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Dr. Paul Urban: Sudden Cardiac Death is what it says ... unless

PaulUrbanBy Dr. Paul Urban
Special to the Star-Banner
Published: Sunday, May 29, 2016

Nearly two weeks ago I attended a concert at Circle Square Commons at On Top of the World. During the opening number Scott, the bass player, suddenly collapsed. In response to a call for medical help, I mounted the stage to assist. Scott had a chin cut, but the blood was merely a distraction. Scott was pulseless and lifeless.

I immediately began CPR — the new kind where mouth-to-mouth breathing has been eliminated. An Automatic External Defibrillator (AED) was brought forward, and I used it to shock Scott’s heart back to a normal rhythm. He was conscious when the paramedics transported him to the hospital. A cardiac procedure showed that he had extensive heart disease. He underwent a four-way heart bypass and left the hospital fully ambulatory and awake.

Scott is one of over 300,000 Americans who will suffer Sudden Cardiac Death (SCD) this year. SCD is usually caused by the sudden onset of a malignant heart rhythm. Often there are no warning symptoms. If the event is unwitnessed, the survival rate is around 6 percent. Unfortunately, most events occur in the home or non-public places and are not witnessed. If the event is witnessed, the national survival approaches 30 percent. Survival improves with bystander CPR and prompt defibrillation (cardiac shock). In cities such as Seattle, extensive public CPR training has led to survival rates over 40 percent. The new CPR guidelines eliminate mouth-to-mouth breathing, so hopefully more bystanders will perform CPR. It is indeed difficult to kiss a dead stranger.

The single most important variable for survival is time from cardiac arrest to defibrillation. Survival decreases 7-10 percent for each minute that defibrillation is delayed, and is very unlikely after 10 minutes without a shock, even with ongoing CPR. Trauma surgeons talk about treatment in the first hour after trauma as crucial to survival. In cardiology, it’s more like the “first frantic five minutes.”

Scott had the good fortune to collapse in a public place where CPR was started promptly and an AED was readily available. Prompt application of these two variables results in higher survival rates. The best place in the U.S. to have a cardiac arrest is in a Las Vegas casino, with survival rates of greater than 70 percent. Downtime before CPR is short, and there are a lot of AED’s around.

Sudden Cardiac Death usually occurs in diseased hearts, so prompt hospital transfer and further care is mandatory. At the hospital, when Scott was more awake, he related a similar but less severe episode two years ago, and a lot of recent “heartburn.” Tests showed that he likely had a least one previous heart attack, showing how silent or underwhelming the symptoms of heart disease can be.

The best treatment of SCD is prevention. Since SCD usually occurs in unhealthy hearts, treatment of well recognized risk factors such as high blood pressure, high cholesterol and cigarette smoking reduces the odds of heart disease and of an attack. A heart sonogram can detect decreased heart muscle function, another risk factor for SCD. A stress test can be useful in screening for coronary artery disease and previous heart attack.

Not all SCD is survivable, but prevention and prompt treatment improve the odds. Scott was in the right place at the right time, where the true star of the show was the AED. A lot of his 300,000 brethren will not be so fortunate.

— Dr. Paul L Urban, a/k/a “Tie Dye Man,” is a board-certified clinical and interventional cardiologist who has been practicing serving Ocala for more than 25 years.


People Of Influence

Doctors of the Cardiovascular Institute of Central Florida

pr-05312015The medical team at the Cardiovascular Institute of Central Florida specializes in prevention, diagnosis and treatment of all diseases of the heart. CVI’s board-certified cardiologists use the latest technological advances available to impact the health, and therefore the lives, of their patients.

Accredited by the Accreditation Association for Ambulatory Health Care, Inc – American College of Radiology – Nuclear (ACR) and the Intersocietal Accreditation Commission – Echocardiography (IAC), the physicians at CVI offer a variety of services to include Nuclear Medicine, Cardiac Catheterization, Venus Ablations, Vascular Ultrasound, Echocardiology, Hoter and Event Monitoring, Pacemakers, Diagnostic right and left heart catheterization, Peripheral Vascular Interventions, Carotid Angiography and EKG/ABI/TEE technologies.

What does this mean for their patients?

Considering the American Heart Association estimates that 79,400,000 American adults are living with cardiovascular disease, it is safe to say that the highly educated and continuously trained staff are taking the life of their patients into their own hands – literally, in an effort combat this deadly disease.

Dr. Shafeeq Ahmed, Dr. Siva Gummadi, Dr. Robert Herman, Dr. Vijaya Koka, Dr. Hima Mikkilineni, Dr. Jigar Patel, Dr. Srisha Rao, Dr. Prem Singh and Dr. Paul Urban work together with a team of ARNPs and PA-Cs to provide a continuum of care that includes trust, experience and attention to detail.

Other services CVI offers includes Carotid Ultrasound, External Counter Pulsation, hospital and office consultations, Nuclear stress testing, Positron Emission Tomography Scan, Prothrombin Time and International Normalized Ration and Vascular sclerotherapy, all with in-house billing.

CVI patients can walk in to any one of the five locations, four of which are in Ocala and one in The Villages, knowing they will be met with urgency and compassion. The professional services provided by their nine physicians supersedes client expectations and leaves a lasting impression – more life to live!


Cardiovascular Institute of Central Florida, LLC, Echocardiography I Laurel Manor receives Echocardiography accreditation by IAC

iac_logo_webDate: July 2, 2015
Contact: Tamara Sloper (

Cardiovascular diseases are the No. I cause of death in the United States. On average, one American dies every 39 seconds of cardiovascular disease – disorders of the heart and blood vessels. The American Heart Association estimates that the direct and indirect cost for cardiovascular disease in the U.S. for 2010 was $503.2 billion.

Early detection of life threatening heart disorders and other diseases is possible through the use of Echocardiography procedures performed within hospitals, outpatient centers and physicians’ offices. While these tests are helpful, there are many facets that contribute to an accurate diagnosis based on Echocardiography testing. The skill of the Echocardiography sonographer performing the examination, the type of equipment used, the background and knowledge of the interpreting physician and quality assurance measures are each critical to quality patient testing.

Cardiovascular Institute of Central Florida, LLC, Echocardiography I Laurel Manor located in The Villages, FL has been granted a three-year term of accreditation in Echocardiography in the area of Adult Transthoracic by the Intersocietal Accreditation Commission (IAC).

Accreditation by the IAC means that Cardiovascular Institute of Central Florida, LLC, Echocardiography I Laurel Manor has undergone a thorough review of its operational and technical components by a panel of experts. The IAC grants accreditation only to those facilities that are found to be providing quality patient care, in compliance with national standards through a comprehensive application process including detailed case study review.

IAC accreditation is a “seal of approval” that patients can rely on as an indication that the facility has been carefully critiqued on all aspects of its operations considered relevant by medical experts in the field of Echocardiography. When scheduled for an Echocardiography procedure, patients are encouraged to inquire as to the accreditation status of the facility where their examination will be performed and can learn more by visiting

IAC accreditation is widely respected within the medical community, as illustrated by the support of the national medical societies related to Echocardiography, which include physicians and sonographers. Echocardiography accreditation is required in some states and regions by the Centers for Medicare and Medicaid Services (CMS) and by some private insurers. However, patients should remain vigilant in making sure that their Echocardiography procedures are performed within accredited facilities, because for many facilities accreditation remains a voluntary process.


Heart Disease

Many of us have heard this term before: Heart Disease. But do we really know what it is? I mean, we can put two and two together – it’s a disease of the heart – that’s true enough. But is there more to it than that? Is there more that we should know? Or maybe even, be concerned about?

The answer is a resolute YES! Heart disease is merely the common term. The medical term is actually Cardiovascular Disease. Additionally, it’s not a single disease, but a classification that other diseases fall under, including heart failure and myocarditis.

Heart disease is the leading cause of deaths worldwide. And while it often affects older adults, the causes of heart disease can begin much earlier; making early prevention and detection efforts necessary from as early as childhood. Healthy eating and exercise are ways to help reduce the causes and heart disease, as well as the avoidance of smoking tobacco. You’re never too young— or too old — to take care of your heart. we can help you with regular wellness exams, and setting up a treatment plan, do not hesitate to make an appointment.


Understanding Blood Pressure

We’ve all heard of it. Maybe we have it ourselves or we know someone who has it. Or maybe you or someone you know is currently battling it; fighting each day to keep it under control: High blood pressure. But how well do you understand it? When your nurse or doctor reads you your blood pressure, do you know what it means? Or are you like the average person who knows that the lower the number is the better?

Let’s go over some of the basics. When a nurse or doctor tells you your blood pressure rating, they may say something along the lines of “blood pressure 110/70 (110 over 70),” to let you know where your blood pressure lies.  Blood pressure is not measured in pounds, but in millimeters of mercury (mm HG). The first number, which is generally the higher number, is your systolic pressure. It measures the pressure in the arteries when the heart beats. The second number, which is generally the lower number, is your diastolic pressure. It measures the pressure in the arteries in between heartbeats. Typically more attention is given to the top number (the systolic blood pressure) as a major risk factor for heart disease for people over 50 years old.
According to the American Heart Association, a healthy blood pressure reading is less than 120/80. Pre-hypertension, or slightly elevated blood pressure, is between that and 139/89. Once you creep over those numbers, you are officially at high blood pressure.  Believe it or not, low blood pressure can be a cause for concern as well. While most doctors only consider low blood pressure dangerous when symptoms are displayed, it can also have an underlying cause. Symptoms of low blood pressure include:

  • Dizziness or lightheadedness
  • Fainting
  • Dehydration and unusual thirst
  • Lack of concentration
  • Blurred vision
  • Nausea
  • Cold, clammy, pale skin
  • Rapid, shallow breathing
  • Fatigue
  • Depression

Regular visits to your doctor or cardiologist is the best way to maintain your blood pressure. We can recommend the best treatment or course of action if your blood pressure is too high or too low.


Varicose Veins

So what are varicose veins?

Varicose veins are veins that have become twisted and enlarged near the surface of the skin. Although they can occur anywhere within the body’s veins, they most commonly occur in the veins in the legs and ankles. Veins have what are known as leaflet valves, or one way valves. The purpose of these valves is to prevent blood from flowing backwards (known as retrograde flow or reflux). If these leaflet valves fail, then the blood flows backwards, causing the veins to build pressure and swell. The legs are most affected because the leg muscles pump the veins to return blood to the heart against the effect of gravity. Varicose veins can run in families, but being overweight, being pregnant or having a job where you must stand for
long periods of time can lead to varicose veins. Varicose veins normally aren’t serious, but they can lead to other things and can be painful.

Mild symptoms include:

  • Heaviness, burning, aching, tiredness, or pain in your legs – possibly worsening over long periods of standing
  • Swelling in your feet and ankles.
  • Itching over the vein.

More serious symptoms include:

  • Leg swelling.
  • Swelling and calf pain after you sit or stand for long periods of time.

Skin changes, such as:

  • Color changes.
  • Dry, thinned skin.
  • Inflammation.

If you’re experiencing any of these symptoms, We can examine your veins and let you know if there are any reasons for concern.


Bundle Up!

As we make our way to the winter months in beautiful Ocala, FL, we’re constantly reminded of the usual traditions and feelings that accompany the Autumn and Winter seasons. The supermarkets stock up on their pumpkins and turkeys while the department stores begin to display their various holiday decorations and knickknacks, reminding us of the time for family, fun and feasting.

These months also bring cooler temperatures. A time to bring out our light jackets and sweaters that serves as a refreshing break from the sweltering summer heat. And let not fool ourselves… in the Ocala, in the winter, there can be days, weeks or even a full month where we would need to bring out a winter coat. It can get COLD.

However, did you know that colder temperatures can affect your cardiovascular health? One study showed that 53 percent more cases of heart attack were reported in the winter as opposed to the summer, according to information found in the National Registry of Myocardial Infarction.

Unsurprisingly, the elderly are most likely to experience changes in health due to cooler temperatures. According to an article posted on, the American Heart Association website, “as people age, their ability to maintain a normal internal body temperature often decreases. Because elderly people seem to be relatively insensitive to moderately cold conditions, they can suffer hypothermia without knowing they’re in danger.” Additionally, anyone with heart disease can also be at risk. Colder temperatures can cause chest pain or discomfort in people with coronary heart disease and can increase the risk of heart attack due to overexertion.

As with anything involving cooler temperatures and health issues, the first step is to dress warmly and in layers. Avoiding alcoholic beverages before heading out into the cold, or while outside, is also a good idea as alcohol gives the feeling of warmth, but actually draws heat away from vital organs.

Of course, your local cardiologist, such as the doctors at Cardiovascular Institute of Central Florida, can answer any questions you have regarding proper heart health during winter time.


Halloween has passed, but its just the beginning of indulgence.

The passing of Halloween ushers in a season of food and family time. With every good feast comes an assortment of sweets and deserts meant to serve as the perfect indulgence after a grand meal.

Here are three sweet treats that are a smarter choice you can enjoy with much less of a guilty conscience. They’re healthier, overall, for the body. And a healthy body and healthy heart go hand and hand.

York Peppermint Patties

With only 140 calories, 3g of fat and 0g of trans fat in each bight sized piece, York Peppermint Patties are great way to get your chocolate fix without surpassing – or greatly surpassing – your calorie intake goal. What more is that their minty centers tend to do a great job of stopping any additional cravings.

Chocolate cover fruit and fruit skewers

Fruit on its own can be a pretty great way to satisfy a sweet tooth, but drizzle a little bit of all natural melted dark chocolate on them and WOW! Strawberries, bananas and pineapples tend to be common favorites when dressed in chocolate, but why not try some on whatever your favorite fruit may be. Or you can cut up an assortment of fruit and make fruit skewers. For a frozen treat, try freezing some banana skewers first and then drizzling chocolate over them.

Rice Krispies Treats

They have less sugar than you might expect, especially when made fresh at home. You can even find recipes online to make them with brown rice puffs and brown rice syrup as the sweetener, which are better for controlling blood sugar levels. For an added taste, try drizzling a subtle amount of melted dark chocolate over these as well.

These are just the tip of the iceberg. You can find a wide variety of tasty treats online that will tantalize your appetite without causing you to start your new year off with regret over your desert choices.


Cardiology: A Run Down

When I was asked to write an article about cardiology, it became strikingly clear to me how little I knew of the subject. I knew that cardiology primarily focused on the heart, but not much more beyond that. This then dominoed into how little I knew of the heart itself. I knew that it pumps blood through the body, making it the engine that keeps our body going. I knew that a well-balanced diet with reduced levels of fat and cholesterol, and a steady regiment of light exercise keeps it fairly healthy which keeps one out of the emergency room – at least for heart related issues. But again, that was pretty much all. So it was time to research.

Now of course, I didn’t set out to become a cardiologist overnight. But having more knowledge and understanding of any subject is always better than having less; and so this article became a reason to arm myself with – as well as share – some information I feel anyone who is not a medical professional should know. Particularly if you’re in your mid 30’s (like myself) and considering beginning regular visits to a cardiologist to maintain a healthy heart. After all, how much can we really learn from the various medical dramas airing on television nowadays?

As I set out to learn, I decided to start with the heart; before moving onto the study of it and its disorders. The heart, for all intents and purposes, acts as a pump. It draws blood in and it pumps it back out, creating a continuous circulation of blood throughout the body. It’s divided into four main sections, or chambers. The two upper chambers are known as the left and right atrium, while the two lower chambers are the left and right ventricles. As the blood circulates, it flows into the atria (plural for atrium) and out through the ventricles.

Now some may wonder, just as I did, why there would be a need for four chambers when the heart seems to have two functions. That would be because the left and right sides of the heart have their own functions. The right side of the heart collects de-oxygenated blood and pumps it into the lungs, where carbon dioxide is exchanged for oxygen. From the lungs, the oxygenated blood flows into the left side of the heart where it is then pumped into the body. With every heartbeat, the right ventricle pumps the same amount of blood into the lungs as the left ventricle pumps into the body. The complete heartbeat, from its beginning to the beginning of the next beat, is known as the cardiac cycle.

Cardiology is the medical profession that specializes in disorders of the heart. Just as the heart is complicated and intricate, so is the specialization in the many things that can go wrong. As I continued to research I was amazed to find just how in depth cardiology actually is. There are more commonly known disorders; such as heart failure, which is failure of the heart to pump enough blood to meet the body’s demand. Or varicose veins, which are veins that become enlarged and twisted due to failed valves.

However, the list of disorders that affect the heart extends far beyond what you may have seen or heard on TV, or discussed amongst your family and friends. There are disorders that affect the four chambers or other parts of the heart such as the walls, arteries or valves. There are also disorders that affect the veins or how the blood circulates through them. There are even disorders that can cause the heart to stop pumping blood.

A cardiologist uses their knowledge and understanding of these disorders to help one maintain optimum heart health. Aside from being referred to one by your primary doctor, it is commonly known that it’s generally a good idea to consult one for various reasons. For example, if your family has a history of heart problems, you may want to consider consulting a cardiologist to make sure you are not predisposed to anything. However, I was surprised to learn that some non-cardiac disorders, such as diabetes or gum disease, can contribute to heart disease; so one may want to consult a cardiologist if you have one of those disorders as well.

The bottom line is that cardiology is, in my opinion, one of the most important fields of all medical professions.


A Healthy Balance: Calories and Activity

( – Unfortunately, portion sizes have grown (a lot) in the last several decades—“supersized” portions are often offered at relatively low prices. As a result, our reference point for what a healthy portion looks like may be vastly distorted. For example, today’s bagels or muffins are often at least two servings, yet we tend to eat the whole thing, thinking we’ve only had one serving.

At the same time, more Americans are eating their meals out of the home at restaurants where they can’t control the ingredients. The problem? Some entree portions are packed with an entire day’s worth of calories, fat and/or sodium.

Plate-Infographic“What we eat may be well more than what our body actually needs, and we know excess body weight can spell trouble for the heart,” says JoAnne M. Foody, MD, FACC, Editor-in-Chief. “Adopting a low-fat, heart-healthy diet and being mindful about how much food you are consuming is an important step to making better choices.”

Why Pay Attention to Portions?

Research shows that people eat more when they are given—or take—larger portions. We tend to eat what’s in front of us, often without thinking much of it. But indulging in bigger portions often means you are consuming more calories and fat than your body needs.

“An overloaded plate with ‘supersized’ portions translates to a lot of calories consumed,” adds Penny Kris-Etherton, PhD, RD, Distinguished Professor of Nutrition at Penn State University. “Too many calories results in weight gain—a risk factor for both heart disease and diabetes.”

Bottom line: Healthy portion sizes are likely a lot smaller than what you are used to putting on your plate.

How Much Food is Enough?

It’s highly individual. Your age, gender, current weight and how physically active you are all play a role. Regardless, it’s important to stay in tune with what your body needs. For example, practice eating more mindfully so that you eat to feel satisfied, and not to the point of being overly full.

Your goal should be to eat a diet composed of a variety of foods that are prepared in healthful ways. Be mindful of salt, sugar and saturated fats, and use steaming, sautéing, baking, roasting or grilling methods to cook versus frying.

“Try to fill half your plate with fruits and vegetables, one-fourth with lean protein and one-fourth with a starch like brown rice, whole grain noodles or a small plain baked potato,” says Kris-Etherton. “Take smaller bites and eat slowly.”