February 2001
Two Women; Two Hearts; Two Stories: One Message

Their stories are different, but their message is the same: heart disease is the number one threat to a woman's health. And taking care of yourself doesn't end with the surgery or angioplasty. It goes on for the rest of your longer, healthier life!

Marge Connery's Story
Two years ago, when then 44-year-old Marge Connery felt a strange tightness in her chest, she did something most women don't do. She promptly told her primary care doctor, Dr. Daniel J. Rudolph at that time, who promptly arranged for a stress test.

What's a Stress Test?
During a stress test, the patient walks on a treadmill while an electro cardiogram (EKG), an electrical recording of the heartbeat, is taken. If there is any concern about the heartbeat, visual images can be taken in one of two ways. An echocardiogram uses sound waves to provide a computer image of the structure of the heart so the cardiologist can see if the heart is pumping efficiently. The cardiologist can also inject tiny amounts of a tracing substance into the circulatory system and use a scanner to see if the arteries are carrying the tracing substance to all parts of the heart. If the substance does not show up in any area, blood supply to that area of the heart may be blocked.

Marge's stress test took much longer than the usual 15 minutes. Finally Dr. Rudolph told Marge, “Your results indicate that you need to see a cardiologist right now.”

Cardiologist Steven Kunkes, MD, reviewed the stress test results, and was quite concerned. He told Marge he wanted to send her to Bridgeport Hospital where he would do an angiogram to find out if any of her arteries were blocked. But Marge didn’t believe her symptoms were that serious. As the mother of two small girls, Brittany, age 10, and Sara, age 12, she felt the need to go home and take care of her family.

So to stabilize her heart, Dr. Kunkes prescribed nitroglycerin for the chest pains, Lipitor® to lower her cholesterol, and an aspirin a day to reduce the chances of blood clots. He made her promise to take it easy that weekend, and call him if she had any problems.

Dr. Kunkes had a question for Marge. “What made you go to the doctor when you felt those symptoms? You’re only 40. Most women your age—and even older—tend to ignore chest pains.” Marge told him about her father, who had died at age 42 of a massive coronary.

“Heart disease runs in my family,” she says. “All these years we’ve been watching my male cousins for symptoms—but it turns out that I’m the one with heart disease.”

    What's an Angiogram? What's Angioplasty?
    What's the Difference?

    Angio=vessel; gram=recording; plasty=shaping. So an angiogram is a diagram of a blood vessel, while angioplasty means reshaping the vessel. For both procedures, the cardiologist makes a small incision in a groin artery and threads a catheter up through the blood vessels to the blockage at the heart. Then the cardiologist releases a special dye into the blood stream, showing where the arteries are ob-structed by a blockage.

    For angioplasty, the cardiologist guides a balloon-tipped catheter to the blockage, and inflates the balloon pushing aside the deposits that block the artery.

That weekend, Marge did keep her promise to take it easy. But Saturday night, Marge felt a burning, pulling sensation in her chest. At 11 p.m. she called Dr. Kunkes. He told her to take an aspirin and get to Bridgeport Hospital immediately. Marge was having a heart attack.

In the Heart Institute, an angiogram showed that one of Marge’s heart arteries was 99% blocked, and another was 30% blocked. Then and there, Dr. Kunkes’s associate, Mitchell Driesman, MD, performed angioplasty and placed a stent within the artery to keep it open. The next day, Marge went home.

Marge now meets regularly with Dr. Kunkes to review her medications and make sure she is keeping up her healthy lifestyle program. “After all,” says Dr. Kunkes, “I am planning for Marge to be around for the next 40 years, celebrating with her children and grandchildren.”

Juliette Pittman's Story
Unlike Marge Connery, Juliette Pittman, at 71, had not one symptom of cardiac disease. No tightness in her chest, no pain, no shortness of breath. But she knew she had a family history. Her mother died suddenly of cardiac arrest at age 43. Juliette's sister, five years younger than Juliette, has already had a heart attack.

So three years ago, knowing that she would be wise seek out a cardiologist, Juliette asked her primary care physician, Michael Rudolph, MD, to refer her to Doron Amir, MD, who was Juliette's husband's cardiologist. Tests showed Dr. Amir that Juliette's heart was fine.

This past winter, Juliette went back for another routine checkup. When Dr. Amir asked her if she had had any symptoms recently, Juliette recalled that she'd had a breathless spell after salting her driveway. “She was wise enough to tell me that, and not pass it off as unimportant, even though it didn't seem to her at the time to be related to her heart,” Dr. Amir says. “It was an important clue to me, because cold weather aggravates heart symptoms.”

So Dr. Amir did another stress test. And looking at the images of Juliette’s heart taken during the test, Dr. Amir realized she had at least one blocked artery, and he would need to perform an angiogram to determine what to do next.

In the Heart Institute, Juliette’s angiogram showed not just one, but three blocked arteries. Her heart disease, which caused her no pain, actually required more drastic treatment than Marge Connery’s painful condition. Juliette needed a triple cardiac bypass, the preferred treatment when more than two arteries are blocked.

Clive Robinson, MD, chief of Cardiothoracic Surgery at Bridgeport Hospital, performed the open-heart surgery. Using an artery from Juliette’s chest wall and veins from elsewhere in her body, he bypassed the blockages in her heart arteries so blood could flow freely to her heart muscle.

Bloodless Open Heart Surgery!
Also closely involved in Juliette’s care: Ron Travaglino, coordinator of Bridgeport Hospital’s Bloodless Medicine & Surgery Program. Juliette Pittman is a Jehovah’s Witness, and her religion does not believe in the use of blood or blood products during surgery. She was reassured to learn that special techniques would ensure that her body would continue to receive the needed oxygen and fluids without the use of blood transfusions. Available for her if she needed them: intravenous fluids to enhance the circulation and volume of blood, medications that stimulate the body to produce red blood cells, electrocautery to seal blood vessels, lasers that seal blood vessels as they cut, an argon beam coagulator to clot blood and seal vessels, and techniques to collect and return her own blood during su

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