[Music] good evening and welcome to doctors on call I'm Dr Mary Owen associate dean of Native American Health and director of the center for American Indian and minority Health at the University of Minnesota medical school I'm also a family physician for the fondak band of Lake Superior chipa and 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 view viewers so please call in your questions or email them to ask PBS do pbsn north.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Le Christensen a cardiologist with St Luke's Cardiology Associates Dr Ryan Harden a family medicine physician with the Gateway Family Health Clinic in sandstone and faculty member at the medical school duth and Dr Jason wall a family medicine physician with the duth Family Medicine Residency program our medical students answering the phones tonight are Regan Carlson from sunberg Minnesota Riley Schmid of cedarberg Wisconsin and Micah Christensen from Alexandria Minnesota and now on to tonight's program on heart problems and high blood pressure welcome you three thanks for being here this evening well we don't have questions from the audience yet so we'll just start out with a few of our own questions that we frequently get as doctors in our clinics um a simple one if you have high blood doctor um Harden will start with you if you have high blood pressure does that auto automatically mean that you have cardiov disease that's a great question um we spend a lot of time in I spend a lot of time in my clinic managing high blood pressure uh there's a lot of people around with high blood pressure it's very common it's asymptomatic and if somebody has high blood pressure for a short period of time it doesn't necessarily mean that they have heart disease the reason that we want to identify diagnose and treat blood pressure um ultimately is to prevent heart disease which which it is the leading cause of death in North America so it's a high high blood pressure is a major risk factor for the development of cardiovascular disease but it's not um not everybody who has high blood pressure has heart disease Dr Wall what are other causes for cardiovascular disease or risk factors certainly uh in our uh working both in the clinic and the hospital we see a lot of the um behavioral so the tobacco use and uh uh unfortunately with the the opioid epidemic a lot of injection substance use and uh um I see a lot of people with uh cardiac disease from infections to the heart from substance use and of course um uh if you are uh tobacco use uh you know it can cause all sorts of uh throughout the body um sort of the proverbial hardening of the arteries and and uh vascular disease and of course the the blood vessels the heart are are not accepted from that so and vascular disease is just disease of those same blood vessels that you're talking about exactly so you know it's going to be kidneys brain um vessels in the neck and of course vessels in the heart as well and before we started the show you mentioned another risk factor for heart disease diabetes so do you see a lot of that certainly uh diabetes is uh I'm very optimistic because technology is getting better and better for treating Di I abetes we have better medications and most importantly we have much better ways there's technology out there now where you know eight of your 8 to 10 of your friends and family can monitor your blood sugars from their cell phones so wow um so that's great because uh not too many years ago we didn't even know like if people weren't taking their blood sugars we didn't know you know it's dangerous if you're raising somebody's um you know insulin too high because then they could become hypoglycemic and that you know could be potentially fatal so technolog is helping us uh but yeah diabetes is uh a significant risk factor for um contributing to vascular disease in the kidneys in the eyes and certainly in the heart too so it sounds like you're saying the way to not get cardiovascular disease then the primary way is to control those risk factors not to feed you any information correct anything else to add to that Dr Christensen um no I think they touched upon that nicely um you know other risk factors um at least modifiable risk factors which are risk factors that you can do something about in control with medications diet exercise things like that uh Beyond uh diabetes high blood pressure um smoking um things like that would be um cholesterol um hyper lipidemia and treating that um there's of course genetic factors as well um you know your family history plays a big role in whether or not you develop cardiovascular disease or not and there's not much you can do about that unfortunately we talked about other forms of um uh cardiovascular disease before we started the show what do you think think you see the most often in your clinic in the Cardiovascular Clinic um well I'm an Interventional cardiologist so you know kind of the plumber of the heart so I treat a lot of um you know heart attacks and things like that um and then structural disease like valvular disease and things like that but you know we treat the gamut of things so we see a lot of hypertension high blood pressure in the clinic that we help manage um high cholesterol things like that and then of course there's all the other things in the the realm of the Heart Like atrial fibrillation abnormal heart rhythms things like that how are heart plumbers working these days what do you do we're busy no I mean what do you do what does it well tell let's explain to the audience what that mean so if somebody for instance comes in with complaints of what's called angena so that's chest pain that's that's um heart chest pain um that's brought on by um uh you know plaque and the in the other the vessels that's gotten to a point that it's limiting blood flow um they might come in and say I'm having these symptoms that are occurring with with exertion or they might feel short of breath uh they might not have chest pain um and in that setting we you know we talk about what their symptoms look like um how they've progressed um and then we order up um you know a variety of tests to help figure out you know is this a heart problem or is it something else and so some of those tests might include a stress test um an echocardiogram which is an ultrasound of the heart um and moving on from there then where it gets into kind of my realm uh would be to do an angiogram and that's a procedure where we put a catheter up to the heart arteries and we uh inject contrast into those vessels to see what they look like and we're looking for blockage essentially and then figure out if there's a problem there if it's something that we can fix um so fixing an artery can um be something with um called angioplastic where we just use a balloon that's not very common anymore that's usually kind of a setup for um the stent which is um like a little metal tube essentially that goes into the into the vessel it smushes that plaque out of the way and helps open things up and then hopefully those symptoms go away um the more dramatic end of this of course would be somebody who comes in with a heart attack and we have to do that you know kind of on a more emergent basis okay excellent thank you that was helpful we do have some questions from our folks out there heart palpitations Dr Wall if someone is feeling heart palpitations what kind of symptoms warrant a trip to the doctor also I heard sometimes you can't feel heart palpitations how do you know if you're having them thanks Dr uh excellent question uh the most common uh reason somebody's having palpitations is uh they're something that you would just notice and they're completely normal uh we all have uh and you really have to go a little deeper into what exactly you mean by palpitation but I kind of the pounding the heart or a skipped beat are common um ways that a I think a palpitation is described to me and so our you know we have these um Prem premature atrial and ventricular the way the heart beats it'll skip a beat from time to time and that's not a sign of anything pathologic or disease causing and you probably wouldn't feel that if it was one or two beats uh when you couple that with uh the palpitations that don't go away you know in a brief period of time meaning you know um uh seconds to minutes or if that's coupled with chest pain shortness of breath uh or if you're noticing it when you're just getting up or if you're um whenever you move I think that those would be caused for concern and would certainly uh any of us I think would want to look at uh an electrical tracing of the heart an ECG or EKG and probably look at the structure of the heart and any number of tests from you know to make sure that there's not um blood flow structural problems with uh um some lack of blood flow to the heart or a previous heart attack any any numbers so uh an occasional skipped beat or a little pounding in the chest is probably just a normal variant but if they persist or if they're coupled with any other then they they could be a sign of disease and I of course defer to my colleagues here to you know embellish upon that but yeah yeah I mean they could really be just about anything so it's kind of a different times in life you get them yeah how long they last how severe the uh the symptoms are when they occur um are and like you said are there symptoms that are associated with it outside of just feeling like a skipped heartbeat are you feeling lightheaded dizzy is there chest pain shortness of breath mhm um so the first thing is you know how bothersome is it um you know obviously if you're if somebody's not feeling well if they feel like they're going to pass out or faint or things like that or they're having a lot of symptoms with it that's when you probably need to go into the hospital and get checked out outside of that um you know like I said just do an ECG we can do a heart monitor um that they can wear um as short as one day 24 hours to help figure things out or sometimes as long as uh four weeks great and then that kind of helps figure out what the problem is is something to worry about or something that you know we just give reassurance for great Dr Harden we hear we're hearing more and more different answers as to what a good blood pressure is patients are starting to hear that or have been hearing that so can you tell us what a good blood pressure is what you aim for for with your patients and we'll see if everybody here disagree I'm just kidding that that's a great question um for the most part um a blood pressure less than 140 over 90 is ideal any if it's lower than that it's actually a good thing so even though if somebody has a blood pressure 140 over 90 or higher we'll generally treat that with a medication if somebody has a blood pressure of 120 over 80 that's better than 140 over 90 we wouldn't typically treat that with a medication though because it's already relatively low you can have a blood pressure that's too low that's that's usually associated with a heart problem or a blood vessel problem or being overmedicated sometimes people are taking too many blood pressure medicines uh there are some disease processes typically diseases of the kidney of the Heart Like congestive heart failure and uh diabetes where we because somebody already has a risk factor for heart disease in one of those other illnesses we try to lower their blood pressure a little bit more so for somebody with congestive heart failure kidney problems diabetes we shoot for a little bit lower blood pressure like 1 130 to 135 over 80 85 but for somebody with no other risk factors under 140 over 90 that's what we're looking for excellent thanks anything to add to that anybody okay how about you Dr Christensen how often does vascular calcification that shows up in a monogram indicate cardiovascular disease a monogram that's what it has here um I thought it was the calcification disease but um well I think if what we're talking about is like incidental finding of of coronary calcification on an Imaging study whether it's a whether it's like a CT scan or maybe they're saying mamogram um what it's a marker of is coronary artery disease or whatever vessel they're looking at so if it got picked up in the neck it's it's a mark calcium is a marker for atherosclerosis plaque in the arteries and typically uh if there's calcium present it's it's a it's a marker of more mature plaque plaque that's been around a little bit longer so again it's it might just be an incidental finding and nothing to worry about um you know we kind of always a couple things that you know the two most important things in medicine we deciding to uh you know order another test or do something invasive is is it going to make the patient live longer or is it going to make them feel better if you can't answer those two questions then you probably shouldn't be going any further um that being said if if something is incidentally found like that you have to kind of go back to how we started this talk with managing risk factors because again it means that there is some degree of atherosclerosis so managing blood pressure managing high cholesterol managing diabetes uh tobacco cessation all of those things and depending on the severity of what you know this incidental finding was it might you know it might be prudent to do more more testing but you know again that's kind of Uncertain it's on a Case toase basis so to speak okay great I see your colleagues here nodding so we'll move on then what causes heart failure Dr Wall excellent question uh you know heart failure there are two to three perhaps more um when you get into the uh the details uh heart failure can be caused due to uh first would be lack of blood flow to the heart so when the heart can't get enough blood it can't squeeze properly and uh therefore you there's this you know blood goes into the heart the heart squeezes pumps it out and when the heart can't squeeze properly that is effectively a reduction in your cardiac output and heart failure so es keemia and then um uh a stiff heart so if your heart uh has been you know pumping because you've had years and years of high blood pressure your heart can't relax very well and so it can't fill very well if your heart can't fill then it can't pump the blood out so that's another reduction of the cardiac output um then there can be certain other forms that are um associated with some rather rare diseases but uh you can get some disease of the heart where um um there's fluid Andor uh um tissue around the heart where it can't fully move within the the the pericardium and that can cause restriction but by and large the most common are going to be you know the lack of the blood flow and then um damages from uncontrolled hypertension or you know uh uh other heart failure uh can also happen like rheumatic fever which we see much less today um can damage one of the valves in the heart and uh when the valves don't work properly then it's hard to get the forward flow out of the heart um unfortunately we see that quite a bit now at least in my practice with um you know injection substance use the damaging bacteria from the skin can get into the heart and damage the valves and fortunately we have good therapies to replace or repair those valves um and uh as far as uh other forms of heart failure um I think those there are a couple more but they're not coming to me right now and I mean I think Dr CHR I'll just I'll add to that that con congestive heart failure is actually a symptom of the heart for some reason the heart's not working right like the reasons that Dr Wall was mentioning so so somebody will come into the emergency room with the typical symptoms of heart failure swollen legs weight gain short of breath and they'll get admitted to the hospital to treat those symptoms and then really the investigation begins what's causing this and how do we treat it so they don't come back to the hospital with these symptoms again so it's a there like you said there's a lot of causes of heart failure and sometimes it's it's hard to figure out what it is sometimes it's you know uh from you have chronic lung disease and um the lungs go through some changes to try to increase oxygen oxygenation and so what that can do is when the blood vessels in the lungs constrict it puts an incredible load on the heart too so it's kind of this when the lungs aren't working right it puts strain on the heart and that can cause the heart to fail as well become too uh even being an extreme athlete you know if you uh train too long some people get a hypertrophic the the muscles of the heart become too large uh this is rare but you know then once again you have a really muscular heart that that doesn't doesn't relax well um but um yeah uh that's our job when people come in is uh you know I know why yep ultrasound chest x-rays um lots of studies to help figure out the reason and of course um um doing an angiography because uh that's one of the first things we look at when somebody comes in with Nuance at heart failure we have to prove ourselves that there's not blocked vessels that we can reverse and then if we reverse then the the the cardiac function will get better thank you all right we got lots of questions coming in from our interested audience so we're going to start flying through some Dr Christensen SVT what does it mean and uh what P should patients be thinking about uh so SVT is short for super ventricular tacac cardia um and you know really that's kind of an umbrella term for any abnormal heart rhythm that's coming from the top chambers of the heart um specifically when we're talking about it like if we're talking about it um we're usually kind of talking about a specific type of of arhythmia that's coming from the top although again it really can be anything that's coming from the top Chambers um so it's a rapid heart rate um usually starts very quickly ends very quickly so it'll be this kind of sudden on and then sudden off um can have a variety of symptoms associated with it uh the fortunate thing is that it can be uh treated easily um sometimes with just medications uh but there's a procedure called an ablation that can be done um where they basically go in with a catheter and kind of Zap the short circuit out um and that's 99% effective of getting rid of the that abnormal heart rhythm forever thank you a lot of heart rhythms are not that easy to treat but that's a specific one that an ablation um can wipe out yeah good thank you Dr Harden uh this gentleman had a mitro valve replacement was placed on mopol and wants to know is he going to have to be on mopol forever probably it depends on how that controls uh his heart rate and if he ever has heart failure with that that would definitely need to be monitored somebody who has a heart valve that's replaced is going to be monitored pretty frequently at least initially by a cardiologist and at least annually and you know mopal La is a medicine you know one person might take 25 milligrams of it one person might take 200 milligrams of it time will tell has to be monitored it depend but he'll probably be on medicine for good okay patients are concerned about medications so I have a patient here asking I'm on a tast Statin my my uh lipids my cholesterol has gone back to normal am I going to have to stay on a tvis stattin Dr Wall thank you for that question uh short answer is yes and uh um it's worth uh talking to your physician because there are um other statins out there if you're having any side effects it's worth trying but uh yes um generally if you need a Statin it's a long-term medication thank you for that gonna get a tough one here okay what effect does stress have on the heart um well I mean there's that's a hard one to answer and I think it kind of depends on the level of stress well these days with the news um but you know there there is a link to you know kind of high stress States and cardiovascular disease heart attacks things like that there's also like a a very specific type of kind of temporary um I'll say heart failure heart condition um which is called broken heart syndrome it has a lot of different names stress cardiomyopathies is another one and takubo syndrome um tasuba means octopus trap in Japanese they were the first ones to describe this and it's a condition where um there's been a a stressful situ yeah it looks like an old school octopus trap apparently like climb into the sack and it would cinch up and that's what the heart looks like where only the base of the heart is kind of moving and the rest is just kind of hanging there like a sack and this happens more commonly in women um who have it doesn't always have to be this way but there's some some sort of stressful situation has occurred whether it's a death in the family or financial crisis something like that and it sets this off so you know that's kind of the more dramatic uh aspect of things but stress does affect the heart okay um yeah all right and I I think this uh it Bears there are these things called social determents of health and there was just a a recent write up and I won't quote the exact Journal cuz I but uh they we used to think that you know there were a lot of looking at different like African-American population um Caucasian population in the US um we used to think that just being a certain um ethnicity or race raised your risk of heart disease and so they looked at certain populations that conceivably had more stress due to financial violence in their neighborhoods lack of you know park space clean air clean water and they found that when they removed all those um they thought it was due to um something genetic or ethnic or racial and it was due to largely due to the stress so so unfortunately yeah stress you know particularly chronic stress is is something that needs to be addressed as far as Wellness in general and particularly heart disease thanks Dr Wall for bringing that up if I could add to that too um a patient of mine actually about a year ago got me onto this something that I probably never would have read or looked up um and he had gotten interested in looking into um what's called Aces which I think stands for adverse childhood events um and so traumatic events that happen in childhood lead to um poor outcomes in health later on in life not just the heart but other things as well I thought that was fascinating this is what Dr Harden and I teach all the time yeah and Dr Wall actually with the residents yeah Dr Mark um Michael Marmet in England has done a lot of work on the effects of chronic stress on cardiovascular disease and chronic disease in general so thank you for bringing it up it's incredibly important um could you explain Dr Harden what uh AV node ablation is in two seconds well AV node ablation is if the AV node is like the um it's involved in monit or making sure the heart beats at a specific rate so AV node oblation is to interfere with the electrical Pathways in the heart to regulate the rate better artificially thank you Dr Christensen could you discuss what pulse pressure is and if it might indicate heart problems uh well so that is sort of the difference between um the the systolic blood pressure and diastolic um I I guess I don't have a quick answer for that one that can mean a lot of different things if it's a wide pulse pressure narrow pulse pressure things like that um so the answer the short answer is yes it might indicate problems um talk to your doctor yeah talk to your doctor sure thank you uh this is a good question that we get fairly frequently my mother passed away and I'll ask you Dr Wall my mother passed away at 883 years old not the specific question from cardiac tamponade I am a 70-year-old female should I have cardiac screening because of that my mom had this disease uh so in responding to that question uh there as far as I know there's no way to screen for tamponade certain conditions can contribute to that and uh uh the so tamponade classically is there's a a thick sack around the heart and um if there's fluid in that sack that uh the the heart cannot freely beat within that sack and so that can happen after heart attacks it can happen with cancer it can happen with infection and it can happen in certain instances of trauma I was just telling you we're short we're getting short on time but thank you no that so so it um I don't think that there's any uh I I don't think that caller should worry about it I think it's just something that to talk about at their their visit with their doctor and find out exactly what if she knows what happened to her mother then it would be easier for us to risk stratify and say this is something you should worry about or that was completely independent okay anything you want to add to that Dr Christensen uh no I I completely agree I mean I think it depends on what was the cause of the fluid accumulation around the heart um that you know that caused tampen not and in her mother um most of the times that's not going to be anything that's genetic um might be some conditions um autoimmune diseases things like that that might be passed down um but that would be kind of a rare okay problem well audience um viewers I'm so sorry we have uh so many questions we weren't able to get to but we had a fantastic conversation I hope you'll join us again the next time we do cardiovascular disease and uh thank you to our guests I want to thank our panelist Dr Leif Christensen Dr Ryan Harden and Dr Jason wall and our medical student volunteers Regan Carlson Riley Schmid and M Christensen next week please join Dr Ray Christensen for a program on women's health and female cancers when his panelists will be Dr Michael cassine Dr Sandy Stover and Dr Addie vitorio thank you for watching good [Music] [Music] night [Music]