OSF HealthCare Cardiovascular Institute is expanding its ability to treat complex heart valve conditions, becoming the first health care provider in Illinois outside of Chicago to offer EVOQUE transcatheter tricuspid valve replacement (TTVR) – a minimally invasive procedure that replaces a damaged tricuspid heart valve without open-heart surgery.

The first EVOQUE procedure at OSF HealthCare Saint Francis Medical Center in Peoria took place in late July. The patient was discharged after the procedure with excellent results.

TTVR gives physicians another minimally invasive option for people with severe tricuspid regurgitation, a condition in which the heart’s tricuspid valve does not close properly and allows blood to flow backward. This can lead to people experiencing fatigue, weakness and swelling, according to the American Heart Association.

“Beyond TAVR, MitraClip and TriClip, the addition of TTVR allows us to advance our program capabilities through a minimally invasive, catheter-based approach for the treatment of valvular disease,” says Sudhir Mungee, MD, director of the structural heart division at OSF Cardiovascular Institute.

Instead of making a large incision in the chest, a team of heart specialists guides a replacement valve to the heart through a vein in the groin using a thin tube called a catheter.

For some people with severe tricuspid regurgitation, traditional surgery may carry significant risks like heart failure, bleeding, infection and stroke. TTVR provides another option, particularly for people who are considered high risk for surgery.

The minimally invasive approach can also mean:

· A shorter hospital stay – often one to two days compared to five to seven or more days for open-heart surgery

· A faster recovery – often days instead of weeks

With the addition of EVOQUE TTVR, people with complex tricuspid valve disease now have access to another advanced treatment option at OSF HealthCare Saint Francis Medical Center in Peoria.

It’s common knowledge that exercise is good for you. But recent research suggests the timing of when you work out may provide additional health benefits you didn’t expect.

Researchers released a new study in the British Medical Journal’s (BMJ) Open Heart publication focused on timing workouts due to the participant’s internal clock. So, what does that mean?

Darrel Gumm, MD, vice president of OSF HealthCare Cardiovascular Institute in Peoria, Illinois, explains, "If we sync that exercise to a person's natural circadian rhythm, there's even more additional benefit on top of what you're already getting," Dr. Gumm says about the recent study. 

"So, if you're a morning person, work out in the morning. If you're a morning person working out at night, you're going to get a benefit, but it won't be as profound as doing that in the morning. Vice versa, if you're a night person and you work out in the morning, you're going to get a benefit, but not as much as if you timed it to your natural circadian rhythm and when you're most alert."

Dr. Gumm says timing your exercise according to when you’re most alert benefits all our modifiable risk factors but especially helps lower our blood pressure. And the best part is, you are your body's top expert. Knowing whether you're a morning person or a night owl will help you decide when to schedule your exercise. 

The type of exercise this study revealed to be better during your natural circadian rhythm were aerobic exercises, which is exercise that works your muscles repeatedly and in a rhythm. “It was a five-minute warmup, 30-minute workout, five-minute cool down,” Dr. Gumm adds.

A study like this offers physicians like Dr. Gumm and other cardiologists at OSF HealthCare Cardiovascular Institute an opportunity to share the research findings with people they see in the clinic and make personalized recommendations for modifying their lifestyle. Knowing whether someone is a morning person or night owl can help tailor the care and recommendations they receive. 

"It's a great opportunity to emphasize the importance of physical activity. It's easy for us to ignore it, put it to the side and forget about it. But our standard recommendation is 30 minutes a day, five days a week," Dr. Gumm says. "If you can do 150 minutes a week, you're really getting a benefit."

The greatest impact the study reveals, Dr. Gumm says, was on lowering participants’ systolic blood pressure. These 150 people were adults in Pakistan, between the ages of 40 and 60, who mainly live sedentary lifestyles.

“But even LDL cholesterol (bad cholesterol) showed a bigger drop in those who aligned their workout time with their circadian rhythm," Dr. Gumm says. "It dropped in both groups, whether you were aligned or not, but there was a bigger drop in the aligned group."

Exercise also helps increase HDL cholesterol, or the healthy cholesterol. It can also help drop a person's triglyceride level, which in turn can increase their HDL levels. Avoiding simple carbohydrates like white rice, white bread, pasta, sugar, potatoes and alcohol can decrease your triglyceride levels and bump up your HDL levels, Dr. Gumm points out. 

If you can’t make time for 150 minutes of exercise a week, Dr. Gumm recommends "exercise snacking." Examples are walking up and down three flights of stairs, three times a day, three days a week. Parking your car a little further from the office and getting in extra steps – simple things that you can modify easily into your daily routine. 

Your primary care provider can help come up with a plan that fits your lifestyle. 

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As children go back to school, doctors’ offices are filled with kids needing check-ups, immunizations, and in some cases, heart screenings.

This is particularly the case for athletes, according to Frank Han, MD, pediatric cardiologist with OSF HealthCare.

“Every time people go back to school, there is a need for heart screenings to help look for heart problems in children,” Dr. Han says.

The National Institutes of Health (NIH) conducted a 10-year review of sudden death during sporting activities. The objective was to characterize the demographics and causes of sudden cardiac death during sports played in Australia. Nearly 20,000 autopsies were conducted between 2006 and 2015. Most deaths were from adults.

The findings showed the small number of children who died from heart conditions either were arrhythmogenic or presumed arrhythmogenic, producing or tending to produce cardiac arrhythmia. Or the kids had inherited cardiomyopathies, an acquired or hereditary disease of the heart muscle.

That’s why Dr. Han recommends parents speak to their children’s pediatricians to make sure they’re aware if their child has a heart condition. If the pediatrician senses the child may have a problem, they’ll recommend they be seen by a cardiologist for further evaluation.

“The general screening to start off is an EKG in the primary care office. After that, along with an assessment of family history, that person may be referred for an echocardiogram or a stress test to see if there’s any issues in the heart valves, or if the heart muscle is too thick,” Dr. Han says. “One of the major uses of the exercise stress test is to try and simulate the hardest possible exercise that person might do. Then we will put all the information together in our visit to figure out if there is an issue.”

While it can be hard, especially for younger children, to know the signs of a heart condition, it’s important to listen if they think something feels unusual.

“They may say things like their chest is ‘beeping,’ or their chest is ‘pounding.’ In older children, they may give you a variety of descriptions, that there’s some difficulty with exercise. This can be chest pain, shortness of breath, or their heart is pounding, particularly when they exercise,” Dr. Han says.

Dr. Han says all heart conditions aren’t caught when the person is younger.

“Some heart conditions that you’re born with don’t really show up as a kid, like genetic conditions of the heart that may show up at a later age,” he says. “The electrocardiogram and ultrasound of the heart are designed to pick that up if it shows up later in age.”

Dr. Han adds it’s very important to know your family health history. If your family has a history of heart conditions, he recommends speaking with your primary care provider and potentially being screened by a cardiologist.

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