Maggie McKay (Host): The heart is our lifeline, and the more we know about it, the better we're equipped to take care of it. So today, Dr. Tina DeGroot and Jonathan Milton join us to discuss Cardiology 101. Welcome to Stoughton Health Talk. I'm your host, Maggie McKay. Thank you so much for being here today. Would you please introduce yourselves?

We'll start with you, Dr. DeGroot.

Tina DeGroot, PhD, APRN: Hi, Maggie. Thanks so much for having us today. I'm Dr. Tina DeGroot. I have a PhD in Nursing and have dedicated the last 35 years of my career to cardiovascular health.

Host: Wow. And Jonathan?

Jonathan Milton, MSN, APRN: Yeah, nice to meet you, Maggie. I am actually a new master's prepared Advanced Practice Nurse. I'm Board Certified as an adult Gero Clinical Nurse Specialist, and I've spent a little over eight years working with acute care cardiovascular patients on the inpatient side, and now I'm working on the outpatient side in cardiology.

Host: Amazing. So here's a big question to kick it off. Jonathan, how does the heart work?

Jonathan Milton, MSN, APRN: That's such a great question, and honestly, the first approach that I think about when trying to think, how does the heart work? I think of it like the heart is a pump. It beats all day and night to move blood through your body. The blood in our body, it carries oxygen and nutrients to your organs and muscles, helping them to work properly.

The heart has ultimately four chambers. There are two on the top. Those are called the atria. And then there are also two on the bottom. Those are called our ventricles. The flows from one chamber to the next, and then is pumped out to the rest of the body. And that's essentially the gist of it. That's how our heart works to pump our blood through the body.

Host: It always amazes me when you actually think about what's going on in your body all the time. It's like it's a miracle. Really. Jonathan, what's the function of the arteries?

Jonathan Milton, MSN, APRN: So, we think of the heart as the pump, and so for the arteries, we can think of those like highways for the blood. Those highways, they carry blood from the heart to all parts of the body. Your blood in the arteries has oxygen and nutrients that the body needs to stay healthy and strong.

When the heart beats, it pushes blood through the arteries so it can reach your muscles, organs, and even your skin. And ultimately, that's part of how we can think about how our arteries are connected to all organs throughout our body. There are even arteries connected to our heart to feed that as the main muscle.

Host: That's amazing. So arteries basically all have blood in them and they are, like you said, the highway to everywhere.

Jonathan Milton, MSN, APRN: Without our arteries, our blood wouldn't be able to get to all the places that it needs to, to feed those vital organs to work properly and for us to function and perform our everyday tasks.

Host: That's why we don't want them clogged.

Jonathan Milton, MSN, APRN: Absolutely. Absolutely.

Host: Dr. DeGroot, what are common tests to look at how the heart is functioning?

Tina DeGroot, PhD, APRN: Most of the time when our patients end up in cardiology, your primary care physician has probably already done some of these tests. So some very basic things that we would start with, whether you're in primary care or whether you're in the cardiology clinic, is just some basic lab work.

We want to know that your blood counts are normal, that your electrolytes are normal, and after that, we also want to start looking at just a basic EKG, and I think hopefully most of us, at least after the age of 50, have probably had an EKG somewhere. It's where we put the patches on your chest, and we hook those up to a machine, and they're measuring and looking at the electrical activity of the heart.

And based on what those tracings look like, and we can see those on all the famous Grey's Anatomy episodes that we have out there; based on what those electrical tracings look like, experts in the cardiology field, again, and your primary care doctor can really quickly determine if everything's functioning like it should, or maybe there's some other things that we need to take a little bit deeper dive into.

So, if, for example, your EKG may be abnormal in the office, the next test that we probably would recommend is called an echocardiogram. And this test is really great for all of us that are looking at the heart because it's basically an ultrasound of your heart. And when you see it, it is so cool because you get to see all the valves and you get to see how the blood pumps through your heart.

We also measure how thick the left ventricle, as Jonathan was talking about, the ventricles are in the bottom part of the heart. And on the left side, particularly, that's the big, huge pump that pumps the blood out to the rest of the body. So we want to make sure that the lining of that left ventricle is a certain thickness.

And we're going to talk about that in just couple minutes when we talk about hypertension. So that echocardiogram gives us a lot of diagnostic information. And the best part about both of those tests is there's no pain involved. So people don't have to get nervous about coming in to have those tests.

So the third test that we take a look at is called the stress test, and we can do that in a couple different ways. The first type of stress test is where we just put you on the treadmill, and we hook you up to an EKG machine, and we put you through some different stages of elevation and speed and get your heart pumping to the 85 percent of what your maximum would be.

And then see how you do. We look at the electrical part of your heart. We also can do a combination test where while you're on the treadmill, we can inject a tracer that allows us to take some pictures afterwards so that we can see how the blood is flowing to make sure that everything within the heart is functioning like it should.

And then thirdly, for a lot of our older patients that are not able to walk on a treadmill or actually more like speed walk on a treadmill; we can do the test while you're sitting in a chair, and we give you a medication that dilates your arteries, so that we can look at the electrical activity, as well as take some pictures afterwards.

So there's three main types of stress tests, along with the EKG and the echocardiogram. Those are our best tests in order, to be able to diagnose cardiac disease.

Host: Dr. DeGroot, somebody say with parents who both had heart issues, like let's say they both had heart attacks, should that person get these tests just to be on the safe side to know in case, is it hereditary?

Tina DeGroot, PhD, APRN: Cardiovascular disease is hereditary, to a certain extent, but when you look into the research, really what we are more concerned about is lifestyle management. So if both of your parents had cardiovascular disease, absolutely talk to your primary care provider about that, but we also want to really start cueing people into lifestyle management.

Weight loss, watch your sodium, exercise. All of those things are really important when we're talking about cardiovascular disease.

Host: And what's the danger of high blood pressure?

Tina DeGroot, PhD, APRN: Oh, I love that you asked this question.Jonathan and I talk about high blood pressure about 96 percent of the time during our day. So, the concern about high blood pressure is that if you have high blood pressure, it really forces that heart to work harder to pump the blood to the rest of your heart. So just as we talked about that left ventricle being your main pump, having high blood pressure makes that left ventricle work significantly harder and over time, can lead to an enlargement of that left ventricle, which can lead to heart failure, or can also lead to a thickening of that wall of that left ventricle.

And both of those increase your risk of heart attack and heart failure. We had some really great new guidelines that came out in 2019 from the American College of Cardiology, which the American Heart Association adopted, and the guidelines were very old, they hadn't been updated since 2003.

And what the researchers found was that back in 2003, when we set the guideline for your blood pressure to be less than 140 over 80, by the time people came into their regular doctor or into the emergency department, their blood pressure was way up 160, 170s, 180s, and we were seeing more strokes, more kidney disease, and more heart disease.

Those great group of experts got together and in 2019, we lowered that number. So, the new number, which we should all shoot for, is that blood pressure should be less than 130 over 80, because this allows us all, both the patient and the providers, to consider earlier lifestyle interventions, such as diet, exercise, reducing salt, and what they found was that by redefining hypertension, to lower that rate to 130 over 80, that we actually were able to predict about 46 percent of the American population really was having already early signs of hypertension.

The great part about that, though, is that really what they found was there was only a small amount of people, especially in the older adults, that required medications to assist in high blood pressure management. What we found with early identification was that in a partnership with the patient and the provider, using lifestyle modifications, people were able to delay or not even have to start blood pressure medications to manage their blood pressure.

Host: Wow. So we have talked a little bit about lifestyle management tips. Let's start with you, Jonathan. Any more that you can talk about or, you know, crucial ones that you'd like to share?

Jonathan Milton, MSN, APRN: Absolutely. When I think about lifestyle management, I think of it as an umbrella term, and each of those spokes of the umbrella as a different topic that different patients or different people might choose to combat or might choose to modify.

So, for instance, one of those spokes might be eating healthy. If one of those blood tests that Tina was talking about, comes back and it shows that we have some maybe higher cholesterol in our body; part of eating healthy might look like altering the food that we put in our body.

So choosing foods like fruits, vegetables, whole grains, lean proteins, avoiding too much salt, too much sugar, and unhealthy fats. That can be a part of healthy eating. Most individuals can consider moving, physical activity, as a big spoke underneath that lifestyle modification umbrella.

Thinking about exercising for at least 30 minutes every day, or most days, and that can look different depending on what your life looks like. You know, 30 minutes for one person might look like just taking a brisk walk, or going biking or swimming. It depends on where you're at and everybody might start out at a different level and that's okay.

It's more about getting moving. That's what we always tell our patients, and it's not necessarily just about getting moving. It's also about getting to a point to where you're exercising, so you're just a little bit out of breath, and that's okay, especially when you've been prescribed this by either your primary care provider or your cardiologist or cardiac team. Tina, did you have any other lifestyle management spokes that you think about considering?

Tina DeGroot, PhD, APRN: That was a great review of our lifestyle management coaching that Jonathan and I do again, just about every day with our patients. But I think one of the other main ones, is stop smoking. So, the research will show that nicotine, of course, carries many carcinogens, and even, of course, vaping, now there's new data out on that, but smoking actually causes what a layperson might say clogging of the arteries, or causes us to lay down plaque in the arteries that Jonathan was talking about.

So, if those arteries are plugged up, how on earth are we going to be able to get that blood out of the left ventricle to all those vital organs? So, we work really, really closely with our patients because we know that nicotine addiction is incredibly difficult to interrupt or to kind of kick, as some of our patients say.

 So we work really closely with them about smoking cessation and help them either with behavioral modification and sometimes some pharmacological support just to help them for sure reduce their amount of nicotine or cigarettes. And of course, the ultimate goal is to stop smoking altogether.

Host: Thank you both so much for sharing your expertise. This has been so helpful and educational and, you know, possibly life saving for somebody listening. You never know.

Tina DeGroot, PhD, APRN: Wonderful. Thank you, Maggie, for your time.

Jonathan Milton, MSN, APRN: Thank you for having us, Maggie.

Host: Thank you both. Again, that's Dr. Tina DeGroot and Jonathan Milton. To find out more, please visit stoughtonhealth.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you. I'm Maggie McKay. Thanks for listening to Stoughton Health Talk presented by Stoughton Health.