Scott Webb (Host): Heart health is on all of our minds, and it's great to have an expert on to learn more about heart disease and how we can keep our hearts healthy. I'm joined today by Dr. Vasundhara Muthu. She's a Non-Invasive Adult Cardiologist with extensive experience treating a wide range of cardiac conditions.

 Welcome to the Live Greater podcast series, information for a healthier you, from the University of Maryland Medical System, I'm Scott Webb. Doctor, welcome to the podcast.

Vasundhara Muthu, MD: Thank you so much, Scott. Great to be here.

Host: It's lovely to have you here. I appreciate that you wore your stethoscope. It adds to the authenticity of things, of course. And I find, Doctor, as I've gotten older that I'm concerned more about heart health, right? As I have gotten into my 50s, I seem to care more than I did when I was in my 20s, let's say. So, what are some of the key lifestyle factors that contribute to a healthy heart, and how do they impact cardiovascular health?

Vasundhara Muthu, MD: So, I think it's actually quite simple. I think the three most important things are F-A-R or FAR. They will take you far for cardiac health. So, the most important, I think, is food, and I think it's important not just for cardiovascular health, but for our health overall. So, as far as the heart goes, the current focus is on eating a diet that is closely or, you know, as similar to a Mediterranean diet as far as possible. So that includes, you know, some whole grains, it includes lean meats, so turkey and chicken and fish, rather than beef or pork or lamb. Making sure that we get enough fiber and enough vegetables in our diet, you know, that's kind of very important.

And then to minimize dairy products. So that may include like yogurt and milk and cheese. So the idea right now, I think, is to have less of animal fat and to focus more on plant based sources of fat, so which may include, like, nuts and avocados. Olive oil is supposed to be the best or with a lot of data behind its use.

There are a lot of studies that show that being vegan would be very good for heart health. You know, I think I find that practically it's a very hard diet to follow, to be completely vegan. But if you could be vegan, then certainly there's a lot of studies to show that your heart health will thank you for it.

So the idea is to just try to minimize the animal fat as much as you can. And then make sure you're getting enough vegetables and fiber in your diet and, small amounts of fruit. I think the diet also needs to be individualized based on health conditions that you may have.

I think the next most important thing after food is, of course, our activity level. And so the recommendation, you know, used to be to try and get to 10,000 steps a day. I think I find myself that if I can get to at least 7, 000 steps in the day, it's a good day. I think if you can walk more, that's even better. The recommendation for all adults really is to do at least 30 minutes of moderate intensity exercise at least five times a week.

And when we say moderate intensity exercise, you're saying anything that makes us breathe a little bit harder, where we can feel that we are actually exercising. So if you and I were to go for a walk, we can talk to each other, but we shouldn't find it very pleasant to talk, because we are working a little bit harder.

So we want to walk at a pace that gets us to that level of breathing. And the idea is that we try and do it over and above those 7, 000 or 10,000 steps at least five times a week for 30 minutes, you know, so a total of 150 minutes. And if you could do more than that, then that would be better. I think there's been a lot of debate about what kind of exercise is right, whether it's low intensity or moderate intensity or high intensity.

And I think overall, my opinion and I guess the consensus might be that moderate intensity exercise is probably the safest, you know. So you can do low, especially as we grow older, higher intensity exercise may be associated with more problems. So doing low to moderate intensity kind of at your own pace, but just making sure that you're doing it consistently. I think consistency is the key is very important. So I think food and activity, I guess, are two of the biggest things.

I think another thing in today's day and age is rest and relaxation. So that's the R. So stress management is very important. I find most of my patients are stressed, you know, either related to work or home. or what might generally be going on in their lives, and I think that negatively impacts their health, and it also impacts negatively sometimes how they seek attention for their health problems.

So I find patients often neglect their health problems because they may ascribe symptoms to stress, and they feel that they're feeling a certain way because, it's just hard at work or home. And it's actually a real health problem. And so by the time they seek attention, you know, sometimes it's later than ideal.

So rest and relaxation and stress management is important for all of us. There's some studies to show that exercises like yoga and mindfulness, that's very helpful as well. And it's specifically good for cardiac health in addition to being good for general overall health.

So I think the rest and relaxation part of it is very important. And I think the last little bit that I would want patients to remember, I think, is to try and be somewhat proactive, you know, to be in charge of their own health or to take ownership of their own health. So if they have medical health conditions that may increase the risk for heart disease and or if they have a family history you know which is not quite good in regards to heart disease and if they have family members who've had some cardiac problem then that's something that they should bring up with their physician sooner rather than later to try and find out if there's proactively something they can do to mitigate their own personal risk.

So I would suggest that those are the few things to keep in mind when we are trying to look after our cardiac health.

Host: Yeah, I appreciate what you said about walking. Uh, many of my friends in their 50s have taken up pickleball and that's led to a whole array of injuries, torn ACLs and a whole bunch of other stuff. And it, looks fun, but it also, I don't really want to get hurt. I feel like I can walk safely.

You know, as you were saying, that that seems like something that's probably comfortable for most of us, right?

Vasundhara Muthu, MD: Yes, I think it's comfortable, it's accessible to most of us, you know, most of us can find a place to walk. I think the key thing is also that we need to escalate exercise gradually. So again, when we kind of become, I guess all of us have bursts of enthusiasm when the New Year comes and we all have our resolutions, and we really want to go and do things, but I think when we are overenthusiastic, if we try to scale up exercise or activity too quickly, that can be associated with real injury, and the real injury is not just the musculoskeletal, or, joint and bone problems, but it could be unmasking a cardiac problem in a way that you didn't want it to be unmasked.

But I think as long as you kind of go slow and kind of scale things up gradually. You know, most people can get to a good level of activity without perhaps, you know, much guidance or supervision. And so I think walking is good. And I think for people who are older, who have some trouble with how they can feel the ground, I often suggest that they go to the mall, early in the morning when the mall is closed.

So there's less traffic, you know, most malls have like, walking, like have a pathway for walking and they can tell you how much you're walking. And the ground is level. So there's less chance of falling. If someone, something did happen, there's always like help at hand. So I think walking is yes, probably the best exercise in my opinion.

Host: Yeah. Wondering what are some of the common misconceptions about heart health that you encounter in your practice? You know, all of us are on media and social media and we all think we're doctors because we can do internet searches now, of course, but how do you address some of these misconceptions with patients?

Vasundhara Muthu, MD: Yeah. So I think there are a lot of misconceptions, including, for example, one would be that, you know, if you're younger than a certain age, like you pointed out that you're more worried about your heart health because you're older than 50 or 55, and I think that's generally when people start worrying about their heart health.

I mean, unfortunately, cardiac disease could affect people who are younger than that as well. And, you know, there's different kinds of cardiac disease. Of course, the one we think of most commonly is like having a heart attack, which is you know, what I like to think of as a plumbing problem in the heart, but people can have electrical problems, structural problems, other things going on in the heart, and sometimes they can occur at a younger age. Of course, the risk of most cardiac health problems goes up as we grow older, but it does not necessarily mean that just because you're younger, you know, you're immune from health.

Now, it doesn't mean that you need to worry about your heart, I think, if you're younger, but it does mean that you still have to be conscious that if you had any symptoms that were unusual or unexpected, you still kind of take stock of them and take them seriously rather than ignoring them because, oh, it can't be my heart, because I'm 40 years old.

So I think that's one key thing. I think the other thing is exercise. So I just pointed out that exercise or physical activity is very good for cardiac health. But you know, I have had personally a lot of patients who are very avid exercisers, if you will, you know, they run, they play tennis, they do some weight training, and they still have cardiac health problems, including not just the plumping problems that we are talking about, but also other cardiac problems.

I mean, the key thing there is that if you're active, it doesn't matter what health problem you have, you're going to do better than someone who's not active. So your prognosis is always going to be better. But again, you're not immune from having health problems, specifically cardiac health problems, if you are an active and relatively fit individual.

So I think that's another common misconception, I think. I think a third related one might be, you know, the weight, often we think of someone who's bigger in size, you know, more likely to have heart problem than someone who's, thinner and skinnier, you know, is less likely to have heart problems. And I think that's not entirely true either. You know, it really depends on the overall person. It depends on what other health problems they have, what their genetics might be. So, for example, I come from Asia and I can tell you that Southeast Asians, have some of the worst heart health that we see.

And a lot of them are very thin and very skinny and they're not really, obese by the guidelines or the standards that we typically use. So that doesn't necessarily mean that they are exempt or immune from heart disease. In fact, they may still have a lot more heart disease than you would anticipate.

So I think that those are the few of the most common misconceptions. I think everyone loves Google. Everyone, you know, now we have AI and you can pretty much go onto any website, get a lot of information. A lot of that may even be correct, but I think perspective and context, matters a lot.

So just because, you know, someone says something is right or correct in a certain situation may not necessarily apply to an individual who's looking this information up on the internet. So I think that's where the guidance from a physician, you know, is still very important. The experience of a treating physician is still very important because it's kind of the breadth of knowledge and the breadth of things that go into treating someone rather than just something that you can look up over the internet.

I don't know, maybe some years from now, AI will be treating patients, but I don't think we are quite there yet.

Host: Yeah, not quite yet. And it's one of the things I love about my job, Doctor, is that I get to speak with the experts. Of course, while they're speaking about things and signs and symptoms, I'm sitting here thinking, well, wait, I felt that before. Does that mean that I have that thing? You know, so I, sometimes I, the only concern is I get a little bit distracted because I start thinking about my own health.

But, you were talking about younger people are not necessarily immune from heart disease or heart problems. So it makes me wonder about risk factors and family history and genetics. So, how do you help patients manage or mitigate the risks that they may have that are beyond their control?

Vasundhara Muthu, MD: Sure so I think, you know, the genetics is a very important part of it. And I think that's fairly obvious, I guess, knowing your family history. So as long as you are aware of what your parents medical problems, you know, your siblings, extended family members, and you can discuss that with your physician. So specifically when we talk about heart disease, not all of it is preventable, but certainly, the coronary artery disease or those plumbing problems that we are talking about where members of the family may have a heart attack at a young age. If you know that there is a risk for that, then there can be aggressive preventive measures, including medications, that would significantly decrease the chance of such an event happening. And, say, I see such a patient who has a bad family history or genetics, there are a lot of things that you would do to sort of what we call as risk stratify them or try to get an estimate of their personal risk as they grow older and there are measures you can use, you know, subjective and objective measures that can be used to come up with that risk estimate and then decide, what are the treatments that might be useful for such a person.

Again, it might simply mean like monitoring the rest of your health conditions more carefully. So when we talk about heart health, you definitely want to make sure that your blood pressure is checked regularly and the blood pressure is well controlled. We want to make sure that our cholesterol or our lipid panel is checked, at least once a year, you know, after we turn 25.

And if that level is high, depending on your other risk factors, it's treated, as needed, both with diet and with medicine. If someone has diabetes, you know, unfortunately that significantly increases the risk of all kinds of cardiac problems. So, if someone is diabetic, again, they need sort of more medical attention overall, not just from cardiologists, but from multiple health professionals to make sure that they can maintain their optimum health.

Folks with type 1 diabetes, that's something they develop when they are younger or can develop as kids. So as they grow older, they need more careful attention to make sure that they are not developing heart disease. And one important thing I forgot to mention earlier, which I think I should have included as far as keeping your heart happy is not smoking.

So again, there can be more intensive counseling. So if you already have sort of the cards, stacked against you where you have a bad family history, perhaps, you have diabetes or high blood pressure, you certainly don't want to smoke and add that you know, to the list of problems you have.

So there are certain things like you were saying that are under our control. And certain things that are modifiable as risk factors. So we really need to work hard on those. And then there may be some that are not quite under our control, but we can work on trying to improve them as best as we can.

Host: Yeah, for sure. I went for my labs, my yearly labs yesterday morning. So I'm feeling pretty good about that since you mentioned that. And certainly I've gone for my regular physical exam and had the EKG and things like that. I want to have you talk about some of the regular screenings and checkups and what people can expect when they're in the office for those things.

Vasundhara Muthu, MD: Sure. So I think the first step, like you said, is, you know, making sure that you at least meet your primary care physician, you know, at least once a year, and then kind of go from what they recommend, as far as how often you need to be seen. And then, like I said, the first step, I think, is discussing with the primary care physician your medical problems, your family history, you know, other things, and letting them decide whether they think that perhaps, you know, you should see a cardiologist or another specialist for whatever health problems you may have.

I think when, if, if someone wants to see a cardiologist, we would routinely, you know, at least do an EKG at the initial assessment. A lot of primary care physicians would also do an EKG. And there's not necessarily any specific recommendations about how often to do it or when to do it, but certainly I think if you're over 40, you definitely need a baseline EKG, at some point, and then depending on what that and the rest of your assessment shows, you may need that at different intervals.

You may need additional testing for the heart. Some of the common tests that we do are like an echocardiogram or an ultrasound of the heart, which can show us the structure and function of the heart and make sure that grossly everything seems to be working well. There are other things we can do, including something known as a calcium score assessment.

And that's something that is particularly useful if you have a family history, or if you're over 40 years of age. It's a low dose CAT scan that will assess how much calcium buildup you have inside your arteries or the arteries supplying the heart. And that's a predictor for future cardiovascular events.

It generates a number which they give you an absolute and a percentile score. So for example, if Scott, you went and did that test, it would tell you your score and you know kind of compare it to other people, other men of your age you know what their score might be and so it would give you an absolute and a percentile score in both of them the absolute score above a certain number or a percentile score that is higher or you know better than what it should be which in terms of a calcium score a higher score is bad so you don't want to; it's a test you don't want to score high on. So the lower the score, the better it is.

So the perfect calcium score is zero, meaning that there's no calcium in your coronary arteries. And for typically up to 40 years of age, you know, that's what we want. You know, someone in their forties, their calcium score should be zero. And then as they grow older, there will be an increase in that, and that will depend not just on their genetics, but also with other things going on with their health and what they are doing to keep their heart happy.

And so if the calcium score is high, that's like a warning sign, okay, we need to do something about it. We need to seek attention, institute some preventive therapies. So I think the calcium score is something that we use very commonly now, I think, in our initial assessment, in addition to the EKG and the echocardiogram.

And then of course, there can be more sort of refined or sophisticated tests for looking for a blockage or looking for electrical problems. And those will kind of depend on what's going on with the patient and you could choose to do it, many different ways. And then I think if you find a problem, you kind of pursue it further.

Perhaps, you know, you're not finding a problem on the initial test. That would be very good. And so, then you know that you don't have to do additional testing.

Host: And of course you could always use your stethoscope as well, right?

Vasundhara Muthu, MD: Well, of course. So you obviously want to listen to the patient and you would assume that, you know, good history and a good physical exam is kind of key. That's where I think everything starts off. And I find like listening with the stethoscope is important, but listening to the patient, I think that's the first listen, I guess, that we need to do is listen carefully to the patient.

The patient doesn't know necessarily what they want to tell you sometimes, you know, so you have to kind of listen carefully, read between the lines, and then figure out from your end what kind of direct questions you can ask them to kind of elicit what their main complaints may be or what might suggest that there's actually like a cardiac problem going on and then of course the next thing would be giving them a thorough exam which a large for the heart especially a big part of that is the auscultation or what we use the stethoscope for.

Host: Yeah, and so we talked about the importance of nutrition, of course, and exercise, and you touched a little bit on, but I want to come back around and talk about stress and how stress, mental health contribute to heart health and maybe what strategies you recommend for managing all this stress we have in our lives and keeping our hearts healthy.

Vasundhara Muthu, MD: Sure, so I think you know, that's something that is applicable pretty much I think to every individual, you know stress management I think a large part of it probably has to do perhaps speaking from my own experiences like time management. I guess, you know, knowing, how much time we are willing to devote to anything that we need to do to be able to make sure that we have enough time for sort of self-care or spending on ourselves and self-care, you know, means spending time for maybe reflection, meditation, exercising, just going for a walk by yourself.

I think social interactions are great. I think having a good social life is very important for all of us, but we need to be able to have time to spend not just with loved ones and friends and family members, but also to spend time with ourselves, you know, trying to figure out what we need.

And what I like to tell most of my patients, and a lot of patients are always worried about, you know, that they need to do this for work, they need to do this for their spouse, for their kids, for their parents. And I think sometimes one just gets lost oneself in all of that. So I think it's not selfish to prioritize oneself to a certain degree.

To have some time just for yourself, so you can think through things, figure out what you need to do. And then try to find out what it's possible for us to do and what sometimes may not be possible for us to do. I think a lot of times we take on assignments or engagements that may, you know, we may not really have time for, I think.

And I think that just adds to our stress. So I think sometimes planning a little bit, figuring out what I really want, you know, what is really important to me, I think, is the first step. And then sometimes it may involve saying no, at work. It may involve saying no, often to family and friends.

And that's sometimes hard for most of us to do, you know, saying no is hard, but that's important. And so I think we need. There's studies to suggest that if you can even set out like five minutes in the morning, in the evening, I like telling my patients, when you first start your day, you get out of bed to spend five minutes just focusing on your breathing, you know, how you're breathing in and out, you're trying to empty your mind. So that you're not thinking of anything else. And five minutes seems like a short time, but if you're trying to do, it's actually very difficult to do, where you can completely empty your mind for just five minutes. But if you can try and work on that, even in the morning, when you first get up and in the evening, when you first get into bed; if you can have those five minutes to yourself, I think that can be good to kind of try and center things and bring you back to like, what you need to do to kind of have enough time for everything, including yourself.

Host: Yeah, you touched on this earlier, the concept of mindfulness and just being more mindful and making time for ourselves, which, as you say, sometimes requires being able to say no. And it's not easy to say no to our bosses, to our family, but sometimes we have to know when we've reached our limit know that it's okay and sort of allow ourselves the grace to say no, right?

Vasundhara Muthu, MD: Yes. And I think that's something that I find most of us have difficulty doing. I mean, I'm guilty of that, or most of my patients are guilty of that. And I mean, just recently, I had a teacher and she was feeling her heart racing every night. You know, she felt that something is wrong. She felt her heart was racing every time in the middle of the night, but she was stressed, there were health problems of family members that she was worried about, there were other things she worried about, so she kind of didn't seek any attention for it. And some days go by, and then she presented at the hospital with a stroke, and she was having something called atrial fibrillation, which is an irregular heart rhythm, and she felt her heart race, but she didn't think it was really her heart, you know, she thought that it's, she's just anxious, that she's worried about other people, and she was, you know, so the anxiety was part of it.

But it resulted in a real physical health problem all because I think she was pushing herself, she was trying to do all these things and not being able to take a moment to say, okay, what's really wrong with me.

Host: Yeah, we could do an entirely separate podcast, Doctor, on how heart attack symptoms present differently in men and women and how it's often not the classic symptoms, signs and symptoms for women and they often dismiss things. That would be a separate podcast, right?

Vasundhara Muthu, MD: I think that's a, you know, that's probably like a big topic in and of itself. But yes, I think in general, not to say that it cannot happen to men, you know, men can have atypical symptoms as well. But just if you think about it statistically, you know, women are just more likely to have atypical symptoms.

And I think it's because their symptoms are often kind of, so to speak, molded by, I think, how they are feeling emotionally. Not to say that the emotional range of a man is less than that of a woman, but, but in general, more women are dealing with more emotional um, ups and downs or more things going on with their emotions.

And I think that kind of has an effect on what they physically feel as a result of that. So I think, yes, you can have vague symptoms where you may just feel some discomfort or feel poorly and not really have like the elephant on the chest, which you would think of with a heart attack. So I think the idea is that anything's unusual, you know, you want to give it some thought and some attention and you know, I like saying no. I think it's also important to know when to seek help. It's okay to ask for help, from anyone.

Host: Yeah, that's great advice from an expert, and I appreciate your time today, knowing when to say no uh, knowing when to reach out for help, knowing the signs and symptoms is a lot to unpack from you being here today, but I appreciate everything, as I'm sure listeners do, so thank you so much.

Vasundhara Muthu, MD: Thank you so much for having me.

Host: And find more shows just like this one at umms.org/podcast, and on YouTube. Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.