THE BEAT New CV Surgeon Joins the WTHVC Team West Tennessee Heart & Vascular Center welcomes Charan Mungara, MD, to the Cardiothoracic Surgery Center. Dr. Mungara specializes in cardiac, thoracic and vascular surgery. His diverse surgical interests include coronary revascularization, aortic surgery, heart failure surgery, lung wedges, paraesophageal hernia repairs and carotid surgery. Dr. Mungara joins Dr. Arthur Grimball, Dr. Alan Spalding and Dr. Eric Sievers at the Cardiothoracic Surgery Center, which provides comprehensive cardiovascular care with quality outcomes that exceed the national averages. Formerly a member of Indiana University Health Arnett Hospital in Lafayette, Indiana, Dr. Mungara graduated from AIMS, Mysore University in B.G. Nagara, Karnataka, India. He underwent general surgery residency training and completed his cardiothoracic surgery fellowship at the University of Wisconsin in Madison, Wisconsin. He is a member of the American College of Surgeons, the Southeastern Surgical Congress and the Cardiothoracic Surgery Network. September 2013 JMCGH Awarded Certification From The Joint Commission As An Advanced Primary Stroke Center Jackson-Madison County General Hospital has earned The Joint Commission’s Gold Seal of Approval® for its stroke program by demonstrating compliance with The Joint Commission’s national standards for health care quality and safety in disease-specific care. The certification award recognizes Jackson-Madison County General Hospital’s dedication to continuous compliance with The Joint Commission’s state-of-the- art standards. JMCGH underwent a rigorous on-site review during which a Joint Commission expert evaluated JMCGH for compliance with standards of care specific to the needs of patients and families, including infection prevention and control, leadership and medication management. “In achieving Joint Commission certification, JMCGH has demonstrated its commitment to the highest level of care for its stroke patients,” says Jean Range, M.S., R.N., C.P.H.Q. executive director, Disease- Specific Care Certification, The Joint Commission. “Certification is a voluntary process and I commend JMCGH for successfully undertaking this challenge to elevate its standard of care and instill confidence in the community it serves.” Top 10% in the nation for Patient Safety JMCGH has received the Patient Safety Excellence Award™ from Healthgrades. • 1 of 5 hospitals in Tennessee • Only 379 hospitals nationwide Read More At www.wth.org/patientsafety Quality of Care at JMCGH “With Joint Commission certification, we are making a significant investment in quality on a day-to-day basis from the top down. Joint Commission accreditation provides us a framework to take our organization to the next level and helps create a culture of excellence,” says Bobby Arnold, President and CEO of West Tennessee Healthcare. “Achieving Joint Commission certification in our stroke program for our organization is a major step toward maintaining excellence and continually improving the care we provide.” West Tennessee Heart & Vascular Center Newsletter 731-541-CARE (2273)
Transcript
THE BEAT
New CV Surgeon Joins the WTHVC TeamWest Tennessee Heart & Vascular Center welcomes Charan Mungara, MD, to the Cardiothoracic Surgery Center. Dr. Mungara specializes in cardiac, thoracic and vascular
surgery. His diverse surgical interests include coronary revascularization, aortic surgery, heart failure surgery, lung wedges, paraesophageal hernia repairs and carotid surgery.
Dr. Mungara joins Dr. Arthur Grimball, Dr. Alan Spalding and Dr. Eric Sievers at the Cardiothoracic Surgery Center, which provides
comprehensive cardiovascular care with quality outcomes that exceed the national averages.
Formerly a member of Indiana University Health Arnett Hospital in Lafayette, Indiana, Dr. Mungara graduated from AIMS, Mysore University in B.G. Nagara, Karnataka, India. He underwent general surgery residency training and completed his cardiothoracic surgery fellowship at the University of Wisconsin in Madison, Wisconsin.
He is a member of the American College of Surgeons, the Southeastern Surgical Congress and the Cardiothoracic Surgery Network.
September 2013
JmCgH Awarded Certification From The Joint Commission As An Advanced Primary Stroke Center
Jackson-Madison County General Hospital has earned The Joint Commission’s Gold Seal of Approval® for its stroke program by demonstrating compliance with The Joint Commission’s national standards for health care quality and safety in disease-specific care. The certification award recognizes Jackson-Madison County General Hospital’s dedication to continuous compliance with The Joint Commission’s state-of-the-art standards.
JMCGH underwent a rigorous on-site review during which a Joint Commission expert evaluated JMCGH for compliance with standards of care specific to the needs of patients and families, including infection prevention and control, leadership and medication management.
“In achieving Joint Commission certification, JMCGH has demonstrated its commitment to the highest level of care for its stroke patients,” says Jean Range, M.S., R.N., C.P.H.Q. executive director, Disease-Specific Care Certification, The Joint Commission. “Certification is a voluntary process and I commend JMCGH for successfully undertaking this challenge to elevate its standard of care and instill confidence in the community it serves.”
Top 10% in the nation for Patient SafetyJMCGH has received the Patient
Safety Excellence Award™
from Healthgrades.
• 1 of 5 hospitals in Tennessee
• Only 379 hospitals nationwide
Read More At
www.wth.org/patientsafety
Quality of Care at JmCgH
“With Joint Commission certification,we are making a significant investment in quality on a day-to-day basis from the top down. Joint Commission accreditation provides us a framework to take our organization to the next level and helps create a culture of excellence,” says Bobby Arnold, President and CEO of West Tennessee Healthcare. “Achieving Joint Commission certification in our stroke program for our organization is a major step toward maintaining excellence and continually improving the care we provide.”
Severe aortic stenosis is defined as:Valve area 1.0 cm² AND Mean gradient 40 mmHg OR Jet velocity 4.0 m/s
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How TAVR WorksTAVR was initially approved by the Food and Drug Administration in November 2011 as a therapy for patients with severe aortic stenosis who are unable to undergo traditional aortic valve replacement. The balloon-expandable Edwards SAPIEN valve is delivered via a catheter in the leg or between ribs without a median sternotomy or the use of cardiopulmonary bypass. The procedure quickly improves patients’ breathing and activity ability, with a much shorter recovery time than traditional surgery.
Your patient may be eligible for TAVR if• The patient has severe, symptomatic calcified native aortic valve stenosis • The patient has risk factors such as prior CABG, frailty, and prior open chest surgery• The patient does not have severe aortic insufficiency• The patient has an ejection fraction greater than 20
Using Echocardiography to Diagnose Aortic Stenosis
Patients must also be considered at high risk or inoperable for a transfemoral TAVR approach. Transapical approach to TAVR is considered for high risk patients.
Meet the TAVR TeamThe WTHVC TAVR team is comprised of leading physicians in the area who went through extensive training to be able to provide TAVR for patients. We are proud of them!
Cardiothoracic Surgery CenterDr. Arthur Grimball, Cardiothoracic SurgeonDr. Eric Sievers, Cardiothoracic Surgeon
Cardiac Anesthesia GroupDr. Michael Bearb Anesthesiologist
Jackson Radiology AssociatesDr. Greg Bruno, Radiologist Dr. John Crocker, Radiologist
The Jackson ClinicDr. Jason Cherry, CardiologistDr. James Crenshaw, CardiologistDr. Michael Osayamen, CardiologistDr. Shahzad Shah, Cardiologist
Mid-South Heart CenterDr. Tommy Miller, Cardiologist
Skyline Cardiovascular InstituteDr. Ronald Weiner, Cardiologist
West Tennessee HealthcareScott Sweat, R.N., Valve Clinic Coordinator
Comprehensive Valve Care at WTHVCThe TAVR procedure is just one of many valve repair and replacement treatments available through West Tennessee Heart & Vascular Center’s comprehensive Valve Care. We recently opened a new Valve Clinic at Jackson-Madison County General Hospital.
Minimally Invasive Valve Replacement without Open-Heart SurgeryTAVR
Heart failure affects 5.7 million Americans and is a frequently seen condition at the West Tennnessee Heart & Vascular Center. For about 10 percent of heart failure patients, the problem advances to a degree that conventional therapies, such as medication and lifestyle adjustments, can no longer control their symptoms. One option emerging more frequently for such patients is a Left Ventricular Assist Device.The Left Ventricular Assist Devise is a surgery-implanted, battery-operated mechanical pump for heart failure patients.
Cardiac rehabilitation is crucial for LVAD patients’ ongoing care. WTHVC offers the only place LVAD patients can receive cardiac rehab between Memphis and Nashville. Beginning in 2013, our Cardiac Rehabilitation Care team began receiving LVAD patients from Vanderbilt to provide rehab closer to home. To refer your patient for Cardiac Rehabilitation, call 731-541-CARE (2273).
This summer, West Tennessee Heart & Vascular Center worked with Medical Center EMS and Air-Evac to stage a surprise STEMI drill at Bolivar General Hospital. BGH’s first choice of treatment for any patient having a heart attack is to transfer that patient as quickly as possible to the closest PCI receiving facility, Jackson-Madison County General Hospital, in order to stop the Heart Attack and save heart muscle. The STEMI team jumped to action and clocked a 95-minute total transfer time from the BGH emergency room to placement of a balloon at JMCGH, clocking a time far below the transferring facility’s goal of 120-minutes — definitely saving heart muscle.
Random STEMI drills at various West Tennessee Healthcare locations evaluate the process and guidelines for treating heart attack patients. Each drill showcases the teamwork and processes set in place for STEMI treatment.They
also allow the teams to pinpoint areas for improvement to ensure patients receive timely care. We are proud of our Heart Attack Care teams!
When an ECG shows a STEMI, a patient’s best chance of survival depends on how quickly they receive primary PCI care.
Follow These Tips for Door In — Door Out times of 30 minutes or less:• You can do minimal paperwork needed for EMS (meds given, name, allergies, etc.). Fax the rest to JMCGH at 731-541-7600.
• Please fax your patient’s STEMI EKG ASAP to JMCGH Emergency Department at 731-541-9595.
• Do not wait on labs, x-rays, etc., to let patient transfer out.
• To eliminate wait times, activate Air EMS if needed as soon as the patient’s EKG is done prior to transfer orders.
• Talk with JMCGH EDP and Cardiologist as a group via Auto Accept/Call Center (1-800-601-0830) to discuss best method of treatment. (Thrombolytics vs. Primary PCI, Use of Plavix prior to transfer vs. holding Plavix)
• Call if any questions on transfers at 731-541-CARE.
Pop STEMI Drill Shows Experienced Team
731-541-CARE (2273)
In the past 20 years hospitalizations for Atrial Fibrillation increased by 66 percent. Afib is a supraventricular tachycardia with disorganized, chaotic atrial activation. It is an irregular rhythm that causes
decreased atrial mechanical function. It is diagnosed by a ECG finding.
It is important to differentiate atrial fibrillation from other supraventricular tachycardias, such as atrial tachycardia and atrial flutter. These tachycardias may cause patients to experience similar symptoms, but the underlying mechanisms, prognosis, and treatment options are different. Afib is often associated with other comorbidities. Some of these include increased weight, valvular heart disease, heart failure, coronary artery disease, hypertension, hypertrophic cardiomyopathy, congenital heart disease, and obstructive sleep apnea. There is also occasionally a familial component.
Afib can also be transient and secondary to an underlying condition. Examples include acute myocardial infarction, cardiac surgery,
pericarditis, myocarditis, hyperthyroidism, pulmonary embolism, pulmonary disease, other arrhythmias, sleep deprivation, emotional stress, trauma, pheochromocytoma, alcohol, stimulants, and infection.
Patients may experience a number of symptoms, or they may not notice any symptoms. Common symptoms include palpitations, fatigue, weakness, dyspnea on exertion, light-headedness, chest discomfort, polyuria, and an overall decreased quality of life. Syncope is occasionally associated, such as after a prolonged post-conversion pause from Afib to sinus rhythm.
Management strategies depend on how the rhythm is affecting the patient. The severity, duration, and pattern of symptoms should be considered. Associated comorbidities may be exacerbated by the arrhythmia, but they also may contribute to episodes of Afib. Also, some patients are more susceptible to a reduction in overall cardiac function and efficiency while others are not.
There are many options for utilizing either a rate or rhythm control approach to treating Afib. Potential strategies include observation, medical therapy, electrical cardioversion, pacing support, and ablative therapy.
To learn more about Afib, visit wthvc.org.
Understanding Atrial FibrillationThe Most Common Heart Rhythm Condition in America
By Dr. Shawn Baldwin
Coronary Chronic Total Occlusions (CTOs) are complex lesions — 99 percent blocked for three or more months. The build up of fatty deposits or plaque on the artery walls causes poor blood flow, increasing the risk of a heart attack. West Tennessee Heart & Vascular Center can treat CTO patients with medicine or coronary artery bypass grafts (CABG), but now we have an even better option for many patients. Percutaneous coronary intervention (PCI), also known as
angioplasty, is a complex minimally invasive approach that reopens blocked coronary arteries using a catheter and balloon to force open a passageway through the blockage. With improved wires to deliver the balloons, PCI has 90 percent and higher success rates.
Each Transcatheter Aortic Valve Replacement case at Jackson-Madison County General Hospital represents hours of Scott Sweat’s time.
Scott oversees Valve Care for WTHVC, including the interviewing and screening process of patients for the TAVR procedure. He works directly with the Valve Care team of doctors and medical staff to ensure each patient receives individual attention and the best care for their situation. He also personally gives each patient and their family the time and attention necessary for them to understand procedures and options.
In the coordinator position Scott leans on both his years of experience as a cardiac nurse at Jackson-Madison County General Hospital and his experience in logistics, human resources and management positions at The Valspar Corporation.
When not screening potential valve care patients, Scott can often be found with his wife and children at church, visiting a water park or enjoying the great outdoors on a four wheeler or jet skis.
Meet a Member of the WTHVC TeamScott SweatRN, Valve Clinic Coordinator
One Phone NumberFor Complete Cardiovascular Care
“I enjoy working with a team of doctors and support staff that put aside everything to focus on what’s right for the patient,” Scott says. “My favorite part of my job is seeing the improvement in the quality of the patients’ lives after their procedures.”
