Nora Eccles Harrison Cardiovascular Research & Training Institute

Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies

Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies

Heat Graphic inside of body- Managing Cardiac Ischemia: Treatment Options and Lifestyle Strategies Graphic

Cardiac ischemia is a condition that is caused by a loss of proper blood flow to the heart, usually as a result of buildup in coronary arteries which are the arteries that feed the heart. Understanding how to treat this condition and manage a healthy lifestyle can go a long way in making ischemia a less life-threatening diagnosis. Of course, every patient is different, so the treatment options can be different as well.

It’s important to manage this condition because ischemia can lead to a higher risk of heart attack and heart disease, as well as a higher risk of death due to heart disease or heart failure. To manage it, of course, you need to start by having a better understanding of cardiac ischemia and all that it can do.

Symptoms and Diagnosis

Cardiac ischemia is usually characterized by pain in the chest or shortness of breath when you perform any strenuous activity. It may also include arm pain, tingling or numbness, and other symptoms, but it’s generally a feeling of discomfort all around. For those with more severe cases, the pain may also be more severe and that could indicate that getting treatment is even more serious.

There are several different diagnostic tools used to determine if someone has ischemic heart disease. An EKG test can be performed while a person is resting. The most diagnostic non-invasive option is to do a stress test. This can be done with physical exercise, or for those who can’t exercise, a chemical based test can be performed instead.

In a stress test, the heart is put under a lot of exertion to see what it can handle. At the same time, you’re hooked up to an ECG and carefully monitored. There are also instances where imaging and other diagnostic tools are used alongside stress tests to get an accurate diagnosis.

Managing Cardiac Ischemia

So, how do you manage cardiac ischemia? Well, that depends on several factors. For starters, it will be important to consider how severe your condition is. Those who have milder forms of the disease may not need to do as much. A few simple lifestyle changes could make a big impact. For others, it might become a full-time job to manage this condition. As mentioned, education goes a long way in helping.

What is the first line of treatment for ischemic heart disease? Usually, it’s a combination of medication(s) and exercise along with lifestyle changes. Especially when the condition is caught early enough, these efforts can make big impacts. The changes that you make to your lifestyle and the medications that you need will depend on your specific circumstances, of course, so be sure to talk to your doctor and figure out what’s best.

Exercise and Rehabilitation

Medications can help, as do exercise and rehab. Physical exercise is best, at a level that is comfortable for the individual. This can help strengthen the heart muscle, and improve overall health.

What exercise is good for ischemia? Honestly, there’s a lot that you can do. Aerobic exercise is best, such as walking, biking, light jogging, or even swimming. If you want to stick to the gym, try an elliptical for low-impact, high-power cardio. Also, make sure that you stretch before and after you exercise to keep your muscles loose and help your heart maintain a regular rhythm.

Talk to your doctor because not all exercises are good for all patients when it comes to heart disease. Some people may be limited to light walks and water aerobics, for example, because they are easy and low impact.

Lifestyle Changes

There are also several lifestyle changes that you may have to undertake as part of managing cardiac ischemia. In addition to adding exercise to your daily routine (30-60 minutes per day, five days per week), you should also:

  • Eat a diet low in saturated fats, trans fats, cholesterol, and salt.
  • Eat lots of whole grains, fruits, and vegetables.
  • Reduce stress and alleviate depression.
  • Stop smoking.
  • Limit alcohol intake (or just stop).
  • Take the prescribed medications for your heart condition and other diseases.

Create Your Management Plan

The best thing that you can do if you are diagnosed with cardiac ischemia is to work with your doctor to come up with a plan to help manage your condition. This will be based on how severe your ischemia is as well as what types of rehabilitation will be most effective and will make it easier for you to take charge of your heart disease and take back your health.

CVRTI

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), many of our Investigators are working on improving diagnostics and therapeutics to better treat cardiac ischemia.  The MacLeod Lab is improving EKG detection of ischemia.  The Guo Lab is understanding the process of ischemia and, using stem cells, is exploring the application of anti-inflammatory agents against it.  The Donato and Lesniewski Labs are experts in vascular biology and what happens with our arteries as we age.  Dr. Craig Selzman is a surgeon and performs bypass and heart transplant surgeries and his lab is exploring therapeutics to lessen the effect of acute ischemia.  If heart failure develops after an ischemic event, the Dosdall and Shaw Laboratories are developing therapeutics against ischemic heart failure. Collectively CVRTI Investigators understand the impact of cardiac ischemia and are leading the fight to develop new and better ways to treat it.

Cardiac Ischemia Diagnosis – Myocardial Ischemia

Cardiac Ischemia Diagnosis – Myocardial Ischemia

Multicolored Heart - Diagnostic Approaches for Cardiac Ischemia Graphic

Cardiac ischemia, also known as ischemic heart disease, is a condition where the heart muscle is deprived of blood flow due to clogged arteries. The U.S. has the second-highest mortality rate for ischemic heart disease, which makes up more than 44% of the deaths related to cardiovascular issues.

According to the CDC, 2021 saw about 695,000 deaths related to heart disease, which was actually down from 2019. However, it’s still too high, and in many cases, early diagnosis of myocardial ischemia, along with the right diagnostic approaches, can make all the difference.

What Is Cardiac Ischemia?

Cardiac ischemia may cause chest pain when you strain the body, such as when you are under excessive stress or exercising. Some people may also experience arm pain and shortness of breath during exercise or stressful periods. Other related symptoms may or may not be present.

Someone experiencing chest pains and symptoms like those listed here should seek immediate medical attention. Getting treated quickly is important, but so is getting the right heart treatment. That will involve taking an active role in learning about this condition and the different heart treatment options based on your circumstances.

Understanding Tests and Techniques

Many people wonder, what is the diagnostic test for cardiac ischemia? The short answer is that there isn’t just one “test” that can be done to determine if you have ischemic heart disease. Rather, a doctor or cardiologist will perform a series of tests based on things like:

●   Medical history of a patient

●   Current presentation

●   Potential risk factors

●   Overall health

●   Lifestyle

Before the myocardial ischemia tests can begin, the doctor will need to perform a full evaluation. This may include things like:

●   Questions about your symptoms, current state of health, personal history, family history, lifestyle, etc.

●   Blood tests to check cholesterol levels, kidney function, blood sugar, and other important functions and levels.

●   ECG or EKG tests (resting)

●   Stress tests

●   Imaging tests

●   Angiography

All of these elements will help them determine the best course of action to get an accurate myocardial ischemia diagnosis, and then from there to create an effective treatment plan for a patient.

What Are the Diagnostic Methods for Ischemic Syndrome?

There is a long list of tests and diagnostic tools that can be used to determine all manner of heart disease conditions. However, when people ask what is the most widely used test for both diagnosis of ischemic heart disease and estimation of risk and its prognosis, the answer is simple.

Stress testing is one of the most common methods that doctors use to assess and diagnose heart conditions like ischemic heart disease. There are multiple ways that this test can be performed, but the goal is the same: put the heart under as much stress as physically (or chemically) possible and see what happens.

ECG exercise testing is most common, but some people may not be capable of performing hard physical exercise. In that case, chemicals can be used to put the heart under stress and try to get a glimpse of what’s going on. This can also be paired with various imaging and testing methods to get a full image of the heart and blood vessels and how they are working (or aren’t working, in some cases).

Imaging tests and cardiac catheterization can also be effective in diagnosing cardiac ischemia and related conditions, but they are usually prefaced by the stress test because it’s the most effective tool to point people in the right direction.

Creating a Treatment Plan

Because every condition is different, the diagnosis and evaluation of your specific type and level of heart disease will help define the best course of treatment. Based on the results of the tests performed, doctors could recommend things like:

●   Further, more invasive testing

●   Cardiac rehabilitation, including medication management and lifestyle changes

●   Non-invasive therapies

●   Surgeries to remove blockages or improve blood flow

Your doctor will work with you to come up with a treatment plan that provides the best outcome based on what type of cardiac ischemia you’re dealing with and how severe it is.

How to Improve Your Health and Reduce Risk

Many cases of ischemic heart disease can be prevented or at least put off if people are more aware of their lifestyle and choices they make. Eating healthy, maintaining a good body weight, and exercising regularly are all important to heart health. It’s also important to reduce stress, avoid smoking and alcohol, and take all prescribed medications to assist with cardiac ischemia and other conditions.

With the right testing and early diagnosis, cardiac ischemia doesn’t have to be a death sentence. Your doctor will help you make the best decisions for your care moving forward.

CVRTI

At the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI), many of our Investigators are working on improving diagnostics and therapeutics to better treat cardiac ischemia.  The MacLeod Lab is improving EKG detection of myocardial ischemia.  The Guo Lab is understanding the process of myocardial ischemia and, using stem cells, is exploring the application of anti-inflammatory agents against it.  The Donato and Lesniewski Labs are experts in vascular biology and what happens with our coronary arteries as we age.  Dr. Craig Selzman is a surgeon and performs bypass and heart transplant surgeries and his lab is exploring therapeutics to lessen the effect of acute ischemia.  If heart failure develops after an ischemic event, the Dosdall and Shaw Laboratories are developing therapeutics against ischemic heart failure. Collectively CVRTI Investigators understand the impact of cardiac ischemia and are leading the fight to develop new and better ways to treat it.  

The Science of Myocardial Recovery: Understanding the Healing Process of the Heart

The Science of Myocardial Recovery and The Healing Process After Heart Attack

3D illustration of Heart, medical concept - The Science of Myocardial Recovery: Understanding the Healing Process of the Heart Graphic

Myocardial infarction, better known as heart attack, is one of the leading causes of death in the United States. According to the CDC, around 805,000 people have a heart attack every single year, which equates to one every 40 seconds. In one-fifth of the cases, the heart attack is silent, and while the heart is damaged, the individual is not even aware of it. 

The good news is that myocardial recovery – healing the heart after an attack – is possible. However, it’s important to understand the process, as well as the stages leading up to a heart attack.

What Are the 4 Stages of Myocardial Infarction?

The need for myocardial recovery is based on having a heart attack in the first place. In most cases, that stems from damage caused by myocardial infarction (the attack). While most people are familiar with the Hollywood depiction of a heart attack, the truth is that they do not always occur quickly, acutely, or painfully. The four stages of myocardial infarction are as follows:

1. Fixed Coronary Stenosis

Stenosis is a narrowing or constricting of a passageway; in this case, it refers to a fixed narrowing of a coronary artery.

2. Acute Plaque Change

Plaques lining the artery change, either through rupturing or hemorrhaging.

3. Coronary Artery Thrombosis

This is the development of a blood clot that cuts off some or all the blood flow to the heart.

4. Vasoconstriction

This is a construction of blood vessels that increases blood pressure by slowing or blocking the flow of blood.

Of course, heart attacks are not the only things that can damage the heart and lead to a need for myocardial recovery. Myocarditis can also damage the heart muscle.

What Is Myocarditis? 

Technically, myocarditis is an inflammation of the heart muscle, specifically the middle layer of the heart wall, called the myocardium. It’s usually caused by a virus but can also be caused by inflammatory conditions. 

When inflamed, the heart cannot pump blood efficiently. The condition can also cause other symptoms, including arrhythmias (irregular heartbeat), chest pain, and shortness of breath.

Can the heart repair itself after myocarditis? Yes, myocardial recovery is possible. In many cases, myocarditis is self-resolving, according to Johns Hopkins Medicine. Some patients will require treatment and will not resolve for several months. Severe cases can lead to scarring, which forces the heart to work harder to pump blood and oxygen.

What Are the Stages of Myocardial Infarction Healing?

Myocardial recovery after an infarction usually follows specific stages, although they tend to overlap one another.

1. Inflammatory Response – Initially, the body creates inflammation as a defense response.

2. Proliferative Phase – During the proliferative phase, chemokines control various cell types, including reparative macrophages that help reduce inflammation. 

3. Healing Phase – The healing phase involves the formation of scar tissue.

Overall, healing from a heart attack can take as little as two weeks or as long as three months, depending on the severity of the damage. However, there are things you can do to help increase your body’s ability to heal itself and reduce the risk of having another heart attack (30% of heart attacks every year are second heart attacks). 

Note that if you’ve had a heart attack, you are 20% more likely to have another one within five years than someone who has never had a heart attack.

Important Lifestyle Changes for Myocardial Recovery and Risk Reduction

If you’ve suffered a heart attack, you’ll notice during recovery that your body may not behave as before. You may not be able to sustain the same physical activity level, engage in the same exercises, and even have difficulty controlling your emotions. 

Activity Levels

Try to follow a gradual return to your normal lifestyle and activities that balances rest and recovery with getting up and active. Your doctor will help guide you here.

Exercise

Exercise is one of the most important preventative measures against heart attacks, but it also plays a central role in your recovery and reducing the risk of a second heart attack. A cardiac rehabilitation program can help with your initial heart attack recovery, but you’ll need to make time for exercise each day once the program ends.

Heart Healthy Diet

You’ll need to follow a heart-healthy diet for myocardial recovery. A healthy diet for your heart should include reducing the amount of saturated fat, sodium, and sugar you consume. Avoid red meat, highly processed meats (bacon and deli meat, for instance), and refined grains (white flour, etc.).

Heart Attack Recovery Conclusion

Myocardial recovery after a heart attack is possible. Many people go on to live long, full lives. However, you must get adequate exercise and follow a healthy diet, along with quitting smoking and limiting (or eliminating) alcohol. 

Cardiac Recovery Research at the CVRTI

The Drakos Lab

Several different labs at the Nora Eccles Harrison Cardiovascular Research and Training Institute are very interested in studying myocardial recovery from HF. First, the Drakos lab and clinical research team has identified molecular, cellular, and physiologic features that influence myocardial recovery after circulatory support with assist devices which has altered paradigms in the field and has generated new therapeutic approaches.

Following a bedside to bench and back approach Dr. Drakos’ research team has been using myocardial tissue findings from cardiac recovery patients to guide their basic science investigations to inhibit or overactivate these specific targets using small and large animal models. With this specific approach Dr Drakos’ research identified novel therapeutic targets for myocardial recovery: (a) MCT4 inhibition, (b) VDAC2 activation and (c) AEBP1 inhibition. Next, the Selzman lab is interested in developing “real-world” therapies to be able to help the heart recover following injury. They have very interesting data to suggest that the use of amniotic fluid (“Mother Nature’s Cocktail)” is beneficial to the heart muscle after injury.

The Shaw Lab

The Shaw lab has been working on defining the paradigm of Targeted Delivery which describes how the cytoskeleton delivers membrane proteins directly to their functional membrane subdomain and why there is less delivery in failing hearts. In the process, the Lab discovered and named a new protein: cBIN1. This protein has a fundamental role in organizing the internal architecture of heart muscle cells and has important translational implications in the treatment of chronic heart failure to achieve myocardial recovery (cBIN1).

The Shaw and Hong Labs

The Shaw and Hong labs have together developed a gene therapy for cBIN1 that may prove extremely favorable to HF patients. Furthermore, in the clinical research arena Drs. Drakos, Selzman and others have led in the field of myocardial recovery several studies. They published structure-function studies characterizing in detail the impact of mechanical unloading on reverse cardiac remodeling. Furthermore, they identified practical clinical predictors, including left ventricular torsion, circulating TNFα and IFNγ and myocardial microstructural changes, that effectively guide heart failure patient selection prior to guide the most appropriate therapeutic interventions.

Altogether, this body of work led to the establishment of the award-winning Utah Cardiac Recovery Program (UCAR) which is currently considered one of the leading programs in the field nationally and internationally. The cutting-edge research that is conducted at the CVRTI surrounding myocardial recovery and cardiac regeneration will pave the way for future therapies to reduce mortality rates and improve the quality of life for the greater HF community. 

Newsletter Testing


Nora Eccles Harrison 

Cardiovascular Research 

and Training Institute (CVRTI)

Annual Newsletter | Vol. 1 | July 2022


Welcome to our annual Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI) Newsletter! 



Established in 1969, the CVRTI is a freestanding 30,000 ft2cardiac research institute on the University of Utah Health Sciences campus that provides a highly integrated approach to the study of basic and translational cardiac biology. CVRTI personnel include 13 full-time faculty Investigators (PhDs, MDs, MD/PhDs, and DVM/PhDs), with over 100 trainees (postdocs, graduate students, undergraduates) and dedicated research staff. Our faculty Investigators are drawn from three Colleges and six Departments across the University of Utah.  In this inaugural newsletter, we take you through a journey of featured highlights of our amazing faculty, their productivity, our New Wing being built, and institute wide activities of the past year.



Robin Shaw, MD, PhD

Director, CVRTI



The CVRTI is expanding with the addition of a 10,000 sq. ft. new wing generously funded by the Nora Eccles Treadwell Foundation, University of Utah’s Senior Vice President of Health Sciences Dr. Michael Good, and University of Utah’s President Taylor Randall. Construction began in May 2022 with an expected completion date of Spring 2023. The addition builds upon the strong growth of wet-bench research at the CVRTI and the University as a whole.

The design will consist of a new two-story building including wet lab space with additional PI and trainee offices, two kitchens, and a gathering space overlooking the Wasatch Mountains. The New Wing will also include a Mother’s Room on the second floor and, in the new basement area, a 1,300 square foot freezer farm.


This year we benefited from many amazing speakers for our 2021-2022 seminar series! Review the videos on our YouTube channel or on our website!

Our Distinguished Speakers the past season were

  • Neil C. Chi, MD, PhD
  • Yoram Rudy, PhD, FAHA, FHRS
  • Mario Delmar, MD, PhD
  • J. Kevin Donahue, MD
  • Kirk U. Knowlton, MD, FACC, FAHA
  • Jose Jalife, MD, PhD
  • Jonathan Kirk, PhD

Be sure to join us when the seminar series returns in September, on Thursday’s 12-1 pm MT!


The 2022 Utah Cardiac Recovery Symposium (UCARS) brought together world renowned speakers on myocardial recovery, stimulating in-depth discussions and highlighting groundbreaking research from around the world.

This year’s symposium was held virtually and attracted over 900 attendees.

Stavros Drakos, MD, PhD

Drakos Lab

Dr. Stavros George Drakos is an investigator at the Nora Eccles Harrison Cardiovascular Research and Training Institute (CVRTI) and a Professor of Medicine Cardiology at the Univ. of Utah Health and School of Medicine. He serves as the Medical Director of the institution’s historic Cardiac Mechanical Support/Artificial Heart Program, Co-Chief Heart Failure & Transplant and Director of Research for the Division of Cardiology. Dr. Drakos and his team published bench to bedside studies which led to the establishment of the award-winning Utah Cardiac Recovery Program (UCAR). He is the chairperson of the Clinical Integrative Cardiovascular and Hematological Sciences (CCHS) at the NIH and a visiting professor in academic medical institutions nationally and internationally. He has been co-chairing the annual international Utah Cardiac Recovery Symposium (UCARS) and the NIH Working Group on Myocardial Recovery.

 Over the years, Dr. Drakos mentored several individuals who are now independent faculty in academic medical centers in the US and overseas. As a testament to his excellence across the breadth of academic medicine and research he was recently inducted in the prestigious ASCI (American Society for Clinical Investigation) and was also recently selected by the University of Utah for the prestigious H.A. and Edna Benning Presidential Endowed Chair.

Over the past year, all of our investigators have published well. Some high impact work in cardiac metabolism and mitochondrial biology (Chaudhuri and Shaw), myocardial recovery (Drakos), and genetics (Tristani-Firouzi) are featured below.


The history and geographic distribution of a KCNQ1 atrial fibrillation risk allele

Hateley et. al., Nat. Commun., 2021, Tristani-Firouzi Lab

This first-of-its-kind study highlights the power of merging human genetics and human history in order understand atrial fibrillation in a historical context. The collaborative effort between the University of Utah, Intermountain Cardiology and AncestryDNA broadens our understanding of atrial fibrillation to include the history of our ancestral origins and population movement across time and continents.

Protective mitochondrial fission induced by stress-responsive protein GJA1-20k

Shimura et. al, eLife, 2021, Shaw Lab

After 30 years of research in ischemic-preconditioning, researchers have not been able to identify the central regulator. We have now identified the long sought regulator of ischemic preconditioning which is a molecule we named GJA1-20k. We found that this stress responsive molecule works with the actin cytoskeleton to split mitochondria in a protective fashion, protecting cells and larger organs against ischemic stress. This achievement also provides a novel therapeutic option to protect organs undergoing anticipated ischemia and stress-related injury.

Protective mitochondrial fission induced by stress-responsive protein GJA1-20k

Shankar et. al., Nat. Commun., 2021, Drakos Lab

VDAC2 is a calcium channel present in the mitochondria of the cells of the heart. We found that removing VDAC2 in mice hearts leads to heart failure by reducing the calcium uptake which led to impaired squeezing/pumping function of the heart. Re-introducing VDAC2 in these mice, resulted in improved squeezing/pumping function and overall cardiac health. Using a VDAC2 activator, efsevin, in mice with heart failure we observed significant improvement of these failing hearts. All of these findings show that VADC2 can be a novel therapeutic target to treat heart failure.




American Heart Association (AHA) 

Trainee Award Recipients

Characterization of Smyd1 Enzymatic Activity

Kathryn Davis, PhD Candidate
AHA Predoctoral Fellowship

A novel mechanism of mitochondrialprotein turnover in Complex I deficient mitochondrial cardiomyopathy

Sandra Lee,MD/PhD Student
AHA Predoctoral Fellowship

Targeting EF Hand Domain Containing 1 protein (EFHD1) in cardiac disease

David Eberhardt, DPhil
AHA Postdoctoral Fellowship


National Institutes of Health (NIH) Trainee Award Recipients

Regulation of Purine Metabolism by Protein Methyltransferase Smyd1

Magnus Creed, PhD Candidate
Ruth L. Kirschstein NIH NRSA F31 Predoctoral Fellowship

Role of Structural Remodeling in Atrial Fibrillation

Eugene Kwan, PhD Candidate
Ruth L. Kirschstein NIH NRSA F31 Predoctoral Fellowship

SMYD1’s role in regulating disease-induced remodeling and gene expression in the cardiomyocyte

Marta W. Szulik, PhD
Ruth L. Kirschstein NIH NRSA F32 Postdoctoral Fellowship


National Institutes of Health (NIH) Ruth L. Kirschstein NRSA

Institutional Training Grant (T32) Award Recipients

The Role of Pyruvate-Lactate Metabolic Axis and Myocardial Salvage Following Ischemic-Reperfusion Injury

Joseph R. Visker, PhD, RCEP



H.A and Edna Benning Presidential Endowed Chair

Congratulations to Dr. Martin Tristani-Firouzi for the honor of being named as a prestigious H.A. and 

Edna Benning Presidential Endowed Chair.

ISHR Outstanding Investigator

Dr. Sarah Franklin was recognized with the ISHR Outstanding Investigator Award for making major and independent contributions to the advancement of cardiovascular science and leading a growing research program likely to play a major role in the future.

The American Society For Clinical Investigation

Dr. Stavros Drakos was officially inducted into the Society at the ASCI Dinner and New Member Induction Ceremony in April 2022.


Ademuyiwa Aromolaran, PhD,FHRS,FAHA

Dipayan Chaudhuri, MD, PhD                     

Derek Dosdall, PhD                        

Stavros Drakos, MD, PhD                             

Sarah Franklin, PhD                  

Guillaume Hoareau, DVM, PhD, DACVECC, DECVECC

TingTing Hong, MD, PhD                                            

Rob MacLeod, PhD                                                                       

Joseph Palatinus, MD, PhD                                                         

Craig Selzman, MD                    

Robin Shaw, MD, PhD       

Martin Tristani-Firouzi, MD                  


Robin Shaw, MD, PhD

Director

Derek Dosdall, PhD

Associate Director

Tara Hitzeman, MPH

Operations Director


CVRTI Senior Advisory Committee

Willard Dere, MD

Priscilla Hsue, MD

Rob MacLeod, PhD

Wes Sundquist, PhD

Joseph C Wu, MD, PhD



The CVRTI Core Staff contributes substantially to our productivity and uniquely attractive research environment. It is made up of seven outstanding individuals, which includes a facilities manager who supports the research laboratories and coordinates larger projects with the University of Utah’s facilities team; a laboratory specialist, dedicated to the management of CVRTI’s operating room, and an IT specialist. Additionally, we have four individuals responsible for administration including pre-award and post-award grants management, accounting, personnel matters, and coordination of seminar series and events.




The CVRTI has openings for talented postdoctoral fellows and lab technicians, as well as new tenure track faculty!


Contact Us:

Nora Eccles Harrison CVRTI

University of Utah

95 S 2000 E, Bldg 500

Salt Lake City, UT 84112

801-581-8183

          

          

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