A Matter Close to the Heart: Patent Foramen Ovale (PFO)

Most of us are familiar with heart-related conditions such as blood clots, stroke, high blood pressure and heart murmurs. If we haven’t been directly affected by a heart condition, we probably know someone who has had a heart attack or undergone heart surgery. In fact, according an article in CNN Health, “more than 70 million Americans live every day with some form of heart disease, which can include high blood pressure, cardiovascular disease, stroke, angina (chest pain), heart attack and congenital heart defects.”

One heart condition that you may not be familiar with is patent foramen ovale (PFO). PFO is an opening or flap in the heart. It is present in everyone before birth, but it closes spontaneously in 80 percent of people a few days after birth.

A few other facts about PFO:
• The cause of PFO is unknown
• Cases have been found in 50 percent of people who have suffered a cryptogenic stroke (stroke of unknown origin) and 50 percent of migraine sufferers
• People with PFO usually exhibit no symptoms
• It may be diagnosed when a child or adult has a transient ischemic attack (TIA)
• Can only be detected by a specialized test, such as an echocardiogram

Dr. Robert J. Sommer, M.D., Director of the Adult Invasive Congenital Heart Services at New York-Presbyterian Hospital/Columbia University Medical Center, presented at Sinai Hospital Grand Rounds last week on“The On-Going PFO Controversy: Is Closure I the End of the Line?” In the presentation Sommer addressed the results of the Closure I trial, as well as PFO studies related to decompression illness, obstructive sleep apnea and migraines.

Closure I is a 2-year study that began in June 2003. The study compared the effectiveness of using a medical device against using conventional medication to permanently close PFO openings. It compared STARFlex septal repair implants against conventional medications (aspirin and clopidogrel) in 909 patients. At the end of the study it was found that there was no difference in PFO between patients that had received the STARFlex implants and those that received medication.

Some of the questions that Sommer posed that could have affected the study were:
• What if the wrong patients were studied?
• What if the wrong medical device was used?
• What if the 2-year follow-up was too short?
• What if the samples used were too small?

Although the results of the study were disappointing, there are still trials ongoing in the U.S. and Europe.

In addition to the Closure I study Sommer also addressed PFO’s link to:
• Decompression Illness in Divers – It was concluded that the risk for PFO is 5 times higher in divers. This is because some divers produce bubbles in their venous blood before and after decompression. Sommer personally treated New York City policemen and firefighters who were divers who had an increased PFO.

• Obstructive Sleep Apnea – Sommer had closed a PFO on a patient who was suffering from obstructive sleep apnea. She told him that 3 weeks after the operation she was dreaming again!

• Migraines – The MIST (Migraine Intervention with STARFlex Technology) study was a double-blind study that tested the effects of closed PFO on migraines. Some patients were fitted with the STARFlex implant while others were not. The results were that 37 percent of patients with the STARFlex implant had reduced migraines while 17 percent of those without the implants had reduced migraines. Sommer himself had a patient who instantly stopped having migraines the day after closing his PFO.

To conclude, Sommer stated that certain goals need to be met in order to better understand PFO: Doctors need to establish which syndromes are casually linked to PFO, they need to know the benefits of closure therapy, and they need to create proper methods of treating patients selected for PFO intervention. Although he sees the future of PFO at a crossroads, there are still people out there, like himself, whose goal is to expand interest and public awareness of this heart-related condition.

Here is a heartwarming story of a patient who underwent successful PFO surgery:

To learn more about PFO and other heart-related conditions, call 410-601-WELL (9355).
-Trish Smith

Northwest ER-7 Shows Gains In Patient Satisfaction

At 7:05 a.m. on Wednesday, June 16, Northwest Hospital’s ER-7 saw its 60,000th patient since July 1 of last year. If current trends continue, the ER will see about 62,380 patients in a year’s time, a new record for the hospital. There’s no question that the Randallstown community has grown, increasing the demand for emergency medical services, and we're constantly striving to improve the ER patient's experience.

Northwest’s current ER was built 7 years ago and was designed to accommodate 50,000 patients a year. Though the emergency department is busy, the staff takes measures to ensure that patients don’t feel the pinch.

Through the creation of a Rapid Evaluation Unit (REU), in which patients are quickly screened by a health care provider and directed to one of seven ER care centers, average waiting time to see a physician has decreased by half. For people in the main waiting room, a guest relations representative makes sure they have what they need, whether it be a blanket, something to read or more information about their loved one. Since 2006, patient satisfaction with the Northwest ER has increased three-fold.

Last June, Northwest’s ER was designated as a Primary Stroke Center by MIEMMS. This means that ambulances will bring patients who present with stroke symptoms to Northwest when it is the nearest Primary Stroke Center. With a stroke, time to treatment is of the utmost importance, and now that stroke patients now are able to be seen more quickly at Northwest, lives will be saved and qualities of life improved.

“Our hospital and community are better off for the commitment [the ER staff has] made to providing top notch care to those who need us in times of emergency,” say Erik Wexler, president of Northwest Hospital.

-Holly Hosler

Northwest Hospital Receives Award for Stroke Treatment Program

When you or a loved on is being admitted for a stroke, it's important to know that your health care team has the latest skills and knowledge.

That's why we're proud that Sinai and Northwest hospitals are designated as Maryland Stroke Centers. Hospitals with this MIEMSS stroke designation showed they have a stroke team that can give acute stroke medicines and have resources to take care of stroke patients.

Now there's one more reason to celebrate our treatment for stroke patients. Northwest Hospital has received the 2010 American Heart Association/American Stroke Association "Get with the Guidelines" bronze award for its commitment to providing high quality care for stroke patients.
This recognizes Northwest's commitment to and success in implementing a higher standard of stroke care by ensuring that stroke patients receive treatment according to nationally accepted standards and recommendations.

Get With The Guidelines® is an evidence-based program for in-hospital quality improvement that focuses on quick diagnosis and treatment for stroke patients. Patients treated in hospitals with a Get With the Guidelines program can know they are getting care that is aligned with the latest scientific guidelines

Northwest and LifeBridge Health are also active in the community in promoting awareness of stroke symptoms. The warning signs of a stroke are:

• Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

To learn more about our stroke programs, call 410-601-WELL (9355) or click here.

Read about Stroke. Hear about Stroke. Know about Stroke

by Linda Pazdalski, B.S.N., R.N.
Stroke Program Coordinator, Sandra and Malcolm Berman Brain & Spine Institute

You read it in any number of publications, hear it on any number of radio programs, and see it on any number of TV commercials almost daily…..Stroke is the third leading cause of death in the US. STROKE IS THE THIRD LEADING CAUSE OF DEATH IN THE US. STROKE IS THE THIRD LEADING CAUSE OF DEATH IN THE US.

But…..are you able to recognize a stroke when it happens?

Stroke warning signs:

• Sudden numbness or weakness of face, arm, or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

Use the mnemonic: F.A.S.T.

Face…….Ask the person to smile. Does one side of the face droop?
Arm……..Ask the person to raise both arms. Does one arm drift downward?
Speech…Ask the person to repeat a simple phrase. Is the speech slurred or strange?
Time……If someone you know has one or more of these signs, call 911 immediately.

The speed with which one who has sustained a stroke receives medical attention greatly influences the speed and quality of their rehabilitation and their return to normal activities. Regardless of type, all strokes can have a devastating impact on the survivors and on all of those who care for them.

Learn the signs. Use the mnemonic. Help someone survive and thrive.

For more information about stroke, visit the Power to End Stroke Web site or contact the American Heart Association, 1-800-AHA-USA-1 (1-800-242-8721). To learn more about stroke programs at LifeBridge Health, click here.

Northwest Hospital Designated Primary Stroke Center

For some residents in Baltimore City and Baltimore, Carroll and Howard counties, lifesaving emergency stroke care just got closer to home. That is because the Maryland Institute for Emergency Medical Services Systems (MIEMSS) has just designated Northwest Hospital as a Primary Stroke Center. Now, ambulances transporting stroke victims will take them to Northwest Hospital for treatment when the hospital is the closest Primary Stroke Center.

Before the designation, emergency vehicles with stroke patients had to drive past Northwest and go to a farther hospital that was a Primary Stroke Center, which wasted precious time. During a stroke, “time is brain,” and it is critical that victims recognize the warning signs, call 911 and receive medical attention as soon as possible. The longer the wait, the potential for extensive brain damage and death increases.

“We’re very happy that Northwest Hospital is now able to serve our community better by providing closer – and therefore faster – emergency stroke care,” says Erik Wexler, president of the hospital. “Being a Primary Stroke Center is an unusual distinction for a community hospital, but we were certified as one because, among other things, we have dedicated neurology coverage; we can administer tPA, a clot-busting drug; and we have the ability to rapidly transfer the most complicated stroke cases to our affiliated teaching hospital, Sinai Hospital of Baltimore.”

To be designated a Primary Stroke Center, Northwest Hospital has to continually meet 10 core measures for stroke patient care outcomes. Gurdeep Ahluwalia, M.D., Northwest’s on-staff neurologist, leads the team of medical experts who enable the hospital to provide 24/7 emergency stroke care. This team is well-versed in stroke protocol, which involves giving the patient a CT scan to confirm the stroke is caused by a blood clot and, if so, administering tPA within the first three hours of stroke symptom onset. This powerful drug has the ability to dissolve clots that are blocking oxygen-rich blood to the brain. Any patients for whom tPA is not appropriate and who require more invasive means of blood clot removal can be easily transferred and treated at Sinai Hospital if necessary.

In addition to providing time-critical emergency treatment for stroke, as a Primary Stroke Center, Northwest provides a full continuum of care for stroke patients that includes a multidisciplinary approach by emergency medicine, neurology, interventional radiology, rehabilitation services, pharmacy, lab, dietary and social work experts. The whole team works collectively to ensure stroke patients recover and are able to resume their daily activities and previous quality of life as fully as possible.

To learn more about Northwest Hospital and stroke services at LifeBridge Health, visit www.lifebridgehealth.org.