foreign [Music] thank you for taking time from your busy day to watch this special presentation from the El Paso County Medical Society I'm Dr Joel Hendricks president of the El Paso County Medical Society and it is my hope that you will find our program of great interest educational and informative about the medical care provided by some of our best physicians in our country right here in the Borderland from all of us at the El Paso County Medical Society please enjoy tonight's program [Music] thank you one in four people die of heart disease in the United States some of the most common heart issues that we have heard about all day every day is heart attacks Strokes coronary artery disease high blood pressure afib heart valve issues structural heart disease and many others there are always tests that we can do to try to show the signs of heart conditions and be able to treat them before they really get to be a problem that's we're going to be speaking about here this evening this program is underwritten by tenant the hospitals of Providence and a huge thank you to the El Paso County Medical Society for carrying over the show now for over 26 years I'm Katherine Berg and you're tuned in to the El Paso physician [Music] thank you [Music] hello thank you again for joining us today we're talking about Heart Care 101 common heart conditions and how they are treated we have with us two doctors two Interventional cardiologists one who's a veteran you may recognize Dr Edward Aussie who is an inventor Interventional cardiologist and he's also the chief of staff at Sierra Medical Center which is a hospitals of Providence with tenet and also we have Dr Bill mesh tripathi and he is also an Interventional cardiologist and new to town he's been here a whopping two months so we need to take him out for some good Mexican food but Dr Aussie let's start with you being on this program several times and again Interventional Cardiology and today we're going to talk about a lot of the basics we're going to talk about the most common heart conditions that people have but in general you're all day every day kind of talk about your role as chief of staff at Sierra Medical Center as well as your Cardiology work hi thanks for having me um yeah so as far as Chief of Staff uh it's just as it says at the Sierra Medical Center I basically work with Administration and help dealing with issues that come about at the hospital especially if it has anything to do with mostly the Physicians um and I interact with them and helping hopefully solve some problems that come about in the day-to-day aspect of the hospital but my my life is really I'm just the cardiologist that gets up in the morning and um usually you hit the day at the hospital and make my rounds see my patients sometimes I'll start off with a procedure that has to be done and then after I uh visit the hospital I head to my office and and see a lot of patients throughout the day again trying to solve some problems of patients coming in with common heart conditions um you know what as far as when the types of problems we see a lot of patients are presenting with symptoms you know chest pain or shortness of breath sometimes we were referred uh for a patient having an abnormal EKG or another physician may hear a murmur uh murmur is just a sound that we appreciate when we use our stethoscopes that can most likely lead to a heart bow problem that's usually what creates a murmur so those are you know and you had mentioned several things atrial fibrillation we see that as extremely common um you know of course uh what where everyone is always concerned about when you talk about the hardest clogged arteries you know do I have a blockage Dr Aussie and how do we figure that out how do I assess them for that and so the whole idea and Dr tripathi I'd like to bring the question to you of Interventional Cardiology so you have a cardiologist and you've got just different areas of practice what is the description of what you do all day every day in the world of Interventional Cardiology great thanks for having me here so we are cardiologists first of all but we get one year of special training in international Cardiology what that means is that we are trained to treat several heart disorders uh using catheter wires and needles um the major one is heart attack I'm sure you have heard of it we are able to go inside hard with help of wires and catheters balloon and put stems so this is one of them but we do a lot of other procedures as well for example pacemakers we do International procedures like well heart disease fixation so so a lot of these is part of our duty as an international cardiologist and Dr Aussie as again Chief of Staff but just in general Cardiology you've been here for quite some time in El Paso 20 years 20 20 whole years I love it congratulations on that thank you so you've had Mexican food you can get doctor I know you can take them out a little bit um but in El Paso what are some of the most common heart issues that you see here on the border and is it different from anywhere else actually so I did training uh uh Baylor Scott and White and the Cleveland Clinic and I always tell uh a lot of new Physicians coming into the area that El Paso I think is very unique we see a lot of path pathology pathologic conditions and more so than I feel like I got in my training just our area I think is inundated unfortunately with diabetes and chronic kidney disease and those two disease States really um attribute to developing or contribute to developing coronary artery disease and I think that there is a lot of coronary artery disease in El Paso unfortunately as well as what we call peripheral vascular disease which is right blockages of other uh arteries in the body mostly the lower extremities so there's there is a I feel that there is a tremendous amount of disease State here in El Paso more so than we see sometimes in other areas and I know we have a high incidence of diabetes so that's something that I think is talked about quite a bit but chronic heart disease I don't hear an awful lot about that you mean sorry kidney disease yeah so diabetes but you're at risk for kidney disease as well as heart disease so okay and so when we're looking at and I do want to talk about peripheral vascular disease because that's something that um is basically people feel it in the legs and often when we talk about hearts and Cardiology think everything's happening up in your chest but that's not necessarily the case as well so I'd like to go into that in a little while um Dr tropasi I'd like to with some of the I don't want to say easy things to address but I feel like a lot of people hear about oh my gosh I have high blood pressure oh my goodness I have to watch my blood pressure Etc so I'd like to kind of start relatively basic and something that a lot of people hear about and may have issues with because that's one of the first things if you see any doctor it's like you know what I'm going to take your pulse and your blood pressure and why is that such an important thing right so high blood pressure highly prevalent disease in the U.S and across the globe actually and incidence increases with age and it is estimated that almost 40 percent of people in New us for more than 18 years of age have high blood pressure this is very important because you know it can lead to so many problems it can affect your heart it can affect your kidneys it can affect your brain so that's why we really focus too so much on controlling blood pressure if you have it if you have risk factors which is after it we see if you have the diagnosis and then we treat it aggressively might you have uh I don't know nothing's ever easy when it comes to an answer but what are some reasons people have high blood pressure right so to answer this question you have to differentiate between two types of high blood pressures so first one is called primary hypertension also known as essential hypertension and the second one is called secondary hypertension so let me explain a little bit so primary hypertension does not have any cost per se but there are several several risk factors that can increase the you know likelihood of having high blood primary hypertension so one of them is Advanced age you really can fix it you know in black people you can have a high blood pressure primary hypertension also there are certain you know lifestyle things for example high alcohol intake high salt intake physical inactivity all these can lead to primary hypertension so and there's other type called secondary hypertension where always there is some medical problem that is causing blood pressure to basically you know go up so so these are the various reasons and you have to differentiate before treating them whether it's primary versus secondary so here's a question from a general audience member if it's something that I understand disease regarding diet exercise Etc if if zero weight to help control your high blood pressure aside from I know again we've got diabetes we've got some things that we don't have control over but how is it that we can control the high blood pressure so you know if so again so you have to differentiate whether it's primary versus secondary right if it's a primary high blood pressure which is present in 90 of the cases then you start with lifestyle modification you know diet exercise low salt diet low alcohol intake but if we can control that with lifestyle modification then we have certain medication that we can use in addition to Lifestyle modification it does not replace lifestyle modification okay and nicely answered on that and again just treatments medications at this point and you talked about some of the dangers so I'd like to kind of move into now um and Dr Aussie you talked about afib I'm one of those that has afib my heart beats crazy all over the place I do have a heart valve that doesn't behave um and I feel like over the last I don't know five-ish years that I hear a lot of advertising about afib or if you have afib and then you know Strokes that may or may not be associated with a heart valve issue etc etc etc so I just feel like this is something that I hear a lot about but there are so many variations with that explain what afib is to the general common person what exactly is happening in your heart when you're missing beats or going faster slower Etc sure of course so atrial fibrillation is probably the most common abnormal heart rhythm that we run into as we get older especially over the age of 60. um I think of the heart almost like a house you know the house basically you're uh you have bedrooms and you have plumbing and you have electricity so the for the heart is basically four bedrooms and those those bedrooms have basically fuel lines and electricity to to run them and the electricity runs within the walls of the heart and in the upper chambers there's a a main electrical generator called the sinus node that fires 60 80 beats per minute when you go into atrial fibrillation the sinus node no longer is functional and it's a very chaotic uh arrhythmia that occurs where there is no regular firing from the sinus node it's coming from multiple areas in the upper bedroom walls that are sometimes going 200 to 300 times a minute and can cause your heart to become very erratic and fast which are you know the problem with atrial fibrillation is that it causes your heart to go fast and that's where people become symptomatic where they feel the palpitations and then the other major problem with atrial fibrillation is that it predisposes you to stroke and the reason for that is that when your normal electrical generator is firing there's contraction of your upper chambers and so blood moves down to the bottom two bedrooms through your valves well with atrial fibrillation there is no contraction and the The upper chambers are just sitting there basically quivering and so when you quiver there's no pumping of blood and the blood becomes stagnant and then can form a blood clot when that blood clot dislodges it can go to the brain or other parts parts of the body but going up to the brain is very common it's one of the most common causes of stroke that we see in the elderly population sometimes people present their first time with a stroke unfortunately in the hospital for atrial fibrillation and a lot of the time when people present to the hospital with a stroke and we look at their EKG and it's a normal Rhythm right at that time we still investigate further because if you're a 70 year old male or female and you come in with stroke for not a real good reason a lot of the time it's because you went in and out of atrial fibrillation and some people are asymptomatic from it like they don't even know they don't feel the palpitations the racing hard or the Jump Beats so we investigate for that if a person is not having it at the time you are present and investigating what is the procedure or how do you find out to see if maybe afib was the issue and again just with my specific self uh other than specific but there are times when I feel it and it lasts I don't know 30 seconds 40 seconds and I'm thinking too for issues of stroke this happens recurringly I guess for whatever time frame that is what are some of the most common time frames I guess when your heart does kind of go crazy and again it's that misfiring electricity and we can talk about ablation too because I think that's something that could be one of the I'm assuming at this point one of the easiest reasons yeah fixing that well I mean so the way we investigate it is basically we have to monitor the patient so while the patient is let's say in the hospital while they're on a constant typical Telemetry monitor so that we can see but if we don't capture it then then the patient really needs to go home with some type of external monitor they may wear that for a month or so we also have these really fancy devices now that can be implanted underneath the skin it's an incision about no no more than like five millimeters half a centimeter uh that we would make the incision we slip the device underneath the skin use a little glue or a stitch to close up the the wound and that monitor connects by a Bluetooth to a device that would allow us to transmit and see the type of abnormal Rhythm the patient has and the nice thing about those internal Loop recorders is that their battery life is three to four years I remember us talking about this on one of the previous shows and I and I think uh that you showed me on a telephone on your smartphone that you can watch how this is going down yeah and how how often is that used now is that a pretty standard way of very standard okay very nice yep and in fact all these patients that are coming in with what we call crypto drone cryptogenic stroke or stroke of unknown reason um a lot of those patients especially if you have the risk factors you're 60 65 70 80 year old with diabetes hypertension we know that we have to try and detect it because it changes our treatment for it and the most common treatment for atrial fibrillation is one you have to protect yourself from forming a blood clot right so a lot of times now everyone's aware of it because you're seeing commercials right for all these medicines that are used to treat it um so when you have atrial fibrillation first and foremost you want to be protected from stroke so you go on a blood thinner to prevent a stroke from occurring and then you want to try and prevent the patient from going into afib or you know get them out of it and maintain them out of the abnormal Rhythm and that's usually done with medication and usually if medication fails then sometimes we can refer to our colleagues that are the electrophysiologists that do right ablation basically zapping little circuits in the heart to prevent the atrial fib from coming on so I would love for you to talk a little bit about and and Dr tapathi we're going to get a lot of we're going to talk about heart attacks with you sure so have fun with that um but we're talking about the electric circuits and the heart I mean they really go hand in hand I know that there's the heart and and brain Institute or clinic talk a little bit about how that communication between the brain and the Heart works and again it's these nerve endings or this electricity that sends back and forth to the heart and ablation is basically having that nerve not cut off but for the most part cut off is that correct or the electricity it's the electricity within the heart okay I mean essentially you know we don't think about our heart beating it just does it right it's got the electrical circuit that just goes without fail and when you go into atrial fibrillation again the electrical signals have become chaotic and so what we rely on our callings the electrophysiologists to do is to go in there and there are specific areas in the left upper part of the upper chamber of the heart called the pulmonary veins and the circuits of atrial fibrillation are pretty much if you can create a little fence around those veins to prevent that electrical signal from being generated there then you could typically and it's you know the technology is is unbelievable and has progressed throughout the years and their success rate is really quite good I mean 80 probably 80 percent of the time with ablation you can fix atrial fibrillation you know we've been doing this program for 26 years and I remember when I did you know some of our first Cardiology shows pacemakers it was all pacemaker pacemaker Pacemaker and this is it but it you know in a whole different on steroids type thing yeah um I would like to talk a little bit about heart attacks as I know we we can get so so inundated with Cardiology in general but when we're going to talk about a heart attack what exactly is happening in the body like physiologically and I know there's different types of heart attacks too but just on a very basic stage somebody had a heart attack what does that mean so what that means is so you know like all other organs in body our heart has those pipes that basically bring the blood from the heart itself and provide nutrition and oxygen to the muscles so doing heart attack what happens is those blood vessels get blocked and then as you said there are different types of you know heart attacks so it depends on the degree of blockage of those blood vessels so when you're looking at the blocking of the vessel so that means oxygen somewhere along the way is not getting to where it needs to go so I'm thinking about time frames if somebody is having a heart attack and maybe we can just it seems that everybody knows it but not everybody does if the symptoms of a heart attack are what what do you have people look out for so most of the times the symptoms can vary in different patients it varies by gender as well sometimes if a patient has diabetes you can have very atypical symptoms but in majority of the patients if you have a heart attack patients feel heaviness or pressure over chest they can be short of breath sometimes they can be lightheaded and they basically sweat profusely during heart attack so these are the more common symptoms but it can vary from person to person and what should they do should they call 9-1-1 immediately is it something that you mess with you're like okay this is going to go away and I'm just the urgency of the matter no it's very urgent they should call 91 right away and get checked in the ER okay so the walk is now through somebody has called 9-1-1 they're in the ambulance the ambulance is maybe calling ahead to the facility to the the hospital what is it that's happening once the patient gets to the hospital what are they how are they going to diagnose what's happening right so you know as an Interventional cardiologist we are always on call 24 7. there's somebody on call for emergencies so let's say somebody's calling and most likely he has heart attacks our paramedics are very trained and they can get like EKG right away and if this basically see that there is heart attack you know uh signs on EKG the alert they are right away once patient comes to the ER he gets all the checkups basically blood work EKG and if there's a if patient has certain type of heart attack called St elevation Mi then is that slower so there's a certain type of heart attack called St elevation myocardial infarction okay so that is one of the dangerous kind of heart attacks in that case we don't wait for any laps or anything ER doctor will directly communicate with one of the Interventional cardiologists who is on call and send the EKG and if the international cardiologist confirms that this is temi or St elevation Mi we directly take patient to the cath lab to open the blocked artery okay so that was going to be my next question the treatment so if you're looking at opening an artery cath lab does what is there an MRI that you're looking at how is it that the doctor is able to see what's physiologically happening with the heart right so in cat lab we have a special x-ray machine and basically what we do is we get access into one of the blood vessels arteries with the help of wires and catheters we go inside the heart into the block blood vessels and we use different tools like you know some contrast some other medications and visualize the location of the blockage then we cross this blockage with some wires open that blockage with balloons and if needed we put the stent there okay and then recovery time I guess it's all different with every different patient correct right yeah most of the times not more than 48 hours but let's say if somebody is presenting very late and he already has or she already has her heart muscles damaged then in that case recovery time may be prolonged so here's a question that I remember getting a lot that once you have had a heart attack or your chances of having an additional one in the future higher yeah that is correct because if you have a heart attack it means you already have risk factors for the heart attack so definitely your chances are higher than the normal person who does not have any risk factors okay makes sense you know what we're going to talk about now heart valves one of my favorite subjects one of mine too is it really oh thank God okay um because that that's I was I was the murmur kid it's like she's got a murmur what's up with her and then it was a click murmur so I've got a mitral valve that doesn't behave for the best way it was described to me for years now it's chronic but for the most part benign um is that where my aphid comes from maybe maybe not we don't know but in general uh heart valves and Replacements I mean there have been everything from pig valves to Mechanical Valves and then I forgot what other animals are used but in general let's talk about a wear and tear there's there's structural heart valve issues that can be when you're born or just your body and then there's wear and tear of the heart valve but in general just just take your favorite subject and go to town on how you want to explain heart valve issues so going back to my house going back to your house I love this little four bedroom house I love that analogy to get from one bedroom to another you have to go through a door right and so you know I the the door is your heart valve it opens and it closes and those doors can get worn out over time those doors separate the chambers of the heart they can get worn out over time because of wear and tear I always say like the hinges get rusty and we get problems where the valve or the door won't open well which can create a major issue or the door doesn't close well anymore right and you get backward leaking of blood into a chamber where it's not supposed to be seeing the blood during that time of the heart cycle so the two more common uh valve conditions that we deal with as we get older um and just like you said there are conditions that you could be born with that can predispose you to one of your valves or doors wearing out prematurely so usually when we hear about a aortic valve which is your main valve that allows blood to exit the heart and if it starts wearing out in a very young person like in their 40s and 50s we usually think that they were born with a malformation of the valve that predisposes them to that condition such as what we call a bicuspid valve which is just two leaflets instead of there being three leaflets um but anyway aortic stenosis which is stiffening of the aortic valve where the door won't open well anymore is a very common condition as we get older and that's usually from fibrosis and calcium depositing on the valve leaflets which then again restricts the valve from opening so aortic stenosis and mitral valve leakage or mitral regurgitation are where the valve doesn't close well are two of the very most common valve conditions that we deal with in adult life later on in our 70s 80s Etc um but we've come a long way in the treatment of these valve disorders um you know are there symptoms to this are there symptoms to valve issues well the most common symptoms are are shortness of breath fatigue with exertion it's aortic stenosis because the valve won't open you can't give blood to the brain and so if you feel like you know one of the more common signs and symptoms I I hear about is Doc I was carrying my trash up the driveway and I felt like I was going to pass out right I get that so not enough blood to the to the brain right and you feel like you're going to black out have a passing out spell just get lightheaded that's why I describe it I just get it yeah dizzy and and eventually these valve conditions can predispose people to developing heart failure or even sudden cardiac death so they're very serious and we've come a long way in the treatment of them I mean if you go back you know really 12 15 years ago the only option for aortic stenosis was surgery right yeah your chest opened up yeah the surgeon goes in takes the valve out and then puts in a tissue valve which we call a bio prosthetic valve or a mechanical valve the problem with mechanical valves is you have to be on lifelong blood thinners Coumadin which is the only blood thinner that's indicated for a mechanical valve okay taking those types of blood thinners can create issues of its own so um you know within the last 12 13 years we've been able to have this great new technology that was developed to avoid people from having open heart surgery not that I'm saying surgery is bad right but it gives us another option especially for our you know elderly population that going through open heart surgery would be a very tough procedure to endure so now we do there's a technique called tavr transcutaneous aortic valve replacement but it's we're not removing the old valve we're actually implanting a new valve and we used alongside the old valve it goes inside the patient's own native valve so we actually yeah we actually use the native valve to help anchor and keep our stented valve it's a big stent with a new tissue valve that's on the inside of it and your old valve gets kind of pushed out to the side but it hugs and grabs the stent to keep it in place I like that idea see the longer I hang out and don't do anything for a while in three or four years maybe I'll come to you and say hey I need a replacement somewhere but so far it's been good um so we were talking about structural heart disease and that's where I have Tabor in my notes here um with heart valves that again I guess it doesn't matter whether it's something that you're born with or if it's something you get later in life bottom line is you still have this procedure that you can do how long has that been an option the Taver option around 12 to 13. okay that really has been that round okay all right we've been doing it now at Sierra Medical Center for the last three and a half years um we're doing a really good job of it we've been supported highly by the administration and the hospitals of Providence and we our program is up and running good to know there's always you know it's nice to me know where you have to go um Dr tripathi I would like to talk about uh the different things that lead up to coronary artery disease because that in and of itself I know that that is a bucket of how it can be caused so coronary artery disease we hear about it a lot again this is kind of Heart Care 101 describe what that is to our audience so coronary artery disease is basically developing plaque inside the blood vessels of heart developing plaque okay so what happens is you know there are several risk factors that can lead to it one of them is age itself so aging population always develops some sort of plaque inside blood vessels but then you can have additional diseases that can lead to it for example diabetes if it's not controlled it can lead to you know progression of coronary artery disease and and you can have heart attack out of that then high blood pressure major risk factor for coronary arteries then some people have high cholesterol or lipids in their blood so that can also lead to formation of plaque and unfortunately sometimes it's just not related to Lifestyle sometimes it would be genetic so some people are born with bad genes leading to very high cholesterol in their blood so these are some of the major risk factors other major is factor that we can modify is cigarette smoking very common so smokers they have plaque here and the legs and the Brain everywhere eventually so that is one of the major risk factors and then we can have some minor risk factors as well as I said before aging population there's some rare diseases for example like homocystinemia I mean you can have high amount of that material in your blood and can cause you know progression of plaque and and coronary artery disease so when is it in this course of coronary artery disease that you apply as the stents approach um I feel like I hear about that all the time too when when is it in cardiology that you use stents so we divide coronary arteries between among basically in two broad two categories essentially one is stable coronary artery disease and other is acute coronary syndromes so what it means is if somebody has predictable chest pain for example it comes only when they're exerting then they are not called to have a stable coronary artery disease in such cases what we do is we try to basically manage their coronary artery disease with medications first and if that doesn't work then we can offer them standing we can go inside put a stent open the blockage on the other hand if patient has acute coronary syndromes which is also known as heart attack in that case we have to put a stent okay our patient has to go to surgery depending on what we see inside the blood vessels so that would be one of the first basic in in fast treatments of a heart attack of getting getting everything opened up the lack of a better word um Dr Aussie so this is there's 50 000 answers of this structural heart disease um I always think about this as something that you were born with that may not show up until later in life what are some of the most common structural heart issues that that you've seen in your career well the the valve issues we lump valve issues as structural heart disease or performing structural treatment of structural valve uh treatment of structural heart disease and valvular disease falls into that so as we were talking about aortic stenosis doing tavr that is in the structural uh heart disease Arena other things that fall into structural heart disease are things where there's a maybe a hole in the upper chamber of the heart called an uh atrial septal defect or a patent foraminal Valley which has been linked to some people having stroke so now I always hear this in the upper chamber why is it always that I'm hearing in the upper chamber is that common in other Chambers too or is it just well you can have ventricular septal defects but they're not as common okay um we see those more they they can be also something that you're born with okay but they don't sneak up on you usually the ventricular septal defects are readily heard on exam and and addressed but the hole in the heart that's in the upper chamber such as natural septal defect or a PFO may never be detected by a physical exam they typically manifest later in life whether like a Peyton frame in a valley which is just the two upper chambers the the tissue kind of when when we're developing inside our mom the tissue grows together and it's supposed to seal uh the separation between the two upper chambers and if that doesn't seal well then that is what we call a PFO which can sometimes predispose someone to a stroke and so the PFO or a part of that septum doesn't heal right or come together there is a device that can be used to close up the hole and that could be done surgically with a stitch or it could be done again what we call percutaneously or through the groin where we go up and put a little device that seals up the hole so that's part of the structural heart Arena as well then we have this other device called a Watchman device which is used to treat structural heart disease so when we talk about atrial fib atrial fibrillation again let's say you have someone that has atrial fibrillation but they can't take blood thinners to protect themselves from a stroke uh right there's a pouch in the upper chamber of the heart the left the upper left room has kind of a little extra pouch that we needed when we were developing but in adult life it has really no function other than being a bad part of the heart that predisposes people to stroke and atrial fibrillation because that's where 90 of a clot of clot that can occur with atrial fibrillation houses it goes so everyone has the spout everyone houses when they were forming in the womb yeah I've never heard about this couch tell me about that it's called a left atrial appendage and that appendage can is where most of the clot forms when you go into atrial fibrillation huh so the Watchman device or an occluder device of the appendage can be put in again percutaneously through the groin going up and you basically seal off the pouch and close it off so that someone doesn't if they can't take blood thinners they have another option it's a procedure it's still you know it's felt to be second line treatment but I I really love that idea so that's normally where the quad would start forming yes and then boom it's right there by the heart yeah so once that pouch is closed off um again the chances of developing then a clot where would that clot then want to develop so we're taking chances away there yeah 90 of your chance of forming clock goes away and most of the research and literature say it protects you as good as taking blood thinners so it is something that um is available we're doing it you know uh in the community throughout the Sierra and again you go through the groin okay describe if you don't mind how how that works and and I and I'd like to talk a little bit too and it's completely not off the subject but you were talking about a procedure also going in through the wrist versus the groin we talked about this a couple of months ago I'm not exactly sure what it is but I'd like to go into that too um but the procedures of going through the groin what arteries you're going through if you can describe it to the audience what it is that that you're doing as a surgeon sure well when we when we go radio that is mainly to look at your heart arteries I mean we can do pressure measurements and stuff but we're we're mainly going through the wrist artery in order to get to your heart arteries to put a stent in okay as Dr chapathi was talking about I mean that's the majority of the time we go through the radial artery to as a conduit to get to our heart arteries so that we can fix that when we're doing structural things with the heart such as the Watchmen or the tavr procedures we're going through our ephemeral artery which is the artery a big artery in the groin and we can't do it through the wrist because it's too small of an artery okay we need a bigger conduit and the femoral artery is a direct approach to our aorta and the aorta is the big pipe that comes off the heart when you see the little model here this is our aorta goes all the way down into our belly and then separates into the vessels and the pelvis and into our legs so we we use the femoral artery to get up here to our big uh aorta to in order to deliver a heart valve for such as transcutaneous aortic valve and pontavre when we're doing Watchman procedures or PFO closures we're actually going through the femoral vein and we use the femoral vein to go to the right side of the heart and as we've talked about there's those two rooms upstairs and two rooms on the bottom well the one room on the right side can you can actually go through the wall that separates those two to get to the left upper room and that level we're actually going through a wall okay to get to like the appendage to close it no kid and so when you're going through the wall then actually when you leave the wall again that's another suture that you're doing but you're getting into that other side that you need to have access to correct see I would love to see a video on this one day um and and you as the surgeon too how my gosh I don't even know how to ask this question how do you see what you're doing like how is the guiding going for you to see what what's happening we're using ultrasound and we're using what we call fluoroscopy which is the X-ray Imaging that Dr tripathi was mentioning before okay you know the the the cath lab equipment fluoroscopy it's kind of like we use dye and imaging and we can see where our catheters are it's like a moving x-ray that allows us to see the different parts of the heart so we use that in combination with ultrasound so most of us lay people and and please don't laugh but most of us lay people we think of different doctor shows and medical shows and it's like oh I've seen that happening before and I'm thinking how much is that real you know but it it is amazing to me how you're able to guide some of that um Dr tripathi I would like to I I see the show often as a show that that helps people out prior to big things happening so I'd love to talk a little bit about lifestyle you brought up some talking earlier died in exercise in general we've got a very high diabetic population in El Paso when we're looking at just trying to keep ourselves healthy you know I've got a couple of things on here cholesterol is is like the big thing we're talking about plaque we're talking about developing stuff in our veins and arteries that shouldn't be there how do you direct your patients to just take better care of themselves I know this is something I feel like we hear about it all the time but this is a great platform to talk about that yeah absolutely so prevention of this heart disease is bigger part of our job right so we always want to do something that will prevent patients from going to the table and I always dedicate some time every single visit with patients talking about lifestyle modification exercise and diet so I normally try to talk to them about quitting smoking right it's it's it's a huge risk factor for coronary artery disease and certain type of diets so if patient has you know high blood pressure I talk about DASH diet which is basically low in sodium basically low in processed meat more veggies and fruits so you say dash dash yeah you know information is available online okay but this is what I talk about a patient has coronary artery disease I always talk about lowering cholesterol in that I'm in fats in the diet right including whole grains and beans in the diet and always talk about cutting down alcohol or just alcohol in moderation Atlas and then a lot of my patients are not Super Active right so and not everybody can do like you know 50 minutes of cardio every day or so but I asked them to do at least 40 minutes of brisk walking four times a week if you can do that this is good and there's 40 minutes of brisk walking yeah four times a week okay yeah they should be enough to keep you healthy okay so at least do that if you do more that's good but at least do this not smelling the Roses on your walk exactly oh get the heartbeat going up a little bit and there's also that thing about Park a little bit farther away than usually do don't fight for that first spot all things exactly you know Small Things um I have again just just from past shows aspirin used to be such a thing and I don't know if that is a thing anymore like we talk about blood thinners um as a prescription but is prescribing aspirin baby aspirin is that even something that we do anymore I feel like I haven't heard about that in a long time right so aspirin was a major part of prevention strategy in the past but then we had several randomized control trials and that have not shown to prevent heart attacks in individuals so we are staying away basically going away from prescribing aspirin for primary prevention what that means is those people who never had a heart attack and we are trying to prevent heart attack that's called primary prevention so we are going on away from aspirin it's not recommended anymore yeah I was going to say there's a reason I haven't heard about that for a while um Dr Aussie I'd like to talk about sleep um specifically I know we did a program a while back about sleep apnea and just the fact that you're not getting enough oxygen to where it needs to when you have apnea per se but let's talk a little bit about that with it being a risk factor and finding out if your sleep issues are apnea or not and maybe describe what that is yeah well obstructive sleep apnea is a very common condition and I mean there's definitely you know as if you're depending on your weight the size of your neck I mean those types of things predispose you to developing periods of where you stop breathing and you know chronic sleep apnea predisposes you to stiffening of maybe the lungs increases the pressure within the lungs and something that we really hit on the last time we did the show with our sleep specialist was the fact that obstructive sleep apnea has many Associated heart related conditions atrial fibrillation comes back resistant hypertension you know I I counsel my patients all the time you know they come in we're treating them for hypertension and they're just not responding to drug therapy and then I start talking to them about possibly do they have some of the signs or symptoms daytime fatigue right um you know falling asleep very easily uh at rest and so uh those types of signs and symptoms may say that they have obstructive sleep apnea and if you don't treat that you may continue to have resistant hypertension that isn't uh responding to medicines or lifestyle modifications so I I counsel all my patients you know the if if they have some of those signs and symptoms or even if they don't have those symptoms of daytime fatigue if they have the risk factors for developing sleep apnea and their blood pressure is not well controlled I typically reform for a sleep study and then once they have uh once they are diagnosed with sleep apnea say and and maybe let's describe what that is so sleep apnea is is snoring heavy snoring but it's when um there is obstruction to the oxygen that gets throughout your body right and so if someone is trying to fight that and I know this is not a sleep show but maybe describe that hey I say this because so many people like oh my husband stores oh my wife snores so where do they go from here so they're hearing a little bit about it right now but how how can they fix that well they need to go get a sleep study they need to go uh see a sleep specialist and get evaluated for it typically an overnight stay where they're monitored to determine how many spells of uh non-breathing no breathing occurs throughout the night and what do their oxygen levels do throughout the night and once that's diagnosed by the Sleep specialist and they're prescribed a machine that allows them to get positive airway pressure to prevent the obstruction okay and let's talk a little bit about uh obesity we can talk about that with sleep apnea we can talk about that in general with Cordy uh with Cardiology the reason I'm bringing this up too it just seems not just seems there was a study actually this morning that I was listening to it's like one out of every five children are now obese and which to me is a staggering statistic but let's talk about we were talking about diet and exercise in general obesity and Cardiology in general interventionally when we're talking about sleep apnea this might be a way to say hey maybe we can start modifying the way we're eating or watching out for obesity yes if you can kind of expand a little bit more on that that's right so you know obesity is core problem in so many cardiac disorders one of them is high blood pressure so it has been shown that if you lose I think two kilograms you are more likely to drop your blood pressure by Five Points the upper number of the blood pressure so it's a major problem with high blood pressure obese people are more likely to have sleep apnea that can put pressure on lungs and can develop a condition called pulmonary hypertension that's very devastating State for the heart too right and then obese patient have more likely to have high lipid levels so definitely this is something that we address every single time a patient comes to our Clinic if they have obesity we always you know talk about you know changing their diet um doing exercise but these days we have other options too let's say if somebody is morbidly obese then we have medication different medication that can help you in addition to lifestyle changes so so that's part of our job as well to discuss and give them options and there's something uh that you can find anywhere now called the BMI calculator which is the body mass index calculator um and I think that sometimes people are surprised to hear that oh I'm not just overweight I now actually hit the mark for being obese and then morbidly obese and I think a lot of that too is in our day and age somebody being overweight has become the norm unfortunately and so again if you just look up body mass index almost on anything you will have a calculator of how right uh you can you can diagnose that exactly we are kind of at a 10 minute Point uh before this program wraps up and I usually like to stop all the questions that I have and ask both of you what it is that for example when you're driving over here tonight there are certain things I want to make sure that I talk about and we may have not touched space on it yet or there's something that we want to reiterate Dr Aussie since you're our veteran I'm going to start with you but just think of some things that um that you that you deal with every day that you think the audience should know about Dr Aussie what are your thoughts I need yeah well and I need to touch base again on coronary artery disease okay good I mean I think it would be I I think if someone could follow me around this just take this past week the amount of patience that we had to one use stents on send to open heart surgery for quadruple triple bypasses i i and and the patient population it's not that it's happening later in life we're seeing it earlier in life we're seeing 50 year olds going to open heart surgery with you know multi-vessel disease which means that not just one artery is blocked but all of your major arteries have major blockages and we can't put stents we can't put 10 stents in you to fix everything I mean we have to send people to typically open heart surgery and you know just the other day the spouse of one of my patients says how how do we fix this how do we stop this right great question how do I become aware of this and when it you know everything is about taking care of yourself early preventing something like this from happening later on in life Eat Right avoid obesity you know obesity is is an issue it's an epidemic I mean it really is yeah and um you know taking those lifestyle measures early to try and prevent something stop change your lifestyle right now if you smoke or if you're eating poorly on a day-to-day basis um and the warning signs you know when you start having chest discomfort don't take it lightly if it's unusual if it's new go in and get evaluated there is nothing that anyone's ever going to say oh you overreacted right get it taken care of go time is muscle right you know we're on the clock anytime that someone is having a heart attack we are as you know that that EMS El Paso Fire when they get to your house and they get that first EKG the clock is ticking right then and there to get the your that patient to the heart lab to get the artery opened up so it is a major um issue if you prolong it because the more time you wait with those symptoms you're damaging more and more heart muscle so I I just you know I I don't know that we could ever emphasize that topic enough so here here is a question of someone who may be really getting the message for the first time you know they've probably heard it they're listening to this program and they're thinking okay you know I have had shortness of breath I I know I'm overweight I know etc etc etc so what do they do now do they call someone at hospitals at Providence do they find out where Dr Aussie is and give him a call I mean in general what is it that you can do and and feel Dr chapathi come in and say okay this is what you do now I need to see someone and who is it that they are say they don't have a primary doctor obviously the answer would be your primary doctor what will they do now so you know I would basically categorize the symptoms based on whether it's acute meaning somebody is doing normally and then all of a sudden they have shortness of breath or they have you know acute chest pain meaning they're doing normally and now they have you know crushing chest pain in those cases I would not want them to wait to see their primary care doctor they should just call 9-1-1 or somebody should drive them to go to the ER to get things checked because there are several disorders related to heart or lungs that can cause these problems on the other hand if somebody is having this slow progression of symptoms right and that that's more what I'm doing yeah just someone who's like you know what I need to get something checked yeah then either they can go to primary care doctor get the referral down get the initial workup done with PCP and then get referral to us or they can just call our Clinic um and and get appointment set up so that's a question so calling your clinic to get an appointment set up right they can just call the hospitals of Providence Heart Clinic heart and brain Clinic I believe it's different for different ones but for my clinic we have direct number they can just call and there's a staff that can help them schedule the clinic yeah look at the center of the heart there we go the hospital is a Providence Center of the heart we have a great group of Physicians new physicians Dr chapathi is extremely well trained we're we're all going to be ready and willing to help take care of and that's really what I'm looking for just the first line of defense like this is what I need to do I need to call so hospitals of Providence Center of the heart um just telephone them and say hey I'd like to make an appointment I want somebody to see me help me out absolutely uh Dr chapathi so you being new to this program is there anything that you'd like to talk about before we start wrapping up anything that you have a passion about in your world of Interventional Cardiology right so I'm an international cardiologist but but I said before I'm a cardiologist too so I see a lot of patients with heart failure in my clinic and I see very less when you say heart failure that's also loaded what does heart failure mean to you right so heart failure is broadly categorized into two groups one where the heart muscle is weak right it's not functioning to the full capacity and the other type of heart failure is where heart muscle is stiff it's not relaxing so there are so many treatments available so by the way heart failure patients have very high mortality in five years and I see a lot of patients they haven't been treated optimally because now we have Lifesaver medications they can be on that and that can increase their life so I want to spread more education about heart failure I I'm very passionate about treating heart failure too because now we have so many options so I think this is a separate topic of its own uh but but um I would just want to have a couple of minutes talk about some of the options to treat heart failure exactly so we have medications called gdmts also known as goal directed medical therapies these are medications not available 10 years back now we have at least five categories of those medications I see only 10 to 20 percent patients who come to my clinic they are an optimal optimal medical therapy we've been here discussing Heart Care 101 common heart conditions and how they are treated I want to say thank you so much to tenet the hospitals of Providence for underwriting the show and always a huge thank you to the El Paso County Medical Society and all the doctors that come on the show and have been doing the show for so many years you can watch the show again on pbselpasso.org you can also catch it on epcms which is the El Paso County Medical Society and that's.com and good old-fashioned YouTube which is not so old-fashioned but in the last 10 years or so you can go to youtube.com and literally type in the El Paso position and you can look on there and see whatever the topic is that you are interested in if you want to talk about Cardiology Heart Care 101 if you want to talk about Orthopedics Etc just type it in there and there are years worth of programs that you will see on there that you'll be able to re-access which is always a great thing thanks for tuning in I'm Catherine Berg and this has been the El Paso physician [Music] thank you [Music]