[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 Fond du Lac band of Lake Superior Chippewa 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 viewer so please call in your questions or email them to ask at wdse.org the telephone numbers can be found at the bottom of your screen our panelists this evening include Dr Catherine benziger a cardiologist with Essentia Health Dr Mark Earhart a college cardiologist with St Luke's heart and vascular center and Dr Addie Vittorio a family physician with St Luke's Mount Royal Medical Clinic our medical students answering the phones tonight are Becca flodon from New Prague Minnesota Elsie Johnson of Oak Grove Minnesota and Hannah stray from Big Stone City South Dakota and now now on to tonight's program on heart problems and high blood pressure welcome glad you're all here tonight so we have one question right off the bat that I was given beforehand and I'm going to ask you Dr Earhart this question what's the difference and pros and cons between an electrical cardioversion and an ablation and what are the risks involved in success rates so we have two hours tonight or do we have just a few minutes really difficult uh atrial fibrillation very common the incidence if you die of old age is about 25 percent of us will experience atrial fibrillation during our lifetime obviously some activities can make it much worse but we have gotten better and better at being able to ablate and cure atrial fibrillation and ablation is your best chance to do that if you're going to cure it now you can go through a cardioversion which will get you temporarily out of the Rhythm it may work longer if there's corrective Behavior that you could do to reduce your risk but it doesn't do anything that's effective tomorrow it gets you out of the Rhythm now and ablation has gotten better and better Through The Years through the last several decades the Improvement the skills the mapping of the heart has gotten so much improved and our medication choices are are very good to help people come out but it kind of depends if if it's an acute phase and there's a reversible cause we'll often do a cardioversion and just get them out of the Rhythm if it's recurrent we want to get to the core and if you don't get to the core of the problem yeah anything for our viewers to just sort of understand what those procedures are um and what atrial fibrillation well yeah so first atrial fibrillation there's a portion of the heart that is most affected by pressure in the heart and that's the left atrium and the left atrium also contains electrical fibers that allow our heart to sort of beep properly and over time with stretch and with damage to that area you can develop a rhythm which causes our heart to I explain it as jiggle and not beat you know beat to beat and so if you can think of atrial fibrillation as not an effective heartbeat the blood pools or cysts in certain parts of the heart and it certainly puts you at risk for a thrombotic stroke where a blood clot can go somewhere else in the body from the heart so when we talk about ablation ablation is actually burning of those Pathways that have developed abnormally in the heart of the heart rhythm and they go in with a catheter through an artery go all the way up it's usually done through a very small vessel either in the arm or in the groin and then cardioversion is actually the process similar to what people think of of being shocked during CPR but a much sort of gentle or more planned process where electrodes or patches are placed on the chest and a directed very organized electrical signal is given to the heart to shock it back to a normal rhythm thank you nice explanation I had no idea that was up to a fourth I hadn't heard that before the people up to a quarter oh yes the instance is huge yeah and one of the biggest you know drivers that we've recently discovered is untreated sleep apnea so we refer now all of our patients for a sleep study before undergoing ablation and we find a lot of untreated sleep apnea so you know that's something who snore something that you could talk to your doctor about the other thing with ablation is it doesn't necessarily reduce your risk of having a future stroke and so we do often recommend people stay on their blood thinners even if they do undergo an ablation procedure yeah and atrial fibrillation can happen in people just with lifelong hypertension chronic alcohol use can predispose you or even you know heavy episodic use can predispose you to atrial fibrillation as well certain drugs that speed up the heart you know things that affect the heart rhythm that reminds me we just talked earlier before this show about any forms of any amounts of alcohol the new study that came out in the New York Times that was reported in New York Times actually a study from last year but it was reported just this year this month and we talked about Dr Earhart you want to yeah it used to be for cardiac conditions people were recommending that up to one to two drinks one for a woman two for a man per day was thought to be potentially even cardio protective meaning it raises the good cholesterol and and may reduce for that reason cardiovascular heart attacks Etc but not necessarily atrial fibrillation clearly atrial fibrillation alcohol intake has always been associated with the increased risk of atrial fibrillation alcohol intake and obviously the more the more more likely but but I I think it's interesting because this is the first time that people have talked about any alcohol for cardiac condition being a negative thing and so I think think it's a change I think the the nice thing about science is hopefully it'll evolve hopefully we'll learn new things if we're doing the same things we're doing 30 years ago you don't want to see that doctor anyways another reason to get up tomorrow I've always thought that science I love it we're finding out more and more Dr benziger I have to ask you um you did a show on young Mr Hamlin the football player and what happened to him can you explain to this audience in case they didn't all see that show yeah so there was an NFL player a few weeks ago who had a sudden cardiac arrest on the football field in the middle of a game and it was thought to be due to something called commercial Cordis which was a sudden hit just at the exact right time during the cardiac cycle where his heart went into a funny heart rhythm and he required some to be shocked and get CPR in order to get him in his heart back into normal Rhythm he was in the hospital for a few days but fortunately it seems like his recovered fully and been discharged from the hospital and I think the really important thing about this case is about the sports trainers and the the first First Responders that were there on the field and how quickly he was able to get CPR and an AED which saved his life you and I were just talking before this show recently just in the last three days something similar happened to an 18 year old sports player in England and the exact same thing happened young people were able to his his uh Team ways were able to do CPR and they got a defibrillator and they saved his life as well I think you know anyone can save a life knowing hands-only CPR is really critical it's actually a Minnesota State High School standard that everybody learned how to do hands-only CPR and you can just go to YouTube and watch a video from American Heart Association hands-only CPR or how to use an AED and and you could save a life it's gotten so much easier now that people don't have to stop and think about the breathing and everything else immediately when someone goes down they start that yes making sure that they can't be resuscitated otherwise yes yes and obviously calling 9-1-1 is really important but sometimes in some of our areas it takes a while for 911 to respond and so uh you know that or for an emergency medical person to respond in so you can as the first responder start hands-only CPR to help the blood circulate and continue getting some perfusion to the brain while you're waiting for a police or an ambulance to come anything else to add to that that you go ahead Dr Earhart usually the kimono quarters is thought to be blunt trauma right to the middle of the chest it used to be thought baseball softball was a classic so this is a little different than what we'd otherwise expect it to come with oh and it and it has been an incidence out there but it's rare it's very rare I mean I I can't think of a time that's ever happened in the NFL before so I I think it's important that there were people there to do something to save that save his life because he's otherwise going to be a healthy guy and he won't have likely any increased incidence of doing this again you're right I have her I remember hearing it about other sports but I don't remember them yeah I think you know when you look at the evidence in sports uh most commonly would be hypertrophic cardiomyopathy or other inherited heart defects and so uh you know I think this is incredibly rare but he's obviously very fortunate to how the outcome that he had and I think it you know sort of speaks to a lot of people were shocked by how long CPR was and what they were doing to this person on the field and how just sort of you know dramatic it seemed and how long it seemed even though it was a very short period of time and we do have to remember that he's a young healthy individual and when we do CPR in out of the hospital or in the hospital we don't normally have as great of outcomes as we would with a young healthy athletic person but I think it really showed people you know sort of what CPR actually looks like yeah that was fascinating at a national level and now he's out of the hospital which is great okay so I'm going to ask you Dr benzinger what's the connection between magnesium and heart health and how about for PVCs yeah that's a great question so electrolytes can affect the frequency of certain arrhythmias in the heart or abnormal heart rhythm so if you have a too low of electrolyte levels whether it's potassium or magnesium those can make those funny heart rhythms more frequent so particularly for people who are on certain medications that can lower those we you know recommend that they take supplements of diuretics in particular are ones that can lower the levels of certain electrolytes and and make you more susceptible to having these funny extra beats okay and I would say for the normal healthy person just sort of in a from a family practice perspective doing super doses of magnesium as a healthy person not only leads to some side effects such as diarrhea but is not necessarily proven to improve move heart health the majority of our fruits and vegetables do contain magnesium and so the average person not on medications that may affect this does not need to Super Supplement magnesium totally agree yeah thanks for coming back around with that we often forget that one Dr erhart why can blood pressure readings suddenly drop over days with no Lifestyle Changes well I think our blood pressure is a dynamic and we all have a change there is no blood pressure cuff that we currently have that runs 24 hours of a day and and I cause people to be hypertensive every day being 45 minutes in clinic can do that and so can put them on a treadmill that's part of our process that's why a proper blood pressure should be taken with both feet flat on the floor resting comfortably in a quiet room for a minimum of five minutes now that's not the way we do it in clinics so you'll see quite a discrepancy but with relaxation techniques your blood pressure may be very normal there's something called white coat hypertension where they come in they're scared to death we're going to recommend something bad or scary to them and their blood pressure will pump up 30 40 50 points sometimes but what really kills with hypertension is not what it does under 15 30 minutes a day it's what it does the other 23 hours of a day that's why the mean blood pressure is the deadly and it's the part of what we why we call that the silent killer Dr Victoria if you see someone with this white white coat hypertension in your office and every single time they come in but you suspect otherwise how do you handle that so we first look for secondary causes so we talk about anxiety we talk about medications such as even the common cold and cough medications that can do this drugs alcohol sleep apnea those are all but sleep apnea is actually a treatable you know cause of hypertension I usually have people who are able to get their blood pressure measured at home and I don't have the measure four or five times a day I have the measure once or twice a day at their most relaxed time and we also kind of talk about that blood pressure is related to sort of our circadian rhythm so sometimes doing a blood pressure first thing in the morning before you have your coffee when you take your medications is not going to get you sort of your resting blood pressure oftentimes it's when you're you know relaxed in the evening once things are sort of all settled so I'll have people check blood pressure is different times throughout the day record them for at least two weeks perhaps four weeks and then bring those to me so that we can review them and I would tell you at least half the time in a person who has higher blood pressures in the office we do see them be lower now they may not be low enough where we wouldn't treat but they are indeed lower outside of the office thanks yeah here's an interesting one for you Dr benziger do you have to modify activity if you have an enlarged left atrium and in large lift day gym can be due to a variety of things we just got done talking about high blood pressure also untreated sleep apnea anything that causes the ventricle to be stiffened something called diastolic dysfunction and so usually we don't worry about exercise we actually encourage people to be heart healthy get at least 30 to 60 Minutes of routine exercise every day as well as eat a heart healthy diet to reduce their future risk of heart attacks and strokes thank you Greg and Hermantown is asking us Dr erhart what connection does body mass index have with heart health it's a very good question because there is a wide variability but in general a high body mass index puts you insulin resistant especially abdominal girth raises the blood pressure you will often see people that have massive weight losses have their blood pressure markedly improved sometimes even come off of medication so we know there's a direct relationship but there is also the ones with sleep apnea sleep apnea is a huge and those are people with big necks more commonly not always many football players have it and especially if they quit playing and they continue to put weight on and it's tough so I definitely think body mass index is one thing that you want to reduce to reduce your hypertension risk and those people that have been diagnosed with hypertension we have a diet DASH diet as we call which which is dietary attempts to slow hypertension they call it stop but I believe it's slow hypertension is a better word for it and that's a high fruits and vegetable whole grain diet moderate exercise on a routine basis alcohol avoids Sleep Quality sleep all of those things will lower your risk and weight loss clearly will lower your your risk and often cause people to be on if not much less medication sometimes no medications anything to add no just to add about sodium you know I think the food company is Sneak sodium into so much even if you don't have a salt shaker on the table you have to really watch out for foods that are high in salt and for people who have high blood pressure we do recommend often less than two grams of sodium per day which is about a teaspoon it's in a lot of things like white breads and pizza cold cuts you know chips and soups and things like that yeah and the average American diet is somewhere between five and six grams of sodium per day it's very hard to get to two grams so you can't eat out can't eat anything out of a can it should be fresh or frozen and should never see a salt shaker it salt sodium is the most common preservative in the American diet so the more man touches it the more we mess it up what Dr Vittorio Ronald and Duluth wants to know can you drink too much water you can drink too much water yes um it's probably less sort of to do with sort of this show and and cardiac issues but more so to do with we have this balance of sodium in our body and our bodies require a certain balance of both sodium and potassium and other electrolytes to function normally to use energy properly and so people who over drink water there there's a probably you know a threshold where if you drink lots of water you'll just urinate a lot but there's also a threshold where people can go above and they can actually change their sodium and their potassium in other electrolytes and then things like the heart or your muscles or other things in your body don't function properly for normal healthy individuals under age 50 it's very difficult to mess up your sodium but as you get older there's a medical diagnosis called siadh and that is very common in the 80 year olds especially those that are put on a thiazide diuretic as part of their hypertension and we see very low sodium levels in those patients and we definitely will restrict free water with those patients on a routine basis but for an otherwise healthy 50 year old you drink water till urine is clear and then you know you're well hydrated yeah yeah it's a poor man's hydration test go ahead Dr Victoria yeah yeah and for those um wondering a thiazide diuretic is just a medication that helps lower your blood pressure by decreasing the amount of fluid we see the majority of people over drinking water in patients with psychiatric histories who drink gallons and gallons of water the point is it's hard to do but I think it's important to note that your water intake doesn't necessarily influence your blood pressure all that much it's sort of the salt that holds the water in certain parts of the body that affects the blood pressure the most so in order to have higher blood pressures and drink lots of water you're like let's say someone is lightheaded and knows they need to drink lots of water to stay hydrated they also should have some salt to kind of hold that water in the proper places in their body okay Dr benzinger a very specific question from Kayla why do patients have open heart surgery versus a stint oh that's a great question Kayla for people who have blockages in the heart arteries the way we diagnose that most commonly is either with a CAT scan or something called an invasive coronary angiogram where again we go through the wrist or the groin and take a look at the heart arteries and at that point if it seems like the lesion is in a place or in a blocked artery that is amenable to putting in a small stent at that time of the procedure they will put in a stent but if the lesion is in a position or there's too many blockages sometimes then we would recommend coronary artery bypass surgery which is a longer term kind of more durable solution to be able to treat all those blockages Dr Earhart you look like you want to add something we for 30 years tents have been around and they've gotten better in their design but one thing we don't have yet is culat stents where you can stint a branch in an artery so there are high risk branches and arteries that we would rather treat with open heart surgery than stents because they become complicated when you put stents against stents and you try to crush them against each other and again I agree totally if your arteries look like sausages and there's blockage but you can't put a stent everywhere is that where you're going to add Dr Victoria yeah and I think I mean just for sort of people to know stents are essentially if you think of your blood vessel as a tunnel they are sort of a wire mesh that has a particular coating that prevents things from sticking to it that sort of opens up that tunnel but a bypass is actually taking a vessel from another part of the body and taking that blood flow and sort of moving it downwards and kind of bypassing that blockage thanks that explanation do you have to be on blood thinners when you're on these stents yeah so after you get a stent it's really important that you follow your doctor's orders most of the time you are on usually aspirin and another blood thinner some people because of history of atrial fibrillation are on an anticoagulant but yes usually for at least six months or up to a year you're on an additional medication to help prevent a clot from forming in that stent so it's not forever not typically forever usually aspirin for most people is forever and I know this has come up a lot with the recent evidence that aspirin is not necessarily A for for everybody who hasn't had a history of heart disease but if you've had a stent or bypass surgery in general people need to be on aspirin unless your doctor says it's okay to stop it Dr Victoria we have a really good question that I hear a lot from my patients Can albuterol and other inhalers cause an increase in blood pressure I would think just based on the inhalation and sort of how fast the drug is taken into the system yes it temporarily there probably is a mild increase in blood pressure there's probably more of actually a heart rate increase in the short term with things like albuterol um but the mech the length of time that the drug actually is sort of active in that phase is short less than 30 minutes or so so even when people experience side effects such as tachycardia or rapid heart rate it's usually very temporary and if you need that medication yep you want to breathe before you exactly because then your heart stops if you're not breathing other problems Dr Earhart this is the afib show tonight again taking certain supplements convert me out of afib uh you mean over-the-counter publicly available supplements the answer is no um they they're the problem with most supplements is they've never been studied in a good double-blind randomized trial but we know of no medications to convert people back to normal rhythm with the exception of electrical current or actually stimulating the heart to actually knock it out so the electro electricians can sometimes go in and take care of it from inside or from outside but not with any over-the-counter supplements that we're aware of okay Dr benziger what part do statin drugs play in the heart oh we know that satin drugs are very effective at lowering the risk of heart attacks and strokes particularly for people who have a family history of high cholesterol or because of our diet have high cholesterol it's really important that if your doctor recommends that you be on a Statin medication that you take it but about one in ten people will have some muscle side effects and can't tolerate it and fortunately at these at this point we have a lot of good Alternatives that will also help lower the cholesterol so it's a very effective medication a reducing heart attacks and strokes yeah and I think independent of even just the cholesterol we know that there's some anti-inflammatory effects of statins so you know even if we can't get your cholesterol to the perfect value there still is quite a benefit to statins okay Dr Earhart back to atrial fibrillation I think we did talk about this at the beginning but someone might not have heard it so I do want to be go back to it can you not get an ablation and just stay in afib do you need to take blood thinners yeah there's a scoring system that we use at Duluth Harvard UCLA and London it's called a it's called a Chad's vas score it tells you what your risk of a stroke is and most people if you have a Chad's vast score of two or higher would recommend long-term anticoagulants for a while all we had was one drug for 50 years it's called Warfarin now we have a couple of other drugs that had to be proven to be at least effective as Warfarin or we wouldn't have the FDA wasn't going to approve them so we do have three or four good alternatives for for anticoagulation but Aspen doesn't work all of the other anti-plated do not prevent Strokes the only thing that does is anticoagulants and so if you have those risk factors and your doctor your score is high enough and it's pretty easy to get to a Chad's vast score of two three four five you should be on an anticoagulant because there are things in life worse than death and one of them is a debilitating stroke where you don't know where you're at and why you're there but yet you survive and and I think that's what we've seen too many times in our career and uh unfortunately after that stroke it's too late to change that and I think in regards to the question about can you remain an afib yes there are many many people who remain in atrial fibrillation either patients who've tried the ablation techniques or the cardioversions and have not gotten results or very elderly patients who certainly don't want to go through with those procedures but there are people who are maintained in atrial fibrillation it's called rate control and rate control is keeping your heart rate between about 50 to 80 with certain medications and if you meet criteria also taking a blood thinner to prevent the stroke complication and I'll just add if you really can't be on a blood thinner because you've had bleeding issues or you have low hemoglobin and things there is a alternative procedure something called a Watchman device that you can talk to your provider about getting that helps lower your risk of having a stroke if you cannot be on the blood thinners excellent anything else that we have 30 seconds left that you think that our our viewers must hear any X last minute thoughts last second thoughts I think since the program was about hypertension yeah hypertension is it's all around us we have more than a dozen different classes of medication to treat it with there are medications that have minimal side effects and that people can really control hypertension and really control that stroke risk over their lifetime not only a stroke risk but all their vascular health thanks to all of you so glad you're here tonight I want to thank our panelists Dr Catherine benziger Dr Mark Earhart and Dr Addie Vittorio and our medical student volunteers Becca flodon LC Johnson and Hannah stray please join Dr Peter nalen next week for a program on ear nose and throat problems including sleep apnea when his panelists will be Dr Andrew Davis Dr Ryan Harden and Dr Mark Rhodes thank you for watching and good night [Music] thank you foreign [Music]