Scott Webb (Host): Heart disease is very common, and although the consequences of untreated heart disease can often be dire, knowing our risk factors and being diagnosed early saves lives. And joining me today is Dr. John Hoyle. He's a board-certified cardiologist with Health First, and he's here today to help us to understand heart disease risk factors, symptoms, and the various treatment options.

This is Putting Your Health First, the podcast from Health First. I'm Scott Webb. Doctor, thanks so much for your time today. We're going to talk about heart disease and risk factors. And let's just start there, what are the common heart disease risk factors, you know, regardless of gender?

Dr. John Hoyle: When I think about heart disease, there's a lot of variability in symptoms from patient to patient. But the thing that I notice the most in terms of commonality between people is the fact that some people feel that they have an idea that something's not right within their body, and that's a very good inner voice to listen to.

I always tell people that describing symptoms in the chest, which is, for my purposes, the area between the jawline and the belly button, can differ from patient to patient, but a few things that are consistent are chest pressure, chest tightness, profound shortness of breath with activities that used to be easy. And sometimes people have symptoms of chest discomfort that radiate. And it's important as to where the symptoms radiate. The patients can have chest pain that seems to go down their left arm and up into their jaw line. And sometimes even between the shoulder blades of their back. But anything like that lasts longer than 10 or 15 minutes is cause for concern. And those symptoms need to be evaluated on an emergency basis. They're not the kind of thing that you can sleep on until in the morning or set an appointment for two weeks away.

We talk a lot about time equaling muscle, and if somebody is having an interruption in the blood flow to their heart, and they have those symptoms, it's very important to get immediately to their nearest emergency department. And they need to activate their local EMS system by calling 911. You need to go to an ambulance for transport if you're having chest discomfort.

Host: Yeah. I've heard that before, that time is heart when it comes to stroke, time is brain.

Dr. John Hoyle: Exactly.

Host: Yeah. And it's just such good advice, right? Listen to your bodies. Your bodies tell us things. And if something just doesn't feel right, and it feels unusual and unexpected, and it lasts for longer than you say, 10 or 15 minutes, call 911, get to the ED where the experts and the medicine and all of that stuff is waiting there for you.

Scott Webb: I'm just wondering, are there any like sort of female-specific risk factors?

Dr. John Hoyle: With women, the symptoms are not considered to be the same as with men. As I mentioned earlier, everybody's a little bit different in how they nuance things. Women have less of a localization of pain over their left-sided chest. Sometimes they have pain that they describe as sharp or stabbing. Shortness of breath is very common. Breaking out into a sweat is common. Nausea, a feeling of something not being right, any pain that happens when you take a deep breath in, you know, those not necessarily are coming from the heart, but they certainly need to be investigated well. In women and in patients with diabetes as well, sometimes the symptoms can be fairly subtle. So, that's where listening to your body and trying to take time to take care of yourself, those become very important things to do.

Host: Yeah. And so if we're someone, let's say who has a family history of heart disease, who maybe is a smoker, who's living a fairly sedentary lifestyle, you know, like all the risk factors greatest hits, if you will, then what should we do? If we know, or we believe that we're at at higher risk for heart disease or high risk for heart disease, what should we do?

Dr. John Hoyle: If people have risk factors without symptoms, they need to bring those to the attention of their primary care provider. I think that many, many lives have been saved because general internal medicine specialists and family medicine specialists and nurse practitioners, the people that really hold the country together in terms of symptom management, bringing those symptoms, or at least those historical facts, to the attention of their primary provider, especially nowadays, is of paramount importance. We can do a lot now to try and circumvent some of the common risk factors if we know about them in advance. So, if I have a family history, that's certainly worth noting and all the elements of the family history with regard to heart disease, obesity, high blood pressure, diabetes, you know, all those things that can play into a risk factor profile. Also, some people, interestingly enough, may not have much in the way of family history that they know about, but any change in symptoms with exertion in particular are important to communicate to your family doctor.

Host: Yeah. You know, I think you and I are roughly from the same era, same generation, we were talking before we got going here. And I always remember Fred Sanford, you know, when he would fake his attacks and he would clutch his chest and he was having the big one, you know. And it really does seem, doctor, that when it comes to the symptoms of a heart attack in men versus women, that they really are different. I have that right, right?

Dr. John Hoyle: You're exactly right. I have said this probably a thousand times, much to the dismay of the people that work around me. And what I say to people is that Redd Foxx is the only person that I know of that actually got it right. Everybody else is a variation. I believe that if it were as simple as what Redd Foxx was able to convey as his character of Fred Sanford, my job would be very easy.

But the fact of the matter is most people have something that's a little bit different than that. Especially nowadays, and I think that the reasons for that are numerous, but we don't see as many classic Fred Sanford type patients in the emergency department as we used to. I'm not sure why that is, but I think a lot of people can have their coronary disease detected earlier if they're alert enough to the symptoms. and we, try to avoid, the progression of events to where it becomes as dramatic as he was able to convey.

Host: Try to avoid the big one, right?

Dr. John Hoyle: Exactly. But I do think that in avoiding the big one, paying attention to the subtle changes that may be present before the actual severity of the symptoms can certainly play a role for us in trying to direct people to the right testing modalities and other things.

Host: Yeah. And wondering, is there a way for us to differentiate we as people and, of course, doctors and nurses are people too, but is there a way to differentiate between heart attack symptoms and maybe panic attacks that they often sort of present similarly and wondering like how do we know and should we call 911 and rush to the ER?

Dr. John Hoyle: I believe that for me and in my business, a lot of the alternative diagnoses that can explain chest pain. We may consider those after we do some testing to exclude the heart. What I tell patients is that you have to focus on the thing that is the most immediate danger to us. And I'm not trying to dismiss the significance that anxiety plays in a lot of people's lives, but when it comes to actual life-threatening issues affecting the engine of the body, you have to make sure that that's not going on first and then we can take a step back and consider alternative diagnoses. When I have discomfort in the chest, it could be related to reflux, maybe I had too many jalapenos with Mexican food. Maybe it is my gallbladder, maybe I am nervous about something at work or in life.

But the thing that I like to tell people is that we need to check the heart first because it's easier to do now and we have better diagnostic testing modalities that we can use. And so, it is quicker for us to exclude the heart as a possibility, and we can do it more accurately now than we have in the past.

Scott Webb: yeah, that makes total sense, right? You know, it's like, you bring your car into the shop and you tell them there's a noise coming from the engine, you know, you try to rule things out. So, we try to rule the heart as the source of these issues. And then if it is GERD or the gallbladder or panic attack or something like that, then there will be time after we've ruled out the heart, right?

Dr. John Hoyle: Exactly. And furthermore, ruling out the heart makes it easier for other subspecialists to focus in on the actual diagnosis that they're thinking about. The gastroenterologist certainly wants to know if he's had his cardiology friend exclude the heart as a diagnostic problem so that he can focus on working up the gallbladder or the upper GI tract and so on. So not only do we like to make sure it's not the heart, our other brothers in healthcare, brothers and sisters, like to make sure that it's not the heart either so that they can focus on their area of expertise.

We frequently do that for other clinicians as well because the worst case scenario is for us to center on the wrong diagnosis that may be less lethal than the heart can be and have the heart rear its head during those diagnostic workups. But those are very rare events, but we always start from the heart. It's the most important cause of chest discomfort to exclude. We like to make sure that the heart is safe before we think about other things to explain the symptoms.

Host: That makes total sense. And, it's been good stuff today, educational, doctor. As we wrap up here, I just want to have you reiterate to folks, you know, we talked about it a little bit earlier and you and I talked about it before we got rolling here, but if you suspect that you're having a heart attack, any of the symptoms, any or all of the symptoms that you mentioned earlier, both for men, women, whatever it is, what should folks do?

Dr. John Hoyle: The magic number is 15 minutes. If the symptoms are persisting for 15 minutes, chest pressure, tightness, squeezing. stabbing, anything that goes into the neck or jaw or down the left arm between the shoulder blades, that's a 911 call. If patients have risks in their family, perhaps their uncle or their father may have just had a heart attack and they want to know what their risks are, bringing those risks to the attention of their primary care provider, those things are very important to do if they're not actively having the symptom. And then, making people aware of our risks. And being aware of things that may help us to do more diagnostic workup, those are important things to consider as we're moving through life.

Host: Yeah, absolutely. And when in doubt, you know, call 911 , have the EMTs, have the ambulance come, have them take you there. They do some life-saving things on the way. Teams of people will be waiting for you if they know what your symptoms are. All good stuff. So, doctor, thanks so much for your time today. You stay well.

Dr. John Hoyle: Okay. Thank you very much. Thank you for having me.

Host: And 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. And if you enjoyed this episode, please be sure to tell a friend, share on social media, and check out our entire podcast library. We look forward to you joining us again.