Penn Medicine News Blog

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

Would you be able to find an automated external defibrillator if someone’s life depended on it? Despite an estimated one million AEDs scattered around the United States, the answer, all too often when people suffer sudden cardiac arrests, is no.

In a Perspective piece published online this week in the journal Circulation: Cardiovascular Quality Outcomes, Penn Medicine emergency physician Dr. Raina Merchant outlines the tremendous potential associated with greater utilization of AEDs in public places.  In cases of ventricular fibrillation – a wild, disorganized cardiac rhythm that leaves the heart unable to properly pump blood through the body, which is the leading cause of sudden cardiac death – quick use of an AED and CPR improve a patient’s chance of surviving by more than 50 percent.

But since the devices are sold through wholesalers, manufacturers have no way to track who purchases them and where they’re ultimately placed. That leaves two problems: No reliable way to connect bystanders with AEDs during emergencies, and no way to locate the devices during recalls or for regular servicing and inspection, like the process used to keep fire extinguishers in working order. Without a map of the devices, the more than 300,000 people who suffer cardiac arrest remain in great peril. Nationwide, just over 6 percent of these patients survive.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

Hot flashes. Night sweats. Sleep disturbances. Mood swings. Irregular and racing hearts. These are all signs of menopause setting in, the time in a woman’s life when her ovaries cease to function signaling the end her fertility years, her menstrual cycle and a drop in naturally produced hormones.

Often aptly referred to as “the change of life,” the period during which some women suffer the many unpleasant symptoms associated with menopause is actually a transitional phase called perimenopause, which can begin from as young as 40 and last until a woman’s early 60s. A woman is considered perimenopausal until one full year after her last menstrual period. After this year has passed, a women can then declare herself as “gone through menopause” and is considered postmenopausal the rest of her life. 

 As if the possibility of menopausal symptoms setting in as early as age 40 isn’t unsettling enough, check out these disturbing facts: a woman’s risk for heart disease automatically increases at age 40, and heart disease is the leading cause of death in women over 40, particularly those in the midst of menopause. Why? Because the decrease in estrogen caused by menopause has multiple negative effects on the female cardiovascular system including: changes in the walls of arteries and blood vessels which makes plaque and blood clots more likely to form; increased fibrinogen levels which make blood clots more likely to form and narrow the arteries; a decrease in HDL – or “good cholesterol” – and an increase in LDL or “bad cholesterol.”

Nothing beats mother’s milk when it comes to helping infants thrive. It contains all the vitamins and nutrients a baby needs in its first six months of life. Breast milk is especially good for premature babies because it is also filled with disease-fighting substances and is much easier for their underdeveloped GI tracts to digest.

But many preemies can’t get the breast milk that is so essential to their well-being; the sucking motion needed to nurse is not yet developed.  In addition, while moms of preemies are encouraged to pump milk for their babies, not all mothers are able to pump due to certain medical conditions while others attempt to pump but don’t make enough.

Now, HUP’s new Donor Milk Program will help bring this powerful ‘medicine’ to its tiniest patients.

Donor milk is breast milk that is pumped by a mother who is not the baby’s birth mother. Although a mother’s own milk is best for her baby, donor milk is a close second in terms of benefits. HUP’s donor milk program will provide this milk to babies in its Neonatal ICU who weigh under 1,000 grams (the equivalent of a mere 2.3 pounds) and whose moms are not capable of pumping milk or not making enough. “It will be for our most vulnerable infants,” said Laura Carpenter, BSN, RN, IBCLC, who led the initiative with Christine Jaslar, RN/IBCLC, both part of HUP’s Lactation Team.  “Our goal is to provide donor milk to every infant who needs it.” She added that it could also be made available for other newborns in special circumstances, to be decided on a case-by-case basis. HUP and Children's Hospital are the only birth hospitals within city limits offering this type of program.

The rise of technology and data overload looms large over medical practice, threatening the human interactions at the core of the doctor-patient relationship. And as it continues, “something definitely will get lost,” says Alan Wasserstein, MD, an associate professor in Penn Medicine’s division of Renal, Electrolyte and Hypertension. “The danger,” he says, “is that physicians turn their work into a pure exercise.”

Educators, researchers, and practitioners across in the United States and abroad have been working to address the rift between personal and impersonal care by developing models that introduce ways to encourage humanism and professionalism to the practice of 21^st century medicine. For more than a decade, Penn faculty – including Dr. Wasserstein – have helped put programs and activities in place to help students and staff that teach caregivers how to show respect and be sensitive to their patients’ needs, as well as demonstrate cultural competency at the bedside.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

The flowers and cards have all been delivered. The chocolates were devoured and Cupid can now take his annual break. But just because Valentine’s Day has come and gone doesn’t mean the time for hearts is over. There’s still some days left of American Heart Month and while the public is bombarded with commercials and news stories about the topic, no one – especially women – should think they’ve heard all there is to know about heart disease.

Heart disease is the number one killer of women. Yet after scores of public education programs and public service campaigns the message still hasn’t sunk in. “For decades, heart disease was considered a man’s disease,” said Nazanin Moghbeli, MD, MPH, FACC, the director of the Women's Cardiovascular Center at Pennsylvania Hospital. “Previous heart disease research and public awareness efforts only focused on cardiovascular disease in men. But we know differently today. Today we’re faced with the sobering fact that a woman suffers a heart attack every minute in the United States. Not only do we need further research and continuing education, we must focus on teaching women the important differences in the symptoms and risk factors of heart disease.”

“It’s obvious that women should be aware of the risks of heart disease and recognize the signs of a heart attack. Yet women also need to realize they can take action. If they know the risks factors of heart disease and can minimize or eliminate them, they can greatly improve their chances of preventing cardiovascular disease,” Dr. Moghbeli says “When it comes to risk factors of heart disease for women, I like to break them down into two categories:  the usual suspects and the not-so-usual suspects.”

Perelman School of Medicine student Dan Hashimoto recently made Penn Medicine proud when he claimed the top spot in the Top Gun Laparoscopic Skills Challenge at the annual Clinical Congress of the American College of Surgeons (ACS). Hashimoto defeated a chief resident and a third year surgical resident from another institution to become the first medical student to place first in the competition since its inception at ACS in 1996!

Dan Hashimoto with Dr. James Rosser, founder of the Top Gun Laparoscopic Skills Challenge

The American College of Surgeons hosts the Top Gun Laparoscopic Skills Challenge on the first three days of the conference. The Penn surgery team advanced to the finals, beating out 30 other medical students, residents, fellows, and attending surgeons.

As Hashimoto writes in his Perelman School of Medicine blog post here, he credits those results to guidance he received from Noel Williams, MD, Kristoffel Dumon, MD, Kenric Murayama, MD, and residents and fellows in the Department of Surgery and helpful training at the Penn Clinical Simulation Center.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

It may seem thoroughly unromantic, but researchers at Penn Medicine’s Cardiovascular Institute are hoping for some broken hearts this Valentine’s Day.  But these broken hearts could wind up being the unlikely heroes in the ongoing search for new therapies to treat one of the most common health conditions in the world – heart failure.

According to the American Heart Association, about 5.7 million people in the U.S. alone suffer from heart failure. Statistics also show that, each year, 670,000 new cases are diagnosed and more than 277,000 people will die of heart failure.

Physicians working to understand and develop new therapies for heart failure rely on human tissues for their investigations. Many of these valuable tissues come from diseased or “broken” hearts that are replaced by transplantation or repaired by implanting medical devices that help keep the heart going. One of the world’s largest repositories for this type of tissue resides right here in Philadelphia, at the Penn Cardiovascular Institute’s Human Heart Tissue Repository.

The program, led by Kenneth Margulies, MD, professor of Medicine and research director for the Heart Failure and Cardiac Transplantation Program at Penn, allows surgeons, physicians and researchers to work together to understand why certain heart defects, such as heart failure, occur and how they can be more accurately treated.

Amyotrophic  Lateral Sclerosis (ALS) is linked to Frontotemporal Lobar Degeneration (FTLD). Parkinson's disease (PD) is linked to Alzheimer's disease (AD). Progressive Supranuclear Palsy (PSP) is caused by an abnormal accumulation of tau, a protein that plays a role in AD.

It may sound like an alphabet soup of diseases, but these intertwined diseases are changing the way we look at, and hope to treat, progressive neurodegenerative diseases attacking the brain.

For diseases historically considered in the domain of distinct neurological sub-specialties - movement disorders, neuromuscular conditions, and dementia - the steady increase in our understanding of their overlapping causes and symptoms, as well as their co-existence in the same individual, has led to a shift in how care is delivered. Physicians, nurse practitioners, therapists, and other care-team members are cross-training and collaborating more than ever.

Rachel Gross, MD, now an assistant professor of Neurology in the Perelman School of Medicine at the University of Pennsylvania, noticed the overlap as she completed advanced training in Neurology. She decided to get dual-trained in both Cognitive Neurology and Movement Disorders while completing her fellowship at Penn. "I realized that patients who suffer from diseases characterized by a movement disorder and dementia would appreciate seeing one physician who can address both their motor and cognitive issues.”

At last weekend's FTLD Caregiver Conference, hosted by the Penn FTLD Center, we saw how neurological sub-specialties are blending, overlapping, and informing each other. For instance, researchers are now considering FTLD and ALS to be on the same spectrum of disease. Some people may start with the physical stiffness seen in Lou Gehrig's disease, while someone else - with the same underlying protein markers - starts with FTLD-symptoms like behavioral outbursts or language mix-ups.

Some of the less common neurodegenerative diseases are also informing the more common diseases. Last year, we reported genetic clues on risk factors and biological causes of a rare neurodegenerative disease called progressive supranuclear palsy (PSP). Biologically, PSP is primarily caused by an abnormal accumulation of tau protein, which is well-known for its secondary role in Alzheimer's disease.

Pieces of research - genetics, biomarker tests, imaging, pathology, and clinical symptoms - are starting to come together to give us a better picture of neurodegenerative disease. The team of researchers and clinicians, at Penn and beyond, are in a race to find a cure. The more experts battling neurodegenerative diseases, the better!

With this year’s Super Bowl setting a record for being the most-viewed show in U.S. television history, concussions – more technically, mild traumatic brain injury (TBI) – have probably been on many a mind this week. TBI has long been a leading cause of death and disability, with over 1.7 million cases in the US alone each year.
 
Misshapened, swollen nerve fibers called axons in the post-mortem brain tissue of TBI patients have been noted by pathologists for years. They assumed the swellings arose from a complete interruption in what the axons were normally transporting between nerve cells. Due to their elastic nature, white-matter axons are susceptible to damage by the stretch and strain produced during TBI.
 
Using a high-powered microscope called TEM, for transmission electron microscopy, a team from Penn Medicine viewed damaged axons in two ways to gain a better idea of what causes the damage: in those grown in the lab and stretched mechanically and in those from post-mortem samples from TBI patients. In both types of axons, they found at each site of swelling mechanical breakage of individual microtubules – tubes for transporting proteins within a cell. This break in the cell’s transport system causes accumulation of the protein cargo. Breakage of different microtubules at different locations on the axons can also cause a series of swellings along the entire length, creating the appearance of beads on a string.

To celebrate February as American Heart Month, the News Blog is highlighting some of the latest heart-centric news and stories from all parts of Penn Medicine.

It’s Day 10 of Penn Medicine’s MyHeartMap Challenge, and more than 200 teams have signed on for the hunt, submitting more and more AEDs each day. From the farthest reaches of the city – all the way up in Northeast Philly’s Pennypack Park area to the Philadelphia International Airport in Southwest Philly – and throughout Center City, participants are snapping pictures and sending them to our team.

They’re providing us with lots of other helpful intell along the way, too. We’re already hearing about companies that are beefing up the number of AEDs they have on hand because they’ve heard about the contest and want to make their facilities more heart-safe. But MyHeartMap Challengers are also letting us know that the scavenger hunt isn’t always easy: Our team has received reports of contest participants being blocked from taking photos of devices in certain buildings, particularly when the AED is in a place that isn’t readily accessible near the entrance. Or, as MyHeartMap Challenge Director Raina Merchant’s own team learned when they previously tried to catalog AED locations themselves, some businesses balk at telling contestants if there’s an AED there at all. And when asked, some employees simply have no idea whether their building has an AED – even in some of the places where the Penn research team already knows there’s an AED.

Dr. Merchant’s message to help combat these barriers is simple: AEDs are a lifesaver, not a liability. And the devices can’t save lives if they aren’t there, or are stashed away in a closet or a drawer where no one knows about them. “We understand that businesses may fear that they’ll be held liable if their device doesn’t work, but think of the reverse: What if they don’t have one and someone needs it, or if they have one but no one knows?” says Merchant, an emergency physician. “By keeping the information guarded, no one will even think to reach for it – possibly cheating someone out of a chance to live.”