WDSE Doctors on Call
Heart Problems and High Blood Pressure
Season 40 Episode 3 | 29m 48sVideo has Closed Captions
Hosted by Dr. Ray Christensen, University of Minnesota Medical School, Duluth Campus...
Hosted by Dr. Ray Christensen, University of Minnesota Medical School, Duluth Campus and guests Ken Ripp, MD, CMH Raiter Family Clinic and Catherine Benziger, MD, Essentia Health Cardiology Department discusses Heart Problems and High Blood Pressure.
Problems playing video? | Closed Captioning Feedback
Problems playing video? | Closed Captioning Feedback
WDSE Doctors on Call is a local public television program presented by PBS North
WDSE Doctors on Call
Heart Problems and High Blood Pressure
Season 40 Episode 3 | 29m 48sVideo has Closed Captions
Hosted by Dr. Ray Christensen, University of Minnesota Medical School, Duluth Campus and guests Ken Ripp, MD, CMH Raiter Family Clinic and Catherine Benziger, MD, Essentia Health Cardiology Department discusses Heart Problems and High Blood Pressure.
Problems playing video? | Closed Captioning Feedback
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Learn Moreabout PBS online sponsorship[Music] good evening and welcome to doctors on call i'm dr ray christensen faculty member of the department of family medicine and biobehavioral health at the university of minnesota medical school on the duluth campus i'm also a family physician at gateway family health clinic in moose lake i'm your host for our program tonight on heart problems and high blood pressure the success of this program is very dependent on you the viewer so please call in your questions tonight or email them to ask wdse.org the telephone numbers can be found at the bottom of your screen our panelists this evening are dr catherine benziger a cardiologist with essentia health and dr ken rip a family physician cmh raider family clinic in cloquet our medical students answering the phone tonight are andy cable from daniel minnesota amanda peterson from tyler minnesota and mackenzie doddler from avon minnesota and now on to tonight's program on heart problems and high blood pressure good evening welcome all right nice to have you both here um ken why don't you tell us a little bit about yourself and your practice uh so i'm a family doc down in cloquet i've been there for over 25 years i think 27 years so treat everything from young kids to senior citizens i rounded the nursing home and then i have a few other hats i actually round at the jail and and work at the fire hall with the paramedics so yeah and thank you both for taking so many of our students who really appreciate it dr benzinger you're new to me uh welcome to duluth i'm not sure how long you've been here but tell us a little about yourself yes thanks for inviting me to the program tonight so i've been in duluth for four years i'm a non-invasive cardiologist at essentia health so i read echocardiograms and see patients in the clinic and in the hospital who have heart problems and i also wear many hats and one of those is uh medical director of heart and vascular research so i'm principal investigator of a number of our clinical trials oh fun yes well i'd like to start tonight with the and you brought this up earlier the infographic life simple seven and i'm hoping that we're able to project that and we do so i'll let you go ahead and lead us through this i think when we talk about a lot of our heart problems we neglect to talk and emphasize the importance of the life simple seven and those simple seven are seven healthy lifestyle factors and behaviors that we can all do to try to prevent or reduce our risk of having heart disease and those are shown here on the slide this one is related to blood pressure the blood pressure is the most common of the factors that patients aren't usually meeting and so knowing what your blood pressure is knowing your numbers is really important to trying to live by the life simple seven and those seven things are having a normal blood pressure normal blood sugar normal cholesterol having a normal body body mass index or weight not smoking and then having adequate physical activity as well as getting a heart healthy diet every day ken comments on this i mean if people embraced all seven of those they would be very healthy i mean and and as a primary care doctor my goal is to somewhat keep them away from the cardiologist no they're great when we need them but if you can really embrace that that will help people live a long and healthy life we really want to keep people out of the hospital especially now so by making those lifestyle changes it can make a huge difference and they are the hardest things to do it is really you know we spend a lot of time trying to count people just to make little changes to get closer to those all seven factors has this last year been difficult last 18 months the kova time the pandemic time has that has that affected the life's simple seven yeah i think you know for sure there's been some uh evidence that's come out that for children particularly elementary children the there there was a big spike in their weight and obesity in children i think also older adults they just weren't getting those usual steps in that they would get running errands or being out and about a lot of gyms were closed or people are uncomfortable going to the gym or to cardiac rehab and things and so they're not getting it nearly as much physical activity as uh is recommended the other thing that seemed to come along when and i think it's in there but i haven't read the simple seven completely lately but isn't alcohol one of those pieces also so what's happened with that yeah that's a great question alcohol is actually not one of the simple seven because there's still a lot of controversy about uh what is attic what is allowed and so right now current recommendation is that you are allowed for women one drink a day and for men two drinks but i think it depends sort of what it is and uh you know depends on where you're where you live because i think it's changed yeah they just changed it this year where they said just one for everyone one a day but i think yeah there is it is controversial there is definitely a benefit from a little bit of alcohol but it can be tricky because some people a little bit there is no little bit and it's a lot and so there is that struggle so finding that healthy once about that healthy balance of some alcohol is probably protective but we have to find that sweet spot and i also see that blood pressure has really emerged more so than it has there's been the ama and others have looked very hard at how we handle and measure blood pressure ken you want to comment on blood pressures uh that is a very good point uh the the how we measure it in the office is often done incorrectly you as a patient should try and make sure we're doing that we're doing it right and that is they need to be seated feet on the floor back supported comfortable position arm out cuff appropriate size cuff on a bare arm at level with the heart you're supposed to have been seated for five minutes no talking before you cannot have recent alcohol tobacco or exercise before getting it checked so within the prior half hour or so and so there's it's very complicated to get to that and it's supposed to be checked in at least once checked in both arms to make sure there's not a big difference between one side and the other so that is and that's probably not all the things that go into a good blood pressure but it is not a simple procedure especially in a busy practice or office and many people get to the office and they're already anxious and then we put a mask on everyone which makes it even a more anxiety provoking experience for people so for my patients if anyone is on the fence or has hypertension i say you know what it is really helpful to have a blood pressure cuff at home bring me in the data because i can do so much better job of managing your blood pressure instead of having one reading one day i can look at 20 or more and once it's under good control you check it once a week or once a few times a month as long as it's good we're good so additional comments katie yeah i mean i think one in two adults in america has high blood pressure and so i think if you're on uh blood pressure medications i think it is a great idea to go to the pharmacy and get a blood pressure cuff if you don't have one and check it periodically and do it the way that you know is recommended so that you can make sure that those numbers are are controlled and that you're on the right medicines for that we have a question if my parents had high blood pressure am i at more risk that's a great question there's definitely some conditions that increase your risk because of the genes that were passed on to you from your parents high blood pressure tends to be one of those that is more likely due to lifestyle factors and diet and so those factors tend to run more in families and that their you know if your family was less active and ate a less heart-healthy diet you know you probably do that more so than than someone else but there's a question that asks about lifestyle changes so maybe we need to address it a little bit more what are the lifestyle changes i need to make to prevent heart problems and i need to lose weight so let's go to somebody else so again uh the american heart association recommends we all live this heart healthy lifestyle and that is getting 150 to 300 minutes of exercise a week which is about 30 minutes 30 to 60 minutes a day and most people don't don't get that much physical activity so just starting to walk walking a couple times a day trying to get up to that 30 minutes can really be helpful also looking at your diet trying to eliminate or really limit the salt that you're taking and there's a lot of salt in the foods that we eat and that can raise your blood pressure i think those are the two biggest ones for me so why don't you go ahead with diet because there's a question also on diet so the diet is tricky the the mediterranean diet has been the one that medically we like the best it is it involves a lot of actually olive oil and you actually have to there's a fair amount of oil and fats in it and there's a lot of whole whole fruits and vegetables there's a lot of nuts some clean proteins and that's a great diet but it is it is a hard diet to follow for most people because it'd be a shift in what they're normally eating the american diet we're probably a little heavy on the carbohydrates and and it's easy to eat a lot of carbohydrates so you have to be careful on your carbohydrate portions this would be my recommendation using a nutritionist is great if you can get to one but unfortunately insurances don't cover nutritional evaluation so it is helpful to bring in your diet history to your physician have them look through so they can say oh wait this is a this is something you need to address for us we see people drinking a lot of their calories and that is pops sweetened teas sports drinks you can take in a lot of calories that way and coffee drinks i mean a chai latte can be 500 calories and so we have that is another area where i find that people when you start to take their diet history they're just drinking a lot of their calories and that's not necessarily good any other comments on that katie there's also more evidence besides the mediterranean diet that the anti-inflammatory diet is also helps prevent heart disease i would tell people stay away generally from the keto diet that has not been shown to reduce your risk of having heart disease what's the problem with inflammatory anti-inflammatory anti-inflammatory is like a you really eliminate animal products and so it's a not just cutting back on processed meats and dairy but really eliminating them because they promote inflammation that can cause increased atherosclerosis and affect the vascular system exactly and what kind of things do you do to offset that is this where statins sometimes come in so again once we've talked about the heart healthy lifestyle and you're still having high blood pressure high cholesterol then i think then we there's a number of medications that are used to help reduce your risk of having a heart attack or stroke and the most common medications are the cholesterol medications called the statins how would cova 19 affect my high blood pressure any comments either one of you if you if you well i will say the pandemic has stressed everyone i think we can agree on that so i think a lot of people are just there's a height level of stress on people that can definitely have a negative impact on your heart health the cova 19 if you got the infection it is a very inflammatory state and it can cause microscopic thrombus or little blood clots that can go to your heart into your brain into all different places in your body and cause problems so 19 has definitely caused people who have a lot of these risk factors to suffer uh worse outcomes than those who did not have obesity or diabetes or you know heart disease and and for the reasons that he mentioned and i think the other thing that uh copenhagen has caused is a lot of delays in care and people not seeking preventative care like getting routine mammograms for breast cancer screening or coming to their doctor to get their blood pressure checked and things like that and uh covet 19 and the heart um i read that there's that covenant 19 does not spare the heart necessarily what kind of things does cova 19 do to the heart that's a great question so both the infection itself and the vaccine can have effects on the heart more commonly the copa19 infection can cause microthrombin and really put a lot of stress on the heart cause people to have something called myocarditis or inflammation of the heart and they can get very sick there's a much smaller risk of getting uh myocarditis or inflammation after getting the vaccine it's pretty rare yeah the um earlier in the pandemic penn state looked at all their student athletes these are division one athletes who had covid and they found a 15 risk of myocarditis on echo and these are high level athletes and so anyone who's young should get the shot because you don't want to risk getting that inflammation in the heart because that may affect your future athletic performance and so for athletes and for really all young people it's important they get the shot can this person exercises daily not overweight low sodium diet still has high blood pressure why the genetically most likely there's a genetic reason now if their blood pressure is super out of control and difficult to control then it may be some other cause such as a problem with a blood vessel to the kidney or some endocrine problem but most likely genetically they are just predisposed to become hypertensive i know that i have a family history and that eventually i will probably end up on something but those lifestyle changes may have prevented him from needing treatment by 10 or 20 years and that's and hopefully it prevents him from having a complication from his from his high blood pressure does your blood pressure fluctuate throughout the day yes definitely what we find is that strokes are more common in the early hours of the day and they find that that's the time that the blood pressure tends to be the highest it fluctuates with cortisol levels it can also fluctuate obviously some of the medications you take don't last all day and so when you're due for your medications uh you can also find this high when you're under a lot of stress emotional stress or work stress or other types of stress that can also increase your blood pressure as well as if you have a big salt meal that'll make it high let's go to the aspirin question recently recently there was a change in in how we look at aspirin by american college of cardiology i believe or uspsft one of the other or both it was both yes uh suggesting that uh we old people don't need to take aspirin anymore so i think in 2019 the american heart association american college of cardiology came out with the new preventative recommendations that those over 70 it was no longer aspirin a day keeps the doctor away and that everyone should be on aspirin but we do know that for select groups particularly those who've already had a heart attack or stroke or have a stent or have a heart valve that's been replaced those people really should need to stay on aspirin it's still very much indicated but for other folks uh you know maybe a 60 year old who's otherwise healthy you know is not on any medications for high blood pressure or diabetes it's probably not recommended that for healthy people without a lot of risk factors that they need to be on a baby aspirin and the risk of course is gi bleed and so on with that ken there's a question from cloquet do i need to be taking both plavix and baby aspirin there and that's all i've got well so so sometimes for certain people we're on multiple i'll just call them anticoagulants or any platelet drugs because of a certain reason that person if they had a stint place so a little stint to hold open a blood vessel somewhere in the body then they need to be on both agents for a period of time and that's where you want to continue to work with your heart specialist and your primary care doctor to see what anticoagulants you need to be on because that person sounds like they must something must have happened to them and so i don't know and so sometimes we keep them on for prolonged periods and sometimes you say nope you only use it for this many months then you can drop one of them katie this is for you as a woman how would i know if i'm having a heart attack and this has really been a struggle everything is white male based it seems like and we're becoming more familiar what the changes are in females and heart attacks but why don't you address that for us yeah so traditionally most of our clinical trials only involved enrolling patients who are males because women of sort of child bearing age were sort of excluded from a lot of these studies but what we've learned is that we have now new trials where a lot of women are are getting enrolled and women tend to have chest pain that's still the number one symptom but they more are more likely to have other symptoms as well really extreme fatigue or exertional shortness of breath like walking up a flight of stairs just just getting so fatigued you have to sit down also having more indigestion having to take a lot of tums is another kind of more atypical presentation of a heart attack in a woman again anything to add you've been out there in the front lines yeah so when i used to work in the er yes you have to have a your radar has to be turned up a little bit higher on women because they can present unusually with just one symptom maybe just distal arm pain or a vague discomfort in their chest that's not classic and so but we have we i think hopefully in medicine have gotten a higher index of suspicion for women in heart disease this is a little bit of a tough question but i want to put it out there how do i make sure i'm getting quality of care in the er if i'm having heart problems what kind of things do we expect that would happen think in the you know emergency rooms across the northland we have very well-trained emergency room physicians as well as family physicians who are you know up to date with all of our uh protocols and and there's a very protocolized way that we treat people who present with chest pain and that we're worried about heart attacks because we're trying to get them to the higher level of care as soon as you know we think that they need it and so the type of care that you would expect is to get something called an electrocardiogram or an ekg as soon as you enter the emergency room or you know that's why we recommend you call 9-1-1 even because they can do that in your house or in the ambulance um and if you're having a heart attack then they can activate what we call our sort of stemi system and get you very quickly transferred to a hospital that can help treat that heart attack and it appears that covetous made that more difficult and people are getting transferred some distances that can't be handled i don't know how it's been in duluth if you've had to divert away but i know some of us in the rural have the um for the most part the hospitals in duluth are still accepting those acute heart attacks some of the other if you have someone unfortunately super stick with covid those beds are not available but the heart attack patients that has been available to us so that that's been that flow has been able to continue well we just we know how important it is we say time is myocardium time is is brain for strokes it's the same you know that you need to get those patients seen urgently and so yes there is a special sort of allotted beds for for those urgent cases and uh to allow them to get into the procedural suites in a timely fashion that's really a great reassurance thank you for that because i think the questions have been there and when you listen to the news you're just not sure what's happening so good what is considered to be good ldl ken um a number uh the i mean under 70 is great if you can get it under 70 that would be awesome and then and then after that it becomes how low can you get it uh using medicines to a point that you can tolerate so i have some patients who are on a who are a moderate dose of a statin but cannot tolerate a high dose of the statin they might get their ldl down to 90 and then you have a conversation saying i think this is good enough or we can explore other options and the biggest thing is at one point they actually the american cardiologists association said that we could actually stop checking ldls and just saying if you the highest dose of statin you can tolerate and you're good and that was you know sort of told us sent us a message saying just push that dose as long as they tolerate it then great if they can't tolerate find a dose that they can tolerate lipoprotein little a yeah what do we do with that so lipoprotein little a is a part of the ldl particle which is the a bad type of cholesterol that can build up in your heart arteries and cause heart attacks and strokes it is often genetic and so it's not part of the normal cholesterol panel that your doctor would send and so you would need to ask them to send this lp little a lab if it's something that runs in your family or if you have a really strong family history of heart attacks at an early age so men before the age of 55 and women before the age of 65 or if you yourself have had a heart attack in that younger age without having very high ldl cholesterol that's when we look for that thank you if my blood pressure is high in the morning should i check my b pills bp pills at night time dr rip yes without so you should work with your physician but you should take at least one of your blood pressure pills at night because that's been another shift in the past five years where the big emphasis on making sure that we have that control in the morning because as a as we mentioned that's when people get into trouble with heart attacks and strokes is usually that first five hours they're awake and so we're trying to so if someone came to me starting on hypertensive therapy the first medicine i give them i say take that one at night now we may split some at night and some in the morning but we want at least one of those blood pressure pills taken at night i think you know diuretic medications the ones that make you go to the bathroom a lot or best taken in the morning but yes there have been a number of studies randomized trials looking at people taking them in the morning at night you have tend to have better blood pressure control and better outcomes if you do take them at night i just worry you don't want to forget taking them right the most important thing is make sure that they are taking them every day why is it when i take my blood pressure at home it's in the 140s but when my doctor takes it takes it it's in the 120s this is a question from then then i would do one thing what however they're checking at home i would bring it into the office and compare and see because the machines are not the whole machines are not perfect and it could and that is actually unusual because usually it's much lower at home does stopping stop eating meat if you stop eating meat does that help lower your cholesterol so the most common source of cholesterol in our diet is through animal products it's not just red meat but also you know poultry and other in pork and other sources of animal products so if you do have a high family history of high cholesterol you personally have high cholesterol you're on cholesterol medications cutting back on animal products is really a good way to cut back on those fats salmon salmon's great for you yes any real cold water fish yes yeah as long as it's not fried i guess yeah yeah don't fry it yet are there other diets beside the mediterranean diet that one could consider um diets low in animal products have been shown to be helpful the mediterranean diet does have that name recognition but when you get on the laundry list of other diets there's not a lot of data there that says that they're protective of your heart so it gets it gets as i would say off into the weeds a little bit i usually say the more fruits and vegetables you eat everyone should be trying to aim for five servings of fresh fruits and vegetables a day i think that the more the leafy greens and things you eat the better off you're going to be what does it mean to have a slightly enlarged heart so in a slightly in large heart sometimes if you get a chest x-ray looking for pneumonia or something the radiologist will will say that often it can be because of uh your you have a something called heart failure um but often it ends up being sort of overcalled and is normal so usually if you have that either finding your talk to your doctor about it often they'll order an echocardiogram that's the best test to look for a weak heart or enlarged heart right and left heart failure got about 30 seconds is there an easy way to tell a difference most commonly it's left heart failure uh the most common cause of right heart failure is is due to the left heart failure and it's all often most likely due to blockages in the heart arteries the best way to tell is with an echocardiogram and talking to your your doctor very good anything else that you'd like to add otherwise it's been a great program and i want to thank both of you for doing this i want to thank our panelists dr catherine benziger and dr ken rippin our medical student volunteers andy cable amanda peterson and mackenzie dotler please join me again next week for a program on infectious disease and immunizations my panelists will be dr harmony tyner and dr adi vitero thank you for watching and have a great night flew that name the toro i didn't [Music] [Music] i'm dr ray christensen from the university of minnesota medical school duluth campus next time on doctors on call join me for a discussion about infectious diseases and immunizations call or email your questions and have them answered live on the air by a panel of doctors thursday evening at 7 on pbs north time good you

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