Transcription:

Scott Webb (Host): Heart disease is the number one killer of Americans. And though genetics and family history may be beyond our control, exercise and lifestyle are not. Joining me today to help us all understand heart disease and how we can keep our hearts healthy is Dr. Peter Bittenbender. He's an Interventional Cardiologist at Summa Health. This is Healthy Vitals, a podcast from Summa Health. I'm Scott Webb. So Doctor, thanks so much for joining me today. We know that 10% of Americans have heart disease and it is the number one killer of people in the US. So when we talk about heart health, who's at the greatest risk for heart disease? And are there any warning signs?

Who is at the greatest risk for heart disease? Are there any warning signs?

Dr. Bittenbender: You know, I think we're all at some degree of risk for heart disease. And when we're talking as a, as a population about heart disease, we're mostly talking about coronary artery disease, which is blockages accumulating in the arteries that feed the heart and keep the heart muscle happy. And again, really we're all at risk of developing coronary artery disease. Some of the major factors that play into the development of coronary artery disease are smoking uncontrolled diabetes. A lot has to do with your genetics. So your family history of having coronary artery disease and then things like diet and exercise. So sort of all the things that you've heard probably talked about in terms of keeping your heart healthy. Warning signs, most the most common symptoms from the development of coronary artery disease are things like chest pain or pressure, particularly when you're exerting yourself, you might get those symptoms, as well as shortness of breath can, can be another common symptom.

Host: And I know that, you know, when it comes to warning signs that a lot of us just feel great most of the time, right? And every once in a while, if we're really exerting ourselves, we might experience some shortness of breath. So at what point, what's the threshold for us to, to think to ourselves, you know what? This is really out of the ordinary. This is more than me just exerting myself. I should maybe go to the doctor. I should maybe get checked.

When is it time to see the doctor?

Dr. Bittenbender: Sure. And it's almost exactly what you just mentioned. I tell patients all the time, you know, if we all got on a treadmill and started running, we'd all get some degree of shortness of breath and we're used to that, but I tell patients, you start getting worried when you're short of breath, out of proportion to what you're doing. So, you know, if you're running on the treadmill and you're getting a little short of breath and you're pushing yourself, that's totally normal. That's something we've all I'm sure experienced. You know, if we sort of let ourselves get out of shape a little bit, and you know, sometimes I go up a flight or two of stairs and I find myself breathing heavy at the top. You know, I think to myself, you know, I just walked up three flights of stairs, that might make me short of breath, but, you know, for walking across the room to the bathroom and we have to stop halfway to catch our breath, that's out of proportion to what we're doing. And that should raise a red flag. And then certainly any symptoms in the chest other than shortness of breath, when we're exerting ourselves like chest pain or pressure, particularly if it involves the left arm, we've probably all heard of that. Those would be things to contact your Doctor about.

Host: Yeah, definitely. And you know, the saying about when it comes to stroke, you know, the time is brain, I know, kind of applies to the heart as well. Time is heart. So early detection is really key, isn't it?

Dr. Peter Bittenbender on early detection

Dr. Bittenbender: Yeah. And you know, that's particularly talking about people having a heart attack. So we say time is muscle, just like, you know, the neurologist say time is brain, with patients having strokes. So I think importantly, if you start developing some of these symptoms when you're not doing anything, when you're sitting at rest and it's not going away, that's something that becomes a bigger emergency and, you know, instead of calling your doctor, you should be calling 911. Because the earlier you can get that addressed, potentially get the artery open with a stent if you're having a heart attack, the less chance you have of major heart damage going forward. And I think, you know, as a, as a country, that cardiology is doing a pretty good job of developing technologies to get those arteries open quickly. And I think the push these days is to get out there what the symptoms are because those technologies can only be used when somebody presents to their healthcare provider, whether it's calling 911 or going to the ER. And so there's a big push to say, all right, well, we've got the technology here. We now have to get people to understand when the present so that we aren't sitting at home for 12 hours wondering what to do. And then, you know, the technology is now 12 hours, you know, behind being effective.

Host: And do you think that one of the complications right now is COVID-19? Do you believe that because of COVID and the concerns that people have perhaps, you know, legitimate concerns that people are not calling 911, they're not going to the doctor, they're not taking advantage of the early detection, you know, tools and technologies that are available, simply be out of fear of COVID-19?

COVID-19 and patient reluctancy

Dr. Bittenbender: That has been a concern. You know, I think during the height of early COVID, if you looked across the country, there was actually a drop in the rate of heart attack, presenting to the hospital across the country. And I think most people sort of thought sat and thought, why would heart attacks be slowing down in the midst of COVID? And really the only rational answer was people may be sitting at home during COVID with active heart attacks for a couple reasons. One, they may say, well, my chest feels funny or I'm short of breath, but, you know, maybe I have COVID and I've been told to stay home. And, you know, with COVID, that's a valid suggestion, but we may be having patients sort of not realizing what is going on. And we also have patients that say, you know what, my symptoms are bearable at home and I'm scared to go to the ER, where there might be a lot to COVID patients. And so, you know, I'm going to deal with this at home. And so I think the, you know, one of the only rational explanations for why heart attack volume at the hospitals has decreased over the last six months is that, you know, patients may be staying home for various concerns related to COVID.

And that's a hard thing to Wade through. You know, you obviously have to weigh the risk of presenting to the hospital versus what's going on with you. But, you know, I think that if you are having an active heart attack, it can be dangerous to stay at home. And so we still encourage people if they're concerned to, you know, call 911, if you're not comfortable with that, you know, call some kind of on call health care provider to talk through, you know, what are the likelihood, this is COVID versus a heart attack. And if it's a heart attack, you know, the hospitals have gotten pretty good at you know, getting patients with heart attacks sort of through the system without exposing them to COVID patients who are isolated in other areas of the hospital. So I think there are lots of efforts put in place to, you know, not have to have patients obviously suffering through this COVID era, but also not having non COVID patients with real health problems suffer through all of this as well.

Host: Definitely. And we know that the hospitals with the full PPE and all the safety measures in place, the hospitals really are the safest place. And as you said, time is muscle. So please don't put that off, you know, call 911, call a service, get to the hospital. If you believe, you know, that you're having a heart attack or experiencing those symptoms. Before we get too far, and I do want to come back to some of the technologies, but what role does genetics play? What factor is genetics in heart disease?

What is the relationship between genetics and heart disease?

Dr. Bittenbender: It's a pretty powerful predictor of likelihood of developing coronary artery disease. So when I list to patients the order in which, you know, risk factors are important, smoking and diabetes are usually right up there at number one and two, and genetics is sort of a close third. You know, I tell patients all the time, there are, there are people that, you know, have all the right habits. They exercise, they eat well, they don't smoke, they do all the right things and they still develop blockages because that's just in their genetics. And there are people that, you know, have lots of bad habits for your heart and they smoke. They don't eat well, they don't exercise and they never develop blockages. And that really all comes down to genetics and family history. So, you know, I have some patients that get frustrated by that and say, Hey, I do all the right stuff, and I'm still developing these blockages. And they sort of have this temptation to give up on all the right things. And I try to turn it around for them and say, no, no. If your genetics you know, are strong for coronary artery disease, that's all the more important to have all the right other good habits to try to sort of delay your development of blockages or maybe you know, get rid of your development of blockages. So, you know, for all of us, we'd recommend all those good habits. It's even more important for people that have strong family history for coronary artery disease.

Host: Definitely. And you would want to, as we were talking about, you know, early detection, you would want people who have a family history where genetics is really not on their side, you would want them to be you know, tested early. And you mentioned some of those technologies, what are some of the early detection technologies? And also maybe talk about some of the innovative treatments for heart disease.

What are some of the innovative treatments for heart disease?

Dr. Bittenbender: Yeah. So, you know, I think the most helpful thing is to sort of discuss these things with your doctor, whether your primary care physician or a cardiologist, you know, if your family history is strong enough that you want to see a cardiologist for sort of preventative heart care that's never a bad idea with a strong family history. You know, a lot of times it really comes down to sort of having a conversation and educating yourself about the good habits that you could be doing. Really the only test that's recommended sort of across the board is to get your cholesterol checked and make sure that that's not elevated enough that you should just right from the beginning, be on a cholesterol medication. You know, other tests like stress tests or, you know, calcium scans or things like that sometimes are not always recommended in somebody who's never had a problem before. And really things like coronary calcium scores are used to simply encourage the other good habits that we probably all should be doing anyway. So really it's a conversation with your doctors. It's developing the right lifestyle, the right habits. Those are probably the most important thing.

Host: Okay. Doctor, and as we wrap up here today, and thanks so much for your time, I want to talk and give you a chance to talk about the modern guide to heart health. I know that that's a big priority for you. And what does that mean exactly? You know, from your perspective as a Doctor and for us as potential patients?

Dr. Peter Bittenbender's modern guide to heart health

Dr. Bittenbender: When I think of sort of modern heart health, and really this can be applied to all of healthcare, not just heart-related, but you know, modern healthcare versus, you know, sort of what we did in the past. I think in the past, it used to sort of follow the strategy of, you know, you see your doctor, your doctor tells you what to do, take these medicines, and you'll be healthier. You know, I think in the last five to 15 years, we've evolved past that. And, you know, I sort of view myself as an educator to patients rather than a, you know, dictator telling them what to do. But, you know, I think modern healthcare is moving much more towards a sort of owning your own health and understanding, you know, what risks you have, what things you could do to improve those risks or to, or lessen your risk of having problems. So again, I tell patients, I see myself as an educator and then you know, you're there to ask questions to understand your own health, as best as possible, and understand what you can be doing to improve your own health. You know, I think a lot of things that can help with your overall heart risk are things that really can't be dictated by the physician, but have to have the patient take ownership of, and that's healthy diet, healthy exercise habits, not smoking. Those are the things that, you know, cardiologists these days can have a discussion with you and educate you on and give you strategies. But it doesn't end when you leave the office visit, it really starts then for you to go out and be as aggressive as you can about those good lifestyle habits in your daily life, rather than just in the office.

Host: Yeah, definitely. And I think if there is a quote unquote, magic pill, when it comes dealing with heart disease or preventing it, exercise is probably at the top of that list. And that's something that obviously you can recommend, but we have to do, right?

Exercise and heart health

Dr. Bittenbender: Yep. For sure. And, you know, I, I am a human and a patient as well, so I have to take my own advice and, you know, I've been through the struggles of busy life and things getting in the way of exercise. And so, you know, I think that's sometimes why I have an easy time talking to patients about this stuff. Cause I say, you know what? I fall off the wagon sometimes too, and have to jump right back on and realize, you know, I can't tell patients all day long in the office, they should be doing these things and then go home and not exercise myself. So, you know, I've been through those struggles too, but yeah, those are all things that I think modern healthcare is geared towards creating healthy lifestyle all day, all year long for patients rather than, you know, take this one pill and you'll be fine.

Host: Yeah, absolutely. That's why I put it in air quotes. You know, there is no real magic pill, perhaps other than maybe for cholesterol, but even then you've got to do your part and take the pill and do all these other things. And all these things are important. And Doctor, I really appreciate your time today. Very educational, very helpful, good to sort of understand the modern approach to heart health and you stay well. For more information or to book an appointment to visit Summahealth.org. And if you found this podcast helpful and informative, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Healthy Vitals, a podcasts from Summa Health. I'm Scott Webb, stay well. And we'll talk again.