Caitlin Whyte (Host): Welcome to UK HealthCast a podcast presented by UK HealthCare. I'm your host, Caitlin Whyte. Today, we are talking all about UK HealthCare Sports Cardiology Program with its director, Dr. Marc Paranzino.

Well, doctor, thank you so much for being here today. To start us off, tell us a bit about what made you interested in Cardiology and specifically Sports Cardiology.

Dr. Marc Paranzino: Yeah. Well, thank you so much for having me. I really appreciate it. I love talking about this. I think the why is always so important and something I'm fascinated about when I listen to other people's stories. So, I think for me to answer that question, I really have to begin with how I ended up in Medicine in general. And so, my path to sitting here, being here with you today talking is somewhat unconventional. I've told this story to a few people in the past, but I went to college in Florida where I was studying Marine Science and thought I had life completely figured out, right? I had these grand plans that I was going to spend my days scuba diving and doing research in these beautiful beaches. But, you know, I think it's funny how life can change directions and change pretty quickly.

And so, you know, I think there's a lot of people have this pivotal moment. There's this single life event they can trace back to why I became a doctor. It just wasn't really the case for me. What I knew is I was unfulfilled with what I was doing. And I thought there was just more out there. And so, I decided to change courses and go to medical school. And, you know, I had been an athlete my entire life, mostly in team sport. But it was about this time that I was getting ready to begin medical school that I found endurance sports, specifically running, and decided I was going to train for a marathon. And as many runners can relate, not only did I fall in love with running and the running community, but I became fascinated with the physiologic changes your body undergoes during training. And I don't think I realized at the time, but looking in the rear view mirror, I think this was the beginning of my path to understanding the cardiovascular system, becoming a cardiologist, and today a sports cardiologist. And so, I think from there, it's all history.

Host: That is so cool. Well, we're so glad to have you in this field now. Tell us about what is unique about having a Sports Cardiology program versus a General Cardiology program.

Dr. Marc Paranzino: I get this question all the time, or at least what is sports cardiology? And I think I'm going to start with my most simple answer that I always give, and that is that Sports Cardiology is General Cardiology. It's just applied to a specific group of people, you know, and I'll say that's athletes and highly active individuals.

But, you know, I think to understand the evolution of Sports Cardiology as a discipline, I guess to a point where we now have specific Sports Cardiology Programs, I think you really have to ask what drove this field. I think, unfortunately, in my opinion, that's sudden cardiac death in seemingly young, healthy individuals. As sports cardiologists, we do so much more than just understanding sudden cardiac death. That's been the focus of the field and that's identifying cardiovascular disease that puts athletes at risk while playing or exercising.

And, you know, I think this concept certainly predates this time period, but this really came into focus in the 1980s, 1990s, when the sports world was seeing healthy athletes dying. Athletes like Hank Gathers and Pistol Pete passing away from heart disease, and I think that forced the medical community to ask why. You know, and I think there were some really innovative and forward-thinking people at the time that started looking into the unique cardiovascular needs of athletes. And fast forward to today, where we are now seeing this large growth in the field and the medical community sort of understanding that athletes require specialized cardiovascular care. And I think everyone at the Gill Heart Institute also recognizes this. And that was our goal in developing the Sports Cardiology Program at University of Kentucky. And that's, you know, to address this need, particularly in our geographical area, providing high level individualized care to athletes, active individuals. So, kind of go back to my first statement, Sports Cardiology, it's General Cardiology. It's just applied to a specific group of people.

Host: Wow. That is fascinating. Thank you. And on that note, Doctor, how do athletes' heart needs differ from other patients?

Dr. Marc Paranzino: Another really great question with a lot of layers there to dissect, I guess, my initial impression or my simple answer here is I don't know that it's so much that there needs differ rather than understanding that their activity differs. And saying that, I mean, that the heart is a muscle. And if you train it, you're going to see changes, right? So, part of what differentiates a sports cardiologist, I guess, at least in my opinion, is understanding that difference. You know, having training, understanding about what is normal, what's expected to see in an athlete and an athlete's heart. And so, this is really the first step to understanding whether what we're seeing as physicians and providers is training-related adaptations in an athlete or actual disease that we're uncovering. And obviously, it's an important distinction between the two. And I think all too often athletes are held out of participation, told they can't compete or they're sidelined because of some findings. So, that's going to be an abnormality on an EKG that was done or imaging like a CAT scans and MRIs that are read as abnormal, but oftentimes this may actually be normal for that athlete.

Host: Well, who would you encourage to see a sports-focused cardiologist? Is it just those highly trained athletes? Is there a specific age? What are some parameters?

Dr. Marc Paranzino: I think while, you know, we do take care of many professional and high-level collegiate athletes, it's not just the elite athletic population that could benefit from care of a sports cardiologist. So, you know, I guess this is another question I get asked fairly frequent. And I say, it's really anyone who exercises, who wants to be active or even needs to be active for work and they want to do it safely, they can benefit from care. And that might be someone with a full time job and they're running marathons and half marathons on the weekend; people who are doing 5Ks, master swim classes or just beginning an exercise program. And we also have our tactical athletes. So, those are people who need to be active for work. So, it's the military, that's police, EMT and firefighters. All of these patients can benefit from the care of a sports cardiologist.

And, you know, I think we can certainly get into this a little bit more, but there's a wide range of patients we are seeing in our program, right? Everything from sports screening to athletes with known heart disease. And, you know, I think I'll take this opportunity for my public service announcement and say, for those that exercise and those that are active, but there's this misconception that fit people can't have heart disease, right? And I guess that's just not true. And so, I tell people all the time, if you have a strong family history of heart disease, you're having symptoms when you exercise, consider seeking out evaluation from a provider. It doesn't have to be a sports cardiologist, right? But these are the things that we are seeing and can kind of give that a little bit specialized care.

You asked about specific age, I think as an adult-trained cardiologist, my typical patient population is over the age of 18. However, by nature of sort of what I do, this often extends into the high school age group and, you know, our team works really closely with the Pediatric Cardiology group at UK to make sure that we're, you know, certainly providing the highest level of care to all patients.

Host: Absolutely. Well, you mentioned heart disease a few times, but what are some common conditions that you treat and how do you treat them?

Dr. Marc Paranzino: Yeah. I think for me, this question goes back to what is a sports cardiologist? And when I'm asked to give lectures, I often show this really great image that was published by some of the well-known leaders in this field. And it depicts what sort of they refer to as the core competencies of Sports Cardiology. It's a really good 30,000-foot view of the field, particularly for those who might not be familiar with sports cardiology. And so, I think within this, you have things like pre-participation sports screening, care of symptomatic athletes, people who are having symptoms, I don't know what they might be from, whether it be chest pains, exercise intolerance. Then, you have caring for athletes who already have known heart disease and want to continue to participate in sport and do it safely.

And I think there's also another great place to talk about this somewhat subjective distinction that we make about the age of like 35, 36. And I think in Sports Cardiology, we sort of talk about these two groups with this being the dividing line. I bring that up because of the question of what common conditions are we treating, and those under the age of 35, 36, this line that we make, these tend to be your college level, elite level, even high school level athletes. And when these patients have heart problems, they're often congenital, right? Something that they're born with or genetic. And this tends to be the group that gets the media attention with sudden cardiac death or episodes. And then, the other category, those above the age of 35 or 36, is where we often get referred to as masters athletes. And we talk much more about acquired heart disease. So, some of the more common things just being coronary artery disease or arrhythmias like atrial fibrillation.

Host: Well, then how does someone get an appointment with a sports cardiologist doctor? Are they referred? Do they have specific symptoms? How do we get that process going?

Dr. Marc Paranzino: Patients come to us from many different avenues. So, we're heavily involved with collegiate and professional screening programs or oftentimes seeing athletes who get identified as being, you know, "high risk" for their risk assessment. And, you know, we get referrals from various high school collegiate trainers, sports medicine providers around the state around the area for athletes, like I was sort of mentioning before, those that might have symptoms or those who, you know, might already have known heart disease and they want to continue playing at a high level, but do not need a referral to come see us. As I had previously mentioned, if you're an active person or you're even just considering starting an exercise program and you have concerns about heart disease, or that strong family history that I was mentioning, you know, we are more than happy to see you at clinic. You do not need to be an elite level athlete and you do not need a referral. We enjoy doing this and more than happy to see patients.

Host: Beautiful. Well, what is the goal for your patients then? How long are they with you and what do they do once they've moved on?

Dr. Marc Paranzino: So, I think the answer to this question varies slightly depending on why the athlete is seeing us. You know, so I think perhaps there's an athlete who gets referred to us after having an abnormal screening exam by their trainer or sports medicine or even their primary care provider. Ultimately, they get sent to us another opinion or for continued evaluation. And I think, in fact, oftentimes their testing may have been normal or expected for an athlete as I alluded to previously. We'll spend some time during the visit going through their testing, and talking to them, make sure they understand why this is normal for an athlete. And maybe they only see us once, I think contrast that with an athlete who's either having unexplained symptoms or has known heart disease. And we may see them every three to six months or more frequently early on. I think in any instance, you know, my goal for patients is that they are as much a part of their healthcare as I am. You know, I think there's been a tremendous shift in all areas of Medicine and particularly within Sports Cardiology towards this model of shared decision-making. So, I think it's my job to educate athletes, their families, trainers, coaches, whoever's involved in everything about this patient about their disease and what their risk is and a decision about participation, sort of where we go from here, that's one that we make together.

Host: Of course. Well, as we wrap up here, Doctor, what would you say is the most rewarding part of your job?

Dr. Marc Paranzino: Yeah. I mean, I think without a doubt, it's the relationships that I get to develop with an athlete and their family. I think I'm often meeting athletes and their families at a time when they recently either received some new diagnosis of heart disease or they said they may have had this abnormal screening exam and their anxiety is high, the first sentence that I hear most of the time when I walk in the room is, "Am I going to ever be able to play again?" And I think thankfully, with the development of the field of Sports Cardiology, most of the time, the answer is yes. But it's the entire process of helping an athlete learn about their diagnosis and then having these challenging conversations about risk and all the way to seeing them return to the sport that they love, that really makes this job rewarding for me.

Host: Well, we love to hear that. And what is your number one piece of advice for active people to keep a healthy heart?

Dr. Marc Paranzino: I think the easy answer to that question is just to reiterate the guidance of the American Heart Association, and that's for adults to get at least 150 minutes of moderate intensity exercise per week. I say we, the medical community, knows this recommendation is there to reduce the risk of things like heart disease and strokes and high blood pressure, diabetes. But I think I'll take that one step further and say, being active is one of the best things you can do for your mind and your body. And exercise does not have to mean running or cycling in the truest sense, right? I tell my patients all the time, find something that gets you moving that you enjoy doing and just make it part of your lifestyle.

Host: Absolutely. Well, thank you for sharing all of your information with us today, doctor. You can find out even more about Sports Cardiology on our website at ukhealthcare.uky.edu. Please remember to subscribe, rate, and review this podcast and all of the other University of Kentucky HealthCare podcasts. I'm Caitlin Whyte. And thank you for listening to UK HealthCast, a podcast from UK HealthCare.