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Heart & Vascular Care

Founded 29 years ago, The Heart and Vascular Institute at JFK Medical Center has become a premier facility for comprehensive cardiovascular care, earning a national reputation for excellence in the process. When your heart is at stake, few hospitals can offer more advanced technology, more experienced heart care specialists and a greater range of support services to effectively diagnose and treat cardiovascular disease.

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Using the area’s most advanced, noninvasive diagnostic tests, the talented team at JFK Medical Center accurately assesses your heart condition. These procedures – available to both inpatients and outpatients – include electrocardiography, Holter monitoring, echocardiography and stress tests. The Heart and Vascular Institute at JFK Medical Center was the first hospital in the region to offer a specialized diagnostic procedure known as transesophageal echocardiography, which provides remarkably high-quality images of areas in the back of the heart that are difficult to see with a standard echocardiogram.

The Heart and Vascular Institute is one of a few hospitals in the United States to offer atrial fibrillation ablation, a procedure for effectively shutting down specific areas of the heart that trigger abnormally fast rhythms. JFK Medical Center’s Electrophysiology (EP) Lab is the premier facility in Florida. Our EP lab is the busiest in the Southeastern United States.

Cardiac Ablations

Cardiac Ablations are procedures that can correct heart rhythm problems or arrhythmias. These procedures are used to treat conditions, such as:

Implantable Devices

Implantable devices provide electrical stimulation to particular areas of the heart to help maintain a normal heart rate and/or rhythm to a heart that’s diseased or damaged.

There are three primary categories of implantable devices:

Interactive Tools

Cardiac Catheterization is a medical sub-specialty dedicated to using minimally invasive techniques with imaging guidance. A heart catheterization – or “cath” exam, as it is commonly called – is a special diagnostic x-ray imaging exam that allows your physician to see if any of the coronary arteries have blockages or evaluate patients’ heart valves functionality. We also have a dedicated Post Interventional Unit with trained staff that specializes in the care of pre and post cardiac intervention patients. JFK Medical Center is a closed Cath Lab – meaning that all of our interventional cardiologists perform close to 1000 catheterizations a year.

  • Right and left heart catheterization
  • Coronary angiogram
    • Left ventriculograms grams and other angiographies
  • Temporary pacemaker insertion
  • Intravascular Ultrasound
  • Intra-aortic balloon pump insertion
  • Pericardiocentesis
  • Thrombolytic therapy
  • Percutaneous Coronary Interventions (PCI) such as:
    • Angioplasty
    • Coronary Stenting
    • Atherectomies

Peripheral vascular disease refers to blockages in arteries of the brain, kidneys, and legs. Peripheral vascular disease is a form of atherosclerosis, also known as hardening of the arteries, and is a progressive disease process.

Atherosclerosis is caused when fatty substances build up inside the artery walls over time and create a narrowed opening which restricts proper blood flow. This build up is most likely to occur in the iliac arteries (lower abdomen leading to the legs), the femoral and popliteal arteries (legs), the renal arteries (kidneys) and the carotid arteries (in the neck leading to the brain).

Disease Symptoms

When organs and muscles in the body receive an insufficient supply of oxygen-rich blood, they literally become starved and alert you to this fact by producing pain. If the blockage occurs in the arteries supplying the legs, the resulting symptom is a cramping pain in the hips, thighs or calf muscle and can limit even casual walking. If the cycle of pain is relieved with rest, we call the condition intermittent claudication. Pain that occurs during rest can sometimes be alleviated by lowering the legs so the force of gravity shunts blood into the feet. If blood circulation becomes so severely restricted that the legs and feet are perpetually starved for nutrition, gangrene–or death of the tissue–can occur. Without treatment, the entire foot or possibly part of the leg may have to be amputated.

Other symptoms of peripheral vascular disease in the lower extremity include: coldness of the leg and foot; paleness of the leg or foot if elevated; blue/red discoloration of the foot or toes; loss or decreased growth of hair on the legs; dry, fragile or shiny-looking skin; numbness, tingling or pain in the leg, foot or toes; sores that do not heal.

Other conditions can also cause these symptoms. Therefore, a thorough examination with a physician is necessary. Symptoms of peripheral vascular disease in the carotid arteries include: sudden, temporary weakness or numbness of the face, arm and/or leg on one side of the body; temporary loss of speech or trouble speaking or understanding speech; temporary dimness or loss of vision, particularly in one eye; unexplained dizziness, unsteadiness or sudden falls. Transient Ischemic Attacks (TIA’S) are mini-strokes and illicit the same symptoms named above except they are temporary. At this time, carotid atherosclerosis can only by corrected by surgery.

Symptoms of peripheral vascular disease in the renal arteries include; hypertension (high blood pressure-consistently higher than 140/90); abnormal kidney function blood tests.

Diagnosis

When any of the above-named symptoms occur, a history and physical examination accompanied by an ultrasound Doppler test are initially performed. The ultrasound Doppler test visualizes the inside of the arteries using sound waves to determine if there is plaque buildup, and if so, to what extent. This test is simple and painless.

If the test shows that the stenosis (or narrowing of the artery) is severe, then a test called an arteriogram or aortagram will give your physician the complete information he or she needs to properly diagnosis your condition.

Arteriogram/Aortagram

Procedure Overview
During the procedure your physician will insert a long, thin tube into a blood vessel in your groin or arm. The tube will be gently directed to the level of your belly button. A contrast dye is then injected into your legs while x-ray pictures are taken.

This procedure can be performed on an outpatient basis at the JFK Medical Center Heart & Vascular Institute. In preparation for your test, blood work will be ordered one to two days before the scheduled date. The day of the procedure, you will be asked to arrive early to the lab and someone should be able to drive you home. About one hour before the procedure, an intravenous line will be started. Once the procedure is complete, the catheter tube will be removed and firm pressure will be applied to the entry site for approximately thirty minutes; also a large, tight pressure dressing will be applied. You will return to your room or recovery area where you will need to lie flat in bed for three to four hours.

When the dressing is removed, you will notice a small bruise at the catheter insertion site, no larger than the size of a quarter. You may also feel a hard lump. It is normal to expect the bruise to become slightly larger and darker the first few days you are home. They are the result of the body's normal healing process and should completely disappear in about two weeks. If you become uncomfortable or are experiencing any discomfort, please call our office immediately.

Treatment Alternatives

Many treatments can be used to improve blood flow through the arteries. The latest interventions for treating vascular disease can bring swift relief and more cost effective than surgery. Most procedures require no more than an overnight hospital stay. Patients enjoy an early return to most normal activities. Devices now available include balloon catheters, stents, atherectomy and lasers. All these alternatives treat the build-up of plaque by removing it, compressing it or displacing it. During these procedures the physician will periodically inject a contrast dye and take x-ray pictures to determine whether or not the artery is sufficiently opened. If the blockage is extremely long or has become very hard and calcified with time, it may be resistant to any of these interventions. In these cases, surgery may be required to bypass the problem area.

Treatment Procedures

What to Expect
Preparation for the interventional procedures is similar to the diagnostic aortagram. Usually patients are admitted to the hospital in the morning for all the pre-procedure testing with the procedure itself being performed later the same day. Discharge from the hospital usually occurs the following morning.

Balloon Angioplasty
Balloon Angioplasty is now the most common method used for opening an obstructed artery. A thin floppy wire is first passed through the narrowed opening in the artery. A deflated balloon is passed along the wire to the obstructed area. The balloon is inflated and deflated, sometimes more than once, often in more than one location. This compresses the plaque against the inside of the artery wall and increases the size of the opening. Balloon angioplasty may be used alone to treat the affected area, or can be used in combination with the other therapies.

Stents
If an artery that has been opened should happen to close or re-narrow during the procedure, a device called a Stent may be inserted to hold the vessel open. It is a small, metal expandable lattice-shaped tube that mounts onto a deflated balloon. When the catheter has positioned the balloon at the blockage site, the balloon is inflated and the stent expands. The balloon and catheter are removed, leaving the stent in place to keep the artery open.

Atherectomy
An atherectomy catheter has a small rotating cutter at its tip that shaves and removes plaque from the artery. Once the plaque is removed, the artery is sufficiently open to restore improved blood flow.

After the Procedure

A nurse will monitor your vital signs and frequently check the pulse in your groin area, behind your knees and at your ankles and feet. You will lie flat in bed for a few hours before the doctor allows you to get up and move around again.

Discharge

Upon your discharge, you will be given instructions about medications which will help keep the arteries open, diet counseling and an exercise prescription.

JFK Medical Center is among the first hospitals in the state of Florida, and the first in Palm Beach County and the treasure coast, to offer patients with non-valvular atrial fibrillation an alternative to long-term warfarin medication with the newly approved WATCHMAN Implant.

The WATCHMAN Implant closes off an area of the heart called the left atrial appendage to keep harmful blood clots from the left atrial appendage from entering the blood stream and potentially causing a stroke. By closing off the left atrial appendage, the risk of stroke may be reduced and, over time, patients may be able to stop taking warfarin.

People with atrial fibrillation have a five times greater risk of stroke. Atrial fibrillation can cause blood to pool and form clots in the left atrial appendage. For patients with non-valvular atrial fibrillation, the left atrial appendage is believed to be the source of the majority of stroke-causing blood clots. If a clot forms in the left atrial appendage, it can increase one’s risk of having a stroke. Blood clots can break loose and travel in the blood stream to the brain, lungs, and other parts of the body. For decades, most people with atrial fibrillation have been treated with blood thinners, to reduce blood clots. But many times these create complications, such as internal bleeding.

Implanting the WATCHMAN Device is a one-time procedure that usually lasts about an hour. Following the procedure, patients typically need to stay in the hospital for 24 hours. The patients are then taken off warfarin by their cardiologist in about 30 to 45 days.

Unique Individuals. Unique Program.

Our Cardiac Rehab experts will work with you to create an individualized, step-by-step program designed to get your heart back in shape and improve the overall quality of your life. By building strength and endurance, you can safely and effectively overcome some of the physical complications associated with certain types of heart disease. Our medically supervised program of exercise and education will also help you reduce your risk of developing heart problems.

Every aspect of our program is designed to speed your recovery. So whether you’ve had a heart attack, bypass surgery, angioplasty or angina, we’ll develop a program that’s perfect for you. Before you know it, you’ll be back doing the things you value most. We want to help you live your life to the fullest.

Improving your health. Step by step.

Ours is a multi-step process that involves input from an entire team of professionals. Your team can include your physician, registered nurses, a dietician, and an exercise physiologist.

Our process includes:

  • A medical evaluation to assess your physical abilities, medical limitations, and other relevant conditions.
  • A medically supervised exercise program that includes monitoring of your heart rhythm, heart rate, and blood pressure. Remember exercise increases blood flow to your heart and strengthens your heart’s contractions so that it pumps more blood with less effort.
  • Lifestyle education. When appropriate you will work one-on-one with registered nurses, a dietician, and an exercise physiologist to help improve your overall well-being. Healthy lifestyle changes can reduce your risk of experiencing another life-threatening event such as a heart attack or a stroke.
  • We’ll provide you with continuous and ongoing support to help you achieve your individual goals. We’ll also create a plan for continued progress with your lifestyle and exercise changes after your program is complete.

Heart & Vascular Center - The TAVR Procedure

Until now, patients with severe aortic stenosis have had to give up much of what makes life enjoyable. But a new procedure at JFK, called transcatheter aortic valve replacement (TAVR), means they won’t have to give up hope.

JFK is part of a select group of hospitals in the U.S. approved to offer this promising new procedure for those considered too high risk for traditional heart valve replacement, or those who were previously considered inoperable. Cardiac surgeons and interventional cardiologists at JFK Medical Center are among the first in the United States, and the first in Palm Beach County and the Treasure Coast, to perform the Edwards SAPIEN transcatheter aortic valve replacement procedure (TAVR).

Aortic Stenosis

Aortic stenosis occurs when the aorta, the main artery pumping blood from the heart, narrows or stops opening fully. This will initially cause a decrease in blood flow, chest pain, weakness, or fainting. Aortic stenosis left untreated can eventually result in further complications and fatalities. Around 30 percent of patients with this condition are ineligible for surgery, because of either ill health or old age. In these cases, noninvasive solutions are vital.

How TAVR Works

During a transcatheter aortic valve replacement, the doctor will run a catheter into the patient’s groin, moving it up the femoral artery toward the heart, eventually reaching the aortic valve. A balloon will inflate, opening the narrow valve, and a new valve will be implanted.

What to Expect

Although patients will need to remain in the hospital for a couple days following the replacement, the actual procedure typically takes less than an hour to complete. Compared to a lengthy heart surgery, and a recovery that spans several months, the transcatheter aortic valve replacement demands a much smaller interruption of life activities.

Benefits and Risks

The crucial time window following a transcatheter aortic valve replacement is 30 days. During this time, patients have a higher risk of strokes and vascular disorders. Bleeding problems could also be a concern, but these instances occur more frequently with those who have undergone traditional heart surgery. Despite the risks, the development of this noninvasive valve replacement has dramatically improved the survival chances of those with aortic stenosis. So far, recovery rates have matched those of traditional surgery, while dramatically surpassing other noninvasive procedures.

Contact Us

To learn more about TAVR, or to see whether you’re a candidate for the procedure, please contact us at (800) 616-1927.

Additional Resources on TAVR

New England Journal of Medicine

Mitral Valve Repair

The South Florida Valve Institute at JFK Medical consists of a team that is able to repair (rather than replace) the valve. For our patients, that means they have a better quality of life, usually without the need of anti-coagulation medication. Ultimately, survival rates are higher with mitral valve repair when compared to replacement.

Our Team

Our skilled multi-disciplinary team includes:

Pharmacists
CHO Cardiographers
Infection Control Specialists
Emergency Staff
Respiratory Therapists
Quality Specialists
Cardiologists

Cardiac Rehabilitation
Professionals Nationally Certified Cardiovascular Operating Room Nurses
Cardiac Surgeons
Cardiac Nurses
Physician’s Assistants

Cardiovascular Surgical Team
Anesthesiologists
Perfusionists
Laboratory
Technicians Nationally Certified
Critical Care Nurses
Radiologist

What is Mitral Valve Prolapse?

Mitral valve prolapse (MVP) is a common, usually benign heart disorder. The mitral valve controls blood flow between the upper (atrium) and lower (ventricle) chambers on the left side of the heart. Normally, blood should only flow in one direction, from the upper chamber into the lower chamber. In MVP, the valve flaps don't work properly; part of the valve balloons into the atrium, which may be associated with blood flowing in the wrong direction, or leaking back into the atrium. Learn more »

What is Mitral Valve Regurgitation?

Mitral regurgitation is the leaking of blood from the left ventricle across the mitral valve, and into the left atrium. The flow of blood pumped by the heart is controlled by one-way valves. These valves assure that blood moves in only one direction. When the mitral valve leaks, some of the blood that should be pumped into the body instead goes backward into the left atrium. If the amount of blood that leaks is severe, mitral regurgitation can be a serious condition that requires care from your doctor. The sooner it is treated, the more favorable the outcome. Your cardiologist can help you determine the optimal time and method for your treatment.

Repair Vs. Replacement

There are several treatment options available for a leaky valve including mechanical replacement, bio-prosthetic replacement, and repair. Emerging research indicates there are significant advantages to saving the natural valve with a repair procedure whenever possible.

Our patients have access to an experienced team of physicians, nurses, clinicians and rehabilitation specialists.

Find a Doctor

Seminar For more information on upcoming mitral valve lectures or to register, call (800) 616-1927

Through our active participation in some of the country’s leading clinical trials, we’re able to bring cutting-edge treatments and procedures to our patients. Our collaboration with many of our physicians has enabled us to participate in well over 200 clinical trials. Please call the Research Department directly to inquire about our current enrolling trials. There may be one that is appropriate for your cardiovascular need. You may reach us at (561) 548-1414.

Transcatheter Aortic Valve Replacement (TAVR)

JFK Medical Center is part of a select group of hospitals in the U.S. approved to offer Transcatheter Aortic Valve Replacement (TAVR). This is a promising new procedure for those considered too high risk for traditional heart valve replacement or those who were previously considered inoperable.

Cardiac Surgeons and Interventional Cardiologist at JFK Medical Center were among the first in the United States, as well as the first in Palm Beach County and the Treasure Coast to perform the transcatheter aortic valve replacement procedure (TAVR). JFK Medical Center is one of the largest and most experienced TAVR programs in the state of Florida.

TAVR is performed on high-risk and inoperable patients with severe aortic stenosis. All patients are carefully evaluated to see if they are candidates for traditional surgical aortic valve replacement and then TAVR can be considered for treatment. The goal is to provide the best treatment for each individual patient.

Aortic Stenosis

Severe aortic stenosis is a narrowing of your aortic valve opening that does not allow normal blood flow.

In elderly patients, severe aortic stenosis is sometimes caused by the build-up of calcium (mineral-deposits) on the aortic valve’s leaflets.

You may notice symptoms like chest pain, fatigue, shortness of breath, light-headedness, fainting or difficulty when exercising.

It is important to remember heart valve disease often occurs with no outward symptoms and may go undetected.

How TAVR Works

Transfemoral Approach

Through a small puncture in the groin or upper thigh, a catheter is inserted into the femoral artery. Imaging helps the physician guide the catheter through the femoral artery to the diseased aortic valve.

The new valve is crimped down to the diameter smaller than a pencil and guided through the catheter with the help of imaging, until it reaches the diseased aortic valve.

Once it reaches the diseased aortic valve, the new valve is expanded into place and allows blood to flow through the aortic valve naturally.

Alternate Approach

The Transcatheter valve can also be inserted through alternate access if there is an issue with the peripheral artery system. These insertion sites are: Transapical, Subclavian and Direct Aortic.

Evaluation in Multi-disciplinary Valve Clinic

All potential TAVR patients are evaluated in our multi-disciplinary valve clinic. They are seen by a team of physicians including a Cardiothoracic Surgeon and Interventional Cardiologist. Our valve clinic nurses play an important role in the coordination of patient care and education of the patient and family before and after the procedure. Our patients can call the valve clinic with any questions or concerns. Our team is always available to assist.

What to Expect Following the Procedure

Although patients will need to remain in the hospital for a few days following the replacement, the actual procedure typically takes between 1-2 hours to complete. Compared to a lengthy heart surgery and a recovery that spans several months, the transcatheter aortic valve replacement demands a much smaller interruption of life activities.

Transcatheter Mitral Valve Repair (TMVR)

TMVR is performed on prohibitive risk patients with severe mitral regurgitation. All patients are carefully evaluated to see if they are candidates for traditional mitral valve repair or replacement and then TMVR can be considered for treatment. The goal is to provide the best treatment for each individual patient.

Mitral Regurgitation

Mitral Regurgitation occurs when your mitral valve’s two leaflets or flaps do not close properly and some blood flows backward through the valve into the left atrium. To compensate and keep blood flowing through the body, the left ventricle pumps harder. This strain can lead to other heart complications. You may notice symptoms like shortness of breath, fatigue, coughing, light-headedness or swollen feet or ankles.

How TMVR Works

Through a small puncture in the groin or upper thigh, a catheter is inserted into the femoral vein. The steerable guided catheter is advanced across a transseptal puncture into the left atrium. The clip delivery system is advanced through the guide, into the left atrium and to your mitral valve. The clip or clips are attached to the leaflets, reducing mitral regurgitation.

Evaluation in Multi-disciplinary Valve Clinic

All potential TMVR patients are evaluated in our multi-disciplinary valve clinic. They are seen by a team of physicians including Cardiothoracic Surgeons and Interventional Cardiologists. Our valve clinic nurses play an important role in the coordination of patient care and education of the patient and family before and after the procedure. Our patients can call the valve clinic with any questions or concerns. Our team is always available to assist.

What to Expect Following the Procedure

Although patients will need to remain in the hospital for 1-2 days following the clip, the actual procedure typically takes between 2-3 hours to complete. Compared to a lengthy heart surgery and a recovery that spans several months, the transcatheter valve replacement demands a much smaller interruption of life activities.

About Heart Failure

Heart failure is a chronic, progressive condition that develops when the heart muscle weakens and is unable to pump a sufficient amount of blood throughout the body. More than 600,000 Americans are living with heart failure and is a frequent cause for hospitalizations. Heart failure worsens over time and is typically caused by persistent high blood pressure, heart attack, valve disease and other forms of heart disease or birth defects. Left untreated, the lack of adequate blood flow causes the organs to progressively fail, resulting in numerous medical complications that deteriorate a person’s quality of life.

What are signs of heart failure?

  • Shortness of breath, especially when lying down
  • Fatigue
  • Coughing and wheezing
  • Swelling in the feet, ankles and legs
  • Weight gain from fluid buildup

Mechanical Circulatory Support Program

JFK Medical Center offers long term left ventricular assist devices (LVADs). The Mechanical Circulatory Support Program at JFK Medical Center has a multidisciplinary team of expert cardiologists, cardiovascular surgeons, nurse practitioners and program coordinators dedicated to helping advanced heart failure patients.

What is a left ventricular assist device (LVAD)?

A left ventricular assist device is a mechanical device that circulates blood through the body when the heart is too weak to pump blood adequately on its own. It is designed to supplement the pumping function of the heart. It is surgically attached to the left ventricle and to the aorta, the main artery that carries oxygenated blood from the left ventricle to the entire body. An external, wearable system that includes a small controller and two batteries is attached by an external driveline. The wearable system is either worn under or on top of clothing.

The type of LVAD used at JFK Medical Center is the HeartMate II® Left Ventricular Assist Device. The HeartMate II LVAD (left ventricular assist device) is a continuous flow, implantable pump. The LVAD is surgically implanted with one end directly placed in the left side of the heart and the other end connected to the aorta (large blood vessel that is attached to the heart). It is then attached to a driveline, which is tunneled through the abdomen and exits through the abdominal wall. This driveline attaches to a controller and is powered by either AC adaption or batteries.

Patients suffering with advanced heart failure who have exhausted medical therapies may be candidates to receive an LVAD. This therapy is recommended by the American Association of Cardiology and the American Heart Association as a treatment option for advanced heart failure. Studies have shown that patients treated with an LVAD can live longer and enjoy an improved quality of life compared to medication management alone.

JFK Medical Center’s Mechanical Circulatory Support Program will determine if you are a candidate for this therapy after an extensive evaluation process of laboratory and diagnostic tests. A team of nurses, physicians, nurse practitioners, social workers, palliative care team, nutritionist, and financial advisors will meet to review the results and determine if you meet criteria for this therapy. The LVAD used at JFK Medical Center is FDA approved for advanced heart failure patients. Not everyone with advanced heart failure is a good candidate for this treatment.

The LVAD is designed to restore blood flow throughout the body, enabling you to breathe more easily and have more energy. An LVAD can significantly reduce heart failure symptoms and improve your quality of life. You should be able to resume normal activities that you were unable to do prior to receiving the device.

LVADs can be used for three specific purposes:

  1. As a bridge to recovery: An LVAD can be used to support a patient that is experiencing heart failure that may reverse itself after temporary support, such as viral infections and post-partum heart disease, amongst others.
  2. As a bridge to transplant: An LVAD can be used to support a patient until a donor heart becomes available.
  3. As destination therapy: An LVAD can be implanted permanently for long-term therapy in patients with severe heart failure who are not candidates for heart transplantation.

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