Thank you for taking time from your busy day to watch the special presentation from the El Paso County Medical Society.

I'm Dr. Joel Hendryx, 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.

Heart attacks, strokes, high blood pressure.

One in four people die of heart disease in the United States.

What are the signs and symptoms and how do we know when it's time to actually seek medical attention?

When do we call 911?

During the next hour, we have experts answering questions about early detection and possible prevention measures of heart disease.

This evening's program is underwritten by Hospitals of Providence, and we want to say a huge thank you to the El Paso County Medical Society for bringing this show to you.

I'm Kathrin Berg.

And this is the El Paso Physician.

Thank you.

This is the El Paso physician.

And tonight, we're going to be talking about early detection and signs of heart disease.

With me this evening, we have two newbies.

I kind of like that.

We have Dr. Clifton Espinoza, who is a noninvasive cardiologist with the hospitals of Providence.

He defines himself as the thinker.

But really, thinkers don't mean anything unless you have a plumber along.

And so we have Dr. Luis Carbajal, who is an interventional cardiologist who is the plumber with the hospitals of Providence.

So thank you so much for being here.

I know that you are a group of 12.

But what I'd like to do for the audience, even though I kind of described what your specialty is, it's always nice for them to hear from you what it is that you do all day, every day.

So as a noninvasive cardiologist, what does that mean?

So I'm more of the traditional cardiologist.

So I see patients in the clinic diagnose common cardiac conditions, treat them medically.

So I don't do a lot of the invasive procedures that Dr. Carbajal would do.

You know, like putting stents, pacemakers, or that sort of thing.

I treat more with medications and, you know, I do the echo echocardiograms, which are ultrasounds of the heart.

Mm hmm.

I see patients in clinic.

I will see patients in the hospitals, of course.

But my treatment strategies don't involve needles and stents like Dr. Carbajal's would.

Okay.

So I do more of the thinking.

And if I need some stents or plumbing work, then I go ahead and send to my.

So here's the question.

And it could be not the proper way of saying it, but are you the person that more diagnoses type things or are you the one that kind of figures out what's going on?

Well, we do a little bit of both.

But I would deal more with the diagnostic aspects of imaging and things like that.

He still deals with it to some degree, even though some of them trying to get away from it.

But it's not always possible.

They love being in the cath lab and tattling on Jesus.

Dr. Carbajal So let's go with that.

So you have the stent guy.

You're the guy that puts stuff in, right?

So you're the inventor, interventional cardiologist.

If you were to describe what you do all day, every day and not comparison with the groups, we're going to go into the others that you have in your in your practices as well.

But what is it that that you can say that you do all day, every day?

Oh, well, other of us, As Clifton mentioned, we all do is spend some time in the clinic and we see and follow all our patients, we try to do some of the diagnostic work.

But as an interventionist, you also have to spend time treating the conditions with invasive procedures.

I see invasive procedures.

Really, there are minimally invasive procedures.

They involve getting through a patient's vessels.

Mm hmm.

With a needle and a catheter.

Take some pictures of the arteries.

And depending on what you find, trying to get the right treatment for the patient.

It sounds simple, but it can be very time consuming.

Some of these procedures can take two or 3 hours.

Some of them can take 20 minutes.

So I'm glad that you think it sounds simple.

It does not sound simple to me at all.

And that's one of the reasons why we're here.

When we talk about heart disease.

I know that there are so many on the table, but tonight I'd like to talk about the general audience when they hear heart disease.

What are we talking about?

I know there's high blood pressure, there's cholesterol, there's just a myriad of things.

But when you are talking to your patients and what you're hearing from your patients, how would you describe heart disease in your area?

So in the classical sense, heart disease, what most patients think of what heart disease is, they come in and thinking, first question is this do I have a blocked artery somewhere?

So what they're referring to with that is, you know, do they have coronary artery disease?

Right.

So coronary artery disease is just the buildup of plaque within your arteries of the heart.

So the heart is a muscle and it gets blood supply just like any other part of the body.

These arteries basically are three major arteries coming off a big trunk.

So over time, you know, depending on lifestyle genetics and co-morbidities or prior diagnoses, patients can develop plaque in some of these arteries and then they eventually may start having symptoms.

So that's coronary artery disease.

But heart disease is a very broad term and it only encompasses coronary artery disease, also includes high blood pressure, which is a cardiovascular disorder, problems with cholesterol metabolism, so high levels of cholesterol that will also, with your hypertension, increase your risk of developing plaque out earlier stages in life.

Of course, you know, there's also congenital abnormalities that you may come across, but not as often as these other entities.

So when you speak of heart disease, technically it's anything and everything that can affect the heart arrhythmias, coronary disease, trauma.

So all of that can have a lasting impact.

So it's a very big term.

And as we said in the beginning of the program, one in four die of heart disease, which is why I want to make that expression real.

People think about cancer, they think about this and that, But when you look at it, heart disease, there are a lot of prevention measures that we have.

And Dr. Carbajal I'm going to ask you about that in just a minute.

But, Dr. Espinoza, you said something to me, and maybe I understood it wrong when you said cholesterol metabolism.

Did you mean to say those words together?

And what does that mean?

Because that fascinates me.

You've got people that eat as well as you possibly can, and they still have cholesterol levels that are high.

And a lot of that's genetics.

But it's also the way our body metabolizes cholesterol.

And I don't think I've ever talked about that on a program, but I think that's a curiosity to the majority of the population, because that is the one thing the doctors tell you to do.

Watch what you eat, keep your cholesterol down.

How how does that work for the for the lack of a better way of asking that?

Yeah.

Explain that to the audience if you could.

So basically, like you said, you know, you have a myriad of patients that are the patients that eat anything and everything under the sun and still their cholesterol is within normal limits.

Yet you have those patients that follow a very strict diet and they have problems with their cholesterol.

So in certain aspects there is a genetic component to it, like familial hypercholesterolemia has a disorder.

Where do you'd say that's slower?

Say that again, familial hypercholesterolemia.

So that means from the family cholesterol.

So it's all from your family, basically an inherited disorder from, you know, your your genes from your family or your ancestry.

So these people that have this disorder, they essentially make a lot more cholesterol from the liver than they should.

So their numbers tend to be a lot higher.

And sometimes they can be treatment resistant.

You know, we use medications to lower cholesterol, sometimes even at the maxed out dosages of those medications.

Sometimes you can get to where you need to be.

And now we have different therapies that can be tried, but essentially everyone metabolizes you know, cholesterol.

So cholesterol has gotten a bad rap.

You know, there is a function for cholesterol.

You know, we use cholesterol in the nervous system.

It's involved in your nerve conduction in the brain and transmission of data.

But the one that we think of when it comes to heart disease is bad cholesterol or LDL.

And there are right persons that they don't metabolize it, get rid of that cholesterol from their arteries and circulatory system, you know, like they should.

And then over time, that will increase their chances of developing heart disease, plaque buildup in all the wrong places, like the arteries of the heart, arteries at the legs, arteries in the neck, and, you know, eventually in the brain as well.

That can cause a stroke.

So in a sense, that is what we mean by metabolism or how quickly or how well someone removes it from the circulation.

So, Dr. Carbajal, even though you are the interventional cardiologist, I think I mixed that up a little bit earlier when we're trying to prevent this from happening in our system.

Are there preventative measures?

I know we were talking about genetic pool.

That's the pool that you're in.

But are there there are some prevention devices other than what we hear all the time or and maybe feel free to repeat what you all tell your patients.

Oh, well, there's not aa1 single formula that fits all.

Cardiovascular disease is a complex disease that has multiple risk factors and that taking care of these different risk factors is what does it as you earlier mentioned, there's people that seem to be doing everything good and regardless, they have a genetic predisposition to it.

But in general terms, you know, for the for the public, a healthy lifestyle, trying to stay active, looking what you're eating, avoiding processed foods.

One of the simplest thing I tell my patients, unfortunately nowadays most of the products you consume things package and it's packaging stuff has gone in.

I keep telling them the simplest ways.

If you stay off the aisles of the supermarket, you know, if you go to the edges, everything that you have to cook, that's the healthy stuff that that will keep you out of trouble, you know.

So say that again.

Stay out of the aisles of the supermarket.

All the edges have the healthy stuff.

That's true.

The fruits and veggies are all in the edges.

Never thought of it that way like that.

That's right.

But physical activity, tobacco consumption, avoiding it is very important.

You know this.

And yet all the stuff we've been hearing, all the stuff we've been here that, that and also, you know, understanding that sometimes you need help.

Right.

And there's a there's silent risk factors such as high blood pressure that most people don't detect unless they get checkups.

Right.

Diabetes, which most people don't detect until they have a complication.

And that takes about ten years of undiagnosed diabetes to have a complication from it.

So seeing your general practitioner, your primary care physician and getting your checkups on time, that makes a big difference because that way you can get ahead of the clock, right.

And don't end up with these problems.

So here's a question to and I'm looking at right now.

Let's say there's a population that does not go to get regular checkups.

And I know this is a cardiologist, so I get it.

But when it comes to diabetes, because we have a lot of diabetes specifically in our region, what are the signs and symptoms of diabetes for some of the think, oh, well, maybe I should find a doctor and get this checked out.

Now, we're not looking at the people that go every year and get their blood tested and you can see it there.

Are there signs and symptoms of diabetes?

I understand it's relatively silent, but if there's something out there that you can tell people, let me know.

There could be you know, there's several types of diabetes, but the most common type, the most prevalent in our adult population is type two diabetes.

There can be signs of your skin.

You know, there's darkening of the skin in the back of the neck.

There can be increase of yeast infections.

There can be changes in weight that you're noticing, very difficulty losing weight later when you start developing the complications when diabetes has been done for a while, you tend to lose function in your eyes.

So difficulty seeing.

You tend to develop these blockages in the heart.

So you can have episodes such as chest pain or location, which means pain in the muscles of your legs when you're walking or cramps.

So it's a it's a myriad of symptoms and it's I don't want to be the guy that comes here and spooks people and try to get them.

All right.

It's more about education.

Yeah.

And again, for the most part, unless I'm wrong, diabetes.

Can you there's a pinpoint of a blood test.

You can really look at a blood test and go, you know what?

You've got some diabetes issues here.

That's right.

I would say, yeah, If you know that it runs in your family and you're turning 35, you know, getting getting close to that age, it's a good idea to go and establish care with a physician and just get a general checkup every now and then.

Right.

Agreed.

Agreed.

Dr. Espinoza, I would like to ask you, we were kind of talking earlier about diagnosing.

Right.

So if you're looking at someone who has, let's just say, shortness of breath, I actually watched the news program this morning and I don't remember what channel it was on, but it was talking about women and heart disease.

And for so many years, women was kind of like, well, men always have heart disease, but it's a really, really high.

And sometimes the symptoms are very different for women.

And this woman just said, you know, one day I just I just felt like I felt nauseous and I just wasn't feeling good.

I thought, well, maybe I eat something wrong.

And we always think of the classic symptoms, Oh, does this your arm hurt?

Does your chest feel like an elephant sitting on it, etc., etc.?

But there are other symptoms as well.

So let's specifically talk about heart attack first and we'll talk about stroke.

I have some A-fib questions in there because I am the queen of A-fib.

I've got it all over the place.

My heart goes everywhere.

But symptoms for heart attacks in men, women and also those that we don't hear about very often.

Okay.

Well, I mean, the first step is just to say exactly what a heart attack is.

Good point.

Yeah.

So a heart attack is when you have an acute occlusion in one of the arteries of your heart.

So it can happen because of a barrier mechanisms.

But the easiest way to understand is these plaques develop in your arteries.

They basically hold cholesterol within them.

Some of these plaques can become unstable and they can burst.

So when that cholesterol gets re-exposed to the blood or the circulation, it causes a cascade.

And in poor inflammation and quote unquote, aggregation or clotting.

So a clot forms there pretty fast.

Okay.

So it's that, you know, very fast occlusion of that artery that impedes blood flow to the muscle.

And it and basically the heart doesn't have the time to compensate for that.

So that's when patients experience a heart attack.

So heart attack is the technical term is technically an infarction because that muscle is not receiving oxygen via the blood.

And the muscle essentially starts to die.

Right.

Eventually in the healing process, it forms a scar there and the scar is weaker than normal tissue.

So that's technically what a heart attack is.

You know, there are certain patients that the artery starts becoming narrower and narrower and narrower over time.

That's what we call stable coronary artery disease.

And they may present with different symptoms, They may develop chest pain, but it's a noticeable pattern that with certain levels of activity to develop the chest pain, they relax or chest pain goes away.

But what happens in these patients is that when that's a slow process, the heart has compensatory mechanism and informs these natural bypasses.

Get around that obstruction.

So maybe they may not be as symptomatic as you otherwise would be, whereas with a heart attack, it's an acute occlusion, right?

So there's no time to compensate for that and the muscle really suffers.

So you hear in the media that it was a small heart attack, a mini heart attack.

I see it as a heart attack is a heart attack is a heart attack.

So when you hear those terms, whether it's in a medical show or what have you, what might those people be referring to?

Well, it really depends, too, on the amount of heart muscle that's involved.

Right.

So, you know, they're the main artery that goes down the front of the heart called the LED or the left interior descending arteries, you know, known as the Widowmaker, because it covers such a large territory of the heart.

So if there is an occlusion right at the origin or very close to the origin of that artery, the amount of muscle that it supplies is very large.

So if a patient has a heart attack because of an occlusion there, you know, they it can be fatal quite quickly.

If someone like Dr. Carbajal doesn't come in and intervene on them.

So when they say a mini heart attack, maybe they had a plaque that burst and didn't completely occlude the vessel.

Gotcha.

But it still caused enough impairment in blood flow that the muscle was injured.

Gotcha.

Or maybe the occluded artery was a very small branch of a main artery and may be the amount of muscle involved wasn't very large.

Okay.

So that may be what they could be referring to when they say that.

So, Dr. Carbajal, now we have someone who has had an ace is having a heart attack.

You come in and do what?

What are your options?

What do you look for?

To know what options are now available for you to perform?

Do you have a very narrow time space?

We like to think of the 90 minute rule.

The patient has 30 minutes to get to the hospital, meaning MSA.

That again is we need people to hear that the patient has 30 minutes to get to the hospital.

We give EMS and the patient 30 minutes to be in the hospital.

You give their doctors to figure this out and make sure that what they're thinking, how the patients presenting is a heart attack.

And I have 30 minutes to open that artery, you know, but any means necessary.

Okay.

But the way we do this procedure is by first doing an angiography, an angiography is taking a picture of those arteries to identify where the blockages.

Do you do that by putting a small needle in the groin or in the wrist?

You take a catheter all the way to the heart and you take these pictures.

Okay, When you do this, there's two different outcomes.

One, there's an actual blockage in the artery that I can fix right away.

And you can see that immediately, right?

You can see that.

Okay.

That the way these pictures work, you use a material that shows you the inner lumen or the inside of the artery, okay, where the blood should be running.

So if you see a stump, you see an area where the artery should be and you see nothing, that's where the blockages.

You can do all right.

By knowing the anatomy, knowing how your arteries are supposed to look, you take a picture and you say there's someone there's something missing there.

This is the one.

So you then immediately go in with a stent or something to unblock that.

Is that correct?

Yes.

Okay.

The the process, you know, has some technical caveats, but basically is put in a wire using different tools that we have nowadays.

Could be a suction catheter.

It could be able to tune.

But ultimately, most of these blockages are going to end up requiring a stent.

Okay.

And a stent for for the audiences, that is a mesh of metal that is expanded with a balloon and that prevents that blockage from recoiling or for narrowing down again.

So when you say stent, because I hear in stents or grays, I think every one of us know at least five people.

Oh, I have a stent.

I have two stents of three stents.

I got a stent ten years ago.

I got it.

Now it's in the competition is more stents.

Isn't that great?

So on that note, say somebody did get a stent ten years ago.

How how different are stents today than they were?

It seems like it's a relatively not basic that's the wrong word, but straightforward type of a way of opening up an artery.

How long do they last?

Is there scar tissue that grows around them, etc., etc..

So let's talk about a patient who got a stent ten years ago and now they're on the verge again of needing some other help.

How?

Give me a case study, perhaps one or two that that you can think of.

Let me start.

Okay.

Let me start this way.

And I'm going to, you know, give a little bit of a history class.

Perfect.

But the field of interventional cardiology is really a new field.

It may seem that it's been around forever, but people were getting emergency bypass, you know, 40, 50 years ago.

Still, we had our first procedure on an artery in 1967.

Okay, that's a great year.

Sorry.

I was born 1967.

I'm old lady.

I know, right?

Small things.

Easy to remember.

I'm always going to remember when you were born.

So there you go.

Now the first procedure on a coronary artery.

It wasn't even a stent.

They just used a balloon to open the artery.

And that was ten years later.

Oh, wow.

Okay.

Did the balloon stay there?

Was it a balloon?

And then the balloon got retracted.

It's a balloon that they just inflated to expand that blockage in that artery.

Actually, in in the widowmaker of the the artery that Dr. Espinoza was just mentioning a second ago, And that procedure was done in Switzerland in the seventies.

That patient got a repeat angiogram, ten years later.

He didn't even have a stent.

We didn't have a stent skin.

And the narrowing was the same.

He never came back.

Wow.

So, okay, obviously, now from doing, you know, thousands and thousands of patients, we have some statistics that can help us predict.

But there's not a general rule that you had a stent in years ago.

You may need one right now.

Gotcha.

But the reality is you may have that stent and he may stay open forever, but you never develop anything else, you know?

Okay.

And because of the I mean, it may not be the best the best advertisement technique, but if stents will open the blockage, but they will not cure the disease that causes the blockages and they do not prevent that disease that causes the blockages.

So if you're still having the same risk factors that are not well-controlled, if you're not taking your medications, if you're not changing your life, I tell my patients we're going to spend 15, 20 minutes together, but the rest of the two or three months that you're on your own, you you're on your own, right?

Yeah.

So it all depends on what you do.

And you may have got a stent this year and you with another one next year.

So it's a team effort.

It's not it's always a team effort.

And I'm glad that you said that to us.

We're looking at support systems as well.

You know, if you can involve someone else in the family or someone that's that's in that area, I would like to talk a little bit about strokes.

Strokes.

People think, okay, that's something that happens with the head, but it happens to the head because it's all a cardiology situation.

So when we're looking at signs of the stroke, you know, again, I feel like there's the obvious, obvious ones out there.

Somebody can all of a sudden their speech is slurring a little bit.

They can't see.

Well, but if there's somebody with you, I think a stroke is easier to see and find.

If you're having a stroke on your own, because we're not with people all the time, what could you be looking for?

Something is just not working right with you.

How would you know that you're having a stroke?

That that's always been a question of one and a fear of mine.

It's because I'm AFib girl, right?

And I'm thinking, okay, if I have a stroke and nobody's with me, how do I know?

Right?

So a stroke.

To put it in layman's terms, you can kind of think it similarly of what a heart attack is.

It's an acute occlusion of one of the arteries that's basically supplying the brain.

Right.

So it's like a heart attack, but in the brain.

So, again, there's different mechanisms for strokes, though.

You know, there can still be plaque rupture in the arteries of the carotid, the internal carotid, which supplies the brain.

So you can have plaque, you know, burst there.

The forms a clinical so the brain or plaque can basically embolize and go to the brain.

So there's two different types of strokes.

There's an ischemic stroke which is caused by an acute occlusion or a clot.

And there's a hemorrhagic stroke which is due to a bleed.

Right.

So maybe somebody has an aneurysm that burst caused a brain bleed and they have a stroke because of that, because now the blood flow to that area is impaired.

So signs and symptoms of strokes, any sort of acute neurological deficit, meaning, is there a sudden onset of weakness to a side of the body, let's say all of a sudden you have significant weakness on one side of the body, arm legs compared to the left side, loss of sensation or feeling in a particular distribution, left side, right side.

There can be strokes that there is vision loss, so acute vision loss asymmetry of the face drooping of the of the mouth, things like that.

Certain strokes can affect the centers that are involved in speech and articulation.

So the there are strokes where patients can still speak, but it's nonsensical, meaning the words are just not going together.

They don't form a sentence.

There are strokes where patients lose the ability to speak.

So those are some of the signs and symptoms that you can look for, for strokes.

But essentially it's any timing.

Let's talk about timing, too.

Just like with heart attacks, you've got to get there within 30 seconds or 30 seconds because to 30 minutes.

But time, you know, times brain.

I've heard that, too.

Exactly.

I mean, muscle cells.

Muscle times brain.

Yeah, exactly.

So, yes, because just like how there are interventions for for the heart, there are certain endovascular interventions that can be done for strokes.

You know, when someone presents to the hospital with signs of stroke, they activate a team and they get quickly assessed by a neurologist because in strokes we don't do it so much with coronary arteries or heart attacks.

But in certain types of strokes, they can sometimes give a clot buster.

Mm hmm.

Which is a special medication that can go in, dissolve a clot, and it can reopen of that artery.

In certain instances, they may go in there with similar techniques, like Dr. Carbajal does with, you know, catheters, wires, balloons and suction devices and remove the clot that way.

But like you said, it's very important that, you know, if there's any sort of even suspicion that there's a stroke stroke happening, that they present to the hospital as soon as possible, because the longer they wait, the more damage that there is to the brain.

And a lot of times it becomes permanent.

Right.

So here's my question to you, because we we advocate on this program and hope you all agree that call 911, it's not worth trying to take yourself to hospital Whoever's with you could but it's better to call 911 because a lot of times the ambulances are not hospital rooms, but they've got a lot there.

So you were talking about hemorrhagic stroke.

You were talking about ischemic stroke.

So the important part there is knowing which one is happening at that time right in the ambulance.

What is it that they have in the ambulance?

Do they have any kind of imaging?

Is there something that they can tell on the ambulance, what type of a stroke it is?

So not necessarily, You know, the only way you would be able to tell if there's a hemorrhagic stroke is if they do a CT scan of the brain.

So that's one of the reasons to be in the hospital.

Right.

That's one of the reasons why when someone comes with a stroke, one of the first thing they do is a plane seat of the brain to make sure that there's not a bleed because there is no bleed.

You you can try and you have an option of using a clot buster If there is a bleed.

You don't want to use a club, you're just going to end up making the situation infinitely worse.

But EMS is trained to recognize the signs and symptoms of a stroke, so they'll be able to, you know, start giving the patient I.V.

fluids and kind of preparing the patient for what's, you know, coming up ahead.

The other reason why it's important to call EMS is there are certain hospitals that have the capabilities needed to treat a stroke.

There are other smaller hospitals that may not have those capacities.

So if a family member drives you to the hospital, they take you a little wrong one.

Well, guess what?

Now you've lost that period of time, that transfer time, and now they have to be transferred to.

And that's always the stress question.

What hospital do you want to go to?

You know, it's it's a good point.

So do ambulance drivers again, when they kind of see what's happening.

Do they do they often say, hey, this would be the best one for your condition?

They take you to the closest center that's capable of treating your stroke or heart attack.

Okay.

So sometimes patients be like, No, I don't want to go to the hospital.

I want to go to this one.

You know, they have to take you to the closest center that is able to treat you.

Okay.

All right.

Did you have something to add to that note, Dr. Holland?

Absolutely, that's correct.

You know, I feel like I'm going down the list here, but I do want to talk about afib.

I think atrial fibrillation is what that is.

It's when your heart doesn't beat, doesn't beat as it should.

You know, sometimes it beats really fast, then it stops and it goes in a girl, you and I and I know this because I have this and I feel like in the media it's been something that we hear about like over the last decade.

We've heard things on television and or in podcasts.

If you have AFib or if, you know, a stroke that's not affiliated with a heart valve problem.

I'm also heart valve girl.

I've mitral valve prolapse with regurgitation and I have AFib.

So let's talk about people who and you can feel it when your heart's not beating right or if it starts speeding up for no reason at all, or all of a sudden it's like you got this big gulp and it's like the butterfly effect.

Some people can, but you'll be surprised.

There's there's several patients that you end up getting called because they had AFib and you never felt it.

Yeah, man, I feel like I feel it all the time.

Oh, there I said, you're the lucky one in saying that.

That's nice of you.

But on that note, what describe what is happening.

I know you know, electrical currents, mine's valve, but it's a little bit electrical to just explain to the audience what's happening so that there's that that that oh, my God.

Moment in their eyes.

I'm going to try to make it as simple as I can.

Please do.

There's the chambers are the heart are upper chambers and lower chambers.

The lower chambers are the veteran calls are where the muscle is, where the pumping happens, The upper chambers are the atrium where the feeling happens.

They're not that muscular, they're not that important for the pumping function itself.

But that's where your natural pacemaker is.

So the arrhythmias that come from the bottom chambers, they're very dangerous and they can kill you if it's not one of this ones.

It comes from the upper chambers.

It won't kill you, but it can cause your stroke.

We know what that the normal rate that which you're not.

Well, pacemaker activates cause between 60 and 100 when you're resting and up to 200.

If you're young and exercising.

But AFib is extremely chaotic.

This is not a rhythm that comes from the natural pacemaker of the heart, comes from areas that no well, the electrophysiologists have investigated and then found out that come around the left atrium when the natural pacemaker is on the right atrium, they come in an area around the pulmonary veins and there are several of these, let's say, ravel pacemakers and then say signals very chaotically at a rate of more than 300.

Okay.

So then got you have that little gatekeeper in between those two chambers that doesn't let those 300 impulses go through, otherwise you would die.

Right.

And that's why otherwise you would die.

That that that that's why the bottom ones are more dangerous.

They have to go to a gatekeeper.

Right.

But this gatekeeper is slowed down and you know, you end up going are one 5160 feeling horrible but you know not but you're okay.

Yeah well you may faint, you may feel a little sick horribly, but it won't kill you because that gatekeeper isn't there.

So here's a question to that.

The time frame that that can last.

And I guess that's where the Y comes in.

And I don't know if there really is an answer for the Y, but you can have it lasting for a couple of minutes.

Mine has never lasted more than like five or 6 minutes, but then it will come back like in an evening.

I will feel that happening four or five times that evening within like four or 5 hours, you know, it comes and it goes.

What might that be?

Again?

This is when I am feeling it.

And it could be happening when I don't feel it.

I don't know if there is a Y.

But again, just people that go through this and when do they seek attention.

So that's one of those things like, oh my gosh, I'm feeling weird.

Say it's the first time they've ever felt this and their hearts just going nuts and they're like, I should I go to the hospital right now?

What should I do?

I would okay.

If you're having the symptoms and they're they're lasting long enough for you to get to the hospital.

I would go to the hospital.

Okay.

Because you don't want to find out that you have A Fib when you already had the complication from a mean in a stroke.

So it's better that the sooner to find out, the better.

Okay.

If it's coming and going and you're having a hard time catching it, get an appointment and ask.

Trying to figure it out would be the the most appropriate thing.

Okay.

Now how long can it last?

You know, there's this term that we have "permanent A Fib".

There's people that live in A Fib their whole lives, you know, And do you just have this strategy of trying to get back?

You're just like, yeah, yeah.

You see them all the time.

Yeah.

Okay.

But there's there's patients like you that have what we call paroxysmal a fib, meaning it comes and goes on its own right and that you can manage with medications you don't know.

Okay.

So far what I've understood my doctor, for me it's chronic but benign.

You know for the most part as long as I kind of pay attention to it and check it out every couple of years right now of things you can treat it.

There's there's procedure.

It's called ablations.

It's I wanted to bring up ablations, but I don't know if you wanted me to go there, so you'd be interventional guy.

Are you a ablation guy?

That's an electrician.

I'm a plumber.

Oh, yeah.

That's the electrophysiologists electricians.

Okay, Playground thinker, the plumbers, electricians all got it.

But basically what that is and I'll I'll just play it really quick and then we'll go on because I want to talk about AEDs, because that's something that the society can look at.

But it's basically taking a nerve, right?

What that does provide a stimulation, electro stimulation, and then kind of Botox makes that nerve go away, cuts that nerve off.

Right.

For the most part, though, it quickly it's it's a catheter based procedure where they enter, you know, through the groins and they go into the inside of the heart and basically map out the electrical system in the atrium.

So basically they find where these pulmonary veins are and the focus where the A-fib is coming from and basically with these catheters, the causes a little scar around those pulmonary veins and isolate them electrically.

So now any impulse that's trying to get out of there is blocked by the scar tissue and then, you know, cause the episode of the ace that's in scar tissue is good in that sense and that sense that that's probably the one.

And only time I do want to talk about this because it's something and I think it's great.

So many cities and I know in El Paso there are some grants.

I work with the El Paso Community Foundation, and we gave some grants around the cities to purchase a AEDs automated and external defibrillators.

So you see these in airports, you see these in sometimes in grocery stores, Right.

Give a brief explanation as to what they are and they're there for.

Yes.

Emergency personnel use.

But do or are any of the general public trained on this?

And I'd like to talk just a smidge about this because we get that question every now and again.

Well, what is that?

Oh, that's for somebody who's having a heart attack and then you never hear about it.

Right?

So so, yeah.

So defibrillators, basically a device that applies an external shock to get someone out of a malignant arrhythmia like the one that Dr. Carbajal spoke that come from the bottom chambers because those can be deadly, because when the bottom teams are going very fast, there's not enough time for those chambers to fill with blood.

And therefore, your circulation basically goes out the window.

So an external defibrillator is not necessarily always for a heart attack.

Heart attacks, yes.

Can cause those malignant arrhythmias, because when the muscle is kind of suffering from improper blood flow, we can go into these arrhythmias.

But there are certain conditions that make patients prone to having these malignant arrhythmias, you know, congenital maladies of the conduction system per se.

Or maybe they're taking medications that cause some changes in their EKG and it makes them prone to have these arrhythmias.

So these devices are not just for patients having heart attacks.

They can be lifesaving for other reasons as well.

And nowadays, there's a lot of training.

You know, I've seen training in schools that they teach students and teachers how to use these defibrillators.

Most of these are very simple devices that come with instructions on where to place the pads, how to connect them, how to turn them on.

And basically that's all that needs to be done by the operator, because a defibrillator essentially will monitor the rhythm and determine whether the patients have any shock able event, meaning a shock arrhythmia that would benefit from the shock.

So it once it analyzes the rhythm, I'll tell you, you know, shock advised and then you can, you know, make sure that everyone's not no one's touching the patient and you press the button to deliver the shock and to get them out of it.

Now, the defibrillator is not the only thing that needs to be taken into account.

You know, the essentially you need to be doing CPR.

So if you see someone unconscious, you come across someone unconscious or you see someone acutely fall down and go unconscious, one of the first things you want to do is, you know, assess the patient.

Does he have a pulse?

If he doesn't have a pulse, make sure you're able to grab a defibrillator or send someone to grab it first.

Before you do all that, you call 911.

Right.

Sorry, what you call nine one and then you immediately go and try and get a defibrillator.

Everyone's available because if they're having one of these arrhythmias, you know, a cardiac arrest is deadly because, you know, no one acts on it a lot of times because they don't have the training or the education.

I wouldn't know what to do.

And I know like I kind of know stuff.

But no, I honestly, I would have second thoughts about pulling that down.

Right.

Yeah.

Well, the thing is that, you know, it's when someone has a cardiac arrest, most people don't make it because of the lack of CPR.

Right.

So a cardiac arrest is just complete cessation of circulation.

So no organ is receiving blood flow, including the brain.

So that's what makes it deadly.

So CPR is lifesaving because you're providing some form of circulation to vital organs and the defibrillator, what it can do is it can shock the patient out of that arrhythmia and restore the regular rhythm so that circulation resumes.

But CPR needs to be started first.

Someone gets a defibrillator, places the free balloon is the shock of a rhythm.

Shock them.

Even after you shock the person you want to continue CPR until you know, EMS arrives and or there is a trained professional that arrives and helps with the situation.

Right.

I love that you're saying all this, Dr. Carhart and then we say lifesaving and then we don't mean the, you know, lightly.

I, I cannot tell you how many stories of of patients coming that will to the prognosis was terrible because the minute you hear this patient lost consciousness and had an outside hospital cardiac arrest, you're already thinking the worst because it was rare that people actually were actually trained to perform effective CPR and to maintain the function of those organs until they got to the hospital.

But but nowadays, we hear every now and then that there was maybe a teacher the other day, I had a patient that his son actually knew how to perform CPR.

Oh, I love this.

He started doing CPR.

Right.

The patient comes, gets the hospital, regains consciousness, goes into a cardiac arrest again.

The doctors save his life.

We bring him to the lab.

He has a blockage, and that widowmaker, spends two weeks in the hospital.

But after one week, he's talking again, you know, and after two weeks, he's back home, you know, back in working.

So.

Right.

So so I think this is a great and this was not part of the show, but if you want to learn how to perform CPR and I think everyone should should it be for everyone just because I'm your mom?

You know, it could be your mom, could be anybody.

I just off the top of my head, I know that the American Red Cross gives classes and I know the American Heart Association gives class you all is cardiologist.

Is there anywhere else that I'm assuming the hospital gives classes every now and again?

So we have to maintain our certifications every two years.

And so we have to go and do the CPR classes and make sure that we're up to date with.

Right.

You know, how effective CPR works because there's been some changes over the general population, like people who are listening to right now.

And we want them to learn how to do CPR because it's great if you're right in the corner for me and I'm having a heart attack and boom, you know, there you are like, there is save me, right?

Not be nice, but just in general.

And with search engines, you can Google that, Right.

So, yeah you can definitely So I know certain hospitals have events where they offer CPR classes.

So, you know, the best way is, like you said, your American Heart Association or the Red Cross, you know, they can make it easy to find areas or days where they offer these classes.

And and a lot of times they offer them for free may not be something that, you know, if cost is an issue sometimes in schools, they have events where they go.

And yes, you know, so there's there's lots of different areas where, you know, you can get the training for CPR, which, you know, you never know when you're going to need it.

Right.

Exactly.

I want to believe it or not, we're already at a 15 minute point for the show ends.

So I know.

Happens fast.

Peripheral artery disease.

Let's touch base on that.

That's something that we hear about every now and again is when it's referred to.

Dr. Espinoza Do you want to take that really quick as the noninvasive guy.

So it's actually more of a plumbing.

It's more of a plumbing.

QUESTION Dr. Carbajal, do you get that one because he loves peripheral.

Yeah.

Oh, you love that.

Excellent.

Okay.

It's one of the most serious and ignored conditions.

Okay, Dr. Espinoza, Cliff already did an excellent job explaining what atherosclerosis of the coronary arteries is.

Right.

Just transfer that to the legs.

Okay?

Okay.

So explain again what atherosclerosis is.

It's the buildup of this plaque and inflammation that causes narrowing in the arteries that narrow inseam, Pete, to circulation in the legs and that causes pain.

Loss of her changes in your skin.

Coldness tends to be asymmetrical, but it can happen on both limbs at the same time.

Again, this is legs.

So this is something we want to talk about.

We're talking about heart disease, but this is happening with the veins in your legs so you can feel it in your leg.

A patient with significant peripheral artery disease, one out of five patients is going to have a major cardiac event in the next five years if they have significant peripheral artery.

See?

So people that are developing atherosclerosis don't don't develop it selectively on one vessel, people that are sick that they already have them in their legs, most likely have them some in some other places in the arteries.

And then that can cause a stroke later in the arteries in the heart that can cause a heart attack.

And, you know, that may seem something benign, you know, just some pain, some cramping.

But in our population that also has diabetes and is prone to have a lot of wounds, the non-healing wound in the amputations make a huge difference in the patient.

You have a 50% one year life expectancy after an amputation from peripheral artery disease.

It's now.

So how do you know?

So you're talking about heaviness in the legs.

You're talking about cramping in the legs specifically that people may think is muscular, but it's not.

So if you were to be able to give a very specific symptom of of again, your legs cramping up, it it being a vein issue in the legs, what are you looking for.

It's that it's an artery issue and it's a common misconception but the vein is the the the pipe or the plumbing that takes the blood back of the arteries, taking it is that is a blood, the pipe that takes the blood into the leg.

So it's it's a narrowing over there.

The the first symptom is usually what we call clarification, meaning I walk, I don't know, five or six blocks and I feel feeling cramp.

What happens is because this sometimes presents later in life to people that are progressively decreased moving.

And they may not say it because I'm starting to have cramps.

They may say, Oh, I'm getting old, I'm going to delay.

You don't tend to think the words, but it's important to be vigilant.

You know that the first time is usually that cramping or pain when you're emulating.

But lots of hair, you know, you use gives to have her legs and all of a sudden there's no no hair, little shiny skin, shiny skin, shiny skin.

It really physiologically.

Why would that be so?

Because you're having decreased blood flow.

So the layers of the skin as are not as thick anymore.

So it's it's thinner skin.

Okay.

You can have decreased wound healing.

You can have longer time to cut your nails, you can have paleness, you can have coldness, you can have cramps, you can have numbness.

It's some of your other symptoms, but it's something serious.

So if there's any message, I would like to leave the public with, is that more than you know, it's going about the the multiple of symptoms that it could mean heart disease is there's several of us in the past, our group has grown twice our size in the last year.

And there's more physicians, of course, taking care of these conditions that can thing that can do the plumbing, that can take care of you.

And in when in doubt, it's better to go and get checked.

Okay, So here's that question.

It's easy for us to say that.

So when we're looking at going for I know we're supposed to go for a yearly checkup, but we just know realistically that's not the case in this community.

And if you're going for a like every five years, he says, okay, I should go get everything checked in.

A And you guys are different because you're cardiologist.

But if you're going into an internal medicine or even a clinic, let's just say it's a clinic.

Would a clinic know what all the check for?

And I know that's not a hypothetical question, but in general, we're talking about don't let these things wait.

But it's best to come with a laundry list of questions that you may have.

And maybe you can talk about what you ask patients to do.

So in order to get to where we're at as cardiologists, we actually have to be internists first.

Good point.

So we know from our training as internists, we are trained to kind of screen for certain processes, you know, based on age and gender.

So, you know, you ask the patient all these series of questions, you know, are you having any symptoms?

Are you having you shortness of breath with exertion, palpitations, chest pain?

Some internists will even do an EKG, depending on their intersection of suspicion.

And every EKG is abnormal.

You know, they'll send them to a cardiologist or maybe you'll see a fib in the patient was in Philly, and all of a sudden you're going to a cardiologist.

So they also do bloodwork to look at your cholesterol levels or screening for diabetes.

If you're a smoker, you know, they'll probably screen for aneurysms of the aorta depending on your age.

So the internist is kind of like the gatekeeper to all the specialties.

So depending on what they see on their physical exam and evaluation, then they'll go ahead and refer to who they need to after that, depending on what they see.

So if they see a very abnormal EKG in someone's I mean, just mean, you know, it may not be someone that doesn't directly talk it maybe they'll send you to the hospital.

They see that you're having an acute heart attack.

Right.

So, you know, the first step is, you know, if there are some symptoms happening, you haven't had a check.

You know, you should start with your internist, because a lot of times, too, you know, we also have to realize that, you know, insurances, you know, certain insurances require referral to come from the primary care.

You know, you can't just walk up to a specialist office and request an appointment.

Some do require that you be seen by an internist first, but they are essentially the gatekeepers.

They will kind of start the evaluation if they see something that, hey, you know, this is probably going to require specialists.

They will facilitate you in being seen by the appropriate person.

Right.

And I'm glad that you brought up insurance, because I know that sometimes doctors don't want to talk about that.

That's just something they kind of pull away from because it does complicate things.

There is to if there is no insurance, there's also cash price.

And I'm I'm saying this out loud because, again, with reality, sometimes not, sometimes cash price is usually a lot less expensive than if you're going through an insurance.

So if you don't have insurance, do not let that stop you.

That's the point that I'm trying to make on the dark cash prices.

And usually medical facilities will work with you on the cash prices because they know you need to get this done.

And that's the thing.

So, yes, if you have insurance, great.

But if you don't don't want that stuff.

Yeah.

And in our in our clinics, you know, they have payment plans and patient assistance as well that can, you know, help patients if they're in a financial situation where they don't have the funds, you know, to be seen.

You know, we will work with the patient to get them the care that they need.

Exactly.

And start to cover.

And if you if you start going early, less likely that you're going to have a major event.

So those end up being cheaper.

Prevention is always cheaper.

And I might not be advocating for what I'm doing because what I do is fixing when things are right pretty bad, right?

But I'd rather have you not ever have a heart attack.

And we prevent than everything.

So if you start coming in early and you know when in doubt get checked, you know, internists know what they're doing, we'll work as a team and they we're happy to take care of you.

I love the team approach.

And I know you guys.

You said that, you know, we've got 12 Cali cardiologists now in the group.

What I'd like to do is we are like that eight minute mark.

And I said I'd stop at around ten, but now it's eight.

So more pressure.

Is there anything that you want to talk about this evening that we have not covered yet?

Cardiology is man.

We can talk about cardiology for 18 shows a year.

There's just so much there's you know, we're not going into structural tonight.

That's a whole nother thing.

But what we want to do is talk about everyday cardiology issues.

What have we not touched base on yet or what would you like to get across?

So I think I never actually touched based on, you know, the classical signs and atypical signs of coronary artery disease.

So I think we we kind of just circumvented the issue.

But so when someone's having a heart attack, one of the things, the classical symptoms that are taught, you know, is that crushing, suffocating chest pain, elephant sitting on chest sometimes the pain can start radiating to the left shoulder angle of the jaw, shortness of breath with the cold sweats.

You know, those are more the, you know, typical symptoms that you would expect when someone's having an acute a mind.

But women, like you said, don't always present that way.

They'll present it typically.

Maybe they'll have pain right here in the top of the abdomen, like a burning sensation.

I don't mistake for reflux.

And that isn't atypical symptoms.

Maybe they'll present with more fatigue or shortness of breath, not necessarily chest pain.

So those would be kind of symptoms to watch out for.

You know, if if all of a sudden these START patients should get evaluated because.

Yes, women do worse when it comes to coronary artery disease, because, again, they don't present typically they have different symptoms and they kind of get, you know, that steer physicians to look for.

It is reflux, as I am sure, attacked.

She's in great shape, right?

Yeah.

So Artie just told us and it may sound funny, but you cannot trust women.

We've all done.

We have.

So we have an audience member here.

Oh, look at the eyeballs.

And it's our fault because all the studies, as you alluded earlier, were made in men.

So we never studied how how women had their symptoms.

But now, now we know the nausea and we're learning more and more every day, you know, because that is something that that is being taken note of.

You Know, it's all been written down.

But don't be stoic.

Don't be a hero.

Your symptoms last more than 20 minutes.

That very potentially can be a heart attack.

Quincy, immediate medical attention.

Remember, you have 30 minutes to get to the E.R.. Jeez, that's scary, because I'm thinking of myself, too.

I mean, I'm beyond, you know, child age right now.

But if I had little ones in home and I wasn't feeling well, you got to get the dinner.

I got to get the homework done.

You got to you got to do all that stuff.

But that's the time.

Just take note that your kids can't do anything if you're not around.

That's correct.

Okay, Dr. Carbajal, anything that we have not touched base yet that you want to get across?

No.

I think once again, prevention.

Okay.

Know Your cardiovascular risk factors, high blood pressure, diabetes, high cholesterol, smoking, lack of physical activity.

How can you bring high blood pressure down really quick?

So we did not talk about that.

We know that that's a thing.

We know that having high blood pressure is bad.

How do you bring it down?

It's not going to go out on its own.

Okay.

But Loss weight can help a lot.

Increasing your physical activity can help.

Sleeping appropriately.

You know, nowadays with 4 hours of sleep, 5 hours sleep and been stressed all the time, that's not going to cut it.

Decrease the amount of salt.

You can take less than two grams a day.

Do you know, I'm sorry, I you two grams a day would be how much, though?

You know, that's just where you read the packages.

You know, it's easy for us to say that here, but just read the packages.

If there's added salt, sodium.

That's that's the thing.

If you if you're buying from the house, you're going to see everything containing fine from the dust.

That can be two crackers.

Right?

Right.

But if you're buying from the edges and you Google how much you know, pumpkin or, you know, the steak you're having has an amount of sodium, it's not going to be that much.

All of that can bring your blood pressure down about 50 millimeters of mercury in average.

So it's pretty significant.

And simple physical activity, too.

That's right.

Yes.

If that doesn't cut it, you know, having that weight with our blood pressure, that prevents you from later having a heart attack or a stroke, because what people don't realize is that the heart is a pump and it gets tired pumping against that pressure.

And the pipes are not made of that.

They're made of tissue, and that high blood pressure eventually will tear them down and will cause these blockages that we're dealing with.

So And if you have extra weight on you, your heart's working that much harder.

You know, it's pulling an 18 wheeler with a Volkswagen engine.

Yeah, pulling an 18 wheeler with a Volkswagen engine.

Kind of love that.

Thank you so much.

I know we have literally we've got we're that funny plays.

I have 3 minutes and so I don't have really enough.

I don't have enough time to ask a question.

But structurally, I'm going to ask really quick what is the most common structural heart issue that people have?

So we're seeing a lot of aortic stenosis.

Okay.

So that's basically over time, you know, when the valves start to degenerate wear and tear, just like any other part of the body, they start to become calcified.

The aortic valve is very prone to this.

And in certain individuals, we don't understand very well why certain individuals get faster calcification of this particular while than others.

Some have congenital abnormalities where instead of having three parts, the valve only has two parts called the bicuspid valve and that degenerates a lot faster and calcify faster.

So you don't have this tightened valve at a younger age.

But in certain patients just wear and tear.

The valve causes continuous calcification in the narrows, and that requires an intervention, which is a valve replacement.

Okay.

Before, the only way to do this was surgically.

But now we can do it via transcatheter means via catheters.

If you have a groin.

I remember, Doctor Assi talking about this one, okay.

And that's something.

Yeah, the boss.

The boss, the boss of the hospitals of Providence, which again underwrote the show tonight.

But no, thank you very much for bringing that up, because I know that we hear a lot about that.

And again, if it's structural, it's something you're born with.

It's something that the heart structures, but it can be fixed.

And I think that's why we're here, too.

If you can find the right people, make the right phone calls, these things can be fixed.

It's all about prevention, about getting things early and making sure you're okay.

Yeah.

Come and see us.

Yes, come and see us.

Doctor Clifton Espinoza, thank you very much.

Who is the noninvasive cardiologist with the hospitals of Providence, The Thinker.

And then we have Dr. Luis Carbajal who is the interventional cardiologist with the hospitals of Providence, who is the plumber.

And we just don't have the electrician around.

You've been watching the past physician.

If you would like to see this program once again, there's three different ways you can do that.

You can go to PBS El Paso dot org.

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You can go YouTube.com.

And on all of these, just look for the words the El Paso Physician.

You will be able to see this program and you'll also backlog to all kinds of programs that have been happening, gosh, through 26 years.

So a lot of times a doctor like you will come on and go, What did the other cardiologist talk about?

We've got to make sure that we got this down.

Right.

So thank you very much, the hospitals of Providence for underwriting this program.

And the El Paso County Medical Society for bringing the show to you now for 26 years.

I'm Kathrin Berg, and this has been The El Paso Physician.