.

Good evening.

I'm Sandy Thomson, the host of Life Ahead and I am so happy that you're joining us this evening.

We have a medical show a new topic for us this evening here on LIFE Ahead and a new guest who is here on Life Head.

I think you're going to be very impressed and very happy to meet Dr. Jason Rodriguez, our main topic is going to be about your heart.

>> We're going to talk about heart health and a failure.

A lot of you have heard that topic or maybe you even have an eight fib issues.

Well, the doctor has some great information about a new procedure that's available to that.

I want to tell you a little bit about Dr. Rodriguez and welcome by the way.

>> Happy to be here.

I've been chatting with him before the show here and a lot of experience goes into his specialty which is the electrophysiology am I saying that correctly?

>> You are electrophysiology which I understand has to do with the electrical systems of the heart, right?

>> That is correct.

So what is it that you monitor or look for ?

>> So cardiologists and cardiac electrical physiologist are specialists who have some specialized beyond cardiology looking at heart and rhythm disorders or arrhythmias.

Now arrhythmias or when the heart beats too slow, too fast or irregular and so this specially developed to treat those conditions.

>> And I understand from my chat with the doctor here that it's a lot more years even of medical training.

>> Would you run that by me real quick again?

How many how many years it takes or the process?

>> Absolutely be happy to so it's four years of med school and then most electrophysiologist will do three years of internal medicine followed by three years of general cardiology and then one or two now it's mandatory for two years of electrical physiology.

>> So it's just a new field or has it become more specialized recently?

No, I wouldn't say that the field's been around for a few decades.

Ablation has certainly been around probably since the 80s but in regards to atrial fibrillation that technology's really been apparent for about the past twenty years.

>> OK, all right.

Now I do want to remind all of you watching it that this is your show.

This is your doctor tonight we welcome you to call in with any cardiac questions that you might have.

>> You're welcome to take calls, correct?

Absolutely be to the number on the bottom of your screen is four to six.

What is it again here?

(969) 27 twenty .

>> OK, and if you're out of the immediate area it's free to you if you just put a one 866- in front of that number.

But our director will be bringing that phone number up periodically during this show.

I want to start by just getting a general overview, Dr. Rodriguez, about cardiac issues.

>> What are the most common ones that are experienced and or do all of them involve electrical system or not?

>> Certainly not know.

Cardiology is a very broad field that deals with the heart ,the vascular system.

Cardiologists deal with conditions like high blood pressure, high cholesterol, heart disease involving angina, heart attacks, heart failure, structural heart disease like valvular heart disease, congenital heart disease and even peripheral vascular disease.

Say it again peripheral vascular like like one like a lower extremity claudication pain with walking or patients who might experience carotid artery disease a vessel that's in their neck.

>> And then there's of course is the component which is the electrical aspect of the heart.

Those would be the arrhythmias .

>> Well what a of those areas within that category.

What are the most common that cardiologists seem to treat or find?

>> Well, many these conditions affect many Americans in the United States, certainly high blood pressure and high cholesterol being two of the biggest other things would be obesity and well diabetes certainly isn't a main focus of cardiology.

The vast majority of our patients suffer from that condition as a as a byproduct of their other conditions.

>> I would say heart failure, ischemic heart disease, valvular disease and the arrhythmias would encompass the most common conditions that cardiologists treat.

>> I hear a lot of people talking about having arrhythmia.

>> Is that serious or treatable?

Well, it certainly can be and yes, it can be serious and it certainly is treatable as I mentioned earlier, arrhythmias or any abnormal beating of the heart.

So if your heart's beating too slow in which case a physician may recommend a pacemaker or if your heart rate is beating too fast we may recommend medications or an ablation or even an implantable cardiac defibrillator.

>> Those are conditions that your physicians and cardiologists can help you with .

>> OK, are there treatments would you say for most of these most common heart issues?

>> Well, it's interesting when you discuss treatments regarding heart issues, certainly the best treatment is prevention and I always point my patients and my fellow clinicians and certainly your viewers to the 2019 ACSI AHJ Consensus update on preventing heart disease and what they really state in that consensus document is focusing on lifelong healthy choices is the best way to prevent heart disease including the scheme of heart disease, heart failure and arrhythmias like atrial fibrillation.

>> Well OK that answers what I was sort of answers when I was going to ask you next what can we do all of our viewers and me and everybody here in the studio do to try to prevent you have a little fly visiting us tonight.

He's not an official guest so don't be intimidated.

>> What can people do to exactly what can we do to try to prevent having some sort of a cardiac issue if it's not genetic?

>> I understand if it's genetic, it's not a lifestyle choice.

No, you're right.

>> I mean there are modifiable and non modifiable risk factors for heart disease.

The non modifiable risk factors are the ones that you're born with or the ones that you were in and that are inherited from your parents grandparents.

>> Those would be most likely like a valve situation or a hole in the heart or those sort of things that they're born with certainly a hole in the heart or what we would call a ventricular septal defect septal defect that would be something that is congenital that you're born with.

But there's also certain ethnicities and races that are predisposed to developing certain conditions or there are certain autosomal dominant conditions that can be inherited and those are things that are not modifiable.

>> What's your viewers really want to focus in on though?

>> Are those modifiable risk factors, those risk factors when we talk about living a healthy lifestyle are making the right choices in life .

OK, do we have a caller that we need to take or yeah we actually we do and I'm going to tell you Dr. Rodriguez, that this is coming in on the teleprompter here.

Jerry has just called in.

Hi Jerry.

Thank you for watching tonight.

And here's Jerry's question.

He said he has had three appellations that have not been successful.

>> Would a fourth be worth having your opinion, Jerry, thank you for your question tonight.

That's a very complex answer and it certainly depends on what kind obligations you've had for what conditions.

Jerry, I'm going to assume you're talking about atrial fibrillation.

>> Some patients are considered a cure.

So if you have Wolf Parkinson's white or Avino it'll ranchman tachycardia even atrial flutter.

These are conditions which with current three dimensional lecky anatomical mapping and the ablation technologies can be considered virtually curative in most patients, however, atrial fibrillation ablation is not to be considered a cure.

It is a treatment that is a part of a complex program to treat their atrial fibrillation .

Sometimes patients do require more than one ablation.

It's not uncommon to require two or three.

I've known of cases where patients have had more than four patients and I would certainly recommend you speak with your cardiologist or electrical physiologist to see if you would be a candidate for more ablation.

>> OK, thank you and I'm sure Jerry thanks you as well.

Rosano is on the phone tonight and welcome to LIFE Ahead.

>> How are you and what is your question tonight for Dr. Rodriguez?

OK, I'd like to know how to detect coronary artery disease.

Is there any hospital I could find out like a coronary that could detect a soft plaque as well as the calcification like OK, Rosano?

>> That's a really good question when we talk about detecting and preventing coronary artery disease, many hospitals and in fact many employers have health fairs and you can inquire about something called a coronary artery calcium scan or a CT scan and that would help sort of risk stratify you along with your physician and or cardiologists to determine if you were at risk for atherosclerotic cardiovascular disease.

>> OK, all right.

And I'm sure that answer is appreciated again, the phone number is (969) 27 twenty .

If you have a cardiac heart question that you'd like to ask our doctor this evening.

Meanwhile, I have more questions about a fib that's kind of the general term but it means what is that about atrial fibrillation, an atrial fibrillation.

>> It's a good thing that we just call it athea.

Explain what that is and and then talk about procedures or treatment for it.

>> OK, I'll be happy to.

So atrial fibrillation or a fib also known as A.F.

is a type of arrhythmia that is frankly the most common arrhythmia in the United States and the risk of patients and your viewers developing atrial fibrillation is about one in four.

In fact, the CDC estimates that about twelve point one million Americans will suffer from this condition by the year 2030.

>> Why is that increasing or something?

>> It is increasing.

That's because we've as a society we've realized that stopping smoking and having patients on cholesterol medications has allowed them to live longer beyond heart tax.

And one of the side effects is that as they develop conditions of the aging process and atrial fibrillation is associated with the aging process so a young person's not likely to be diagnosed with Abib that's not necessarily true.

I have taken care of patients as young as 21 years old with atrial fibrillation that kind of goes back the non modifiable risk factors maybe they were born with a certain heart structure, a defect where they can have atrial fibrillation.

To answer your question though, what atrial fibrillation is it's disorganized electrical activity coming from the top chambers of the heart whereas the heart the top chambers in the heart called Atrium would typically contract and squeeze and fill blood efficiently into the lower chambers called ventricles and atrial fibrillation that becomes disorganized and the heart beats irregular and fast.

How would I know if I had a fib?

I mean what would I sense it would I feel it physically or would I not know unless I visited a physician?

>> So some patients have atrial fibrillation and don't even realize it.

>> But for patients who do experience atrial fibrillation, what they would experience is an irregular heartbeat and they would feel physically feel it.

>> They can this is called palpitations, palpitations.

I've been described as a fluttering or flipping in the heart the sensation of butterflies one patient called it feeling like a flock of pigeons were in their chest.

So those are palpitations.

But what I would say is universally my patients experience extreme fatigue, shortness of breath with exertion, lightheadedness and some even experienced chest pain with atrial fibrillation all right.

Let's talk about physicians then.

So if I start experiencing any of those symptoms, do I go to my primary care physician?

Do I go to a cardiologist emergency room?

What do I do?

>> Well, it's interesting.

So we live in a very modernized world with a lot of technology.

Everyone has a smartphone and an eye watch or Fitbit and a lot of these devices have the capability to detect arrhythmias and so sometimes patients first realize they have an abnormal rhythm by using the technology that they have with them every single day.

But if you do experience those symptoms, I encourage you to speak to your physician where your physician will obtain an electrical cardiogram or EKG to see what your rhythm is and then he senses there, sees anything.

Then he sends you on to a cardiac cardiologist or a specialist, is that it?

>> That would be correct and the treatment really focuses on a number of things.

So we haven't talked about this yet.

But stroke is associated with atrial fibrillation in patients who have atrial fibrillation are four to five times more likely to suffer a stroke.

In fact, when you look at strokes in the United States, one in seven strokes are caused by atrial fibrillation.

So the first thing your physician want to do is evaluate your risk for having stroke associated with atrial fibrillation and put together appropriate treatment plan which may require anticoagulation commonly known as blood thinners like Coumadin or something.

>> Certainly Coumadin was one of the first that we have that we had available.

Now there are newer medications that have been developed in the past few decades.

>> Dr. Rodriguez, we have another phone which surprised me this time from Ruth and Ruth says she would like to know exactly what heartburn is.

>> Is it something in the digestive system or actually affects the heart?

>> Yeah, it's a great question.

So heartburn generally does not affect the heart.

Why do we say heart?

Well, see, there's many different structures around the heart.

So when you think about chest pain and if you were to simply just draw a line through the chest, chest pain could come from the skin or the muscles under the skin or the ribs or the lungs something we call pleurisy.

Then there's angina or cardiovascular chest pain and then the first structure behind the heart is the esophagus and so when patients experience GERD or I've heard of that that is the sensation of heartburn or a burning sensation.

>> It's often accompanied with having alcohol or caffeine or a large meal.

And I would encourage your viewers to talk to their primary care provider about treatment plans or heartburn.

>> Yeah, I've heard the term GERD.

What does that stand for ?

I'm sure it's an acronym.

Yeah, it's a gastro esophageal reflux disease so it's having to deal with stomach acid and reflux of the stomach contents into the esophagus causing a burning sensation and because of its location it's not because it may feel like it's coming from your heart.

>> Is that what you're saying?

Correct.

There are many different mimics of chest pain.

Any time a patient's concerned or your viewers concerned, they should really seek out the care of a health care professional.

This is particularly true for women.

We know women don't have the classic chest pain grabbing chest falling over to the ground.

Women may experience jaw pain or simply shortness of breath as or angina or equivalent or chest pain equivalent and I would encourage those patients to seek health care.

>> Well, I'm just curious a lot of medical shows on TV right now and obviously a lot of heart issues come up.

Do they portray them correctly or not because you always see them grabbing their chest and falling over?

>> Well, I think that depends on which show you're watching.

>> I don't think Scrubs, for example, display as much accurately but it's very entertaining.

>> You know, when we define cardiac chest pain, we're really looking for retro sternhell heaviness burning that is worse with exertion and improved with rest.

And so if your patients begin or your viewers begin to experience anything like that, they certainly want to go to a health care provider as soon as possible.

>> Well, that brings me to a question we had a guest last month an emergency management director and we talked about when you should go to the E.R.

when you should go to ready med if you start experiencing some those physical symptoms you're talking about, should you go right to one of those places?

>> I think it's important if you have an established relationship with a health care provider, certainly call your health care provider any time you're at fear for your life where you feel something is off, it's always appropriate appropriate to call 911 one have EMS come evaluate you and be seen either in an emergency department or already met?

>> OK, I mean, you know, if you're experiencing angina or shortness of breath or something, you're very fearful if you don't want to wait till nine o'clock the next morning to call your family.

>> No, I would not wait when those conditions come up it can certainly be life threatening.

>> It can be acute and time becomes of the essence.

Let's talk about the Abberline and the new treatment that for a fib can you describe what it is and when it would be used?

>> Absolutely.

The first thing I would want to share with you though is before we get to oblation there are other ways to manage atrial fibrillation.

>> The first is lifestyle modifications.

So patients really do need to embark on heart healthy eating which includes vegetables, fruits, nuts, your fish, your poultry and avoiding the trans fats, the red meats, the processed meats, the refined carbohydrates and the sweetened beverages.

>> And then we would also want to focus on an active lifestyle.

So your patients or my patients and your viewers would really want to try to get one hundred and fifty minutes per week of moderate intensity exercise I batter up mine.

>> Yeah.

So what I tell my patients in clinic when you break that down is they should really embark on a walking program thirty minutes a day at least five times a week or seventy five minutes of high intensity aerobic exercise.

>> Then when lifestyle modifications are not enough we usually try medications first.

OK medications come in a number of varieties and I would encourage any patients or any person with atrial fibrillation to talk to the cardiologist about which medications would be best for them when medications are not enough or medications have failed.

>> Those are the patients that we would consider for a catheter ablation of atrial fibrillation catheter catheter procedure catheter ablation catheter ablation and how is that similar to a catheter catheterization you would do for other heart issues or how to do similar but it focuses on a different aspect of the heart.

So as cardiac electrical physiologist really looking at the way the electricity or the electrical signals propagate through the heart, other catheterizations are looking at the vessels around the heart for blockages sample when we do a catheter ablation for atrial fibrillation what we're really targeting are the triggers of atrial fibrillation and those triggers we found actually Dr. Cigarroa who was a physician in Bordeaux France published this in 1998 in the New England Journal of Medicine and the triggers come from the pulmonary veins or those veins and drawing blood from the lungs to the heart.

And so when we do an ablation for atrial fibrillation we are targeting those pulmonary veins and isolating those from the rest of the heart.

>> What do you do?

How do you treat that?

I mean do you send an electrical impulse like a pacemaker would be or how do you see that work?

>> We use a number of different technology.

>> The first technology available was radio frequency ablation or heating the tissue.

OK, later we've developed a cryo ablation or freezing the tissue and the technology which I do for my patients is a laser ablation.

They all do the same thing and the analogy that I tell my patients in clinic is if you think about a forest fire on the West Coast and you want to contain this fire and stop it from spreading to the healthy trees of the forest, the firefighters will do a controlled burn or dig a fire ditch so it doesn't spread thin.

>> OK, a cardiac ablation is very similar and what we do is we would isolate those veins with heating or cooling so those signals in the veins don't spread into the heart putting the heart into atrial fibrillation.

>> OK, all right.

That makes sense.

We have two more phone calls on.

OK, Rodriguez we'll we'll try to get to both of those.

We have five or six minutes left.

>> Norma, you are on the line with us this evening.

Thank you for watching.

LIFE Ahead, what question do you have for Dr. Rodriguez Norma?

>> Is Norma still there?

Yes.

Can you talk about stress as it relates to heart health and what does it mean when you have an elevated homosocial level?

I was thinking that I was told like when you're under a lot of stress maybe you can have elevated homocysteine and that does permanent damage to your heart.

>> All right.

Good question.

And first you have to define for me what I will do my best there.

So Norma, thank you for your question.

Yes, stress has a dramatic impact on the body and particularly the heart.

So any time you're at an increased level of stress there are hormones, adrenaline, epinephrine, things of this nature which can have an impact on the heart and can sometimes be a driver for some of these arrhythmias.

It's very important to reduce stress in your life .

>> One of the best ways to reduce stress is to embark on that exercise program.

>> What I tell my patients in clinic if you if you have an active lifestyle or you do a lot of walking at work that doesn't count.

That's not exercise.

You really need to take 30 minutes away from work, away from the stress of life to decompress that helps not only improve your heart function but improve your stress levels.

Homocysteine is a number of inflammatory markers that we use to evaluate a patient's risk for cardiovascular disease.

>> It's one of many different markers that your doctor or your cardiologist could review with you.

>> OK, all right.

I hope that helps you, Norma and gives you some information and confidence in that.

Well, yeah, I just called in as well and he said that he is having heart felt heart palpitations, a weight change and heart burn.

>> Could this be a fib Doctor regarding William first thank you for your question regarding the heart palpitations that would be a concern for a fib depending on your age.

The older we get the more common atrial fibrillation is.

So if you're in your seventh or eighth decade of life and you begin to experience palpitations, chances are that this could be atrial fibrillation.

The weight changes I'm not as familiar with if you have unintentional weight loss that is something that I would strongly encourage you see your doctor about as unintentional weight loss can be a manifestation of many conditions.

Sure.

If you're having weight gain sometimes patients with atrial fibrillation also have heart failure and the weight gain may not be adipose or fat tissue but it may be swelling or edema.

And so I think when you discuss these conditions, William, it is important to get to seek health care and see your physician.

>> OK, good advice and it sounds like Dr. Rodriguez, we have a lot of people interested in cardiology and no doubt because it is extremely an extremely prevalent condition.

You have about a minute, Doctor, to give people any last bit of advice that you might want to share with your viewers.

>> Yeah, I would like to share with everybody if you have any concerns at all, please don't wait.

Seek health care, seek resources.

There's plenty of literature online.

Your local library will have plenty of literature and talk to family and friends.

>> And if you have any of these conditions that we discussed, please schedule appointment with your doctor and again electrophysiologist would be like the top of the line in terms of caretaking.

>> Well, thank you.

That's very flattering.

I mean I usually break it down to as an electrician of the heart but oh there you go.

But on top of the line I will take that compliment.

>> OK, thank you.

Well you have been an amazing guest.

I really appreciate it and I hope that we'll be able to do more shows with you here on cardiology and and medical issues.

>> Dr. Rodriguez, thank you for coming to Fort Wayne .

First of all to be a part of the network here and for sharing not only your professional expertize at work but here on LIFE Ahead.

>> It's my pleasure.

And for the rest of you, I hope you'll watch us again next Wednesday night.

We turn to legal issues.

>> We're going to be talking about guardianships and how a family should look guide to guardianships and we'll have some attorneys here to answer your questions.

Meanwhile, have a great night and thank you once again for sharing LIFE Ahead with us tonight