Michelle Rupp: Hello and welcome into this week’s edition of AFMC TV. I’m your host, Michelle Rupp. Thanks for joining us. Today as we are on the cusp of a new month, February and heart month, we want to talk about heart disease. And joining me this morning is Dr. Andre Paixao from Arkansas Heart Hospital to talk about heart disease. Good morning. Dr Paixao.

Dr. Andre Paixao: Good morning, Michelle. Thanks for having me. It’s always a pleasure.  

MR: Thanks for joining me. So, you know, we hear this term heart disease. Is that really kind of just a catch all maybe for all the ailments of the heart? Or is there in fact a disease of the heart? 

MR: Yeah, heart disease is an all-encompassing term and it’s going to have a bunch of heterogeneous conditions there. What most people tend to think of first when they think of heart disease is disease of plaque buildup. Cholesterol and inflammation in the arteries of the heart, leading to potential heart attacks. But also, blockages that might need stents or bypass surgery to be treated. Well, that’s at least where we live- the more common clinically significant type of heart disease. And that’s what we kind of focus the most on prevention in public health and with individual patients. But there are other types of heart disease. There are diseases of the heart valves. They can become tight and not open. Well, they can become leaky and not close well. There’s congestive heart failure, which can be from either a weak heart muscle or stiff heart muscle. And they’re also electrical problems that can affect the heart and cause arrhythmias like atrial fibrillation and things along those lines. All those conditions would have specific risk factors and treatment. But in general, things like healthy diet, exercise and avoiding smoking would be applicable to most of those diseases. 

MR: So how would we know if we have a problem with our heart, excluding the heart attack symptoms or like what we might see on television or the movies where you clench your chest. 

AP: Yeah, so the heart attack is almost by definition, a blockage that’s occurring suddenly in one of the arteries that supply the heart muscle. That’s usually from a plaque that will rupture, and a blood clot will suddenly develop on top of that plaque almost instantly, occluding blood flow. That will cause a sudden onset of symptoms, usually not necessarily triggered by physical activity. That can be chest pain. It can radiate to someone’s arm. It can radiate someone’s jaw. It can be accompanied by cold sweats, nausea, shortness of breath. But it doesn’t need to be like that. Not everybody will have these typical symptoms. So, when we’re worried about heart attacks, we’re worrying about sudden onset of symptoms in the chest area, which can be pressure or just shortness of breath. In some people, the pain may be a little bit lower and and almost feel like it’s in the center of your stomach, but it’s usually a pressure pain. If someone has that, the proper course of action is to call 911 and have an ambulance take you to an emergency room. Not trying to drive yourself. When someone is having a true heart attack, there is a risk of a sudden death of abnormal heart rhythm that ceases completely the heart function. And if that’s the case you need to be shocked. So, if you’re in an ambulance or if EMS is with you, they can promptly shock you. So, if you have some of those symptoms don’t call a friend to drive you, call 911. Outside of a heart attack, most symptoms from heart disease will be things that get predictably worse with physical activity. So, if you notice that every time you kind of push yourself a little bit more- let’s say you’re going up a flight of stairs at a fast pace, you start to have some chest tightness or you get winded with a level of activity that you’re not expecting to get winded. That may be a sign of a stable blockage developing. And if that’s the case you want to be in touch with your primary care physician or with your cardiologist. And they can, in an outpatient setting, work up those symptoms and make sure they’re not coming from a blockage. 

MR: How often should we be getting our heart checked? Is this something that can be done at an annual physical with a primary care, or do we need to see the cardiologist? 

AP: Yeah. Most people don’t really need to see a cardiologist unless they’re having symptoms that are worrisome for heart disease. The United States Preventive Task Force is a very conservative institution and all they recommend is annual blood pressure checks, cholesterol checks and screening for diabetes. In addition to trying to adopt a healthy lifestyle. There are, however, other societies that that are a little bit more aggressive with that. And one testing modality specifically has actually a lot of data behind it. And that’s the calcium score CT. It’s a CAT scan, without contrast. No dye is involved. There’s no IV that’s placed in a patient for that test. And in that CAT scan we can measure how much plaque buildup someone has in the arteries of their heart. And that’s the best predictor for the future risk for strokes and heart attacks. So, it’s not something we’re using necessarily to identify a blockage. But we’re using to measure someone’s future risk Just from a probability standpoint, the more plaque you have, the higher the chances of one of those black suddenly rupturing and causing a heart attack. So, I think in general it’s a reasonable recommendation for people in their early 40s or early 50s to seek out one of those tests? You can think of it as a mammogram for your heart? It exposes you to a little bit of radiation. But it’s not much. It’s mildly more than a true mammogram. It’s not something that would need to be repeated frequently. And it’s actually a test that can be offered without a doctor’s prescription. So, there are several hospitals across the state, including the Heart Hospital, that offer’s screening programs like this. We call ours Keep the Beat. And it’s a relatively affordable test. If you’re signing up for just a CAT scan itself, I believe the cost for the patient would be just $50. It’s not something for very young people. In a young population the chances of picking up plaque is pretty low. And then it probably doesn’t make sense exposing them to that radiation. But I would say if you’re in a man in your early 40s or a woman in their mid to late 40s, that would be a good time to seek out one of those programs. Especially if you have risk factors. Not just high blood pressure, diabetes, but if you have a family history of heart disease. That test can really allow us to get an early start. Start addressing the problem early so that we’re not sort of chasing our tails later and treating multiple blockages. 

MR: And that leads me to my next question. And that is just how powerful of a role does genetics play when it comes to matters of the heart? Or are the genetics there, but then what you as the individual do kind of tips the scales or not?  

AP: Yeah, that’s really hard to quantify with the current studies. But we believe that about 50% of someone’s risk is from environmental factors and about 50% is from your genetic background. That relative importance that will be higher in younger patients and will be lower in older patients. I mean the older we get, more of our lifestyle choices will take a role, as opposed to our genetic background. But, there’s not much we can do about the genes we were given. There’s a lot we can do with our lifestyle choices. So, following a healthy diet, trying to exercise, staying away from smoking- those things can have a huge impact. Even if you have genes that predispose you to heart disease. 

MR: I thought about you earlier. I saw a news report that indicated that one of the top diets for 2022 is the Mediterranean diet. And I know that that is one of the diets or the only diet that you really advocate for and believe strongly in. 

AP: Yeah, that’s true. Nutritional science is also something that’s not always well portrayed in the media. I mean, a lot of the recommendations come from low quality studies. We do have two large, randomized studies where patients, either with established heart disease or with multiple risk factors for heart disease, were randomized to a low-fat diet or Mediterranean diet. So, basically you flip a coin and that decides which diet you’re going to follow for the next few years. And then in those two studies, one in France and one in Spain, those patients were followed for up to five years and the patients randomized to the Mediterranean diet experienced about 30% less heart attacks and strokes than the patients in the low-fat diet. Those randomized studies with clinical endpoints are really the highest tier of scientific studies. So, because of those two results, that’s what we tend to recommend. That’s what’s on the guidelines for most scientific societies as well. 

MR: Okay Dr. Paixao, is there anything else that you would like to add today? 

AP: No, I think that’s it. I think we’ve covered most of the things that I usually tell my patients. 

MR: Fantastic. And if someone wanted to get in touch with you, they could reach out to Arkansas Heart Hospital and they could put you in touch.  

AP: Absolutely. We’re always taking new patients.  

MR: Fantastic. Well, Dr. Paixao thank you very much for joining us today. We hope you have a great rest of the day and we want to thank you for joining us as well. We’ll see you back here next Wednesday for more AFMC TV.