Preventing Heart Disease 

HeartPrevention is a primary focus of Tyler Heart Institute. After all, the best time to stop heart disease is before it even starts. Even if you feel healthy, you need to know your numbers:

  • Blood pressure - Optimal blood pressure is below 120/80.
  • Cholesterol - Your "good" cholesterol (HDL) should be greater than 50; and your "bad" cholesterol (LDL) should be less than 100, but less than 70 if you have heart disease or are at high risk for heart disease. Your total cholesterol (HDL and LDL combined) should be less than 200.
  • Glucose - Fasting glucose should be less than 100.
  • Waistline - Waist measurement can be an important factor in determining risk for heart disease. Women should have a measurement of less than 35 inches, while men should have a measurement of less than 40 inches.

Tyler Heart Institute

Every Beat Counts 

Not counting broken hearts, one in four people will have a heart-related problem in their lifetime.

Community Hospital's Tyler Heart Institute might not be able to help in the romance department, but it's the place to go for most all medical matters of the heart.

"Community Hospital has a history of providing heart-disease prevention and intervention," says Mike Barber, RN, director of Tyler Heart Institute. "But in the last few years, our program has advanced dramatically as we have broadened the spectrum of care and continued to build our team of experts who deliver it."

A series of major milestones has been achieved since all facets of the hospital's cardiac care were pulled together in 2007 under the Tyler Heart Institute umbrella. The name recognizes Bill and Susanne Tyler, who made a generous contribution to the program. Among the recent milestones:

  • Open-heart surgery program. Under the leadership of renowned surgeon Vincent Gaudiani, more than 450 open-heart surgeries have been performed since Valentine's Day 2007, with stellar results that far surpass national averages. Last fall, veteran cardiothoracic surgeon Dr. Gregory Spowart joined the surgical team as associate medical director, providing around-the-clock care. Between them, Gaudiani and Spowart have performed more than 20,000 open-heart surgeries, specializing in valve repair and complicated cases.
  • Two new cardiac catheterization labs. Community Hospital now has three of these state-of-the-art labs, where a range of procedures can be performed, from interrupting a heart attack or diagnosing disease with an angiogram to placing a stent that opens a blocked artery.
  • Electrophysiology program . Based in one of the three cath labs, this program is for diagnosing and treating irregular heartbeats. After the electrical signals of the heart's muscles are mapped with tiny electrodes to determine the nature of the problem, doctors may decide to implant a supporting device such as a pacemaker or defibrillator, or to perform a procedure called ablation to treat the cells causing the problem. All of these can be done right in the lab.
  • The latest imaging equipment. Community Hospital's computerized tomography (CT) technology, for example, delivers incredibly detailed pictures of the heart - captured in a single heartbeat or in multiple sections - to give clinicians the optimal views for diagnosis and treatment planning.
  • Cardiac Wellness gym . An array of new exercise and monitoring equipment purchased by Community Hospital's Auxiliary is available in the gym. This facility houses the Cardiac Wellness program that guides people through rehabilitation after a heart-related illness, with input from a team of nurses, dietitians, and exercise physiologists.
  • Prevention programs that include the Advanced Lipid Management Program to lower cholesterol; and Kick the Nic, a multifaceted program to help people stop smoking.

Tyler Heart Medical DirectorsHaving these services available is important for the community, but delivering them with a personal touch is key, says Dr. Richard Gray, medical director of Tyler Heart Institute.

"My own personal philosophy about making progressive, successful, quality care with top outcomes is to treat each patient in a most personal way," Gray says. "In addition to top-notch programs and technology, it is important to treat each one of our patients as we would a family member.

"The secret to caring for patients," Gray says, "is caring about patients."

Gray joined the Tyler Heart team last fall after more than three decades with other organizations, including Cedars- Sinai Medical Center and California Pacific Medial Center

"The resources at Community Hospital are far beyond what would normally be expected from a community hospital," Gray says, "and our results reflect that, both in outcomes and in patient satisfaction."

The teams that make up Tyler Heart Institute oversee the continuum of heart care and approach it in that start-to-finish way. The goal is to be proactive, focusing first on prevention, followed by screening and other diagnostics, treatment, recovery, and then prevention of recurrence to bring the effort full circle.

People looking to head off heart disease might enter the Tyler Heart Institute through a program like Women's HeartAdvantage, led by Dr. Soteria Karahalios, or through the Advanced Lipid Management Program, run by Dr. Terrance Moran.

Open Heart Patients Where our open heart patients live

The reputation and results of Tyler Heart Institute's open-heart surgery program
are drawing patients from around the state - and beyond.
* Out of state 2%

Women's HeartAdvantage starts with lab tests, a risk assessment, and an individual consultation with a cardiologist. Participants are given a personalized plan for reducing heart risk, the latest information on prevention, and recommendations for further testing if necessary.

"The most recent studies show that women are dying from heart attack at greater rates than men," Barber says. "One of the key risk factors in women is the amount of stress they take on in their lives. Through Women's HeartAdvantage, women who don't have their own cardiologist can participate in a program dedicated to assessing their risk factors and doing something about them."

The lipid program involves cholesterol-testing to assess risk for heart disease and then, if necessary, developing a treatment and management program to maintain healthy numbers. Research indicates that a treatment program, which may include medication, dietary modification, and regular exercise, can help lower cholesterol and thus lower the risk of developing heart disease.

"Getting a lipoprotein profile, which is a series of tests to determine the risk of heart disease, is a primary form of prevention," Barber says. "If patients can get their lipids (cholesterol) in line, they have a much higher chance of staying away from heart disease and avoiding medical procedures."

Those who do need procedures may be treated in one of the three cath labs overseen by medical director Dr. Pir Shah. Since March 2005, more than 4,000 patients have received cardiac catheterization services. In that time, more than 220 patients have had an actual heart attack interrupted.

If surgery becomes necessary, patients find themselves in the skilled hands of Gaudiani or Spowart. Tyler Heart Institute has lower mortality rates, generally shorter stays, and fewer complications such as stroke or infection among its open-heart patients when compared to national averages.

Mike Barber, Director of Tyler Heart InstituteMike Barber, RN, director of Tyler Heart Institute

"Community Hospital has a history of providing heart-disease prevention and intervention. But in the last few years our program has advanced dramatically as we have broadened the spectrum of care and continued to build our team of experts to deliver it."

"Our surgeons have compiled an impressive record of successful outcomes," Barber says. "Monterey County is extremely fortunate to have two heart surgeons of this caliber."

After surgery or any other cardiac intervention, care continues through Cardiac Wellness, which includes a 12-week rehabilitation program that begins when patients are at Community Hospital and continues as an outpatient service.

"With guidance from a registered nurse and an exercise physiologist," Barber says, "patients can recover from their heart disease and focus on preventing recurrence.

"Part of cardiac rehabilitation is getting regular exercise, and patients can do that in the medically supervised Cardiac Wellness gym," Barber says.

On any given day, 50 to 75 patients come to the gym at Hartnell Professional Center to get stronger and healthier through monitored exercise.

"Our cardiac rehabilitation program also includes nutrition counseling and stress management," says Barber, "as well as a wide variety of heart-healthy classes to help people stop smoking, develop positive nutrition habits, incorporate exercise, and reduce stress."

By focusing on areas like those, Tyler Heart Institute staff hopes to help slow the growth of cardiovascular disease, which is a factor in one-third of the deaths in Monterey County, according to the American Heart Association.

"Whether we're providing prevention education, performing open-heart surgery, or guiding someone through rehabilitation," Gray says, "the commitment at Tyler Heart Institute is to comprehensive, seamless, and integrated cardiac care delivered with a human touch."