Staying Ahead of Heart Failure: Janet’s Story

To see Janet Henry now, as a successful Human Resources executive for an international chain of stores, and gracious hostess who loves to entertain, it’s hard to realize all she has been through. In the space of one year, she experienced serious health crises: breast cancer, followed by toxic shock, followed by heart failure.

Janet.heart.failure“Many people don’t realize that heart failure is not the same as heart disease,” explains cardiologist Sara Weiss, MD. “Patients with heart disease experience atherosclerotic plaque, or hardening of the vessels which may lead to a heart attack. Heart failure happens when the heart muscle is weakened and is failing to pump consistently enough to serve the needs of the body.”

Heart failure can be caused by heart attack, alcohol abuse, or, in Janet’s case, a complication of the medication she was receiving to combat breast cancer.

When the cancer therapy began, Janet’s oncologist Nanette Robinson, MD, knew one of the biologic medications (a medicinal preparation made from living organisms and their products) would have to be monitored closely because of its possible impact on the heart. Throughout treatment, she and Dr. Weiss, communicated, overseeing Janet’s treatment to minimize, when possible, any impact on her heart. Then, in the middle of the cancer treatment, Janet contracted toxic shock which added to the stress on her heart. Soon after, she began to feel the extreme fatigue that is an indicator of heart failure.

“Because I was in the middle of cancer therapy it was difficult to understand what was causing the fatigue,” Janet remembers. “When we determined the fatigue was caused by heart failure, I began seeing Dr. Weiss weekly. She prescribed and adjusted medication strengths until we had the right dosage and I didn’t feel the fatigue anymore.

“I think I’m doing really well with the medication,” Janet adds. “My heart numbers are right where they’re supposed to be.”

“Heart failure is very treatable,” according to Dr. Weiss. “Medication and special pacemakers are the primary treatment. Patients are also encouraged to make lifestyle changes, which include eating healthy food, exercising and maintaining a healthy weight.”

Heart failure can also be experienced as shortness of breath because of fluid buildup in their lungs or abdomen. To prevent heart failure, Dr. Weiss recommends that patients work with their primary care provider to learn what their health numbers are for blood pressure, cholesterol level, body mass index and glucose level. They should also follow a plan to control existing conditions including high blood pressure and diabetes.

Janet is now cancer-free and her heart failure is under control. Along with the medical support she received, Janet credits Team Janet, her family and friends whose “tremendous support saw her through this difficult time.” Janet maintains her health with a low salt diet. She also added a new member to her family, an energetic black lab named Annie, who encourages her to walk every day.

 


A version of this story also appears in the Virginia Mason Health System 2018 Annual Report. 

Watchman Device Potential Alternative to Blood Thinners

People with atrial fibrillation – an abnormal, irregular heart rate – are at increased risk of stroke due to blood clots. The abnormal rhythm may cause blood to pool and form clots, mainly in a small chamber of the heart known as the left atrial appendage. To prevent these clots from forming, many atrial fibrillation patients considered at high risk for stroke are treated with blood thinning medications such as warfarin.

But there’s a catch: for many patients, taking blood thinners is problematic, due to bleeding issues or other health problems that interfere with the medication. For the right patient, a new device offers a potential alternative to long-term blood thinners. The device, called the Watchman, is a quarter-sized implant placed in the left atrial appendage of the heart. Once in place, it permanently closes off the appendage, preventing clots from escaping and causing a stroke.

WATCHMAN_device

Watchman Device Implant

The minimally invasive Watchman procedure is performed under general anesthesia through a catheter inserted in the groin. Patients typically leave the hospital the next day and quickly return to normal activities.

“The Watchman device is a great alternative for patients with a history of bleeding, frailty, falls, dementia or inability to maintain their target blood values on warfarin, despite their best efforts,” says Moses Mathur, MD, interventional cardiologist, Virginia Mason Heart Institute.

Patient Selection a Key to Success

While the goal of implanting the Watchman device is eliminating medications like warfarin, patients must be able to take a short course of blood thinners after the procedure until imaging tests show the appendage is permanently closed. After that, patients are transitioned to an aspirin regimen.

Other key criteria for Watchman candidates include:

  • Diagnosis of atrial fibrillation not due to a heart valve problem (such as rheumatic mitral stenosis, or presence of a mechanical heart valve)
  • Increased risk for stroke based on age and other current health conditions
  • Left atrial appendage anatomy compatible with the Watchman device
  • Ability to undergo an ultrasound scan of the heart (transesophageal echocardiogram), to ensure no existing clots are present and to examine the left atrial appendage during and after the procedure

Due to thorough patient assessments and the focus of an experienced team, Virginia Mason has an over 95 percent success rate implanting the Watchman device and eliminating long-term blood thinner regimens for patients.

“By assuming a small procedural risk up front, patients are offered the promise of being warfarin-free for the rest of their lives,” says Dr. Mathur. “And along with that comes fewer side-effects, less bleeding and less cost, year after year.”

Why the Heart Institute at Virginia Mason?

The Watchman procedure requires a heart team with expertise in structural interventional cardiology, where interventional cardiologists, electrophysiologists, imaging specialists and others work together to achieve the best outcomes for patients. This approach ensures every part of the procedure – from patient selection to post-procedure follow-up care – results in fewer complications and an optimal recovery.

Cryoablation: New Hope for a Heart Out of Sync

VM_Heartv2

Jon Zimmerman

Imagine you are speaking to a large audience when your heart suddenly starts fluttering and racing. You have to finish your talk without letting anyone know about the symptoms you are experiencing. Sounds like a nightmare, but this was Jon Zimmerman’s reality.

Despite these symptoms, Jon continued his grueling speaking schedule for 10 months, hoping the irregular heartbeats (arrhythmia) would stop. But they didn’t. Jon realized he had two choices: he could quit his profession or find a way to stop the arrhythmia.

First, he saw a cardiologist at another medical center but was dissatisfied with the impersonal approach. He didn’t believe he was getting the attention he needed. Then, a friend of his wife suggested he get an appointment with Virginia Mason cardiologist and electrophysiologist Christopher Fellows, MD, FACC, FHRS.

Dr. Fellows and Virginia Mason’s electrophysiology team are a regional referral center for the Pacific Northwest, and perform more than 1,800 electrophysiology tests and ablations (to correct irregular heart rhythms) a year.

“At that first visit with Dr. Fellows, I knew I was in the right hands,” Jon recalls. “Dr. Fellows was very focused on me. He asked all the right questions about my history and how I was feeling. I knew I was with a top-notch professional.”

To achieve an exact diagnosis, Jon was given a physical exam to check his pulse, blood pressure and lungs; an EKG (electrocardiogram) to record the electric impulses of his heart; a stress test to monitor his heart during exercise; a chest X-ray to view the heart and lungs; and a blood test to check for thyroid and metabolic conditions.

When the results were analyzed, it was determined Jon had an atrial flutter, which occurs when the upper chambers of the heart beat too quickly and are out of sync with the lower chambers (ventricles). He also had atrial fibrillation (AFib), when the four chambers of the heart contract at different speeds because of faulty electrical signaling.

Dr. Fellows prescribed cryoablation to restore the normal heart rhythm. During the procedure, a balloon catheter was inserted into a blood vessel in the upper leg. Using advanced imaging techniques, Dr. Fellows then threaded it though Jon’s body until it reached the heart and the inflatable balloon on the end reached the pulmonary vein.

When the balloon was at the opening of the pulmonary vein, extremely cold energy was directed through the catheter to freeze a small amount of tissue at the opening of the vein. This blocks the electrical signals that caused the AFib and restores a healthy heart rhythm.

“We have found that using cold, instead of heat, for cardiac ablation increases the chance of success and decreases the risk of serious complication,” Dr. Fellows says, adding, “Recent studies have found cryoablation to be significantly more effective than medication, and patients generally experience less pain than with radiofrequency ablation.”

“I was symptom-free as soon as the procedure was completed,” Jon states. “Dr. Fellows gave me my life back. I’m traveling and making presentations. My wife and I are able to enjoy hiking and riding our bikes again. This hospital is where miracles happen.”

Jon’s annual aftercare is with cardiologist Gordon Kritzer, MD, FACC. “The handoff was perfection personified, which added to my confidence,” he adds. “I see Dr. Kritzer every year now.”

Jon gives the attention he received at Virginia Mason high marks. “Not just those who provided and supported my care, but also the team members who communicated with me clearly so I knew what I needed to do and what to expect. They all are world-class.”


A version of this story also appears in the Virginia Mason Health System Annual Report.

New Heart Valve Possible for More Patients with TAVR

**By Moses Mathur, MD, MSc, FACC**

HeartbeatLess than a decade ago, replacing the aortic valve required open-heart surgery and involved a long recovery.

Then in 2002, the first transcatheter aortic valve replacement (TAVR) was performed in France – a tipping point that spurred a period of intense clinical research and medical device development. The culmination of these efforts led to Food and Drug Administration (FDA) approval of the first TAVR device in the United States in 2011.

Today, select hospitals around the country with comprehensive heart care programs, like Virginia Mason, offer the catheter-based procedure for people affected by severe aortic stenosis, which happens when calcium deposits form and reduce blood flow through the aortic valve.

Treating severe aortic stenosis in Seattle

Between 2015 and 2017, Virginia Mason interventional cardiologists performed 112 TAVR cases in a specialized “hybrid” cardiac catheterization lab.

One patient who underwent the procedure last year is 90-year-old Juneau, Alaska resident Finn Larsen, who learned about TAVR from his family doctor. Knowing Larsen had long suffered from shortness of breath, his doctor told him he might be a candidate for the minimally invasive surgery given his symptoms and age.

“My choice to avoid open-heart surgery made the decision to have TAVR an easy one,” said Larsen, a father of three who has six grandchildren and two great-grandchildren. “I definitely feel better and take solace in knowing that I can soon begin cardiac rehab and resume normal activities.”

How TAVR works

Almost all TAVR procedures can be performed through catheters (small plastic tubes) placed in the arteries of the leg or hand. For a minority of cases, where leg arteries are too small for TAVR delivery, several alternative approaches exist. The most appropriate TAVR delivery approach is finalized after a discussion between the interventional cardiologist and heart surgeon, who work together.

Similar to how a stent is placed in a coronary artery, TAVR delivers a collapsed, biologic replacement valve to the aortic valve site through a catheter. The patient’s diseased aortic valve is replaced without being removed. The new valve is inserted within the old valve using X-ray and ultrasound guidance. Once delivered, the replacement valve instantly takes over the job of regulating blood flow.

Most TAVR procedures are performed under light anesthesia without a breathing tube, which helps with faster recovery. In most cases, patients are able to walk the next day and are usually discharged within one to two days of the procedure.

Risk vs. rewards

As with any procedure, TAVR is associated with some risks. Potential complications include vascular injury, post-procedure stroke, the need for a permanent pacemaker, or a leak allowing blood to flow around the TAVR valve. With improvements in device design and implantation technique, the risk of complications has diminished significantly over the last few years. These advances have enabled patients considered too frail for traditional heart surgery to receive the life-saving procedure.

Good candidates

Currently, TAVR is approved for patients with symptomatic, severe aortic stenosis, who are at intermediate or high risk for undergoing open-heart surgery. Advanced age increases risk, as does chronic illness or a condition that would complicate open-heart surgery and recovery. A care team comprised of specialists in cardiothoracic surgery, interventional cardiology, anesthesiology and echocardiography work together to determine the best candidates for TAVR.

People interested in learning if they might be candidates for TAVR should speak with their primary care provider or a cardiologist.


Moses Mathur, MD, MSc, FACC, is board certified in interventional cardiology, general Dr Moses Mathurcardiology, echocardiography and internal medicine. He practices at Virginia Mason Hospital and Seattle Medical Center. Dr. Mathur specializes in structural and interventional cardiology, transcatheter aortic valve replacement (TAVR), MitraClip, Watchman, atrial septal defect (ASD) and patent foramen ovale (PFO)

 

A New Life After Open Heart Surgery: Daniel’s Story

DanDaniel Lo, 77, was diagnosed in 2010 with multiple myeloma, a relatively rare cancer affecting plasma cells in the bone marrow. The condition was discovered when Daniel was scheduled for open heart surgery to repair blockages found during a routine angiogram. The diagnosis was a surprise since Daniel had none of the symptoms of multiple myeloma, which include fatigue and problems with bruising and bleeding.

The heart surgery was canceled and Daniel began chemotherapy, while his family gathered round to lend their support. Daniel and his wife, Colleen, had raised three sons and were looking forward to a move to Edmonds following his retirement after 40 years as a pharmacist in the Tacoma area.

“There was a lot going on for us,” says Daniel. Rather than open heart surgery, his cardiologist decided to put in stents while Daniel continued his chemotherapy. He and Colleen made the move to Edmonds and for a couple of years, Daniel was relatively stable. But in May 2012, he was diagnosed with congestive heart failure, an inability of the heart to pump adequately. Symptoms include shortness of breath, fluid retention and rapid heartbeat.

Daniel’s daughter-in-law, who is a nurse, recommended he transfer his cardiac care to Virginia Mason. “It was a good move,” says Daniel. He desperately needed open heart surgery, but it was considered too risky because of his ongoing chemotherapy for the multiple myeloma. The Virginia Mason doctor gave Daniel hope that the surgery could be done. In late spring of 2014, Daniel was well enough to go off chemotherapy for two months, a requirement for the surgery to be scheduled.

“The multiple myeloma made surgery a big risk, but because they took that risk, I got my life back.” 

In June, the open heart surgery was done to replace Daniel’s mitral and aortic valves. During the hours-long operation, Colleen was surrounded by family and appreciated the Virginia Mason practice of frequent updates on how the surgery was progressing.

By the time Daniel was out of recovery and into intensive care, he was “really doing well.” He could tell right away, he says, that the surgery was successful because of the way he felt. After seven days in the hospital, Daniel went to a transitional rehab facility and then home. For now, Daniel doesn’t need to resume chemotherapy since tests show that he is “stable.” There is no cure for multiple myeloma.

Today, Daniel goes to the gym regularly to do exercises that keep his heart strong. “And I go for walks just like a normal person,” he says with a laugh. He adds that one of the things he appreciates most about his care at Virginia Mason is that the doctors decided to do the surgery at all. “The multiple myeloma made it a big risk,” says Daniel, “but because they took that risk, I got my life back.”

Heartburn or Heart Attack? Pay Attention to Symptoms

**By Gordon L. Kritzer, MD, FACC**

heartattackSince large meals are often part of celebrating, it’s easy to overdo it on special occasions. If you’ve just eaten a big meal and you feel a burning sensation in your chest, you might think it is heartburn, and it might be. However, there is a chance that the chest pain could be caused by reduced blood flow to your heart (angina), or an actual heart attack.

What is heartburn?

Heartburn, often called acid indigestion, is discomfort or actual pain caused by digestive acid moving into the esophagus, which carries swallowed food to your stomach.

Signs of classic heartburn are:

  • A burning sensation starting in the upper abdomen and moving up into the chest after eating, or while bending over or lying down.
  • Symptoms that awaken you from sleep, especially if you have eaten within two hours of going to bed.
  • Symptoms that are relieved by antacids.
  • Getting a sour taste in your mouth, especially when lying down.
  • A small amount of stomach contents rising up into the back of your throat (regurgitation).

Common confusion

Despite its name, heartburn is related to your esophagus, not your heart. But because the esophagus and heart are located near each other, either one can cause chest pain that sometimes radiates to your neck, throat or jaw. This is why many people mistake heartburn for angina and vice versa.

Since heartburn, angina and heart attack may feel very much alike, even experienced doctors cannot always tell the difference from your medical history and a physical exam. That is why if you go to an emergency department for chest pain, you will immediately have tests to rule out a heart attack.

What to do if you’re unsure

I often tell patients that if you burp and symptoms go away, it probably isn’t related to your heart, but to your esophagus. However, if you suddenly experience shortness of breath and sweating or persistent chest pain, then it’s likely a heart-related issue and you should call 911 immediately.

Also, call your doctor if you had an episode of unexplained chest pain that went away within a few hours. This is important because both heartburn and a developing heart attack can cause symptoms that subside after a while. The pain does not have to last a long time to be a warning sign.

Heart attack vs. sudden cardiac arrest

It is also important that people are able to recognize the difference between a heart attack and sudden cardiac arrest. When someone is having a heart attack, he or she is conscious and might complain of chest pain or other symptoms.

When a person is experiencing sudden cardiac arrest, the heart has unexpectedly stopped beating and blood is no longer pumping throughout the body or brain. The individual may lose consciousness and appear lifeless. Some victims gasp and shake as if they are having a seizure. Death can occur within minutes.

If someone is experiencing heart trouble, here are five ways to help them:

  • Call 911. Whether it is a heart attack or sudden cardiac arrest, step one is always to call 911 to report the emergency and allow emergency dispatchers to coach you through some simple, potentially lifesaving steps.
  • Ease strain on the heart. If the person is conscious and possibly suffering a heart attack, help move them into a comfortable position – half-sitting, with head and shoulders well supported and knees bent, to ease strain on the heart. Also, loosen clothing at the neck, chest and waist.
  • Have the person chew and swallow an aspirin. If the person is conscious, give them a full dose (300 mg) of aspirin. Have the person chew it slowly so it dissolves and is absorbed into the bloodstream more quickly when it reaches the stomach. Aspirin helps break down blood clots, minimizing muscle damage during a heart attack.
  • Perform cardiopulmonary resuscitation (CPR). If the person is unconscious, the next step is to start chest compressions. To do this, press down hard (about two inches deep) and fast (100-120 times per minute) on the center of the chest.
  • Look for an automated external defibrillator. These commonly found devices have clear instructions and are designed for use by the public. To use one, simply attach the pads as indicated on the machine, then it will talk you through the process. It will only deliver a shock if the patient’s condition warrants it. Leave the machine switched on at all times, and leave the pads attached – even if the patient has recovered.

Awareness is key

Learning to recognize simple heartburn and the symptoms of a serious heart condition will help you act quickly when it matters most. Knowledge is power as we become better health advocates for ourselves and for others.


Gordon L. Kritzer, MD, FACC, is a board certified cardiologist who specializes in interventional and invasive cardiology as well as cardiac rehabilitation. He practices in the Heart Institute at Virginia Mason Hospital and Seattle Medical Center (206-341-1111). For more information, watch Dr. Kritzer’s “Signs of a Heart Attack” video.

 

Advanced Procedure Makes Heart Valve Replacement Possible for More Patients

Heart_Partridge_Rantos_low_res

With his new heart valve, Bob Partridge can walk without getting winded. Trish Rantos, ARNP, measures his progress.

When Bob Partridge’s cardiologist told him it was time to treat his faulty heart valve, Bob was very aware of the problem. He couldn’t walk the 14 steps from his basement to the kitchen without stopping to catch his breath or even make it across his yard. Bob’s aortic valve had narrowed, obstructing blood flow. His heart straining to pump enough blood left him profoundly tired and weak.

Bob had severe aortic valve stenosis, a condition primarily treated by replacing the valve during open-heart surgery. Because Bob has a stoma — a permanent opening in his neck to breathe following treatment for laryngeal cancer — a chest wound from operating on his heart might become infected. Open-heart surgery was too risky for Bob, but his interventional cardiologist, Gordon Kritzer, MD, FACC, had a less invasive treatment in mind.

Bob learned he could receive his new heart valve by way of a balloon catheter inserted through a small incision in his groin. Known as transcatheter aortic valve replacement, or TAVR, a new valve is guided through an artery all the way to the heart, then expanded to replace the damaged valve. A newly constructed operating suite with the advanced imaging capability needed to perform TAVR had just opened at Virginia Mason. Bob would be the first patient to undergo the procedure there.

“I had no objection; they are great doctors,” says Bob. “I have a lot of faith in Dr. Kritzer, and Dr. Velamoor (cardiac surgeon Gautam R. Velamoor, MD, FACS) really impressed me. I said let’s do it. Somebody has to be first.”

Right after the procedure, Dr. Kritzer reported to Bob’s wife, Jacolyn, that everything had gone very well and she’d be able to see him in a few minutes. “He got such good care afterward, they were really on the case,” remembers Jacolyn. “His recuperation was so much easier than it would have been with open-heart surgery.”

Bob went home only five days after having TAVR. He wore a monitor for the first couple of weeks to track his heart rate, but didn’t feel any pain or other effects from the procedure. What he did feel was back to normal, walking and taking the stairs like he used to, without getting winded.

“My laryngectomy was a big operation, but TAVR wasn’t anything compared to that,” says Bob. “I was very willing to go along with it because I like my doctors, I know them. It was a good experience.”

 

New Procedure Helps Some Patients Avoid Coronary Bypass Surgery

Virginia Mason’s cardiovascular intervention team treats hundreds of blocked coronary arteries every year, all by way of small incisions and specially equipped catheters in a procedure known as percutaneous coronary intervention (PCI). Recently, cardiologists Gordon Kritzer, MD, and Wayne Hwang, MD, performed successful PCIs on patients who might otherwise have required major surgery to bypass their severely blocked arteries. 

The patients suffered from chronic total occlusion (CTO), a complete, longtime blockage of a coronary artery with debilitating symptoms including frequent chest pain. In the past CTO has proved challenging to treat with PCI, as total blockages are frequently impervious to the usual catheter-based tools. Now with more advanced operative tools and improved techniques, success rates of treating CTO with this minimally invasive technique have increased dramatically.

“This is an exciting technique we can use to treat patients with severe symptoms and high-risk occlusions of their coronary arteries,” says Dr. Kritzer. “These new CTO techniques use a different approach, with new wires and tools, and special training for physicians and catheterization lab staff. With these improvements the success rates for opening totally occluded vessels has gone from below 50 percent to near 90 percent.” 

Because treating CTO in the catheterization lab requires an initial investment in both training and new equipment, not all medical centers choose to offer the advanced procedure. Dr. Hwang, director, Cardiac Catheterization Laboratory, notes that senior leadership at Virginia Mason was in favor of the practice from the beginning. 

“We knew bringing this cutting-edge capability to Virginia Mason was essential to keeping us at the forefront,” said Dr. Hwang. “These are the most demanding and challenging type of cases that we face.” 

Identifying appropriate patients remains a critical part of successfully treating CTO using catheterization. Drs. Kritzer and Hwang rely on a patient algorithm developed especially for determining good candidates for the procedure. With proper patient selection, complication rates of performing PCI for CTO patients are comparable to those of treating non-CTO cases, and many patients can be spared the trauma and risk of invasive coronary bypass surgery. 

“Our first patient who underwent CTO treatment in the catheterization lab was up and walking the halls the same day as her procedure,” says Michaelle Wetteland, RN, director, Acute Care Services. “She said she felt great.”

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A version of this article was originally published on Virginia Mason’s internal news site.

Give Your Heart Healthy Goals Inspiration This Valentine’s Day

by Diane Osborn, ARNP ***

Statistics regarding heart disease as the No. 1 killer of both men and women in the United States abound. Few people doubt the benefits of regular exercise, healthy eating, weight control and smoking cessation, all of which can significantly reduce one’s risk of experiencing a heart attack or a stroke. In fact, countless people attempt to change unhealthy habits each year as evidenced by improved fitness being the most popular New Year’s resolution two years in a row. Unfortunately one third of these goals are abandoned by February, and 90 percent fail by year’s end. Why is it so hard to follow through on such good intentions?  

HeartDecisions about lifestyle behaviors do not result from rational, logical or deductive thought processes. Instead, behavioral decisions take place in the emotional part of the brain. Sustained heart-healthy change requires inspiration, a clear vision and ample self-worth. We need to not only believe that we can succeed, but also value ourselves enough to make our objectives a priority. 

Most people today are time-starved, stressed out and budget-challenged. We have limited resources that are quickly used up if we do not take the time to care for ourselves. Changing your mindset to embrace your heart will take time. Focus on developing a vision or long-term goals that inspire you to pursue healthy habits every day, every week, every month and every year.

***
Diane Osborn, ARNP, works for the Virginia Mason Cardiac Wellness Clinic.

Get Heart Healthy with a Mediterranean-Inspired Pacific Northwest Diet

by Tina Marsh Begg, MS, RD, CD ***

The health benefits associated with the traditional Mediterranean diet are no secret:  lower risk of heart attack, lower cholesterol levels and lower blood pressure. But have you ever wondered how to adopt a more Mediterranean diet given the (often cold and gray) Pacific Northwest climate? Surprisingly, many foods found in the traditional Mediterranean diet have alternatives found right in our backyard. 

iStock_000016218804Small[1]The traditional Mediterranean diet is rich in minimally processed foods with an abundance of plant foods including vegetables, fruits, whole grains and legumes. Only modest amounts of red meat are consumed while seafood plays a very prominent role, especially oily fish like sardines and mackerel. A great Pacific Northwest alternative to these Mediterranean fish is, you guessed it, SALMON!  

Salmon sourced from the cold waters of the Pacific (Washington, Alaska and British Columbia, Canada) is an excellent source of the same heart-healthy fats found in abundance in the Mediterranean diet. Strive to include oily fish in your weekly diet when in season. 

Round out your meals with an array of colorful seasonal vegetables or greens with an extra-virgin olive oil dressing and a side of herbed whole grains. Enjoy this with a small glass of Washington state red wine with your dinner meals. 

End your meals the Mediterranean way: fruit-based desserts (think Northwest berries) with slivered nuts and a hint of sweetness from honey.   

Roasted Salmon with Fresh Herbs

  • 2 pounds skinless salmon fillet, wild-caught
  • 1/4 cup extra-virgin olive oil
  • 3 tablespoons lemon juice, freshly squeezed
  • 1/3 cup scallions, minced, white and green parts
  • 1/2 cup fresh dill, minced
  • 1/2 cup fresh parsley, minced
  • 1/4 cup Washington state dry white wine (such as dry riesling or pinot gris)
  • kosher salt and pepper, to taste
  • lemon wedges, for serving 
  1. Preheat oven to 425 degrees. 
  2. Place salmon in a ceramic, glass or stainless-steel roasting pan and sprinkle with two small pinches salt, generous amount of pepper. 
  3. Whisk together olive oil and lemon juice and drizzle evenly over the salmon.
  4. Let it stand at room temperature for 15 minutes.  
  5. In a small bowl, mix together scallions, dill and parsley. Scatter the herb mixture over the salmon, turning it over so that herbs cover both sides of the salmon. Pour wine around the salmon fillet. 
  6. Roast the salmon for 10-12 minutes, until almost cooked in the center (or thickest part). Remove salmon from oven and cover dish tightly with aluminum foil and allow salmon to rest for 10 minutes. Serve hot with lemon wedges.

***
Tina Marsh Begg, MS, RD, CD, is a nutritionist with the Virginia Mason Cardiac Wellness Clinic.