News & Info
Dr. Michael Turner Published by Medical Journal
An article submitted by Dr. Michael Turner MD, FACC, FSCCT, preventive cardiology specialist with Cardiovascular Specialists in Lake Charles was published last month in the medical journal Echocardiography.
The article, "High Risk Plaque with Near Normal Coronary Angiograms," appeared in the new "CT Rounds" section of the journal. Dr. Turner has extensive experience in the evaluation of emergency room patients with complaints of chest pain. In the article, he details the identification of a subgroup of patients who may be at risk for future cardiac events that may not have been discovered without the results of the Cardiac CT Angiogram (CCTA) during their emergency room evaluation. This finding allows initiation of preventive treatment in these individuals. The CCTA evaluation allows the cardiologist to see troublesome plaque in the wall of the heart artery not readily visible with conventional invasive coronary angiography.
Dr. Turner is the director of Cardiac CT at CHRISTUS St. Patrick Hospital (CSPH). He has been instrumental in developing a Cardiac CT triage program for the emergency room at CSPH utilizing the new 128-slice Siemens CT scanner located next to the emergency room. Dr. Turner is also the Director of Cardiac CT for the Imperial Health Imaging Center and is co-editor of the “CT Rounds” section of Echocardiography.
Dr. Michael Turner Named Co-Editor of Medical Journal
Dr. Michael Turner MD, FACC, FSCCT, preventive cardiology specialist with Cardiovascular Specialists, has been appointed co -editor for the new CT section of the international online journal Echocardiography, the official publication of the Society of Cardiovascular Ultrasound.
Dr. Turner is a founding member and Fellow of the Society of Cardiovascular CT and is board certified in both Cardiovascular CT and Cardiology. He has over 45 years of experience in his field, and over the past decade has actively used advanced CT technology in his preventive cardiology practice. He recently successfully implemented a state-of-the-art CT triage system to evaluate chest pain in the Emergency Room, the first program of its kind in Louisiana.
He is a senior partner with Cardiovascular Specialists, an affiliate of Imperial Health, the largest multispecialty medical group in Southwest Louisiana. Dr. Turner serves as the Director of Cardiac CT for CHRISTUS St. Patrick Hospital and Imperial Imaging. In that capacity, he supervises and interprets over 500 cardiac CT scans per year, including patients referred from as far away as New Orleans.
Dr. Turner is passionate about the benefits Cardiac CT offers for early detection of cardiovascular disease. “Cardiac CT has developed into one of if not the best initial imaging strategies for evaluating coronary artery disease as well as congenital heart disease,” he says. “Rapid advances in technology have allowed scans to be done with very low radiation exposure while producing clear, precise images.”
Closing the Heart Disease Gap
February is American Heart Month, and since its inception in 1964, this annual observance has done much to increase awareness about cardiovascular disease and how to prevent it. As a result,
improvements in heart disease prevalence and mortality rates are being made each year.For example, 2014 statistics from the American Heart Association report that on average, one person dies
every 40 seconds from heart disease, an improvement from 39 seconds in 2012. However, heart disease is still the number one killer in the United States, responsible for 1 in every 3 deaths, or
787,650 American live lost each year.
According to cardiologist Corey Foster, MD, with Cardiovascular Specialists, heart disease causes more deaths in Americans of both genders and all racial and ethnic groups than any other disease. "Unfortunately, many Americans believe that the highest rates of heart disease affect only older, white men, which can lead to a false sense of security. The truth is that heart disease takes a greater toll on certain racial and ethnic groups. And more women than men die of heart disease each year, although more men have heart attacks.”
In addition, Dr. Foster says women, Black Americans and Hispanic Americans who are at a high risk for heart disease are less likely to receive lifesaving treatments than Caucasian males. Even
when they have insurance and are of the same social class, minority groups often receive a lower quality of care than their Caucasian counterparts.
These disparities in heart disease prevalence and treatment are what medical researchers call "the gap" in heart care, and efforts are underway across the country to help close it, through
awareness, research, education and treatment programs.
Here are just a few examples that illustrate "the gap” in heart care:
· Black Americans are at greater risk for cardiovascular disease and stroke than White Americans.
· Black Americans are 2 times more likely than White Americans to be diagnosed with diabetes and 1.5 times more likely to be diagnosed with hypertension-important risk factors for heart disease.
· Black Americans have a risk of first-ever stroke that is almost twice that of White Americans.
· An estimated 30% of adult Hispanics have diabetes, but nearly half don’t realize it.Untreated, diabetes can lead to serious complications, including cardiovascular disease and renal failure.
· Among Latino Americans age 20 and older, 77.5% of men and 75.1% of women are overweight - an important risk factor for heart disease.
· Heart disease is the leading cause of death for women in the United States, killing more women than all cancers combined. However, only 42% of women aged 35 and older are concerned about heart disease.
· Almost two-thirds (64%) of women who die suddenly of coronary heart disease have no previous symptoms.
· At age 45, the lifetime risk for cardiovascular disease is more than 1 in 2 women.
· Some diagnostic tests and procedures, including the exercise stress test, might be less accurate in women then men.
"The prevalence of heart disease and related conditions in minority groups is compounded by the fact that these populations are also less likely to receive life-saving treatments than Caucasian males,” says Dr. Foster. "That’s why awareness and education are so important.”
Minorities and Heart Disease
In the United States, members of ethnic and racial minorities, especially African-Americans, have higher rates of death from heart attacks, strokes, heart failure and kidney failure than the
majority white population.
Is skin color, race, or ethnicity a cause of diseases of the heart and blood vessels?"Not directly,” explains Dr. Foster. "The major causes of diseases of the heart and blood vessels are high
blood pressure, high cholesterol, cigarette smoking and diabetes. However, it is also true that African-Americans with high blood pressure and diabetes are less likely to receive early and
sustained medical care.”
Much of the difference in the frequency of risk factors and the risky behaviors that contribute to higher risk for African-Americans is related to lower levels of education, social and economic
status, the ability to buy healthy foods and to obtain medical care that would protect against early death. Those with less than 12 years of education (high school graduation) are more likely to
have one or more of these risk factors: high blood pressure, high blood cholesterol, cigarette smoking and diabetes. They are also less likely to engage in regular physical activity.
Latinos now make up 16.7 percent of the U.S. population and are likely to make up more than 30 percent by the year 2050.A particular problem among Latinos is diabetes mellitus, which is related
partly to diet and obesity. Awareness of high blood pressure among those who have it, the frequency of treatment and adequate control, are also lower among Latinos than among African-Americans
and Non-Hispanic whites. Abnormal cholesterol profiles are also much more frequent among Hispanics.
Biological factors and lifestyle factors that contribute to higher rates of high blood pressure in African-Americans include lower potassium intake from fruits and vegetables, and weight gain.
Among Latinos, especially those of Mexican origin, and among African-Americans, weight gain and obesity lead to the development of diabetes in adults, and in recent years, even in children.
What’s the solution? "Reducing the impact of risk factors on premature death from cardiovascular disease among Latinos and African-Americans will require a combination of approaches,” says Dr. Foster. "For African-Americans, it will require attempts to improve control of blood pressure, to bring about smoking cessation, and to reduce the rapid increase in obesity and diabetes by bringing about dietary change and increasing physical activity. Among Latinos, it will require increased outreach and education across language and cultural barriers to change the lifestyles that contribute to obesity and diabetes, and to ensure adequate care to control and manage risk factors. The risk for minorities are susceptible to change. Increased mortality does not have to be linked to ethnicity.”
Women and Heart Disease
Think that breast cancer is the #1 killer of women? "Think again,” says Dr. Foster. "Heart disease is more deadly by far.”
As with men, for women the most common heart attack symptom is chest pain or discomfort. But Dr. Foster says women are somewhat more likely than men to experience signs and symptoms unrelated to chest pain, particularly shortness of breath, nausea/vomiting, and back or jaw pain. "It’s important for women to be aware of these types of symptoms and to pay attention to them.”
Risk Factors & Prevention for Everyone
Once you know the facts, take steps to reduce your risk for developing heart disease:
Learn about risk factors Understand the risk factors for heart disease you can and can't control.
Assess your risk Find out what's putting you at risk.
Reduce your risk Learn how to take control of lifestyle factors that contribute to heart disease.
Talk to your doctor Talk to your doctor about your risk factors; ask pointed questions and be honest about your risk factors to develop a plan to reduce your overall risk.
For more information about heart disease risk, or to schedule an appointment, call Cardiovascular Specialists, an affiliate of Imperial Health, at (337) 436-3813.
Shift Work Could be Breaking your Heart
If you work the graveyard shift instead of nine-to-five, you could be at increased risk for heart attack, according to recent research.
Although the heightened risk isn’t fully understood, research from the University of Western Ontario and Harvard Medical School have linked shift work—including night shifts, rotating shifts, split shifts, and other non-daytime schedules—to higher blood pressure, increased cholesterol, and diabetes.
“Further research needs to be done to get more information regarding the underlying factors contributing to this link, but there are several theories as to why it exists,” says cardiologist Thomas Mulhearn IV, MD, FACC, with Cardiovascular Specialists.
Researchers said it’s possible that shift workers engage in riskier behaviors, such as smoking and unhealthy eating, and might be less likely to exercise regularly; however, the risk remained elevated even when those factors were eliminated, according to researchers.
It’s also possible that irregular schedules disrupt the sleep cycle, which could ultimately affect overall health.
“The body is biologically programmed to wake at sunrise and sleep at night. When that cycle is interrupted, it can create sleep and health issues,” Dr. Mulhearn says.
Researchers with the University of Western Ontario found that the risk is particularly heightened in the first 10 or 15 years on the job. Compared with people who worked during the day, shift workers were 23 percent more likely to have a heart attack, they noted.
The most recent study—from Harvard Medical School—tracked 22 years of data from about 75,000 nurses nationwide and found that people who worked rotating night shifts for more than five years had an 11 percent increased risk of death from heart disease and other adverse health conditions.
Researchers also found that the risk of death from heart disease was 19 percent higher in those who worked these shifts for six to 14 years, and 23 percent higher for those who worked shifts for 15 years or more.
“Research is ongoing to help us understand more about the relationship between shift work and the risk of heart disease and other health problems, but it’s clear that shift workers need to be give particular attention to their personal health and habits,” Dr. Mulhearn says.
Make a Healthy Shift to These Habits: Dr. Mulhearn provided these heart disease prevention tips for shift workers to help reduce their risk factors:
Get regular health exams. Be diligent about routine healthcare, especially if you have other risk factors, such as a family history of heart disease. Visit your physician at least once a year for an annual check-up—more if needed.
Improve your diet. Busy schedules can sometimes breed unhealthy eating habits. “For people on the go, it may become habit to go through the fast-food drive-through on the way to work then hit the same spot on the way back,” Dr. Mulhearn says. “But each fast food visit has potential negative consequences on your health, especially if it’s part of your regular routine.” Eat more fruits and vegetables. Limit your intake of fast-food and junk food. Choose water instead of soda.
Take regular breaks. Make a point to dedicate ten or fifteen minutes to yourself in the first and last half of your shift.
Don’t smoke. “This goes without saying,” Dr. Mulhearn says. “Smoking is the single worst decision a person can make for their personal health.”
Exercise. Try to get more daily physical activity—even if you have to start in small doses. Take the stairs instead of the elevator. Don’t park so close to the front door.
For additional information about heart disease and risk factors, or to schedule and heart risk evaluation, call Cardiovascular Specialists, an affiliate of Imperial Health, at (337) 478-3813
Dr. Miguel De Puy First in Region to Implant New ICD System for Patients at Risk of Sudden Cardiac Arrest
Patients can now get the same protection from sudden cardiac arrest as they would get with a defibrillator but through a less invasive procedure that does not touch their heart and blood vessels,
thanks to the world's first and only commercially available subcutaneous implantable defibrillator (S-ICD).
Dr. Miguel De Puy with Imperial Health Cardiovascular Specialists was the first cardiologist in Southwest Louisiana, and among the first in the state, to implant the Boston Scientific S-ICD® System. He performed the first procedure at CHRISTUS St. Patrick Hospital earlier this month.
Sudden cardiac arrest (SCA) is an abrupt loss of heart function. Most episodes are caused by the rapid and/or chaotic activity of the heart known as ventricular tachycardia or ventricular fibrillation. Recent estimates show that approximately 850,000 people in the United States are at risk of SCA and indicated for an ICD device, but remain unprotected.
Dr. De Puy explains that the S-ICD System is designed to provide the same protection from SCA as traditional transvenous implantable cardioverter defibrillators (ICDs). However, the entirety of the S-ICD sits just below the skin without the need for thin, insulated wires – known as leads – to be placed into the heart itself. This leaves the heart and blood vessels untouched, providing a exciting new solution for both physicians and patients. “This is a less invasive procedure with fewer short- and long-term complications,” says Dr. De Puy. “It functions as well as, if not better, than current technology and is usually more tolerable.”
The less invasive S-ICD device had two main components: a pulse generator, which powers the system, monitors heart activity, and delivers a shock if needed; and an electrode, which enables the device to sense the cardiac rhythm and serves as a pathway for shock delivery when necessary. Both components are implanted just under the skin — the generator at the side of the chest, and the electrode beside the breastbone. Implantation with the S-ICD System can be done without x-ray imaging, using only the anatomical landmarks of a person’s body structure.
The S-ICD System is intended to provide defibrillation therapy for the treatment of life-threatening ventricular tachyarrhythmias in patients who do not have symptomatic bradycardia, incessant ventricular tachycardia, or spontaneous, frequently recurring ventricular tachycardia that is reliably terminated with anti-tachycardia pacing. The S-ICD does not provide pacing therapy, so it is not indicated for patients who need the pacing function of a traditional defibrillator
“The treatment for adverse heart conditions continues to evolve. It’s important that physicians understand how to perform procedures and treatments using the most advanced technology available,” Dr. De Puy said. “As our knowledge, research and technology become more complex, less invasive and high-performing methods become available—and we want our patients to have access to that.”
Dr. De Puy is Board Certified in Internal Medicine and Cardiovascular Disease, a fellow of the American College of Physicians, the American College of Cardiology and the American Heart Association. His special interests include invasive cardiology and cardiac pacemakers/defibrillators. He is also a Certified Cardiac Device Specialists by the Heart Rhythm Society. He is the only physician in the region trained to perform the new S-ICD implantation. For more information, call Cardiovascular Specialists at (337) 436-3813 or visit www.csswla.com.
The Wrist May Provide a Safer Route to the Heart
As a general rule, people undergoing heart catheterizations in the United States do so with the procedure starting at the femoral artery found in the groin. However, local interventional cardiologist Dr. Thomas Mulhearn with Cardiovascular Specialists is using a new technique that accesses the pathway to the heart through the wrist. It’s called the transradial approach to cardiac catheterization, and he says it offers many benefits to patients.
Dr. Mulhearn says 95 percent of patients are candidates for transradial catheterization, which offers a quick recovery time and decreased risk of complications. "Patients are able to sit up and eat right away, whereas with femoral artery catheterizations, traditionally, patients have to lie flat for four to six hours after the procedure," he said.
Joe Pool, a 67-year-old DeRidder resident, was a perfect candidate for the transradial catheterization.
"Over a year, I was experiencing discomfort in my chest and a little problem with getting my breath," he said. Pool’s failure of a cardiac stress test last fall led Dr. Mulhearn to discover that he had a 90 percent blockage in one of his arteries that needed immediate attention.
The transradial approach uses the wrist to gain access to arteries that lead to the patient’s heart. Once access to the artery is made, the physician is able to perform either a diagnostic procedure, which determines if and where there are blockages that impede the flow of blood to the heart muscle, or an interventional procedure—angioplasty or stenting—to open up the blocked artery.
Each year, more than a million cardiac catheterizations are performed in the United States, with most starting with a puncture to the femoral artery in the groin. While this is the most common approach, the entry point is sometimes difficult to access and has a greater associated risk of bleeding complications, especially in women, as well as post-procedure pain and a slower recovery period.
Now that Pool is feeling 100 percent again, he has been able to get back to his family and the DeRidder church he pastors. "I'm doing great. The doctor told me I can do anything I want. I have to take medication for it. I wish I didn't have to take the medications, but I have no choice. I can take the medications or die earlier!" said Pool.
“As the use of the transradial approach becomes more and more common, we look forward to many more stories of shorter recovery times, fewer complications and a high level of patient satisfaction like in Mr. Pool’s case,” adds Dr. Mulhearn.
Cardiovascular Specialists chosen as site for study of diagnostic test effectiveness
Cardiovascular Specialists of Southwest Louisiana was selected as an investigative site for the PROMISE Trial, a study of the effectiveness of tests to detect coronary artery disease. Michael C. Turner, M.D., is principal investigator and Thomas J. Mulhearn IV, M.D., is co-investigator.
The PROMISE Trial is funded by the National Heart, Lung and Blood Institute and coordinated by Duke University. The study seeks to answer the question as to which noninvasive tests offer the best long-term results for detecting and treating coronary artery disease. The results of this study will determine to a large extent what test cardiologists choose in evaluating a patient for heart disease. It is the largest comparative effectiveness trial of its kind and will enroll 10,000 patients worldwide.
Candidates for this trial are men over 45 and women over 50 who have risk factors for coronary disease, and are considered low to intermediate risk. Subjects are randomized to receive either a routine graded exercise test, myocardial profusion scans, or cardiac CT angiography. These three modalities will be compared for their effectiveness in diagnosing and treating disease.
Participation in the study requires the principal investigator to be trained to a level-three status for cardiac CT or to be board-certified in that specialty. Dr. Michael Turner completed level-three requirements in cardiac CT in 2007, and in 2008 became board-certified in cardiovascular CT. He is a founding member of the Society of Cardiovascular CT and was named a fellow of the Society of Cardiovascular CT in June 2010.
For information on participation in this study, contact your primary care physician or Cardiovascular Specialists at (337) 436-3813.
Cardiovascular imaging assists in diagnosis
Advanced tools for cardiovascular imaging can help detect heart disease or other heart problems and can put patients on an effective treatment course.
Cardiologists use three main types of imaging: the cardiac CT scanner, nuclear myocardial perfusion imaging (nuclear stress test) and echocardiography.
Heart and vascular disease represents the number one cause of death and disability in women (as well as men). Sudden cardiac death is all too frequently the first sign of heart disease. These statistics are real and frightening. They beg the question "what can be done?"
The answer is PREVENTION. We now have at our disposal the knowledge that healthy lifestyle changes and proper medical management of those at risk can substantially change the outcomes in heart and vascular disease.
Early detection is the key to prevention. The earlier we can detect and treat heart disease, the better the outcome. Standard risk factor screening can be supplemented with a new and powerful risk assessment tool called calcium scanning. Calcium in the walls of arteries is a marker for plaque and correlates well with the risk of heart attack and death. When detected with a quick CT scan this information can be used to determine how aggressive treatment should be or provide reassurance for those not at high risk. For those with the suspicion of heart disease cardiac CT angiography (with dye) can produce striking pictures of the heart and arteries that can diagnose the presence or absence of disease with astounding accuracy- often years before it can be detected with stress testing. Armed with accurate risk information you and your physician can team up to change your outlook with regard to heart attack and stroke.
Cardiac CT Scanner and CT Angiography
The cardiac CT scanner allows cardiologists to get a full view of every angle of the heart and vascular system. The images are gathered by rotating an X-ray beam system
360 degrees around the body while scanning detailed cross-sections of the heart. A powerful computer then compiles the images into a series of three-dimensional, semi-transparent images.
CT-angiography, one of the procedures performed with the cardiac CT scanner, is used to diagnose the presence and severity of coronary artery disease.
“What we get from this scanner is a complete three-dimensional scan of the heart, a virtual trip through the heart using a noninvasive, outpatient procedure,” Dr. Turner said. “This cardiac CT scanner in many instances allows us to gauge the health of the coronary artery system as effectively as an invasive procedure performed in the hospital, and is actually superior to cardiac catheterization in its ability to look at the anatomy of the heart.”
According to Dr. Turner, this is an exciting, new technique that will have expanded uses over the next several years.
Nuclear Stress Test
A nuclear stress test is a gold standard test for looking at abnormalities of blood flow to the heart. It is used by doctors to assess the risk of and presence of blockages in the
The test consists of two parts. The first involves injecting a tracer into the blood stream and then electrodes are placed onto the patient’s chest. The cardiologist then has the patient exercise on a treadmill at gradually increasing speeds and inclines. During this period of time the cardiologist monitors the patient’s heartbeat for abnormalities.
After the exercise portion of the exam is complete the second phase of the test begins. Special cameras that can detect the previously injected tracer are used to take pictures of the heart. The tracer is carried by blood throughout the body and the camera is able to detect the amount of blood flow from the heart.
An echocardiogram is simply an ultrasound of the heart. The echocardiogram was the first medical application of ultrasound technology, and when combined with a Doppler
examination, cardiologists are able to assess blood flow.
“Echocardiograms allow us to look at abnormalities of valves and heart function or blood flow,” Dr. Turner said
Calcium Scan of the Heart—A self-referred exam.
A fourth test is available and patients don’t need a physician’s referral for this one. A calcium scan of the heart is an useful tool for someone who has no known
indications of coronary disease. A calcium score, or the amount of plaque in the arteries, is an excellent way to predict the risk of a future heart attack.
“If a patient has a very low calcium score then their ten year risk of a heart attack is very low,” said Dr. Turner. “Conversely, if a patient has a high calcium score (more than 400) then their ten year risk of a coronary event may be as high as 20 percent.”
A calcium scan is independent of and can be used in addition to traditional risk factors to predict a heart attack.
Early Detection Saves Lives
With this imaging technology, cardiologists are able to add new meaning to the words “early detection.”
These imaging tests often complement each other and one may suggest a problem that another test can confirm.
“Just like many other diseases, early detection can mean the difference between life and death,” Dr. Turner added. “It is especially important when dealing with heart disease, however, because often people with heart disease have few visible symptoms, if any at all.”
We Welcome Dr. Thomas Mulhearn
June 1, 2011—We are pleased to welcome Thomas J. Mulhearn IV, MD, to the practice of cardiology.
Dr. Mulhearn maintains office hours at Cardiovascular Specialists’ Lake Charles and Sulphur offices, and he is on the medical staffs at Christus St. Patrick and West Calcasieu Cameron hospitals.
Dr. Mulhearn provides general cardiology care and specializes in interventional cardiology, which focuses on the diagnosis and treatment of the heart and vascular disease via cardiac catheterization, using procedures such as angioplasty and stent placement.
Dr. Mulhearn, a native of Southwest Louisiana and graduate of Barbe High School, has recently returned to his hometown after completing specialized training at some of the world’s most highly respected medical centers. He is board-certified in cardiovascular disease, and completed a fellowship in cardiovascular disease at the Duke University School of Medicine and a fellowship in interventional cardiology at the University of Alabama Birmingham. Dr. Mulhearn performed his internship and residency at the Johns Hopkins Hospital in the Osler Medical Housestaff Training Program. He received his Doctor of Medicine degree from Louisiana State University School of Medicine in New Orleans and a Bachelor of Science degree from Louisiana State University.
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