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Monthly Archives: December 2015

What is it?

Idiopathic hypertrophic sub aortic stenosis (IHSS) is a genetic disease characterized by marked hypertrophy of the left ventricle in the absence of chronic pressure overload (HTN, or aortic stenosis), involving specifically the interventricular septum and the left ventricular outflow tract. Also called hypertrophic obstructive cardiomyopathy (HOCM). Umbrella term: hypertrophic cardiomyopathy (HCM).

Epidemiology

  • Most common cause of sudden cardiac death in young athletes in the US.
  • Occurrence rate of 1 in 500.
  • Most common (Mendelian) genetic heart disease.
  • Presents after puberty (average age in mid-20s, but more and more in 40s and 50s).

Pathogenesis

  • Genetic abnormality of muscle cell proteins:
    • Autosomal dominant with variable penetrance (i.e. everyone who has the genes does not necessarily get the disease).
    • Most genes are for sarcomere proteins (Beta myosin heavy chain and myosin-binding protein C are most common). Currently, 11 or more causative genes with over 1400 mutations in genes encoding the thick or thin myofilament proteins of the sarcomere have been reported.
    • Most mutations lead to a single amino acid change.
    • These mutations cause myofibral disarray. Muscle cells are normally lined up linearly but in IHSS the muscle fibers are in disarray (i.e. in all different directions).
  • These abnormalities do not allow the heart muscle to contract properly.
  • Because of this, the heart compensates for this lack of effective contraction by hypertrophying (i.e. the cells get bigger).
  • Thus, the walls of the heart get bigger, and distinctive of this disease is that the inter ventricular septum becomes asymmetrically enlarged. The papillary muscles and mitral valve are deformed by the thickened septum, and thickening of the mitral valve leaflet also commonly occurs.
  • This hypertrophy can result in two major problems:
    • Since the walls of the ventricle are bigger, the chambers have become smaller. This leads to decreased ability of the heart to fill during diastole and thus the heart cannot pump enough blood forward to the systemic circulation during systole. This is termed DIASTOLIC heart failure.
    • Intermittent outflow obstruction:
      • The thickened septum causes a narrowing of the left ventricle outflow tract. In 75% of cases there is no obstruction. Ejection of blood through a narrowed outlet leads to the Venturi effect. Venturi forces pull anterior mitral leaflet toward septum during systole causing obstruction. This is called systolic anterior movement of mitral valve (SAM).
      • It is intermittent because it is dependent on how hard the heart muscle is working. If someone with this disease is exercising really hard and the heart rate is really fast, the diastolic period (the time when the heart fills with blood) is shorter so there is even less time to fill the ventricle. Since there is less blood in the ventricle the outflow tract becomes narrower and you get more obstruction. On the other hand, when the heart rate is slower, there is more time for the ventricle to fill in diastole so the outflow tract is widened by the blood, and there is less obstruction.

Diagnosis

1) History and physical

-Symptomatic vs. asymptomatic: Most patients have few or no symptoms

If a patient is symptomatic he/she may have dyspnea, syncope, angina, palpitations, dizziness, or sudden death

  • Dyspnea (most common symptom): Due to diastolic dysfunction. Blood backs up into the lungs because it cannot enter the chamber of the hypertrophied left ventricle. This causes fluid in the lungs and consequently dyspnea.
  • Palpitations: from arrhythmias that occur in IHSS such as premature atrial and ventricular beats, sinus pauses, atrial fibrillation, atrial flutter, supraventricular tachycardia, and ventricular tachycardia. The arrhythmias occur due to fibrosis and myofibrillar disarray of the heart muscle.
  • Angina: due to more oxygen demand from thickened wall, than supply of oxygen available. Exacerbated during exertion.
  • Orthopnea/paroxysmal nocturnal dyspnea: observed in severe IHSS. Due to a combination of impaired diastolic function and subendocardial ischemia.
  • Dizziness: due to outflow tract obstruction and thus less blood flow to brain
  • Syncope/sudden death: due to ventricular arrhythmias that are caused by fibrosis and myofibrillar disarray

2) Physical Exam:

  • A murmur is usually the first clinical manifestation of the disease.
  • You will hear a systolic crescendo-decrescendo ejection murmur along the lower left sternal border, or apex, that increases with a decrease in preload (valsalva or standing up) or after load (anti-hypertensive medications) or decreases with an increase in preload (squatting) or afterload (clenching fist).
  • Can also hear S4 murmur due to non-compliance of left ventricle during diastole.
  • May also have accompanying MR murmur from systolic anterior motion of the mitral valve and significant LV outflow gradients.
  • A double peaked carotid pulse that occurs due to a quick rise, then fall (due to outflow tract obstruction) of blood flow through left ventricular outflow tract, then secondary rise of blood flow through the outflow tract.

3) Routine tests:

  • Labs: usually normal, but may have elevated BNP.
  • CXR: The cardiac silhouette ranges from normal to markedly increased in size. Left atrial enlargement can be observed especially when significant mitral regurgitation is present.
  • ECG: You can see LVH, left atrial abnormality, and left axis deviation. You may also see WPW with certain mutations, deep and broad Q waves in inferior and precordial lateral leads (likely related to gross septal hypertrophy rather than MI), and T wave changes.

4) Special tests:

  • Echocardiogram will show an increased septum: LV wall thickness ratio (> 1.5:1)
  • Cardiac MRI: especially useful when echo is questionable.
  • Cardiac catheterization: most accurate test to determine precise gradients of pressure across outflow tract.

5) Confirmatory tests

  • Genetic testing.
  • Cardiac muscle biopsy: Will show myofibral disarray.

Treatment

  • Asymptomatic patients
    • A significant number of patients will not have any symptoms and will have a normal life expectancy. However, these patients should still be counseled to avoid particularly strenuous activities and medications that decrease preload such as nitrates or diuretic blood pressure medications.

2) Medications

  • Medications are used to relieve symptoms: palpitations, dyspnea, angina, syncope
  • Beta blockers are considered first-line agents, as they can slow down the heart rate and allow for increased diastolic filling and decreased myocardial oxygen consumption. This reduces obstruction in outflow tract and ischemia respectively. Non-dihydropyridine calcium channel blockers such as verapamil and diltiazam can also be used.
  • Disopyramide: decreases contractility and SVT arrhythmias.
  • Amiodarone: the only agent proven to reduce the incidence and risk of cardiac sudden death. Very effective at converting atrial fibrillation and atrial flutter to sinus rhythm.

3) Surgical myomectomy

  • For patients who remain severely symptomatic despite medical therapy and/or with an outflow gradient of more than 50 mm Hg.
  • Involves removing a portion of the inter ventricular septum to widen the outflow tract.
  • Complications include possible death, arrhythmias, infection, incessant bleeding, septal perforation/defect, and stroke.

4) Alcohol septal ablation

  • Involves injection of alcohol into one or more septal branches of LAD.
  • The ablation is a “controlled heart attack” in which the part of the septum involved with the outflow tract is infarcted and subsequently contracts into a scar.
  • Less invasive but produces similar results to septal myomectomy.

5) Ventricular pacing

  • Pacemaker activates the inter ventricular septum before the ventricular free wall. This decreases the gradient across outflow tract.
  • Will also help treat arrhythmias.
  • Indications: 1) family history of sudden death 2) wall thickness > 30 mm. 3) unexplained syncope 4) history of ventricular arrhythmias

6) Cardiac transplant

  • For cases refractory to all treatments.

Natural history

  • The course of IHSS is extremely variable but in general the disease is progressive and there is usually a latency of 3 years between the discovery of a murmur and the manifestation of the first symptoms of the disease.
  • Occasionally symptoms actually diminish or disappear spontaneously with the passage of time.
  • About 1% per year suffer sudden cardiac death.

new-year-582250_960_720 (1)

We hope that 2015 has been a great year for you and your family. The staff and everyone at the Cardiovascular Institute wish you a happy new year. Once again we would like to remind everyone to be safe and adhere to a healthy new year celebration. Remember to eat healthy and stay active. 

4

If you have had blood tests done at our office, you can now
view your results online!

Please send us a request at:  ubenzurmd@gmail.com.
We will provide you with a username and password.
Once you are logged in you can change your password at any time.

To log in, please
go to: drbenzur.com and
click the ‘patient portal’
button on the right-hand
side of the page.
Untitled-2

We urge you to log on so that you can access your account at any time in the future.
We will be working hard over the next few months to add many more features to this site.

Thank you very much!

Uri Ben-Zur M.D., F.A.C.C.
Assistant Clinical Professor, U.C.L.A. David Geffen School of Medicine.
Assistant Clinical Professor, Western University College of Osteopathic Medicine.
Assistant Professor, Touro University College Of Osteopathic Medicine.


Benzee Benzee the Heart says:

“Maintaining a healthy weight through diet and exercise may avoid the complications of heart disease.”

Benzee Please take a look at our book online From Our Heart To Yours, a guide for better heart health using diet and exercise.

Stroke


A stroke is the result of injury to the brain due to an interruption of blood flow or bleeding from a blood vessel in the brain. Every person who suffers a stroke, however mild, is changed forever. Much is now known about the causes of stroke, and many strokes can be prevented. Knowledge of the causes and symptoms of stroke is the key to prevention.

TYPES OF STROKE

There are two types of stroke. An ischemic stroke is the most common type, and is due to an interruption of blood flow to the brain. It can be caused by a clot that forms in a blood vessel or an artery.

The other main category of stroke, called hemorrhagic stroke, occurs when an artery in the brain leaks or ruptures. Intracerebral hemorrhage is the term for bleeding into the brain. It is commonly, although not exclusively, associated with hypertension. Subarachnoid hemorrhage is the term for bleeding at the base of brain, most often due to rupture of a brain aneurysm. Although the least common type of stroke, it is the most devastating, sometimes resulting in sudden death.

WHAT ARE THE SYMPTOMS OF STROKE?

Signs of a stroke may include:

  • Sudden numbness or weakness of the face, arm or leg;
  • Inability to speak or understand speech;
  • Loss of vision, usually in one eye;
  • Sudden dizziness or loss of balance or· coordination. If you experience any symptoms lasting more than 15 minutes, a stroke may be occurring.

WHAT ARE THE RISK FACTORS FOR STROKE?

Several factors are known to place a person at an increased risk for stroke. The single most important risk factor for is hypertension, or high blood pressure. Smoking, diabetes, and elevated cholesterol are also important factors. An irregular heartbeat can play a role in some strokes. Birth control pills may contribute to the risk in young women. Obesity contributes to the risk by promoting some of these factors.

WHAT IS A TIA?

TIA stands for transient ischemic attack. A TIA is a temporary disturbance of neurological function caused by an interruption of blood flow to the brain. Signs of a TIA are similar to those of a stroke. Most TIAs last less than 15 minutes, and tend to resolve themselves. Even though the symptoms disappear after a short time, a TIA can be a strong indicator of a future stroke and should be evaluated by a physician without delay.

HOW SHOULD A TIA/STROKE BE EVALUATED?

Your physician will conduct a series of diagnostic tests to help determine the cause of the stroke or TIA, and to select the appropriate therapy. Blood tests, including a test to determine cholesterol levels, will be performed. A CT scan or MRI of the brain may be performed to evaluate damage and to further study the circulation of blood. An ultrasound of the carotid arteries in the neck may also be performed. Medications such as blood thinners or drugs such as aspirin may be prescribed. If narrowing of the carotid artery in the neck is determined to be the cause, surgery or an endovascular procedure may be indicated.

If a stroke is in progress, immediate treatment in a hospital emergency room that has a stroke program may minimize and/or prevent further progression. Eligible patients can receive a clot-dissolving medication, known as tissue plasminogen activator (t-PA) within the first three hours of the onset of symptoms.

If you are experiencing the symptoms of a stroke, seek immediate medical attention in a hospital emergency room. Do not call your personal physician. Time is the most important factor in stroke treatment.


The Cardiovascular Institute, founded by Uri M. Ben-Zur, M.D., F.A.C.C, is located in the heart of San Fernando Valley in Tarzana, California. In close proximity to, Encino, Sherman Oaks, Burbank, Calabasas and West Hills. Our practice is open to patients and future medical professionals Sunday through Friday starting at 6AMdaily. We are committed to enhancing the quality of healthcare for all of the residents of the Greater Los Angeles area. Dr. Ben-Zur is an attending physician at Providence Tarzana Medical Center. He offers a wide variety of cardiac services. Radiofrequency ablations for cardiac arrhythmias, pacemaker implantation, coronary stent placement and angioplasty are some of the many procedures we specialize in. As an expert onhypertension, hyperlipidemia, congestive heart failure, and arrhythmias, Dr. Ben-Zur is able to diagnose and treat patients in our new state of the art facility. Almost 60 million Americans suffer from hypertension and cardiovascular related diseases. Due to the nature of these diseases, most patients go undiagnosed until it is too late. Diagnosing these diseases early in life can dramatically decrease the risk for future complications. We are always welcoming new patients for heart related screening and have same day appointments available. Additionally, at the Cardiovascular Institute of Tarzana, California, Dr. Ben-Zur’s staff serves patients in multiple languages! Whether it be Hebrew, Russian, Spanish, Swahili, Armenian, Tagalog, Hindi, Urdu, and many more the Cardiovascular Institute will often have someone to serve your language and heart health needs.
Our practice is fortified by his acceptance of medical professionals and ultrasound technicians from various organizations including Western University College of Osteopathic Medicine, Touro College of Osteopathic Medicine, and UCLA David Geffen School of Medicine and the University of Southern California. The Institute fosters an ideal environment for future physicians and local technicians to help the unique population of the Greater Los Angeles area. Including, Tazana, Encino, Burbank, Sherman OaksWest Hills, and Calabasas.
Dr. Ben-Zur’s past medical education in electrophysiology and angioplasty is unparalleled. Guided by pioneers in both fields early in his career, he has had the opportunity to gain experience in major academic centers in New York City and San Diego, California. Many of his research projects are featured in various medical journals such as The New England Journal of Medicine and The Journal of the American College of Cardiology. Furthermore, Dr. Ben-Zur has multiple publications for his patients to learn more about their health and how they can prevent diseases by improving their lifestyle through diet and exercise. Our newest publication can be found on our website under patient resources!
This holiday season,be mindful of your health. Stress and overindulgence may put your body at risk for serious cardiac problems. A study by the Heart Institute states there are 33% more cardiovascular events from ischemic heart disease in December and January than the rest of the year in Los Angeles County. We advocate for our patients to familiarize themselves with the signs of acute coronary syndrome. The quicker symptoms are recognized, the better the outcomes. We encourage you to explore our website for more information about our practice!

Hypertrophic Obstructive Cardiomyopathy

-genetic dz characterized by marked left ventricular hypertrophy in the absence of chronic pressure overload (HTN or aortic stenosis). The hypertrophy specifically involves the interventricular septum and left ventricular outflow tract.

Epidemiology
– most common cause of sudden cardiac death in young athletes in the US
-occurrence rate of 1 in 500
– most common (Mendelian) genetic heart disease
-Presents after puberty (average age in mid-20s)

Pathogenesis
-genetic abnl in muscle cell proteins
-autosomal dominance with variable penetrance. Most genes for sarcomere proteins (B-myosin heavy chain and myosin binding protein C most common)
-mutations cause myofibril disarray and heart muscles do not contract properly. This results in compensation and the left ventricle to hypertrophy with the interventricular septum becoming asymmetrically enlarged
-hypertrophy of the inventricular septum leads to two major problems
1. decreased ability for the heart to fill during diastole causing diastolic heart failure
2. Intermittent outflow obstruction.  Hypertrophy of the interventricular septum causes narrowing of the left ventricle outflow tract. Ejection of blood through a narrowed outlet causes a Venturi effect, where Venturi forces pull the anterior mitral leaflet towards the septum during systole causing obstruction. This is called systolic anterior movement of the mitral valve (SAM). The amount of obstruction depends on the amount of left ventricular filling. During periods of increased exercise, the heart rate is faster leading to a shorter diastolic period. Since there is less time to fill the left ventricle, the outflow tract becomes narrower, causing more obstruction. However, if the heart is slower, this allows more time for the left ventricle to fill in diastole, which widens the outflow tract and causes less obstruction.

Signs and symptoms
-Most patients have few or no symptoms
-Symptoms include:
-dyspnea – due to diastolic dysftn and fluid backing up into the lungs.
-angina – due to increased myocardial oxygen demand from thickened wall, than supply of oxygen
-orthopnea/paroxysmal nocturnal dyspnea – impaired diastolic function
-dizziness – due to  outflow tract obstruction and decreased blood flow to the brain
-palpitations – due to fibrosis and myofibrillar disarray – causing ventricular arrhythmias: premature atrial contractions, premature ventricular contractions, a-fib, a-flutter, SVTs, and v-tach.
-syncope/sudden death – ventricular arrhythmias that are caused by fibrosis and myofibrillar disarray

Physical Exam
-systolic crescendo-decrescendo ejection murmur along lower left sternal border or apex that increases with decreased preload (valsalva or standing up), and decreases with an increased preload (squatting) or increased afterload (clenched fist)

Routine tests
– labs: elevated BNP
-CXR – cardiac silhouette ranges from normal to markedly increased. Left atrial enlargement can be observed when significant mitral regurgitation is present.
-EKG – LVH, left atrial abnormality, and left axis deviation. You may also see WPW with certain mutations, deep and broad Q waves in inferior and precordial lateral leads (likely related to gross septal hypertrophy rather than MI) and TY wave changes

Special tests
-Echocardiogram will show an increased septum: LV wall thickness ratio ( >1.5:1)
-Cardiac MRI: especially useful when echo is questionable
-Cardiac cath: most accurate test to  determine precise gradients of pressure acrossoutflow tract

Confirmatory tests
-Genetic testing
-Cardiac muscle biopsy: will show myofibril disarray

Treatment:

Asymptomatic patients

o    A significant number of patients will not have any symptoms and will have a normal life expectancy. However, these patients should still be counseled to avoid particularly strenuous activities and medications that decrease preload such as nitrates or diuretic blood pressure medications.

2) Medications
-Medications are used to relieve symptoms: palpitations, dyspnea, angina, syncope

·         Beta blockers are considered first-line agents, as they can slow down the heart rate and allow for increased diastolic filling and decreased myocardial oxygen consumption. This reduces obstruction in outflow tract and ischemia respectively.

·         Non-dihydropyridine calcium channel blockers such as verapamil and diltiazam can also be used.

·         Disopyramide: decreases contractility and SVT arrhythmias.

·         Amiodarone: the only agent proven to reduce the incidence and risk of cardiac sudden death. Very effective at converting atrial fibrillation and atrial flutter to sinus rhythm.

3) Surgical myomectomy

·         For patients who remain severely symptomatic despite medical therapy and/or with an outflow gradient of more than 50 mm Hg.

·         Involves removing a portion of the inter ventricular septum to widen the outflow tract.

·         Complications include possible death, arrhythmias, infection, incessant bleeding, septal perforation/defect, and stroke.

4) Alcohol septal ablation

·         Involves injection of alcohol into one or more septal branches of LAD.

·         The ablation is a “controlled heart attack” in which the part of the septum involved with the outflow tract is infarcted and subsequently contracts into a scar.

·         Less invasive but produces similar results to septal myomectomy.

5) Ventricular pacing

·         Pacemaker activates the inter ventricular septum before the ventricular free wall. This decreases the gradient across outflow tract.

·         Will also help treat arrhythmias.

·         Indications: 1) family history of sudden death 2) wall thickness > 30 mm. 3) unexplained syncope 4) history of ventricular arrhythmias

6) Cardiac transplant

·         For cases refractory to all treatments.

IMG_1430
I’ve named the three of us “the three amigo’s.” Two amigos would probably not be here if not for the third ” Dr. Amigo.”

Hi! My name is Robert Stoliker (above, right), and my brother’s name is Larry Stoliker (above, left).

I knew something was really wrong with my twin brother the day I noticed one of his legs was completely swollen. I had been talking to him for months about seeing my doctor, but he was resistant. He had been seeing his practitioner for decades and, I guess, it was familiar for him. Several months earlier I started to noticing that he was getting progressively more fatigued, weak, and dizzy. He kept taking longer and longer to get up from sitting, and eventually he was even having trouble standing. He just kept going downhill. I was began to worry about him. Then, the day I saw the swollen leg I said, “That’s it Larry, you gotta go to my doctor and let him take a look at you.” I drove him straight to the Cardiovascular Institute. Dr. Ben-Zur was very concerned and immediately sent him to the nearest hospital for a full work-up. It turns out that my brother had an acute medical condition that needed urgent attention. My brother had an anuerysm in his aorta that was huge and was close to bursting. I was so relieved that Dr. Ben-Zur caught it in time, without him, I don’t know if he would have survived.

Today my brother is doing much better. He’s engaged in physical therapy at his rehab hospital and is feeling more like himself. In addition, Dr. Ben-Zur has been monitoring and adjusting his medications to reduce some very unwanted symptoms of dizziness and light-headedness that seemed to go unnoticed by his previous physicians. We’ve also started to understand the importance of diet change. Larry’s previous doctor told him he could eat whatever he wanted as long as it was in moderation, but Larry doesn’t eat in moderation. Dr. Ben-Zur has been encouraging us to change our health from the inside out, starting with what we put into our bodies. So please, pay attention to your health and the health of your loved ones. If you suspect something’s wrong, or if you just need to get checked out, may I recommend Dr. Ben-Zur and his staff. We can all be our brother’s keepers. Between everyone there, you can’t get better service. I’ve honestly never met anyone more concerned about their patients than the staff at the Cardiovascular Institute.

I’ll see you at Dr. Ben-Zur’s office.

Robert


Benzee Benzee the Heart says:

“Maintaining a healthy weight through diet and exercise will avoid complications like heart failure.”

Benzee Please take a look at our book online From Our Heart To Yours, a guide for better heart health using diet and exercise.

Aneurysm


Email5
The holiday season is all about family, fun and food! Getting your family to eat heart-healthy, especially during the holidays, takes effort. This following are three recipes to help you in making this holidays season a healthy one.

Breakfast: Morning Sweetness

Ingredients:

1 sweet potato or yam, scrubbed and dried
1/4 cup plain or vanilla soy yogurt
1 tablespoon pure maple syrup
2 tablespoons chopped nuts (walnuts, cashews, almonds, etc.)

Directions: Heat the oven to 375°F. Pierce the sweet potato several times with the tines of a fork. Place the sweet potato inside a loose nest of foil. Bake until tender when pierced with the tip of a paring knife, 40 to 50 minutes. Remove them from the oven and let them cool enough to handle. Open the sweet potato across the top, pushing the flesh slightly so it rises out of the skin. Spoon on the yogurt, then the syrup. Sprinkle with nuts, and serve.

Lunch: Chickpea Salad “Sandwich”

Ingredients:

2 Leaves of butter lettuce (or romaine); 1 Can chickpeas, drained and rinsed; 1C Celery, chopped fine; 3 green onions, thinly sliced; 1/4C finely chopped red bell pepper; 3T soy yogurt; 1 Clove garlic, minced; 1 1/2t yellow mustard; 2t fresh dill, minced; Juice from 1/2 lemon; Ground black pepper.

Directions: 1. Mash the chickpeas with a fork or potato masher in a large bowl; 2. Add the remaining ingredients, except the lettuce, and stir to combine; 3. Top each lettuce leaf with 1/2 cup of chickpea salad and enjoy!

DinnerTempeh Quinoa Salad (4 servings)

Ingredients:

2C Cooked quinoa (1cup dried, cooked in water); 1 8oz package of tempeh, diced into bite-sized pieces; 1T water (instead of olive oil); ½ Onion, chopped; 1 Bell pepper, chopped; ½ C Cherry tomatoes, halved; Juice from 1 lime; 1 can of low sodium organic black beans, drained and rinsed; 2T fresh cilantro; 1 Avocado, diced.

Seasonings: 1t cumin; 1/4t each: cayenne pepper, chili powder, garlic powder, black pepper.

Directions: 1. While the quinoa cooks, prepare the tempeh: heat water in a skillet on medium heat and add onions. Cook until soft (about 5 minutes); 2. Add the bell pepper, tempeh, lime juice and seasonings and cook the mixture for about 15 minutes (stirring occasionally); 3. Pour the cooked quinoa and tempeh mixture into a bowl and add the black beans, cilantro and tomatoes; 4. Serve with sliced avocado, a dollop of soy yogurt hummus.

Many more delicious healthy recipes are available in our book, Our Heart to Yours: A Guide to Better Heart Health Using Diet & Exercise.

  1. Click here to read the book ONLINE.
  2. Click here to pre-order your PRINTED COPY.

Benzee Benzee the Heart says:

“Eat healthy; be nice to me.”

Benzee Please take a look at our book online From Our Heart To Yours, a guide for better heart health using diet and exercise.

Cholesterol


staff

How wonderful it is to look back on the past year and realize how much you have accomplished. The New Year is the best time to dedicate ourselves to new goals!

This year, aim to do what no one else can do for you, take charge of your health. There is no medication as effective as prevention. Only the sick know the true value of health. Health is the best gift you can receive this Holiday Season and it will keep on giving for years to come.

If you’re already on the right track, please think about how to improve. Even a little change every day will make a huge impact by next years end.

We at the Cardiovascular Institute have committed our lives to raising awareness about heart disease. We encourage you to please adhere to a healthy diet and exercise regimen. Consider these to become habits. As we see you succeed we hope you send this message to others. “If you save but one life, it is considered as if you have saved the entire world.”

In May of 2016, we are planning a heart Walk-a-thon. To join our effort against heart disease, please click here to sign up. This event will be at no cost to you. But you must sign up before January 10, 2016. Space is limited, so please sign up now.

From the Cardiovascular Institute family to yours, may your New Year be filled with health and happiness — and may all of your New Year goals and wishes come true. We look forward to seeing you and greeting you with open arms in 2016!

Thank you so much,

Your Friends at The Cardiovascular Institute

Benzee Benzee the Heart says:

“If you do eat out, do it in moderation! Try dining out for one meal a week at a vegan restaurant.”

Benzee Please take a look at our book online From Our Heart To Yours, a guide for better heart health using diet and exercise.

Arrhythmias



The Cardiovascular Institute, founded by Uri M. Ben-Zur, M.D., F.A.C.C, is located in the heart of San Fernando Valley in Tarzana, California. In close proximity to, Encino, Sherman Oaks, Burbank, Calabasas and West Hills. Our practice is open to patients and future medical professionals Sunday through Friday starting at 6AMdaily. We are committed to enhancing the quality of healthcare for all of the residents of the Greater Los Angeles area. Dr. Ben-Zur is an attending physician at Providence Tarzana Medical Center. He offers a wide variety of cardiac services. Radiofrequency ablations for cardiac arrhythmias, pacemaker implantation, coronary stent placement and angioplasty are some of the many procedures we specialize in. As an expert onhypertension, hyperlipidemia, congestive heart failure, and arrhythmias, Dr. Ben-Zur is able to diagnose and treat patients in our new state of the art facility. Almost 60 million Americans suffer from hypertension and cardiovascular related diseases. Due to the nature of these diseases, most patients go undiagnosed until it is too late. Diagnosing these diseases early in life can dramatically decrease the risk for future complications. We are always welcoming new patients for heart related screening and have same day appointments available. Additionally, at the Cardiovascular Institute of Tarzana, California, Dr. Ben-Zur’s staff serves patients in multiple languages! Whether it be Hebrew, Russian, Spanish, Swahili, Armenian, Tagalog, Hindi, Urdu, and many more the Cardiovascular Institute will often have someone to serve your language and heart health needs.
Our practice is fortified by his acceptance of medical professionals and ultrasound technicians from various organizations including Western University College of Osteopathic Medicine, Touro College of Osteopathic Medicine, and UCLA David Geffen School of Medicine and the University of Southern California. The Institute fosters an ideal environment for future physicians and local technicians to help the unique population of the Greater Los Angeles area. Including, Tazana, Encino, Burbank, Sherman OaksWest Hills, and Calabasas.
Dr. Ben-Zur’s past medical education in electrophysiology and angioplasty is unparalleled. Guided by pioneers in both fields early in his career, he has had the opportunity to gain experience in major academic centers in New York City and San Diego, California. Many of his research projects are featured in various medical journals such as The New England Journal of Medicine and The Journal of the American College of Cardiology. Furthermore, Dr. Ben-Zur has multiple publications for his patients to learn more about their health and how they can prevent diseases by improving their lifestyle through diet and exercise. Our newest publication can be found on our website under patient resources!
This holiday season,be mindful of your health. Stress and overindulgence may put your body at risk for serious cardiac problems. A study by the Heart Institute states there are 33% more cardiovascular events from ischemic heart disease in December and January than the rest of the year in Los Angeles County. We advocate for our patients to familiarize themselves with the signs of acute coronary syndrome. The quicker symptoms are recognized, the better the outcomes. We encourage you to explore our website for more information about our practice!

Email3

It’s essential that you measure your risk of heart disease and make a plan for how to prevent it in the near future.

Assess:

  • Start off by calculating your risk for a Heart Attack. Have your recent Cholesterol and blood pressure numbers ready, and click here to calculate. The calculator will give you your risk percentage of having a heart attack over the next 10 years

Understand:
Blausen_0259_CoronaryArteryDisease_02

  • Next, educate yourself on risk factors for having a heart attack. 

Total Cholesterol:

  • This is simply a total of all your cholesterol you have in your blood which includes the bad cholesterol  (VLDL and LDL) as well as the good cholesterol (HDL).
  • Anything over 240 mg/dL is considered high and puts you at twice as much of a risk of developing a heart attack
  •  The AHA recommends keeping a total cholesterol level below 200 mg/dL

HDL Cholesterol:

  •  This is considered the good cholesterol. It is good because it carries cholesterol in your blood and brings it to the liver to remove it from your body. In doing so, HDL helps fight the “bad” cholesterol from building up in your arteries, thereby preventing strokes, heart attacks and high blood pressure.
  • Anything below 40 mg/dL puts you at risk for a heart attack
  • The AHA recommends a level above 60 mg/dL for optimal heart protection.
  • One of the best ways proven to increase your HDL or “good” cholesterol is exercise! Regular walking, jogging, or activity each day has been shown to increase HDL cholesterol
Total cholesterol  
Desirable Below                       Below 200
Borderline high                        200-239
High                                           240 or above
LDL (bad) cholesterol
Optimal                                 Below 70
Near/above optimal 100-129
Borderline high 130-159
High 160-189
Very High 190 or above
HDL (good) cholesterol
High 60 or above
Low Below 40
Triglycerides
Normal Below 150
Borderline high 150-199
High 200-499
Very high 500 or above

High Blood Pressure 

  • A heart attack is the result of a blocked blood supply to the heart muscle tissue. This can happen when the arteries to the heart become thicker and harder from a buildup of plaque. High blood pressure causes scarred arteries that fill up with plaque and become more prone to blood clots. Sometimes plaque or a blood clot can completely close an artery, blocking the blood flow to tissue on the other side.
  • High blood pressure, over time, also puts a strain on the heart and makes it work harder to pump blood out to the body. With this extra effort to pump, the heart grows in size and may compromise its ability to pump blood as well.

Implement:

Two of the biggest things you can do to lower your risk of both cancer and heart disease is to eat a healthy diet and exercise daily.

Exercise

  • Daily exercise is highly encouraged. We recommend 30 minutes to 1 hour of aerobic exercise. This can include jogging, walking, swimming, or biking. The benefits of daily exercise will not only make you feel better, more confident and happier but it will ultimately prevent disease and unnecessary trips to the doctor.

Diet

  • The old saying of “we are what we eat” has truth to it. We get out of our bodies what we put into them and how we care for them. New research points to a plant based diet reducing the risk of heart disease and many cancers. We also highly encourage a diet low in salt and carbohydrates. For numerous tips on what to eat , tasty recipes, and exercise please take a look at our book online, From Our Heart To Yours.

Benzee Benzee the Heart says:

“I can’t believe the best dietary advice I ever got as a child was from Popeye!”

Benzee Please take a look at our book online From Our Heart To Yours, a guide for better heart health using diet and exercise.

Smoking and How it Affects Your Health


The Cardiovascular Institute, founded by Uri M. Ben-Zur, M.D., F.A.C.C, is located in the heart of San Fernando Valley near Calabasas andWest Hills. Our new state of the art facility is dedicated to giving nearby residents complete and thorough cardiovascular care. Dr. Ben-Zur is one of the premier pacemaker and electrophysiology specialists in the greater Los Angeles area.  Our practice staffs multiple ultrasoundspecialists and offers in office stress testing daily. Open six days a week with same day appointments makes it easy for our patients to quickly get the care they need in a timely fashion.
Dr. Ben-Zur’s medical foundations were developed under the guidance of experts in electrophysiology and angioplasty. During this time he also developed a passion for interventional cardiology. He completed multiple fellowships at Albert Einstein College of Medicine in New York City and Scripps Clinic and Research Foundation in La Jolla, California. After moving to Los Angeles, Dr. Ben-Zur established an affiliation with the Providence Tarzana Medical Center to facilitate procedures including stent placements, pacemaker implantations,radiofrequency ablations and more. To learn more about these procedures and about our practice we encourage you explore our website!
Uri M. Ben-Zur, M.D., F.A.C.C is the founder of The Cardiovascular Institute of Greater Los Angeles. Dr Ben- Zur is a board certified cardiologist and a Fellow of the American College of Cardiology. He completed his Internal Medicine residency at the prestigious Albert Einstein College of Medicine (site of implantation of the world’s first transvenous pacemaker) before pursuing his training in the field of cardiology. He finished separate fellowships in general cardiology, interventional cardiology, cardiac pacing and electrophysiology. Early in his career, Dr. Ben-Zur was guided by physicians, including Seymour Furman M.D., who made groundbreaking progress in the field of electrophysiology and pacemaker implantation in the Bronx, New York. Soon after completion, he went on to a fellowship in interventional cardiology at Scripps Clinic and Research Foundation in La Jolla, California. During his tenure there, he was guided by Dr. Richard Schatz, co-inventor of the first implantable coronary stent.
Today, Dr. Ben- Zur is dedicated to providing impeccable and compassionate patient care for the residents of the Greater Los Angeles, Calabasas and West Hills areas. Patients often drive from West Hills and Calabasas and even as far as the Inland Empire to seek the various services the cardiovascular institute has to offer. His expertise in pacemakers and electrophysiology makes him one of the most sought after cardiologists in the greater Los Angeles, Sherman Oaks and West Hills areas. For years he has been servicing the surrounding cities ofEncino and Tarzana. He recently opened a new state of the art facility in Tarzana to better serve his patients. In conjunction with the facilities at Providence Tarzana Medical Center, Dr. Ben-Zur is able to utilize his expert skills in angioplasty and radiofrequency ablations to better serve his patients. We encourage you to explore our website to learn more about our practice!
Uri M. Ben-Zur, M.D., F.A.C.C is the founder of The Cardiovascular Institute of Greater Los Angeles. Dr. Ben- Zur is a board certified cardiologist and a Fellow of the American College of Cardiology. During his years spent in academia, Dr. Ben-Zur has been published a number of times in prestigious journals including the New England Journal of Medicine, The Journal of The American College of Cardiology, Pacing and Cardiac Electrophysiology and The American Heart Journal. Starting from early in his career, Dr. Ben-Zur was guided by mentored by world renowned physicians. Among them, Seymour Furman M.D and Richard Schatz M.D, who were both pioneers in electrophysiologyand coronary angioplasty respectively.
Dr. Ben-Zur has spearheaded the establishment of The Cardiovascular Institute because he is committed to enhancing the quality of healthcare for all of the residents in the Greater Los Angeles areas, including Calabasas and West Hills. The new cutting edge facility is equipped to provide patients with the most optimal care possible. He is available to see his patients six days a week, with minimal to no waiting time and same day appointments.
Furthermore, he is dedicated to the advancement of medical education and clinical research. This vision is fortified by his acceptance of medical students from various organizations including Western University College of Osteopathic Medicine, Touro College of Osteopathic Medicine, and UCLA David Geffen School of Medicine and the University of Southern California. The Institute fosters an ideal environment for students to study the unique population of the Greater Los Angeles area, as well as, Burbank, Sherman Oaks, West Hills, and Calabasas. We encourage you to explore our website for more information about our practice!

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