- According to the CDC, heart disease is the leading cause of death for men and women in the United States.

- In this country, someone has a heart attack every 40 seconds.

According to the American Heart Association, Hispanic women are more likely to develop heart disease than non-Hispanic women.

On this episode, we're going to examine cardiovascular disease, the conditions of an unhealthy heart, and speak with a recovering cardiac patient who underwent open-heart bypass surgery this past February and is currently in cardiac rehab.

Welcome to A Su Salud - Cheers to Good Health.

I'm your host, Genesis Ortega.

We're broadcasting from inside the PPL Public Media Center in Bethlehem.

My first guest is St. Luke's University Health Network expert Dr. Raymond Durkin, chairman of cardiovascular medicine.

Thank you, Dr. Durkin, for joining us today.

- Oh, I'm pleased to be here.

- Doctor, let's start here.

What is cardiovascular medicine?

- Cardiovascular medicine is really taking care of the heart, so it's diagnosing and treating heart disease, but it's also preventing heart disease.

We also deal with the arteries in the veins throughout your body, and that's the vasculature.

So, I'd say 80% of the practice of a cardiologist is concerning the heart, and the other 20% is the major vessels that come off of the heart.

- I'm just going to have you break down some terminology for us.

Can you explain the difference between heart disease and cardiovascular disease?

- Again, the cardiovascular system, the heart pumps blood throughout all the arteries in the body, so the cardiovascular disease is just more broad, it encompasses the heart and all the vessels that come off the heart, the aorta, the other arteries in the body.

When we talk about cardiac disease, we're focused just on the heart, the heart muscle, the heart arteries, the heart valves, the heart rhythm.

- So, what are some primary types of cardiac conditions that exist?

- Well, you know, first and foremost, heart disease is the leading cause of death in the United States, Probably half of heart disease is related to disease of the heart arteries.

So, the heart arteries are the pipes that supply the heart muscle with blood and oxygen.

And they have a tendency, as you age, depending on your risk factors and genetics, to develop plaque.

So, you can develop plaque in the heart arteries gradually over time, which can reduce flow and cause symptoms.

Or that plaque can suddenly form a clot in a heart artery, and the heart artery can suddenly totally occlude.

And that's a heart attack.

And that's the most common kind of heart disease that we treat and try and prevent.

- Now, you touched upon it, but I want to expand on that.

What are some other warning signs of an unhealthy heart?

- Well, the two most common symptoms we see in heart disease are either chest pain or shortness of breath.

So, if somebody isn't getting enough blood because of a blockage in a heart artery like I just described, or if they have a sudden blockage, meaning a clot forms in the artery and there's no flow of oxygen, the typical symptom is chest pain.

It's typically in the middle of your chest.

People say it feels like there's an elephant sitting on their chest.

It's more of a pressure than a sharp pain.

It may go into your neck or your left arm.

It could be associated with shortness of breath and sweating.

So, that's one common symptom.

People can also, shortness of breath is also a symptom.

So, shortness of breath can be from a lot of things.

It can be from lung disease.

It could be from something as simple as deconditioning.

But it can also be from heart disease, particularly if it's a disease of the heart muscle or the heart valves.

- Now, is heart disease, an irreversible condition?

- Well, it's certainly a condition that can be treated and modified, so again, part of it is that the type of heart disease we're talking about, for instance, coronary artery disease, is there's always going to be a propensity as you age to form plaque in a heart artery.

But we can arrest a lot of that by doing, by mitigating risk factors.

So what's that?

It means don't smoke.

It means eat a healthy diet and exercise regularly.

It means control your blood pressure.

If your cholesterol is high, take a statin drugs, treat your diabetes.

So, we can definitely prevent heart disease from happening.

And, even if you have established heart disease, we can continue to treat those things to make sure it doesn't progress even more.

Some people may develop disease in a heart valve, such as, a common problem with a heart valve is called aortic stenosis.

And that's typically a progressive disease with aging that you can't really do anything to prevent.

When it gets severe, we have modalities to treat it however.

- Now, you mentioned some risk factors, and I actually wanted to expand on that.

What are some other risk factors for heart disease and particularly in communities of color, the Latino community, are there any risk factors that you see higher in these communities?

- Yeah, that's actually, that's a great question.

And that's a bit of a complex question.

There is a certain genetic tendency, no matter what your background or race is, to have heart disease based on your genes.

Some people are just more prone to having it.

And then, there's more...

Sometimes things that are a little harder to tease out or a social influence.

So, again, things I talked about, blood pressure, diabetes, diabetes can be related to being overweight.

So, you know, again, being able to maintain an appropriate diet, being able to see a physician regularly.

Those are the types of things of treating risk factors, not smoking, that are very important.

And those are things we take into account as we look at different populations of people.

- Now, let's take a look at gender, for example.

Can you explain some of the differences when it comes to symptoms seen in men and women when they're experiencing a heart attack?

- Yeah, and again, you know, you know, heart disease and coronary artery disease, and heart attacks are the leading cause of death in women as well as men.

Men have a tendency to have coronary disease or manifested a bit earlier in life, women later in life.

And there may be some protection that women get premenopausally, but they catch up as they get into their 70s and 80s for having heart artery disease.

The other big difference is that men are more likely to have the classic symptom, like I described before, of the elephant sitting on the chest, pressure, pain into the neck or arm.

Women are more likely to have what we call atypical symptoms.

So, instead of chest pain, they may have shortness of breath, or they may be nauseated, or just feel profound fatigue or sweating, or pass out.

So, whenever people come in with symptoms, and again, based on their risk factors and things, I think when you're evaluating people particularly emergently, you need to be cognizant of that, that women symptoms may be different and a little more what we call atypical.

- Debunk something for me, Doctor, what is the relationship between aspirin and heart health?

Should you really take an aspirin if you're experiencing a heart attack?

- Yeah.

And...

Your second question there, should you take an aspirin if you're experience a heart attack?

The answer to that is definitively yes.

Aspirin is a drug that, even at low doses, it inhibits small blood cells called platelets.

And platelets are one of the things that makes arteries clot.

So, if you inhibit the ability of your platelet to clot the artery, you can reduce the risk of a heart attack.

So, in people who are at high risk for heart attack or having a heart attack, aspirin is very beneficial.

The downside of aspirin is it can make you bleed, or it can cause an ulcer in your stomach.

So, people who are at very low risk of a heart attack, the risk of bleeding probably outweighs the benefit of preventing a heart attack or a stroke.

So, aspirin's not for everybody, but it's definitely for some people, and it's definitely part of the treatment of a heart attack.

- Now, Doctor, we have about a minute left, but I want to close on this.

What are your thoughts, closing thoughts, on heart health and helping our viewers maintain a healthy heart?

- You know, first of all, I'd advise everybody to get a regular checkup every year with their primary care physician, no matter what your age is.

Again, know the risk factors for heart disease and the big ones that you can modify.

Smoking is a big one.

So, people think smoking causes emphysema, lung disease, which it does.

But it's a very, very big contributor to heart artery disease.

Maintain a proper weight.

You know, know what your blood sugar is, know what your cholesterol is, know what your blood pressure is.

Those are all modifiable risks.

And that's the advice that, if most people follow that, that would prevent a lot of heart disease.

- Dr. Durkin, St. Luke's University Health Network, thank you so much for being with us today.

- Thanks for having me.

- My next guest is Dr. Alberto Esquenazi from the Moss Rehab Facility in Philadelphia, here to discuss cardiac rehabilitation.

Thanks for joining us today, Doctor.

- Thank you.

Thank you for the opportunity to talk to your audience.

- Let's get right into it.

Can you tell us more about what cardiac rehabilitation is?

- So, most people know about the issues that occur when a person has a heart attack.

And so, that's a perfect example.

People that have cardiac disease and suffer a major event want to recover from that through rehabilitation.

Not different than what you would do with any other type of injury.

So, cardiac rehabilitation can be classified in four different groups.

We call it class one for those patients that are, or stage one, where those patients are in the hospital and they're starting to exercise to be sure that they can regain their physical fitness.

Number two would be, or stage two, is for those that are ready to move into a more ambulatory kind of place where they are working from an outpatient facility.

Level three, those that are in a class that's more of a team or a supervised exercise program in an outpatient support program.

And then, four are those that are at home and may be in touch either, and now with Covid-19 in touch through video, like going to Zoom class or going to a yoga class, but you're doing your cardiac rehab exercise program.

- So, tell me, what are some of the benefits of actually going through cardiac rehabilitation?

- So, one of them is the motivation part.

The fact that when you are supervised and in a group, that makes it much easier to participate.

The other is that when you are in the first two phases of rehabilitation, you have supervision from a clinician, a nurse, or a physiotherapist who have special training and can monitor you during the exercise process.

Remember, you've had a major heart problem.

We want to be sure that that heart doesn't get overtaxed by the exercise.

But on the other hand, we want to be sure that it exercises enough so that it can return to its previous stage.

- Now, who should go through cardiac rehabilitation?

Are there any eligibility guidelines for that?

- Anybody who's had cardiac surgery, has had any cardiac event, either a heart attack or has congestive heart failure, problems with their heart, they are eligible to participate in a rehabilitation program.

- Are there any risks involved with the rehabilitation program?

- Well, as I mentioned before, that's why you want to have the supervision, because, yes, there are risks.

As you are exercising and you're taxing your heart, you could make your heart get into a situation where it needs to be slowed down and allowed to rest.

And so, a cardiac rehab program will have supervision and metrics that you follow to be sure that you're not overtaxing that individual's heart.

- What type of education takes place alongside exercise in cardiac rehab, if any?

- Yeah.

Remember, after you've had a cardiac event, people become very afraid that this may happen again, particularly if it happened during a bout of exercise.

So, educating people about how to appropriately exercise, what are the rates of effort, and what are the symptoms that may present early are of critical value.

In addition to that, you include things like diet, appropriate nutrition, stop smoking, drink with measure.

All of those things are of critical importance in the education.

And we tend to educate also family members who may be quite scared of saying, you know, "I was present when my loved one had a heart attack.

"Their heart stopped, and I didn't know what to do."

- Now, you're also a Latino and a Spanish-speaking doctor.

What types of things come up when you're speaking to patients who are Latinos?

- You know, we tend to eat a slightly different diet.

We tend to like different things that are not the usual or customary for people who are born and raised in the US.

And so, we Latinos tend to eat a little bit more fat.

We tend to be more in favor of drinking sugary sodas.

And all of those things tend to not be very positive for our heart.

We also tend to smoke, and cigarette smoking is not a positive thing to do for your heart.

Lastly, although some of us like dancing, many of us don't like exercising in a routine manner, and so, if you want to exercise by dancing, that's perfectly OK, you can do that.

- Can you give us an example of a heart-healthy diet?

- We always look at having low salt, low fat as important components of a diet that is heart-healthy.

- OK, low sodium, low fat, and, like you said, with the Latino food culture, pastilles, empanadas, I mean, all of that good stuff is in our diet.

Any swaps?

How do we make those changes?

- Yeah, so you eat more vegetables, more green, leafy vegetables, particularly, fruits are good.

So, substitute the idea of eating maybe a small pastillito or eating an empanada, and replace that with a piece of fruit.

It is much more healthy.

It'll keep you trim, it'll keep you much able to be fit and be healthy.

- And for those who choose to dance, maybe a little bit of salsa as their exercise, how long should they do it for?

- So, the important thing here is you want to be in a progressive program, you are progressing your exercise tolerance like an athlete.

You know, athletes don't start running a marathon on day one.

They start by running short tracks, and then gradually increasing.

Same is true for dancing.

If you at any time feel shortness of breath or chest pain, you certainly should stop, but otherwise, you can gradually increase your exercise tolerance.

Now, Doctor, with the Covid-19 pandemic challenges infiltrating all methods of patient care, I would be remiss if I didn't ask you about how the CORE+ unit that you helped to develop at the Moss Rehab Center, how that's worked.

Tell us more about it.

- Yeah.

So, we actually, because of core and working in a rehabilitation facility, we needed to be sure that we could continue our rehabilitation efforts even when Covid is present.

And so, we developed a unit that is focused specifically for that kind of activity where patients are protected, staff is protected by having appropriate personal protective equipment.

Remember, in the beginning, we didn't have enough masks, enough gowns.

And so, with that, we purposely created an area of the hospital that we dedicated just to that, where our staff could be appropriately fitted with equipment to protect themselves and protect patients while we were providing the best care possible to them.

That unit is now a year old, and we've seen over 150 patients.

And fortunately, everybody has done very well.

And we have been able to return those patients home and to their communities.

- One year in, 150 patients so far.

What type of feedback have you been hearing from those patients?

- Well, patients are very appreciative that we were able to address their needs, and certainly to be able to rehabilitate them to the point that they could return to their own communities, with their families, be with loved ones, particularly after long stretches of time where they were really solo.

They couldn't see anybody.

Remember, we were not allowed to have visitation in hospitals or other health care facilities.

So, those patients really were very scared.

And, just as in cardiac rehabilitation, our role is to educate people to the fact that we are here, we're going to provide them the health and support that they need, and that their families are going to be appropriately educated for what they are in need to do.

I think I forgot one area that we didn't touch on during cardiac rehabilitation, but that's returning to life, intimate life, having, you know, sexual relationships with your partners.

And certainly, that is something that we use as part of our education.

- We're running out of time here.

I'm glad that you mentioned that, Doctor.

Any final thoughts that you have on this topic?

- So, first of all, education is of high importance.

Exercise, when done appropriately, is safe, and an appropriate diet and elimination of risks such as smoking, drinking, alcohol, in excess, and eating a diet that is not appropriate are of key importance in the rehabilitation of these patients after a cardiac event.

- Dr. Esquenazi, thank you so much for being here with us and sharing your insight on this topic.

- I'm very privileged to do that.

And my best regards to you and your community.

Stay safe, and I hope you're all vaccinated, or at least en route to doing that.

- I hope so, as well.

Thank you again, Doctor.

My next guest is Ted Shuler, a man who has overcome much adversity in his life.

Most recently, he's recovering from open-heart bypass surgery and currently engaged in cardiac rehabilitation.

Thank you, Ted, for being here today.

- My pleasure.

Let's start here.

Would you mind sharing your story with us briefly?

- Yes, I...

I changed my cardiologist back in November, and I got directed towards Einstein and Dr. Singer, and Dr. Lenini, and we did standard tests to just see where I was at, and they found multiple blockages and ended up getting open-heart surgery.

- I also understand you are a diabetic.

Did your cardiologist suggest at all that this may have attributed to your heart issues?

- Yes, diabetes has a lot to do with, you know, blockages in your heart and your arteries, and they contributed to my diabetes over the years, to that's where my blockages developed.

And I had to end up getting open-heart surgery.

- Now, how long are you in cardiac rehabilitation for?

- I am in it for 24 to 31 sessions with the cardio rehab at Moss Rehab over in Norristown.

- So, what's a typical rehab session like for you?

- I go in, I get there like ten minutes early for my session, I check my sugar and my blood pressure, and you're not allowed to start unless it's a certain number.

And then, they check my blood pressure when we get started, and I get hooked up to a monitor, which they keep track of all my vitals during my rehab session.

And then I warm up with stretches and exercises that they gave me from the beginning.

And then, I go through a series of different machines, treadmills, step machine, bicycle, and I do that two times through, and they monitor my blood pressure and all after each of the machines and everything.

And then, when you're done, you have to go into what they call "cool-down".

They have to check your sugar again and your vitals.

And, when they say everything's all right, then you detach from the monitor, and you're done for the session.

- Now, besides the exercise, is there anything else that the doctors tell you you should monitor in your recovery from open-heart surgery?

- Yes, they talk about my diet and, you know, watching what I eat, portions, drinking plenty of water, and continuing to do exercises and walking and stuff at home on my non-section days, which is something was one of my goals was to get back to my walking.

Before the surgery, I was walking 3-4 miles a day and doing a 7-8,000 steps.

And within a month, I'm already back to that just in my hour session.

So, I've already reached my goals in one month.

- That's great.

I'm glad to hear that.

What's your overall feeling of well-being since being in cardiac rehab?

- I just feel like the whole program from start to finish... Jess, when he evaluated me, I had to fill out a booklet with all these questions about my lifestyle, my health history, my goals for what I wanted to achieve at cardio rehab with them.

And every session, we talk about something in there about nutrition, how I feel where I'm at, what do we feel that we have to do differently?

What do we want to do next?

And every week, we increase the time, the level of effort, and add a different exercise or machine on to every session each week.

So, it helps me in many ways, not just condition-wise, but mentally.

It's getting me to feel really good about myself and about life.

- Now, would you mind sharing with us where you are at now with your rehab?

What goals do you have?

My goals are I want to get back to my walking and get back up my steps to 8-10,000 steps, I have a goal of getting down to 200 pounds and losing weight and getting into a healthier weight, and getting under 200 pounds.

And we've already started working on that, as far as diet and talking about what foods to eat and how much, and foods to start eating more of.

So, that's a goal that I have, and we're already working towards that.

And I just want to get back to doing things that I enjoy doing.

I coach high school swimming and swimming year round, and I want to get back on deck to coach.

I want to start playing golf again, even though I'm not very good at it, but I want to get back to it and just do things with family and friends that I was a little limited to doing before the surgery.

- And from what I hear, I understand, for me, this is a long journey, right?

And you've been putting in a lot of work.

But since the surgery and now rehab, how has your perspective on everyday life changed?

- It's changed a lot.

It's made me look at what I was doing and how I can do it differently, things I can add, just do that I never did, and that I have no limitations, that as long as I work hard and, you know, and get my conditioning and get my health back to where it is and even better, that I can do anything I want to do.

- What advice can you offer other cardiac patients who might be considering rehab?

- The advice I can give is Moss Rehab is probably the best kind of rehab that I've ever done.

They have a plan, they have a program, they work with you.

They're patient with you.

My two people that I work with, Jess and Colleen, they've just been awesome.

They have already kept me on my program.

And we just keep working towards the final goal.

And doing cardio rehab, you can get back to a healthy lifestyle and even better than you were before any of the surgery that you might have.

And it can make your life better in many ways, mentally, physically, emotionally.

And Moss is definitely the place to go.

And, you know, Jess and Colleen, like I said, they really helped me get to where I want to be and beyond already.

- Great.

Thank you so much, Ted, for sharing your story with us.

I appreciate your time.

- You're more than welcome.

Thank you.

- I want to thank our St. Luke's University health network expert, Dr. Raymond Durkin, Moss Rehab physician Dr. Alberto Esquenazi, and Mr. Ted Schuler for joining me today.

And thank you for tuning in.

We look forward to seeing you again soon.

If there's a medical subject you'd like for us to cover, send me a message on social media.

You can find me on Facebook and Instagram.

Plus, you can tune in to hear more of our reporting on 91.3 FM WLVR News, your local NPR News source, all day, every day.

I'm Genesis Ortega, and from all of us here at Lehigh Valley Public Media, stay safe, be healthy, and cheers to your health.