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Well hello welcome to Health Live.

I'm Jennifer Bloomquist.

I appreciate you tuning in tonight.

If you're new to the show you're going to love it because you'll always learn something I guarantee that this is a live program and that's why we have the phone number up at the bottom of the screen because we welcome any questions you may have during the show.

We have a cardiologist joining us tonight which is great.

We haven't had a cardiologist well I guess we had one last week but it's been before that it's been a long time since we had the cardiology specialty focused on so call in with any questions we had that our cardiology related and again there's a number of nine six nine to seven to zero just put an 866- in front of them in case you're outside of the Fort Wayne area and it will still be a free call for you.

I just want to let you know in case you're new to the show, we don't just throw you on the air if you're a little nervous about calling and you will talk to somebody on the phone first, they'll get an idea of what you want to ask and you're welcome to ask the question live or you can just relay your question to the call screener and then they can give me your question and I'll ask the doctor for you.

So take advantage of getting some free advice.

It's a rare opportunity because almost nothing in this world is free any more are truly free.

So let's go ahead and introduce you to our guests tonight.

I have been practicing pronouncing her last name so let's see if I get it correct.

This is a cardiologist and this is Dr. Sabena from Ricchiardi and thank you so much for joining us.

>> Thank you for having me.

>> Evening to all the viewers as well.

And you know, we were talking a little bit about that before the show just that cardiology that specialty can be kind of scary to most of us who are not familiar with it when we have a loved one or maybe ourselves having a heart issue there.

So it's such involved specialty and it could be kind of frightening.

So I don't know if you want to we were going to start off I think talking about if you're having some heart problems, maybe some tests or things you could do to identify what the issue is.

>> I don't know if you want to talk about some of the the procedures you could have done .

Sure.

That that's a very interesting question and yes, truly, you know your heart's one of the most important organs in your body.

So if you're having any issue with your heart, it certainly could affect a lot of things for you for your caregivers and your family.

So it's important to recognize some of the symptoms of heart disease that could indicate trouble for you.

And I'm just going to go over those quickly.

The typical ones you think of or chest discomfort maybe pressure, heaviness, shortness of breath or fatigue, exertional intolerants sometimes you may have a fluttering or a flip flopping sensation in your chest and sometimes it may be just nausea or your pain or arm pain and those are all symptoms that should prompt you to be concerned.

Now sometimes you don't have symptoms but you've got a strong family history of heart disease and so you're worried about what what is your risk and what do you need to do to take care of yourself before you start having problems.

And so you know that the the main thing there would be to start with knowing your numbers, OK, so I have a blood test.

Get your cholesterol numbers, check your blood pressure, know your weight, your body mass index and of course keep track of your family history and and those are certain things that you can do even without a doctor.

You know, there are some screening tests available to you which do not require a doctor's prescription.

Some of those tests are heart smart skin vascular screen the heart smart skin is basically a test looking for a hard plock or hardening of your arteries of the heart.

>> So it is a simple CAT scan.

It does not involve any contrast or radiation.

>> You really don't hardly need an appointment for it.

You could go in and get it done.

It's just a few minutes and the test will be processed.

It will come up with a number and that number is really an indication of how much plaque you have.

It is not a test to tell you if you have blockage or not.

So the way to use the data from that test would be if you have a score of zero that means you have no plaque at all.

And what we translate that to mean is that your five year risk of heart issues such as a heart attack is low at that point if you have a zero score now beyond five years, that score could very well have changed and a typically starts to change perhaps in that year four to five window.

So repeating the test if you've had a zero score makes sense at that five year mark from the current test that gave you a score of zero if you have a score of anything but a zero then that means you have the start of hardening of the arteries.

OK, the the score itself can be categorized into minimal mild moderate or severe with cutoffs that we use.

But regardless of what the actual number is, you have hardening of the arteries and so in that situation repeating the test in that four year or that five year mark that we were talking about is not really going to answer any more questions for you.

We expect the score to go up as we get older so there is a certain degree that it is going to get higher and if it's already a non-zero score, it's not going to add any further information.

>> So let's say you had the heart smart scan done and you have a score that is a non-zero score and you want to know well does that indicate I have a blockage or not because that that's what I'm most worried about right now.

>> And so, you know, in order to evaluate that further at that point you should be talking to your doctor or your cardio or go see a cardiologist even if you have no symptoms because there are certain things that can be done or pursued to see what is the best approach to figure out if there is a blockage and also even if it turns out you don't have a blockage, what can you do to reduce your risk for heart attacks because that non-zero score gives you a certain risk assessment and so if you've got a really high score there's a chance that you may have or a good chance that you may have a blockage but it's not perfect.

So there are people with a very high score that still have no blockage.

It's just the plaque is distributed evenly and so you have to do certain things to prevent that from progressing into a blockage situation.

>> We always promote on this show the importance of establishing a relationship with a family doctor because that's probably going to be the first person to pick up on an issue and then refer you to a specialist for that problem.

But you know, I wanted to go back because I'm glad you touched on this about you know, if you have a family history of heart issues and I realize the technology has changed and things you know, maybe what your dad or grandpa experienced is not necessarily how you're going to experience heart issues with all the advances that have been made.

But I suppose you know, like I knew somebody whose dad just died very suddenly at the age of forty seven from a heart attack, maybe a little overweight but other than that didn't really have a lot of you health issues.

So when this guy turned forty seven he was just paranoid that he was going to die suddenly like his dad .

>> So what what how should you approach it if you have family history because you know with cancer they'll say oh well if your mom was diagnosed with cancer at age 50, you know, so many years ahead of time you should start doing mammograms.

What would be your advice to somebody who does have a family history?

>> How do you approach that?

What do you do?

Yeah, so you if you have a family history there is a recommendation to you know, your numbers sooner as far as your cholesterol numbers with your blood pressure numbers, your body mass index and you know American Heart Association has the life simple seven which which includes your blood sugar knowledge of that and exercising and so you know that can be a rough guide for you and you don't have to wait till the age that your parents or your siblings or your grandparents had heart issues.

>> You can always start early as far as knowing those numbers .

>> So in fact I think the guidelines now start checking screening for cholesterol in children if there is a strong familial high cholesterol history.

>> So screening for for that can start younger at least after the age of 20.

Everybody should get your cholesterol checked once every five years as long as their numbers are good at less frequent you know, at more frequent intervals I should say if the numbers aren't good and when you when you have the heart smart scan added in with those numbers, it really gives you an assessment and of course if there are any symptoms it regardless of the age you should talk to your physician and you know, get things checked out.

There are simple tests that that can be done straight in the office such as an electrocardiogram that is an EKG which takes a few seconds to hook you up with little patches, sticky patches on your chest.

>> Is that because I've even one of my children had to have that after he fainted one day they came.

That was one of the tests they did and they just put all these little sensors around his chest and but I wasn't really sure what exactly they were monitoring just heart is it heart activity or yes.

>> So we put a few sticky patches in the chest and hook it up to the electrocardiogram machine and it records your heartbeat as it's happening.

So we have you hold real still for a quick second and get a printout and that gives us an assessment of the electrical activity from the EKG.

We can interpret rhythm disturbances if they're happening at that moment, if there's a heart attack happening or if there's a concern for blockage that's going on, we can see certain changes on those EKG's.

But also there are other conditions, some of which may be familiar like a really thickened heart muscle which can be potentially a cause of sudden cardiac death or cardiac arrest and those would be picked up on the EKG.

So we would see evidence of heart muscle thickening up even if you've dealt with high blood pressure.

>> So we would see certain changes on the EKG.

Of course the rhythm problems is the big one there to show if somebody has an irregular rhythm such as atrial fibrillation that would be a good test to pick it up right away.

>> And I just want to remind everybody that we only have Dr. Ricchiardi here until eight o'clock at the time flies by.

So we're talking about diagnostic tools for cardiologists to use to to figure out maybe what issue you're having.

But if you want to ask anything else cardiology related, please don't hesitate to call.

And again, there's a phone number at the bottom of your screen (969) 27 two zero.

You don't have to ask it live.

You can just talk to the call screener and give your question to them so you have a couple of options there.

And again she's only here to eight o'clock so take advantage of getting some free advice tonight.

So a lot of people probably have heard of the EKG but you also had I have a list from your office, another one cardiac C.T.

What would that do and how is that performed?

>> So we talked a little bit about the heart smart scan which is the CAT scan which does not involve any use of dye.

Now if you want to know further and let's say you have a mild or a moderate degree of hardening that showed up on that heart smart scan a further test that can be done to look for blockage would be what we call a coronary CT angiogram or a cardiac C.T.

for coronaries and that is a CT scan but it involves the use of contrast through a small peripheral intravenous axis that we put in and the CAT scan obtains pictures of your heart arteries as they fill with that contrast in order to obtain good quality images for the CT scan, we want to catch the heart in a brief moment of standstill between two heartbeats.

So we like to slow down the heart rate before we get that test done so we're not catching motion.

It's kind of like if there's a player on the field and you're trying to photograph them, you want to have perhaps a moment when they're not running that quickly or that little split second before they catch the ball or you know, turn around and throw something so you get the best clear pictures in that situation.

>> And so that test is a good test to look for blockage and it can be done what we call non invasively because we are not it's not a procedure as far as cutting open or putting in big IVs.

>> It's just a small little peripheral I.V.

that through which the contrast is administered.

So once the test is done, people walk out of the hospital .

>> Yeah, OK, so it sounds worse.

It's an outpatient test.

OK, so you have these long names that we wonder we have somebody calling in.

They're going to they're wanted to have ask you the question.

So I believe it was Alex called in and wanted me to ask you what is a fib?

>> Sure.

Kayfabe is an irregularly irregular heart rhythm.

It's abbreviation for atrial fibrillation.

It originates in the top portion of your heart which is called the atrium and typically it's from the left atrium where the veins that collect the blood from the lung empty into the heart on the left side that's most often the source of this rhythm.

We see a lot of atrial fibrillation these days and you know some of the risk factors that cause atrial fibrillation if you've had high blood pressure that stretched out the top chamber of your heart, if you've had leaky valve issues or if you've had what they call a mitral valve prolapse with the leaky valve mitral regurgitation, all of those changes result in enlargement and stretching out of the top left portion of your heart and that's where the aphid comes in.

>> There are people that have sleep apnea which is where your tongue falls back or your brain center does not activate your breathing at night when you're in a deep sleep.

So it's almost like you quit breathing for even just a few seconds at a time but it's enough to result in your oxygen levels dipping down and that's been found to be a trigger for atrial fibrillation caffeine, alcohol use.

These are other triggers that result in atrial fibrillation but we see atrial fibrillation even when situations such as a really bad infection or after surgery or procedures we we see this irregularity in the rhythm.

>> The reason why we worry about the atrial fibrillation is twofold a it tends to make your heart rate speed up and really go haywire and that can drop your blood pressure or make you feel really out of breath or feel poorly when that's happening.

>> And B, the second risk is that of stroke because when that top chamber is in this irregularly irregular rhythm it's almost like if you see stagnant water in a pond, if you will, there's some scum that's going to form on the top of it.

So tiny blood clots can form within that top chamber and let's say you go out of that rhythm back into a normal rhythm and your heart starts to pump pieces of that clot out.

Well, you could shower those to any part of your body if it goes to your brain you could have a stroke or a TIA or it could go to other organs and cause problems with the functionality of those organs.

So atrial fibrillation is really something not to take lightly.

Yeah, I would I would not take any of these things lightly.

You know and what's interesting and I've seen a lot of public service announcements over the years about you signs of heart attack and things because it's not always what you watch in the movie and they just grab their heart like they have this horrible pain in their heart.

But you know, as you mentioned earlier, it can present itself in different ways.

So I guess a good rule of thumb is if something seems out of whack, it's you know, they're not going to make fun of you at the hospital or the doctor's office for checking it out.

>> I always like to tell people they're not going to laugh at you so absolutely that in you know, atrial fibrillation is sometimes silent.

People don't feel that irregular in that heartbeat or they don't feel the shortness of breath or anything if the heart rate's not fast and they're not, you know, feeling it, it's hard to know sometimes we're fortunate these days a lot of people have smartwatches or smart devices and you know, the artificial intelligence behind some of those devices is good at picking up the irregular in the rhythm.

>> And so sometimes we find that will alert you to an irregular rhythm in some of those devices are even capable of printing off the equivalent of an EKG with just one strip at home.

>> And so if you have one of those that and it indicates that that would be something that you should take with you to the doctor's office when you go because it will help confirm some things and you know, further determine what testing plan you should have.

>> Yeah, the more information you have the better.

So exactly.

>> And I just wanna remind everybody we do have a call coming in but we we haven't had a lot of callers tonight and they just will be the car that we're I think we're down to under seven minutes now.

So don't don't delay if you want to call sometimes it happens we get a whole bunch of questions about at the end if we can't squeeze them in.

So call the number (969) to seven to zero.

We only have Dr. Rajani here until eight o'clock.

So looks like do we have somebody on line one either is it Rozario?

Hello.

OK, I'm not sure if if they're there or not but the phone lines are all open.

>> If you want to call and ask a question I want to ask you Doctor.

You know you talked about a lot of the quote unquote artificial intelligence.

These electronic devices today are amazing.

But one thing I've heard a number of doctors we've had in all different fields say be careful about self diagnosing.

>> You know, people go online and there are different kind of medical websites where you can just type in a question, you know?

Well, this is what's happening to me what what what could the problem be?

And sometimes they say that's that's dangerous to do that.

So I don't know what if you want to touch on that, maybe get some information but don't rely on that is your diagnosis.

>> I have to agree with that.

Doctor, Google is probably not your doctor.

>> So I would say it's it's good to use the Internet to have some information so you know what questions to ask those devices that I mentioned?

Yes.

Some of those have to be interpreted with caution.

So that's why I say you take it with you to the doctors so they can look at it and you're not going by completely by what the artificial intelligence is diagnosing you with.

>> So yes, absolutely caution.

>> Yes.

Right.

Taken with a grain of salt.

Yes.

All right.

Another question I want to ask another test that I wanted to ask you about was the stress test which a lot of people probably heard about it and probably know people have had it.

>> But what exactly does that check for ?

Yes, very good question.

Stress test is commonly done to look for blockage.

So we touched a little bit earlier on that heart smart scan.

If that's abnormal, where do we go from here?

So you know, there are different flavors of stress testing, if you will.

Some of those involved walking on a treadmill simply by itself.

Others involve pictures of the heart combined with the process of walking on the treadmill.

So you may have a nuclear stress test combined with the walking on a treadmill or a chemical stress test.

>> So the chemicals stress test is mostly for people with really abnormal EKG's that makes the interpretation of the EKG when you walk on the treadmill difficult or if if a person cannot walk on the treadmill because the treadmill stress test does involve it progressively speeding up impaired and there's also an incline that goes along with it.

So if there's significant mobility issues or you know, concerns with joints or an inability to walk for other reasons if you're frail or have a fall risk, you don't necessarily want to walk on the treadmill and in those situations we administer a chemical that would simulate as if you had been exercising so the chemical would potentially raise your heart rate and your heart would feel as if it's been stressed with an exercise even though you physically did not exert yourself for the test anyway.

>> That's a nice option to have because yeah, there are probably a lot of people who fall that category of not being physically able to do it right.

>> And the pictures that go along with that chemical will be able to localize if there is a blockage it does not show you the blockage but indirectly tells you that there might be a blockage based on how the pictures turn out so we can tell that and sometimes we can combine the treadmill with other imaging such as an echocardiogram.

It's what we call a stress echocardiogram.

So the person has pictures of their heart taken before they walk on a treadmill.

>> Then they walk on the treadmill and we get pictures of the heart as soon as they get off the treadmill.

So if there is an area of blockage, you would expect that that portion of the heart muscle would be lagging behind once you put down under stress and get your heart rate up.

And so that would show up on the pictures that we get so right.

I'm just going to see if we can sneak in a question super fast.

Rosano was the one waiting on the phone before Rosano.

Are you still there with a with a question?

>> Hello, Rosano.

All right.

I guess you're not there.

All right.

I want to give you another shot so sometimes he can tends to be a regular caller doctor.

So why don't we just quickly because we only have about a minute left if you have any advice for four people I know last week the show is about preventative care and we all know we should eat healthy, not smoke, drink, you know, things like that.

But I don't know if you have any other advice to give to people you know, should is it worth it to have a invest in some of these electronic devices, you know, some of the watches or things on your phone can help you to monitor?

There's a wide variety of those out there.

But I do think people should if they've had blood pressure issues invest in the blood pressure machine to check at home and that would be more important than some of the pricier devices I think because that really helps us a lot.

Sure.

Because sometimes people have what we call the White hypertension.

They're always high when you go to doctors and so it's hard to regulate medicines if you don't know what you're doing outside of the office setting.

>> So and then you also want to include that make sure you keep your stress levels in check and also get a good night's sleep because those things are also affecting your heart in the background if you're not paying attention to those makes a big difference for sure.

>> Yes.

Well talk to me because I get from Ricchiardi thank you so much for coming on tonight.

>> You did a wonderful job and I know you helped out a lot of folks so thank you to everybody who called in tonight.

I appreciate the questions.

I just want to remind everybody that this is heart Health Month ,a women's heart health month.

So something to keep in mind, you know, looking out for yourself and for your heart .

And I want to remind you that we also will have another show next Tuesday.

So in the meantime, take here have a great week and we'll see you next Tuesday.

>> Thank you