Bill Klaproth (Host): This is BayCare Health Chat from BayCare Health System. I'm your host, Bill Klaproth. Our guest today is Dr. Clauden Louis. He is a Board Certified Cardiothoracic Surgeon with BayCare Medical Group at Winter Haven Hospital's Bostick Heart Center. Dr. Louis, thanks for being here today.

Clauden Louis, MD: Thank you for having me. I'm excited.

Host: Absolutely. It is great to talk with you. So let's jump in with this. What are some early warning signs or symptoms of potential cardiac issues that should prompt individuals to seek a doctor's opinion? And what symptoms then are more immediate than others?

Clauden Louis, MD: Awesome. Great question. So I just want to remind the audience I'm a Cardiothoracic Surgeon and the area in which I mostly take care of our patients as it pertains to these signs and symptoms would be things like having chest pain. We call that angina in our realm. And the concern would be for a heart attack.

That's really concerning. And when it comes to having a heart attack or potential heart attack that needs to be diagnosed, time is of the essence. So once you feel that sensation and your hand goes on your chest. That is important. And to be honest with you, that's more emergent than even seeing your primary care doctor.

That is something that you're calling 9-1-1 for and going to the emergency physician in order for them to diagnose you. Because there's an EKG they need to do and some blood work. Those are probably one of the most critical early warning signs of potential cardiac issues. As we continue this conversation, we'll talk further about things like having fluid in the legs. There's some other chronic things that may show up, but the most pressing and urgent matter would be having unrelenting chest pain.

Host: Okay, I was going to follow up on that. When we hear chest pain, I would imagine once you feel it, you know it. Is that like a pressure on the chest? Is that what that is?

Clauden Louis, MD: Honestly, everyone describes it a little bit differently. Some may say they're having this chest pain and it's central. Others may say they have a crushing type pain. It's not like a sharp stabbing pain, but a crushing pain. Others may say, I feel like an elephant is standing on my chest, which obviously would be very painful if I was to have an elephant standing on my chest.

But believe it or not, we sometimes have some chest pains that we call our atypical. They describe it as having like a reflux symptom and they don't typically have reflux or they took their acid reflux medication and that discomfort is still present. And believe it or not, it can go down to your arm, sometimes left, can go up towards your neck, sometimes goes towards your back. That may be a little less common, but it's just this discomfort that's in different areas around the chest.

Host: Yeah, I've heard of people that have gone to the emergency room and it turned out that they had some kind of acid reflux or even gas, if you will. But I was just asking about that because we hear about chest pain. So thank you for clarifying some of that. Sometimes it's not, but it sounds like, as you said, time is urgent.

If you feel any pressure in the chest, don't fool around. It seems like better safe than sorry. Would that be right, Dr. Louis?

Clauden Louis, MD: Absolutely.

Bill Klaproth (Host): Yeah. So are there some things, cardiac symptoms, that you can wait until your next planned primary care visit?

Clauden Louis, MD: Certainly. Sometimes there are some symptoms that you may not know are related to the heart. But if you've been noticing your body for some time, some are starting to develop a little bit of fluid in the lower legs. And although there are other reasons why that can be there, the heart is sometimes the culprit for the reasons why you have what we would call pitting edema in the lower extremities, which means fluid is starting to build up in your lower legs. And the question is, why is that? Well, if your heart, which is a pump, by the way, is not behaving like a good pump, then it may be causing a traffic jam. So the blood that's supposed to be going to the heart to get pumped out is sometimes lagging in the area that is dependent based on gravity and then fluid starts to seep out of those veins and enter the tissues. And then that's when we start to get concerned. Those are not emergencies. You're not necessarily rushing to the hospital to get evaluated, to ask them for any emergent imaging to find out if the pump misbehaving.

That would be a conversation you would save for your primary care doctor and say, “Hey, I'm not having chest pain or shortness of breath.” If that's true, then you then would say, “But I'm noticing there's some fluid in my lower legs or my legs are puffy towards later in the day. Then when I wake up in the morning, it starts to build up.

What's going on? When I raise my legs, it starts to go away.” And then they would start the work up because believe it or not, that may be a cardiac symptom.

Host: Hmm, so when you have fluid in the lower legs, that's a sign that something is happening where the heart just isn't strong enough or something's happening where it can't pump that blood or whatever back up into the system. Would that be right?

Clauden Louis, MD: That's correct. It is a possibility. Of course, it's the primary care physician's job to rule out what other reasons someone can have these type of edema, for instance. I would expect it to be in both legs, not one. If it's only in one leg, you have to ask yourself, is it the pump or is there something going on in that one specific leg?

How are their protein? Have they been putting protein in their diet? Because protein helps keep fluid inside of the cardiovascular system as opposed to seeping out into the tissues. But lastly, and more commonly, if it's in both legs, you have to ask yourself, could it be a heart problem?

Host: Okay, good to know. So then how do risk factors like hypertension and diabetes influence the decision to consult a cardiac specialist?

Clauden Louis, MD: This is incredibly important, especially when they're uncontrolled. Just to speak on hypertension, that is high blood pressure. Your heart literally needs to squeeze blood into a system that has a lot of pressure. So imagine the pressure the heart is feeling when it needs to squeeze blood into an area that already is not willing to accept the blood.

The heart can fail just because of that. We call that in the cardiology and cardiac surgery realm, afterload. Because you're now asking the left ventricle, which is the chamber we're focusing on, that's the one that sends blood everywhere to your brain, to your tippy toes. We're asking that to lift weights in order to do its job description. And it may get tired. So hypertension or high blood pressure, especially when it gets higher and higher, is not a good thing to have for the long term.

Diabetes is a big deal. When we look at diabetes, it's such a risk factor for what we call coronary artery disease, which means blockages of the blood vessels of the heart. Diabetes, believe it or not, is almost equivalent to having had a heart attack in your life when it comes to the life expectancy changes, should this be unmanaged; it is almost equivalent to having a heart attack. So when we deal with patients that we see in clinic, once they say they have diabetes, we know we have to look even further for coronary artery disease. Because now they have a substantial risk factor for those blood vessels to be blocked. They go hand in hand.

Host: Well, that is so interesting that you say diabetes is just about the equivalent to having a heart attack. So, that's really of major importance for, one, somebody that's in pre diabetes, don't get into full blown diabetes, and you, if you have diabetes, you really need to pay attention to your heart and know the risks.

So thank you for bringing that up, Dr. Louis. Really, really important. Let's talk about some other signs. We hear about shortness of breath. Might that have a cardiac origin? And when should that prompt a referral to a cardiologist?

Clauden Louis, MD: Well, now this is really, really similar and on par to the discussions we were having. Shortness of breath, which by the way, could happen for a multitude of reasons, but more commonly cardiac origin is one of the most important reasons why you can have shortness of breath. Just the same way you may have a traffic jam in your lower legs, the same is true when it comes to having blood flow going in and out of the lungs.

If your left ventricle, which is one of the four chambers of the heart, the most important one, by the way, is not really squeezing as it should, so that pump, let's say it's failing, it's misbehaving, you actually have more blood that's stagnant in the areas before that chamber, because that chamber is supposed to empty it out so it can accept new blood and guess where majority of that blood will sit?

The lungs, because in the actual pathway, the lungs are before the blood gets to the left ventricle. So if your left ventricle is not squeezing, blood will sit longer in the lungs and blood will sit longer in your legs. And you'll start to get fluid seeping out in the legs. We call it pitting edema, but in the lungs, we call that pulmonary edema. You start to get fluid building up in those organs.

Host: Wow, so as we talked about, you can have fluid buildup in the legs, and then you can have fluid buildup in the lungs as well. These are two warning signs of heart disease?

Clauden Louis, MD: Yeah, so that could be shortness of breath. And then now we have to find out why is the pump misbehaving? Now, the reasons could be, is it heart disease? That means the blood flow that feeds the muscle of the heart is inadequate because of blocked vessels?

Or could it be a valvular heart disease? That means the valve, which is a door from which the blood literally leaves the chambers, is that aortic valve misbehaving? And we call that aortic valve stenosis. Or if it's letting blood go backwards back to the heart inappropriately, we call that aortic valve regurgitation. So a number of workup will have to be in progress so you can figure out the reason why, but as it pertains to it being cardiac related, the answer is yes, it is possible that shortness of breath is a sign of a heart problem and definitely should lead to a prompt referral to a cardiologist.

Host: So if we are short of breath, is that because the lungs then have fluid buildup and there's less room for air? So we're out of breath because we're not getting enough air because there's so much fluid in the lungs? Is that what's happening?

Clauden Louis, MD: Essentially, yes, because the lungs are just an area to transfer what is being received from the air. We call those sacs that receive the air and oxygen, which is the most important component that is coming from the air. We call those sacs the alveoli, and those alveoli, its sole purpose is to send oxygen into the blood vessels that are surrounding it and then take our waste product, which is carbon dioxide, after we use the oxygen, and put that back in the alveoli so you can breathe it out.

Host: Okay, that's really interesting. So you hear of fluid in the lungs, but I never really correlate it. That's why you're short of breath. So that really makes a lot of sense.

Clauden Louis, MD: Because that fluid is literally starting to block those transfers. It's starting to take up space, the fluid is building up in areas it shouldn't be, and the alveoli is no longer able to do its job description. But again, we can probably go deeper into that, but then we'll all be doctors just from listening to me.

Host: How can early collaboration with experts such as yourself improve outcomes for patients at high risk of heart conditions?

Clauden Louis, MD: Well, it's important that we start the process because you know, the first step is the most important step. Is there a problem? And we have a lot of stoic individuals who are able to tolerate a lot, but the heart believe it or not may be struggling. And as it struggles, we start to lose out on a perfect window of opportunity to make change so that we can fix the issue.

So these signs are all important and being able to get the next step ready, to do the correct study so we can fix it. In some cases, if it's the heart vessels that are blocked, which is known as coronary artery disease, then you may need to get a stent. Perhaps you may need to get a bypass surgery. And if it's a valve that's misbehaving, you may have to get a valve replacement.

And the options are excellent. Some are surgical. And we also have, believe it or not, a method to change that aortic valve without opening your chest at all. And we call that procedure, TAVR, transcatheter aortic valve replacement. And we just go through a vessel that's in your groin, which is in your leg.

And that artery, we travel inside of your body and put this valve that was compressed to the size of your finger. And on the inside of you opens up like an umbrella. And then we take all our tools out and that valve stays in there forever. And it replaces your malfunctioning aortic valve.

Host: That TAVR procedure is kind of a game changer, isn't it?

Clauden Louis, MD: Absolutely.

Host: It's so good to know that there are these types of procedures, and like you said, the TAVR procedure, minimally invasive. The best thing is to the saying goes, an ounce of prevention is worth a pound of cure. So, as I'm talking to you, Dr. Louis, it sounds like, know your numbers, right? Get that blood pressure checked, for sure. You should absolutely know that number.

Clauden Louis, MD: Absolutely. Make sure you watch and see how your body is participating and see if it's asking for help. Those warning signs are important.

Host: Yeah, absolutely. So, in this day and age, we have wearables. I have an Apple Watch on right now. It'll tell me if I'm an AFib, which I'm not and never have been, but I know it can do things like that. Can wearable devices assist individuals in determining when to get medical advice when it comes to heart issues and heart related things?

Clauden Louis, MD: You know, I look at these devices as augmentation. It's there to provide an assistance. I would never depend on it as the end all be all. And it's very important that we understand that. These things are what we call sensitive, but not specific. They're supposed to let you know if a concern is arising, but in the absence of your devices alerting you, still seek the help.

So essentially, it's just one data point of a bunch that you need to use to dictate, “Am I feeling well? Do I have chest pain? Is this shortness of breath? Am I no longer able to play the things that I was able to play within a month's time? Am I taking these five steps and now I'm significantly out of breath, and that's a new normal for me?” Because now you can really ask yourself, these changes are not something that's correlating with my normal, let me get worked up. But if you have a wearable device that starts to say, Hey, your heart rate is too low, or it's going way too fast, or more importantly, you have atrial fibrillation, most certainly I would definitely use that as a reason to get evaluated and ask an expert.

Host: Yeah. That makes sense. Use the technology that's available, especially if you have a wearable, and, uh, use it as an add on to what you're feeling physically or symptoms. It can also be a tool to help you realize that, “Hey, maybe I need some help here. Maybe I should go get checked out.” Well, Dr. Louis, this has been great. Thank you so much for your time today. Anything else you'd like to add?

Clauden Louis, MD: Yeah. You know, honestly, continue to work hard and do the things that you do. Those who are listening, listen to your body and go from there. Stay tuned, stay in touch with your doctor and eat an apple a day to keep the doctor away.

Host: I love that. And I love that listen to your body. Like you said in the beginning, some people are stoic, stubborn. “I'm fine. I'm fine.” No, go get checked out. That's the best way to deal with things like this for sure. Dr. Louis, thank you so much for your time. This has been a pleasure.

Clauden Louis, MD: No problem. Take care.

Host: And that wraps up this episode of BayCare Health Chat. Go on over to the website at BayCare.org for more information and get connected with one of our providers. Please remember to subscribe, rate, and review this podcast and all of the other BayCare podcasts. Thanks for listening.