"DOCTORS ON CALL."

"DOCTORS ON CALL."

♪ DR. CHRISTENSEN: GOOD EVENING, AND WELCOME TO "DOCTORS ON CALL."

I'M DR. RAY CHRISTENSEN, FACULTY MEMBER FROM THE DEPARTMENT OF FAMILY MEDICINE AND BIOBEHAVIORAL HEALTH AT THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL, DULUTH CAMPUS AND FAMILY DR. AT THE GATEWAY FAMILY HEALTH CLINIC.

I AM 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 TONIGHT OR SEND THEM IN AHEAD OF TIME TO OUR EMAIL ADDRESS, ASK@PBSNORTH.ORG.

THE TELEPHONE NUMBERS CAN BE FOUND AT THE BOTTOM OF YOUR SCREEN.

OUR PANELISTS THIS EVENING INCLUDE DOCTOR CATHERINE BENZIGER, A CARDIOLOGIST WITH ESSENTIA HEALTH.

DOCTOR RYAN HARDEN, A FAMILY PHYSICIAN WITH THE GATEWAY FAMILY HEALTH CLINIC IN SANDSTONE AND FACULTY MEMBER AT THE MEDICAL SCHOOL DULUTH.

AND DOCTOR DAVID HUTCHINSON, A FAMILY MEDICINE PHYSICIAN WITH ASPIRUS-ST. LUKE'S.

HERE IN DULUTH.

OUR MEDICAL STUDENTS ANSWERING THE PHONES TONIGHT ARE ELLIE GAMRADT FROM WRENSHALL, MINNESOTA, ALEXANDRA REVIER FROM OLIVIA, MINNESOTA, AND WYATT WINDHORST FROM ALEXANDRIA, MINNESOTA.

AND NOW ON TO TONIGHT'S PROGRAM, “HEART PROBLEMS AND HIGH BLOOD PRESSURE."

DR. BENZINGER, LET’S TALK ABOUT THE WOMEN’S HEART RATE.

>> TOMORROW, THE AMERICAN HEART ASSOCIATION IS RAISING AWARENESS ABOUT WOMEN’S NUMBER ONE KILLER, IF YOU WANT TO SHARE YOUR STORY AND TELL PEOPLE ABOUT SOME OF THE SYMPTOMS THAT YOU HAD TO OTHER PEOPLE CAN BE MORE PREPARED, ALL OF US NEED TO WORK BY LIVING BY THE AMERICAN HEART ASSOCIATION’S LIFE ESSENTIAL EIGHT FACTORS AND BEHAVIORS TO TRY TO LIVE A LIFE FREE OF HEART DISEASE THOUGH YOU DON’T END UP SUFFERING A HEART EVENT IN THE FUTURE.

DR. CHRISTENSEN: THANK YOU.

NICE PLUG FOR THE AMERICAN HEART ASSOCIATION.

THE WHOLE MONTH, YOU HAVE GOT THINGS PLANNED, BASICALLY WHEN WE TALKED EARLIER, EACH DAY IS A DIFFERENT TOPIC.

>> THE WHOLE MONTH WITH VALENTINE’S DAY COMING UP, IT IS HEART DISEASE AWARENESS MONTH, THERE’S ALSO VALVE DISEASE AWARENESS, YOU HAVE FOUR HEART VALVES AND THERE CAN BE PROBLEMS WITH ALL OF THE HEART VALVES, WE HAVE DIFFERENT TREATMENTS, THERE IS A VALVE DISEASE AWARENESS DAY AND A WHOLE FOR CONGENITAL HEART DISEASE, KIDS BORN WITH HEART DEFECTS, TO RECOGNIZE AND ADVOCATE FOR BETTER RESEARCH AND BETTER INFORMATION AND TREATMENTS FOR ALL THOSE CONDITIONS.

DR. CHRISTENSEN: THANK YOU, RYAN, TELL US MORE ABOUT YOUR PRACTICE AND WHAT YOU ARE DOING.

>> I DO PRIMARY CARE IN SANDSTONE AT GATEWAY FAMILY HEALTH CLINIC AND I AM A PART-TIME FACULTY MEMBER OF THE UNIVERSITY OF MINNESOTA MEDICAL SCHOOL IN DULUTH, TEACHING OUR NEXT GENERATION OF DOCTORS.

DR. CHRISTENSEN: HUTCH, GOOD TO SEE YOU AGAIN.

>> GOOD TO SEE YOU, TOO.

MY PRACTICE, I HAVE BEEN IN SEVERAL PLACES, CURRENTLY ON LAST AT ASPIRUS-SAINT LUKE, THE FIRST RACE SUPERIOR EASE CLINIC.

OFFERING FULL-SERVICE PRIMARY CARE TO RURAL AND URBAN PATIENTS.

IT’S NEXT BEING ON THE EDGE OF TOWN.

I MAINTAIN THAT RURAL ASPECT IN MY PRACTICE AS PEOPLE HERE KNOW, I FORMALLY PRACTICE WITH RAY AT MOOSE LAKE.

DR. CHRISTENSEN: WHY DON’T WE START OFF AND TALK A LITTLE BIT ABOUT BLOOD PRESSURE?

SOMETHING YOU HAVE DEALT WITH FOR A LITTLE LESS THAN I HAVE, BUT BOTH OF US FOR A LONG TIME.

FILL US IN.

>> BLOOD PRESSURE IS IMPORTANT TO BE AWARE OF.

IT’S ONE OF THE BASIC AND MOST IMPORTANT RISK FACTORS FOR THE DEVELOPMENT OF ALL FORMS OF VASCULAR DISEASE INCLUDING CARDIOVASCULAR DISEASE.

IF UNCHECKED, IT LEADS TO HEART ATTACKS, STROKES, PERIPHERAL VASCULAR DISEASE, KIDNEY FAILURE, HEART FAILURE, AND IN CONCERT WITH OTHER DISEASES LIKE DIABETES, IT IS A REALLY STRONG REDACTOR OF -- PREDICTOR OF VASCULAR DISEASE.

IT IS SOMETHING WE PAY A LOT OF ATTENTION TO.

IT’S ONE OF THE FIRST THINGS THAT GETS CHECKED WHEN YOU’RE COMING TO A CLINICIAN’S OFFICE.

VITAL SIGNS INCLUDING BLOOD PRESSURE .

DR. CHRISTENSEN: WHAT IS A NORMAL BLOOD PRESSURE THESE DAYS?

IT KEEPS CHANGING.

>> LEFT MEDICAL SCHOOL -- WHEN I LEFT MEDICAL SCHOOL, IT WAS 100 PLUS YOUR AGE.

KIDS TEND TO HAVE LOWER BLOOD PRESSURE.

AS NORMAL.

FOR MOST OF THOSE, WE WANT TO SEE THE BLOOD PRESSURE LESS THAN 140 OVER 90.

IF SOMEBODY HAS CHRONIC DISEASE OR A HEART PROBLEM OR DIABETES OR KIDNEY DISEASE, WE TRY TO TREAT THE BLOOD PRESSURE TO A LOWER GOAL, TO DECREASE THE PRODUCTION OF THE -- THE PROGRESSION OF THE KIDNEY DISEASE OR HEART DISEASE BE A GOOD 130 TO 135 AS THE TOP THE SYSTOLIC NUMBER, OVER 80 TO 85.

I WILL SAY ONE THING ABOUT NORMAL BLOOD PRESSURE, IF YOUR BLOOD PRESSURE IS 138 OVER 88, THAT IS NOT SOMETHING WE WOULD TREAT WITH A MEDICINE OR SOMEONE WITH AVERAGE RISK.

A LOT OF STUDIES ARE COMING UP SHOWING THAT HAVING A LOWER BLOOD PRESSURE THAN THAT IS SIGNIFICANTLY TO YOUR BENEFIT TO PREVENT HEART DISEASE.

EVEN THOUGH IT’S NOT SOMETHING WE WOULD TREAT WITH THE MEDICINE, WE WOULD WANT TO TRY AND LOWER THAT BLOOD PRESSURE THROUGH LIFESTYLE CHANGES.

DR. CHRISTENSEN: ANY ADDITION?

>> DATING BACK TO THE WOMEN’S HEART DISEASE, HYPERTENSION IS OUR NUMBER ONE RISK FOR DEVELOPING HEART DISEASE.

ONE ENTRY WOMEN HAVE HIGHER BLOOD PRESSURE.

A LOW SODIUM DIET IS IMPORTANT FOR LOWERING THE BLOOD PRESSURE WITHOUT MEDICINE.

AS I MENTIONED IF YOU HAVE RISK FACTORS, FINDING THAT LOWER GOAL, LESS THAN 130 OVER 80 IS A GOOD TARGET FOR THOSE WHO HAVE HAD A HEART EVENT OR HAVE RISK FACTORS.

DR. CHRISTENSEN: SO, WE KIND OF TOUCHED INTO THIS -- I THINK MAYBE ALL THREE OF YOU, HOW DO WE LOWER BLOOD PRESSURE WITHOUT TAKING MEDICATIONS?

YOU CAN STRAY INTO MEDITERRANEAN AND DASH AND OTHER THINGS IF YOU WANT.

>> BASICALLY DIET AND EXERCISE, THOSE ARE THE BIG ONES.

THE MEDITERRANEAN DIET HELPS WITH THE RISK OF HEART DISEASE AND STROKE.

EATING A LOW SALT DIET.

MAYBE SWITCHING TO A TYPE OF SALT THAT HAS POTASSIUM -- A LITTLE BIT OF POTASSIUM INSTEAD OF SODIUM CHLORIDE.

ONE OF THE ONES I WANT TO MENTION HIS TREATMENT OF SLEEP APNEA.

A A LOT OF PEOPLE I FOUND IN MY PRACTICE WHO HAVE BLOOD PRESSURE THAT IS REFRACTED HAVE UNDIAGNOSED SLEEP APNEA AND WAS THEY HAVE THE SLEEP APNEA TREATED WITH CPAP, THEIR BLOOD PRESSURE NORMALIZES.

>> BREAK POINT.

ANYONE NOT WELL-CONTROLLED ON MEDICATIONS OR POORLY CONTROLLED, YOU SHOULD BE LOOKING FOR OTHER CAUSES SUCH AS SLEEP APNEA FOR THOSE WHO SNORE AND ALSO THERE ARE MORE RARE CAUSES OF SECONDARY HYPERTENSION ESPECIALLY HIGH BLOOD PRESSURE IN A YOUNGER PERSON.

>> I USUALLY TELL PATIENTS WANT TO PUT THEM ON A BLOOD PRESSURE MEDICINE, TO NOT FEEL THAT IF THEY END UP ON TWO BLOOD PRESSURE MEDICINES, MOST PEOPLE NEED TWO TO GET BLOOD PRESSURE UNDER CONTROL, BUT ONCE YOU GET TO FOUR OR FIVE, THERE MIGHT BE SOMETHING ANATOMICAL DRIVING THE BLOOD PRESSURE SO HIGH.

>> I AGREE WITH YOU BE MOST PEOPLE ARE ON MORE THAN ONE THAN JUST ON ONE MEDICINE.

TO ADD ANOTHER LAYER ABOUT NONPHARMACOLOGICAL TREATMENT, WHICH IS IMPORTANT TO FOCUS ON, MANAGING ALL RISK FACTORS BEGIN WITH DIET AND EXERCISE.

WE CAN SPEND HOURS TALKING ABOUT DETAILS ON HOW TO CHANGE SOME OF THOSE THINGS IN LIFESTYLE, ALCOHOL MINIMIZATION IS IMPORTANT, PAYING ATTENTION TO HOW MUCH CAFFEINE YOU DRINK, AND I DO WANT TO EMPHASIZE SEPARATE FROM EXERCISE, WEIGHT LOSS REALLY WORKS TOWARD LOWERING BLOOD PRESSURE.

GIVEN JUST 10 POUNDS WEIGHT LOSS CAN SIGNIFICANTLY BEGIN TO LOWER BLOOD PRESSURE INTO NORMAL RANGES WHERE WE CAN AVOID INITIATING MEDICATION.

OF COURSE EXERCISE HELPS YOU LOSE WEIGHT AND THEY DO GO HAND IN HAND BUT THEY WORK AS A SEPARATE CONTROL MECHANISMS.

DR. CHRISTENSEN: YOU TOUCHED ON ALCOHOL, MORE AND MORE WHAT I AM SEEING IS ALCOHOL HAS NO VALUE FOR THE HEART, IT REALLY HAS NO VALUE IN MY MIND EXCEPT FOR SURFACE STERILIZATION OR SOMETHING LIKE THAT, AND APPARENTLY IT CAUSES A LOT OF PROBLEMS WITH THE HEART, ATR OFIB AND OTHER THINGS.

>> REALLY LIKED RED WINE AND THEY WANTED TO KEEP IT BUT WE DON’T RECOMMEND ONE DRINK -- MORE THAN ONE DRINK FOR MEN OR WOMEN A DAY.

IF YOU HAVE A DRUG REGULATION -- ATRIAL FIBRILLATION, HEART DISEASE, CUT BACK INTO LESS THAN THAT BECAUSE IT CAN CAUSE EXACERBATIONS OF THOSE PROBLEMS.

>> ALCOHOL CAN CAUSE SO MANY DIFFERENT PROBLEMS WITH THE HEART, IT CAN WEAKEN HEART MUSCLES.

YOU CAN THINK OF IT AS A TOXIN FOR THE HARD FOR SOME PEOPLE.

IT CAN WEAKEN THE STRENGTH OF MUSCLE CONTRACTION AND THE VENTRICLE.

THEY CAN CONTRIBUTE TO THE RISK OF ATRIAL FIBRILLATION OR KEEP US FROM CORRECTING ATRIAL FIBRILLATION IF WE ARE TRYING TO.

AND IT CONTRIBUTES TO DEVELOPMENT OF DIABETES AND HIGH BLOOD PRESSURE, WHICH CONTRIBUTE TO VASCULAR DISEASE FORMATION.

>> THE OTHER THING THAT GOES ALONG WITH ALCOHOL IS A SMOKING AND THERE’S OBVIOUSLY A VERY STRONG CONNECTION BETWEEN TOBACCO AND SMOKING AND HEART DISEASE, SO THAT TO ME IS THE BIGGEST THING IF YOU ARE CURRENTLY USING ANY TOBACCO PRODUCTS, TO CUT BACK" AND THERE ARE MANY TO HELP PEOPLE DO SO.

DR. CHRISTENSEN: WHAT IS ATRIAL FIBRILLATION?

>> ATRIAL FIBRILLATION IS A VERY COMMON IRREGULAR HEARTBEAT, WHERE THE TOP PART OF THE HEART KIND OF STARTS TO BEAT ERRATICALLY, IS CALLED THE ATRIA, AND THAT CAUSES THE LOWER HEART OF THE HEART THAT PUMPS OUT BLOOD TO THE REST OF THE BODY TO BEAT REGULARLY.

YOUR HEART SHOULD TYPICALLY BEAT LIKE A METRONOME WITH A REGULAR RHYTHM.

IF SOMEBODY HAS A TRUE FIBRILLATION, ONE OF THE FIRST THINGS THEY MIGHT NOTICE, IT CAN BE ASYMPTOMATIC.

A LOT OF PATIENTS ARE DIAGNOSED, THEY DID NOT KNOW THEY HAD ATRIAL FIBRILLATION AND THEY HAVE A HEART STUDY AND IT SAYS THEY ARE IN ATRIAL FIBRILLATION, THEY WILL SEE THE HEART BEAT IS A REGULAR AND THAT PROMPTED A VISIT TO THE CLINIC.

THE REASON WE WANT TO TREAT ATRIAL FIBRILLATION IS A CAN LEAD TO HEART FAILURE IF NOT MANAGED APPROPRIATELY WHICH CAN BE HARD TO REVERSE.

IT SIGNIFICANTLY INCREASES PEOPLE’S RISK OF STROKE, ATRIAL FIBRILLATION.

DR. CHRISTENSEN: BRING US UP-TO-DATE A LITTLE BIT ON WHERE WE ARE.

>> ATRIAL FIBRILLATION IS A VERY COMMON PROBLEM AS PEOPLE GET OLDER WHEN THEY GET INTO THEIR 70’S AND 80’S.

ANYONE WHO WAS ON A BLOOD PRESSURE MEDICINE SHOULD HAVE A BLOOD PRESSURE CUFF, NOWADAYS, THEY CAN DETECT IF IT IS AN IRREGULAR HEART RATE, AND IF SOMEONE HAS AFIB, A LOT OF PEOPLE HAVE THESE APPLE WATCHES THAT CAN ALSO DETECT ATRIAL FIBRILLATION, I THINK IT IS IMPORTANT TO GET IT CHECKED OUT EVEN IF YOU’RE NOT HAVING SYMPTOMS BECAUSE YOU MIGHT NEED TO BE ON A BLOOD THINNER TO PREVENT STROKE.

THAT IS A BIG DEAL BE IF THE HEART RATE IS TOO FAST, OVER 100, YOU CAN DEVELOP HEART FAILURE.

THE ELECTROPHYSIOLOGIST’S IN TOWN ARE EXCELLENT IN TREATING THE HEART RHYTHM OF IT CONTINUES TO BE A PROBLEM IT IS DIFFICULT TO CONTROL.

DR. CHRISTENSEN: I COME FROM THE DAYS OF RHYTHM CONTROL.

NOW THE GOAL IS TO GET RID OF THE RATE -- THE RHYTHM, TO GET BACK TO A NORMAL RHYTHM.

>> AS MUCH AS YOU WANT TO RESTORE IT, GETTING BACK TO NORMAL RHYTHM IS DOUBLE.

-- IS THE GOAL.

DR. CHRISTENSEN: SOMETIMES MY BLOOD PRESSURE IS 160 OVER SOMETHING BUT SOMETIMES THAT IS 85 OVER SOMETHING, WHAT IS MY NORMAL BLOOD PRESSURE AND WAS THE DIFFERENCE BETWEEN THE DIFFERENT TIMES I THINK IT?

>> IS A GREAT QUESTION.

IT’S REALLY IMPORTANT TO SIT FEET FLAT ON THE GROUND, NOT LOOKING AT THE NEWS, SOCIAL MEDIA THESE DAYS, I RECOMMEND PEOPLE TAKE IT IN BOTH ARMS AND TAKE THE LOWER OF TWO READINGS, SOMETIMES OUR NATURAL -- SOMETIMES THERE ARE NATURAL FLUCTUATIONS THROUGHOUT THE DAY, IF YOU HAVE BEEN EXERCISING, IF YOU’VE HAD COFFEE, THOSE TYPES OF THINGS.

I DON’T REACT TO ONE BLOOD PRESSURE TO MAKE A DIAGNOSIS OF HYPERTENSION.

YOU HAVE TO HAVE THREE DIFFERENT BLOOD PRESSURES THAT ARE ELEVATED OVER A COUPLE WEEKS’ TIME.

THEN AGAIN LIFESTYLE IS THE FIRST LINE BUT DO NOT BE ALARMED IF THERE IS ONE ABNORMAL READING.

IT’S ABOUT A TREND MORE THAN ANYTHING.

>> YOU SAID PEOPLE SHOULD MANAGE OR MONITOR BLOOD PRESSURE AT HOME -- THERE’S SOMETHING CALLED WHITECOAT HYPERTENSION WHERE PEOPLE GO INTO THE DOCTOR’S OFFICE AND THEY’RE WORRIED THEY WILL HEAR BAD NEWS SO THEY GET ANXIOUS, BLOOD PRESSURE GOES UP BUT WHEN THEY MONITOR IT AT HOME IT IS A NORMAL RANGE, PEOPLE OVER 40 OR 50 SHOULD HAVE ACCESS TO A HOME BLOOD PRESSURE CUFF, THEY NEED TO KNOW THAT THEY ARE TAKING BLOOD PRESSURE APPROPRIATELY, SITTING ON THE FLOOR SITTING FOR FIVE MINUTES BEFORE THE JACKET, WRITE IT DOWN AND BRING IT TO THE NEXT DOCTOR’S APPOINTMENT.

>> WE CAN SPEND SO MUCH TIME MAKING SURE THAT THE TECHNIQUE IS DONE PROPERLY AT HOME BUT IT IS IMPORTANT, BOTH FEET FLAT ON THE FLOOR, THE CUFF AT THE LEVEL OF THE HEART, THE ARMS ARE RELAXED AND SUPPORTED RATHER THAN HELD, FIVE MINUTES OF REST, REST FOR THREE TO FIVE MINUTES AFTER YOU PUT THE CUFF ON BEFORE YOU PUSH THE BUTTON -- EXACTLY RIGHT.

>> IF WE ARE GOING TO ADD EXTRA MEDICATIONS, THE SIDE EFFECTS CAN BE LOW BLOOD PRESSURE, THE ELECTRONICS IN THE KIDNEY, WE DON’T WANT TO OVERMEDICATED WE DON’T NEED TO.

WE WANT TO GET ACCURATE NUMBERS.

IF YOU ARE A DIABETIC ON INSULIN, YOU NEED TO BE CHECKING YOUR BLOOD SUGARS.

A PATIENT WITH HIGH BLOOD PRESSURE, IT’S A GOOD IDEA TO HAVE A BLOOD PRESSURE CUFF.

DR. CHRISTENSEN: HIS HEART DISEASE HEREDITARY -- IS HEART DISEASE HEREDITARY?

>> YES.

ATRIAL FIBRILLATION IS HEREDITARY.

HIGH BLOOD PRESSURE CAN BE HEREDITARY.

FOR SHORT CHOLESTEROL.

THERE IS FAMILIAL HYPERCHOLESTEROLEMIA, INHERITED.

USUALLY A PROBLEM WITH THE LDL RECEPTORS AND THE LIVER AND YOU CAN HAVE EXTREMELY HIGH CHOLESTEROLS, LDL’S IN THE 200 TO 500 RANGE -- THAT CAN LEAD TO HEART ATTACKS AT A YOUNG AGE.

PEOPLE IN THE 40’S AND 50’S.

-- THERE 40’S AND 50’S.

>> BUT HEART DISEASE IS NOT INEVITABLE.

THERE’S A LOT OF MODIFIABLE RISK FACTORS FOR HEART DISEASE.

YOU ARE STUCK WITH YOUR GENETICS WHAT YOU CAN EAT A HEALTHY DIET AND MAINTAIN A HEALTHY WEIGHT.

DR. CHRISTENSEN: HOW MUCH EXERCISE?

>> THE AMERICAN HEART ASSOCIATION WOULD SAY WE SHOULD ALL BE GETTING 30-60 MINUTES OF PHYSICAL ACTIVITY EVERY DAY AND STRENGTH TRAINING EXERCISES TWICE A WEEK.

THE EVIDENCE SUGGESTS THAT WOULD BE IDEAL.

DR. CHRISTENSEN: SO STRENGTH TRAINING AND FREQUENT AEROBIC TRAINING IS THE IDEAL.

IT’S A LOT TO ASK FROM EVERYBODY.

>> IF YOU INCORPORATE IT INTO YOUR DAILY ROUTINE, IT IS A LOT EASIER.

I WAS TALKING TO SOME OF MY COLLEAGUES WHO WORK FROM HOME A COUPLE DAYS A WEEK -- WHEN I WORK FROM HOME, I MAY BE ONLY GET 1000 OR 1500 STEPS.

YOU ARE NOT INCORPORATING STEPS INTO YOUR DAILY ROUTINE -- IT IS REALLY HARD.

WE GENERALLY SAY TO GET THAT HALF-HOUR 8000 TO 10,000 STEPS IS WHERE THE SWEET SPOT IS JUST WALKING, IF YOU ARE NOT LEAVING YOUR HOUSE IN THE DAY, IT IS HARD, YOU JUST HAVE TO WALK BACK AND FORTH A LOT OF TIMES TO GET 8000 STEPS.

>> I WILL ADD ONE THING ABOUT EXERCISE, PEOPLE NEED TO FIND A TYPE OF EXERCISE THEY LIKE TO DO.

IF YOU LIKE TO DO IT AND YOU LOOK FORWARD TO IT AND YOU MAKE TIME IN YOUR DAY FOR IT, IT’LL HAPPEN.

IF YOU DON’T ENJOY IT, IT IS EASY TO NOT FIT IT INTO YOUR DAY.

>> AND THE OLDER WE GET, FINDING MORE THAN ONE THING YOU LIKE TO DO BECOMES IMPORTANT, CROSSTRAINING SAVES JOINTS.

>> YES, DEFINITELY.

TRY TO INCORPORATE IT, PARK FURTHER AWAY WHEREVER YOU ARE GOING AND ALWAYS TRY TO TAKE THE STAIRS, THAT’S THE EASY WAY TO GET EXTRA STEPS IN, AND TRYING TO GO TO THE BATHROOM THAT IS A LITTLE FURTHER AWAY, SOME WAYS TO INCORPORATE MORE ACTIVITY INTO YOUR DAILY ROUTINE.

DR. CHRISTENSEN: WHAT ARE CAUSES OF AND WHAT IS TOO LOW OF A BLOOD PRESSURE?

>> THE DEFENSE, PEOPLE WHO HAVE HEART FAILURE, WE ROUTINELY ARE USING NOTABLE BLOOD PRESSURE MEDICINES TO LOWER BLOOD PRESSURE, SYMPTOMS INTO THE TOP NUMBER IN THE 80’S, AS LONG AS THEY ARE NOT LIGHTHEADED OR DIZZY WE WILL CONTINUE THE HEART FAILURE MEDICATIONS BECAUSE WHEN THE HEART IS WEAK, IT’S BETTER FOR IT TO BE BUMPING AGAINST THE LOWER PRESSURE.

BUT SOME PEOPLE GET LIGHTHEADED AND DIZZY OF THE TOP NUMBER IS IN THE 90’S OR THE 100.

IT DEPENDS ON THE PERSON.

>> ESPECIALLY IN OLDER PEOPLE, PROBABLY THE MOST COMMON CAUSE OF LOW BLOOD PRESSURE IS MEDICATIONS, PERIODIC MONITORING IS IMPORTANT.

>> THAT’S LIKE TAKING BLOOD PRESSURE STANDING UP IS IMPORTANT SOMETIMES, TOO.

-- WHY TAKING BLOOD PRESSURE STANDING UP IS IMPORTANT SOMETIMES, TOO.

DR. CHRISTENSEN: WHEN DOES BRADYCARDIA BECOME A CONCERN AND WHAT IS IT?

>> THAT’S ON THE HEART RATE IS VERY SLOW USUALLY BELOW 60 BUT WE USUALLY GET CONCERNED WHEN IT IS IN THE 30’S AND 40’S, SOMETIMES IT CAN BE DUE TO A PROBLEM WITH COMMUNICATION FROM THE TOP TO THE BOTTOM OF THE HEART, SOMETHING CALLED THE HEART BLOCK, IT WOULD BE FIXED WITH A PACEMAKER, USUALLY IF YOU’RE FEELING FATIGUED OR TIRED, IF YOU ARE HAVING SYMPTOMS OF DIZZINESS, PASSING OUT, THOSE ARE REALLY CONCERNING FINDINGS IN SOMEONE WHOSE HEART RATE IS SLOW, SOMETIMES IT IS REVERSIBLE AND WE CAN STOP THOSE MEDICINES AND IT WILL COME BACK UP BUT IF IT DOES NOT COME BACK UP, OFTEN PEOPLE NEED A PACEMAKER.

>> BRADYCARDIA CAN ALSO BE A SIGN OF A HEALTHY HEART IF SOMEBODY IS EXERCISING ALONE, LIKE THEY ARE A TRIATHLETE OR A MARATHONER, THEIR HEART RATE CAN BE IN THE 30’S AND 40’S AND THEY DON’T HAVE ANY SYMPTOMS.

>> ESPECIALLY DURING SLEEP.

DR. CHRISTENSEN: WE HAVE TOUCHED ON THIS LITTLE BIT, WHAT HEART EVENT IS ASSOCIATED WITH LEFT INTERIOR VESICULAR BLOCK?

I DON’T HAVE AN ANSWER BUT I’M LOOKING?

-- BUT I’M LOOKING.

>> I WOULD SAY A SMALL HEART ATTACK COULD CAUSE THAT BUT THAT IS NOT -- >> DO A LOT OF SCREENING.

EKG’S FOR EVALUATIONS IN PRIMARY CARE.

THE ELECTROCARDIOGRAM CAN READ SOMEONE IS HAVING A HEART ATTACK AND WE OFTEN HAVE TO OVER READ THOSE EKG’S AND CORRECT THESE FINDINGS THAT THE COMPUTER THINGS ARE ABNORMALITIES.

SOMETIMES IT HAS TO DO WITH REPLACEMENT.

BUT IF THE COMPUTER IS READING IT, I WOULD GET REPEATED AND GET AN ECHOCARDIOGRAM TO SEE IF THERE’S BEEN ANY OTHER CONDUCTION ISSUES -- IF THE ECHOCARDIOGRAM LOOKS NORMAL, I WOULD NOT WORRY TOO MUCH ABOUT THAT ISOLATED FINDING ON AN EKG.

DR. CHRISTENSEN: THE SOURCE OF THE QUESTION WAS SOMEONE SIDE ON THEIR EKG READING, IT WOULD BE IMPORTANT TO HAVE A DISCUSSION WITH THE DOCTOR AND THE PERSON’S CONTEXT I WOULD SAY, IT IS SUCH A COMMON PHRASE ON A COMPUTER EKG READING, IT IS USUALLY NOT A CONCERN.

WHEN DOES AN IRREGULAR HEART RATE BECOME A CONCERN?

YOU ARE JUST A PERSON OUT THERE WITH AN IRREGULAR HEART RATE.

AND YOU CAN JUMP IN ON THIS ON -- ANYONE OF YOU CAN JUMP IN ON THIS ONE.

>> IT IS NORMAL TO HAVE AN OCCASIONAL SKIPPED HEARTBEAT FROM THE TOP OR BOTTOM OF THE HEART.

SOME PEOPLE FEEL EVERY SINGLE SKIPPED BEATS.

SOME PEOPLE HAVE NO IDEA THEY ARE GOING ON.

IT DEPENDS ON HOW OFTEN IS HAPPENING AND FOR HOW LONG.

IF IT IS GIVEN FOR A LONG DURATION, THAT COULD BE A SIGN OF A TRUE FIBRILLATION AND THAT IS MORE SERIOUS THAN SOMETHING CALLED PVC’S, PREMATURE VENTRICULAR CONTRACTIONS.

>> THE SOURCE OF THE REGULARITY IS IMPORTANT AND WE HAVE TO MEASURE IT AND OBSERVE IT TO SEE WHAT THAT SOURCE IS, SO MANY PEOPLE HAVE THOSE PREMATURE VENTRICULAR CONTRACTIONS, SOME CANNOT FEEL THEM, SOME CAN AND IT IS BOTHERSOME, THEY ARE USUALLY NOT HARMFUL BUT KNOWING IF THEY ARE HAPPENING IN SEQUENCE OR IN CERTAIN PATTERNS OR IF THE REGULATORY IS A DIFFERENT RHYTHM LIKE A TRUE, THAT IS IMPORTANT TO KNOW ABOUT -- ATRIAL FIBRILLATION, THAT IS IMPORTANT TO KNOW ABOUT.

>> THERE ARE A LOT OF WEARABLE DEVICES THAT YOU CAN BUY A TARGET OR BEST BUY, A LOT OF THESE SMART WATCHES HAVE A SINGLE LEAD EKG THAT CAN DETECT ATRIAL FIBRILLATION.

THEY HAVE ALGORITHMS TO DO THAT.

IF IT’S SOME OF THESE OTHER THINGS, IT WILL SAY AND AND YOU CAN BRING THOSE TRIPS TO YOUR DOCTOR TO REVIEW.

THAT CAN BE HELPFUL TO KNOW WHAT’S GOING ON WITH YOUR HEART.

DR. CHRISTENSEN: ARE YOU ALL SUPPORTIVE OF SOME OF THE NEW DEVICES, THE WEARABLES?

>> I THINK IT’S GREAT, THE ISSUE IS HOW TO DEAL WITH ALL THIS INFORMATION OVERLOAD ON THE HEALTH SYSTEMS THAT BE A GOOD BUT EMPOWERING PATIENTS TO TAKE RESPONSE ABILITY FOR THEIR HEART AND BLOOD PRESSURE AND AFIB IS REALLY IMPORTANT TO MAKE SURE IT’S UNDER BETTER CONTROL.

>> ESPECIALLY DETECTING EACH OF HER RELATION WHICH IS COMMON, WHICH IS IMPORTANT TO KNOW ABOUT, THOSE DEVICES HAVE FOUND CASES THAT WE DON’T.

DR. CHRISTENSEN: WHAT IS A NORMAL TO OPEN -- NORMAL TROPIN?

IS 55 CONCERNING?

>> THERE ARE SOME PEOPLE WHO HAVE CHRONICALLY ELEVATED TROPONIN, IF THEY ARE NOT HAVING ANY SIGNS OF CHEST PAIN OR CHEST TIGHTNESS OR PRESSURE OR SHORTNESS OF BREATH, ANYTHING THAT WOULD SUGGEST THEY ARE HAVING A BLOCKED ARTERY OR HEART ATTACK, I WOULD NOT WORRY TOO MUCH ABOUT IT.

DR. CHRISTENSEN: HUTCH OR RYAN, OHIO HDL -- HOW HIGH HDL CHOLESTEROL IS TOO HIGH?

>> I THINK THE HIGHER THE BETTER.

HDL PARTICLES REMOVE THE BED -- BAD LDL PARTICLES FROM YOUR BLOOD.

I THINK IT IS FOR YOUR BENEFIT BE I’VE NEVER SEEN A CASE WHERE IT IS TOO HIGH.

>> I HAD A CASE WHERE IT WAS 140 AND THEY HAD HIGH LDL AS WELL BE I THINK IT WAS A GENETIC ISSUE.

THEY ENDED UP HAVING HEART PROBLEMS.

IN GENERAL THE HDL IS PROTECTIVE BUT YOU CANNOT IGNORE THE LDL.

EVEN IF YOUR TOTAL NUMBER IS HIGH BECAUSE YOU’RE HEALTHY CHOLESTEROL IS GOOD, YOU STILL NEED TO GET THE LDL ON DURABLE -- ON DURABLE WHICH IS LESS THAN 100 AND IF YOU HAVE DIABETES OR A HEART EVENT, LESS THAN 70 IS IDEAL.

>> LDL IS THE ONE WE TALK ABOUT WITH OUR PATIENTS BECAUSE WE HAVE MEDICINES THAT CAN LOWER IT THAT ARE QUITE EFFECTIVE AND WELL TOLERATED.

DR. CHRISTENSEN: THE USE OF ASP IRIN.

>> DEPENDS ON THE PATIENT.

IT USED TO BE ACROSS THE BOARD.

IF YOU’VE NEVER HAD A HEART ATTACK, THE USE OF ASPIRIN IS COMING INTO QUESTION.

BUT SOME PEOPLE WE WOULD RECOMMEND THEY TAKE AN ASPIRIN EVERY DAY.

THAT IS A CONVERSATION EACH VERSION SHOULD HAVE WITH THEIR DOCTOR -- PERSON SHOULD HAVE WITH THEIR DOCTOR.

>> USE ORDINARY ARTERY -- WE DO CORONARY ARTERY CALCIUM SCANS NOW.

THEY ARE IN A HIGHER GROUP.

DR. CHRISTENSEN: WE NEED ANOTHER HALF HOUR.

THERE IS A LOT HERE.

THANK YOU VERY MUCH.

I WANT TO THANK OUR PANELISTS, DOCTOR CATHERINE BENZIGER, DOCTOR RYAN HARDEN AND DOCTOR DAVID HUTCHINSON, AND OUR MEDICAL STUDENT VOLUNTEERS, ELLIE GAMRADT, ALEXANDRA REVIER, AND WYATT WINDHORST.

NEXT WEEK, PLEASE JOIN DOCTOR MARY OWEN FOR A PROGRAM ON UPPER GI PROBLEMS, WHEN HER PANELISTS WILL BE DOCTOR JONATHAN GAPP, DOCTOR KRISA KEUTE, AND DOCTOR DYLAN WYATT.

THANK YOU FOR WATCHING AND GOOD NIGHT.

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