Joey Wahler (Host): February is American Heart Month. So, what better time to discuss heart health? Our guest, Dr. Todd Carlson, a primary care provider with Jefferson Healthcare. This is To Your Health, a Jefferson Healthcare podcast. Thanks for being with us. I'm Joey Wahler. Hi there, Dr. Carlson. Thanks for joining us.

Todd Carlson, MD: Hello.

Host: First, what are some of the warning signs or symptoms people should be on the lookout for when it comes to their heart, generally speaking?

Todd Carlson, MD: Absolutely. So, I think a lot of people know, I mean, chest pain. We often will say not just pain to pressure because sometimes people don't say it's pain, but they'll say it feels like something really heavy is sitting on them, classically in the chest. Sometimes it radiates out to the arm or up to the jaw. But interestingly, I've had people who feel like, "It can't be my heart," they said, "because it wasn't going to my neck or jaw." No, anything up here could be. And then classically, other things with it, shortness of breath, sometimes people break into a cold sweat with it, feel their heart racing, or beating irregularly, sometimes feel sick to their stomach, maybe some dizziness, and that's the primary symptoms.

Host: So that being said, when people have heart health concerns, naturally they're most likely to first get in touch with their primary care provider, like yourself. So, what are some of the things you and yours do to check to make a diagnosis.

Todd Carlson, MD: It'll vary. I mean, of course, if they're calling in to our clinic, and having symptoms at the moment of something that's a 911 situation, they need to go to the ER. But not infrequently, people will come in and say that they've had these symptoms off and on, say they're fine when they're, you know, at rest. They're fine with just walking, kind of routine stuff in the house. But maybe if they're walking up a hill or carrying something, they'll get these symptoms and they go away when they stop. And so, that would be really suspicious for it. And at that point, we often will get a chest x-ray, maybe get some blood work if they haven't seen some of things like cholesterol checked or checking for diabetes, we'll check those. But typically, we're then setting them up for a stress test.

Host: Now, speaking of which, you led me beautifully into my next question right there. If someone has a family history of heart disease, for instance, how much more diligent should they be about having certain things checked like blood pressure, cholesterol, et cetera.

Todd Carlson, MD: Yeah, it really makes a difference. And most people have some history of heart disease in the family. We really worry more about, especially people who have it at a younger age. You know, if you had a family member have a heart attack in their 40s or something like that, that certainly raises the index of suspicion. And for those people, if we get a good family history, we'll be talking to them, even in their 20s, making sure they don't have extremely high cholesterol that we want to start intervening early on, making sure we're keeping up with blood pressure. But, you know, everybody should be diligent because heart disease is a huge problem across the world and everybody's at some risk. And so, we're always looking for risk factors and trying to optimize the situation.

Host: When you say it's a huge problem, anything from your experience and dealing with this on a daily basis you can share with us, statistically or otherwise, just to give people a little better idea of how big of a problem it is.

Todd Carlson, MD: Yeah, I kind of stumbled when I was talking because it's like, "Is heart disease number one or number two?" Cancer and its various forms has that and heart disease have been one and two for decades. So, it's up there, and I wish I knew for sure right now. But it's either number one or number two cause of death in the United States. So, it's huge.

Host: I think you'd agree that says it all right there, regardless of which it is, right?

Todd Carlson, MD: Yeah, exactly.

Host: So when you see patients with heart issues, what would you say is most common among the following? Is it people at high risk? Is it those looking to prevent heart disease or is it something else entirely?

Todd Carlson, MD: I probably see more people at risk that we're talking in our daily basis. As a primary care physician, I see a lot of people with diabetes, I see a lot of people with high blood pressure, I see a lot of people who smoke and those are all big risk factors. And so, we're talking about trying to modify risk factors from early on. And you know, a very common thing that we do in our practice. But we definitely have people come in specifically, because they had a brother who just had a heart attack or a good friend or because they have symptoms.

Host: Let me pick up on what you mentioned there about smoking. Give us an idea in layman's terms, if you would please, doc, exactly what negative impact does smoking have on our heart?

Todd Carlson, MD: It puts extra strain on especially the blood vessels in the body and in the heart. Because it gets pretty deep. But how plaque forms in your arteries, which can cause blockages that then can rupture and cause a heart attack, smoking influences that and increases the risk of building a plaque like that. And it also directly influences the risk of these plaques rupturing. And when they rupture, a clot forms on them, and that blocks the blood flow to part of the heart, and that's a heart attack that's the most common kind of heart attack.

Host: How about overusing alcohol?

Todd Carlson, MD: Overusing alcohol, yeah, it works in a couple ways. I mean, it definitely can cause more of, you know, heart problems with angina, things like that, but also can cause risk of congestive heart failure, which is when your heart just doesn't pump as well. So, it is toxic to the heart tissue, to the heart muscle, and over time that heart can get enlarged and not function as well, not pump the blood as well.

Host: So to be proactive and try and prevent heart problems, let's talk about a few other things that we can control to some degree. What are some do's and don'ts, for instance, regarding what we eat?

Todd Carlson, MD: Yeah, that's a great topic. To some extent, this is why family history makes a difference because, say, your cholesterol, a lot of that is just programmed in your genes. But even with that, you can make some difference and eating healthy, exercising regularly. So, the current recommendations are getting at least moderate exercise, 150 minutes a week, at least, which is 30 minutes, five days a week, which most people can get in. And that doesn't need to be super vigorous. Even gardening is considered moderate exercise, because you're just up and down and carrying things and doing things. And of course, just brisk walking, cycling, et cetera. And so, that makes a big difference. It actually impacts people's blood pressure, which we'll come back to, I'm sure, almost immediately within a couple of weeks of starting on an exercise program, the blood pressure drops significantly, which is good.

And then, eating a really heart-healthy diet. You know, limiting animal fats. I'm not going to go to, you know, whether people should be vegan or vegetarian. You know, there's definitely proponents of that and some benefit, but people not willing to go there, focusing heavily on fruits and vegetables, whole grains, the good fats, which are olive oil, canola oil, nuts and nut oils. Those are all really healthy. So, it's kind of the Mediterranean diet, is what you find online. And that has really, really great benefits for the heart.

Host: Now, regarding exercise, to get back to that for a moment, as you well know, so many people complain they don't have the time, things along those lines. They'll often bring up obstacles as to why they don't get more exercise. Isn't the most important thing here for heart health really just to do something on somewhat of a regular basis, right? Even if it's 10 or 15 minutes a day, just so that when you are active, it's not a shock to the system and to your heart, so to speak, right?

Todd Carlson, MD: Yeah. And that brings up something that, back when I was in training, we always said you had to turn on your stopwatch, and you're going 30 minutes of uninterrupted exercise, and, it's been quite a while now, but they found that dispersing that through the day, if you're doing 5, 10 minutes at a time of different activities that still adds up, and it makes a difference for your heart health. And you always hear about, you know, park at the back of the parking lot at the grocery store, or take the stairs instead of the elevator, those things, it all adds up and makes a difference.

Host: Absolutely. Few other things. One being, there's that old saying, "You're going to give me a heart attack," right? How important is managing stress and can too much of it actually contribute to heart problems?

Todd Carlson, MD: Wow. That's a tough one. The data is probably still evolving on that. I mean, I think, we probably overemphasized that before, but we're learning more and more about, especially chronic stress and, you know, raising your cortisol levels, which are your stress response, your fight or flight hormones. And over time, especially if your body's exposed to that repeatedly, it can influence your cardiovascular system significantly. You know, does that acute moment cause it? If you're not already predisposed, you know, some really high stress thing isn't going to do it, but it's more the chronic exposure to stress. So, working on stress management is very important.

Host: So if anyone happens to say that to me down the road, I'm going to say, "Uh-uh-uh I just spoke to the doctor. He says that's not going to happen."

Todd Carlson, MD: Yeah, maybe not in the moment, right? But long-term.

Host: So in summary here, doctor, it seems one key, as we've discussed, to heart health in general is just avoiding excess overall in our lives and just using good old-fashioned common sense here, right?

Todd Carlson, MD: Yeah. I talk about, you know, with an asterisk, but everything in moderation, to a lot with my patients. Not overdoing it, living your life, but being really cognizant. And I look at it as, are you going to have regrets if you go on and you have a heart attack? "Oh, if I'd only done this," you know, it's like, are you going to really be kicking yourself for it? Well, make some good choices. It's pretty easy to make, even the small incremental changes and workup from there. So, it's worth doing.

Host: in closing here, do you think sometimes people tend to take their heart for granted?

Todd Carlson, MD: Absolutely. You don't think about it much, right? It's just going, and it's been doing that since before you were born. And you just go about your way and behavior change that most of us need to do some of, always seems like, "Oh, maybe after I get past this thing or this thing." And, you know, the time to make the changes is now, right? You wait until tomorrow, it's never going to come. But yeah, it's easy to take for granted for sure.

Host: Well, folks, we trust you're now more familiar with maintaining good heart health. Dr. Todd Carlson, thanks so much again.

Todd Carlson, MD: Thank you. I appreciate you having me on. 

Host: And thanks for hopping aboard. For more information, please do visit jeffersonhealthcare.org. Again, that's jeffersonhealthcare.org. Now, if you found this podcast helpful, please do share it on your social media. I'm Joey Wahler. And thanks again for being part of To Your Health, the Jefferson Healthcare Podcast.