Nolan Alexander (Host): Welcome to UK HealthCast, a podcast presented by UK Healthcare. I'm Nolan Alexander, and joining me today is Dr. Peter Haigh, a non-invasive cardiologist from the UK Gill Heart and Vascular Institute. We are here to dive into an important conversation about heart valve disease and explore the newly structured heart valve program at UK Healthcare.

Well, Dr. Haigh, how are you today?

Peter Haigh, MD: I'm doing great, Nolan, thanks so much for having me on the show.

Host: It's our pleasure, and let's establish the basics here. What exactly is heart valve disease?

Peter Haigh, MD: Yeah, it's a good question Nolan. I think to understand what is heart valve disease, it's first helpful to talk about what are the heart valves themselves. And so if you imagine rooms in a house, you have doorways that connect room to room. And those are basically the valves. And just like rooms in a house, we have chambers of the heart.

And so these doorways or valves sort of open and close to help blood flow through the heart in an organized fashion. Valve disease boils down into two main problems. Those little doorways either have a hard time opening, we call that stenosis, and that restricts blood flow forward. Or the valves or little doorways don't close properly, which allows blood to leak back the wrong way.

We call that regurgitation, and if either of these problems occur, it can cause a patient to feel unwell with symptoms like shortness of breath or fatigue or exercise intolerance and left untreated, these problems can progress and become quite serious leading to things like heart failure or even death.

So it's important that if someone does have a valve problem, it's followed appropriately and it's intervened upon when the time is right.

Host: What happens when someone's diagnosed with heart valve disease?

Peter Haigh, MD: Sure. So typically the diagnosis is made when your doctor hears a murmur, when they listen to your chest with a stethoscope. That murmur is usually followed up by a test called an echocardiogram, which is just an ultrasound of the heart. And on that test, we can figure out what's causing that abnormal heart sound, what's causing that murmur.

We can figure out what valve is leaking or not opening well. We can figure out how bad it is and then determine the appropriate next steps. For many patient's, this will mean additional monitoring, but sometimes we catch something that it's advanced enough that the time is right to go ahead and do an intervention on that valve, be it a valve replacement or a repair.

Host: So how common is valve disease and are cases increasing?

Peter Haigh, MD: Yeah, valve disease is quite common and cases are increasing. One of the main risk factors for valve disease is increased age. And as our population continues to get older and older, so does the prevalence and the number of people walking around with valve problems. So the devil's in the detail here, Nolan.

So if you ask me how common is a leaky valve? Well, that's extremely common, and many times that's actually a normal finding. But if you take valve problems that are moderate or severe, meaning it's bad enough that it might cause symptoms or certainly need follow-up, the prevalence of that increases with age.

So if you look at people over the age of 60, having a significant valve problem is about 2 to 3%, which is a whole lot of people. There are also valve problems that people are born with, so about one to 2% of the population are born with something called mitral valve prolapse or an abnormally formed aortic valve, and those often are not caught until somebody is much older in life when an astute physician hears a murmur on exam.

Host: Building off what you said about age, who would you say is most at-risk for valve disease?

Peter Haigh, MD: Well, the people most at-risk for valve disease are elderly individuals. People that either have had a lot of time for wear and tear damage to occur. The human heart beats about a hundred thousand times a day. And so if you do the math there, that's a lot of heartbeats over the course of years and decades of life.

So it's not surprising that some wear and tear occurs. Otherwise certain medical problems that one develops or acquires over the course of their lifetime can then go on to make valve disease more likely. For example, people that develop heart failure for other reasons or have had heart attacks, all those problems can leave valve problems, autoimmune conditions, radiation therapy, and even certain medications. So the list is quite long in terms of what can cause valve disease.

Host: Doctor as people go about their day-to-day lives, what symptoms should people be watching for that might signal a valve problem?

Peter Haigh, MD: Sure. So most valve problems are identified by symptoms such as shortness of breath, exercise intolerance, and fatigue. Sometimes they'll also have things like chest pain, dizziness, and passing out. Now all those symptoms can be due to a huge number of causes. The list of things that can cause fatigue is just about endless.

So really, if you're having symptoms like that, the next step is go see your doctor and have them do a good physical exam and take a close, listen to your heart with a stethoscope. If they find evidence of heart failure or heart murmur, the next step should be an echo or a heart ultrasound. And from there if there's a problem there, going to see a cardiologist.

Host: Well, let's talk about that. If someone's coming to UK Healthcare, what can a patient expect when coming into the Valve Program at UK healthcare?

Peter Haigh, MD: So patient's who are referred to our valve program can expect streamlined expert care for their cardiology needs, especially their valve disease. After being referred, one of our nurse coordinators will reach out to the patient and make sure that they understand where to go, why they're coming to the appointment, and make sure that we on our end, have all the relevant tests and imaging results.

This way when the patient shows up to the clinic, we can have a meaningful conversation about what's going on with their heart and their valve. And there's not any wasted trips to the doctor while we're waiting on tests. On some occasions, we may also arrange for a test on the same-day. One of those echocardiograms I keep bringing up, so that we get a look at the valve then and there. From there, we can then refer patient's on to an interventionalist or a surgeon if the time is right. But the idea with our valve clinic is it's comprehensive, that we have everything we need under one roof and we can minimize the number of trips patient's are making. Because we realize that patient's are coming from sometimes hours away across the state of Kentucky.

Host: That shows a real care for the patient. And with that, what inspired UK to restructure its approach to treating those with valve disease?

Peter Haigh, MD: Sure. Nolan, I like to use the word restructure because it is true that for valve disease we already have all the pieces necessary to take care of patient's with valve problems. In fact, for just about any valve problem, we now have options. So if you go back 10, 20 years ago, if you had a valve problem that pretty much meant you're going to need to have surgery.

I always tell patient's a valve problem is a mechanical problem and medications just doesn't work. In this day and age, we now have minimally invasive approaches where valve disease can be corrected or fixed by going through the artery or vein, so through a catheter rather than having an incision and going to the operating room for open heart surgery.

There's a lot of factors that influence which decision or which treatment is best for each patient. But the point is valve disease has become much more complicated to treat just because we have so many different options of management for various valve problems. So having the surgeons, the interventional cardiologists, and cardiac imagers like myself, all under one roof, all seeing the patient together, is what makes this so special for taking care of patients.

Host: So how do you feel that that restructure, that holistic approach has improved patient outcomes?

Peter Haigh, MD: We want to make sure that we have the experts from all the different areas weighing in on the patient. We have a conversation about the patient and get everybody's perspective on what's going to be best for that patient's anatomy and their valve lesion. In addition, when patients are referred to our valve clinic, they'll be enrolled into our valve tracking program, which will be a system for us to make sure no patient's fall through the cracks.

So if a patient has a valve problem, but it's not quite ready to be fixed, we want to make sure that that patient doesn't get lost. So they're going to need regular appointments, physical exams and imaging tests so that we can monitor the valve and catch it when the time is right to intervene. And then after a patient does get a new valve, we want to make sure that we're keeping an eye on that new valve because as hard as we try, nothing is as good as the valves that we're born with, although technology's starting to creep up on that.

So all these different procedures need to have appropriate follow-up care. And for many patients that'll mean not coming back to Lexington, but following with a cardiologist locally. But for those that want to make the trip to Lexington or live close enough, we want to make sure that we're doing everything on our end to make sure that nothing progresses without us knowing about it.

Host: You've already demonstrated a great ability to try to put yourself in the patient's shoes as they go through this journey. But heart treatments and procedures, they can be very nerve wracking for so many. How do you support your patients, both medically and emotionally?

Peter Haigh, MD: Nolan, that's a great point that valve disease and all cardiology tests and procedures can be anxiety-provoking and nerve wracking. I think some of that is normal and human to have a little bit of anxiety before you have a procedure or surgery. And I find that it's the unknowns about these things that drive a lot of fear.

So I do my best when I'm sitting with a patient to explain, hey, this is what your valve problem is. These are the treatment options. This is what you can expect for each of these approaches, and just removing some of those unknowns and uncertainties. But for those patients that are still really having trouble coping with the emotional mental health component, we actually have a dedicated cardiac psychiatrist that we can refer patients to.

And I've heard nothing but glowing reviews from patients that I've sent for this. So we like to think that we have a really comprehensive approach for treating not just the heart, but also the mind.

Host: It seems like y'all have thought of everything.

Peter Haigh, MD: We're certainly doing our best and we have a lot of help. We have a big team and we want to make sure that this is going to be good for patients at the end of the day.

Host: So you mentioned some symptoms earlier, signals to look for. At the end of this podcast, if listeners are experiencing symptoms or if they have some concerns, what's the best next step for them to take?

Peter Haigh, MD: Great question. So if patient's are having symptoms that raise concern, like trouble breathing or exercise intolerance and fatigue, the next step is to get in with your family doctor who knows you well. From there, I'd recommend a really careful physical exam, taking a good listen to the heart and seeing if they hear anything abnormal. From there, the next step is an echocardiogram to get a good look at the heart.

Host: And lastly is there anything else you'd like to add on this topic today?

Peter Haigh, MD: I'd just like to restate that this valve clinic is a huge multidisciplinary approach from multiple different cardiologists coming from different expertise from interventional cardiologists who specialize in those minimally invasive procedures, to our cardiac surgeons that can offer state-of-the-art care and all the advanced surgical techniques for valve disease,

to our imagers, nurse coordinators, nurses, social workers, cardiac psychiatrists, cardiac pharmacists. It's a huge undertaking, but I think it's going to be great for patients.

Host: It's a large team that works together and we are so thankful to have Dr. Peter Haigh with us today. Dr. Haigh, thank you so much for your time.

Peter Haigh, MD: Thank you, Nolan. It's been a pleasure.

Host: That was Dr. Peter Haigh. If you enjoyed this podcast, please share it on your social channels and explore our entire podcast library for topics of your interest. And thanks for listening to UK HealthCast, a podcast from UK Healthcare.