ROCHESTER, Minn. — A study at Mayo Clinic suggests that an hourglass-shaped stent could improve blood flow and ease severe and reoccurring chest pain in people with microvascular disease. Of 30 participants in a phase 2 clinical trial, 76% saw improvement in their day-to-day life. For example, some participants who reported not being able to walk around the block or up a flight of stairs without chest pain were able to do these ordinary physical activities at the end of a 120-day period. Clinical measures of blood flow related to the microvasculature of the heart significantly improved during follow-up, according to findings published in the Journal of the American College of Cardiology: Cardiovascular Interventions.

Microvascular disease is a condition in which tiny blood vessels in the heart are not working properly, resulting in reduced blood flow to the heart. The resulting chest pains, or angina, can be debilitating, limiting a person's ability to exercise, do household chores or even walk to the mailbox. About 40% of patients receiving a diagnostic coronary angiogram for chest pain do not have blocked arteries that also can cause angina. However, up to 66% of these patients do have coronary microvascular disease, which is more common in women overall and found in people with conditions such as diabetes, high blood pressure and obesity.

For decades, there have been few viable treatment options to improve blood flow through the tiny vessels of the heart. At most, doctors have treated symptoms of angina with several medications and cardiovascular disease prevention methods, including healthy eating, weight loss and regular exercise. The use of a stent could target the issue behind the chest pain — the severe reduction in blood flow affecting the heart muscle.

Unlike tube-shaped stents used to open clogged arteries, the hourglass-shaped stent narrows in the middle. The different design is thought to increase back pressure, redistributing blood flow more fully through small vessels in the heart that were not working at capacity.

"The patients with heart-related microvascular dysfunction in this study had little ability to control their chronic angina, which severely limited their day-to-day activities," says Amir Lerman, M.D., a cardiologist at Mayo Clinic and senior author of the study. "Beyond reductions in chest pain and being able to comfortably handle more physical activity, the majority of patients in the study also showed a connection between the changes in their coronary flow reserve, which is a measure of maximum blood flow, and changes in their quality-of-life responses on the survey. This points to the link between the physiological measurement and angina symptoms."

Dr. Lerman notes that more studies are needed to better understand how the reducer stent works and its long-term effects on blood flow. The stent did not improve chest pain symptoms in 20%-30% of the participants, so future research studies will need to better identify which patients respond best to this therapy.   

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu

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Watch: The Mayo Clinic Minute

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Different people need different amounts of sleep, and, on average, we can say most people need seven to eight hours," explains Dr. Somers.

He says to consider the quality of sleep, not the quantity. He offers these ideas to help you have good sleep hygiene.

Tips for better sleep

"In the bedroom, you want absolute darkness," says Dr. Somers.

And that means no screens, no TV, no laptops, no phones, and no ticking clocks or LED displays.

"Avoid bright lights, avoid looking at your phones because light from there can affect your melatonin," Dr. Somers says. That's the hormone that regulates sleep.

He says when it comes to quality sleep, less stimulation is best.

"Minimize alcohol, minimize exercise, minimize lights, minimize external inputs before about two hours or so before bedtime. The bedroom is for sex and sleep. It's not for spreadsheets," says Dr. Somers.

Exercise can help improve sleep, but working out near bedtime can raise arousal levels, making it harder to sleep. And consider a sleep schedule. Going to bed and getting up at the same time each day reinforces your body's sleep-wake cycle.

Related posts:

• Mayo Clinic Minute: What happens to your body when you have obstructive sleep apnea?
• Mayo Clinic Minute: How excessive daytime sleepiness can affect heart health

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ROCHESTER, Minn. — Doctors at Mayo Clinic used a new catheter-based approach to draw out resistant pockets of infection that settle in the heart, known as right-sided infective endocarditis, without surgery. Unless treated quickly, the walled-off infections can grow, severely damaging heart valves and potentially affecting other organs as well. In a recent study, over 90% of the participants had their infection cleared, and they had lower in-hospital mortality compared to those whose infections remained.

The research is part of a Mayo Clinic-led study across 19 U.S. sites involving patients who were not good candidates for surgery and whose right-sided heart infections had not responded to antibiotics. Abdallah El Sabbagh, M.D., an interventional cardiologist at Mayo Clinic in Jacksonville, Florida, was the study's principal investigator. Dr. El Sabbagh presented late-breaking research findings at the Transcatheter Cardiovascular Therapeutics Symposium on Oct. 30.

High-risk patients have few treatment options when a serious infection becomes entrenched in a heart valve. People with weakened immune systems, such as those who have had a transplant or cancer treatment, are more susceptible to such infections. IV drug users and patients with implanted medical devices such as pacemakers and artificial heart valves are also more likely to develop infective endocarditis. Approximately half of the 285 study participants were people who inject IV drugs.

"Our research findings show that using a catheter to draw out most of the heart infection potentially made a significant difference in a patient's response to antibiotic therapy afterward to clear up the infection. The participants in this study were all high-risk patients, and most were not responding to antibiotic therapy alone and were considered to have significant risks with open heart surgery. We were able to show that minimally invasive catheter-based aspiration of the infection is feasible, successful and may help a significant population of patients who otherwise have no alternative therapeutic options," says Dr. El Sabbagh.

The catheter-based system was originally developed to remove blood clots from the lungs without surgery. While its off-label use for infective endocarditis shows potential as a safe and effective option, Dr. El Sabbagh notes that further prospective study is needed.  

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Terri Malloy, Mayo Clinic Communications, newsbureau@mayo.edu

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DEAR MAYO CLINIC: My dad was diagnosed with cardiac amyloidosis shortly after his 70^th birthday. It's difficult to pronounce let alone understand. What is cardiac amyloidosis? Am I at risk if it is genetic?

ANSWER: Amyloidosis is a rare condition defined by the abnormal production of proteins that bind together to form amyloid proteins. These amyloids can gather in different organs throughout the body, including the heart, liver and kidneys. When amyloids form in the heart, the condition is referred to as cardiac amyloidosis.

In cases of cardiac amyloidosis, the amyloids can lead to the thickening of the heart wall, disrupting heart function. This thickening makes it more challenging for the heart to fill with blood between beats. Cardiac amyloidosis also can affect the heart's electrical system, causing an irregular heart rhythm.

There are some genetic factors that increase the risk of developing heart disease in certain populations, including amyloidosis, which has a genetic component. We see this at a high prevalence in African American populations. There are specific genetic factors that place Black people at a greater risk for developing heart disease, and there are specific heart disease types that have genetic factors linked to them. Cardiac amyloidosis is one of them and is one of the heart conditions that affect the heart-pumping function of the muscle.

Having a strong family history of traditional risk factors, such as high blood pressure and diabetes, significantly increases the risk of developing heart disease. If your family has had it before, you may be more likely to develop one of these heart disease risk factors. However, these are modifiable risk factors, which gives us hope that we can prevent heart disease in these patients.

The treatment for these conditions is many-sided. First is focusing on lifestyle change — eating healthier, minimizing stress, getting enough sleep and regular physical activity. If you have some of these conditions such as diabetes and hypertension (high blood pressure), you also may need to take medications to control them. It takes adequate follow-up with your healthcare team to ensure that it's under control.

At our Cardiac Amyloidosis Clinic, people with a diagnosis of cardiac amyloidosis receive treatment from a team of experts. If you have related symptoms such as swelling of the ankles and legs, shortness of breath, irregular heart rhythm, chest pain or an unexplained stroke, it's important to talk with cardiologists who understand the condition.

Early diagnosis of cardiac amyloidosis is crucial for successful treatment in addition to identifying which kind of amyloid you have. Tests and procedures to determine this may include blood or urine tests, an electrocardiogram (ECG or EKG), echocardiogram, biopsy tissue sample or MRI of the heart.

Mayo Clinic specialists treat more than 2,500 people with amyloidosis every year and work to improve treatment and reduce side effects for patients. They also have discovered new forms of amyloidosis. Talk with your healthcare team about treatment that might help. You or your family member might be eligible for clinical trials in cardiac amyloidosis. — LaPrincess Brewer, M.D., Cardiovascular Medicine, Rochester, Minnesota.

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World Stroke Day on Oct. 29 is a time to raise awareness about the signs, symptoms, treatments and ways to prevent stroke. Each year, an estimated 15 million people around the globe experience stroke, according to the World Health Organization, with one-third resulting in death. That's why immediate stroke treatment is crucial.

Watch: The Mayo Clinic Minute 

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When the symptoms of stroke present, calling 911 and seeking care immediately is the most crucial step to prevent disability or death.

“We have excellent treatments to reverse stroke symptoms, but these treatments are incredibly time-dependent,” says Dr. Stephen English, a Mayo Clinic neurologist.

For an ischemic stroke, which occurs when blood flow to the brain is blocked, there are two main treatment options to restore blood flow.

The first treatment that we can potentially offer is a medication that helps to dissolve blood clots," says Dr. English. "The second stroke treatment is a treatment where we can intervene by placing a catheter, a small tube in your blood vessels, and navigate to that clot in your brain using an X-ray. Then, we can administer a device or use suction to help remove the blood clot."

Hemorrhagic stroke occurs when a weakened blood vessel ruptures. Surgery may be needed to repair the rupture, remove blood in the brain and prevent swelling.

"We lower blood pressure to help prevent the growth of the bleeding, then we reverse issues that can contribute to further bleeding," says Dr. English. Surgery may be needed to repair the rupture, remove blood in the brain and prevent swelling.

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Watch: Braxton Wohlferd's story

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Wetting a line and catching fish is just one of the many passions of young teen Braxton Wohlferd.

"Whatever they like to bite is what I like to throw," Braxton says. "I just like the aspect of being outdoors and just hanging out with people and having fun."

But earlier this year, this healthy, athletic high schooler from St. Charles, Minnesota, had his world turned upside down in a flash.

"He called frantically," says Melissa Wohlferd, Braxton's mother.

It was the morning after his 16^th birthday. Braxton thought he had the stomach flu. He was vomiting. Suddenly, it got much worse.

"I was like, 'You need to get home. Something's not right,'" Braxton says.

His mom, Melissa, a registered nurse, arrived moments later. "And he was lying on the floor, and his hands and feet were mottling," she says.

"My hands were turning, like, blue, almost. And then we tried to come upstairs, and I collapsed on the third stair," Braxton says.

"He said, 'Mom, I just can't do it. I can't catch my breath. My chest hurts,'" Melissa says.

Braxton was rushed to the Emergency Department at Mayo Clinic. Not long after he arrived, he went into cardiac arrest. Life-saving CPR was performed until Braxton was put on a life support machine.

"I believe it was 22 minutes, full chest compressions. His heart never beat again," Melissa says.

But why?

"Completely healthy and then, within a blink of an eye, he's hooked up to every machine possible, keeping him alive," Melissa says.

Doctors at Mayo soon solved the mystery — a common childhood illness called parvovirus B19, also known as fifth disease.

"The majority of people who get parvovirus may not even know that they've had it," says Dr. Rebecca Ameduri, medical director of the Pediatric Heart Failure and Heart Transplant Program at Mayo Clinic. "Most people, when they get parvovirus, will just have kind of common cold effects and will not have severe side effects like Braxton did."

Braxton's body had an extremely rare reaction to the virus causing his own immune system to attack and break down his heart muscle. "They said it was more likely to get struck by lightning," Melissa says.

"Sometimes, in cases like Braxton, it's what we call fulminant myocarditis, where it happens very rapidly, where those children can deteriorate in less than 24 hours," says Dr. Ameduri.

Braxton's only option was a heart transplant. "It was just so scary," Melissa says.

In less than a week, a miracle occurs. A donor heart arrives. "It was a perfect match for Braxton," Melissa says.

And a heart transplant performed by Mayo Clinic surgeons is a success. "It's kind of surreal to think that I'm still here," Braxton says.

"Without that organ donor, Braxton would not be here," Melissa says.

"Thank you doesn't even cover what I'd like to say. It's unbelievable. It's a selfless act that they give their organs away," Braxton says.

The virus also affected Braxton's legs, causing a condition known as compartment syndrome, which required emergency surgery to remove some of his leg muscles.

"I feel great. Feel like I'm getting my strength back, and I'm gonna keep working at it and plan on keep getting stronger," Braxton says.

Braxton hopes to be back playing baseball next year and planning plenty of future fishing trips.

"I don't know how many other people would have went through this and survived," Braxton says. "They said I was very lucky, I'm a miracle. And I feel like I'm a miracle."

Related stories:

• Mayo Clinic expert explains parvovirus B19, a common childhood infection
• Mayo Clinic Minute: What is myocarditis?

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Dr. Virend Somers, a Mayo Clinic cardiologist with a focus on sleep apnea, says it's a serious medical condition that can cause heart problems and other health issues. Dr. Somers co-authored a recent study published in the Journal of the American College of Cardiology on the treatment of obstructive sleep apnea and its impact on cardiovascular disease.

Watch: The Mayo Clinic Minute

Journalists: Broadcast-quality video (1:06) is in the downloads at the end of this post. Please courtesy: "Mayo Clinic News Network." Read the script.

Obstructive sleep apnea occurs when a person stops and starts breathing while asleep. It happens because the throat muscles relax and block the airway.

"The tongue can fall backwards and can obstruct the airway, causing either snoring or obstruction," says Dr. Somers.

When a person is breathing normally, their blood oxygen saturation level is usually between 95% and 100%. Dr. Somers says obstructive sleep apnea can drop that oxygen level down to as low as 70% or 60%. It can cause high blood pressure and strain your cardiovascular system, increasing the risk of heart problems. 

"What we can do is give you an oxygen monitor to wear at home and look at the oxygen tracing. And if it looks problematic, then you can have a sleep study," he says.

If you're diagnosed with sleep apnea, treatment may include weight loss; a continuous positive airway pressure machine, or CPAP; a mouthpiece designed to keep the throat open; postural therapy to prevent you from sleeping on your back; or even surgery or implanting a device that stimulates the airway to be more open during sleep.

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Watch: The Mayo Clinic Minute

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Needing to rest your body after a great workout or after a long day of work are examples of being tired — which is different than being sleepy.

"Being excessively sleepy during the daytime is, in a sense, falling asleep very quickly, having a very short period between the time you lay down or the time you sit down and actually falling asleep, and having no clear, obvious cause for being sleepy, or a cause related to a sleep disorder," says Dr. Somers.

While there are many causes, the bottom line is excessive daytime sleepiness means you’re not getting enough quality restorative sleep. 

Using an alarm clock?

"When you need an alarm clock to wake you up, then by definition, you haven't had enough sleep," says Dr. Somers. "Because you could have slept more."

Not getting the sleep your body needs can pose health risks.

"There seems to be an association between being sleepy and having a higher risk of cardiovascular disease," says Dr. Somers. "We've found — independent of other things that we can identify that increased cardiovascular risk — that daytime sleepiness seems to be linked to a higher risk of heart disease, of sudden death, of cardiovascular death."

Read about Dr. Somer's research on excessive daytime sleepiness and cardiovascular mortality in adults across the U.S.

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World Heart Day is September 29  

JACKSONVILLE, Florida — Leg pain and leg cramps aren’t always an orthopedic issue: Both can be signs of peripheral artery disease, or PAD, a serious blood-flow issue with implications for the heart. In this expert alert, Young Erben, M.D., a vascular surgeon at Mayo Clinic in Jacksonville, Florida, explains how the most common form, PAD that affects the legs and feet, is treated. Options include a surgical technique from the past that Mayo surgeons are reviving and refining to offer new hope to patients with advanced PAD. 

In peripheral artery disease, narrowed arteries reduce blood flow to the affected limbs. They do not get enough blood flow to keep up with the demand. It is important to manage PAD as early as possible, Dr. Erben says. In the worst cases, PAD can progress to open sores that do not heal, causing tissue death and limb loss. 

Globally, peripheral artery disease tends to be undertreated, even though doctors widely recognize it as a risk factor for heart disease. PAD has become more prevalent in recent years; at least 113 million people worldwide 40 or older have the disease, a 2023 report shows.   

“Lower extremity PAD, or PAD in the legs and feet, is a spectrum,” Dr. Erben says. “It ranges from people who have leg pain when walking to more advanced cases, where the blood flow to the leg is so impaired that patients are in pain when they’re resting or are developing wounds in their toes and feet.”   

Common symptoms include leg pain or cramps while walking and small sores on the feet that do not heal, Dr. Erben says. Your first inclination might be to think of these as small things to ignore, but it is best to bring up these symptoms with your healthcare team, she advises. 

“Especially if you have diabetes, high blood pressure, high cholesterol or smoke cigarettes and you have these aches and pains, bring it up to your doctor because it may uncover something,” Dr. Erben says. “Those little details are how we catch most PAD.” 

Treatment depends on where someone is on the spectrum. Early on the spectrum, treatment typically includes: 

• Addressing risk factors for peripheral artery disease such as high blood pressure, high cholesterol, diabetes, obesity and smoking.  

• Screening for additional blood-flow problems, such as coronary artery disease, may be needed.  

• Developing a walking program — typically involving time on a treadmill — that the patient can pursue at home or with a physical therapist or trainer. 

“Walking develops new collateral blood vessels and increased blood flow to the legs,” Dr. Erben explains. “I have seen it with my patients over time: Over three to six months, if they’re very diligent about walking, the pain with walking will diminish, and people who are in the very early stages of PAD can almost go back to normal.”  

People in the middle of the PAD spectrum will have more plaque buildup and blockages in blood vessels in their legs. Medication may be needed to increase blood flow. In some cases, a procedure may be needed, such as the minimally invasive insertion of balloons and/or stents to open arteries; surgery to remove blockages; or bypass surgery, in which a surgeon removes a vein from another area in the body and connects it above and below a blocked artery to improve blood flow, Dr. Erben says.  

Blood thinners may be prescribed to help maintain the improved circulation. 

In the most advanced peripheral artery disease, people may have ulcers in their feet that become infected. The goal then becomes saving the affected limb: Surgeons may perform bypasses and, in some cases, an operation called deep vein arterialization (DVA), in which they connect an artery with a vein to try to provide additional blood flow to help wounds heal.  

This procedure was pioneered elsewhere in the 1970s. It lost popularity amid the development of less-invasive techniques such as balloons and stents that could be used earlier in PAD. Vascular surgeons at Mayo Clinic are now reviving and refining it, Dr. Erben says.  

“It is considered an innovation, but it is one of those that was an old technique, then somehow forgotten, and now it has been resurrected. We started doing this roughly three years ago for patients whose limbs are threatened in the last stage of PAD and we are having success.” 

In very advanced cases of peripheral artery disease, treatment may require amputation of the affected limb, such as toes or the leg below or above the knee.  

The worst-case scenarios with advanced PAD and the success often seen when the disease is recognized and managed early, are why it’s important to tell your doctor if you start experiencing recurring leg cramps, also known as charley horses; leg pain that starts with exercise and ends with rest or that doesn’t go away; or a foot sore, even a small one, that lingers, Dr. Erben says.  

“The mild symptoms are the ones that people tend to ignore,” Dr. Erben says. “Unfortunately, they often do not realize that they have a problem until it becomes a dire problem. The most important message that I can give to patients is that you may think it’s a little complaint, but please bring it up to your doctor. Because it may uncover something that you never thought of.” 

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About Mayo Clinic  
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and to providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.   

Media contact:  

• Sharon Theimer, Mayo Clinic Communications, newsbureau@mayo.edu

The post Peripheral artery disease: Leg pain, leg cramps, lingering foot wounds among symptoms appeared first on Mayo Clinic News Network.

Dr. Jesse Bracamonte, a Mayo Clinic family medicine physician, says preventive screenings for cancer and other diseases are effective ways to help reduce these burdens.  

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"Colorectal cancers and breast cancers are on the rise in the Hispanic community. And one of those reasons may be from lack of preventive screening," says Dr. Bracamonte.

He says culture, access to care and past experiences contribute. But early screening can prevent future serious health issues.

"Screening tests for diabetes (such as checking a simple blood sugar), for cardiovascular disease to prevent strokes (such as checking on cholesterol and blood pressure), colon cancer screening, breast cancer screening for females, are all available tools," he says.

Talk with your doctor to determine the right preventive screenings and when to begin. For instance: 

"Colon cancer screening for both men and women, usually at age 45, is an option, breast cancer screening for women in their 40s such as with mammogram," he says.

Dr. Bracamonte recommends having a list of questions for your doctor about what you can do to stay healthy.

"Have that list prepared about what I should get done to keep me healthy in the long term. What behaviors can I do in the long term to stay healthy? Because I think prevention is a key," says Dr. Bracamonte.

Related posts:

• The importance of diagnosing, treating diabetes in the Hispanic population in the US
• Expert Alert: Mayo Clinic Healthcare cardiologist explains link between diabetes, heart disease.
• Disparities in opioid treatment access remain for women, Black and Hispanic people

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