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HopkinsPulse
NEWS FOR FRIENDS
OF THE JOHNS HOPKINS HEART AND VASCULAR INSTITUTE
s u mm e r 2 0 1 4
Lectureship Honors
Cardiac Education Legacy
C
The Man
Behind the
Lectureship
Stephen Achuff, M.D.
David J. Carver Professor of Medicine emeritus at
the Johns Hopkins Heart and Vascular Institute
• Completed his internship, residency and fellowship
in cardiology at The Johns Hopkins Hospital.
• Served as director of adult cardiology clinical
programs at JHH for 25 years.
• Served as assistant director of the adult cardiac
catheterization laboratory and cardiologist for
the Lipid Research Clinic.
• Served on the board of governors for the
American College of Cardiology from 1988
through 1991.
• Authored or co-authored articles for 71
publications, including 25 book chapter sections.
Photo: Bryan Burris, courtesy of Baltimore Magazine
ardiologist Stephen Achuff may have
nearly flunked economics in college, but
for the past 12 years he’s been getting high
marks from one of the most authoritative
economists in the country. In fact, so pleased is
Achuff’s patient Alan Greenspan with his care that
the former chairman of the Federal Reserve Board is
a lead donor to a lectureship in Achuff’s name. The
lectureship honors Achuff’s upcoming retirement in
June and was permanently established through the
generosity of several additional grateful patients.
“Lectures are one of the most important
ways to communicate ideas,” says Greenspan, a
Washington, D.C., resident who served at the Fed
for 18-plus years and is a frequent guest lecturer
himself. “I think highly of Dr. Achuff—and all my
Hopkins doctors,” he says. “I thought contributing
to a lectureship would be the ideal way to show my
gratitude.”
Achuff, the David J. Carver Professor of
Medicine emeritus, is a 45-year Johns Hopkins
veteran and served as director of adult cardiology
clinical programs for 25 years. Achuff says he
enjoys a warm relationship with Greenspan and
was “quite honored” by the news about the gift.
“It was incredibly generous of him,” he says. “The
lectureship is in line with my interest in clinical
care and education.”
Indeed, Achuff is something of a legend among
young trainees. “Steve has an encyclopedic
knowledge of cardiology, a commitment to teaching
and a calm, unflappable personality,” says Clinical
Cardiology Director Ed Kasper, recalling his
days as an intern under Achuff’s tutelage. “The
lectureship is a fitting way to honor Steve.”
Achuff says he derives great satisfaction from
mentoring residents and cardiac fellows. Besides
offering them clinical insights on heart disease,
Achuff is known for his eagerness to share his
breadth of historical knowledge about Johns
Hopkins Medicine.
The St. Louis, Missouri, native’s passion for
the institution began went he spent a year doing
pathology research followed by a clinical clerkship
in medicine at The Johns Hopkins Hospital. “I
came to love this place and its great history,” says
Achuff. “Hopkins is unique, because my sense
is that it’s among the most collegial of academic
centers.”
The inaugural cardiology lecture takes place on
Sept. 10, 2014.
Despite plans to retire soon, Achuff remains
committed to serving on various committees and
to furthering cardiac education, beginning with
the new lectureship. But he also looks forward to
spending more time with his wife, Cary, son, two
daughters and three grandchildren.
On a recent follow-up visit, Greenspan was
surprised when Achuff handed him a copy of
Greenspan’s new book, The Map and the Territory,
to inscribe. “It’s not often that a doctor hands you
your book to sign,” says Greenspan, 88. “I was
impressed that he had read it.”
Looking back on his career, Achuff says he has
no regrets that he never pursued his original plans
Economist Alan Greenspan: “I’m
a lecturer by profession, and I
find it one of the most important
ways to communicate ideas.”
to become a stockbroker. Though he still reads the
Wall Street Journal, he says he never quite grasped the
elaborate mathematical formulas behind economics.
“My grade in economics was a huge disappointment
to my father, who was a businessman,” recalls Achuff.
Instead, Achuff followed the path of many other
relatives, including five generations of Norwegian
doctors on his mother’s side.
Greenspan’s journey to the Fed was equally
nonlinear. A Juilliard School student, Greenspan
played saxophone and clarinet professionally before
pursuing economics. These days, he enjoys playing
piano and tennis twice a week with his wife, NBC
correspondent Andrea Mitchell. How does he keep his
mind sharp? “I use it,” he says. “Analytically, I’m still
capable; I can still do differential equations. Getting
people’s names right is another story.”
But philanthropy, notes Greenspan, is not a
complex subject. “Giving money to support causes that
are meaningful to you is a very easy thing to do.” n
“I came to love this place and its great history. Hopkins is unique,
because my sense is that it’s among the most collegial of
academic centers.”
—Stephen Achuff
COORDINATED CARE
I N N OVATI O N S
Finding the Rhythm When
Defibrillators Miss a Beat
E
The Multidisciplinary Diabetic Foot and Wound Clinic
team includes podiatrist Ronald Sherman, vascular
surgeon Christopher Abularrage, endocrinologist Nestoras
Mathiodakis, physician assistant Katy Hines and podiatrist
Alex Kor (not pictured).
A One-Stop Shop for
Diabetes Vascular and
Wound Care
D
onna Brown, 53, was
diagnosed with diabetes
more than 20 years ago.
“I didn’t understand
it or take it that seriously until I
started having a funny feeling in
my legs that turned out to be a
blockage,” she says.
Due to a lack of blood flow to
her right foot, gangrene developed
in her big toe and it had to be
amputated. Her primary care
doctor referred her to the Johns
Hopkins Multidisciplinary
Diabetic Foot and Wound Clinic,
where patients can see several
specialists in one visit.
Vascular surgeon Christopher
Abularrage opened the blockage
in Brown’s leg with angioplasty to
immediately restore blood flow.
However, she had a lingering
wound in her foot despite
the angioplasty and needed
procedures to remove damaged
tissue and expel excess fluid.
Abularrage enlisted the help
of plastic surgeon Justin Sacks,
who was able to stretch a flap of
skin over the wound as well as
perform multiple skin grafts to
seal Brown’s ulcers. Those steps, in
combination with bypass surgery
to detour the blood around
a recurrence in the blockage,
allowed her foot to heal.
“Ms. Brown is typical
of patients who need the
2 • HOPKINS PULSE • SUMMER 2014
services of all of us—not just
vascular surgeons, but also
podiatrists, plastic surgeons and
endocrinologists,” says Abularrage.
He and his colleagues
developed the Multidisciplinary
Diabetic Foot and Wound Clinic
to provide coordinated care for
the growing number of patients
with diabetes-related vascular
and wound complications.
“Our goal is to catch problems
early and intervene to prevent
hospitalizations and amputations,”
says Abularrage, the clinic’s
medical director. “Of course, we
also care for patients with more
advanced, complex problems.”
“When I came in distressed
and scared, they really helped me
through it,” says Brown. “They
explained exactly what was going
on, told me all the options and
gave me a chance to make up my
mind. I am very grateful for this
clinic.”
Brown also is pleased with
being able to see several specialists
in one clinic visit. “Patients like
me have a hard time getting
around, and this saves us from
making multiple trips.”
“It’s too much to ask them
to see different specialists on
different days,” Abularrage says.
“It delays their care.” n
ach beat of a healthy heart sends blood to the lungs to be refreshed and then
recirculated throughout the body. Heart failure—a decline in the heart’s
ability to constantly pump blood—can leave people feeling tired and short of
breath, like North Carolina resident Susan Brinkley.
Brinkley’s heart failure comes in the form of cardiomyopathy, or the weakening
or hardening of the heart muscle, which can be caused by everything from age to
high blood pressure. It also occurs as atrial fibrillation, a rapid quivering of the heart’s
upper chambers caused by a malfunction in the heart’s natural electrical system.
Normally, the heart delivers a charge to the upper
right chamber, or atrium, which spreads to the walls of
The remedy can
the lower chambers, or ventricles. The pulse causes the
ventricles to contract near-simultaneously to pump blood be as simple as
up and out of the ventricles and into the lungs and body. adjusting the
In people with atrial fibrillation, the electrical impulses
device, modifying
come from all over the upper chambers. Blood collects in
medications
the atria and does not completely fill the lower chambers.
or getting
To regulate Brinkley’s heart rhythm, surgeons
other health
implanted a biventricular defibrillator in her chest.
When the defibrillator detects a rapid heartbeat, it sends
conditions
a signal through the wires surgically placed in the right
under control.
atrium and in both ventricles to restore a normal rhythm At other times,
and cause the ventricles to contract within milliseconds
a surgical
of one another.
procedure may
Although Brinkley was hoping that the device would
be necessary to
restore her energy level so she could participate in
activities with her children and grandchildren, as the
move or add an
months went by, she says, “I continued to be exhausted,
electrical lead.
and I wasn’t feeling any better.”
Her daughter suggested she visit the Johns Hopkins
Resynchronization Optimization Clinic, which evaluates
people who don’t seem to respond to cardiac resynchronization therapy (CRT).
According to cardiac electrophysiologist and clinic director John Rickard, only
six or seven out of every 10 patients respond to CRT. “For the others, the prognosis
for survival is very poor unless something is done,” he says.
The remedy, says Rickard, can be as simple as adjusting the device, modifying
medications or getting other health conditions under control. At other times, a
surgical procedure may be necessary to move or add an electrical lead.
After assessing Brinkley’s defibrillator, Rickard found that the wire to her left
ventricle was not delivering enough energy to that side of her heart. “It was pacing
the right ventricle all of the time, which can make the heart failure worse,” he says.
Rickard corrected
the problem by
increasing the voltage
on the left lead. He
also adjusted the
timing on the device
to mimic the natural
pace of the heart,
programming it to
have a 20-millisecond
(one-fiftieth of a
second) head start
before the firing of the
right lead.
Now, Brinkley
says she can breathe
much easier. “I’m so
grateful,” she says.
“They took the time
John Rickard says the goal of the clinic, which is one of the few
to figure out the
of its kind in the country, is to use a multipronged strategy
problem.” n
to help people who are not responding to resynchronization
therapy.
G I V I N G BAC K
Fashionably Informed
Cardiologist Shellee Nolan was
among the Johns Hopkins cardiology faculty and advisory board
members who served as models
at a fundraiser fashion show
hosted by heart patient Bettye
Leibowitz and her husband, Jerry,
on Oct. 6, 2013. Guests enjoyed
the latest Nordstrom styles and a
heart-healthy brunch while they
learned about exciting research
and programmatic initiatives taking place within the Heart and
Vascular Institute.
A Hearty Donation
Johns Hopkins Medicine teamed up
with a local philanthropic foundation
to provide automated external
defibrillators (AEDs) to 10 Baltimore
City middle schools for use, if needed,
during sporting events and practices.
The portable devices, which are
used to shock the heart back into a
normal rhythm, can save the life of
a student athlete, coach or spectator
who collapses due to a heart rhythm
disorder that causes sudden cardiac
arrest. The idea for giving AEDs to
the schools began with cardiologist
Theodore Abraham, director of
the Johns Hopkins Hypertrophic
Cardiomyopathy Center of Excellence,
and was funded by a $10,000 donation
from the Israel and Mollie Myers
Foundation. “This is a gift that may one
day give life back to someone,” says Jon
Myers, a trustee of the foundation and a
member of the Cardiovascular Advisory
Board at Johns Hopkins.
The AEDs were donated on Sept.
24, 2013, at an event with officials of
Johns Hopkins Medicine, the Israel
and Mollie Myers Foundation, and
principals and coaches from the schools
receiving the AEDs. n
What Will Your Legacy Be?
A single gift in 1873 from our founding benefactor, Johns Hopkins, inspired a revolution in American medicine. The Johns Hopkins Legacy
Society honors Mr. Hopkins and welcomes those who make their own
legacy gifts to secure the financial future of Johns Hopkins Medicine.
There are many ways to become a member: Include Johns Hopkins in
your estate plan, designate Johns Hopkins as beneficiary of a retirement
plan or life insurance policy, or give in a way that also provides income
to you. To learn more about these and other creative ways to give, visit
rising.jhu.edu/giving, call the Johns Hopkins Office of Gift Planning at
410-516-7954 or 800-548-1268, or email [email protected].
R A PI D RES PO N SE
Arrive for Papilloma Removal, Leave with Cardiac Bypass
W
hen 64-year-old Jerry Pena, the
co-owner of an ornamental iron
business, went to a local community
hospital for treatment of vocal
papillomas by Johns Hopkins otolaryngologist Lee
Akst, he was expecting to go home the same day. But
as he was being prepared for the outpatient operation
to remove the benign growths on his vocal cords, he
began sweating and feeling dizzy and nauseous.
“The room quickly filled with people—they
thought I was having a heart attack,” Pena says. He
was admitted to the hospital for a range of tests.
Although it wasn’t a heart attack, an abnormal
stress test pointed to coronary artery disease, and
he was transferred the following morning to The
Johns Hopkins Hospital. There, cardiologist Jeffrey
Brinker performed a cardiac catheterization and saw
that Pena had three significant blockages in his left
main and left anterior descending artery.
“I was told that because of the severity of my
blockages, I needed bypass surgery,” Pena says. “I
was surprised because I had no idea that I had heart
disease. I never had chest pain.”
Two days after his symptoms started, with his
family at his side, Pena was being prepared for a
double cardiac bypass operation. Cardiac surgeon
Christopher Sciortino says Pena was fortunate
he had the symptoms in a medical setting and was
diagnosed quickly.
“He had severe blockages,” says Sciortino, who
performed the operation.
Pena made a very fast recovery, left the hospital
five days after surgery and went back to his busy job
within six weeks.
“I heard that walking was the best way to
recover, and little by little, I increased the amount
of walking every day,” he says.
Three months after the bypass surgery,
feeling that he had “more energy than before the
operation,” Pena finally got to keep his appointment
to have his vocal papillomas removed. n
Cardiac surgeon Christopher Sciortino
HOPKINS PULSE • SUMMER 2014
• 3
To learn more about the many
ways the Heart and Vascular
Institute is changing care, visit
hopkinsmedicine.org/heart .
The Newest CT:
Faster than a Heartbeat
I
n one revolution around the body, the
newly arrived 320-detector computed
tomography (CT) scanner at The
Johns Hopkins Hospital is poised to
change the management and outcomes
of coronary artery disease (CAD). The
only other such scanner in the U.S. is at
the National Institutes of Health. Johns
Hopkins will be the first to use the new
scanner for clinical purposes.
The fastest CT scanner available,
it scans cardiac vessels and the heart
in less time than it takes for a single
heartbeat. The scanner is poised to
replace invasive tests such as angiography
To make a gift to the Division
of Cardiology or the Division
of Cardiac Surgery, please
call 443-287-7384 or email
[email protected].
for sorting patients
having chest pain who
need treatment (e.g.,
coronary angioplasty,
To make a gift to the Division
a cardiac stent, bypass
Joao Lima and colleagues showed in an international
of Vascular Surgery, please call
surgery) from those
study that two tests they developed for the 320 scanner
443-287-7953.
are as good as or better than conventional tests at
who don’t.
revealing heart vessel anatomy and blood flow.
“Our goal,” says
Joao Lima, director
of cardiovascular imaging for Johns
“Speed and accuracy of
“We are learning more and more,
Hopkins, “is to increase certainty about
diagnosis
are
the
bottom
line,”
which clinicians everywhere can
which patients need an invasive procedure
says
Lima,
who
sees
CT
as
the
use to make better assessments of
for opening an arterial blockage and to
ultimate
device
for
assessing
coronary disease and administer
spare patients who do not from the risk of
patients
for
CAD
the
world
over.
the best care.” n
unnecessary diagnostic procedures.”
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This newsletter is published for the Johns Hopkins Heart and Vascular
Institute by Johns Hopkins Medicine Marketing and Communications
Heart and Vascular Institute
James Black, M.D., Director of Vascular Surgery and Endovascular Therapy
Duke Cameron, M.D., Director of Cardiac Surgery
Gordon Tomaselli, M.D., Director of Cardiology
Fund for Johns Hopkins Medicine
Shannon Wollman, Director of Development, Cardiology
and Cardiac Surgery
Kathleen Hertkorn, Director of Development, Vascular Surgery
Marketing and Communications
Dalal Haldeman, Ph.D., M.B.A., Senior Vice President
Mary Ann Ayd, Managing Editor
Ellen Beth Levitt, Judy F. Minkove, Writers
David Dilworth, Designer; Keith Weller, Photographer
Questions or comments about this issue?
Call 443-287-2233 or email [email protected]
© 2014 The Johns Hopkins University and
The Johns Hopkins Health System Corporation
HopkinsPulse
Inside
NEWS FOR FRIENDS
OF THE JOHNS HOPKINS HEART AND VASCULAR INSTITUTE
1Lectureship
Honors Cardiac
Education
Legacy
2
Finding the
Rhythm When
Defibrillators
Miss a Beat
s u mm e r 2 0 1 4
3Arrive for
Papilloma Removal,
Leave With
Cardiac Bypass