Dr. John Marenco says that, when most people think of health care for the heart, they think about a heart attack or acute coronary event where someone is rushed to the hospital for urgent care. But the practice of cardiology involves far more than treating emergency situations.
“Over the past two or three decades, enormous strides have been made in prevention and the treatment of patients with advanced coronary disease; people live with conditions today that used to lead to death,” said Marenco, a partner at Pioneer Valley Cardiology, P.C., a board-certified cardiac electrophysiologist, director of electrophysiology at Mercy Medical Center, and an assistant professor at Tufts University School of Medicine.
Pioneer Valley Cardiology (PVC) has offices adjacent to Mercy Medical Center and Baystate Medical Center, which allows its 12 board-certified physicians to honor patients’ hospital preferences as well as have access to the most up-to-date medical equipment. “What makes our group unique is that we are able to use either hospital. Decisions are made based on the medical details of each patient and their insurance, but this allows us to choose the best and most efficient treatment options based on the technology that is available,” Marenco said, adding that the group provides additional services at Noble Hospital.
Physicians at PVC perform a wide variety of functions. “It runs the gamut from treating high cholesterol, high blood pressure, obesity, and diabetes to using imagery which includes ultrasound, stress tests, EKGs, and outpatient heart monitors, which are used to diagnose problems and determine if disease is present, to managing conditions once they have been identified,” Marenco explained. All this is accomplished via lifestyle changes, medication, and surgical procedures.
The latter includes angioplasty to open blocked arteries as well as implanting pacemakers and defibrillators in patients with severe heart disease who are at risk for a heart attack or sudden death.
The staff includes two interventional cardiologists who are trained to care for people during an acute heart attack, an arrhythmia specialist (Marenco), and a number of general cardiologists who specialize in imagery, stress testing, and managing chronic cardiac disease. The practice also employs nurse practitioners whose focus is heart failure and the management of cardiac disease.
Having all of these specialists within one group, as well as the technology and medical equipment to conduct testing right in the office, is a bonus for patients.
“We can provide all of the cardiac services someone needs under one roof so people don’t have to be referred to Boston, Hartford, or Worcester and shuttled from one visit to another,” Marenco said, adding that the group has electrocardiogram machines in the office and conduct nuclear stress tests there as well as traditional stress tests on treadmills. “We also do ultrasounds of the legs and carotid arteries in our offices and are moving to one of the most advanced cardiology electronic medical record systems available to improve the efficiency of obtaining and reviewing data; it will make communicating with physicians easier and faster.”
In the Right Vein
PVC began 40 years ago when three Springfield cardiologists made the decision to unite their practices. “The initial group merged with a practice based at Mercy in the late 1990s and opened offices at both Baystate and Mercy,” Marenco said. The practice has continued to grow since that time and today includes in-house nuclear stress testing, electrophysiology, peripheral arterial imaging, and advanced congestive heart-failure services.
Many of the staff members and physicians have been at PVC for decades. Their doctors are in charge of the cardiac intensive care unit at Baystate Medical Center for a significant amount of time each year, and also play a major role in training internal-medicine doctors and future cardiologists at Baystate and Tufts University School of Medicine.
They are also on call for consultations when patients are admitted to the hospital via the emergency room and the hospitalist needs help.
“Our doctors evaluate patients and decide, along with their physicians, what tests or treatments are necessary,” Marenco explained. “Many people today are living with advanced heart disease or congestive heart failure and need advanced services such as a heart-failure specialist.”
The group is expanding its Mercy office at a new site. It is expected to open in the fall, and will contain state-of-the-art equipment to conduct echocardiograms, stress testing, and imaging to help physicians determine if a patient has cardiovascular disease.
The staff and doctors at PVC are proud of their long history and understand how anxious people can become when they are told they need to see a cardiologist. “Patients are worried that they may have heart disease or need surgery,” said Marenco, “so we try to provide them with a pleasant experience. We do all we can to get patients in and out of the office in an expedient manner as well as providing a quick response to phone calls.”
Listening skills are critical, he continued, and the physicians at PVC schedule plenty of time to confer with patients about treatments.
“We try to use traditional training and good clinical ability to provide the patient with an accurate diagnosis. But we also limit the need for and use of tests and procedures; we only order them when it is absolutely necessary,” said Marenco. “There can be complications from tests as well as additional costs to the patient and insurers, along with false positives which make additional testing necessary to clarify the diagnosis.”
Patients at PVC come from a large geographic area. “We’re one of the largest practices in the area and see people throughout the Pioneer Valley, from Southern Vermont to the Berkshires to Northern Conn. to Palmer,” Marenco said.
One of the conditions the group specializes in is atrial fibrillation, also known as AFIB or AF.
“This is an abnormal heart rhythm that affects millions of Americans. It predisposes patients to stroke and results in the upper chambers of the heart beating rapidly and irregularly, which causes palpitations, fatigue, shortness of breath, and chest pain,” said Marenco, who is one the region’s most experienced specialists in treating heart arrhythmias with catheter ablation. “It’s a procedure where small wires or catheters are advanced from a vein in the groin to the heart, where the source of the abnormal heart rhythm can often be eliminated.”
He also treats patients using cyroablation, which involves freezing tissue in the heart where the abnormal rhythms originate. Marenco is the only electrophysiologist in the region who can treat AF with both cryoablation and radiofrequency ablation.
Mercy is one of the first hospitals in the Pioneer Valley to have the advanced technology needed for cyroablation, while both Mercy and Baystate have advanced mapping systems that allow physicians to make a 3-D map of the heart that helps them treat all types of abnormal heart rhythms. “What makes our group unique is that we are independent and able to use either hospital,” Marenco said.
The group’s services range from preoperative assessments to determine the risk of doing surgery on patients with an underlying cardiac condition, to procedures done in and outside of the hospital.
“As treatment become more advanced and people live longer with cardiovascular disease, it gets more complicated,” Marenco said. “Fifty years ago, doctors didn’t do angioplasties or put in pacemakers or defibrillators. But we continue to learn more, which leads to breakthroughs in treatment.”
The practice has also been on the forefront in the management of congestive heart failure, which is usually caused by heart attacks or abnormal heart valves. “By using nurse practitioners and special heart devices, we have been able to reduce the frequency of patients needing hospitalization as a result of retention of fluid in their legs and lungs,” Marenco said.
Changing the Beat
A healthy lifestyle can play an important role in the prevention of cardiovascular disease. But although many people know they are not eating right and shouldn’t smoke, most fail to make changes until they have a problem.
“We typically see people too late — after an internal medicine doctor thinks there is active disease going on,” said Marenco, who urges people to seek help early if they are having unusual symptoms. “It’s up to us to sort out whether there is something wrong, if it is serious, and what to do about it.”
All of which can all be accomplished under one roof at Pioneer Valley Cardiology.