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Knowing Your Own Heart

BarbSkusa1A lifelong athlete, Barb Skusa, was startled to discover she had a 90 percent blockage in one of her arteries. After cardiac intervention, Barb, shown with her protégé Dillon Hayes, is back to playing racquetball twice a week.

Barb Skusa thought she knew her own heart.

She led a busy life as a high-school teacher, wife, mother of two stepchildren and grandmother. She made an effort to eat healthy and worked out routinely in her home gym. In addition, she played racquetball two nights a week, a continuation of her forty-year avocation as a nationally ranked racquetball player.

But she began to have second thoughts about a year ago when, on the same weekend, a “fit and healthy” colleague underwent emergency quadruple heart bypass surgery; and her husband went to the emergency room complaining of chest pains. Her friend survived surgery and is doing well; her husband’s pains were due to costochondritis, an inflammation of the sternum wall, probably brought on by lifting weights.

But those episodes caused Barb to do some soul searching about her own heart health. She knew her family’s history was not the best: her mother died of a heart attack at age 71, and her sister had a mild heart attack at age 57, the same age Barb is now. And, despite her commitment to regular exercise, she was overweight.

So she made an appointment with her family doctor to have a physical exam – something she had not had for many years. Her doctor ordered several basic heart tests as well as a coronary-artery calcium scoring test. (This test is not considered “basic” but was warranted by Barb’s family history and her high cholesterol.)

The tests showed mostly normal results, although her doctor increased the dosage of her cholesterol-lowering medication. The real shock was her coronary-artery calcium (CAC) score. “I didn’t react when the doctor told me my score was 338,” recalls Barb. “I did react when he told me that a ‘normal’ score was between 1 and 10. I thought I was doomed to having a heart attack.”

Actually, Barb’s CAC score placed her in the intermediate range – albeit, at the high end – for risk of having a heart attack (a score of 400+ is considered high). Her score was too high to be ignored, however, and she was right to be concerned.

What Is a Coronary-Artery Calcium (CAC) Test?

A CAC test detects the presence of calcium in the coronary arteries (see below). In simple terms, the buildup of calcium in the walls of coronary arteries indicates the presence of coronary artery disease (CAD). The quantitative results (the score) indicates the patient’s risk of having a heart attack.

The test – which is not covered by most private insurers or Medicare – is not for everyone. Indeed the American Heart Association and the American College of Cardiology do not recommend a CAC for people at low risk for heart disease or for people already diagnosed with heart disease. In the latter case, the results won’t change their current treatment.

But for people like Barb, whose risk was somewhere in between, the test can be a life-saving message. 

Assessment

Barb’s doctor referred her to Mukul Chandra, MD, whose medical specialty is preventive cardiology. Dr. Chandra, who is in practice with Miami Valley Cardiologists, Inc., is director of Premier HeartWorks at Miami Valley Hospital. He is also a clinical associate professor at Wright State University Boonshoft School of Medicine.

Dr. Chandra reviewed Barb’s test scores and, due to her symptoms, prescribed a treadmill stress test, which she passed. He also increased the dosage of her cholesterol-lowering medication. As far as her CAC score, Dr. Chandra opted to take a “wait-and-see” approach.

“You can’t get rid of calcium that has built up in your arteries,” explains Dr. Chandra. “But you can stop it from getting worse. In that sense, an abnormal CAC score can motivate patients to take prescribed medications and to make lifestyle changes.”

Chandra HS
Mukul Chandra,
MD
JainHS
Steven Jain, MD

According to Dr. Chandra, “Cardiologists look at CAC scores in the context of other factors such as blood pressure, cholesterol levels, symptoms (e.g., chest pain, shortness of breath, fatigue) and lifestyle. In the absence of negative indicators, invasive intervention is not warranted; however, a patient with intermediate to high CAC scores is on my radar screen.”

The blips on that radar screen intensified several months later when Barb complained of chest pains after a strenuous workout on her treadmill. 

Intervention

Serendipitously, Barb’s six-month checkup was scheduled for the next day. This time, suspecting heart disease, Dr. Chandra recommended a cardiac catheterization, which he performed on Barb at Miami Valley Hospital. During the procedure, Dr. Chandra inserted a catheter though a blood vessel in her groin and, guided by x-rays, into her heart. The test revealed a 90 percent blockage in the heart’s left anterior descending artery.

The next intervention, performed at the same time, was the insertion of a stent to open up the blocked artery. Steven Jain, MD, a colleague of Dr. Chandra, performed the procedure using an advanced drug-coated stent. This newer stent, in comparison to non-coated stents, has been shown to prevent re-narrowing of the artery. A day later, Barb checked out of the hospital; and a few days later, she returned to work.

Another intervention Dr. Chandra recommended was for Barb to enroll in an ongoing cardiovascular program (after her four-week mandatory cardiac rehab program following surgery). She found just what she needed at the Women’s Cardiovascular Program at MVH South.

The Women’s Cardiovascular Program

The Women’s Cardiovascular Program, a division of Premier HeartWorks, is specifically designed to meet the special needs of women’s heart health. The program enables women to take a more active role in their health through education, counseling, and exercise in a supportive environment.

Many women, like Barb, have been motivated to join the program because of a health scare. Others join as a pre-emptive measure.

Barb meets twice a week for an hour with exercise physiologist, Christine Broomhall, RN. After an initial assessment, Barb has been following a customized workout program designed to increase muscle strength, endurance, flexibility, aerobic capacity and body composition. Barb also confers with a registered dietitian, who recommends dietary changes geared to Barb’s weight-loss goals and lifestyle.

Knowing Her Own Heart

BarbSkusa2
Barb Skusa works out under the
watchful eye of Christine Broomhall,
MS, RN (left), an exercise
physiologist at the Women’s
 Cardiovascular program at Miami
Valley Hospital South.

Today, Barb has a much clearer picture of her heart. She’s losing weight and working to lower her LDL cholesterol and triglycerides levels. In July, she and her husband celebrated their 20th wedding anniversary on a cruise. She’s looking forward to retiring in a few years. 

But, she doesn’t plan to slow down. She – and her heart – are in it for the long run.

These Miami Valley Hospital locations offer Cardiology Services.
Cardiology and Vascular Services at Miami Valley Hospital
Premier HeartWorks at Miami Valley Hospital South
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Visit the Miami Valley Hospital Directory.

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