HER+ Fight with Cancer

Ruth was 79 years old when she was diagnosed with early stage I breast cancer in 2018.  A breast lump had been found on a routine examination.  

A biopsy later confirmed breast cancer.  Further testing confirmed that the surface of her cancer cells was covered with a protein called HER2.  The presence of HER2 protein on the cancer cells indicated a more aggressive form of breast cancer with a higher recurrence rate. Fortunately, there was an effect therapy for HER2+ breast cancer.  Ruth’s oncologist wanted her to receive Herceptin (trastuzumab), an immune therapy shown to improve survival and decrease cancer recurrence.  After undergoing a lumpectomy to remove the cancer, her oncologist prescribed treatment with from Herceptin and Taxol, a chemotherapeutic agent. 

Before starting Herceptin, Ruth had an echocardiogram, which is an ultrasound study to evaluate the heart pump function.  Unfortunately Ruth’s echocardiogram showed that her heart heart function was moderate to severely reduced.  One of the potential side effects of Herceptin was a weakening of the heart pump, which can cause congestive heart failure.  She was therefore referred to the Cardio-Oncology Clinic at MHVI.   Ruth’s cardiologist decided that she could improve her heart function with the use of a special pacemaker, called a biventricular pacemaker.  This pacemaker was designed to improve heart function in patients with a low heart function and certain electrical conduction defects.   A biventricular pacemaker was successfully placed in Ruth (see x-ray).   A follow-up echo showed that her ejection fraction had improved enough to start treatment with Herceptin.  She was followed closely in the Cardio-Oncology Clinic while receiving cancer treatment and in the end completed 6 months of therapy with Taxol and Herceptin with no signs of additional weakening of the heart function.  Throughout her course of chemotherapy, Ruth was able receive cancer treatment with minimal damage to her heart.   Now, more than two years later she is doing well.  Ruth is able to play with her grandkids, attend church, and she remains cancer-free. 

Ruth’s story highlights one of the main goals of the Cardio-Oncology Clinic at MHVI.  We work closely with cancer patients and their cancer specialists to help patients receive optimal cancer therapy while trying to prevent or minimize cancer related heart toxicity and symptoms.

 

>> Learn more about Cardio-Oncology Clinic
>> Learn more about Biventricular Pacemaker (Cardiac Resynchronization Therapy)

 

 

Freedom from Fibrillation

Joan Vasseur was a 54-year-old busy career woman when she started to experience atrial fibrillation, a common heart rhythm disorder that affects more than 3 million Americans each year. Each time she had atrial fibrillation she experienced fluttering in her chest and a choking sensation in her throat. These episodes often occurred at night, and she became afraid to fall asleep. For the first two years, Joan’s symptoms were controlled with medications. But for the next 10 years, her rhythm condition worsened, and she began to have frequent visits to the emergency room with many hospital admissions.

Eventually Joan retired, but she felt like she was being robbed of a peaceful retirement due to the endless ER visits, sleeping difficulties and constant fear of going back into an irregular rhythm. In April 2008, after 12 years of battling her heart rhythm condition, Joan underwent catheter ablation for atrial fibrillation (also known as pulmonary vein isolation). Dr. Joseph Lin, a heart rhythm specialist at MHVI and Mercy Hospital, performed a pulmonary vein isolation. With catheters that were steered from veins in Joan’s groin into her heart, Dr. Lin precisely delivered radiofrequency energy to electrically deactivate tissue around four veins in her heart so that electrical impulses could not get out and start the the irregular rhythm that afflicted her. Joan went through the procedure without incident and in the end, it was able to control and prevent recurrences of the arrhythmia that so debilitated her.

“Although I was certainly apprehensive about the procedure, I now wish that I had had it 10 years earlier because it’s given me back my life,” said Joan. “I feel confident now that when I plan something, I can actually do it. Dr. Lin and his care was superb and the proof is that I haven’t had atrial fibrillation since I had the ablation. I am very grateful for the great care I received at Mercy.”  Two years after her ablation, Ms. Vasseur sent a framed picture, The Liberation of Saint Peter by Rafael (1514) to Dr. Lin.  It was a gift to thank him for freeing her from what she felt was the bondage of her heart condition.

>> Learn more about A Fib ablation.
>> Learn more about our  A Fib Clinic.
>> Learn more about our Electrophysiology/Arrhythmia program.

 

Young and Alive Again

Jim Brunelle was 57 when he underwent a quadruple bypass surgery for blockages in his heart. Things went well for him until 10 years later when he began to notice right buttock, hip, and thigh pain every time he walked. At first hewould not feel this hip and leg pain after walking three blocks. Gradually the pain got more severe with less and less activity.  Jim felt bad on road trips with his friends when they had to stop and wait for him every few minutes because of his leg pain.

Things worsened to the point where he had to get a handicap sticker for his car because very little walking would cause leg pain. To evaluate these debilitating symptoms, Jim underwent an MRI of the arteries of his legs, which revealed significant blockages.

On December 15, 2009, Dr. Daniel Dulas, an MHVI vascular disease specialist successfully opened up these blockages in Jim’s legs with angioplasty balloons and stents. This restored much needed blood flow and oxygen down to the leg muscles, and he was able to walk out of Mercy Hospital later the same day without any more pain.

Six months later, while on a motorcycling trip to Iowa, Jim was able to pass all his younger friends walking up to a lookout at the top of a hill.

Now at 69, Jim feels young and alive again.

A Pacemaker that Restores Heart Function

Patricia Siedlecki was 64 when she was diagnosed with congestive heart failure.  Over the next several years she would become more and more fatigued and winded from a weakening heart.  Her heart enlarged even though she took heart medications and religiously did her cardiac rehab.  She required more and more diuretics just to keep her lungs from filling up with fluid.

Patricia’s cardiologist, Dr. Mark Kraemer, a heart failure specialist at MHVI, became increasingly convinced that her deterioration was from a left bundle branch block, a sign that different parts of her weakened heart were not timed correctly, resulting in an inefficient heart pump.  He talked with her repeatedly about getting a biventricular pacemaker to “re-time” the left and right sides of her heart so it could pump blood more efficiently.  “I think I was in some sort of denial,” Patricia said, “because I wanted no part of it.  I really had a hard time accepting that I had a heart problem.”

Eventually, Patricia’s heart pump weakened to the point where she could barely walk into clinic from her car to see her doctors.  She needed to ride a cart just to do grocery shopping.  Previously an independent woman, she increasingly relied on her daughter to do simple chores for her at home.  Finally, five years after her diagnosis of heart failure, she agreed to receive a biventricular pacemaker-defibrillator.  Dr. Joseph Lin, an MHVI heart rhythm specialist, performed this implant at Mercy Hospital.  Within months, Patricia’s heart responded to the pacing and her heart pumped more efficiently.  It went from being severely reduced in function to normal function.  Looking back, Patricia says, “I should have listened to Dr. Kraemer and had this done sooner.  I feel wonderful now.  She reported recently, “My energy level has improved.  I am doing my house chores.”  She boasts, “I am very active socially.”

For certain patients with congestive heart failure, a biventricular pacemaker can markedly improve their energy level and quality of life.  By “re-timing” the way the left and right sides of the heart contract, a process called cardiac resynchronization, many patients in the heart failure program at MHVI have seen tremendous recovery in their heart function.

Gold Medalist after Two Stents

Gene Bak was 68 when he starting having chest pain. Decades of a sedentary lifestyle and an unhealthy American diet had finally caught up with him. At first he thought he was just having indigestion, but further evaluation revealed he had significant blockages in his heart. At age 68 he had 2 stents placed in his heart by Dr. Randall Stark, an interventional cardiologist at MHVI.

This took care of his chest pain symptoms but Dr. Stark impressed upon Gene the importance of controlling his high blood pressure and cholesterol in order to avoid progression of heart disease that may some day require more heart stents or perhaps even a bypass surgery.  Gene had a hard time tolerating medications due to side effects, so he eventually took up cycling, thinking this may be a good way to get down his blood pressure and cholesterol. He got a carbon fiber bicycle and got serious…really serious.

Fast forward twelve years.  Gene is now 80 years old and last year won four gold medals at the State senior games in men’s cycling for the 5K, 10K 20K, and 40K.  Gene was ecstatic that he was able to attain an average of 23.6 miles per hour during the 20K competition. He recently wrote a letter to Dr. Stark and said, “I am still running on your two good stents…and praising you and my Lord for being able to do so.”

Gene Bak is an inspiration to all of us. His story reminds us that with enough determination, hard work, and a little help from modern medicine, patients with heart disease can maintain active healthy lifestyles and achieve amazing things with their bodies.

Freed from Blood Thinners

Sandra Warneka came to Mercy Hospital after fainting at home.  She had severe abdominal pain and felt very weak, after losing half of her blood volume from internal bleeding.  She required blood transfusions and eventually improved.  Sandra had been taking warfarin (Coumadin), a blood thinner, because of an irregular heart rhythm condition called atrial fibrillation.  This made her very high risk for stroke, more than five times that of the general population, and because of this her doctors advised her to continue taking warfarin.

Due to her high risk for stroke and equally high risk for bleeding while taking blood thinners, her cardiologists at MHVI referred her to have a Watchman device implanted.  This device was performed by MHVI specialists Dr. Joseph Lin and Dr. Jeffrey Chambers, who inserted it through a vein in her leg and steered it up to her heart.  They deployed it to plug up a small pouch in the heart called the left atrial appendage, where blood pools and forms clots that can break off and cause strokes.  The procedure took an hour to do and Sandra was discharged home the next day.

>> Learn more about the Watchman procedure.

 

Time is Muscle

Steve Q. was a previously healthy 49-year-old man when he got out of bed to use the bathroom in the middle of the night and then suddenly collapsed without warning. His wife awoke from sleep to find him unconscious on the floor. He was not breathing.  She immediately called 911 for help and started CPR on her husband until paramedics arrived. An EKG promptly diagnosed a massive heart attack and Steve was immediately rushed to Mercy Hospital.

At Mercy, the heart attack team led by Dr. John Lee, an interventional cardiologist at Metropolitan Heart and Vascular Institute (MHVI), performed an emergency coronary angiogram and found a blockage in one of major arteries of Steve’s heart. This was successfully opened with a coronary stent within 30 minutes of his arrival. Although Steve was very ill upon arriving at Mercy, he eventually made a complete recovery. He is now back at work full time and enjoying a full life again with his family.

A large part of this success story can be credited to the rapid response team that worked quickly to open up Steve’s acute blockage. There’s a saying among cardiologists: “Time is muscle.” In the setting of an acute heart attack, the time it takes to open up the blockage and restore blood flow is crucial in saving the heart muscle, preserving heart function, and affecting patient survival. As a result of the nationally-recognized heart attack program created by MHVI cardiologists in collaboration with partners from emergency services, the median time in which it takes for a blockage to be opened in a heart attack patient (door-to-balloon time) at Mercy Hospital is approximately 50 minutes. This is 34% lower than the national average of 76 minutes.

Shocked By Specialized Cardiac Care

Garry Frankel, a 55 year-old photographer from Winnipeg, Canada, was visiting Minnesota for an international youth soccer tournament when on July 19, 2009, he suffered a sudden cardiac arrest in his motel room. His wife woke up at 1 a.m. to a gurgling sound coming from Garry. He had stopped breathing and was unresponsive.

Mrs. Frankel called for help, and two security guards who had taken CPR classes just two weeks earlier started chest compressions. An ambulance arrived at the scene three minutes later to shock Garry out of the fatal heart rhythm, and he was admitted to the intensive care unit at Unity Hospital. While at Unity, he underwent therapeutic cooling (also known as hypothermia) to prevent permanent brain damage from the arrest.

After completing his cooling protocol, Garry woke up and he was transferred to Mercy Hospital, where he received two stents to a coronary artery that had severe blockages. Despite opening up these blockages, however, he continued to have life-threatening heart rhythms (called ventricular tachycardia) that required numerous shocks to break. Heart rhythm specialists from Metropolitan Heart and Vascular Institute (MHVI) then inserted an implantable defibrillator in his chest and paced his heart at 130 beats per minute for the next two days to keep the life-threatening rhythms from coming back. Ultimately, Garry was stabilized and transferred to his home hospital in Winnipeg 13 days after he was first hospitalized.

Garry made an amazing recovery. He and his wife returned to Minnesota one year later to personally thank the cardiologists at MHVI who performed the interventional heart procedures that saved his life. They expressed personal gratitude to Dr. Stephen Remole, a heart rhythm specialist, who took care of him from day one until he was on the plane back to Winnipeg. According to Garry, the care he received from MHVI cardiologists while at Unity and Mercy was “very much more aggressive in every respect [than] that is typical at home…[The doctors and nurses] never gave up until I recovered, even though I wasn’t doing well…and I lived.”

Cardiologists at MHVI have built an exceptional program with other specialists from emergency services and intensive care to treat patients with out-of-hospital cardiac arrest. The average survival rate for patients admitted to Mercy Hospital with cardiac arrest is 50%, compared with the national average of 13%. For information on sudden cardiac arrest, please refer to the educational site at the American College of Cardiology.

The Transplant Candidate and the Insanity Workout

QP was a 37 year old male who with a 10 year history of an enlarged heart (also known as cardiomyopathy) when he was admitted to Mercy Hospital after 2 weeks of a worsening cough and breathing difficulties. Shortly after arriving at Mercy it became increasingly clear to his doctors that he had severe pump failure.  His blood pressure was 67/40 when Dr. Chad Olinger from the MHVI Heart Failure service first met him. He was in shock.

Dr. Olinger stabilized QP temporarily with special IV infusions to improve the squeeze of his heart and keep up his blood pressure. A special device called a balloon pump was emergently inserted into his aortato treat his pump failure. However, Dr. Olinger and the heart failure team recognized that QP was rapidly deteriorating, and that he would likely need advanced surgical therapy for heart failure, such as a heart transplant. By the next day he was transferred to Abbott Northwestern Hospital. QP was evaluated by Dr. Katarzyna Hryniewicz-Czeneszew and the Heart Transplant Service who deemed him to be a good transplant candidate, but he would need to receive an artificial heart pump as a bridge to transplant while awaiting his new heart. Three days later QP underwent implant of an artificial heart pump called a left ventricular assist device (LVAD) by Dr. Ben Sun. This device is a mechanical pump which the surgeon sewed onto his weakened heart so that it can do most of the work of moving his blood for him.

After two weeks of recovery, QP got stronger and was able to go home. “Dr. Olinger [and the Heart Failure and Transplant teams at Mercy and Abbott] saved my life,” QP reflects. “I wouldn’t have survived without their expertise.” QP has gotten stronger and stronger since placement of his LVAD. At times, he even brags that he is now able to do the Insanity Workout 5-6 times a week. He is eagerly awaiting for the day he will receive his new heart.

The MHVI Heart Failure service partners with nationally renowned heart transplant centers to deliver advanced surgical therapies such as transplantation and ventricular assist devices to our patients in the communities we serve.

Breathing Easier

Del Salter of Blaine, Minnesota is one of the five million people in the United States who has heart failure.  Every day, he takes twelve medications. Despite that, he felt tired and weak and had trouble controlling his weight from fluid build-up due to a weak heart pump.  Eventually, Dr. Amin Rahmatullah, a heart failure specialist at MHVI convinced him to have a miniaturized, wireless monitoring sensor called CardioMEMS implanted in his pulmonary artery at Mercy Hospital.  Every day since then he has transmitted sensor readings to his cardiologist.

“The data is real time and easy to interpret. We are able to intervene at least two weeks before patients actually start feeling the symptoms,” said Dr. Rahmatullah.  Pulmonary artery pressure increases appear before weight and blood pressure changes, which are often used as indirect measures of worsening heart failure.  Based on the sensor readings, his heart failure doctors and nurses adjust Del’s medications.

“I think it’s miraculous, and I think it has kept me out of the hospital,” said Del. “I feel much better and confident. It’s comforting to know that the numbers are good.”

Cardiologists at the Metropolitan Heart and Vascular Institute at Mercy Hospital are using the CardioMEMS Heart Failure System by St. Jude Medical.  It is the first and only FDA-approved heart failure monitoring device that has proven to significantly reduce hospital admissions.