Michael R. Anderson, MD (Host): Hello, everyone, and welcome to this episode of the FortCast, the official vodcast of Fort HealthCare. I'm your host, Dr. Michael Anderson, president and CEO of Fort HealthCare. And with me today, I have a very special guest. I have our cardiologist, Dr. Raaid Museitif, who on this episode is going to talk to us about myocardial infarction, otherwise known as a heart attack.

But before we get started, I'd like Dr. Museitif to introduce himself a little bit to all of us. So, Dr. Museitif, how long have you been with Fort HealthCare now? And just tell us a little bit about yourself.

Raaid Museitif, MD: Hi, Dr. Anderson. Thanks for having me on. I appreciate it. Always good to be back. Again, my name's Raaid Museitif. I'm from Wisconsin, born and raised. And I did my undergrad in medical school at the UW Madison, undergrad in the UW Medical School. I have multiple board certifications in cardiology, interventional cardiology, nuclear cardiology, and I'm a registered vascular interpreter.

It feels like I've been in Fort forever, but it's been over two years now, and so since I think 2023. And so, we're real excited on some of the things that we've been able to do and work together on.

Host: I tell you, we're happy to have you. You do such a great job. And our patients and community really appreciate your work. And that's a lot of board certifications. I think a lot of people, including other physicians, don't realize how many board certifications you have to go through to do what you do. I mean, that in and of itself is a testament to how much education you need to be an interventional cardiologist.

Raaid Museitif, MD: Yeah, I appreciate it. Yeah, they make you jump through a lot of hoops, but I guess it's good.

Host: Well, let's jump in on our topic here, Dr. Museitif. And let's talk a little bit about heart attacks. And let's just start with a basic definition. What is a heart attack? What is happening to the heart when somebody has a heart attack?

Raaid Museitif, MD: It is a great question. When we say heart attack, typically, what we're talking about is the death of your heart muscle. So, every organ in our body is alive. And they're made up of cells. And there's different types of cells. But your heart is a pump, and your heart's main job is to circulate the blood in your body. And we have two different types of blood. We have oxygenated blood with energy and oxygen in it. And then, we have the venous blood that has all the blood that the oxygen's been taken out of it, the energy's been taken out of it, and it has to get recycled through your lungs and pick up oxygen, and then go back around.

And the way you think about it, or the way we explain it is it's no different than this building or your home. You have water that comes in from the city, that's your arterial blood. And then, once you wash your hands or use it in the kitchen or in the shower, it goes down the drainage and that's your venous blood. And you have to have a pump to make that go all the way around. And that's your heart. But your heart itself also needs blood. So even though it's the one that's pumping the blood, it needs its own blood pipes to feed itself and drain itself.

And when one of those pipes is blocked, just like the sinks in our house or building get blocked, if your sinks blocked, nothing goes down it, and it backs up. And when your arteries of your heart get blocked, there's no blood that comes into your muscle in that area, and that muscle dies. And that's what we call a heart attack.

You can have "heart attacks" for other reasons too. Sometimes you can have the muscle of the heart die for different reasons, and it can mimic that. But typically, when somebody says the fancy word of myocardial infarction or heart attack, that's what we're visualizing. The arteries that supply blood to the heart itself are blocked, and that area of muscle that is getting the blood dies.

Host: And that clearly is very bad. So when that blood to the actual heart muscle itself becomes compromised, that's what leads to the heart attack. So, can I back up a little bit? What predisposes us humans to potentially having a heart attack? What has happened throughout our lives that potentially contribute to that?

Raaid Museitif, MD: So, it's a great question. The interesting thing is when we talk about pipes, and when I talk about like city pipes and the sewage drainage at our house, remember the sewage drainage is like our veins and the artery pipes are the water that comes into our body. When we picture that, we picture the old lead pipes that we grew up with, our lead poisoning days in here in Wisconsin when we we're a child, or the PVC, the plastic pipes. But those are just solid pipes in our body. It's not that simple. These are not solid pipes or solid tubes. These are living organisms themself.

So, they have multiple layers. So, we have an inner layer that we call the intimal layer. And then, behind that, we can have a muscle layer and connective tissue layer. And then, we can have an outer layer called an externa. And when you look under a microscope, these are not just smooth areas of plastic. These are tiny cells that lock like our hands through these spaces we call gaps or gap junctions. But when you look at it, it looks like a smooth piece of plastic.

Now, what happens over time is we get older, people smoke, people have high blood pressure, people have high cholesterol, people don't move and are inactive, they don't exercise, people eat bad food, people have bad genetics. And so, you get inflamed. Now, what happens is those inner cells on the inner layer of the artery, they stretch and they create little holes in them called gap junctions. And our cholesterol on our body, inflammation, and all those things I talked about will cause those cells to stretch apart on a microscopic level. And then, our own body's cholesterol, which serves a lot of good purposes, will float in your bloodstream and go through one of those cracks.

When they go through the crack, it activates our immune system. And our immune system is alerted just like an alarm system and it says, "Hey, there's something behind our inner layer that shouldn't be there." And they send their soldiers called macrophages, which is a fancy word for big eaters, to go get them out of there, just like soldiers or police. And so then, they go and they follow them through that gap junction. And when they find our cholesterol, and that's our bad cholesterol. A lot of people who are watching this know their cholesterol, that's your LDL cholesterol, that's your bad one. Then, the macrophages will eat it. And when they eat it, just like Pac-Man that we played when we were younger, when the Pac-Man eats the ghost, it gets bigger. And when the macrophage eats your cholesterol, it gets bigger and it gets trapped that it can't come back out into your blood and get cleaned out and they die. And when they die, they start to build plaque. And over the years, they keep happening over and over again. And you can imagine an artery keeps shrinking and shrinking because all that cholesterol and plaque keeps developing behind it. And it narrows your artery to a point where you get chest pain or your short of breath when you walk.

But if it ruptures, sometimes it doesn't make it all the way block. A lot of heart attacks happen from mild blockages of less than 35%. That can just be unstable. All the plaque can build up one little area and it can pop open. And when it pops open, all that fat and that context pours inside your blood vessel, your drainage, and your body attacks it as a foreign object and forms a big blood clot. When you have a blood clot in a pipe that's feeding blood to my heart muscle, it cuts off the oxygen, you get a heart attack.

So to answer your question, that's the mechanism. But it's from genetics, it's from not exercising, it's from smoking, it's from having high cholesterol untreated, it's from having diabetes untreated, it's from obesity. All those things combined add to developing that process that I just explained.

Host: So, there is a lot of factors-- chronic factors, if you will-- that lead to potential heart attacks. And you named them very nicely. So if somebody is having a heart attack, what typical symptoms would they have, Dr. Museitif?

Raaid Museitif, MD: So, that's a great question. What are your symptoms of a heart attack? Unfortunately, a lot of times people never have any symptoms at all when they have a heart attack, or at least they tell us that. But the typical symptoms, especially in a man, in a male, is that you develop left-sided pain over your breast area that feels deep. It feels like a pressure or a squeezing pain. It may radiate. That pain may radiate from your chest to your arm or to your jaw. That pain typically gets worse when you exert yourself or walk. It gets better when you sit down and relax. It can be associated with shortness of breath when it happens. You can get lightheaded when it happens. You could be dizzy when it happens. You could be nauseous. So, left-sided deep kind of a squeeze pressure-like pain is the typical.

I tell you women though often don't have those same symptoms. Women's symptoms can be very vague. They can just be shortness of breath when they walk. They could be nausea. They could be fatigue. They could be weakness. Sometimes they have pain in their jaw and back. And so, women often sometimes don't have the same symptoms as men, although they can have that classic symptom.

Host: So clearly, there's some warning signs that can happen before the actual heart attack occurs. Dr. Museitif, what are some of those warning signs that people can be aware of or caregivers, for those who they're caring for? What are some warning signs that may say, "Hey, you may want to get your heart checked out. You may want to call up Dr. Museitif and get things looked at"?

Raaid Museitif, MD: Yeah, it's a great question too. Like I said, a lot of us will blow symptoms off. You don't think about it. When somebody comes in with a heart attack and you start to ask them, they say, "Oh, I did have this, I did have that." But typically, if you know, and especially if you're watching your loved ones, sometimes they're just slowing down. You're walking and they're not keeping up, and maybe they're not keeping up because, you know, it is just a normal process of age, but maybe they're winded, they can't walk as quickly or for as long as they used to walk. Or every time they walk, they get really short of breath, or every time you walk, you start to get lightheaded, or every time you walk, you start to get a little pressure on your chest. Those are all concerning for possible blockage. And that's when you want to come in early so that we can catch it before it ends up in a heart attack.

Host: Dr. Museitif, if you see somebody or a primary care physician or provider sees somebody and they suspect that they may have the patient may have blockage, what are some of the tests, whether it's radiologic diagnostics and/or lab work, what goes into the workup to kind of determine if there is blockage?

Raaid Museitif, MD: Yeah, good question. When we're checking someone to see if they have coronary disease, or if we're checking somebody to see if they have a heart attack, we think of them as two different things. If you come in and you're having chest pain and we're worried that you're having a heart attack, we have two things that we do right away. Let's say you came into the Fort Emergency Room, within five minutes of saying that you have chest pain, you should have an EKG. That's where they put the stickers on you and we get the electrical waves of your heart. Just from that, we can tell a lot. There's some heart attacks that become medical emergencies and we really have to open up the blood vessel very fast. And there are other ones that we have more time to deal with it.

The other thing that we do is we have a blood test. We can actually check your blood and it's a specific test that tells us if your heart muscle has died. So, we have muscle all over our body that can die. Your muscle in your leg, your muscle in your chest, or your back, that's a different type of muscle. But we have a blood test that's specific just for the heart. And in the ER or in the hospital, we can check that and know what's going on. So, those are a couple tests that we do: the EKG and the blood tests, as long as examining you and taking a history, that can tell me if you're having a heart attack right now.

Now, the second thing of that is someone who's having these symptoms, and we don't know if they have heart blockages that potentially cause a heart attack. So, what should you do in there? Well, you talk to your doctor. It starts with a good history and physical examination. They'll ask you the questions they want to know about your family. Do people in your family have heart disease? They want to know all your allergies, your medicines you're taking, et cetera. They'll examine you. They'll do the same EKG, because that helps us tell if you've had a problem.

And then, we can do an echo cardiogram, which is basically an ultrasound. That's just like ultrasound they do of your gallbladder or when someone's pregnant and they look at the baby, we can actually just put that right over the heart. When we do that, we can see how the heart's pumping and if somebody's had a heart attack, we can see part of the heart not moving correctly. We can also check your heart valves. That will just tell us how your heart's pumping now.

And then, the next test that they would do is they would do what we call a stress test, where you will run on a treadmill and we'll be able to see if you have blockages. So, that's kind of the way we divide it up.

Host: Well, that sounds like you have a lot of different techniques and good ones at that to determine the state of somebody's heart and/or blockage. Now, Dr. Museitif, take us through what treatments are available. Let's say if somebody does have blockage or is having an acute heart attack, take us down that path a little bit.

Raaid Museitif, MD: Yeah. So if you are having a heart attack, obviously, everybody's listening who has new chest pain that's not going away, you should call 911. And then, let us figure out what type of a heart attack it is. But once we've determined that you've had a heart attack, then we want to go in those blood vessels, that drainage. It's kind of very similar to when a plumber comes to your house and kind of puts the snake or the camera down your drains to figure out why it's blocked. We do something very similar And what we can do now is we just go right through the wrist. So, a lot of people listening may have had it or have had family members have had it. And we used to go through the groin. We still do that.

But now, we've developed techniques where you just lay on the table. We can stick a little IV under ultrasound in your radial artery. And we run a little tube up on x-ray into your heart. And we use something we call contrast. It's just a solution that we can see on x-ray. And we can actually see where a blockage is. And when we find a blockage, then we can just run a little balloon in there that opens up. And you can imagine just like a snake that they do in your plumbing, we can remove some of that blockage and restore flow.

And we can keep that open with something called a stent. And a stent looks like a straw that's shaped like a chain link fence, you know, the little diamonds on a fence. So, we take that, and we crush that over a balloon, we shrink it real small. And then, we stick it where your blockage is, and we blow the balloon up. Now, what that does is just like a chain link fence or chicken coop wire, it just traps all the plaque behind it and expands. And the little diamond shapes keeps the tube expanded so it doesn't collapse again. So, we basically open up the blood vessel and restore flow.

Host: That's pretty remarkable. And that's called-- what is that called? What is that procedure called, Dr. Museitif?

Raaid Museitif, MD: So, you might see it differently, but those are called coronary stents. But some people write PTCA on a piece of paper, which is percutaneous coronary angioplasty. There's different type of techniques that we can do for that. Now, what a coronary artery bypass is, is sometimes you have too many blockages in your heart or blockages where we don't think stents are appropriate for you, then we would send you to a different type of heart doctor called a cardiothoracic physician who would then do a bypass. And what a bypass is, if my finger is the tube, I would go Roto-Rooter in there and just kind of open it up. But if the blockage is my knuckle, a CV surgeon would do a bypass by cutting a hole in the blood vessel above it and cutting a hole in the blood vessel below it and putting a vein or a little artery as a tube. So now, the blood would come down. And normally, it would get stuck there. Now, it will go in the side branch and go around. That's why they call it a bypass. We literally build a bypass road around the blockage. That's surgically. A lot of times, now we can do it through your wrist instead, but some people still need surgery.

Host: It's pretty remarkable where technology has taken us with the treatment of a blocked coronary artery. And once that blockage is relieved, then the heart muscle can then again get its oxygen and blood supply, and hopefully become healthy again.

Raaid Museitif, MD: Yeah, absolutely. So, we have a statement that says time is muscle. One of the amazing things about heart muscle is if you cut off the blood, if your blood vessel gets blocked, like in the process of a heart attack, it's not like your cells instantly die. Your muscle cells have a mechanism where they can literally hibernate like a bear. So, they can just stop moving. They don't get enough blood. Before they die, they go into hibernation mode. And if we can restore the blood flow, then they literally store. Just like a bomb shelter inside of them, they got a little canned food in there or something. They can kind of survive for a while. And if we can give them oxygen with blood, then they can wake up and your heart can get strong again. But they go into survival mode, they shut down, they hibernate. And then, we have a limited amount of time to restore flow before they run out of the limited oxygen and food that they're trying to store and survive. So to answer your question, yes, once we restore flow, then the heart can wake up. And then, it can come back and pump normally.

Host: Well, that is incredible. That is absolutely incredible. Dr. Museitif, I can't thank you enough for being on this episode of the FortCast. Thank you for taking us through all that knowledge surrounding heart attacks.

Raaid Museitif, MD: I appreciate you having me and thank you so much.

Host: All right. Well, thank you everyone for joining us on this episode of the FortCast. Please don't forget to share us on your social media platforms. And we will see you at the next episode of the FortCast. Have a great rest of your day.