular dysfunction, the more successful you will be at reversing it,” Dr. Erlebacher said.

Dr. Erlebacher believes every center should have at least one or two cardiologists who are willing to take the time to specialize in cardio-oncology. “If you have a doctor who is not well versed and sees some of these changes, his first reaction may be to tell the oncologist to stop lifesaving chemotherapy,” he said. “The role of the cardio-oncologist is to watch the patient closely, treat if necessary, and permit the oncologist to give the patient as much chemotherapy as is safe, not stopping prematurely.” Thus, a trusting relationship between the cardiologist and oncologist is critical for the optimal care of cancer patients.

Posted September 2017

Taking the Stress Out of Going for a Stress Test

Posted on September 18, 2017February 12, 2019 by John Williams

Nuclear Stress Test: Cardiovascular Imaging — Cardiovascular imaging machines may be used to support a diagnosis of a heart condition or cardiovascular disease.

Driving in heavily populated northern New Jersey can be demanding even at the best of times.

Add the worry that your patient, who might have cardiovascular disease, is driving in this stressful environment to obtain cardiovascular imaging recommended by you, and you have a prescription for additional stress.

To address this patient need, Englewood Hospital and Medical Center is working to make cardiovascular testing more convenient. The hospital system is bringing its high-quality imaging centers closer to patients’ own communities, nearer to their primary care physicians. The procedures are done as an outpatient service to save them the trip to the hospital.

Englewood Hospital’s three new outpatient locations offer nuclear cardiology, stress testing, echocardiography, vascular testing, and Holter monitoring. The practices are located at several sites in Fair Lawn, which is in Bergen County, and in Pompton Plains and Woodland Park, which are both in Passaic County.

The Cardiac Imaging Centers of Englewood Hospital and Medical Center join two Englewood Hospital satellite imaging facilities: Advanced Medical Imaging of Englewood Hospital and Medical Center in Emerson, Bergen County; and Magnus Imaging of Englewood Hospital and Medical Center in Glen Ridge, Essex County.

“The main issue is the convenience and the ease of access and the ease of booking testing for patients in their own communities,” said Mahesh Bikkina, MD, a cardiologist at Heart & Vascular Associates of Northern New Jersey, P.A. “Englewood Hospital is providing this hospital-quality outpatient service so the patient doesn’t need to go to the hospital for this testing.” The imaging centers maintain the same rigorous quality standards in their testing as those established by the hospital for testing performed at Englewood Hospital.

Dr. Bikkina acknowledged that patients tend to worry when they have to go for any test, but being able to travel within their own community and being close to home might eliminate some of that anxiety. “You pull into our parking lot and we are right there,” he said.

“Patients are much more comfortable having their tests done in a smaller, easier to navigate and comfortable outpatient setting,” Dr. Bikkina said.“Sometimes patients have multiple tests being done and our centers work very hard to schedule them all around the same time, which patients are very happy with.”

To further facilitate the care of patients, imaging results are added to patients’ electronic medical records, which are available to patients’ primary care physicians and doctors at Englewood Hospital if further referrals are needed. This creates a seamless flow of patients’ medical data among their physicians, which could substantially reduce the incidence of medical errors while serving to avoid inconvenient and costly duplications of testing.

Physicians can take advantage of the considerable expertise that Englewood Hospital, a leading cardiovascular center, has. The care that it provides goes beyond hospital-quality diagnostic testing and the comprehensive interchange of medical data.

Posted September 2017

Focus on Teamwork and Best Practices Lead to Success in Cardiothoracic Surgery

Posted on September 18, 2017November 1, 2018 by John Williams

Cath lab — Cardiac surgeons and cardiologists at the Heart and Vascular Institute have extensive experience with the latest technological developments.

When the Department of Cardiothoracic Surgery at Englewood Hospital and Medical Center was founded in 2000, James Klein, MD, chief, cardiothoracic surgery, made a commitment to create a culture of caring and cooperation. To accomplish this, the department initiated a new policy: Two surgeons would be required to oversee each surgery in the operating room. The thinking behind this policy was to have a built-in safety net during every procedure.

“Our goal was to foster a teamwork environment,” Dr. Klein said. “We followed a mantra of cohesiveness and helping each other, not a mantra of competition. We were striving for perfection in terms of outcomes.”

The efforts of the cardiothoracic team have paid off. Over the last 17 years, the department has performed close to 4,800 heart operations.

The hospital’s mortality and survival data for bypass surgery also show the department’s success in building a durable safety net. The overall survival rate for isolated bypass surgery since the inception of the cardiothoracic program is approximately 99%.

Many factors contribute to this low mortality rate. One is the department’s careful blood transfusion policy.

“Blood transfusions can lead to inflammatory and immune response reactions,” Dr. Klein explained. “If you can avoid both, you’re probably ahead of the game because you’ve succeeded in eliminating one set of complications and compounding issues.”

The cardiothoracic team pays closer attention to what’s happening to the patients’ organs than to their blood counts. They have taken the position that if the brain, heart, lungs, and kidneys are functioning properly, they will forgo a blood transfusion—even if a patient’s blood count is low.

“The Society of Thoracic Surgeons (STS) has established guidelines similar to what we’ve been doing for years,” Dr. Klein said. “We were among the first institutions to follow this practice.”

Since 2012, the department has ventured into a new arena: performing transcatheter aortic valve replacement (TAVR), also known as transcatheter aortic valve implantation. The procedure is performed by cardiothoracic surgeons in partnership with interventional cardiologists. TAVR is typically performed in Englewood Hospital’s new, state-of-the-art hybrid operating room.

Prior to the introduction of TAVR, the only option was for surgeons to go through the chest to replace the aortic valve, but that approach is being used less frequently. Instead, surgeons are inserting the new valve up through the femoral artery in the groin. The old valve is left in place and simply pushed aside. TAVR is performed on patients suffering from aortic stenosis, or a narrowing of the aortic valve. The Department of Cardiothoracic Surgery has performed more than 250 TAVR procedures, with numbers increasing each year.

Originally, TAVR was confined to older or frailer patients, but that is changing, according to Dr. Klein. An increasing group of intermediate-risk patients, who are younger and less frail, are now opting for TAVR. As the number of patients documented in New Jersey and STS databases grows, Englewood Hospital can use this information to compare its morbidity and mortality data with other institutions in the state and region.

“Although there is the potential for leg complications, doing the whole operation without touching the chest is less invasive and less aggressive,” Dr. Klein said. “The procedure can be done in about an hour and often results in shorter stays in the hospital and an easier recovery for the patient.”

These innovations have not gone unnoticed. Over the last two years, the department has experienced tremendous growth and expanded significantly, with 2017 likely to be the busiest year yet.

“Our efforts in blood conservation and TAVR have put us on the map. As a result, we have growing local, regional, and national reputations,” Dr. Klein said.

Posted September 2017

Englewood Hospital Tackles Cardiology, Preventive Care in the Korean Community

Posted on September 18, 2017May 17, 2023 by John Williams

Englewood Hospital and Medical Center goes above and beyond to take care of its Korean neighbors. That’s why the Center for Korean Health and Wellness helps educate patients about the top-notch care at the hospital’s Heart and Vascular Institute.

“The Korean population cannot avoid cardiac issues,” said Jaehoon Chung, MD, a cardiologist at Englewood Hospital and Medical Center, whose expertise is in diagnosing and treating heart disease. “We offer the full spectrum of cardiovascular and diagnostic services to everyone, including the Korean community, which has close and easy access to us. We have the best technology in cardiac imaging, excellent surgical teams, and a dedicated team of nurses.”

As Korean immigrants and first-generation citizens age, their need for comprehensive medical care grows. Dr. Chung notes an uptick in the numbers of Koreans with coronary artery disease or heart and vascular disease.

“Fortunately, the Center for Korean Health and Wellness does a fantastic job of community outreach, which is no small feat,” Dr. Chung said. “They help patients get access to medical services. They help the patient navigate the paperwork, and they make sure that someone with limited English gets to the right doctor.”

The Korean center will even serve as a liaison with social services to ensure its community members are able to pay for necessary medical treatment.

Dr. Chung champions the Korean center’s ability to educate the community it serves with its weekly health fairs. Each fair focuses on a different aspect of health. When the focus is the heart, Dr. Chung will sit on a panel with other top cardiologists to discuss the services that Englewood Hospital provides and the importance of preventive care.

The health fairs break down various specialties and explain how to access medical services so members of the Korean community do not feel so overwhelmed, according to Dr. Chung.

“The first step is the most difficult for a lot of patients,” he said. “They will think a lot before coming in for a diagnostic workup, but it’s so important that they do. It’s often very difficult and takes a lot of understanding of the makeup and the unique culture of the immigrant community.”

Dr. Chung notes that many Korean immigrants have never had appropriate medical care, often because their finances prohibited it or they were too busy working.

“There’s a notable characteristic among Korean immigrants where they have an incredibly high pain threshold,” he said. “Then they’ll often make a self-diagnosis, and the next thing you know they’re in the emergency room with a serious and potentially fatal disease. That’s something that we need to break through.”

To that end, the Korean center stresses the importance of seeing a primary care physician, helps aging Koreans find a doctor who understands their needs, and creates a relationship with the family.

“With the Korean community, family dynamics are different and need to be understood in order to have effective communication,” Dr. Chung said. “As a doctor, sometimes you need to talk to the family members, not the patient, and you need to recognize that medical decisions are often made by the family, not just the patient. Now that’s a very different situation from many other patients that we serve, so it’s really beneficial to the families and to the cardiovascular teams to have someone from the Korean center who understands those communication nuances. Englewood Hospital recognizes that cultural differences shouldn’t prohibit someone from obtaining excellent care.”

Posted September 2017

Englewood Hospital and Medical Center Implants World’s Smallest Wireless Pacemaker

Posted on August 16, 2017May 17, 2023 by Michael Chananie

Miniaturized heart device provides patients with the most advanced pacemaker available

The Heart & Vascular Institute at Englewood Hospital and Medical Center is now offering a wireless pacemaker for patients with bradycardia, or slow or irregular heart rhythm. The device — Micra™ Transcatheter Pacing System (Medtronic®) — is an FDA-approved and Medicare-covered pacemaker one-tenth the size of conventional pacemakers.

Dr. David Feigenblum, an electrophysiologist at Englewood Hospital and Medical Center, successfully implanted the hospital’s first Micra pacemaker. “Unlike traditional pacemakers, this device does not require cardiac wires, or leads, or a surgical pocket under the skin,” he said. “Thanks to its small size, we can deliver it through a catheter and implant it directly into the heart. That means it’s invisible outside of the body and avoids complications associated with leads.”

“Pacemakers have long been a life-changing way of restoring the heart’s normal rhythm and relieving symptoms like dizziness, fatigue, and fainting,” Dr. Grant Simons, section chief of heart rhythm services at Englewood Hospital and Medical Center said. “This new device is really something special, and a great advancement for the treatment of individuals with bradycardia.”

The Micra™ Transcatheter Pacing System is also the first and only transcatheter pacing system to be approved for both 1.5 and 3 Tesla (T) full-body magnetic resonance imaging (MRI) scans.

To find an electrophysiologist performing this procedure, patients can call 844-33-MDNOW, the physician referral line for MDPartners of Englewood Hospital and Medical Center.

Leading-Edge Technology for Prostate Cancer Detection Introduced at Englewood Hospital and Medical Center

Posted on August 3, 2017July 15, 2020 by Michael Chananie

An advanced technology called MRI ultrasound fusion biopsy is now being used to diagnose prostate cancer at Englewood Hospital and Medical Center. The technology uses a two-step process that offers greater accuracy over traditional prostate cancer biopsies. First, a patient undergoes magnetic resonance imaging (MRI) of the prostate. A radiologist evaluates the images and identifies and marks any suspicious areas for further evaluation by a urologist. The urologist then fuses or superimposes the images with real-time ultrasound images, which produces 3D images of the suspicious areas and offers improved ability to biopsy the prostate.

Some 60 percent of newly diagnosed prostate cancer patients are considered low-risk on initial biopsy, but if a biopsy is repeated, that number drops to 30 percent. Those considered to be at low risk can be placed on active surveillance, or watchful waiting, but standard biopsy has shortcomings in determining the risk level. This new MRI ultrasound fusion biopsy technology has been shown to more accurately determine whether a patient has higher risk prostate cancer or lower risk prostate cancer. By risk stratifying patients, physicians can better inform them about their treatment options, be it active surveillance or surgery or radiation therapy.

“This is an exciting advancement in imaging and cancer diagnosis,” said Dr. Mark Shapiro, chief of radiology at Englewood Hospital and Medical Center. “Using a 3-Telsa magnet – the most advanced on the consumer market – MRI is proving to be effective in diagnosing clinically significant prostate cancers that require treatment. As a radiologist reading the images, I can now localize for the urologist a potentially clinically significant lesion that requires biopsy. MRI by itself cannot diagnose prostate cancer, but it is a powerful tool to help urologists provide the most accurate diagnosis for patients to give them a personalized treatment plan.”

The traditional approach to prostate biopsy involves ultrasound, but without the benefit of enhanced visualization offered by the fusion technology. Using an ultrasound probe with a needle through the anus, a urologist extracts small samples of prostate tissue to look for cancer. But these ultrasound images are generally of poor quality. As a result, the samples are taken from random areas of the prostate and can miss a prostate tumor entirely.

MRI ultrasound fusion biopsy is ideal for men who have an elevated prostate-specific antigen (PSA) as determined by a blood test, including those with a previous negative biopsy result, men with an abnormal rectal exam, or men diagnosed with prostate cancer who are on active surveillance, also known as watchful waiting.

The procedure is performed on an outpatient basis. A patient must first be evaluated by a urologist to determine if he is a candidate for MRI ultrasound fusion biopsy. For more information and a referral, patients can contact The Lefcourt Family Cancer Treatment and Wellness Center at Englewood Hospital and Medical Center 201-608-2266 or cancer.center@ehmchealth.org.

Put the Brakes on Summertime Injuries

Posted on August 1, 2017September 19, 2018 by Cody

Warm sandy beaches and lush green courses offer the perfect backdrop for sailing, swimming, and golfing. It’s hard to argue that summertime is best experienced outdoors, but while your mind may be ready to dive right in, your body may not be. We sat down with Dr. Asit Shah, chief of orthopedic surgery, Dr. Marc Arginteanu, chief of neurosurgery, and Dr. Jeff Pavell, chief of rehabilitation medicine, all at Englewood Hospital and Medical Center, to learn how to prevent injuries and get the most out of athletic and leisure activities in the summer and early fall.

Q: When the temperature heats up, many people flock outside for leisurely and athletic activities. What steps should people take before starting?

Dr. Shah: Take it slow when you first start. Unless you’re very active during the winter months, your body needs time to adjust to exertion activities like biking, running, hiking, and waterskiing. These are great activities for the body and can help keep muscles and joints strong and supple, but if you overdo it or don’t have proper form, it can easily lead to injury. We often treat patients for hip fractures, knee pain, and both ankle and knee sprains.

Q: When do you know if you should see a specialist for an injury?

Dr. Shah: When in doubt, get checked, particularly if pain is disrupting your life or an injury is impacting function. We always look to treat patients with the least invasive approach possible using noninvasive or minimally invasive techniques to help them safely get back to enjoying normal activities.

Q: Beach and water activities are some favorite summer pastimes. What are the most common injuries you see from these activities?

Dr. Arginteanu: We often see people with herniated discs in their lower back or neck, mid-back pain and spasms, as well as arthritis in the neck or spine. Swimming, kayaking, sailing, surfing, and golf are some favorites, but the repetitive motions can be tough on the neck and back and may cause traumatic injuries where the repetition itself causes injury.

Q: How can people prevent these types of injuries?

Dr. Arginteanu: Neck and spine injuries can become chronic or permanent if not treated in time. The best way to prevent injury is to warm up the body and mimic the motions of the activity before starting. It’s also important to build your core strength as these muscles helps support the neck and spine. Yoga and Pilates are good examples of core-building exercises.

Q: What are some general tips for protecting your muscles and joints from injury?

Dr. Pavell: Everyone should be mindful of their form and take safety precautions.

Warm up before any activity.
Do at least 5-10 minutes of gentle exercises to gradually increase your heart rate and blood circulation so your muscles and joints are ready for more intensive activity.
Wear appropriate attire and protective gear.
Choose clothing that lets your skin breathe and removes excess perspiration. Footwear should be appropriate for the terrain – the right shoes can help prevent slips and keep your joints stabilized. Helmets can help prevent concussions and other head injuries. I recommend wearing one when biking, cycling, or waterskiing.
Take breaks and hydrate.
Your body needs time to recharge. Don’t push your body to exhaustion – you’re more likely to be injured or develop muscle strains. Take breaks as you need them.Make sure to hydrate. Dehydration is a common summertime condition that occurs when your body doesn’t have enough fluids. It can be serious and impact your balance and coordination, which can lead to falls. The best way to prevent dehydration is to drink plenty of water throughout the day.
Maintain correct form throughout the activity.
Before starting a new activity, make sure you know how to perform exercises properly to avoid hyperextending or straining your shoulders, neck, hips, knees, and back, which can lead to injury. Consider taking lessons from a professional before starting.

Q: What are some treatment options if you get injured?

Dr. Pavell: For minor strains, spasms, or other injuries, take it easy and rest up. Ice can help with inflammation while elevation of the injured area can reduce swelling. Pain is typically two-fold: physical and emotional. Manual therapies and complementary care may address both types of pain, which are often intertwined. The Graf Center for Integrative Medicine at Englewood Hospital offers evidence-based therapies such as therapeutic massage, acupuncture, and meditation that can help with pain management.

Posted on July 19, 2017