One in four women will die of cardiovascular disease — and one in three of those deaths will have been preventable. Dr. Anabel Facemire hopes to reduce those statistics.
A board-certified cardiologist, Facemire has joined the team at Walla Walla General Hospital to focus on comprehensive care and prevention of cardiovascular disease. Full of energy, the cardiologist glows when she talks about prevention and health, her excitement palpable in her cozy office.
When the mailers introducing Facemire to the community said, “Your heart health is her passion,” it wasn’t an overstatement.
“I’m very passionate about finding heart disease and killing it before it kills you,” Facemire said, her eyes brightening. “I’m also a champion for women. ... We care for our homes and our families, and not always for ourselves. People come in and say, ‘My mom died at 50, I’m 40 — what can I do?’ and my goal is to prevent that.”
Facemire’s zeal for women’s cardiac health stems from how rarely the issue is talked about. Although cardiovascular disease kills both men and women, the symptoms in each might differ wildly. In men, heart disease symptoms include a pressure on and squeezing of the chest, but in women, this pain — angina — might, instead, exhibit as shortness of breath or as pain in the throat, abdomen or back. In men, angina worsens with activity and goes away with rest; however, women are more likely to have angina while resting or sleeping. Some women might have no symptoms at all.
Facemire aims to help women become more aware of the symptoms and risk factors of the disease, while helping all patients work toward prevention and minimizing risks.
Born in Quito, Ecuador, Facemire was a second-grader when she decided to become a doctor. She earned her medical degree at the University of Guayaquil in Ecuador before completing a residency in internal medicine at Graduate/Hahnemann University Hospital in Philadelphia. She then served a fellowship in cardiovascular disease at Mount Sinai Medical Center in New York City. Most recently, Facemire was a general cardiologist, focusing on preventive cardiology and women’s health, in Bel Air, Md.
The Facemires — Anabel; her husband, Fred; and two children, Melody and Ethan — were living at a rapid pace until a family tragedy brought life to a screeching halt. While Anabel continued her medical practice and Fred worked as an engineer, Facemire’s mother, Carmen, cared for the children. In 2014, Carmen was diagnosed with a terminal illness and died three months later.
Realizing they needed a lifestyle change, the Facemires started looking for somewhere slower. Facemire interviewed across the country, from Florida to California, but it took only one visit to WWGH to know where she wanted to go.
“I fell in love with this place,” she said. “I just see a vision in this place to help the community. Everything here is patient-centered.”
That emphasis on patients is something Facemire has yearned for. She prefers to interact with her patients one-on-one, asking questions and building relationships. When approaching women in danger of heart disease, that relationship can bring to the surface risk factors patients did not realize they had.
“I ask questions like, ‘Did you have pre-eclampsia when you were pregnant?’ because there is a connection between heart disease and pre-eclampsia. There is also postpartum cardiomyopathy: women who develop heart failure after giving birth. Early screening is important for women,” she said.
In addition to a personal connection, Facemire has state-of-the-art tools in her toolbox. She works with arrhythmias and uses tests like calcium scoring — checking for the amount of calcium detected in a cardiac CT scan — to help predict and understand a patient’s risks and potential symptoms.
The cardiologist is also trained in TEE — transesophageal echocardiography — a test where a patient will swallow a type of camera that uses sound waves to create pictures of the heart. The TEE is useful for patients with infections or who use prosthetic valves, or for those who have experienced strokes for which there isn’t an obvious cause.
Facemire’s concentration on preventive health complements the work of Dr. Bradley Titus, Walla Walla General’s interventional cardiology and endovascular specialist. While Titus works with emergency and invasive situations, Facemire covers comprehensive care, including prevention, education and noninvasive procedures. She plans to participate in health fairs and public presentations and interact with the community.
Facemire also speaks Spanish and accepts patients who speak little to no English.
Long term, Facemire plans to develop a heart-failure clinic at Walla Walla General. The clinic would have nurses staffed to monitor patients so they can receive personalized care and testing without going into the emergency room. The clinic might also help increase willingness to seek treatment and testing for some women who are resistant to visiting the emergency room.
“I respect each patient’s style and I work with them,” Facemire said. “I usually tell my patients, tell my community, ‘You have to start somewhere. You can’t just give up.’”
Facemire takes a personal interest in her patients, and says she treats every patient as if he or she is a member of her family. She has a drawer of letters and cards from her former patients.
“When I feel tired or discouraged, I open and read,” she said. “I know I have a mission to be a physician. It is a calling. I think we can do great things for the community with the team the Walla Walla General Hospital has.”
Providence St. Mary expands interventional cardiology
The service’s 24-hour availability means patients can be treated rapidly in emergency situations.
Providence St. Mary Medical Center now offers emergency interventional cardiology — seven days a week, 24 hours a day and 365 days a year.
Providence St. Mary has had a cardiology program since the 1970s, but patients in need of emergency heart services had to be transferred. On weekends and after hours, patients had to be taken to Tri-Cities, both increasing the patient’s risk for complications and tying up the emergency medical services team for three hours.
“We’ve been analyzing the need for this in the community for a couple of years. We decided this is something the community deserves,” says Rob Watilo, chief strategy officer for Providence St. Mary. “We want to offer the community the best access to a high standard of care, and we felt the community deserved access to the service 24/7.”
The “emergent primary percutaneous coronary intervention” service went live Feb. 16, and, in March, the Washington State Department of Health designated Providence St. Mary a Level 1 Cardiac Center, the highest designation available.
During a PCI procedure, an interventional cardiology feeds a catheter to the blockage site in the heart and inflates a balloon to open the artery and improve blood flow. A stent is often placed in the heart to keep the artery open.
Watilo said the service is typically measured in the “door-to-balloon time,” or the number of minutes from when a patient arrives at the emergency room until the blockage is cleared. The national standard is 90 minutes; in its first eight weeks, Providence St. Mary has averaged 36 minutes.
On March 9, a patient suffered a heart attack in a field in North Powder, Ore., 107 miles from Walla Walla. The patient was airlifted to Providence St. Mary, where the team was prepped and ready to go as soon as the helicopter landed. On that patient, the door-to-balloon time was 12 minutes.
Without the expanded care, that patient would have had to travel an extra distance to Tri-Cities or Boise — each extra mile putting his heart at greater risk.
“Things have been going really better than anybody could have expected,” says Dr. Lisa Abrahams, an interventional cardiologist. “I think people are really happy to see us here.”
Watilo attributes the program’s success to the staff and to early preparation. The organization hired extra staff and brought on additional sets of equipment for the expansion. Once the program was set in motion, teams spent more than three months on focused preparations, including holding practice drills in the hospital and with partner agencies, such as emergency medical services.
The emergency interventional services mean Providence St. Mary can serve patients on the entire spectrum, from diagnostics to angiograms, emergencies to cardiac rehab, 24 hours a day. Abrahams said the expanded services allow Providence St. Mary to serve emergency heart attacks and other stages of heart disease.
“It’s not just all about the major heart attacks. It’s about the patients who don’t realize they’re having heart pain or a heart attack,” Abrahams said. “People, in general, think it’s going to be severe pain, and it isn’t. In most people, it’s a squeezing, a pressure, and not that ‘hit your thumb with a hammer’ pain. People always tell me, ‘Well, I would have come in sooner if I’d known.’ If a person starts to have chest discomfort that is new to them, they need to come in.”
Common heart attack symptoms for women
- Shortness of breath
- Lighteadedness or dizziness
- Pain or discomfort in arms, back, neck, jaw or stomach
- Pressure on or squeezing in the center of the chest
- Chest pain
Common heart attack symptoms for men
- Heartburn, indigestion or stomach pains
- Headache, toothache or pain in the jaw
- Cold sweat
- Sharp pain in the arm (most commonly the left)
- or the upper back
- General chest discomfort that may not be painful
- Pain, fullness or squeezing in the chest — sometimes described as an elephant sitting on the chest.
- Chest pain