OF SOUTH CAROLINA HEARTBEAT MUSC HEALTH HEART & VASCULAR CENTER THE TOP EXPERTS BRING HOPE WHEN HEARTS FAIL COMPASSIONATE CARE GROUNDBREAKING TREATMENTS DEDICATION TO PREVENTION
State of the Heart All locations can be found at: muschealth.org/medical-services/heart/locations TO SCHEDULE CALL 843-792-1952 MUSC Health Heart & Vascular Center is where you are. We have locations across the state for appointments and treatment. Call to schedule, close to home!
MUSChealth.org/heart | 1 MUSC HEALTH HEART & VASCULAR CENTER WELCOME FROM DR. DI SALVO Dear Friends, This year marks my fifth year as chief of the MUSC Health Heart & Vascular Center, which includes a premier, multidisciplinary heart failure program. I’ve seen our patients come through the doors apprehensive – even fearful. Sometimes their doctors have recommended our Heart & Vascular Center; other times, patients have been told there is nothing that can be done to improve the quality of their lives, let alone lengthen them. This publication is filled with examples of hope-filled paths that the MUSC Health Heart & Vascular Center offers. When patients work with our team of experts, their fears fade. From admission to years after they are back home again, our patients feel like they are part of a caring family that partners with them as they take a life path filled with possibilities. At the MUSC Health Heart & Vascular Center, you are the boss. As my colleague Dr. Anthony Carnicelli noted, “We are not here to tell patients what to do. We empower them by sharing information about therapies, procedures, medications and lifestyle changes so they can make informed and educated decisions.” In our hands, with premier technology and groundbreaking procedures, patients have better survival rates, lower risk of stroke and fewer complications such as pump failure or pump stoppage because of clots. It is an honor to serve at the MUSC Health Heart & Vascular Center. We will continue to work collaboratively, with passion and dedication, to ensure that if your heart fails, we will not fail you. Sincerely, Dr. Thomas Di Salvo, M.D., MPH ADVANCED HEART FAILURE AORTIC CENTER ARRHYTHMIA CENTER CARDIAC AMYLOIDOSIS CARDIAC CATHETERIZATION CARDIAC REHABILITATION CARDIO-ONCOLOGY CARDIOTHORACIC ANESTHESIOLOGY CARDIOVASCULAR GENETICS CHEST PAIN CENTER CONGENITAL HEART PROGRAM HEART HEALTH PROGRAM HEART SURGERY SERVICES STRUCTURAL VALVE CARE VASCULAR SERVICES COMPREHENSIVE HEART & VASCULAR CARE To schedule an appointment, call 843-792-1952 “We are not here to tell patients what to do. We empower them by sharing information about therapies, procedures, medications and lifestyle changes so they can make informed and educated decisions.”
2 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER If you are sitting in the waiting room of a doctor’s office keenly aware – or even mildly suspicious – that your heart is not healthy, you are one of many in our state. Heart disease is South Carolina’s number one leading cause of death, according to the Centers for Disease Control (CDC) and the South Carolina Department of Health and Environmental Control (SCDHEC). “Unfortunately, South Carolina has pretty high rates of many risk factors that we know contribute to heart disease,” said Dr. Brannon Traxler, director of public health at SCDHEC. “Risk factors include smoking, high blood pressure, diabetes and lack of exercise.” Half of the adults in South Carolina do not get the CDC’s recommended 30 minutes a day, five days a week of physical activity – a sedentary lifestyle that is estimated as a cause of 30% of coronary heart disease, or hardening of the arteries, SCDHEC confirmed in 2020. Statistics were startling before the pandemic and have remained alarming since. “There is a tidal wave of patients with heart failure,” said Dr. Anthony Carnicelli, an advanced heart failure and transplant cardiologist with MUSC Health Heart & Vascular Center. “During COVID, people sought less care. Either they could not get in for care, or they were less likely to go in and the disease progressed. Offices and hospital beds were also filled with COVID patients.” The progression of heart failure due to COVID is not the patient’s fault, Dr. Carnicelli added. Heart disease is a broad term that encompasses a wide range of heart conditions, one of which is heart failure – when your heart doesn’t pump enough blood for your body’s needs. In the United States, there are 5 million individuals with congestive heart failure and approximately 250,000 with advanced heart failure who could benefit from either a heart transplant or ventricular assist devices. The MUSC Health Heart & Vascular Center has a premier, multidisciplinary advanced heart failure program and is the state’s only transplant center. “Coordinated care in one place is critical,” said Dr. Carnicelli. “Heart failure impacts so many other parts of the body that medical and surgical specialties and subspecialties have to work closely together to ensure the best outcome for each of our patients.” SOUTH CAROLINA HEARTS ARE FAILING Heart failure comes in many forms. It can be acute, where the condition develops suddenly and goes away with time, or chronic, where the condition develops slowly and may worsen over an extended period of time. The two major causes are either ischemic cardiomyopathy – blockages are present in heart vessels – or nonischemic cardiomyopathy, which means heart failure without blockages. Less common causes of heart failure include hypertrophic cardiomyopathy, where the walls of the heart are very thick, as well as peripartum cardiomyopathy, which develops in women after pregnancy. There is also the possibility of congenital heart disease. Cardiogenic shock, one of the most severe forms of acute heart failure, requires immediate attention and often intensive care. MUSC Health has a new cardiogenic shock program that includes a conference line or “shock team” made up of specialists who can hop on an emergency conference call to provide a consensus opinion to cardiogenic shock patients who need highly specific, immediate care. “Coordinated care in one place is critical,” said Dr. Carnicelli. “Heart failure impacts so many other parts of the body that medical and surgical specialties and subspecialties have to work closely together to ensure the best outcome for each of our patients.” FAST FACTS ABOUT HEART FAILURE
MUSChealth.org/heart | 3 MUSC HEALTH HEART & VASCULAR CENTER WELCOME FROM DR. TEDFORD It is my honor to serve as the section head of heart failure and medical director of heart transplantation at the MUSC Health Heart & Vascular Center. As director, I participate in and witness firsthand how our premier advanced heart failure center changes and saves lives. Some impressive truths about the MUSC Health Heart & Vascular Center include: • We provide personalized, compassionate care and the most advanced and effective treatments for your individual heart and vascular needs. • We are the only program in South Carolina to offer heart transplantation, robotic valve surgery and complex aorta surgeries. • We have the state’s only cardiovascular genetics program, offering personalized care for people and families with inherited heart and vascular conditions. • The members of our faculty are internationally recognized experts in their fields. The words that best captured the Center’s unique strengths come from our patients: “The whole place is outstanding. Another hospital told me there was nothing they could do. Look where I am now – home changing some habits. I’ve lost 50 pounds. I don’t want to see a doctor closer to home; I would rather drive four hours to see Dr. Carnicelli. I don’t trust my life with anyone else.” - Roy McCaslan “I consulted with the Mayo Clinic and with another highly recommended hospital and picked MUSC Health’s Center. From their welcome through recovery, MUSC Health had a streamlined process that included confident, compassionate experts working collaboratively with me. I was blown away by the coordination. There were no inexplicable stops, starts, repeats or delays. The Center should take its show on the road – it is such a blessing. More hospitals and doctors need to adopt their philosophy and their approach to the whole patient.” - Kathleen (Kathy) Cooper I am pleased that many of our patients had the positive experiences that Mrs. Cooper and Mr. McCaslan shared, and it humbles me to know just how hard the entire staff works to ensure those positive experiences. At the MUSC Health Heart & Vascular Center, we work collaboratively to discover new heart and vascular treatments. Our leadership in national and international clinical trials enables us to offer the latest therapies, access to cardiac devices and medications that are not available elsewhere. Heart failure does not have to be a journey filled with gloom and doom. This is the place where the journey includes innovation and hope. When the solution calls for finding quality for every month that you have left, that is our specialty, too. Your heart is in compassionate, state-of-the-art care at MUSC Health. This truth is what really makes my job an honor. Dr. Ryan J. Tedford “I never dreamed that my doctor would be my advocate, which is what Dr. Coney was for me. We developed such a good friendship as well. We are thick as thieves when it comes to friendship and family.” —Wendy “My physician’s assistant, Shannon, and her team answered all my questions. They are there for you 24/7. I knew from the get-go it would be at least a year-long journey. There were lots of medications that had to be monitored and tweaked. It was hard, but we all worked together – and sometimes I was not real pleasant.” —Kathy “I love Dr. Houston. We had many doctors before him. We are an unusual family; we want to know the ‘whys.’ He is very patient and answers everything.” —Sheila “I’m giving back now. They gave me another life.” —John “I have a new heart inside of me. It’s doing its job. No defibrillator, no pacemaker and I’m alive and thankful.” —Norman To schedule an appointment, call 843-792-1952 HIGHLIGHTS FROM THE ADVANCED HEART FAILURE PROGRAM
4 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER “I remember waking up with a new heart and thinking, ‘I’m still alive,’” said Norman McGill, 54. “The whole thing is a miracle.” Throughout a long night last October, a team of cardiothoracic surgeons at MUSC Health, led by Dr. Arman Kilic, made history when doctors transplanted the first heart in South Carolina obtained by donation after circulatory death (DCD) into Norman. Despite other forms of intervention, Norman’s damaged heart was barely beating. In medical terms, he was in persistent end-stage heart failure, and he had ventricular tachycardia, which can be a fatal irregular heartbeat. A mechanical pump supported him, but, even with that help, Norman needed a transplant. He had been in the hospital for two months hoping for a miracle. Norman’s miracle unfolded when Dr. Kilic, the John M. Kratz Endowed Chair in Cardiac Surgery in the Division of Cardiothoracic Surgery, and the MUSC Health team partnered with Transmedics, a medical device company that created a machine that keeps organs functional and healthy during their journey from donor to recipient. “I knew they were making history,” said Norman’s mother, Lillie. “They showed me a picture of the heart beating in a little suitcase.” “The little suitcase” Lillie referenced aptly describes Transmedics’ ex vivo perfusion system. It looks like a clear, tube-infused suitcase that cradles the donor heart. The Transmedics system is designed to mimic the human body, which likely contributes to better organ function right away, Dr. Kilic explained. In addition, by keeping blood flowing to the organ and keeping it warm, the machine allows more time to gain access to organs. With the traditional method of keeping a heart cooled on ice, the maximum safe travel time is around four hours, which limits the distance a donated organ can travel for transplantation. But with the Transmedics system, donated hearts can come from much longer distances, and Dr. Kilic shared that some centers have successfully transplanted organs donated on one side of the country and then transported to the other. ‘THE WHOLE THING IS A MIRACLE’ Cohesive Partnerships Made Historic MUSC Transplant Possible Transmedics’ ex vivo perfusion system
MUSChealth.org/heart | 5 MUSC HEALTH HEART & VASCULAR CENTER Traditionally, organ donors are individuals who have no neurological function; they are considered “brain dead.” However, organs from DCD donors are available after a patient meets the criteria for circulatory death once life-sustaining assistance stops. The decision to donate is sometimes a tough one for families, but an increasing number of people are opting to give back as DCD donors. Of the 135 centers nationwide performing heart transplants, MUSC Health Heart & Vascular Center is one of only about 20 that work with DCD heart donors. “I share the surgical team’s pride,” Dr. Kilic said as he reflected back on the historic night. “For the transplant to unfold as seamlessly as it did, there was months of behind-the-scenes work, collaboration and support from administrative leadership. Ultimately, we were able to put an end to the long wait for an organ for our patient and gave him a new chapter in life.” These days, Norman and Lillie are taking care of each other in their Kingstree, South Carolina, home about 80 miles north of Charleston. Norman enjoys watching “Gunsmoke” and auto mechanic shows until he can move around a little more easily. He still loves “all food, especially rice and meat,” but he listens more to Lillie when she said, “we’re having more vegetables – peas, cabbage and broccoli.” Their advice to anyone with heart concerns: “Get to MUSC Health. Then pray and relax,” said Norman. “Pray and exercise. That’s what you really need to do,” Lillie added. Dr. Arman Kilic is the John M. Kratz Endowed Chair in Cardiac Surgery in the Division of Cardiothoracic Surgery at MUSC. He serves as the surgical director of the Heart Failure and Heart Transplant Program. He is board-certified in both cardiothoracic surgery and general surgery. Dr. Kilic’s clinical practice encompasses the entire spectrum of heart surgery for adults, including coronary artery bypass surgery, valve repair or replacement, heart transplantation and ventricular assist devices. He has particular expertise in high-risk operations, advanced coronary surgery techniques including off-pump and multi-arterial coronary bypass surgery, surgery for heart failure and minimally invasive procedures. Dr. Kilic left in operating room performing a Heart Transplant “Ultimately, we were able to put an end to the long wait for an organ for our patient and gave him a new chapter in life.”
6 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER Dr. Gregory Jackson’s interest in the intersection between heart failure and sleep apnea contributed to his expertise in the diagnosis and advanced therapies for both. “Pure numbers caught my attention initially,” said Dr. Jackson. “As many as 75% to 80% of the patients we treated for heart failure had sleep apnea and other co-morbidities like obesity and high blood pressure. That sparked our intrigue, so we started to do home sleep tests while patients were under our care.” Sleep apnea, the cessation of breathing for 10 seconds or longer, temporarily reduces the supply of oxygen to a person’s heart and lungs. The two main types of sleep apnea are obstructive sleep apnea (OSA) and central sleep apnea (CSA). OSA, the most common type, occurs when the throat muscles relax during sleep and collapse, which blocks a person’s upper airway, Dr. Jackson explained. CSA occurs when a person’s brain does not send out signals to maintain normal breathing, or the body does not correctly receive those signals. Do you fall asleep while watching TV? Do you wake up not feeling refreshed? Do you wake up to go to the bathroom at night? By asking patients traditional questions like these, Dr. Jackson and his team determined who needed to be set up with a sleep study. “We found that when we studied heart failure patients pre- and post-therapy, within the LVAD population, numerous patients had central sleep apnea,” Dr. Jackson explained. “We started seeing a decrease in re-admissions and in mortality rates once we were able to diagnose the condition, get patients on therapy and help them understand the other co-morbidities,” Dr. Jackson added. Dr. Jackson hopes that testing for sleep apnea, especially for patients with cardiovascular disease, will become more common. He is researching and championing new technology for remote monitoring for sleep apnea – technology that improves the testing experience for many patients. Dr. Jackson’s other clinical interests include left ventricular assist devices, cardiac transplantation, echocardiography and cardiac catheterization, and his research interests include the intersection of sleep apnea and cardiovascular disease. He graduated from the University of Florida with highest honors before receiving his medical degree from the George Washington University School of Medicine & Health Sciences. He completed internal medicine residency training at the Cleveland Clinic and his cardiology fellowship at the Medical University of South Carolina, where he served as chief fellow. Dr. Jackson went on to complete the Advanced Heart Failure and Transplantation Fellowship at the University of North Carolina-Chapel Hill before returning to MUSC as an assistant professor of medicine in the Division of Cardiology. SLEEP APNEA FAST FACTS ABOUT SLEEP APNEA It’s estimated that patients with sleep apnea are two to four times more likely to develop heart arrhythmias (abnormal heart rhythms) than people without this condition. Sleep apnea increases the risk of heart failure by 140% and the risk of coronary heart disease by 30%. Source: sleepfoundation.org Intriguing Correlation with Heart Failure Dr. Greg Jackson Dr. Greg Jackson right, Kathy Law center and Julie Ehret left
MUSChealth.org/heart | 7 MUSC HEALTH HEART & VASCULAR CENTER Dr. Daniel Silverman will be the first to assure you that “it’s a good time” to be practicing as a cardiologist. “We are finally understanding and targeting therapies to underlying causes when something goes wrong in someone’s heart,” said Dr. Silverman. “There are more potent medications to control blood pressure, better ways to detect fluid retention, devices that might help change the structure of the heart, medications to control weight loss and more devices to lower pressures on the heart,” he added. “When I first started in training, these tools didn’t exist.” Dr. Silverman and the team of experts at the MUSC Health Heart & Vascular Center are changing what’s possible as they trial treatments that involve placing an atrial shunt device between the upper chambers of the heart to improve blood flow. “Some patients have heart failure with preserved ejection fraction, or HFpEF,” Dr. Silverman explained. “Their heart doesn’t relax appropriately. Pressure rises on the left side of the heart so when there is a hole, the flow is closer to normal, which reduces pressure on the heart.” “I’ve had a chance to work in some great centers dedicated to studying this syndrome,” said Dr. Silverman. “We have the right team of experts with interests that dovetail with each other. Collectively, we have all the tools necessary so our patients have exposure to the most cutting-edge clinical trials available.” “We know, however, one of the biggest causes of heart issues – our unhealthy habits and sedentary lifestyles,” said Dr. Silverman. “But opting for healthy food and an active lifestyle is not the path most people have chosen. I struggle with that. Aren’t we just ignoring the low-hanging fruit?” “Yes, it’s a good time to be a cardiologist,” Dr. Silverman added, with the reminder of the importance of patients making lifestyle changes to supplement medical intervention. IMPROVING BLOOD FLOW Atrial Shunt Helps Heart Relax Dr. Dan Silverman “It’s a good time” to be practicing as a cardiologist. To schedule an appointment, call 843-792-1952
8 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER Heart failure can be tricky to diagnose and treat because there are so many causes. Each of Dr. Brian Houston’s patients confirm this fact, as well as why it is important to get the specialized and collaborative care that the MUSC Health Heart & Vascular Center offers. Dr. Houston met one young patient in the ICU who was experiencing shortness of breath, tightness in his chest and inexplicable fatigue for days before. A cardiac PET/CT scan confirmed that the patient had heart inflammation that could be treated with an anti-inflammatory drug. Within a short time, the inflammation was gone, and the patient went back to working two jobs and enjoying a normal life. “It is nice to see a young patient doing so well. It would have been dangerous to miss that diagnosis,” said Dr. Houston, who specializes in the management of advanced heart failure, including the care of patients before and after heart transplantation or left ventricular assist device (LVAD). Other patients in Dr. Houston’s care learn that their heart failure has genetic etiologies; in addition to successful treatment, HEART FAILURE Treatments Come in Many Forms Dr. Brian Houston
MUSChealth.org/heart | 9 MUSC HEALTH HEART & VASCULAR CENTER Dr. Houston and his team screen family members and provide family counseling, early treatment and ways to delay failure for decades. A middle-aged woman who had already seen other cardiologists and was concerned about her diagnosis learned from Dr. Houston and the expert team at the MUSC Health Heart & Vascular Center that a non-invasive procedure to clip her heart’s mitral valve would stop the regurgitation she experienced during physical exertion. In short, she could be back to her active self soon. “Each case highlights our expert multidisciplinary, skilled approach to diagnosis and treatment,” explained Dr. Houston. “I have a world of experts across the hall, so I can poke my head out to gather pulmonologists, radiologists, surgeons – any expert needed to come to a consensus on treatment.” Each case also confirms that patients “are not alone – that they can still live their best life with heart failure,” Dr. Houston added. It is the combination of knowing his role in patient success stories and “finding that space where you can support patients even when things are not going well” that Dr. Houston said he enjoys the most. “I enjoy the more cerebral part of cardiology – the physiology and theoretical parts,” he added. “There is great reward in being able to explain to patients why we are using a specific medication or a different form of intervention, including a transplant.” Mount Pleasant resident John Evans is one of many of Dr. Houston’s patients who appreciates his surgical talent as well as his ability to explain what is happening. “I’d be pushing up daisies if it weren’t for Dr. Houston and the LVAD. Mine is the third generation – a Heart Mate 3,” said Evans, who added that he loves being “the walking and talking proof that the pump works.” Dr. Houston and his team surgically placed the LVAD inside Evans’ chest and attached it to the left ventricle of the heart and the aorta. He then passed a “driveline” through the skin of the abdomen and connected it to the controller and the power supply. “I’m battery operated during the day, and at night I unscrew from batteries and go to a long chord,” said Evans. “I don’t have a pulse; I have a whirring sound. This pump is spinning 5,500 rpms; it’s unbelievable.” Evans returns to the MUSC Health Heart & Vascular Center for regular checkups with his LVAD care team. He confirmed that Dr. Houston and his team can’t offer him a prognosis for his life span. “This is all still a work in progress,” he explained, “which is exciting. Someday there will be an entire system that can be implanted into the chest cavity with no wires running out.” Dr. Houston echoes Evans’ thrill about medical advances. “I’m excited about the future of this field. The fact that we can cure someone with a transplant and that we can put a mechanical pump in someone’s body and connect it with electricity is miraculous,” said Dr. Houston. “Advances continue to unfold here every day.” Each case also confirms that patients “are not alone – that they can still live their best life with heart failure,” Dr. Houston added. To schedule an appointment, call 843-792-1952
10 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER Back in what he thought were his good old days, Calhoun Falls resident Roy McCaslan was a hardheaded truck driver who hit the road for distances as far away as Los Angeles, with occasional stops for fried chicken, fried potatoes, even gravy made from grease. He spent more than 18 years in the trucking life. “Truck driving is the worst job there is for trying to stay healthy,” said McCaslan, 62. In fact, McCaslan would probably still be out on a haul in the middle of Louisiana today were it not for a catastrophic moment in September 2022, followed by superb medical care at the MUSC Health Heart & Vascular Center, the support of family and experiences that McCaslan knows were miracles along the way. McCaslan was visiting his daughter, Mandy Couch, in Charlotte, North Carolina. Around 10:30 p.m., he went to bed with mild discomfort in his chest; at 1:30 a.m. he woke up struggling to breathe and in pain. “I was dying and it hurt,” he said. McCaslan remembers waking up his wife, Renée, to alert her, but little else. That night, his diagnosis and initial treatments are a collection of what others told him, combined with his own hazy recollections. He knows he lost consciousness and remained unconscious for four days. He knows he was transported to more than one hospital, placed on a ventilator and eventually told that it was time to call in the family because there was little chance he would make it. “Plaque had broken off and blocked the ‘widow maker,’” McCRITICAL CARE/SHOCK ‘Turning Tragedy Into A Miracle’
MUSChealth.org/heart | 11 MUSC HEALTH HEART & VASCULAR CENTER Caslan said, referring to the large artery that provides 50% of the heart’s blood supply. “My heart wasn’t pumping; I had three blockages, and there was so much damage to my heart that the doctor assured me it was grave.” “We ruled out an operation when I was told there was a 50% chance that I would not make it through,” he added. McCaslan’s wife, whom he calls his hero, and his daughter listened to all the bad news. With McCaslan, “they lost it,” he said. And then they said they would not accept the “you-will-notmake-it” news. McCaslan received an Impella heart pump at a local hospital to keep blood flowing at 6% – just enough to keep him alive during a 200-mile transport to the person and the place that proved to be his literal lifeline: Dr. Anthony Carnicelli and the team of experts at MUSC Health’s Heart & Vascular Center. Dr. Carnicelli, an advanced heart failure and transplant cardiologist, specializes in treating critical care patients like McCaslan. One of the newest members of the MUSC Health team, Dr. Carnicelli had already made history with his colleague, Dr. Arman Kilic, when they performed the first donation after circulatory death (DCD) heart transplant in South Carolina. The team used an ex vivo perfusion machine to transport and evaluate the donor organ before successfully transplanting it into a patient with end-stage heart failure. “Turning a tragedy into a miracle for a patient who has lived with a chronic illness is an amazing thing,” said Dr. Carnicelli about the historic moment. “There is nothing else like this kind of specialized work in medicine that touches so many lives.” Dr. Carnecilli and his team saved McCaslan’s life with stents, a defibrillator and medications that ultimately led to a major improvement in his heart function and quality of life. “He told me that if he took 100 patients who had what I had, 99 of them would be dead,” said McCaslan. “I will never forget that.” Dr. Carnicelli completed his medical residency training at Harvard Medical School’s Brigham and Women’s Hospital and fellowship training in cardiovascular diseases, clinical research and advanced heart failure and transplant cardiology at Duke University before joining the faculty at MUSC. “MUSC employs a truly amazing, forward-thinking group of cardiovascular disease specialists,” said Dr. Carnicelli. “Heart failure patients have many more paths to improved quality life given the rapidly evolving landscape of cardiovascular medications, procedures and advanced therapies like heart pumps and heart transplants.” “In the cardiac intensive care unit, we are seeing a more diverse population with a wide variety of cardiac and noncardiac diseases, often with multisystem organ failure,” he added. “We are very proud to be able to provide our patients with exceptional, state-of-the-art, multidisciplinary cardiovascular care at MUSC.” The new Roy McCaslan walks every day; in fact, he tries to walk 4 to 5 miles a day. He eats right and he enjoys fishing with his grandchildren. “I want to be a good patient,” he said. “I pray for Dr. Carnicelli every night. He is a miracle; the whole place is outstanding,” McCaslan added. “Another hospital told me there was nothing they could do. Look where I am now – home, changing some habits. I’ve lost 50 pounds. I don’t want to see a doctor closer to home; I would rather drive four hours to see Dr. Carnicelli. I don’t trust my life with anyone else.” “Turning a tragedy into a miracle for a patient who has lived with a chronic illness is an amazing thing,” said Dr. Carnicelli about the historic moment. Dr. Anthony Carnicelli
12 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER At MUSC Health’s Heart & Vascular Center, more than 50 clinical trials are enrolling at any given time. These trials offer access to leading-edge drugs, devices and treatments that may not be available elsewhere in the state or even in the United States. In fact, by the time some treatments are approved for widespread use, MUSC Health doctors have already been using and evaluating them for many years. “There have been some game-changers with regard to medications and treatments for heart failure,” said Dr. Ryan J. Tedford, section head of the heart failure and transplant team at MUSC. “Clinical trials are a key part of these breakthrough discoveries and new treatments.” During clinical trials, doctors test how well new medical approaches work in people. Each study answers scientific questions and tries to find better ways to prevent, screen for, diagnose or treat a disease. Clinical trials may also compare a new treatment to a treatment that is already available. Some of the game-changing medications and treatments that are a direct result of clinical trials include Barostim, an implanted device that uses electrical impulses to stimulate the nerve that regulates blood pressure, inducing the blood vessels to relax. When the blood vessels out in the periphery are relaxed, that makes for less work for the heart, according to Dr. Jean Marie Ruddy, a vascular surgeon who served as the principal investigator at the MUSC site for the clinical trial of the implantation of Barostim. “Although the device does not usually reverse heart failure, it can improve patients’ quality of life,” explained Dr. Tedford. “It’s intended for patients who are in that middle ground of not getting sufficient benefit from medication but not sick enough for a heart pump or heart transplant.” “Clinical trials are on a constant cycle,” said Dr. Tedford. “One particular source of pride for me is our doctors’ collaborative contributions to many firsts for therapies and procedures for heart failure.” MUSC TRIALS INCLUDE • The use of biomarkers to signal early heart transplant rejection; • Novel devices to reduce acute and chronic heart failure symptoms; • The use of SGLT2 inhibitors to reduce the risk of heart failure and heart attacks and slow the progression of kidney dysfunction; • Lifestyle and pharmacologic interventions to support weight loss; • New drug therapies for pulmonary hypertension and heart failure; • Strategies to reduce bias and improve allocation of advanced heart failure therapies; • Minimally invasive heart valve replacements and heart pump implantation. CLINICAL TRIALS Where People Help Medicine Advance Dr. Ryan Tedford “Clinical trials are a key part of these breakthrough discoveries and new treatments.”
MUSChealth.org/heart | 13 MUSC HEALTH HEART & VASCULAR CENTER From structural heart imaging to genetics, from human valve implants to ways to shrink the heart down when a patient has an aneurysm but does not want mechanical support or a transplant – MUSC Health experts remain on the discovery forefront. Dr. Tedford is an internationally recognized clinical researcher and has published more than 200 peer-reviewed original research manuscripts, invited expert reviews, editorials and book chapters. His research efforts are focused on hemodynamic assessment of the right ventricle function and its interaction with the pulmonary circulation and left heart. This research spans the fields of pulmonary hypertension, left heart disease, exercise physiology, systemic sclerosis and mechanical circulatory support. He is a deputy editor for The Journal of Heart and Lung Transplantation and serves on the editorial board for Circulation: Heart Failure; CHEST; and JACC: Heart Failure. BE A PART OF GROUNDBREAKING RESEARCH Every medication that we take for our own health conditions is only available because other people have volunteered to participate in research. On any given day, MUSC Health enrolls as many as 340 people in more than 50 clinical trials. Often we lead the nation in participation enrollment because we have earned participants’ trust. Although some research studies are investigating a particular illness or health condition, other studies use healthy volunteers. Each study has very specific eligibility criteria. The following resources will help you find a study that may be right for you. SCresearch.org - The South Carolina Research Studies Directory, designed specifically to help people like you, locates research studies in which to participate. Browse by topic, location and more. Researchmatch.org - A not-for-profit online resource that matches people who want to participate in research with researchers throughout the country who need volunteers for their studies. Hollings Cancer Center Trials - Cancer research clinical trials at MUSC. Call 843-792-8300 and speak to a research professional about other study opportunities available at MUSC. To schedule an appointment, call 843-792-1952
14 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER Patients are quick to tell anyone who will listen that their experience at the MUSC Health Heart & Vascular Center – from start through each stage of care – unfolded smoother than they could have ever imagined. “From their welcome through recovery, MUSC had a streamlined process that included confident, compassionate experts working collaboratively with me,” said Kathy Cooper, 70, who has had several procedures done, including ablation, valve replacement and intricate procedures to correct electrical misfires in her heart. “I was blown away by the coordination. There were no inexplicable stops, starts, repeats or delays.” Smooth transitions, high return rates for follow-up care and cardiac rehabilitation therapy are all points of pride for the MUSC Health Heart & Vascular Center and have earned patient and national praise. MUSC Health has a Blue Distinction® Center+ designation in the area of cardiac care. Blue Cross and Blue Shield awards this recognition to medical centers that deliver quality care and better overall outcomes – and costs – for patients. “There is always more that we can do to improve life for our patients,” said Dr. Chakradhari Inampudi, an advanced heart failure and transplant cardiologist. “And nothing is accomplished without team effort.” Led by Dr. Inampudi, the MUSC Health & Heart Vascular Center explored the patient experience to better understand how to help them. Specifically, the team looked at re-admission to the hospital rates and lack of scheduled follow-up appointments PATIENT EXPERIENCE ‘BETTER THAN IMAGINED’ From Start Through Each Stage of Care
MUSChealth.org/heart | 15 MUSC HEALTH HEART & VASCULAR CENTER for heart failure patients. Their research confirmed that patients were missing appointments because of financial struggles, lack of transportation and a lack of understanding about the importance of follow-ups. “I noticed that patients who do come back often wonder, ‘Why am I here?’” Dr. Inampudi said. Understanding re-admission rates and follow-up appointment rates from a patient’s perspective helped the team create more efficient procedures. The Advanced Heart Failure Program now reports about a 100% scheduling rate for follow-ups and a reduced re-admission rate. “These are great accomplishments, but there is more to be done,” said Dr. Inampudi. There are many other changes on the horizon to improve the patient experience at the MUSC Health Heart & Vascular Center. Dr. Inampudi is adamant about improving the efficiency of getting prescribed medications to patients. For example, there are avenues to improve health literacy about the medical conditions patients have, he explained. The program recently released a phone application for heart failure patients that provides information about their condition, nutrition and exercise modalities and the benefits and impacts of specific medications. “It is easier to identify the day-to-day challenges in patients’ lives when you consider yourself a patient, too, and ask, ‘What do I need and want,’” Dr. Inampudi said. “Or ask, ‘If my mother, father, sister, brother or friend was living with heart failure, what would I want for them?”’ Dr. Chakradhari Inampudi specializes in treating patients with all forms of heart failure and pulmonary hypertension, including patients with advanced heart failure requiring IV medications, left ventricular assist devices (LVAD) and cardiac transplantation. “From their welcome through recovery, MUSC had a streamlined process that included confident, compassionate experts working collaboratively with me,” said Kathy Cooper
16 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER Dr. Adrian Van Bakel’s patients call him the “Chuck Norris of the cardiac world” because he has taken on some of the most complex cases and saved so many lives. With more than 30 years as a cardiology specialist at MUSC Health, he enjoys the advantage of caring for patients for the long haul when needed. Perhaps the best example of the long-haul-Chuck-Norris advantage that Dr. Van Bakel brings to MUSC Health is his history with 47-year-old patient Jonathan Wigfall, who has been in Dr. Van Bakel’s care since 2008, after several successful heart surgeries by other MUSC Health experts. As a teen, Wigfall got rheumatic fever, which damaged his heart valves. Before he met Dr. Van Bakel, he had survived several valve replacements and, later, an aortic root replacement, but his heart continued to fail. In June 2023, with trust in Dr. Van Bakel’s advice and surgical expertise, Wigfall knew it was time for a heart transplant. “That whole Chuck Norris thing – it’s true,” said Wigfall days after the transplant and his release from the hospital. “He is both firm and fair. I was a tough cookie when we first met. I didn’t always listen to his advice, especially about exercise and nutrition. I was a real big guy, over 360 pounds.” “He really listened to me though,” Wigfall added. “And I eventually realized what he wanted me to understand and things got a lot better.” Wigfall started exercising and eating better; the weight fell off and Wigfall said he could feel Dr. Van Bakel’s pride in his progress. “I got to the point where I looked forward to going to him,” Wigfall said. “And, if I messed up, it hurt me more to hurt him. He has been so passionate about making me feel better.” “Jonathan is always trying to do better,” said Dr. Van Bakel. “He has been through a lot, and we developed quite a bond over the years.” The two have known each other for so long, they don’t just say hello or high five when they meet – they hug. As Wigfall leaves his appointments and after he woke up after his heart transplant, he greeted Dr. Van Bakel by saying, “I’m just happy to be here.” This humanity in medicine is what fuels Dr. Van Bakel the most. He appreciates knowing that he has made a positive impact on patients’ lives and that they share mutual gratitude for the positive steps they make toward better health together. “Trust me, I’ll do anything for him right now,” said Wigfall. “I have a new heart. I’m Peter Pan and I’m so happy to be here.” COMPLEX CASES Dr. Adrian Van Bakel has been on the faculty at MUSC Health since 1991, and he served as the medical director of the Heart Failure and Cardiac Transplant Program from 1991 to 2017. “When I started, I was the only faculty member specifically trained to work with heart failure and transplant patients,” said Dr. Van Bakel. “Now we have over 12 experts in this area. There is such a need for all of us because heart failure cases continue to rise.” Prior to his tenure at MUSC Health, Dr. Van Bakel graduated from the University of Louisville School of Medicine in 1981, then completed his Ph.D. in pharmacology from that institution in 1983. Dr. Van Bakel has been the principal investigator of many multicenter clinical trials in congestive heart failure and cardiac transplantation. His research interests include congestive heart failure management, novel immunosuppression strategies and the pharmacogenomics of drug absorption and metabolism. Long-Term Relationships Matter “He really listened to me though,” Wigfall added. “And I eventually realized what he wanted me to understand and things got a lot better.”
MUSChealth.org/heart | 17 MUSC HEALTH HEART & VASCULAR CENTER Hands-Only CPR Join a Nation of Heartsavers™ today. heart.org/handsonlycpr Don’t drop the beat! Know it. Feel it. Push it. Keep it. TWO STEPS TO SAVE A LIFE 1 Call 911 2 Push hard and fast in the center of the chest ©2021 American Heart Association DS17758 5/21
18 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER The Medical University of South Carolina (MUSC) has been training leaders in cardiology for more than 50 years. Dr. Jessica L. Atkins, an advanced heart failure and transplant cardiology specialist, is among an elite group of graduates who benefited from that training. Now her patients and her colleagues at MUSC Health’s Heart & Vascular Center are benefiting, too. After completing MUSC’s general cardiology fellowship in 2021, Dr. Atkins continued her professional trajectory with the Advanced Heart Failure and Cardiology Transplantation Fellowship program. She was among 500 of the brightest and most promising physicians in the country who applied for the fellowship, and, ultimately, Atkins joined just six other doctors as a fellow. “I had amazing mentors who were – and remain – dedicated to teaching,” said Dr. Atkins, who completed the fellowship in 2022. “We took care of patients with complex cases. Even today, other alums from the fellowship program and I have great mentors within the MUSC faculty.” MUSC Health’s Heart & Vascular Center offers more treatment options for congestive heart failure than any other program in South Carolina. In addition to an extensive surgical experience, Dr. Atkins participated in outpatient clinics and hospital rounds. Heart transplants and treatments, as well as cardiogenic shock – which requires interventions such as mechanical heart pumps – sparked her interests and skills the most, she said. Today, Dr. Atkins specializes in structural heart failure therapies, most notably treatments for hypertrophic cardiomyopathy (HCM), an inherited condition that causes the heart muscle to thicken. The FROM FELLOW TO VALUED TEAM MEMBER Hypertrophic Cardiomyopathy Fellowship Program Dr. Jessica Atkins left with Charlee Porcelli right “We took care of patients with complex cases. Even today, other alums from the fellowship program and I have great mentors within the MUSC faculty.”
MUSChealth.org/heart | 19 MUSC HEALTH HEART & VASCULAR CENTER thickened muscle obstructs the flow of blood out of the heart during each heartbeat. “Patients with HCM often struggle with shortness of breath, heart palpitations, a racing heartbeat or the scariest symptom – sudden cardiac death,” Dr. Atkins explained. From monitoring and medication management to more advanced options, including surgery, Dr. Atkins and MUSC Health’s experts evaluate each patient’s condition and recommend individualized care. “Dr. Atkins is someone who really cares; you can see it in her eyes,” said Katherine Woodward, 28. “You can hear that care in the questions she asks and the connection she keeps with you before and after treatment.” Woodward, an ER nurse, turned to Dr. Atkins and two others on the MUSC Health team – Dr. David Gregg and nurse practitioner Rochelle Judd – for help navigating her high-risk pregnancy with HCM, a form of heart failure she found out she had three years ago. Dr. Atkins, Dr. Gregg and Judd helped Woodward create a Plan A for a delivery without complications and a Plan B for a delivery that might be far from smooth. Plan B, which required an emergency cesarean section, was the plan they employed. “MUSC was nothing short of amazing,” Woodward said. “I’m not the best patient; I have so much anxiety about everything. Dr. Atkins came to see me each day after her clinic rounds; Dr. Gregg came to see me twice daily, sometimes in the middle of the night and on his entire weekend off. Rochelle was alongside each doctor. It was refreshing to feel so cared for during such a trying time.” “That is been best part of joining the faculty here,” said Dr. Atkins. “At MUSC Health, heart failure patients have the unique advantage of multifaceted care and intervention because we know each other and each person’s expertise so well.” Today, Woodward is a proud mother of a baby girl and “doing better than I was before pregnancy,” she said. The coveted Advanced Heart Failure and Cardiology Transplantation Fellowship Program provided Dr. Atkins and generations of other bright participants a space for discoveries. As the doctors who lead the program hope, Dr. Atkins and others are now sparking change for their patients. MUSC Health’s Heart & Vascular Center is the only program in South Carolina that offers heart transplantation, robotic valve surgery and complex aorta surgeries. The Center has the state’s only cardiovascular genetics program, providing personalized care for those with inherited heart and vascular conditions. In addition to standard options such as medication management, we also offer these specialized programs: Heart transplants; Mechanical circulatory support (VADs); Shock and cardiac emergency care; Heart valve procedures; Cardio-oncology; Hypertrophic cardiomyopathy; Sarcoidosis; Telehealth, including CardioMEMS™; Cardiovascular genetics. “ Dr. Atkins is definitely at the top of all the doctors I’ve seen. She is amazingly empathetic, very patient and kind. She answers all questions and is genuinely happy when there is good news and sad when it’s not. – Florence resident Mitzi Moore, 65 ” Dr. Atkins left with Dr. Ryan Tedford right To schedule an appointment, call 843-792-1952
20 | MUSChealth.org/heart MUSC HEALTH HEART & VASCULAR CENTER When Dr. Jan Griffin first meets patients, they are often short of breath, they can’t sleep and their legs are swollen because of accumulating fluid. Many of them have been to two or three other providers who weren’t able to ease their discomfort. “What I love the most about my job is helping patients feel better. I love seeing a smile on their face after an appointment. It’s great to hear them say, ‘I feel better. I can walk, and I can sleep now,’” said Dr. Griffin, an advanced heart failure and transplant cardiology specialist at MUSC Health. Dr. Griffin’s first approach with patients is symptom management, which usually involves easing fluid retention and getting patients on the right balance of medications, she explained. Dr. Griffin’s research focuses on infiltrative cardiomyopathies, particularly cardiac amyloidosis and cardiac sarcoidosis. Treatment for both conditions, especially sarcoidosis, calls for collaboration with other specialists, including those with expertise in dermatology, rheumatology, ophthalmology, cardiology and neurology. “With our interdisciplinary approach at MUSC Health, I can ensure that patients are seen by the right specialist,” said Dr. Griffin, adding that she appreciates her colleagues’ detailed approach to each patient and their shared dedication to getting patients the best care. Dr. Griffin and her team lead clinical trials, some international, for new therapies and treatments they believe will bring groundbreaking changes to patients soon. A clinical trial involving a treatment for transthyretin amyloidosis involving TTR gene editing is one that she said was “very exciting.” Transthyretin is a protein made in the liver. With aging, or when there is a mutation in the TTR gene, this protein can become abnormal and form deposits of amyloid – plaques – in organs including the heart. TTR is one of two main types of amyloidosis that affect the heart. The other type is AL amyloidosis, which is the most common amyloidosis. With AL amyloidosis, plasma cells in the bone marrow overproduce free light chains, which misfold and form insoluble amyloid protein. This AL amyloid protein can deposit in body CARDIAC AMYLOIDOSIS AND CARDIAC SARCOIDOSIS Interdisciplinary Approach Required Dr. Jan Griffin
MUSChealth.org/heart | 21 MUSC HEALTH HEART & VASCULAR CENTER tissues and organs such as the heart. AL amyloidosis is also called immunoglobulin light chain amyloidosis. “Light chain amyloidosis is much more serious,” Dr. Griffin explained. “It can affect any organ in the body. People get sick very quickly, and, when the heart is involved, it can be very severe.” “TTR is a more slowly progressing disease. In fact, one of the co-morbidities is carpal tunnel syndrome,” she added. “Someone who had carpal tunnel 10 years ago could have been experiencing the first manifestation of TTR amyloid deposition.” Dr. Griffin’s work at the MUSC Health Heart & Vascular Center is a welcomed extension to research she did as a fellow in advanced heart failure and transplant cardiology – then an assistant professor of medicine – at Columbia University Irving Medical Center in New York, she said. Prior to her work in New York, Dr. Griffin completed a cardiology fellowship at Johns Hopkins Hospital and her residency in internal medicine at the University of North Carolina in Chapel Hill. RARE CONDITIONS THAT REQUIRE A TEAM APPROACH Amyloidosis is a rare condition that results from a buildup of an abnormal protein called amyloid. Amyloid can be produced from any one of over 30 proteins. When the amyloid proteins build up in your heart, they cause heart failure. There are several types of amyloidosis, differentiated by which protein causes the deposits. Identifying amyloidosis can be challenging because the symptoms aren’t always specific. Signs include bruising easily, swollen legs and shortness of breath. Your doctor uses a combination of blood tests, imaging studies and sometimes a biopsy – taking a sample of tissue – to diagnose amyloidosis. Cardiac amyloidosis causes heart problems that can lead to heart failure. With amyloidosis, heart failure usually occurs because the heart becomes stiff and cannot pump blood properly (cardiomyopathy). MUSC Health offers South Carolina’s only heart transplant program, which may provide an option for people with some amyloid disorders. We have performed heart transplants for people with inherited TTR amyloidosis and advanced heart failure. MUSC Health doctors are also researching the relationship between amyloid plaques in the heart and on the brain. These types of plaques cause dementias such as Alzheimer’s disease. Sarcoidosis is a complex, multisystem inflammatory disease that can affect any organ in the body. Sarcoidosis is most commonly found in the lungs and lymph nodes but also appears in other organs, including the eyes, kidneys, heart, brain and skin. While there is currently no cure, sarcoidosis is a treatable disease. Additional Resources • MUSC Amyloidosis Support Group - MUSC Health hosts an amyloidosis support group to provide community, connection and education. www.amyloidosissupport.org • My Amyloidosis Pathfinder - The MUSC Amyloidosis Center has teamed up with ARC to simplify patient-provider visits and communication with our amyloidosis team for treatment plans and goals tailored to your needs. www.amyloidosissupport.org/ support_groups/southcarolina.html • Sarcoidosis Support Group – www.amyloidosissupport.org/treatment/southcarolina.html “What I love the most about my job is helping patients feel better. I love seeing a smile on their face after an appointment.”
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