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Conditions & Treatments

At Penn State Health St. Joseph, we have an extremely dedicated staff committed to providing the best heart care in Berks County. Our program is designed to treat all aspects of Cardiovascular and structural heart disease.

Interventional Cardiology

Traditionally, heart catheterizations have been performed through the groin (femoral artery). We now have the expertise to perform them through the wrist (radial artery). Performing catheterizations through the radial artery is associated with less complications, shorter recovery time, and earlier discharge. Patients with critical blockages are now able to undergo interventional procedures which would have been considered high-risk just a few years ago.

Our Cardiologists have played a major role in the development of breakthrough interventional procedures, including coronary, peripheral and carotid angioplasty and stenting. Penn State Health St. Joseph is only hospital in the county to have performed peripheral and carotid procedures under research protocols prior to Food and Drug Administration approval. In some instances, our results have been used as part of the process to obtain FDA approval.

Our interventional procedures include:

  • Coronary angioplasty and stenting, including drug eluting stents. This procedure involves threading a small catheter through the artery to the area of blockage in the heart. A tiny balloon at the tip of the catheter compresses the plaque against the wall of the artery. A metallic spring-like device, called a stent, is placed in this area to allow for increased blood flow.
  • Peripheral vascular angioplasty and stenting. This procedure is performed in the legs, kidneys and pelvic area. The technique is the same as the coronary angioplasty and stenting procedure.
  • Carotid angioplasty and stenting. This procedure involves placing a mesh stent into the carotid arteries to allow increased blood flow to the brain.

Structural heart disease procedures.

  • Balloon valvuloplasty for aortic valve blockages. This procedure is used for patients with severe aortic stenosis (narrowing). A large balloon is inflated in the aortic valve to improve the flow of blood from the heart to the rest of the body.
  • Transcatheter Aortic Valve Replacement (TAVR). TAVR is the most advanced and cutting edge FDA approved treatment for aortic valve disease. It is approved for patients with severe aortic stenosis who are at high risk for aortic valve replacement or were considered inoperable. An aortic valve stent may be placed via the femoral (groin) approach.

Diagnostic Testing

The Heart Institute offers a wide range of diagnostic tests and treatments. These tests provide important information to physicians in diagnosing heart and vascular problems and establishing the best course of treatment.

Tests include:

  • Electrocardiography (EKG)
  • Holter Monitor
  • Cardiac Stress Testing
  • Transthoracic echocardiogram
  • Transesophageal echocardiogram
  • Intravascular ultrasound
  • Computed tomography angiography

Congestive Heart Failure

Congestive heart failure (CHF) is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body’s other organs. The heart keeps pumping, but not as efficiently as a healthy heart. Usually, the loss in the heart’s pumping action is a symptom of an underlying heart problem.

Diagnosing CHF

In addition to a complete medical history and physical examination, diagnostic procedures for congestive heart failure may include any, or a combination of laboratory tests, chest x-ray, electrocardiogram (ECG or EKG), echocardiogram and nuclear test (MUGA or RNCA).

Treating CHF

Specific treatment for congestive heart failure will be determined by your physician based on your age, overall health, and medical history, the extent of the disease, your tolerance for specific medications, procedures, or therapies, expectations for the course of the disease and your opinion or preference.

The cause of the congestive heart failure will dictate the treatment protocol established. If the heart failure is caused by blockages in the coronary arteries, a procedure or surgery to relieve these blockages may be recommended. If the heart failure is caused by a valve disorder, then surgery may be recommended. If the heart failure is caused by a disease, such as anemia, then the disease is treated. And, although there is no cure for heart failure due to a damaged heart muscle, many forms of treatment have proven to be successful.

The goals of treatment are (1) to improve a person’s quality of life by making the appropriate lifestyle changes and implementing drug therapy and (2) to prolong life. Treatment of congestive heart failure may include: controlling risk factors, use of medication, cardiac resynchronization, implantable defibrillator (ICD) and, for the most severe cases, a patient can be referred for heart transplantation.

Cardiothoracic Surgery

At Penn State Health St. Joseph, our cardiothoracic surgeons are part of a multi-disciplinary team that provides advanced treatments and technologies for adult heart disease. We perform state-of-the-art surgical procedures for heart valve repair and replacement, coronary artery bypass surgery, aortic aneurysm repair and treatment of atrial fibrillation. In addition to traditional open-heart surgery, advanced surgical techniques used at Penn State Health St. Joseph include minimally invasive valve surgery, transcatheter aortic valve replacement (TAVR) and endovascular descending thoracic aneurysm repair with stent grafts.

We’ve recently created The Valve Clinic, which is a multidisciplinary team consisting of cardiothoracic surgery and cardiology physicians. The team works together to find the best treatment plan for patients with valvular heart disease. Aortic, mitral and tricuspid valve disease are treated through minimally invasive procedures: minimally invasive aortic valve replacement, minimally invasive mitral valve repair and replacement, TAVR (Transcatheter aortic valve replacement), balloon valvuloplasty, as well as traditional open heart surgery.

Conditions we treat:

  • Heart valve disease:
    • Aortic stenosis
    • Aortic regurgitation
    • Mitral regurgitation
    • Mitral stenosis
    • Tricuspid regurgitation
    • Endocarditis
  • Coronary artery disease
  • Aortic aneurysms/dissections involving:
    • Aortic root
    • Ascending aorta
    • Aortic arch
    • Descending aorta
  • Atrial fibrillation
  • Reoperative cardiac surgery

Approaches:

We use three different approaches to treating heart and aortic disease. The approach used is determined by the surgeons and is based on the type of cardiac problem needing surgery and the specific needs of the patient.

  • Traditional open-heart surgery. This is done by dividing the breastbone (median sternotomy) and placing the patient on the heart-lung machine. This approach has been used for a long time by cardiac surgeons throughout the world and is associated with excellent outcomes.
  • Minimally invasive surgery. Minimally invasive surgery involves operating on the heart without the large breastbone incision. Studies have shown a minimally invasive approach results in less pain, a lower risk of complications, a faster recovery and return to normal activity. We currently use a minimally invasive approach for isolated
    • Aortic valve replacement
    • Mitral valve repair or replacement
    • Tricuspid valve repair
    • Atrial tumor resection
    • Atrial fibrillation
  • Endovascular and transcatheter approaches. This involves gaining access to either the heart or aorta via peripheral vessels, such as the femoral artery. Patients often recover from these procedures quicker than traditional open-heart surgery. We currently use an endovascular approach for
    • Descending thoracic aneurysms
    • Descending thoracic ulcers/intramural hematomas
    • Aortic arch
    • Abdominal aneurysms (performed by vascular surgeons)

A transcatheter approach is used for high risk patients with aortic valve stenosis. This procedure is known as Transcather Aortic Valve Replacement (TAVR) and is done through collaboration between cardiology and cardiac surgery.

Cardiac Surgery procedures performed at Penn State Health St. Joseph

  1. Aortic valve replacement: There are two main ways that valves malfunction. The first problem is when there is valve leakage, or regurgitation and blood travels in the wrong direction. The second valve problem occurs when there is valve stenosis, which is a narrowing limiting the amount of blood that can flow through the valve. When the degree of malfunction is severe and associated with symptoms surgery to replace the aortic valve is recommended. Currently at St. Joseph’s we offer three different options for replacing the aortic valve. The decision about which approach is best for the individual patient is based on multiple factors.
    • Minimally invasive aortic valve replacement: The aortic valve is replaced through a partial sternotomy using the heart-lung machine. This approach is best for patients that require isolated aortic valve replacement.
    • Traditional aortic valve replacement: The aortic valve is replaced through a traditional (complete) sternotomy using the heart-lung machine. This approach is done on patients that require more than isolated aortic valve replacement. For example, patients that require coronary bypass surgery and aortic valve replacement or double valve replacement.
    • Transcatheter aortic valve replacement (TAVR): An aortic valve stent is placed via the femoral artery (groin) or the apex of the heart (transapical) via a small incision in the chest. This procedure is FDA approved for very high risk patients with severe aortic stenosis.
  2. Mitral valve surgery. The mitral valve can weaken over time causing severe regurgitation (leakage) or stenosis (narrowing), which will cause the heart to work harder. If untreated, this may lead to heart failure. When the mitral valve is not working correctly it can either be repaired or replaced. Mitral valve repair avoids the complications associated with mitral valve replacement including the need for lifelong blood thinners or a reoperation. Therefore at St. Joseph’s Medical Center, mitral valve repair is our preferred surgical approach. However, sometimes the valve is so damaged that the patient must get a mitral valve replacement. Most of the time the mitral valve surgery can occur through a small incision over the right chest (right anterior thoracotomy).
  3. Coronary artery bypass surgery. When multiple coronary arteries have significant blockages, coronary artery bypass graft surgery (CABG) may be needed. A CABG involves taking blood vessels from the chest, legs or arms to reroute the blood around the clogged portions of the coronary artery. Most bypass surgeries that require multiple bypasses are done by dividing the breastbone and using the heart lung machine. In specific situations, our surgeons may perform coronary artery bypass machine without the heart-lung machine, which is called off-pump coronary artery bypass surgery.
  4. Aortic aneurysm surgery: An aortic aneurysm is when the aorta enlarges to more than 50% of it’s expected size. Aortic aneurysms can occur in any part of the aorta and surgical is indicated based on it’s size, rate of growth or symptoms. The type of surgery offered is mostly based on the location of the aneurysms. If the aneurysms involves the aorta around the aortic valve (aortic root) or the ascending aorta, a sternotomy and the use of the cardiopulmonary bypass machine is required. Aneurysms of the descending thoracic aorta (aorta in the chest) or the abdominal aorta (in the belly) can often be repaired with less invasive techniques, through the femoral artery using stent grafts.

Electrophysiology

Irregular heart rhythms affect millions of Americans, yet if they are accurately detected and diagnosed, treatment can be very effective. St. Joseph offers the following diagnostic studies and treatments for patients with Atrial Flutter and Fibrillation, Ventricular Fibrillation, Supraventricular Tachycardia, Ventricular Tachycardia, Bradycardia and other irregular heart rhythms:

Portable Heart Monitoring

Outpatient wearable monitors can can monitor a patient’s heart rhythm continuously for 24 hours (Holter monitor) or longer (event recorder) as the patient goes about their normal daily routine. This prolonged monitoring can enhance the ability to diagnose an abnormal heart rhythm and guide appropriate treatment.

Electrophysiology Studies

An electrophysiology study is a minimally invasive diagnostic test of the heart’s electrical (conduction) system. The study is performed by inserting small catheters through the groins, and advancing them into the heart. The catheters are used to measure electrical signals in the heart. The information obtained during an electrophysiology study can help your physician determine if you may benefit from a pacemaker or defibrillator implantation, or an ablation.

Ablation Therapy

Similar to, and often performed at the same time as an electrophysiology study, an ablation involves using a special catheter to destroy the cells that cause abnormal heart rhythms, while leaving the conduction system intact. To enhance the safety and success, sophisticated 3-dimensional mapping and intracardiac echocardiography (ultrasound) are used during the procedure. An ablation can stop the symptoms caused by arrhythmias, and may also eliminate the need for certain medications.

Pacemaker Placement

A pacemaker is an implanted device that treats abnormally slow heart rhythms. Patients with slow heart rhythms often feel fatigued, short of breath, lightheaded, or even pass out, and the slower heart rate may limit the use of important cardiac medications. A pacemaker will help ensure a regular and rhythmic heartbeat.

Defibrillator (ICD) Placement

An implanted cardioverter-defibrillator (ICD) is a device similar to a pacemaker, that recognizes and treats abnormally fast, life-threatening heart rhythm disturbances. When an abnormal rhythm is detected, the device will provide a shock to the heart to reset the heart rhythm and save the patient’s life. An ICD may be implanted in a patient who is a survivor of a cardiac arrest, or in a patient who may be at risk for sudden cardiac death.

Cardiac Resynchronization Therapy (Biventricular defibrillators and pacemakers)

Some patients with congestive heart failure have difficulty performing normal, everyday activities due to the heart’s bottom chambers (ventricles) being “out of synch”. Highly specialized pacemakers and defibrillators are implanted to increase the efficiency of a patient’s heart by resynchronizing it. These patients may see improvement in symptoms of fatigue and shortness of breath, increased exercise tolerance, and may realize an improvement in their overall cardiac function.

Cardiac Rehabilitation Our commitment to comprehensive cardiac care extends beyond diagnosis and treatment. Cardiac rehabilitation is a key component of cardiac care. Cardiac rehabilitation begins soon after admission as our team of nurses, exercise specialists, and nutritionists offer education, exercise guidelines and counseling. The goal is to help cardiac patients adopt lifestyle habits that will help to improve cardiovascular health and fitness. What is Cardiac Rehabilitation?

Cardiac rehabilitation is a medically supervised program to help heart patients recover quickly and improve their overall physical, mental and social functioning. The goal is to stabilize, slow or even reverse the progression of cardiovascular disease, thereby reducing the risk of heart disease, another cardiac event or death. Our cardiac rehabilitation program is designed to meet the needs of the individual patient, depending on the specific heart problem or disease.

The cardiac rehabilitation program includes:

  • Counseling so the patient can understand and manage the disease process
  • Beginning an exercise program
  • Counseling on nutrition
  • Helping the patient modify risk factors such as high blood pressure, smoking, high blood cholesterol, physical inactivity, obesity and diabetes
  • Providing vocational guidance to enable the patient to return to work
  • Supplying information on physical limitations
  • Lending emotional support
  • Counseling on appropriate use of prescribed medications

Cardiac rehabilitation is helpful to patients with angina pectoris (chest pain due to clogged heart arteries), recent heart attack, stent placement or balloon angioplasty. It is also helpful to patients with recent open heart surgery to include coronary artery bypass graft surgery, heart valve surgery or heart transplant.

Cardiac rehabilitation is divided in to three phases:

Phase I

A critical care nurse will meet with you during your acute hospital stay.

Phase II

Penn State Health @ Berks Cardiologists

Phase III

This is our maintenance program where professional exercise physiologists will work with you to design a program at Penn State Health St. Joseph Exeter Ridge Health Complex. This program is open to the general public and is a self-pay program.

Penn State Health St. Joseph Exeter Ridge Health Complex