Letter from the Chairman

Dr. Kenneth EllenbogenFriends and Supporters,

Welcome to the winter edition of The Beat. We recently celebrated American Heart Month, a special time when we work to raise awareness in the community on the prevention and treatment of cardiovascular disease. In this issue, you can learn about the special events that took place during American Heart Month, and some of the research and programs we are undertaking to improve the lives of our patients.

Our cover story is especially fitting, as it provides a glimpse of our long and storied history in heart transplantation—from the days of Dr. Richard Lower to the outstanding physicians and scientists who are carrying on his pioneering legacy today. Heart transplantation is an incredible gift of life for many patients, truly one of the miracles in medicine.

One of my favorite stories is the trip to India made by Dr. Jay Koneru and nurse practitioner Cha Roberts. These two concerned providers worked long hours caring for the needs of some very ill patients with complex cardiac conditions. At the same time, they provided training to local doctors and nurses to ensure their impact would be lasting.

Sarcoidosis and amyloidosis are two rare but often life-threatening diseases that are often underreported by healthcare providers. In this issue, you’ll learn how Dr. Jordana Kron and Dr. Keyur Shah are working to help identify these patients earlier and connect them with some very impressive treatments and therapies through their comprehensive, multidisciplinary clinics.

Finally, I want to thank the incredible members of our Pauley Heart Center community. The gifts made to support innovative research through the new Pauley Heart Pilot Research Grants and the Christine B. and David E. Cottrell Surgical Innovation Laboratory are truly transformative. Thank you for allowing us to stay at the forefront in the fight against heart disease.

Sincerely,

Dr. Kenneth A. Ellenbogen
Chairman, Division of Cardiology


Cardiac Arrest vs. Heart Attack?

Many people confuse heart attacks with cardiac arrests, but they are very different.

A heart attack is a circulatory problem that results when blood flow to the heart is suddenly stopped due to a blocked artery, usually causing symptoms like chest discomfort, sweating, and shortness of breath. A cardiac arrest arises when an electrical malfunction in the heart leads to an arrhythmia that causes the heart to suddenly stop beating.

While a heart attack victim may experience immediate discomfort, generally their symptoms will worsen over hours and the vast majority of these people do not die. A victim of cardiac arrest will become unresponsive within seconds and die within minutes if they do not receive treatment. A very small percentage of heart attack victims—10-20%–may secondarily go into cardiac arrest. For either situation, call 911 right away.


In Memoriam

Pauley has lost a few beloved friends of the Consortium.

Robert Huntington Cropp, of Williamsburg passed away on Sunday, Aug. 27, 2017, at the age of 79. He enjoyed a 35-year career with the IBM Corporation, which took him from San Francisco to Honolulu, Sacramento, Calif., White Plains, N.Y., Los Angeles and Washington, D.C. He was active in many organizations, including the Kiwanis Club of the Colonial Capital, the Boy Scouts of America and the American Bible Society. With his wife, Gloria, Bob was a devoted member of the Consortium, who gave generously to support the work of the Pauley Heart Center.

“Bob Cropp was a great family man, a business leader and an inspiration to so many others. He will be missed by all,” said Charles Crone, MCV Foundation board member.

Jeanette Lipman passed away Jan. 10, 2017, at the age of 102. “She was an extremely caring, generous woman and devoted Richmond philanthropist. She made an incredible impact,” said Dr. Kenneth Ellenbogen.

At VCU Health, Jeanette and her late husband, Eric, established several endowed faculty positions, including the Eric Lipman Research Professorship in Cardiology, the Hermes A. Kontos, M.D. Professorship in Cardiology, the George W. Vetrovec Chair, and the Jeanette and Eric Lipman Chair in Oncology. The family also created several research funds, including the Aubrey Sage MacFarlane Lung Injury Research Fund and the Carol Jean Lipman MacFarlane and Ann Debra Lipman Cancer Research Fund.

H. Merrill Plaisted, III, died on Nov. 30, 2016, at the age of 81. “Although H. Merrill Plaisted, III, was born in Maine to a family of governors, we were fortunate to call him a dedicated Richmonder since 1960,” said Ellenbogen.

A prominent member of the real estate industry, “Mr. Plaisted was committed to many community organizations, serving as president of Big Brothers and Big Sisters of Richmond and giving generously to Pauley.”


VCU Health CMH Opens New Hospital

In November, VCU Health Community Memorial Hospital (CMH) opened its new, state-of-the-art, 167,000-square-foot facility in South Hill. The new facility offers 70 acute care beds, along with a cardiac catheterization lab, an emergency department, three operating rooms, an obstetrics suite and other facilities. The new building is the first medical facility erected in South Hill since 1954. VCU Health has committed at least $75 million in funding to the hospital. VCU Health CMH provides health services for the south-central region of Virginia and portions of northern North Carolina.

On Nov. 11, 28 patients were moved from the old hospital to the new one, with the support of several rescue squads. “We ushered in a new era of health care today with this patient move. It’s a culmination of years of hard work by the CMH board, our partners with VCU Health and, of course, our staff and volunteers,” said Scott Burnette, CEO of VCU Health CMH on the day of the move. “There were more than a few misty eyes when we announced at 10:42 that the old CMH was officially closed. A lot of fantastic work was done over the past 63 years inside those walls.”

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Did you know…
The Virginia Medical Group in Colonial Heights joined Pauley in June 2016. The outpatient cardiology and neurology practice, now known as VCU Health at Colonial Square, is located at 2905 Boulevard, Colonial Heights, VA. 23834. Phone: (804) 526-0682.


Celebrating Heart Month

February is American Heart Month. To raise awareness about cardiovascular health and disease, Pauley participated in numerous events throughout the community.

On Feb. 2, our staff took free blood pressure readings and calculated body mass indexes (BMIs) in the lobby of the VCU Medical Center’s Gateway Building. Last year, we provided this service to more than 800 individuals.

A myriad of speakers appeared at the Third Annual Women’s Heart Health Symposium. The event took place Feb. 3 at the Virginia Historical Society. (See p. 5 for more details.)

VCU Health also presented three seminars at Lewis Ginter Botanical Garden. On Feb. 1, Dr. Vigneshwar Kasirajan, Dr. Keyur Shah, and Dr. Daniel Tang, presented “The Future of Heart Replacement Therapies.” Interventional cardiologist Dr. Luis Guzman and vascular surgeon Dr. Mark Levy, presented “Peripheral Artery Disease—Know Your Risk and Your Options,” on Feb. 8; then on Feb.22, cardiologist Dr. Phoebe Ashley presented “Are you doing your part to maintain a healthy heart?” The seminars were held at Lewis Ginter’s Kelly Education Center, 1800 Lakeside Avenue in Richmond. All seminars were free and open to the public. To learn more about upcoming seminars visit: vcuhealth.org/events.


Mended Hearts: Patients Share Lessons

Joe Shocket knows a lot about recovering from heart surgery. For one thing, patients’ feet tend to swell. That’s why he recommends they bring sandals, slippers or other loose-fitting shoes to change into when they leave the hospital.

Shocket, who underwent a quadruple heart bypass in 2009, “imparts tidbits of information” like this to patients of Pauley. He’s the visiting chairman of Richmond Chapter 28 of Mended Hearts, which runs a hospital visitor’s program and presents speakers at its monthly meetings. Mended Hearts has approximately 200 chapters in the U.S., with over 20,000 members.

“It’s the largest peer-to-peer support group in the country for heart patients and their family members,” he said.

Locally, there are 14 active accredited visitors who have gone through the organization’s training program. In 2016, those visitors met with 1,879 individual patients at five hospitals—the majority at VCU Medical Center because of the size of the program. In terms of cardiac care, “I don’t think you could find a better place than here,” he said.

Wearing a red vest accented by a heart symbol, Shocket is a familiar face around the hospital on Mondays. He usually stops back on Wednesday “to catch any patients that I might have missed.” Another volunteer, Sharon Feldman, comes by on Fridays.

His routine begins with a knock on the patient’s door. He asks for permission to come in, then introduces himself. “I tell them, ‘I’m a former heart patient. I was in a bed like you are about eight years ago, and I know how it feels.’”

In August 2009, Shocket went in for a pre-employment health screening at Chippenham Hospital. “Everything was fine, and then I went on a treadmill to take a stress test. I was able to complete it, but there were obvious issues for my heart.” He went in for an angiogram and discovered he had 95% blockage. Surgery followed at the hospital.

“I think that when a person’s sick, the ability to talk to other people with heart disease makes a huge impact on their health and recovery.” — Dr. Kenneth Ellenbogen

“Open-heart surgery knocks you for a loop,” he said. “You’re really stiff, really sore.” He remembers standing, then gradually beginning to walk down the halls of the hospital. “It’s like scaling a mountain. You begin in very small increments. Each time you walk, you try to go a little further.”

While he was in the hospital, someone from Mended Hearts stopped by. “I really appreciated the visit,” he said. “You know, you can feel kind of down after heart surgery.” He attended his first Mended Hearts meeting that December.

“I think that when a person’s sick, the ability to talk to other people with heart disease makes a huge impact on their health and recovery,” said Dr. Kenneth Ellenbogen.

The visitors help patients understand what to expect before, during and after surgery, and discuss the importance of good nutrition and cardiac rehabilitation. They also leave behind the Mended Hearts HeartGuide with information on heart disease.

Sometimes patients just enjoy having someone to talk with. Shocket recalled one patient from the Northern Neck who loved to talk about fishing and seafood. “We might start talking about heart failure, but it would always end up, `how was that oyster roast you went to the other night?’ Or: ‘This is the way you make oyster stuffing.’

“Part of visiting is to engage the patient and get them to a positive, happy place.”

Mended Hearts Chapter 28 meets the first Tuesday of each month and usually features a speaker in the cardiac field. To learn more about the organization, visit MendedHeartsRichmondVa.org and MendedHearts.org.


Pauley Hosts 2nd Annual Heart Walk

On Oct. 7, crowds gathered for the American Heart Association Richmond Heart Walk at West Creek Parkway. That same day, a group of heart and stroke patients and their supporters strolled through hospital hallways as part of Pauley’s second annual “internal” heart walk. The event took place in VCU Medical Center’s Main Hospital, and the cardiovascular thoracic surgical step-down unit, where stroke patients reside.

“All patients and family members were invited to participate. Cumulatively, we had 2,786 laps, which totaled 253 miles. One patient did 62 laps throughout the day,” said Kimberly Nelson, doctor of nursing practice, clinical nurse specialist. Last year, she and transplant patient Craig Trowbridge launched Pauley’s first internal heart walk.

New this year, were vendors such as Zoll Medical Corporation, which demonstrated its LifeVest defibrillator and sponsored the lunch, as well as Hands Only CPR, Mended Hearts and Air Medical Transport.
This year’s participants raised $5,140 for the AHA. Including both walks, VCU Health teams brought in $54,000 for the organization.

Channel 6 was on hand. The opening ceremony featured speeches by Nelson as well as Deborah Davis, CEO of VCU Hospitals and Clinics, Melinda Hancock, chief financial officer of VCU Health System; and a patient. “We encouraged everyone to participate in fighting heart disease and stroke by being active,” said Nelson.


Air Transport Provides Critical Care

Boarding LifeEvac HelicopterWhen lives are on the line, VCU Health’s helicopters are a welcome sight.

“We have two helicopters and a 35-member team that responds to about 1,200 to 1,300 calls each year,” said Jay Lovelady, R.N., operations manager of the critical care transport program and flight nurse. Often, VCU Health crews transport patients from smaller hospitals, car wrecks and other emergency scenes around the state to VCU Medical Center, the only Level I trauma center in the region.

Each aircraft is staffed by three people. “They’re on duty 24/7, 365. There’s one pilot, one flight nurse and one flight paramedic available at all times.” The crew is supported by medical director Dr. Harinda Dhindsa, and clinical manager Katie Rodman.

The fleet includes the new Airbus H145 and an Airbus H135. “They’re very similar, but the 145 is a larger aircraft. It will fly a little bit further, it carries more weight,” he said.

The 145’s larger size allows for transports of heavier patients or an additional person—such as the parent of an injured child. Specialty transports, such as ECMO patients, who require a heart perfusionist and additional equipment, are now possible.

Airbus H145 is based at Dinwiddie County Airport and often serves cities in southern Virginia, such as South Hill, Emporia and Farmville. West Point is the hub for Airbus H135, reaching patients in Williamsburg, Northern Neck, the Peninsula and Tidewater. The team also supports the Virginia State Police’s MedFlight program with flight nurses and staffs a ground critical care transport ambulance based at VCU Medical Center.

Lovelady, who has worked as a flight nurse for 13 years, previously served as a firefighter, paramedic, and ER and ICU nurse. “The critical care transport setting is really a blend of a lot of that,” he said. “I always enjoy the fact that no two days are alike.”

Air Medical Transport crew members wear specialized gear, including helmets with integrated communications to protect their ears from the thundering sound of blades.

“Safety is really paramount to everything that we do,” said Lovelady. Once it gets dark, crew members wear night goggles so that they can better identify power lines and other dangers as they fly over the state.

Cardiac patients make up about one-third of our patients; trauma and pediatric cases comprise the remaining two-thirds. The on-board medical equipment includes a specialized cardiac monitor, a pacemaker defibrillator, a ventilator, a video laryngoscope for intubating patients and various ICU medications.

“Every week, we pick up patients having STEMIs or other heart attacks. We will fly to a remote part of the state to pick up a patient who’s having chest pain, and we’ll start their treatment. At that point, we become the eyes, ears and hands of Pauley until we can get here and transfer care.”

Such patients often have faster recoveries than some trauma patients, who may take months to recover. “That’s why I think taking care of cardiac patients is one of the more rewarding things that we do,” he said. “Often, in the short time that we’re with them, we get to see some improvements.”

Above: Flight Nurse Beverly Harris is administering blood products to a patient. Right: VCU health’s AirBus H145 in flight.


Dr. Patricia Uber Assists Heart Patients

Patricia Uber, PharmDEach year that passes is a celebration for the patients of Patricia Uber, PharmD.

“My youngest patient was 13 days old. He’s now 15 years old,” she said. “He plays tennis and runs track and field for the Transplant Games of America.”

The patient was one of many she met while working for Dr. Mandeep Mehra, at the Ochsner Clinic’s busy Cardiomyopathy and Heart Transplantation Center in New Orleans, from 1997 to 2005. Surgical teams performed 50 to 60 heart transplants each year at the hospital, which was also involved in trials for the early heart pumps.

At the Ochsner Clinic, she was concerned by the mortality rates of African-American transplant patients; few survived more than two to three years. “A lot of them died by what we call antibody mediated rejection,” she said. “It was very difficult to watch.” Seeking answers, she was involved in pivotal studies exploring a new drug. “We changed our immunosuppression therapy from cyclosporine [a groundbreaking, highly effective drug for other groups] to tacrolimus, and we saw a dramatic improvement in the survival rates of African-Americans.”

She and a colleague left Ochsner to help Mehra build the heart transplant and pulmonary arterial hypertension programs at University of Maryland. In 2009, Mehra became editor of the prestigious Journal of Heart-Lung Transplantation, and Uber the executive editor—a position she has held ever since.

“Patricia Uber is an expert in the field of transplant pharmacotherapies and world-renowned in her work with the journal.” — Dr. Keyur Shah

Dr. Keyur Shah, who had met Uber when he was a fellow at Maryland, successfully recruited her to come to VCU Health in 2015. “Patricia Uber is an expert in the field of transplant pharmacotherapies and world-renowned in her work with the journal,” said Shah. “When the opportunity arose to recruit her to VCU Health, we thought it was a perfect match with her expertise and our intent on having a world-class advanced heart failure program.”

At VCU Health, Uber enjoys working with other team members to tackle the challenges of these complex patient populations. With transplant patients, “their immune systems are not normal and their medications are very specialized, so the interactions with other medications can have severe consequences,” she said.

Even a virus can wreak havoc on their systems. “What I explain to the patient is that they live the rest of their life walking a fine line between rejection and infection,” she said. The risk of rejection is highest in the first year. During this time, the patient is closely monitored through regular visits and biopsies. “That’s where we’re doing the most adjustments of their anti-rejection meds. If they can make it through the first six months to one year without any major rejection episode, then things are looking pretty good for what’s going to happen over the next 5,10, 15 years.”

Uber has celebrated birthdays and weddings with patients and likes to follow them through the years. “I think what I like the most about it is, you know them the whole way through their journey—the good and the bad,” she said. “It’s longitudinal care.”


Research Highlighted at Heart Ball Reception

In anticipation of the upcoming 26th Annual Richmond Heart Ball, VCU Health hosted a reception that raised awareness of the critical research made possible by the American Heart Association and Pauley. Over 60 guests attended the event, which took place at the McGlothlin Medical Education Center in November.

“Pauley has a long history of partnership with the AHA,” said Dr. Kenneth Ellenbogen, one of the evening’s speakers. He noted that AHA’s first grant to VCU Health was awarded in 1972 to Dr. Richard Lower, to study how to more successfully reanimate the heart during a transplant. “Since that study, 138 Pauley researchers have been funded by the AHA. Just this year, we received $7 million from the AHA for specific innovative research.”

In addition to the AHA grants, he said, VCU Health researchers would also have access to a new source of funding, the Pauley Pilot Research Grants program. “Pilot grants may sound like something every academic medical center is doing, but as healthcare budgets get tighter across the country, we are extremely fortunate to rely on the philanthropic support of our Pauley Heart Center donors. The Pauley Pilot Research Grants program is completely funded by gifts from grateful patients, alumni, faculty and staff.”

Other speakers that evening included Patti Jackson, AHA’s executive director; Larry Little, vice president of Support Services and Planning and 2018 AHA Heart Ball chair; and Deborah Davis, CEO of VCU Hospitals and Clinics and AHA’s board president.

Following the short speeches, the guests enjoyed a dinner catered by Mosaic. They then had the opportunity to mingle with Pauley researchers, who had set up posters about their studies.

“The evening was an opportunity for those who support the American Heart Association to see the commitment and discoveries that are being made at VCU Health to cure heart disease,” said Ellenbogen. “It is exciting to receive recognition for all the great work going on in Richmond.”