Jaime Lewis (Host): Heart disease is the leading cause of death in America, but many risk factors actually lie within our control. So how does a person know if their heart is truly healthy? Well, today we're exploring heart health with Dr. Michael Deucher, a Cardiologist at Southwest General Health Center. Welcome to Southwest General Health Talk, a podcast from the specialists at Southwest General Health Center.

I'm Jaime Lewis and Dr. Deucher, thank you for being here.

Michael Deucher, MD, FACC: Thanks Jaime. Great to be here.

Host: So let's start with a big question that I often wonder about myself. How do I know if my heart is actually healthy? What are some of the indicators that I should be paying attention to in my daily life?

Michael Deucher, MD, FACC: Great question, Jaime. I think, you know, we all know our bodies. We all know what they're capable of. So I think if you're getting short of breath or fatigue or your stamina is not as good as it was, you know, six months or a year ago; you should alert your doctor. First and foremost, I think everybody should have a good primary care physician.

So I always encourage my patients, make sure you have a great PCP you meet with once a year. He or she can do a physical exam, listen to your symptoms, do some blood work, do an EKG. So, I don't think people need to come see me directly, per se. I think they need to have a good relationship with their PCP.

Host: That makes a lot of sense to have that as a jumping off point. I know that blood pressure, I think a lot of us know that blood pressure has something to do with heart health, and I've heard it called the silent killer, but what makes high blood pressure so dangerous, and what can people do to keep it within a healthy range?

Michael Deucher, MD, FACC: Great question. I think high blood pressure, as you mentioned, is a silent killer because oftentimes, people do not have symptoms. Typically a normal blood pressure should be less than 120 over 80. High blood pressure is defined as above 140 over 90, and in between is pre-hypertension. So I encourage my patients, especially if they're on medications, you know, get a blood pressure cuff at home.

Omron, O-M-R-O-N is a great brand and check it, you know, a couple times a month just to see where your trends are. Because oftentimes people do not have symptoms. Before this call, one of my neighbors texted me and he said, Mike, I have a really bad headache. I said, check your blood pressure, it is 180 over 100.

So clearly we're going to modulate his medications. He'll see me in a couple days. But listen to your body.

Host: Well, you're a very valuable neighbor to have in that case. Well, I think we also know that diet and exercise are foundational to good health and to heart health, but there's so much conflicting information out there. We all want to do what's right. Whether or not we're able to follow through on that is another story, but we want to know what the right thing to eat is and the right amount of exercise to do. Can you speak to that a little bit?

Michael Deucher, MD, FACC: Of course. In terms of exercise, I think what I tell my patients and what I try to heed myself is 150 minutes per week of aerobic activity. So I don't care if you like to walk or do the treadmill or swim or do the stationary bike. So whatever format that gets your heart rate up makes you a little short of breath; 150 minutes per week is kind of the rule of thumb. So if that means you want to go to the rec center, fine, or if you want to work out in your basement, that's fine also, so you don't have to train for the Senior Olympics or anything like that. And then the second part of your question is in terms of diet. I've read all the books.

I know what's out there. In terms of diets, I recommend looking at would be the Mediterranean diets, just kind of the number one diet recommended by doctors around the world. Me, as a cardiologist and the people I see, I really like the South Beach Diet.

It's written by cardiologists in South Beach, Florida. I use these as templates. Just try to read these books. Learn, you know, what are good fruits? What are bad fruits? What are good nuts? What are bad nuts? What's a saturated fat? Is butter better than margarine? Is olive oil better to cook with than Crisco? So, diet doesn't mean losing weight. Diet means how do you eat? It's hard. I mean, I think if you want to eat healthy, it means going to the store a couple times a week. You know, buying the fresh fruits, the fresh vegetables, steaming them, not frying them. How do you make your meats, whether it's lean meat or fish or chicken. It's all in the prep work.

Host: Beyond lifestyle factors, what role do other cardiac risk factors play? Like for instance, are we surprised by anything with maybe genes? The genes that we inherit from our parents or from extended family, what role do those play?

Michael Deucher, MD, FACC: Good question. I think, you know, genetics is a very important role, especially in cardiology, but you know, you can't pick your parents. So I think, you have to work with the cards you're dealt. So the things I work with is what can we modify your lifestyle? So we've already talked about the blood pressure issues.

We've talked about diet and exercise, cholesterol levels. Yes, we eat cholesterol, but that's not the cholesterol we've see in our bloodstream. It's kind of modified, and the liver's a very important role in cholesterol levels in our body. So, a lot of it's genetics. So, I mean, I see a lot of people that are healthy.

I have this one patient, he's 39 years old, probably 2% body fat, coaches his high school basketball team. He's got a couple stents. You know, it's mostly genetics, but we're modifying what we can and go from there.

Host: When it comes to screenings that we all should be having, what kind of tests should we be discussing with our doctors? Does everybody need the same tests or is it different based on risk factors and the like?

Michael Deucher, MD, FACC: So I think in terms of cardiac disease, there's something called the coronary calcium test. So I think it's a great test for people ages say 30 to 70 that are asymptomatic. So per our cardiology guidelines, we should not do stress tests on asymptomatic people. There's been no evidence that says we help prevent heart attacks by doing stress tests if you have no symptoms.

So, coronary calcium test is a free test. We have a grant here at Southwest Hospital that we wrote a proposal a few years ago, so it's free for any patient that gets an order by their doctor or nurse practitioner. In fact, one of the doctors that orders a lot of them at our house is an obstetrician, because he realizes the importance of, you know, heart disease and blocked arteries.

So what a coronary calcium test is, is it's a quick CAT scan, takes about three minutes. There's no IV involved, there's no claustrophobia. I've done one myself, my family members. And what it shows me is the amount of calcium buildup you have in your heart arteries. So in terms of a coronary calcium score, for a human being, it should be zero.

So if there's any evidence of calcium buildup in the heart arteries, we circle the amount of calcium buildup and it gives us a score or a number. So in my mind, a normal or low risk score is zero to 100. High risk would be over five or 600. So once you start to give above five or 600, and I really, my antenna goes up, I really hone in on the risk factors.

And then there's data that says if your coronary calcium score is above 400, you can do a stress test. I mean, I can think of three people this year already that came in, saw me, they were asymptomatic. Their early sixties, they're about ready to retire and they're like, I want to get my heart checked out. So we started with the coronary calcium test.

It was like 600. We did a stress test was not normal, and we did a heart catheterization, and these three people needed bypass surgery. So these are the people that you hear about, friends, families that Jimmy or Susie was healthy, they're doing great. They walked their dog around the block this morning and they didn't come back.

They had a sudden cardiac death due to a blocked heart artery that they didn't know about.

Host: That's amazing preventative medicine and what did you say were the ages? Who's eligible for a test like that?

Michael Deucher, MD, FACC: Anybody's eligible with a, an order from the doctor at our hospital. So I don't know about other parts of the country, but people ages say 30 or 40 up to 70. And people that, you know, maybe have family history of heart disease, people may have high cholesterol, high blood pressure, maybe a little bit overweight, maybe they smoke.

But how do we tease the people out who are at risk for heart attacks, strokes? So I, every weekend I work here at the hospital, there's already three, three or four heart attacks and there's people our age that come in and say, yeah, I was fine past 10 years, no problems. And then, boom, heart attack.

Host: Okay. Well, that's a great option for people to take. As for listeners who are wanting to be proactive about their heart health, what are some of the most important questions they should be asking at their primary care doctor visit or when they come to meet with you?

Michael Deucher, MD, FACC: Good question. So I think in terms of what should they be asking, what's my blood pressure, what's my cholesterol? The only thing worse than having high cholesterol is not knowing you have high cholesterol. I can't tell you how many people come in, they get a couple stents or whatever and their cholesterol is 250, 270, 280, whatever, and they had no clue.

I think, we as a society need to do a better job of being proactive. We're the best country in the world in taking care of people when they're acutely sick, whether it's pneumonia, sepsis, heart attacks, but in terms of prevention, we're not very good. We're about number 32 in the world in terms of life expectancy for a country.

So we need to do a better job for ourselves.

Host: Wow, those are heartening statistics. Thank you for sharing all of that and for all of your expertise and insight today.

Michael Deucher, MD, FACC: Of course.

Host: That was Dr. Michael Deucher, Cardiologist at Southwest General Health Center. To schedule an appointment or to learn more about cardiology services, visit swgeneral.com. Thanks for listening to Southwest General Health Talk.