Transcription:

Prakash Chandran: Heart disease is the leading cause of death in the United States. But if you're informed, a diagnosis is far from a death sentence. Today, we are talking with Health First cardiologist, Dr. Kevin Campbell and cardiothoracic surgeon, Dr. Matthew Campbell, on the signs and symptoms of heart disease and what treatment options are currently available.

This is Putting Your Health First, the podcast from Health First. I'm your host, Prakash Chandran. So first things first, Dr. Campbell and Dr. Campbell, I've been told that you are not related to one another and was also firmly informed that, in fact, it is not mandatory to have the last name Campbell in order to get hired as a cardiac specialist at Health First. So Dr. Kevin Campbell, how often is this funny coincidence called out?

Kevin Campbell M.D.: You know, it's pretty funny because the other Dr. Campbell is a very tall gentleman and I'm a very short gentleman. So I'll always ask them, "Are you looking for the short Dr. Campbell or the tall Dr. Campbell?"

Matthew Campbell M.D.: No, it's funny. I think it's the first time I've worked with a Campbell in the same specialty, same area, same process. So it's definitely a first.

Prakash Chandran: Okay. Awesome. Well, for clarity and for the audience, moving forward, I'm just going to refer to you as Dr. Kevin and Dr. Matthew, is that okay with both of you?

Matthew Campbell M.D.: Sounds good.

Kevin Campbell M.D.: Absolutely.

Prakash Chandran: Okay, so let's go ahead and get started. Dr. Kevin, according to the CDC, one in five heart attacks are silent. Could you explain what exactly that means?

Kevin Campbell M.D.: So, first of all, we know that most common symptoms of a heart attack are crushing chest pain, shortness of breath, sweatiness, maybe some pain in your neck, arm, and jaw, but not every person reads the textbook. And oftentimes, we can see heart pain manifested in a different way. You may have a feeling of dread. You may feel anxious. You may feel some indigestion. And these can be the "silent heart attacks." It's more important to really know what your risks for heart disease are rather than to just focus on symptoms alone.

Prakash Chandran: Well, Dr. Kevin, let's expand on that a little bit more. You mentioned risks. What exactly are they?

Kevin Campbell M.D.: There are several published risk factors that everyone really needs to know their risks. First of all, if you're a man, male gender confers extra risks for heart disease, so our genetics play a role. If you're a smoker, that is a huge risk factor. That is modifiable, meaning you can stop. High cholesterol, high blood pressure, diabetes, physical inactivity and obesity, all of these are risk factors. The other risk factor I think about very commonly is that of high cholesterol. So it's really important that you, as a patient, talk to your primary care doctor and understand what is your risk for having heart disease and how can we modify that risk?

Prakash Chandran: So Dr. Matthew, you know, I think the audience has probably heard of the term heart attack and heart disease, but not everyone really understands the differences or the overlap between the two. Is that something that you could speak to for us?

Matthew Campbell M.D.: Sure. I think when we see a majority of patients who present to us with a diagnosis because remember I'm on the surgery side, so I'm usually after the diagnosis has been made. I'm more of one of the guys on the end user end of the spectrum. So when patients come into us with a diagnosis they use the word heart disease, but usually when they think of heart disease, they're thinking about heart attacks and heart attacks are related to the arteries that feed the heart, things like cholesterol and the factors that Dr. Kevin had mentioned are direct correlates to patients that usually develop these issues. The other side of heart disease that patients don't think about is the valve function of the heart or the muscle function of the heart that we also see on the surgery side of things.

So sometimes the word heart disease is kind of used generally, but usually they're using it to talk about heart attacks and the arteries of the heart. The other side of the coin is the function of the heart, so the the valves and the structural aspect of it that we deal with in surgery.

Prakash Chandran: So Dr. Kevin, when someone comes in and presents to you with a heart issue, whether it be squarely in the heart disease category or the heart attack, what are the most common signs or symptoms that you see patients coming to you with?

Kevin Campbell M.D.: Some of the more common symptoms that can indicate a patient may have heart disease or a heart problem, particularly one that relates to blockages, they may be short of breath. They may be very short of breath with exertion. They may have chest pain when they exert themselves. They may have a decreased exercise tolerance.

Now, as Dr. Matthew also mentioned, there is an overlap with structural and valvular heart disease. Some of these symptoms can also be indicative of a valve problem or a structural problem. And our job as cardiologists and cardiothoracic surgeons is to really work together to sort out not only what is the cause of these symptoms, but what is the best treatment for these symptoms? And that's one of the great things about Health First in our collaborative work together. Dr. Matthew and myself and our teams often discuss patients and we determine what's the best way to treat whichever problem we have made the diagnosis for.

Matthew Campbell M.D.: I agree. The symptoms can sometimes overlap for two completely different disease processes. But the good news is the team at Health First has all the tools in the toolbox. So we're able to diagnose what's going on, go in the right direction and then offer the treatment plan for almost anything that's happening in the diagnosis. So, through the collaborative efforts, we're able to pull our strengths together and make the right decisions at the right time for the patients here in Brevard.

Prakash Chandran: So Dr. Kevin, diagnosis was mentioned a couple times there. I'm curious as to the type of testing that you do to confirm a diagnosis of heart disease or otherwise.

Kevin Campbell M.D.: You know, it really depends on what the symptoms are the patient is experiencing. But if I have a suspicion that a patient may have obstructive or blockage-related coronary artery disease, then the typical thing I like to do is I stress test. And in a lot of cases, I can exercise the patient on a treadmill with an EKG connected to the patient and we look for specific signs and symptoms and changes in that EKG with exercise that suggests that there are blockages there. Sometimes we even image the heart with nuclear imaging before and after exercise to give us even more information. If these types of tests are positive, suggesting that there's a high likelihood of blockages, then we will go and take the patient to the cardiac catheterization laboratory where I'll stick catheters through the blood vessels into the heart arteries and I'll inject dye. And that way, I can see a real time picture of what the heart arteries look like and where the blockages are and how best to treat them. Oftentimes, when we do these cardiac catheterizations, we'll call Dr. Matthew, have him look at these films with us and we together determine the best way to treat these patients.

Another important diagnostic test is called an echocardiogram, which is an ultrasound, kind of like a pregnant lady might get of her belly and her baby, we do it of the heart. And we can tell very detailed information about the structure and function of all the valves, which really helps Dr. Matthew in his approach surgically to some of these valvular problems that we come across so that we're able to really know exactly what we're attacking, how we're going to attack it and what type of outcome to expect.

Prakash Chandran: So before we move on to treatment, Dr. Kevin, I wanted to ask a more broad question around demographics that heart disease or just heart problems affect. Like is this something that, you know, middle-aged people 40 and above should be mindful of? Or does heart disease and a lot of the things that we're talking about today affect younger people as well?

Kevin Campbell M.D.: So there are certain types of heart disease that affect younger people, particularly congenital heart diseases, meaning that you are born with structural abnormalities. Some types of valvular heart diseases also affect younger people. There are more rare instances where folks can have premature heart disease. But yes, it's more of a disease process, when it comes to valvular heart disease and obstructive coronary artery disease, that happens later in life.

The one thing to remember is with respect to gender, and I've written a book about this, women are affected equally, if not more than men. Women are often undertreated and underserved when it comes to heart disease and it's imperative that women understand what their risks are and they understand that the number one killer of women in the US today is not breast cancer or uterine cancer, it's heart disease. So just as we kind of sometimes think of heart disease as a disease of men, it's not. It's a disease of both genders.

Prakash Chandran: So understanding your risk factors is one piece of it, but let's say someone has those risk factors under control, like they're exercising, they have low cholesterol and things of that nature. What are actual physical symptoms or things that express in one's body that tells them, "Hey, I should really go and get this checked out." like, is it chest pain? What really tells them that they need to be proactive about getting this looked at?

Kevin Campbell M.D.: You know, I think the most important thing for me as a cardiologist and what really gets my antennas to come up in the office when I'm seeing a new patient is if they tell me, "I've had a change in my exercise tolerance. I can't do the things I used to do. I get winded walking up a flight of stairs" or "Sometimes I feel chest pressure when I'm doing simple things." You know, these types of symptoms are very concerning. And what I always say is, yes, it's important to know your risk factors, but you've got to understand how to interpret the symptoms in the context of risks. It's important to say, "Okay, I've got multiple risk factors for heart disease, and I'm having these symptoms that are a little atypical, but they still sound like chest pain and shortness of breath. I need to go see my doctor and get this checked out."

Matthew Campbell M.D.: Yeah, I agree. That's one of the challenges, especially on Kevin's side of the cardiac services is to find the people who have serious issues going on, yet their symptoms are a little bit atypical or mild. That's one of the biggest challenges in medicine. The heart itself is oddly built. It doesn't have the same nerve structure that your hands and your feet do. So as you mentioned before, some people can have pain. They can have shortness of breath instead of pain. They can have pressure, which is very indicative of a blockage as opposed to pain, more of a squeezing sensation on their chest. So those kinds of symptoms really bring up the red flags.

And then definitely, a common question that I ask patients, specifically with valve disease is "How long have you had the problem? Do you notice that it's new? You did a lot of stuff six months ago, but now you don't do so much." So those kinds of things usually can be concerning for the heart.

Prakash Chandran: So Dr. Matthew, Dr. Kevin earlier talked about the comprehensive options that one has to get diagnosed. So if a patient has a diagnosis of heart disease, do you typically lean towards a surgical approach right away? Or do you evaluate it differently?

Matthew Campbell M.D.: Yeah. Not always surgery. And that's one of the things that's important for patients to understand, especially in this day and age. It's not always a big heart surgery to fix everything. There are some things that are best managed with just medical management, but usually during the diagnostic testing, if I meet a patient who has been diagnosed with something, it's probably more of a mechanical process, either a blockage or a bad valve. Those things don't usually get better with any medical therapy. So then we have to start talking about are there some interventions that we can do either surgical or more procedure-based non-surgical interventions. And certainly, we have a pretty deep toolbox here at Health First that covers almost all the gamut of cardiac care that we can come across.

Prakash Chandran: So expanding on that, Dr. Matthew, you mentioned some non-surgical treatment options. Can you talk to us a little bit more about what those are?

Matthew Campbell M.D.: Sure. From the disease process standpoint, it always matters what the problem is. So there's no one fix that fixes everything. From an artery blockage standpoint, the kind of disease that causes heart attacks and is a leading cause of death in the United States, those are more blockages inside of the small arteries of the heart. If you have one blockage in one artery and it's an appropriate anatomy and appropriate location, stenting is actually an excellent way to solve that problem. So the interventional cardiologists use small stents on wires, on catheters and essentially to the patient, it looks exactly like the catheterization procedure that Dr. Kevin would have performed to diagnose it. But instead of just shooting the dye, they actually put a stent inside and take care of the blockage by expanding it and providing nice flow of blood through it.

The next option is if you have disease in multiple arteries or if you have disease in arteries like the left main artery that feeds the whole working part of the heart or complex disease that has bad anatomy, usually we meet those patients from a surgical standpoint. The interventional cardiologist may be able to do some stenting, but sometimes when you have to do a lot of different vessel stenting, the best option is to have a bypass surgery. Bypass surgery actually goes around the blockages. It is the classic concept of open heart surgery. It's the most common procedure in the United States from a surgical perspective. Outcomes are quite good. There's a 1% or less mortality for most patients. And the concept is that we're routing blood flow around the blockage and the heart muscle gets continuous flow, even as the blockage continues to get worse over time, which is the natural history of most of these blockages.

Kevin Campbell M.D.: And one thing that I would add is, you know, we have decades full of clinical trials and really good data to help guide our decisions. Dr. Matthew was absolutely spot on. There are situations where we know that surgery is superior to stenting and the clinical trials from way back in the 1980s have really borne that out. And we continue to advance the science as cardiologists and cardiothoracic surgeons, as we collaborate and try hybrid procedures and also try, you know, all kinds of new procedures that Dr. Matthew is expert at where you are doing, you know, minimally invasive type bypass surgery. So I think we're very fortunate here that each patient at Health First gets, you know, thought about by multiple smart people and we come up with the best treatment option that will provide them with the best outcome. And that's what's so great about working here with Dr. Matthew..

Prakash Chandran: Yeah, it's very reassuring to hear about the collaborative team approach that goes in to figure out which treatment is best for each patient. So, Dr. Matthew, one of the things that was mentioned was minimally invasive treatment options. I've heard of a lot of different things that fall in this category, but maybe you can expand on it for us.

Matthew Campbell M.D.: Absolutely. One of biggest and fastest growing areas for technology in less invasiveness in cardiac care is on the structural side. And when we use the word structural, we're talking about the valves typically at the heart. So when we see patients with valve disease, we've actually created a multidisciplinary valve clinic -- ironically, we just had our valve clinic today -- where I evaluate patients from a surgery standpoint, as well as an interventional cardiologist who works closely with me because we both combine our efforts to do some of the more advanced or newer technological procedures. And it's been about seven years since I started the TAVR Program here. And what we're doing there is we're using a catheter-based valve that's inside of a stent to treat a bad aortic valve. We've done just about 700 of these and have excellent result profile. And it's just absolutely an excellent procedure for the right patients.

The second options that we have available to us are some catheter-based intervention for the mitral valve that we've done probably close to a hundred of since we started those a couple of years ago. And then for patients that don't have the appropriate anatomy for a catheter-based or a procedure-based intervention because technology has not caught up with the disease process or their anatomy just requires surgery, we do offer a full gamut of surgical options. I would say probably 80% of my surgical procedures are minimally invasive, small incisions through the chest on the right side, instead of splitting the breast bone, which is what people always think of with open heart surgery. We're doing a lot of valve work through small incisions in between the ribs and a lot of other options too. So we're giving patients what is the gold standard procedure, whether it be the surgical replacement or a complex repair of a valve through a small, minimally invasive incision on the side of the chest, which aids greatly in recovery or we have the ability to offer them an actual catheter-based intervention based on their disease process.

Prakash Chandran: So one of the things that Dr. Matthew mentioned was that one of the hardest things in medicine is to identify patients that are exhibiting symptoms that are atypical. And it seems like the only way to really address this is that each patient is proactive and takes ownership of their own heart health. So to each of you, and Dr. Kevin, we'll start with you, how exactly can patients best protect and improve their heart health?

Kevin Campbell M.D.: You know, for me, it's all about what I call know your numbers. What does that mean? I want you to know your blood pressure. I want you to know that I want your blood pressure lower than 130/80 or less. I want you to know your cholesterol. I want your cholesterol total to be 200 or less, and your bad or LDL cholesterol to be less than 100. I want you to know your BMI or your body mass index so that you can, if necessary, work with your doctor to lose weight. I want you to know your family history, and I think that's another important part of all of this. And then obviously, you know whether you smoke or not.

I think knowing your numbers empowers patients. Data empowers all of us to make wise informed decisions. And I think it's important if you know that you're at risk and that out of these risk factors, you can change many of them through behavior or through medicine, it's very empowering. You can avoid a lot of situations, having a bad situation where you have a heart attack and can potentially lose your life.

Prakash Chandran: And Dr. Matthew, I will ask the same question of you. How can patients be proactive and best protect and improve their heart health?

Matthew Campbell M.D.: Yeah, I think I echo Kevin's sentiments. Knowing more about your risk factors is a key aspect of it. And a lot of the heart health concept is fairly common sense. You know, the idea of smoking and obesity, these are all bad things for the heart. Doing things that make common sense. Mobility's important for the heart. Exercise is important for the heart, the heart actually gets stronger and better. So the concept is relatively common sense. But unfortunately, the wildcard is the genetics and genetics can play a role in many of the patients that we see. And if you have a strong family history for early heart disease, it's important that you have kind of high antenna about any issues. You really want to be watching your Ps and your Qs. Because the genetics is a component that medicine doesn't fully understand yet nor may we ever how strongly it influences things like heart disease. But there's no question that patients need to pay attention to the numbers, even closer with a strong genetic history.

Prakash Chandran: So in practice, Dr. Kevin, does this mean just going in for your annual blood work, understanding the numbers, making sure that they are kind of within range of everything that you mentioned?

Kevin Campbell M.D.: I think it does. I think that each and every one of us can take control of our own heart health and our own health in general. I think it's absolutely essential that everyone has a primary care doctor. We have many wonderful internists and family doctors within the Health First system and you need to partner with that person. You need to understand what their goals are for you, and you need to make them understand what your goals are for your overall health.

you have risk factors for heart disease, you need to come see myself or one of my partners who, you know, as a cardiologist, so that we can start the process of screening you and getting you the therapy you need so that, you know, when appropriate, we will send you down to see Dr. Matthews so that we can get the best treatment for you. And, you know, there's tons of treatments out there and we work really hard to make sure that each patient gets individualized care and each treatment is catered to that patient's specific needs.

Prakash Chandran: Okay. And just one final question before we close here, it's something that I like to ask of all my guests. You know, Dr. Matthew, starting with you, given all of your experience, all of the patients that you've seen, what's one thing that you just know to be true, that you wish more patients knew before they came to see you?

Matthew Campbell M.D.: I think it's probably related to ignoring symptoms. You know, there's one side of the spectrum where, you know, the hypochondriac feels that everything is the end of the world. But we work in a world where the heart is our focus and, when the heart is causing symptoms, it's a big deal. What's amazing about the body is our compensates for it, overcomes it. But eventually, if the heart is the real problem, it always will surface in the end. And frequently what we see on the therapeutic side of things, i.e. the surgery side, is late comers, so patients who were referred too late for us to solve what's wrong because all the wheels have fallen off the cart per se.

So, you know, I think that's one of the things I always mention is the heart is a bit of a special thing obviously. And for many of us in the United States, it is what determines the length of our life. So don't ignore significant symptoms and be a little bit aggressive in your care as well. So don't accept somebody ignoring your symptoms as well.

Prakash Chandran: And finally Dr. Kevin, last question to you. What's one thing that you wish more patients knew before they came to see you?

Kevin Campbell M.D.: I think one of the most important things that we can do as patients and family members is advocate for one another. I think that, you know, mom and dad typically look after the kids and then the kids look after their kids. Let's look after each other. Let's make sure that we don't blow off our own symptoms. Let's make sure that we advocate for ourselves and advocate for our loved ones. There's a lot of times where someone in your family may be blowing off symptoms because they don't want to bother anyone. Let's have that dialogue at the supper table as a family and talk about, "Hey, how are you feeling? How are you doing? Maybe you should go see your cardiologist this week." But again, advocate for one another, advocate for yourself and I think most importantly, let's make sure that women know that they are not immune from coronary disease. Women are undertreated and underserved and women really have to speak up. They have to push their own agenda in order to get the appropriate treatment in many cases. Make sure, as a woman, that your doctor listens to you and takes your symptoms seriously.

Matthew Campbell M.D.: And I would add on the therapeutic side of things, just to mention is sometimes the reason people don't bring up their symptoms is they think of what they remember as a kid and, you know, somebody's grandfather had to have open heart surgery and boy, oh boy, it was horrible in 1974. Have some faith. Things have changed dramatically. The therapeutic profiles are really much better. Like you said, we have new technologies that let us do more complex things without surgery or with smaller surgery. The overall outcomes have dramatically improved in the United States over the last 25 years to the point where the chance of dying from a traditional heart surgery in a traditional patient is 1% or less. So, when we're talking about diseases of the heart, the chance that disease is going to take your life is quite high. So don't be afraid of the therapeutic options that may be offered. Certainly, pursue them if your symptoms are significant.

Prakash Chandran: Well, doctor Campbells, I think that's the perfect place to end. Thank you both so much for your time.

Matthew Campbell M.D.: No problem.

Kevin Campbell M.D.: Thanks so much for having us.

Prakash Chandran: That was Health First cardiologist, Dr. Kevin Campbell and cardiothoracic surgeon, Dr. Matthew Campbell, for Health First. Thank you for listening to Putting Your Health First. To find out if you're at risk for heart disease, you can take a free assessment at hf.org/heart. Once again, that's hf.org/heart.

Thank you so much again for listening. My name is Prakash Chandran, and we look forward to you joining us again.