The University Hospital’s cardiac services are on the forefront of technology. With state-of-the-art facilities and cutting-edge practices, The University Hospital’s cardiac services have been recognized both locally and nationally for their excellence in care.

Our surgeons combine medical expertise with an emphasis on research and clinical application of new technology. They are highly trained and excel in coronary revascularization techniques, complicated valve repair and internal cardiac defibrillator placement. In addition, The University Hospital participates in many pioneering clinical trials.

Awards and Achievements

The University Hospital was named one of the Top 100 Cardiovascular Hospitals in the nation for the third time, once in 2000, then 2002 and again in 2003 by Solucient, a leading health care information content company. As one of the 100 Top Cardiovascular Hospitals, The University Hospital:

• has better clinical outcomes in terms of mortality and complications
• has lower costs.
• maintains shorter lengths of stay.
• appears to be technologically and clinically advanced in terms of the usages of stents and internal mammary artery grafts.

In addition, The University Hospital received a Mercury Award in October 1998, recognizing the hospital’s cardiology program as one of the top three in Greater Cincinnati. This study comparing 15 hospitals in Greater Cincinnati was conducted by HCIA.

First and Foremost
on the Forefront of Technology

- October, 2003
Named by Solucient as on of the 100 Top Heart Hospitals in the U.S.

- October, 2002
University Hospital is again named a 100 Top Cardiovascular Hospital for the third time.

- July, 2002
Walter Merrill, MD is appointed chief of cadiothoracic surgery at the UC College of Medicine, department of surgery. Dr. Merrill is a cardiothoracic surgeon with special expertise in heart transportation, heart failure and cardiac valve repair, as well as the treatment of lung and esophageal cancers.  He came to Cincinnati from Vanderbilt University, where he was on the faculty since 1983.

- May 2001
The Health Alliance installs the nation’s largest cardiovascular information system at The University Hospital. The state-of-the-art digital system, VERICIS Cardiology Integrated Cardiovascular Repository, has the ability to display test results from both cardiac catheterization labs and echo labs simultaneously. The former system recorded all test results on videotape and film, which were difficult to archive and store. The new system allows physicians to access patients’ records more quickly so they can determine necessary treatment.

- February 2001
Physicians of The University Hospital take part in a new clinical study known as the COMPANION program. This study evaluates new treatment options for patients with heart failure, including new drugs and the use of implanted Guidant medical devices to resynchronize the heart’s contractions.

- September 2000
Physicians at The University Hospital become the first in the region to implant the Guidant Contak pacemaker device in a patient to treat heart failure. The device works by electronically synchronizing the heartbeat of the right and left ventricles, helping the heart’s pumping chambers to get blood out of the rest of the body, instead of leaving it uselessly in the heart. The Guidant device and others like it have found stunning success, helping patients go from barely being able to walk to their mailboxes to biking 10 miles a day within a few months of the implant.

- August 2000
A University Hospital vascular surgeon performs the region’s first endograft stent graft repair of a thoracic aortic traumatic rupture. After consulting the trauma surgical team, the surgeon contacts the FDA for emergency approval to use the stent graft to repair the patient’s ruptured aorta. A stent graft is a long metal tube, inserted into the aorta by a catheter, which expands, creating a new wall in the ballooned section of the aorta through which blood passes. The University Hospital becomes one of only five places in the world in which this surgery is performed.

- March 2000
The region’s first portable HeartMate left ventricular assist system (LVAS) is successfully implanted by physicians at The University Hospital. This device improves the health of end-stage heart failure patients by helping their natural heart produce the force necessary to propel oxygen-rich blood throughout the body until a transplanted donor heart can take over this function. Now portable, the HeartMate allows patients to wait for a donor heart in the comfort of their home.

- March 1999 and 2000
The University Hospital is ranked among the Top 100 Cardiovascular Hospitals in the nation by the HCIA, a leading health care information content company.

- February 2000
The University Hospital opens the Heart Failure Treatment Center in Kenwood.

- January 2000
The region’s first portable HeartMate left-ventricular assist system was implanted in a patient at The University Hospital.

- July 1999
The University Hospital became the first hospital in the Tri-state to use the BioZ.com system, a non-invasive device used to diagnose and treat congestive heart failure patients by accurately measuring cardiac output.

- November 1998
Physicians at The University Hospital are the first in the nation to successfully implant a cardiac stimulator developed specifically for the treatment of heart failure.

- October 1998
The University Hospital receives a Mercury Award recognizing the hospital’s cardiology program as one of the best in Greater Cincinnati.

- October 1998
The University Hospital begins performing off-pump coronary arterial bypass (OPCAB) procedures. Unlike traditional bypass surgery, this revolutionary procedure is performed on a beating heart.

- October 1996
The region’s first successful HeartMate implantable left-ventricular assist device operation is performed. The procedure assists heart function in patients awaiting a heart transplant for untreatable heart failure. The University Hospital is one of the few hospitals in the country offering this revolutionary technique.

- November 1988
University Hospital physicians were the first in the region to implant the experimental Novacor cardiac assist device.

- November 1987
University Hospital physicians were the first in the region to implant Thoratec, an experimental cardiac assist device.

- February 1986
The longest living heart transplant recipient to date received his transplant at The University Hospital.

- December 1985
The region’s first adult heart transplant was performed at The University Hospital.

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Electrophysiology

The University Hospital has one of the most advanced electrophysiology labs in the world. The electrophysiology, or EP, lab is used to correct abnormal heart rhythms, also known as arrhythmias or heart rhythm disorders. The irregular heartbeat may cause dizziness or fainting. They are normally harmless, but can cause cardiac arrest or even death.

An electrophysiology study (EPS) is a recording of the electrical activity within your heart. It is used to help your doctor determine the cause and treatment of a heart arrhythmia. During the test, an electrophysiologist inserts a catheter tube into your heart through your veins to test your heart’s electrical system and susceptibility to arrhythmias. The electrophysiologist may also safely reproduce an arrhythmia, and then give you medications to see which one controls it best.

Cardiac Surgery and Transplant

The University Hospital has the Tri-state’s only heart transplantation program, which began in 1985. The program is among the largest in the nation, and allows the patient to have a new chance at life.

Specialized cardiologists and surgeons work together to correct abnormal, and potentially fatal, disturbances in the heart rhythm. Our cardiac surgeons assess and implement the newest option to ensure that surgery’s results are successful.

Heart Failure Overview

Heart failure is a condition that occurs when the heart cannot pump blood efficiently enough to meet the body’s oxygen needs. This occurs because the heart muscle is significantly weakened. Common symptoms of heart failure include shortness of breath, fatigue and an inability to perform usual daily tasks easily. Fluid is also commonly retained in the lungs, abdomen, legs and feet, as a result of this condition.

Many people believe that heart failure occurs as a sudden event. Although the symptoms of heart failure may seem to develop quickly, it is important to realize that this disease usually develops over many months to many years. Heart failure is a chronic condition with ongoing healthcare needs that require close communication between the patient and health care providers.

Heart failure occurs most frequently in elderly individuals, however it can occur at any age. There are approximately 6 million people in the United States with heart failure, accounting for more than 1 million admissions to the hospital each year.

In the past decade, clinical studies have shown that early identification and treatment of patients with heart failure results in a strong, positive impact on quality of life and survival rate. With patient and family education, the correct medications, appropriate diet modifications and activity guidelines, common problems with heart failure can be lessened or avoided.

Causes

The most common form of heart failure is caused by systolic dysfunction or a weak squeeze by the heart muscle. Symptoms result from a decreased flow of blood out of the heart. This causes water retention, in the lungs, abdomen, legs and feet. The most frequent reasons for development of heart failure are:

Symptoms

The most common symptoms of heart failure are:

• Shortness of breath, especially when lying down at night
• Coughing with physical activity, or at night
• Fatigue or shortness of breath with minimal activity
• Rapid weight gain
• Swelling in the ankles or legs
• Bloating in the abdomen back to top

Medical Tests

In order for your health care provider to obtain a clearer picture of the condition of your heart, several medical tests may be performed.

Common tests for heart failure include:

Chest x-ray – this picture will allow the physician to determine if your heart is enlarged and if there is any fluid build-up around the heart or lungs.

Electrocardiogram (EKG) – this tracing of the heart’s electrical function includes pulse rate, heart rhythm and detailed information about the heart’s electrical conduction pathways.

Echocardiogram (Echo) – this test is performed by placing an instrument on the outside of the chest to collect sound waves and then create a picture of the structures of the heart. Detailed information about the heart’s wall thickness, chamber size, valve function and ventricular wall motion are collected.

Exercise Stress Test – this test involves collecting data about the heart’s response to exercise. The patient exercises on a treadmill or bike while EKG, pulse rate, blood pressure, (sometimes) maximal oxygen consumption, and other clinical signs and symptoms are monitored. This test helps the physician to understand if the heart is able to compensate for the body’s increased requirement of blood and oxygen when physical work or activity is performed.

Multigated Ventriculogram (MUGA) – this test involves combining a small amount of the patient’s blood with a radioactive tracer and then injecting this combination into the
blood stream. Pictures are taken after the tracer is injected. This shows the physician the left ventricle’s ability to eject blood effectively. back to top

Treatment Center Program

The solution to the treatment of heart failure is a collaborative approach. The Heart Failure Treatment Center brings together the very best expertise from The University Hospital, the Health Alliance and the University of Cincinnati (UC) College of Medicine

Using tools developed at The University Hospital and UC College of Medicine, the Heart Failure Treatment Center works in partnership with hospitals and physician practices around the Tristate. Experts at the Heart Failure Treatment Center assists community partners with patient care and access to cutting edge therapies, teaches clinicians in the field about the latest treatment options for heart failure patients and acts as a community resource for Greater Cincinnati.

Location – The University Hospital campus

The University Hospital 234 Goodman Street ML 802 Cincinnati, OH 45219	map & directions
Heart Failure Treatment Center at University Pointe 7700 University Court West Chester, OH 45069 Phone: 513-475-8000	map & directions

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Physician referral – The Heart Failure Treatment Center requires the referral of a physician. Patients who need assistance in obtaining a referral can call The University Hospital office at (513) 584-7217.

Insurance – Most insurance plans are accepted. Our social worker researches and assists with various financial obstacles, and a financial counselor is available to assist you.

Multidisciplinary Team – Our team is made up of expertly trained clinicians from a number of disciplines specializing in the treatment of heart failure:

Disease Management

Patients at the Heart Failure Treatment Center are treated on an outpatient basis, with emphasis placed on reducing hospital admissions, improving quality of life, and increasing activity tolerance and survival.

Heart failure patients are at the center of this program, and are able to benefit from the efforts of an integrated team of physicians, nurses and other clinicians who deliver the most current clinical treatment and research available. The multidisciplinary team approach results in positive outcomes for heart failure patients.

The Primary Care Physician's Role

The heart failure patient’s primary care physician works closely with the team at the Heart Failure Treatment Centers to ensure the best possible outcome for their patient. This program believes in a team approach to treating heart failure, with the primary care physician being at the forefront of the clinical team. Primary care physicians are kept abreast of their patient’s treatment, involved in medical decisions and manage their patients whenever possible.

Modern Therapies
May Include a Number of Treatments

Common prescription drugs for the treatment of heart failure include:

Digoxin – this medicine is also useful for patients with a significantly weakened left ventricle. This drug may reduce risk of hospitalization and improve quality of life. Drug blood levels are monitored, to insure proper dosing.

Aldosterone Antagonists – These medications are considered an additional therapy for patients who continue to have symptoms of heart failure after they are already on diuretics, ACE inhibitors and Beta Blockers. They block some of the negative effects of aldosterone on the heart muscle

Anticoagulants – this drug class should be prescribed for individuals with a history of atrial fibrillation or blood clots. Blood clotting times are monitored to insure proper dosing.

Angiotensin Receptor Blockers (ARB's) – These medications are sometimes used as an alternative when a patient is unable to take an ACE inhibitor due to side effects. Recent studies have shown that their benefit was not inferior to that of ACE inhibitors.

Angiotensin Converting Enzyme (ACE) inhibitors – this drug class should be taken by all patients who can tolerate them and who have a weakened left ventricle. ACE inhibitors have shown to prolong life, reduce the risk of hospital admission, and increase quality of life.

Beta-blockers – this drug class has also recently demonstrated to prolong life, reduce the risk of hospital admission, and increase quality of life. It is recommended that this drug be taken by all patients with a weakened left ventricle. A physician who has expertise in the treatment of heart failure should administer beta-blockers.

Diuretics – this drug class assists the body in excreting excess sodium and water. Sodium restriction in the diet is also recommended. Unfortunately, many diuretics also cause the body to excrete potassium; therefore, potassium blood levels are monitored and supplemental potassium prescribed, if necessary.

Hydralazine and Isosorbide – These medications are considered an additional therapy for patients who continue to have heart failure symptoms after they are already on diuretics, ACE inhibitors and Beta Blockers. They have been found to be particularly effective in Africans Americans with hypertension.
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Clinical trials
The Heart Failure Treatment Center offers patients the opportunity to participate in clinical trials. Promising drugs and devices, which are not currently available through most physician offices, are available to patients who wish to participate. See clinical trials.

Left ventricular assist device (LVAD)
Is a mechanism that is surgically implanted in the heart in extremely advanced heart failure. This can be used as a bridge to transplant in very sick individuals. The LVAD helps the heart pump more effectively.

University Hospital’s Transplantation Center is Greater Cincinnati’s only heart transplant program. One of the goals of the Heart Failure Treatment Centers is to determine when the risks impeding survival due to heart failure become sufficiently high that transplantation needs to be considered. Our clinical staff is well versed in the evaluation and educational process for those needing transplantation.

Stephanie Dunlap, DO
She is Medical Director of the Cardiac Transplant and Heart Failure Program at The University Hospital and Associate Professor of Medicine at the University of Cincinnati.

Dr. Dunlap grew up in West Virginia and went to medical school at West Virginia School of Osteopathic Medicine in Lewisburg, West Virginia. After receiving her medical degree, she completed her internship at Humana Hospital-South Broward, Hollywood, Florida, residency at Southeastern Medical Center, North Miami Beach, Florida and three fellowships at the University of North Carolina at Chapel Hill and the Cleveland Clinic.

She comes to University Hospital with many years of experience at Rush Medical College, Rush University, Chicago, Illinois and at University of North Carolina at Chapel Hill. She is board certified in Cardiology with years of experience in heart faiure and cardiac transplant.

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SELF-CARE

Monitoring signs and symptoms of early heart failure:

Daily weight monitoring – it is important to check body weight daily. First thing in the morning, after urinating and before eating or drinking, weigh yourself. If your weight increases two or more pounds in a 24-hour period, or five or more pounds over a seven-day period, consult your health care provider.

Other significant signs and symptoms – if shortness of breath increases, swelling in the lower legs increases, persistent dry cough occurs, abdominal bloating or fatigue increases with minimal activity, call your physician.

Medication compliance – several drugs are usually required to effectively manage heart failure. An optimal medication combination is one of the easiest and most effective methods of controlling heart failure. See Disease Management Modern Therapies. To achieve an optimal drug effect, it is essential to take the medications exactly as prescribed. If one or more of the medications seem to be causing a negative effect, it is important to immediately consult your physician about the symptoms that are occurring. Many times altering the dose of the drug or changing to a similar, equally effective drug, will alleviate the negative symptoms.

Low Sodium Diet - Heart failure patients should consume a limited amount of sodium in their diet. Excessive sodium consumption is likely to increase the amount of water that the body retains, which in turn increases blood volume and therefore the workload that is placed on the heart. The American Heart Association recommends that heart failure patients consume a maximum of 3000 mg of sodium per day. It is important to read food labels to tabulate sodium consumed during each day, and avoid consumption in excess of the 3000 mg recommendation. As heart failure progresses, a more strict sodium limitation may be required.

Activity Recommendations – It is important for heart failure patients to engage in daily physical activity to keep the body conditioned. Before engaging in an activity,
consult your health care provider to obtain specific guidelines about what is and is not appropriate for you. Recommended activities for heart failure patients include walking, biking and water walking. Starting with a low duration (5-10 minutes) and low intensity, and gradually increasing the minutes and intensity is best. Try to avoid performing activities that require straining, such as lifting heavy weights, that put an excessive workload on the heart.back to top

Other Web Links
Texas Heart Institute
HealthFinder
Rush Congestive Heart Failure
Heart Failure Society of America
Heart Failure Forum
American Heart Association
American College of Cardiology
PubMed
Department of Health and Human Services Guidelines to Heart Failure Management
National Heart, Lung, and Blood Institute’s Data Fact Sheet on Congestive Heart Failure

Additional Cardiovascular Services Include:

• Angioplasty (balloon dilation)
• Biventricular pacemaker
• Brachytherapy
• Cardiac bypass surgery
• Cardiac catheterization
• Cardiopulmonary exercise test
• Coronary stents
• Critical care cardiac units
• Directional coronary atherectomy
• Drug-eluting stents
• Dobutamine(r) stress echo
• Echocardiography
• Electrophysiology study
• Endomyocardial biopsy
• Heart rhythm ablation
• Implantable cardioverter defibrillator
• Intra-coronary ultrasound
• Left ventricular assist device
• Major vascular reconstruction
• Minimally invasive coronary artery bypass
• Off-pump coronary arterial bypass graft surgery
• Percutaneous atrial septal defect repair
• Percutaneous peripheral vascular procedures
• Peripheral vascular ultrasound
• Radionuclide ventriclogram (stress MUGA)
• Rotoblator
• Septal ablation
• Single and dual chamber pacemaker
• Stress myocardial perfusion imaging (dual isotope and thallium)
• Tilt table testing
• Transesophogeal echo
• Treadmill testing
• Valve surgery
• Valvuloplasty