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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.” HopkinsPulse Non-Profit Org U.S. Postage PAID Permit No. 5415 Baltimore, MD Johns Hopkins Medicine Heart and Vascular Institute Marketing and Communications 901 South Bond Street , Suite 550 Baltimore, Maryland 21231 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