Transcription:
Getting to the Heart of the Matter – Heart Health and Treatment Advancements

Caitlin Whyte: It can be hard to keep up with all the changes going on at Community Memorial Healthcare these days. But today, we are going to talk about our latest heart health and treatment advancements with cardiologist, Dr. Alon Steinberg.

This is Wise and Well, presented by Community Memorial Healthcare. I'm Caitlyn Whyte..

Well, welcome, Dr. Steinberg. Can you start us off by telling us a bit about yourself and your area of medical specialty?

Dr. Alon Steinberg: Oh, that's a great question. I'm a cardiologist here in Ventura, California. I've been here for the last 18 years. I previously had lived in New York State and also in Texas. I've been in a group called Cardiology Associates over the last 18 years. I'm essentially a general cardiologist. I've been the head of the cardiology department at our hospital, Community Memorial Hospital, over the last 12 years. I've been in charge of more or less quality, credentialing and peer review regarding that. I've been the medical director of the cardiac rehab program, which is a program that after someone has a cardiac event. We try and educate them about diet and exercise, and we have an exercise program in the hospital that we do.

My main interest is cardiac imaging, which is basically pictures of the heart. I do ultrasounds of the heart called echocardiograms and stress tests, including ones with nuclear solutions called cardiac PET scans. But my real interest is also in pictures of the heart with cardiac MRI, MRI of the heart, as well as CT scans of the heart. So, that's my main contribution here to the area. I'm like the main guy who reads these studies and interprets them.

Caitlin Whyte: Wonderful, doctor. Well, as you well know, heart health is so, so important, especially with heart disease, as the leading cause of death in both men and women. What are the most important things for a person to do for heart health beyond the things we already know about, like eating well, maintaining good weight, and exercising? What else can we be doing?

Dr. Alon Steinberg: Well, I mean, if you already know you have heart disease, obviously, you have a cardiologist and they should hopefully guide you to reduce your current risk factors. So in order to prevent any events in the future. If you don't have heart disease, then you should work with your primary care doctor on your risk factors and get educated and actually go there and ask them, "What is my future risk of heart?"

A test that I really, really recommend on patients that are kind of intermediate risk or questionable risk for heart disease in the future and have not been diagnosed with heart disease is a test called a cardiac CT for calcium scoring. It's a very quick test, takes about 15 minutes. And what we do is we take a picture of your heart, we look inside the arteries of your heart to see if you're developing calcification, which correlates with plaque or arterial sclerosis, and then we can measure how much plaque burden by giving you a score. And we kind of compare you to other people your age and see what your risk is. If you're essentially above average or you have a very high score, then you're a person that we need to be very aggressive with regarding modifying your risk factors. You may end up needing a stress test for screening for any problems. So if you really want to know your future risk and you've not been diagnosed with heart disease, I usually like to recommend a cardiac CT for calcium scoring and is done here through Community Memorial Hospital and Grossman Imaging. It's usually not covered by insurances. It's around $150 though, which is, I think very cheap for a scan. But it's a very good insight in looking inside your heart to see if you're developing plaque.

Caitlin Whyte: Great. Well, I'd love to ask you, doctor, are you seeing any increases in more complex heart disease requiring serious interventions? I know there's some concerns with long COVID patients and things like that. Are you seeing any of these kinds of trends in your office lately?

Dr. Alon Steinberg: I've been asked that a lot. From COVID itself, I have not seen a lot of secondary heart complications out of the ordinary. We've seen some, but not a tremendous amount. The main issue, what we've seen with COVID, is that a lot of patients have avoided the cardiology office or their doctor's office over the last two to three years, which has delayed some care. Also because of COVID, people are not going to their gym as much. They're not exercising as much. They're gaining weight. Again, these are causing, I think, increased cardiology and cardiovascular issues. So, we've seen people who've come in late or did not want to come into the emergency room in a hospital in fear of COVID and they end up having a lot more complex disease and are a lot sicker than usual. But I wouldn't say this is a huge amount of people, but enough for it to be a concern.

Caitlin Whyte: Well, always a great reminder to stay on top of your appointments and get checked out when things feel off. I'd love to now move to medical technology and advancements always helpful in the cardiovascular area. Can you speak to some of the current advancements and how they are helping to deal with heart issues?

Dr. Alon Steinberg: We have a lot of advancements in cardiology. I don't think we have as much time that we can discuss all of them, but we'll start with just medicines. Regarding congestive heart failure, we've had a lot of interesting new medicines that have come out that we've discovered that improve heart health, reduce the risk of hospitalizations and cardiac mortality in people with congestive heart failure. And these are SGLT2 inhibitors and medicine called Entresto, as well as Farxiga and Jardiance. And these medicines have been really, I think, revolutionary in reducing your risk of dying from congestive heart failure. So from the medical point of view, those I think are the most interesting.

From atrial fibrillation, people have a higher risk of stroke and we usually give blood thinners. But blood thinners have a higher risk of bleeding. And there's a new technology called a Watchman device, which is a little occluder device that blocks the area, what usually causes blood clots in the heart. And this way, it'll reduce your risk of strokes as well as you will not need to take your blood thinner like Eliquis or Xarelto or Coumadin, if you need to take that for atrial fibrillation. So, we're putting Watchmans in.

A decade ago, everyone who has a severe valve problem, like severe aortic stenosis, where the aortic valve is very stiff, or the mitral valve is very leaky, they would need open heart surgery. But now with new technology, we're able to basically fix the valve or replace these valves invasively, but not surgically, through either the leg or your neck. We can go in there and we can basically repair the valve or replace the valve. And instead of being in the hospital for a week after major surgery, you're maybe in the hospital overnight, that's it. So, that's been a big advancement. And I know we've done the last few years a tremendous amount of these valve replacements that we're one of the top hospitals, I feel, in Southern California for this technology, thanks to my partner, Dr. Omid Fatemi, who's done a significant amount of these procedures.

Caitlin Whyte: Absolutely. Well, are these technologies only available at academic medical centers? What is Community Memorial Healthcare doing to help bring these technologies to the Ventura community at large?

Dr. Alon Steinberg: Yeah, that's exactly right. They usually start in academic centers. But, luckily, we have a lot of young cardiologists who have trained on these technologies while they're in academics, and they've brought this technology here at Community Hospital. So, a patient doesn't have to travel an hour away to Cedars or UCLA to have a lot of these procedures.

I think at our hospital, we can practically do any cardiac procedure that they can do at tertiary care centers except possibly a heart transplant, which we obviously don't do. So, we have some affiliations with hospitals over at Los Angeles that we send people if they need something that's technical. But hopefully, we do everything we can to prevent that from happening. And we work together with doctors over there at Cedars and UCLA to collaborate and take care of these patients. But again, mostly, we take care of literally most things here, right here in our community.

Caitlin Whyte: Great. Well, wrapping up here, doctor, what should someone do when they are looking at surgery options for valve and aortic disease?

Dr. Alon Steinberg: Well, what we do here, I send a person to my partner, Dr. Omid Fatemi, who's our structural cardiologist. He does these things called TAVRs, which are aortic valve replacements through the leg. He also does mitral clip, which is fixing a leaky mitral valve. But all these patients get a consultation with one of our cardiothoracic surgeons, either Dr. Wan or Chicotka, or Bushnell. And they work together with the cardiologist, the cardiothoracic surgeons, and we make the right decision for the patient whether or not they should get the procedure through the leg or through the open heart. You actually get two opinions from both sides, and hopefully a lot of these patients also have a non-interventional cardiologist like myself, who also helps with the decision. And we try and use guideline-based data to help you make the decision right here. So, we try always to do the right thing for the patient.

Caitlin Whyte: Well, thank you so much, doctor, for your time today and for sharing this information with us. You can always find more podcasts and resources online at mycmh.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you.

This is Wise and Well, presented by Community Memorial Health System. I'm Caitlin Whyte. Be well.