Transcription:
Keeping Your Heart Healthy

Prakash Chandran (Host): Heart disease is one of the leading causes of death in the United States. Identifying and testing is an important part of treating the condition. And there are several technological advances that are resulting in better patient outcomes from treatment and recovery. Here to tell us more is Dr. Khalid Chaudhry. He's the Medical Director of the Cardiac Catheterization Lab in Summerland Hospital.

Welcome to Health Talk with the Valley Health System presented by the Valley. I'm your host Prakash Chandran. So Dr. Chaudhry, really great to have you here today. Thank you so much for your time. Let's start with the basics. What exactly is heart disease and who does it affect?

Khalid Chaudhry, MD (Guest): So, heart disease itself is a very wide spectrum of conditions that includes coronary artery disease, congestive heart failure, heart rhythm disorders, valve issues. You can ge even conditions involving covering of the heart, that's the pericardial disease. And it is a very common condition in the sense that, one in three adult Americans will have some form of cardiovascular disease in their life. And there have been longitudinal studies saying that two in three of men at one in two of women will have some form of cardiovascular condition.

Host: Yeah, so, I can see why it is such a leading cause of death. Now in doing some research for this, I saw that the CDC says that one in five heart attacks are silent. Well, what exactly does that mean?

Dr. Chaudhry: So, one thing I can tell you is no heart attack is truly silent. Now, when we say you have a silent heart attack, often heart attack is associated with symptoms that has three components to it. One is some kind of a chest discomfort. Often people say it's not pain it's discomfort. That's number one.

Number two is it's provoked by something either by exertion or some kind of an emotional stress. And the third part of that is if you rest or take nitroglycerin, it goes away. So if all three components are present, that's your typical symptom of a heart attack. Now about 15 to 20% of people will have some kind of coronary event or a heart attack with symptoms that are either very subtle or they are not typical at all. Meaning, it could be just simple shortness of breath or just simple, something simple, like they just didn't feel well. Or they have symptoms that they thought were heartburn. And then later, they have some kind of an investigation done, stress testing or EKG, and it shows evidence of heart attack. So this by definition is silent, but in reality, like I said, nothing is silent.

Host: Yeah, that makes a lot of sense. My dad had a small heart attack a couple of years ago and he had exactly what you were saying. That chest discomfort, he knew something was wrong. I don't think he thought it was a heart attack, but he knew something was wrong. And so when we went in there they could detect that he had in fact had a heart attack. I imagine this is something that you see a lot?

Dr. Chaudhry: Absolutely.

Host: So, you talked about a couple of symptoms that you see patients present with. Can you talk about some of the most common ones that people should be aware of?

Dr. Chaudhry: So, your symptoms will depend on the age group. So often, folks with who are less than 60 years of age, and this is just a tentative cutoff. They will have symptoms of chest discomfort. And like I said earlier, know, often people describe that as not pain, but just discomfort. Now over 60 often we see atypical symptoms where it's more like unusual shortness of breath or fatigue, or they feel their heart fluttering.

And a lot of times they can't describe any symptom specifically, they'll just say, I just didn't feel right. Something was not right. So, again, it depends on the age group, but symptoms can vary. There's a wide variety of symptoms that can present as a heart attack.

Host: Now we're talking about heart attacks specifically, but I'm trying to like understand the difference between a heart attack and heart disease. Can you maybe explain the differences or overlaps between the two?

Dr. Chaudhry: Sure. So when we say heart attack, generally it refers to a specific kind of heart disease that involves the arteries of the heart or the coronary artery disease. Now the coronary artery disease is something that we all have some degree of it. That's the lifestyle we live. That's the diet we eat. We all have some degree of coronary artery disease. And if I could give you an analogy if you, if the heart is like a house, it has its plumbing and electrical wiring. Coronary arteries are like the plumbing of the heart and with time and a lot of factors play into that you can get plaque buildup in the walls of these arteries that slowly causes narrowing of the arteries.

And once you get a narrow pipe, then the flow is not going to be normal. So that is coronary artery disease, basically in a nutshell. Now, when we say coronary artery disease, we're dealing with again, two kinds of coronary artery disease. One is stable, meaning somebody has a blockage that has developed slowly over time.

And the blood flow to the heart is compromised and they have symptoms related to that. That is stable coronary artery disease. Opposed to that is the unstable acute coronary artery disease, which is basically the heart attack. So you can have a stable coronary artery disease at 20, 30, 40, 50% narrowing of the arteries.

And then it can stay like that for you know for years. And that same plaque can become unstable break. And as soon as it breaks, it comes into contact with the blood. And all of a sudden, within a matter of seconds, you get a blood clot. As soon as you get a blood clot that blood flow stops immediately. Now that is a heart attack.

So you can have heart attack in the stable coronary artery disease, and you can have heart attack even in coronary artery disease that was not very severe to begin with. So it's a matter of stability. And instability of the coronary disease.

Host: Yeah, I love that house metaphor that you gave. I've never heard it described that way. So using that same analogy, basically if the plumbing gets clogged or backed up and that's effectively what a clot is, right. And that causes the heart attack. But if it's a slow leakage, right, there's buildup, but it's still allowing blood flow. That's just more conducive to what we call a heart disease that is not acute. Is that correct?

Dr. Chaudhry: That is absolutely correct.

Host: So, when we talk about heart disease or even a heart attack itself, how does it get diagnosed? Like when I go in and maybe I'm giving, I'm having some discomfort, how does a doctor or health provider know that I actually have an issue?

Dr. Chaudhry: Let's say, if you go see your primary care physician, often, and if you have enough risk factors, the first thing they'll do is probably an electrocardiogram. So EKG is the basic thing we do to look at the electrical system of the heart. And often the electrical system of the heart will indicate if there has been some kind of a coronary event, so that's the first step EKG. Now, if the EKG is abnormal or if somebody has enough risk factors for coronary disease and the EKG is kind of borderline normal; the physician may elect to send you for more testing. So for example, they're examining you, they hear a heart murmur and they think there may be something going on with the heart valve.

So the next step would be to do an ultrasound test of the heart, which is an echocardiogram, fairly simple test. Now based on that and the symptoms and the risk factors, the physician may decide to send a person for a stress test. So those three modalities are basically what we use to diagnose coronary disease and heart disease. And obviously it's simplified answer, but basically it's the electrocardiogram, the echocardiogram, and some form of a stress testing.

Host: Okay. And let's say that it's detected that there is some form of heart disease or it's detected that maybe there has been a cardiac event. What are the most common modalities for treatment? Let and let's maybe talk about non-surgical first.

Dr. Chaudhry: Sure. Sure. So, again, it depends on the kind of heart disease. So let's talk about coronary artery disease first. And again, if the coronary artery disease is stable, the first line treatment always is medications. No, let's say they have tried medications and medications have not been effective in controlling the symptoms. Then the next step is to define the extent of coronary artery disease and the imaging modality, or the test that comes into play, at that point, is some kind of an angiogram test. We can do either conventional catheter based angiogram, or we can do angiograms using a CT scan. Either way, the first step is to define the extent and severity of the coronary artery disease.

And then based on that and the other risk factors, the other treatment options would be either fix the blockage with a balloon angioplasty and a stent, which basically is the same procedure and it rarely if ever we do just balloon angioplasty, often these blockages recoil after balloon angioplasty.

So we do implant stents and the third option is surgical bypass surgery. So those three treatment modalities are basically what we look into and it's a very individualized treatment plan, but medical treatment, stents or surgery, it's often the way we manage these.

Host: So I want to move the conversation on to really understanding what causes heart disease in the first place and how the people that are listening to this that don't have it can be proactive about their heart health. So let's start with the question of what causes heart disease?

Dr. Chaudhry: Sure. So, think everyone knows about the the conventional risk factors that we talk about that lead to heart disease. Number one, being high cholesterol, smoking obviously is a big culprit. Then diabetes is obviously one of the the big risk factors there. High blood pressure which is often unrecognized and untreated. And then we get into the unfortunate obesity epidemic we have, which is directly related to physical inactivity and diet. And then there are some ethnic risk factors there as well, where we know sort of south Asians as a group have a higher cardiovascular risk than other ethnic groups and Mexican Americans have a higher rates of coronary artery disease compared to other ethnic groups. African-Americans have a higher rates of high blood pressure, that can affect the kidneys and the heart. So if those factors are present, and especially if anyone has these conventional risk factors that we call modifiable risk factors, meaning smoking, anyone can work on quitting smoking. You can exercise and lose weight. You can treat your high blood pressure, your diabetes. If anyone has any one of those risk factors, then I think that conversation needs to happen with their physician. Where should they be screened for coronary disease or for heart disease. And I think that should have been starting point.

Host: Makes a lot of sense. And so I think the modifiable risk factors of quitting smoking, leading a healthy lifestyle, eating that heart-healthy diet, those are all things that bar none can help everyone regardless of your background. That will be the largest indication to preventing and or preventing the heart disease and keeping a healthy heart. Is that correct?

Dr. Chaudhry: That is absolutely correct.

Host: Now another thing that I wanted to ask you about was just proactively taking measurements on the blockages or the buildup that's happening. I feel like so many of us, over time don't necessarily know what's going on in our own body. And we'd like to know sooner if there was that calcification. Are there tests that people can proactively take to check on that?

Dr. Chaudhry: Absolutely. Generally, when I have discussion with the folks I take care of in that context, I always tell them, know your numbers. What I mean by that is when you discuss with your physician about your blood test results, know what your cholesterol numbers are. So we don't look at the total cholesterol number. There are three components to that. There is the good cholesterol, the HDL, the bad cholesterol, LDL, and triglycerides, and each one of those needs to be addressed separately. Then know your blood pressure numbers, where are you and where you need to be. Set a goal with your physician, where you want to be. When you get your blood test done, know if you have diabetes, what is your hemoglobin A1C? Anyone who has diabetes is familiar with that word. It tells you how high the blood sugars have been over the last three to four months. And the cutoff, there is six, where are you? How high are you? And what can you do to bring that level down. Know your weight? And what is your body weight at this point? What is the ideal weight for your height and and your gender, and set a goal as to how you want it. So, first step, I think is know your numbers. Second thing, I think if I can get one advice as a cardiologist is you can never underestimate the significance of exercise and diet. And if I could take all the medications away and just substitute them with regular exercise, watch what you eat, manage your weight; I think we will be able to control a lot of this. You, can't get rid of coronary artery disease, it is there to stay, but it can be managed. Now going back to your question about how can we know what's going on with the arteries. Now there is testing available that can look into that.

Stress testing is one way of knowing if coronary artery disease is significant enough and it's interfering with the blood flow, but there is a test available that has minimal radiation involved. It's a CT scan that looks at the degree of calcium buildup in the arteries of the heart. And often people who have sort of intermediate risk, they have one or two risk factors, but they don't have a whole lot of symptoms or they have symptoms that are very atypical, are the best candidates for this, where you can get a CT scan. It tells you the calcium score. And there are you know different cutoffs for that. Less than a hundred is good. More than 400 is significant where it indicates some. And I have seen folks who have had serial CT calcium scores over years and that can be a good indicator of where they stand.

Host: So just before we close here, is there anything else that you'd like to share with our audience regarding heart disease or heart health?

Dr. Chaudhry: Yeah, I think just to remind everybody that it is the most common, one of the most common causes of morbidity and death in this country. More than many of the cancers combined, and if you have risk factors, if you have symptoms, sit down with your physician, bring up these issues, no matter how typical your symptoms are, don't attribute your symptoms to, oh, I'm getting old so I'm supposed to feel this way or, oh, it's just heartburn. There's reasons why we call it heartburn because you can't tell the difference between an acid reflux and real pain of the heart. So, just listen to your body, just, just take these symptoms seriously.

Host: And just one final question around that, you mentioned the first thing that you can do is to know your numbers. When we talk about getting the blood panels and looking at these numbers, is that a once a year thing, is that a once a quarter thing? Can you talk more about that?

Dr. Chaudhry: Sure. So most primary care physicians will do a routine blood test at least once a year. Now, if everything comes back normal and everything is normal limits for that person's risk factor and their age, then, repeating the blood test once a year is fine, but let's say the cholesterol is off.

Now mind you that the thresholds for treating cholesterol will be different in somebody who has established coronary artery disease and in someone who doesn't. So, if the numbers are off, then generally what we do is we institute some kind of a treatment plan, either diet or weight loss, or exercise or some form of medication.

And then it's always a good idea to revisit the issue in three to four months. So, generally I do that in three to four months. If you are going to try diet and weight loss, give it about three to four months, recheck the cholesterol. And if we have not reached the goal, then go on to the next step. Because, in reality, diet and exercise will bring your cholesterol down to a certain level, but you may need help with medications.

Host: All right. Fair enough. Well, Dr. Chaudhry really appreciate your time today. Fascinating conversation.

Dr. Chaudhry: Well, thank you very much.

Host: That was Dr. Khalid Chaudhry, Medical Director of the Cardiac Catheterization Lab at Summerland Hospital. For more information, you can visit valleyhealthsystemlv.com. And if you found this podcast to be 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 again for checking out this episode of Health Talk. My name is Prakash Chandran. Be well, and we'll talk next time.