Interventional Cardiology at PIONEERS
A healthy heart supports your overall health and wellness. Dr. Richard Jacoby, Medical Director of Cath Lab at Pioneers, discusses interventional cardiology.
Featuring:
Richard Jacoby, MD
Dr. Richard Jacoby is certified by the American Board of Internal Medicine in Interventional Cardiology and comes to the Imperial Valley from the Novant Health Heart and Vascular Institute in North Carolina, where he practiced since 2009 before joining Pioneers Memorial. Dr. Jacoby received his medical degree from Temple University School of Medicine and has been in practice for more than 20 years. Transcription:
Prakash Chandran (Host): A healthy heart is essential to a long and healthy lifestyle. But there are many things that can go wrong and sometimes the cause is not obvious. Luckily, there are different types of cardiologists that specialize in nonsurgical treatments that can prevent or correct certain conditions and today, we’ll talk about it with Dr. Richard Jacoby, an interventional cardiologist at Pioneers Memorial Hospital. This is Pioneers Memorial Health Talk, the podcast from Pioneers Memorial Hospital. I’m Prakash Chandran. So, first of all Dr. Jacoby, let’s start with the basics. What exactly do you do as a cardiologist?
Richard Jacoby, MD (Guest): As a cardiologist, I do medical care focused on the heart. And one of the first things I have to do as a cardiologist is decide if a patient who presents to me with symptoms, actually has heart disease or not. And when I was younger, I think I always thought that doing the big intervention, taking care of someone with a heart attack was the most good that we did. Well sometimes also just simply letting someone know that their heart is healthy, and everything is okay and reassuring them in that they can go on with their life is helpful as well.
We try to improve the quality of life. We can do that by helping our patients who may have chest pain or shortness of breath alleviate their symptoms and remain active. We can decrease the need for hospitalizations. And we can also focus on trying to prevent premature death. A lot of people think when they have heart disease, that that’s kind of a death sentence. Well, that may have been true about 30 years ago or so. Most of the time these days, the people take medications, they know they have a heart problem, they make some effort to take care of themselves. They can live a normal lifespan and remain active. In fact, a lot of times, I worry more about the people who don’t know they have a heart problem since sudden death often occurs in people who aren’t on medications and don’t know they have a problem with their heart.
The other thing that we do as a cardiologist is help families of patients understand what’s going on with their loved one’s illness and also realize there’s a genetic component oftentimes to heart disease. So, patient’s first degree relatives, their parents, brothers, sisters, children also have their own risk of having the same type of blockage issues.
Host: So, you talked about addressing heart problems, but I’m curious to understand what exactly that means.
Dr. Jacoby: The most common that we deal with probably is coronary artery disease and basically what that means is plaque in the heart arteries. And plaque in the heart arteries limits blood flow to the heart and can cause heart muscle damage which is what a heat attack is. So, that’s a big issue. About a third of everybody gets coronary artery disease throughout out life and one thing a lot of people don’t realize is actually coronary disease starts when you are in your teens and 20s. it doesn’t start when you are 40 or 50. And we know that from the Vietnam War when autopsies on the young GIs who were killed in war, they had fatty streaks in their coronary arteries which is the beginnings of plaque in the heart arteries.
So, we are sure that that starts early. Things that contribute to it are pretty widespread, things like diabetes, obesity, smoking, high blood pressure, genetic factors which obviously we can’t control, sedentary lifestyle and poor diet all of those things, a lot of us have multiple risk factors but all of those things contribute to plaque in the heart arteries. And when an artery does get blocked, it limits blood flow to the heart muscle and people experience chest tightness or pain or shortness of breath with exertion. If that only occurs with exertion and it goes away after a few minutes or rest, we call that angina or angina. If the artery gets blocked completely or more less completely and limits blood flow to the heart; you can actually have heart muscle damage and that’s a myocardial infarction or heart attack and the main difference is that the pain or symptoms last long enough, maybe 20 minutes or so, that it’s actually doing heart muscle damage.
Treating heart disease, is kind of treating all aspects of it where we are using medication to diminish the amount of plaque that’s in the arteries, we’re using anti-inflammatory medications, lifestyle modifications and then sometimes doing catheter-based therapies. Heart catheterizations with angioplasty or stents or drug eluding stents to fix the arteries and – in terms of doing procedures, we are doing these things in a minimally invasive fashion with a spaghetti like catheter, something very small, oftentimes through the wrist or sometimes through the groin these days that works very well and is minimally invasive.
Host: Got it. And so I see in your title, that you are an interventional cardiologist. And I actually have not heard about that before. So, I was wondering if you could shed some light into the differences between an interventional cardiologist like yourself and a normal cardiologist.
Dr. Jacoby: An interventional cardiologist treats heart problems that have a structural basis. And the most common thing that means is treating plaque or coronary artery disease that we just described but also valvular heart disease is another thing that we will treat as an interventional cardiologist. So, as a cardiologist, we look at the heart as a pump. It’s heart muscle that squeezes and pushes blood throughout the body and that muscle needs its own blood supply, so it has coronary arteries that supply the blood flow to the heart itself. It has an electrical system and it has heart valves to allow the blood to go one direction through the heart, so the heart is an efficient pump.
So, I deal with the clogged pipes if you will with the arteries that are blocked and also with valves. The valves can either get leaky and not be very efficient, so the heart has to work extra hard to pump the blood or they can get narrowed. They can get scarred and narrowed and we can fix that sort of thing as well. In terms of training, a cardiologist first has to go through medical school then internship and residency and become an internist, an internal medicine physician then go on and do a cardiology fellowship usually a couple of years’ worth to learn general care of the heart and medications. If one chooses, one can go on and become an invasive cardiologist and do diagnostic heart catheterizations, then one can also get additional interventional training as I’ve done and become an interventional cardiologist putting stents in, doing angioplasty and then on top of that, I’ve also learned structural heart disease meaning fixing the valves through catheter procedures. Again, just like doing heart catheterizations, these are small catheters through the groin predominantly for fixing the valves. It’s minimally invasive and doesn’t involve having to get open chest surgery.
Host: Okay and one of the things that you said that resonated with me was making sure that the heart remained healthy, that it didn’t necessarily need to be a massive procedure like an open heart surgery but that over time, making sure that the health of the heart was good. So, you said that some plaque can start building when people are teens. So, I’m curious as to when people should start to come in to check on the health of their heart.
Dr. Jacoby: As an interventional cardiologist, I love doing procedures on people who need it but obviously, I’d rather do preventive care if possible. What I would say is if someone has any risk factors again those things being diabetes, high blood pressure, family history of someone in their immediate family having had blocked arteries or heart trouble, obesity, poor lifestyle or diet, all of those things are risk factors and I would say probably in their 30s or so, they should have a discussion with their primary care doctor about whether or not a stress test or maybe a CAT scan, coronary angiogram to look for early plaque development might be in order as well as probably cholesterol testing and any sort of lifestyle modification that can be done.
And if someone has plaque in the heart arteries, then typically I would treat them with medication to try to make sure it never gets to the point where we do need to do an invasive procedure on them.
Host: Okay, I got it. That’s really helpful to know. One of the things that I’m curious about is you talked about some of the difference between yourself as an interventional cardiologist versus a basic one, I’m curious as to what other value you feel like you bring as an interventional cardiologist to the Brawley area.
Dr. Jacoby: Well many people here in Imperial Valley which is where Brawley is have risk factors such as obesity, diabetes, smoking, a lot of them have vascular disease, genetic factors and high blood pressure. So, a lot of them are likely to have or do have coronary artery disease whether or not they know it. and part of my role here is to extend the best new treatment options. One of the things that I’m involved with, I’m working with Pioneers Memorial Healthcare District to start a heart catheterization lab in the community. That would allow us to do diagnostic procedures here rather than transferring patients out for this sort of thing. Right now if anyone has heart disease that require anything beyond medication; we have to transfer the patient to two hour away or so to the San Diego area to get those sorts of things done or helicopter them out if they are sick.
And that’s a big burden on patients and their families to have to go far away. It’s also a high bar and a lot of patients don’t get treated simply because the bar is too high. And if we can offer that care locally, I think that will help a lot. Our plan is to start the heart cath laboratory which is actually under construction now, hopefully be done in a couple of months or so and then to add PCI or percutaneous coronary intervention which is stents and angioplasty so we can treat patients locally here and then once that’s up and running; to offer 24/7 heart attack care so that instead of the patient having to take that helicopter ride to San Diego they can get all of that done locally right here.
And the other things that I offer is I have an affiliation with Scripps La Jolla so for patients who do need more involved care, maybe they are sicker, have more complex things going on or need valve procedures done that can’t be done locally here; I can take care of those patients as Scripps La Jolla and then come back and see them in the community here as well.
Host: Yeah, it’s really amazing to hear that patients are soon going to be able to get that comprehensive level of care at Pioneers. One other question that I wanted to ask is what is something that you wish more patients knew before they came to see you?
Dr. Jacoby: One of the other things that gets me excited in cardiology about what we do is anytime we can do something new that we didn’t do before or help patients who didn’t get care before; that’s something that I always get kind of excited about and the valve disease treatment is something that I’ve become involved in in the past several years. Patients who have aortic stenosis might have a heart murmur and have limitations of flow out of their aortic valve. There’s a relatively new procedure that I’ve done a lot prior to coming to this area called TAVR, it stands for transcatheter aortic valve replacement and it involves putting a fine catheter up through the groin and actually putting a new valve in. it’s essentially a stent with valve leaflets sewn in it. But putting it in someone’s aortic valve and replacing a valve that way rather than open heart surgery. And similarly, we have a procedure called MitraClip for the mitral valve. It’s not a valve replacement but we can actually put clips on the valve while the heart’s beating watching with ultrasound and close off the areas where it’s leaking.
These type of procedures, patients usually go home in a day or two afterwards. And recover very quickly. It’s something that they don’t have to go through a major open heart surgery. They have less chance of not surviving or having major complications. And I think that’s something that’s really going to revolutionize care for patients with valve problems.
Host: Certainly, well, it’s really exciting to hear how far technology has come. And you as an interventional cardiologist can offer that comprehensive level of care. So, thank you so much for your time today Dr. Jacoby. That’s Dr. Richard Jacoby, an Interventional Cardiologist at Pioneers Memorial Hospital. Thanks for checking out this episode of Pioneers Memorial Health Talk. Head to www.pmhd.org to get connected with Dr. Jacoby or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and looking forward to our next conversation.
Prakash Chandran (Host): A healthy heart is essential to a long and healthy lifestyle. But there are many things that can go wrong and sometimes the cause is not obvious. Luckily, there are different types of cardiologists that specialize in nonsurgical treatments that can prevent or correct certain conditions and today, we’ll talk about it with Dr. Richard Jacoby, an interventional cardiologist at Pioneers Memorial Hospital. This is Pioneers Memorial Health Talk, the podcast from Pioneers Memorial Hospital. I’m Prakash Chandran. So, first of all Dr. Jacoby, let’s start with the basics. What exactly do you do as a cardiologist?
Richard Jacoby, MD (Guest): As a cardiologist, I do medical care focused on the heart. And one of the first things I have to do as a cardiologist is decide if a patient who presents to me with symptoms, actually has heart disease or not. And when I was younger, I think I always thought that doing the big intervention, taking care of someone with a heart attack was the most good that we did. Well sometimes also just simply letting someone know that their heart is healthy, and everything is okay and reassuring them in that they can go on with their life is helpful as well.
We try to improve the quality of life. We can do that by helping our patients who may have chest pain or shortness of breath alleviate their symptoms and remain active. We can decrease the need for hospitalizations. And we can also focus on trying to prevent premature death. A lot of people think when they have heart disease, that that’s kind of a death sentence. Well, that may have been true about 30 years ago or so. Most of the time these days, the people take medications, they know they have a heart problem, they make some effort to take care of themselves. They can live a normal lifespan and remain active. In fact, a lot of times, I worry more about the people who don’t know they have a heart problem since sudden death often occurs in people who aren’t on medications and don’t know they have a problem with their heart.
The other thing that we do as a cardiologist is help families of patients understand what’s going on with their loved one’s illness and also realize there’s a genetic component oftentimes to heart disease. So, patient’s first degree relatives, their parents, brothers, sisters, children also have their own risk of having the same type of blockage issues.
Host: So, you talked about addressing heart problems, but I’m curious to understand what exactly that means.
Dr. Jacoby: The most common that we deal with probably is coronary artery disease and basically what that means is plaque in the heart arteries. And plaque in the heart arteries limits blood flow to the heart and can cause heart muscle damage which is what a heat attack is. So, that’s a big issue. About a third of everybody gets coronary artery disease throughout out life and one thing a lot of people don’t realize is actually coronary disease starts when you are in your teens and 20s. it doesn’t start when you are 40 or 50. And we know that from the Vietnam War when autopsies on the young GIs who were killed in war, they had fatty streaks in their coronary arteries which is the beginnings of plaque in the heart arteries.
So, we are sure that that starts early. Things that contribute to it are pretty widespread, things like diabetes, obesity, smoking, high blood pressure, genetic factors which obviously we can’t control, sedentary lifestyle and poor diet all of those things, a lot of us have multiple risk factors but all of those things contribute to plaque in the heart arteries. And when an artery does get blocked, it limits blood flow to the heart muscle and people experience chest tightness or pain or shortness of breath with exertion. If that only occurs with exertion and it goes away after a few minutes or rest, we call that angina or angina. If the artery gets blocked completely or more less completely and limits blood flow to the heart; you can actually have heart muscle damage and that’s a myocardial infarction or heart attack and the main difference is that the pain or symptoms last long enough, maybe 20 minutes or so, that it’s actually doing heart muscle damage.
Treating heart disease, is kind of treating all aspects of it where we are using medication to diminish the amount of plaque that’s in the arteries, we’re using anti-inflammatory medications, lifestyle modifications and then sometimes doing catheter-based therapies. Heart catheterizations with angioplasty or stents or drug eluding stents to fix the arteries and – in terms of doing procedures, we are doing these things in a minimally invasive fashion with a spaghetti like catheter, something very small, oftentimes through the wrist or sometimes through the groin these days that works very well and is minimally invasive.
Host: Got it. And so I see in your title, that you are an interventional cardiologist. And I actually have not heard about that before. So, I was wondering if you could shed some light into the differences between an interventional cardiologist like yourself and a normal cardiologist.
Dr. Jacoby: An interventional cardiologist treats heart problems that have a structural basis. And the most common thing that means is treating plaque or coronary artery disease that we just described but also valvular heart disease is another thing that we will treat as an interventional cardiologist. So, as a cardiologist, we look at the heart as a pump. It’s heart muscle that squeezes and pushes blood throughout the body and that muscle needs its own blood supply, so it has coronary arteries that supply the blood flow to the heart itself. It has an electrical system and it has heart valves to allow the blood to go one direction through the heart, so the heart is an efficient pump.
So, I deal with the clogged pipes if you will with the arteries that are blocked and also with valves. The valves can either get leaky and not be very efficient, so the heart has to work extra hard to pump the blood or they can get narrowed. They can get scarred and narrowed and we can fix that sort of thing as well. In terms of training, a cardiologist first has to go through medical school then internship and residency and become an internist, an internal medicine physician then go on and do a cardiology fellowship usually a couple of years’ worth to learn general care of the heart and medications. If one chooses, one can go on and become an invasive cardiologist and do diagnostic heart catheterizations, then one can also get additional interventional training as I’ve done and become an interventional cardiologist putting stents in, doing angioplasty and then on top of that, I’ve also learned structural heart disease meaning fixing the valves through catheter procedures. Again, just like doing heart catheterizations, these are small catheters through the groin predominantly for fixing the valves. It’s minimally invasive and doesn’t involve having to get open chest surgery.
Host: Okay and one of the things that you said that resonated with me was making sure that the heart remained healthy, that it didn’t necessarily need to be a massive procedure like an open heart surgery but that over time, making sure that the health of the heart was good. So, you said that some plaque can start building when people are teens. So, I’m curious as to when people should start to come in to check on the health of their heart.
Dr. Jacoby: As an interventional cardiologist, I love doing procedures on people who need it but obviously, I’d rather do preventive care if possible. What I would say is if someone has any risk factors again those things being diabetes, high blood pressure, family history of someone in their immediate family having had blocked arteries or heart trouble, obesity, poor lifestyle or diet, all of those things are risk factors and I would say probably in their 30s or so, they should have a discussion with their primary care doctor about whether or not a stress test or maybe a CAT scan, coronary angiogram to look for early plaque development might be in order as well as probably cholesterol testing and any sort of lifestyle modification that can be done.
And if someone has plaque in the heart arteries, then typically I would treat them with medication to try to make sure it never gets to the point where we do need to do an invasive procedure on them.
Host: Okay, I got it. That’s really helpful to know. One of the things that I’m curious about is you talked about some of the difference between yourself as an interventional cardiologist versus a basic one, I’m curious as to what other value you feel like you bring as an interventional cardiologist to the Brawley area.
Dr. Jacoby: Well many people here in Imperial Valley which is where Brawley is have risk factors such as obesity, diabetes, smoking, a lot of them have vascular disease, genetic factors and high blood pressure. So, a lot of them are likely to have or do have coronary artery disease whether or not they know it. and part of my role here is to extend the best new treatment options. One of the things that I’m involved with, I’m working with Pioneers Memorial Healthcare District to start a heart catheterization lab in the community. That would allow us to do diagnostic procedures here rather than transferring patients out for this sort of thing. Right now if anyone has heart disease that require anything beyond medication; we have to transfer the patient to two hour away or so to the San Diego area to get those sorts of things done or helicopter them out if they are sick.
And that’s a big burden on patients and their families to have to go far away. It’s also a high bar and a lot of patients don’t get treated simply because the bar is too high. And if we can offer that care locally, I think that will help a lot. Our plan is to start the heart cath laboratory which is actually under construction now, hopefully be done in a couple of months or so and then to add PCI or percutaneous coronary intervention which is stents and angioplasty so we can treat patients locally here and then once that’s up and running; to offer 24/7 heart attack care so that instead of the patient having to take that helicopter ride to San Diego they can get all of that done locally right here.
And the other things that I offer is I have an affiliation with Scripps La Jolla so for patients who do need more involved care, maybe they are sicker, have more complex things going on or need valve procedures done that can’t be done locally here; I can take care of those patients as Scripps La Jolla and then come back and see them in the community here as well.
Host: Yeah, it’s really amazing to hear that patients are soon going to be able to get that comprehensive level of care at Pioneers. One other question that I wanted to ask is what is something that you wish more patients knew before they came to see you?
Dr. Jacoby: One of the other things that gets me excited in cardiology about what we do is anytime we can do something new that we didn’t do before or help patients who didn’t get care before; that’s something that I always get kind of excited about and the valve disease treatment is something that I’ve become involved in in the past several years. Patients who have aortic stenosis might have a heart murmur and have limitations of flow out of their aortic valve. There’s a relatively new procedure that I’ve done a lot prior to coming to this area called TAVR, it stands for transcatheter aortic valve replacement and it involves putting a fine catheter up through the groin and actually putting a new valve in. it’s essentially a stent with valve leaflets sewn in it. But putting it in someone’s aortic valve and replacing a valve that way rather than open heart surgery. And similarly, we have a procedure called MitraClip for the mitral valve. It’s not a valve replacement but we can actually put clips on the valve while the heart’s beating watching with ultrasound and close off the areas where it’s leaking.
These type of procedures, patients usually go home in a day or two afterwards. And recover very quickly. It’s something that they don’t have to go through a major open heart surgery. They have less chance of not surviving or having major complications. And I think that’s something that’s really going to revolutionize care for patients with valve problems.
Host: Certainly, well, it’s really exciting to hear how far technology has come. And you as an interventional cardiologist can offer that comprehensive level of care. So, thank you so much for your time today Dr. Jacoby. That’s Dr. Richard Jacoby, an Interventional Cardiologist at Pioneers Memorial Hospital. Thanks for checking out this episode of Pioneers Memorial Health Talk. Head to www.pmhd.org to get connected with Dr. Jacoby or another provider. If you found this podcast helpful, please share it on your social channels and be sure to check out the entire podcast library for topics of interest to you. Thanks and looking forward to our next conversation.