Allegheny Health Network

Cardiogenic shock remains a life-threatening challenge for the medical community, but Allegheny Health Network’s (AHN) specialized Shock Team at Allegheny General Hospital is improving patients’ chances for survival.

To boost survival rates in cardiogenic shock, AHN has implemented a multidisciplinary team-based protocol. Identified as the Shock Team, this group includes interventional and heart failure cardiologists, cardiovascular surgeons, and critical care physicians.

Once a patient is diagnosed with cardiogenic shock, the AHN Shock Team activates through a single-call line and assembles within minutes. Aligning with a patient’s needs and planned exit strategy, the team often decides to place a patient on temporary mechanical circulatory support. The temporary heart pump supports circulation for a brief time and aids in reversing metabolic abnormalities.

The Shock Team meets during daily rounds at AHN Allegheny General to assess their patients’ progress and recovery of heart function. They also consider permanent heart pumps or heart transplant if the heart does not recover.

Dr. Subbarao Elapavaluru, cardiothoracic intensivist and surgical director of AHN ECMO services, explained the primary goal is to quickly identify that a patient is in shock before it adversely affects other vital organs, such as the brain, liver, and kidneys.

“A patient can slip into shock within hours and even minutes, so the team’s expertise in recognizing shock is vital to a patient’s survival,” Dr. Elapavaluru said. “It’s also essential that we know when ECMO is the right treatment for a patient and when it’s too late, because we don’t want to needlessly prolong the patient’s and family’s suffering.”

Shock occurs when the heart is so severely damaged that it can’t pump enough blood to meet the body’s needs. Without blood and fresh oxygen reaching the organs and brain, the body goes into a state of shock. It’s often caused by a severe heart attack, but it can also result from other heart issues.

Many patients need advanced monitoring and invasive treatments, such as mechanical heart pumps or extracorporeal membrane oxygenation (ECMO), to allow the heart and lungs to rest. Even with advanced care, about 50% of patients who suffer a myocardial infarction complicated by cardiogenic shock die, according to the American College of Cardiology.

“Temporary heart pumps and ECMO are powerful tools, but not magic bullets. They’re a bridge, a lifeline, which buy us time to address the underlying cause of a patient’s critical illness,” said Karthikeyan Ranganathan, MD, an interventional and heart failure cardiologist who leads the AHN Shock Team.

“That bridge needs to be built and maintained by a team of experts — surgeons, intensivists, cardiologists, nurses, respiratory therapists, pharmacists, rehabilitation teams, and more — all working together to provide the specialized care that these patients desperately need.”

Highest level of international recognition for ECMO excellence

The Extracorporeal Life Support Organization (ELSO) recently awarded AHN Allegheny General the Platinum Level Center of Excellence Award, joining just 13 other adult centers in the U.S. It indicates that AHN Allegheny General demonstrates an exceptional commitment to evidence-based processes and quality measures, staff training and continuing education, patient satisfaction, and ongoing clinical care.

This award adds to AHN Allegheny General’s rich history of ECMO care, previously recognized as a Gold Center of Excellence by the ELSO every year since 2015.

“We are honored to be the recipient of such a prestigious award for the advanced care provided to our patients,” said Tyler VanDyck, MD, cardiothoracic intensivist and medical director of AHN ECMO Services. “This accomplishment reflects the multidisciplinary team’s dedication to advancing health care that we continuously strive to achieve at AHN.”

The multidisciplinary Shock Team at AHN Allegheny General are available 24/7 for consultation or evaluation of a patient with cardiogenic shock. They provide the full spectrum of ECMO care, including patients who require venovenous (VV) ECMO for lung support and venoarterial (VA) ECMO for those needing heart support.

Dr. Ranganathan explained that when a doctor refers a patient for cardiogenic shock, the AHN Shock Team immediately consults with bedside providers at other hospitals to determine a collaborative treatment plan.

“When a patient is too ill for transport to Allegheny General using conventional life support, our mobile team may consider placing the patient on ECMO prior to transfer,” Dr. Ranganathan said. “Then we can transfer the patient to AHN Allegheny General where the highly specialized care continues.”

To activate the cardiogenic Shock Team for patient care consultation or transfer, call the AHN Transfer Center at 1-888-660-4884. For more information on our clinical programs, email our cardiogenic shock and ECMO coordinator Debra Camp at debra.camp@ahn.org.

Articles

Allegheny Health Network's Shock Team at Allegheny General Hospital enhances survival rates for cardiogenic shock patients through a multidisciplinary approach. The team, comprising cardiologists, surgeons, and intensivists, rapidly assembles upon diagnosis to provide timely interventions, including temporary mechanical circulatory support. Daily assessments guide treatment decisions, potentially leading to permanent solutions like heart transplants. The team’s expertise in recognizing shock and timely ECMO application is crucial. AHN's ECMO excellence is internationally recognized, underscoring their commitment to advanced, evidence-based care and patient satisfaction.

AHN's specialized Shock Team at Allegheny General Hospital works to fight against cardiogenic shock.

Cardiogenic Shock: A Silent Killer, But Here’s How AHN’s Shock Team Fights Back

Sleep is much more than a nightly ritual. It’s the foundation of health, impacting everything from cardiovascular function to mental health. Yet for millions of people, quality sleep remains elusive with disorders like sleep apnea, insomnia, restless leg syndrome, and narcolepsy.

The AHN Center for Sleep Medicine doesn’t just help patient sleep better, they address the root cause of their health condition. Through advanced diagnostics, innovative therapies, and personalized care, AHN specialists can give patients relief.

“At our center, we take a multidisciplinary approach to care, combining expertise across specialties to uncover diagnoses and deliver solutions that help our patients achieve restful, restorative sleep,” said Daniel Shade, MD, pulmonologist, sleep medicine specialist, and director of AHN Sleep Medicine.

The team includes specialists from pulmonary medicine; neurology; cardiovascular surgery; psychiatry; ear, nose, and throat surgery; oral maxillofacial surgery; and dental medicine.

Abnormal sleep patterns and their causes are identified by sleep studies, conducted at home or at one of AHN’s seven testing locations. Two studies might be required for a proper evaluation and diagnosis of a sleep disorder — from apnea and narcolepsy to parasomnia and insomnia. Testing options include:

is used to diagnose obstructive sleep apnea in patients who are high risk and don’t have other medical conditions, such as heart disease, pulmonary disease, or neuromuscular disease. It allows patients to sleep at home wearing equipment that collects information about their breathing during sleep.

If results determine the patient has a sleep disorder, they may be scheduled for an in-lab positive airway pressure (PAP) titration study. If a patient tests positive for obstructive sleep apnea, they may be eligible for Auto CPAP therapy, an at-home device that delivers a continuous stream of air at the patient’s optimum pressure level.

requires an overnight stay at one of our sleep centers. It’s a complete evaluation of a patient’s sleep patterns, including brain wave recording, heart rhythm, eye movements, leg movements, respiratory effort, snoring, and oxygen levels. The patient will be scheduled for an in-lab PAP titration study if the sleep study reveals the patient has a sleep disorder.

is a follow-up study that determines the level of airway pressure needed to minimize episodes of a sleep disorder. During the night, the technologist will adjust the airflow to the correct level for the patient’s needs.

AHN offers several treatments for sleep apnea, including continuous positive airway pressure (CPAP) therapy, medication, dental appliances, behavioral therapy, dietary modifications, respiratory muscle stimulation, and surgery.

“After the treatment has started, we will closely monitor the effectiveness of the therapy,” Dr. Shade said. “We will determine if the methods are successful or if the patient would benefit from additional interventions.”

For patients with obstructive sleep apnea, AHN offers a technology called Inspire® that’s implanted just under the collarbone. The patient controls the device with a remote, turning it on before sleep and off when they wake up. It delivers gentle pulses to the airway muscles to keep the airway open so the patient can breathe regularly and sleep soundly.

AHN physicians offer another implantable device called remedē® System, which treats central sleep apnea. The battery-powered system, positioned under the skin in the upper chest area, employs a thin lead to sense breathing patterns and administer stimulation therapy. During sleep, the device stimulates the phrenic nerve, which sends signals to the diaphragm.

“These therapies have been proven to improve a patient’s quality of life, reduce daytime sleepiness, and minimize the overall number of disrupted breathing events,” said Dr. Shade.

AHN provides cognitive behavior therapy for insomnia (CBT-I), an evidence-based approach to treating chronic insomnia by addressing the thoughts and behaviors that disrupt sleep. It focuses on identifying and changing negative beliefs and habits surrounding sleep and replacing them with healthier ones.

AHN has CBT-I trained specialists at several of its primary care offices. Patients can participate in these appointments in person, over the phone, or through a video visit.

“CBT-I focuses on treating the root cause of the insomnia, not just the symptoms,” Dr. Shade said. “It’s drug-free and has lasting results compared to sleep medications.”

The Remedē system is registered trademark of ZOLL® and used with permission. Inspire® is registered trademark of Inspire Medical Systems, Inc., and used with permission.

Sleep is crucial for overall health, yet many suffer from disorders like sleep apnea and insomnia. The AHN Center for Sleep Medicine employs a multidisciplinary approach, utilizing advanced diagnostics and personalized care to address these issues. They offer various testing options, including home and in-lab studies, to accurately diagnose sleep disorders. Treatments for sleep apnea include CPAP therapy, dental appliances, and innovative implantable devices like Inspire® and remedē®. For insomnia, AHN provides cognitive behavior therapy, focusing on long-term solutions without medication.

A collaborative approach to patient sleep health

Allegheny Health Network: Restoring Sleep

We are thrilled that a new cohort of physicians have joined the CVI, and we warmly welcome them to Allegheny Health Network. These talented individuals add much needed expertise to expand the breadth/depth of cardiovascular care we provide in the region. We’re proud to share the following:

Dr. Davies completed medical school at Sanford School of Medicine at the University of South Dakota. He then did residency in internal medicine, fellowship in cardiovascular medicine, and fellowship in advanced cardiac imaging, all at Mayo Clinic, Rochester, MN. His clinical and academic interests include cardiac amyloidosis (ATTR, AL), advanced cardiovascular imaging (Cardiac MRI, CT, PET, and echocardiography), cardiomyopathies (hypertrophic, dilated, genetic, substance/medication-induced), and systemic heart diseases. His wife Sushma (an AHN movement disorders neurologist) moved from Minnesota with our English Cocker Spaniel "Indy.” He enjoys spending time outdoors, hiking, golfing, music, and cooking/eating great food. He loves baseball and is excited to be entrenched Pittsburgh’s sports culture. He will primarily be working at AHN Allegheny General.

Dr. Morgan completed medical school at Edward Via College of Osteopathic Medicine (Blacksburg, VA). She came to Pennsylvania to complete her internal medicine and pediatrics residency at Geisinger Medical Center. She then completed fellowship in multidisciplinary critical care medicine (IM/CCM) at the University of Pittsburgh Medical Center, where she was Chief Fellow.

Her special interests within critical care are primarily related to mechanical circulatory support (especially ECMO) in additional to patient safety (primarily satisfaction and communication). Outside of medicine, she loves spending time outdoors from hiking/running to gardening. She loves cooking and experimenting with new recipes; recently she started dabbling in mixology! She also has a strong creative side and enjoys watercolor and painting. She will be working at AHN Allegheny General.

Dr. Pesyna is a Pittsburgh native, returning home from New York City. He completed medical school at the University of Chicago in Chicago, IL. This was followed by an emergency medicine residency at the Icahn School of Medicine, and anesthesiology critical care medicine at New York Presbyterian Hospital; both in New York, NY. For the past three years, he was an attending physician at Mount Sinai Hospital’s Cardiothoracic and Cardiac Intensive Care Unit, and its Department of Emergency Medicine. He has particular interest in mechanical circulatory support, emergency airway management, and the use of transesophageal echo at the bedside of critically ill patients. He will be working at AHN Allegheny General.

Valentino Bianco, DO, MPH is a board-certified Cardiothoracic Surgeon specializing in cardiac and advanced aortic surgery. Dr. Bianco obtained his Master of Public Health Degree from the University of Pittsburgh and completed his medical degree at the Arizona College of Osteopathic Medicine of Midwestern University. He went on to do his residency training in Cardiothoracic Surgery and Aortic Surgery Fellowship at the University of Pittsburgh Medical Center. After Fellowship, Dr. Bianco was an attending surgeon at Mayo Clinic Arizona and worked as a Senior Associate Consultant in the Division of Cardiovascular Surgery, performing cardiac and advanced aortic surgery. He has numerous national presentations and peer reviewed publications, with a primary focus on clinical outcomes research in cardiac and aortic surgery.

Dr. Nestasie is an interventional cardiologist with AHN Cardiovascular Institute focusing on diagnosing and treating complex heart conditions for patients. Dr. Nestasie attended medical school at Lake Erie College of Osteopathic Medicine in Erie, Pennsylvania. He then completed his internal medicine residency and general cardiology fellowship at Allegheny Health Network in Pittsburgh, Pennsylvania, where he also served as Chief Medical Resident and Chief Cardiology Fellow. During his fellowship, He was inducted to the Alpha Omega Alpha Honor Society through Drexel University College of Medicine for his high academic achievement and demonstration of leadership, education, and service. He was born and raised in the Pittsburgh area. In his free time, he enjoys watching all 3 major Pittsburgh sports teams, outside activities with his family, and helping to coach his son in baseball. His clinical interests include complex coronary artery disease, cardiogenic shock, mechanical circulatory support, pulmonary embolus percutaneous therapies, and left atrial appendage occlusion. He will primarily be at AHN West Penn and AHN Allegheny General.

Dr. Khurana completed his medical school at Sardar Patel Medical College, Bikaner, India. He completed internal medicine residency at the University of Connecticut, Farmington, CT. He came to Pittsburgh for his fellowship in cardiovascular medicine at Allegheny General Hospital, Pittsburgh, PA where he also served as Chief Cardiology Fellow; then remained at Allegheny General Hospital for a one-year fellowship in interventional cardiology. His clinical interests lie in coronary artery disease interventions, structural heart procedures like transcatheter aortic valve replacement (TAVR), pulmonary embolism therapies, and mechanical circulatory support devices. He will primarily be at AHN Forbes and AHN Hempfield.

Dr. Siddique finished medical school at the Chhattisgarh Institute of Medical Sciences, India. She completed her internal medicine residency at Coney Island hospital in Brooklyn, NY. This was followed by a fellowship in cardiovascular medicine from Maimonides Medical Center in Brooklyn, NY. She has an interest in clinical and imaging cardiology, and is excited for what practice has to offer at AHN St. Vincent.

A new cohort of physicians has joined Allegheny Health Network, enhancing cardiovascular and critical care services. Dr. Daniel Davies specializes in cardiac amyloidosis and advanced imaging. Dr. Amelia Morgan focuses on mechanical circulatory support and patient safety. Dr. Colin Pesyna brings expertise in emergency airway management and transesophageal echo. Dr. Valentino Bianco is a cardiothoracic surgeon with a focus on cardiac and aortic surgery outcomes. Dr. Michael Nestasie and Dr. Abhas Khurana specialize in interventional cardiology, with interests in complex coronary interventions and structural heart procedures. Dr. Saniya Siddique focuses on clinical and imaging cardiology.

AHN Welcomes New Physicians

David Stapor, MD
Credit: Allegheny Health Network

At the Allegheny Health Network (AHN) Orthopaedic Institute, bone health is always a focus. AHN Jefferson Hospital was the first medical center in western Pennsylvania to participate in the American Orthopaedic Association’s Own the Bone® program, which uses proven bone care practices along with personalized support to help patients live a full and active life after experiencing a fragility fracture.

Once patients are discharged from the hospital after a fragility fracture, they can be referred to the AHN Osteoporosis and Fragility Fracture Clinic for more specialized care. AHN first brought this dedicated osteoporosis clinic to the region in 2020 and now treats patients in six locations across Pittsburgh’s southern suburbs.

The clinic treats patients who have sustained fragility fractures, provides preventive care for patients with osteoppenia, and helps patients prepare for spine and total joint surgery. Our osteoporosis experts use research-based practices to help strengthen bones and prevent fragility fractures. We also coordinate treatments with primary care providers and other specialists to make sure everything aligns with each patient’s overall health goals.

“We collaborate closely with primary care providers, physical therapists, and other specialists to ensure our patients receive comprehensive, coordinated care,” said David Stapor, MD, orthopaedic surgeon at AHN and lead physician at the Osteoporosis and Fragility Fracture Clinic. “We want to make sure everyone is on the same page and working together to achieve the best possible outcome.”

As part of their comprehensive osteoporosis treatment plan, your patients will have access to a wide range of services including on-site medication injections and infusions, lifestyle and nutrition counseling, collaboration with physical therapy for balance and gait training, and certified professionals in DEXA scan interpretation. “Our goal is to provide a truly holistic approach to bone health,” said Stapor. “We want to empower and educate patients to take control of their bone health and live active, fulfilling lives.”

To refer your patients to the AHN Osteoporosis and Fragility Fracture Clinic, call (412) 267-6200.

The AHN Orthopaedic Institute prioritizes bone health, with AHN Jefferson Hospital being the first in western Pennsylvania to join the Own the Bone® program. This initiative focuses on comprehensive care for patients post-fragility fracture, offering specialized services through the AHN Osteoporosis and Fragility Fracture Clinic. The clinic, established in 2020, provides preventive care, surgery preparation, and treatment coordination with primary care and specialists. Services include medication, lifestyle counseling, and physical therapy collaboration, aiming for a holistic approach to empower patients in managing their bone health.