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Deborah Howell (Host): Question: what have you done for your heart lately? Welcome to our series, CGH about your health. I'm Deborah Howell and we're here today with Dr. Scott Reese; an interventional cardiologist at CGH Medical Center in the heart of the Sauk Valley in northern Illinois. This podcast is called Healthy Hearts: A Heart-to-Heart Talk. Thank you so much for joining us, Dr. Reese.

Dr. Scott Reese, MD (Guest): Thank you for having me.

Host: A pleasure. What is an interventional cardiologist and how does it differ from other cardiology?

Dr. Reese: Interventional cardiologists are heart specialists- medical heart specialists as opposed to surgical, who fix problems with the heart by going inside the body, being invasive to correct problems. The primary function of most interventional cardiologists is to fix blockages in the heart arteries that are either causing or felt to likely cause a heart attack. That's what the three of us here do. We also do general cardiology, which is diagnosing and treating all sorts of heart conditions with the tests that we have available and various medications.

Host: Let's talk about that. What are some of the conditions you typically treat?

Dr. Reese: We treat a very broad range of heart conditions, including things that often can lead to more serious heart problems, such as high blood pressure, high cholesterol, helping people quit smoking. These conditions often lead to blockages in the heart arteries which can cause chest pain and heart attacks. We treat heart rhythm disorders, we treat problems with heart valves and the heart muscle. It's pretty much the entire range of heart conditions. The advantage we have here is that if it's something that's beyond our capabilities, we have a number of higher level facilities that provide much more specialized care, including some interventions, some new valve procedures that are things that we don't do here.

Host: Got it. And what are some of the symptoms to look for?

Dr. Reese: The heart can be very sneaky, unfortunately. The classic symptoms to look for are very limiting shortness of breath, chest discomfort. Not necessarily pain, but discomfort, tightness, squeezing often in the center of the chest, often going into the neck or down the arm. These are some of the more classic heart attack or heart pain type symptoms called angina that we worry about. But it also could include passing out, being extremely dizzy, having excessive fatigue. It can even present sometimes as abdominal or discomfort high in the abdomen right below the rib cage. So unfortunately, the heart doesn't read any rule books regarding what symptoms it can have.

Host: So why do you think patients put off calling for help if they think they're having a heart attack?

Dr. Reese: Well, I wish I knew the answer to that. Part of the problem of course relates to what we just talked about that you don't know you're having a heart attack. At the same time, when people are concerned they might be having a heart attack, that's a hard thing to face and, be upfront with yourself and admit that, "I may have a serious problem." Most of us throughout our lives have ignored a multitude of symptoms and we've gotten away with it, and we'd like to think that we can potentially get away with it one more time. That obviously can be problematic because that may be the one time you get that symptom and that may be it. So we clearly wish that more people would come to the hospital or seek some sort of medical attention sooner for any symptoms that they feel are different, new, concerning, and most people get it pretty right. Most people know.

Host: That's good to know. Now what should people look for when finding a hospital to treat heart attacks?

Dr. Reese: Well, it depends. If it's an actual heart attack, then probably the closest hospital is the most important thing. To get the ambulance to your house, especially if you can't get to the hospital quickly on your own. But the standard recommendation is to call 911 and have an ambulance come. And then it's a little bit out of your hands. The ambulance services are all very good, and the majority of the time, they will go to the closest facility. On occasion, the ambulances will bring someone to a hospital that has interventional capabilities on a 24 hour a day, seven day a week basis, as we have here. If you have symptoms that you're concerned about enough to seek attention but not wanting to call the ambulance for whatever reason, then going to that type of facility is probably reasonable if it's close or very close as to the next closest hospital. But usually the general rule is closest facility.

Host: Got it. CGH was recently accredited a chest pain center from the American College of Cardiology. Can you tell me a little bit about that?

Dr. Reese: Sure. That encompasses more than just heart attacks. Lots of people have chest discomfort and fortunately a lot of them don't have heart attacks, but it's making that distinction in a quickly appropriate sort of way that makes a difference. And by being chest pain accredited, it means that we have met some fairly strict standards regarding that process so that we take consistent uniform care of people who might be having a heart attack, and it's not clear at the very beginning, and we then do all the right things to make sure that we keep those people safe. But at the same time, if it turns out that they are safe, that then many of them could go home and not have to stay in the hospital.

Host: Great. What are some of the things we can do to maintain a healthy heart?

Dr. Reese: Live right. I read somewhere once that mostly important lessons in life are learned in kindergarten.

Host: Yeah.

Dr. Reese: Such as taking naps, and sharing, and things like that, and some of that I think can be said for the heart. As a famous philosopher once said, I think we're born with good health, we just have to work to keep it. And most of us know when we do things that are not ideal for our health. You know, certainly smoking is right up there as one of the most unhealthy things that you can do. Getting enough appropriate exercise. They recommend about thirty minutes of exercise, five days a week. That's a reasonable rule to follow. Keeping our weight under control, eating the right portion size, eating the right things. Most of us can go down a list of food, a buffet or wherever, and identify probably what we should eat and probably what we shouldn't eat. I think that's where probably 70% to 80% of the heart problems come from; not following those simple rules.

Host: Easier said than done, but boy once you do it right and you're feeling so much better, it's even harder to go back to your bad ways. Right?

Dr. Reese: We hope so.

Host: I've just a couple more questions for you, Dr. Reese. Can you explain catheterization and how it might help diagnose heart disease?

Dr. Reese: Sure catheterization and the terms we use around it can be very confusing. Catheterization basically involves putting a tube into the body. And when we put tubes into the body, we put them either into the blood vessels of the arm or leg, into the veins or arteries, for the purposes of initially diagnosing heart conditions. The more specific example of this is to advance a tube or catheter through an artery from the wrist or the leg into the heart, and by the heart, to inject a dye and take pictures of the heart, which are called angiograms - that's the picture word - of usually the heart arteries, and the medical term we use for those heart arteries are called coronary arteries, and that's where we look for these cholesterol blockages that are the bad habits we just spoke about. That's where these blockages occur that can progress and cause the chest pain we talked about and the heart attacks we've talked about.

Host: I was just thinking- as you were saying that, it was so visual the way you were picturing it for me. I was thinking of Susan Lucci, who is such a thin, healthy, fit person, but she had a 90% blockage. So even if you're on the skinny side, it's always important to really still take care of what you eat and get that exercise in, correct?

Dr. Reese: Oh, absolutely. And doing all the right things helps enormously, but unfortunately it's not always everything. And that's why when you have these symptoms that you feel are concerning, even though you may be the picture of health, it bears looking into in order to be safe. Unfortunately with the heart, you may only get one warning. You may only get one strike, and we don't want to waste that opportunity.

Host: In your opinion, when is the right time to go through the catheterization process?

Dr. Reese: That's a very complex discussion and it varies very much from individual case to individual case. That's a circumstance where you need to talk to the physician who's caring for you and the circumstances of who you are, and your life, and your other medical circumstances. But generally when it is felt that you have a high likelihood of a blockage that has a high likelihood of causing or is causing a problem at the time, then that's when catheterization enters the discussion in order to evaluate that blockage or possibly multiple blockages, and decide the best way to take care of it, or hopefully find that in fact there are no blockages.

Host: Yeah. Okay, well that leads to my final question to you. Are cardiac devices like pacemakers also something patients should consider as a preventive measure?

Dr. Reese: Not really as a preventive measure. Pacemakers and most of the other electronic devices are primarily for heart rhythm problems, either heart rhythms that are too fast or too slow. They can be a consequence of heart attacks, they can occur on their own, but as a preventative measure, generally not. There are some circumstances where that's appropriate. If you had, for example, significant damage to your heart and your heart needs some electrical support, we might do that even in the absence of any symptoms. But pacemakers, for example, are pretty much always put in for people who have symptoms of, as we talked about at the very beginning, dizziness, light-headedness, or even fainting.

Host: Well thanks so much for clearing that up, and thank you also, Dr. Reese, for taking time out of your extremely busy day to be on the podcast with us. We do appreciate it.

Dr. Reese: My pleasure. I hope it helps.

Host: I'm sure it will. I'm Deborah Howell. Thank you for listening to this episode of CGH about your health. Head on over to our website at www.CGHMC.com to get connected with one of our providers. If you found his podcast helpful, please share on your social channels, and be sure to check back in soon for the next podcast. Have yourself a terrific day.