February 23, 2017

New clinic focuses on treating complex arterial disorders

When Jessica Biggs first met Esther Kim, M.D., associate professor of Medicine at Vanderbilt, the 33-year-old burst into tears.

When Jessica Biggs first met Esther Kim, M.D., associate professor of Medicine at Vanderbilt, the 33-year-old burst into tears.

Biggs said she couldn’t contain her emotions after struggling to find answers for her recurring heart problems.

Jessica Biggs, here with her husband, David, and son, Jackson, was the first patient of a new Vanderbilt clinic dedicated to treating complex arterial disorders.

“Three hospitals, six stents and four heart attacks later, I am finally sitting with the person who can help me,” said Biggs. “I just bawled and hugged her. It had been a very long seven months. I asked her to please help me.”

Biggs was the first patient in the Arteriopathy Clinic, the newest addition at the Vanderbilt Heart and Vascular Institute (VHVI). The clinic specializes in care for patients with complex arterial disorders including spontaneous coronary artery dissection (SCAD) and fibromuscular dysplasia (FMD) and aneurysmal disease.

VHVI is one of a few centers in the country with a dedicated arteriopathy clinic and the only such center in Tennessee.

As director of the Arteriopathy Clinic, Kim provides a new dimension of care as a vascular medicine specialist. She joins Josh Beckman, M.D., director of the Section of Vascular Medicine.

“We are unique to Vanderbilt and this entire area,” said Kim. “The purpose of developing a dedicated clinic is to provide up-to-date, literature-based care for these patients with uncommon vascular diseases who often have delay in diagnosis and require expert care for treatment and dedicated surveillance of their affected blood vessels.

“Review of prior medical records and an in-depth clinical visit is an essential part of the clinic,” she added. “When they come in, I have done extensive work on what the next steps will be and identified specialists in many different fields whose expertise we may need.
“It’s pretty labor intensive, but I want to know how best to attack the problem.”

It is that model of care that offered Biggs her first level of comfort. After two visits, Biggs said she can finally take a deep breath.

“She has gotten me to where I feel somewhat human and normal again,” said the eighth grade English teacher. “I feel safer now. I have gone from taking 12 pills a night to four.

“I am no longer scared to fall asleep for fear I might not wake up. I finally have someone who is looking out for me, and that gives me so much optimism.”

Biggs’ journey to the Arteriopathy Clinic was a jagged one.

“The first time I had symptoms, I ignored them,” said Biggs. “I didn’t know what it was. I bent over, sneezed and when I stood back up, all of a sudden I felt like I had the flu, bronchitis and a pulled muscle all at the same time.”

That was in June 2016. Her online search of her symptoms returned heart attack.

“I kept thinking — ‘I am 32 years old. I don’t have high cholesterol. I don’t have high blood pressure and I am in great shape and athletic. I am not having a heart attack.”’

For the next three days she said she felt fine, like nothing had happened. But on that fourth day, the pain returned. It took her an hour before she called her husband to take her to the emergency room, where she was told she was indeed having a heart attack.

“All my life all I was told about was mammograms and Pap smears,” said Biggs. “No one had ever talked about what a heart attack felt like or what a heart attack looked like for women.

“In reality, I had about 15 minutes left. They said you have 90 minutes with a heart attack, and I was down to my last 15 minutes when I got to the hospital.”

Biggs’ second heart attack came 12 hours later while she was still hospitalized.

In August, four days into the start of the new school year, the pains returned. She was experiencing her third heart attack. Two months later, after her fourth attack, she was diagnosed with SCAD and told about the arrival of one of the country’s premier SCAD physicians.

SCAD is a rare condition that that occurs when a tear forms in one or more blood vessels, which can slow or block blood flow to the heart and cause a heart attack. It is mostly found in middle–aged women with the average age of presentation in the 50s. FMD is another disorder primarily affecting young and otherwise healthy women.

Kim treats patients with a range of cardiovascular disorders but has a special interest in patients with uncommon arterial disorders including FMD and SCAD. She participates in the United States Fibromuscular Dysplasia Registry and is the current chair of the Scientific Advisory Board for SCAD Alliance while serving as the associate editor for the specialty’s premier journal, Vascular Medicine.

The Arteriopathy Clinic provides multidisciplinary care through its collaboration with specialists including stroke/neurology, nephrology, interventional cardiology, interventional radiology, vascular surgery, cardiac surgery, exercise physiology and genetics.

“Our clinic will provide comprehensive medical management and surveillance for patients for whom not a lot of expertise exists in the cardiology world,” said Kim. “We are in the process of starting a couple of registries at Vanderbilt and we will begin taking part in multicenter research projects as well.

“I not only want to care for my patients, but I also want to raise awareness among physicians. It is so important that they become more familiar with these disorders and know that our clinic is here.”