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 FondeLac Band.

and I'm your host for our episode tonight on heart and vascular problems from coronary disease and valve issues to high blood pressure as well as how they're diagnosed, prevented and treated.

The success of our program is very dependent on you the viewer.

So please call in your questions or send them to our email address at askpbsnorth.org.

Our panelists this panelists this evening include Dr.

Dr.

Katherine Benziger, a board-certified cardiologist and director of heart and vascular research with Essentia Health in Duth where she leads advanced cardiovascular care and clinical research.

And Dr.

Scott Mel, an interventional cardiologist with Aspirus at St.

Luke's Aspirus St.

Luke's Cardiology Associates in Duth where he provides advanced health care, heart care, and cardiovascular treatment to patients in the region.

Our phone volunteers tonight are Andrew Tisher from Wheaten, Minnesota, Katie Sherman from Duth, Minnesota, and Payton Schultz from Carver, Minnesota.

They're standing by to answer your calls.

And now on to tonight's program on heart and vascular problems.

I think I should have practiced that one, huh?

You did great.

Welcome to both of you.

And uh Dr.

Benziger, you asked me to ask you why you're wearing red tonight.

Well, February is the American Heart Association Heart Month, and we try to raise awareness among women's heart disease.

Tomorrow, the first Friday in February is Go Red for Women Day, and we encourage everyone to wear red to raise awareness around heart disease and women.

Good.

Anything to add to that, Dr.

Michael?

Completely agree.

I didn't wear red.

Clearly, you don't doubt her training on this one.

What's that?

You don't doubt her training on that answer?

Uh, no.

I I support Go Red and actually have led the uh the fundraisers and whatnot back in Iowa City.

So, excellent.

It's an excellent cause.

Why the emphasis on women?

Well, a lot of times we think about heart attacks being in men, kind of an elephant sitting on my chest and sort of a man's heart attack.

And a lot of times, you know, women have different symptoms and we want to raise awareness around uh women having maybe uh more subtle chest discomfort, maybe some jaw pain, shortness of breath.

A lot of times they experience fatigue.

uh they don't realize that their maybe symptoms are are that of a heart attack.

And uh and while chest pain and chest discomfort still is the primary symptom that people will have if they're having a heart attack, uh we know that women's outcomes are worse.

Usually they present later, they don't get as aggressive therapy.

They don't get recognized in the emergency room and they don't get, you know, Dr.

Mike and the interventional cardiologists to treat them as quickly as uh male counterparts.

Excellent.

So it's good not only for the patients to know that but all the people who live with them and yeah because they come across it.

Before we started we're waiting for some questions from the audience but before we started you were mentioning how busy you both are as cardiologists.

Are you more busy than usual or the same amount of busy and why is that?

You know with the aging population and people just living longer they tend to have more heart problems as they get older.

Uh later this month is also valve disease awareness month and uh we see a lot of people in this region who have like aortic stenosis and and get valve replacements.

There's four heart valves in the heart and they can all have you know problems and and used to be people used to have to have open heart surgery to fix that and now we have a lot of uh less invasive uh therapies where we can go in uh through the blood vessels and and fix the heart valves uh in a less invasive approach.

And so valve disease is a huge problem and and a big cause of business in our area.

Heart failure we were talking about is a main contributor to hospital admissions in this area.

Uh people have heart rhythm problems like atrial fibrillation and then of course heart attacks.

Anything to add Dr.

Mel?

No I completely agree.

It's um you know everybody has a heart and actually it's interesting that yes that as the population ages you see more and more but I don't know interestingly over the years it seems younger patients are now starting to come in more frequently as well.

I don't know if that's lifestyle issues or um you know genetics or whatever.

Have you earlier recognition stuff like that and whether that's valve or coronary disease kind of run-of-the-mill stuff but uh um you know it's all it's omnipresent it's all the time in the ERS and in our clinics.

So what's your gut tell you tell you it is?

You said you're not sure if it's genetics or lifestyle.

I think I think it's all the above.

And I, you know, part of what we were talking about earlier was um substance abuse, specifically in relations to congestive heart failure.

And one of the things that's uh pretty pretty prominent and and frequent right now is methamphetamine induced um heart issues that her and I both encounter at both hospitals frequently.

And that's that's an induced thing.

But you know when you take it take into consideration smoking, vaping, all of the other things that get into all of them have some sort of effect on the heart whether it be rhythms or uh the heart arteries or even vascular you know or peripheral vascular issues.

I still see smoking being a huge problem in our communities uh in in some of the Iron Range you know communities.

People tell me they start their uncle gave them a cigarette at age seven.

They start smoking regularly age 12 and they've been smoking you know for a few decades.

And so then they come in in their 40s and 50s with heart attacks.

And I think that to me is still a major risk factor that we have not um been able to get under control.

And then in addition uh the obesity epidemic over the last 20 30 years has uh really contributed to more high blood pressure, high cholesterol, diabetes and all of those risk factors set people up for having heart failure and coronary disease.

I was going to add that diabetes in particular in the younger population and then how quickly you know that uh pushes this.

It's almost like pouring kerosene on a fire.

And so it's already the fire is already there.

It's just you accelerate it that much.

So the hard part is is so many people they don't because diabetes is a silent is so silent.

They don't even understand the inflammation that's going on in their body and the worsening of their vessels.

Yeah.

Regarding the smoking, it's actually smoking's uh on the decrease has been on the decrease, but the obesity is going up.

Right.

So yeah, I I think over time smoking continues to slowly go down.

It's still the prevalence of smoking is still 14 15% across Minnesota and and and I'll say that is one of the biggest contributors to these heart attacks that we see in young people.

It's people who have high cholesterol and then have another risk factor like smoking or diabetes uh is what you know and and a lot of times they have young children, young families having a significant event.

Sometimes people when they have a heart attack they don't make it to the hospital.

They present with something we call sudden cardiac arrest and and you know they can really that can be really devastating for a family.

Absolutely.

Agreed.

Okay, we got a question.

Can you and Dr.

Mikeell, I'm going to ask you, can you talk about why CPR and public AED use and access is so important?

Oh, uh, well, if you look at the data, uh, people that have heart attacks in the community, uh, 50% never make it to us and that data hasn't really been updated, um, as of late and really hasn't changed.

It's true.

We assume that 50% of people that have heart attack or a dysriythmia fatal dysriythmia at home won't make it to the hospital at all.

uh the one thing that the the singular intervention that has been made even in my career here in Duth is the uh distribution of AEDs and then CPR training in the community because doing high quality CPR in that moment even between the time that somebody arrests and the time that EMS arrives is paramount and the brain will survive the heart you know will peruse if you do high quality CPR and then if you add the AED into it and it's a shockable rhythm it's even that much more important and life-saving We I say this frequently at work.

I'm no good without my tools.

And so in the community that I'm the same way.

I can do CPR and I can do I can use an AED, but other than that, I don't serve much of a purpose.

It's when we get the patient to the hospital, that's the point.

We have to get them to the hospital first to be able to take care of that.

I think everyone can do hands only CPR.

Uh the American Heart Association has some great videos on how to do hands only CPR.

Some people are worried about giving mouthtomouth.

That's no longer the recommendation.

Most of the cardiac arrests are from the heart and they just need that to pump on the the chest.

The new Bad Bunny song apparently is the just like Staying Alive is the right rhythm.

Uh so you can uh whatever pick your song, but it's about 100 beats a minute is the is the rhythm that you need uh for providing CPR.

CPR, you can watch the Super Bowl this weekend.

Yes, that's right.

Get the rate down.

Uhhuh.

Yep.

And learn CPR.

That's right.

No, but but they've really simplified CPR.

So I would encourage people I mean it's easy to encourage people to learn it.

Absolutely.

And usually the rate limiting step is exactly as she says that the was people are scared of the rescue breathing.

Yeah.

So the hands on the chest.

Yep.

Absolutely.

All right.

Uh one of our viewers asked I noticed tacoc cardia two weeks postcoid booster shot about three to four minutes at a time.

Is there a correlation I'll ask this one to you Dr.

Benziger and then Dr.

Masel.

Is there a correlation between that is studied with COVID booster and tacocardia?

That is an excellent question.

I do not know if there's uh any randomized trials looking at the COVID boosters or any vaccines and arrhythmias.

I can tell you a lot millions of people have received all of you know the viral uh vaccines both influenza and covid and we per I personally haven't seen a increase in people complaining about it but it is pretty typical that people have arrhythmias these fast heart rhythms that are benign meaning they're not life-threatening.

Uh we put halter monitors um to try to detect these heart rhythms if people are experiencing palpitations or fast heart rates to make sure they don't have you know more concerning heart rhythms like atrial fibrillation which can increase your risk of having a stroke or these fatal ventricular arhythmias that we talked about.

Uh and so but a lot of times it just ends up being something kind of benign and if it only lasts a couple minutes we don't usually worry too much about it.

Anything to add Dr.

Maxel?

Uh I would agree with that.

I mean there's the small small small infantile risk of myocarditis that actually has been proven typically in the younger population and teenagers that's not um generally in the adult population.

Um and I haven't read anything that's really truly associated in that regard.

Um all vaccines carry some sort of you know risk of something but the benefit always far outweighs the risk of any of that business.

um and with the understanding that these vaccines are working in a way that helps uh prevent severe disease.

It doesn't prevent all disease, but it prevents or lessens the risk of very severe disease.

And that's that's why we all recommend these things because our patients in particular are very susceptible to RSV, flu, COVID, and to decrease the risk of severe disease, not the actual infection, but again, severe disease is the focus and the and the most paramount point in that regard.

Definitely.

I think the viral illnesses are really stressful on the body and when you have a weak heart muscle or any of these underlying heart conditions, it's very difficult for the heart to kind of keep up and be able to fight those infections.

Thanks for that point.

I didn't think to talk with my patients as much about that with the co the importance of the co vaccine.

Additionally though, we just don't even know all that co's going to do in the future.

I mean, we haven't seen it all yet.

Hasn't been studied long enough.

I mean fortunately the current strains uh that went around this winter were much weaker than the ones we saw obviously five years ago.

Uh influenza was uh very very bad this year and we had uh it entire wards of p you know flors of patients with very very sick with influenza A. So I I think I agree we recommend strongly for all of our heart patients to get vaccinated every year.

Absolutely.

Excellent.

Thanks.

All right.

Are there stress tests that do not involve metal?

patient has a metal allergy to all metals and can't under undergo diagn diagnostic tests that have metal there.

You know, the standard stress test uh is just somebody walking on a treadmill and if you have a normal EKG and you're you can walk, you know, three, four, five blocks.

Uh the regular treadmill exercise trust test is an option for anyone and does not require any metal.

Often we get an inconclusive answer or people aren't able to exercise long enough to get their heart rate to the level that they need to make it a diagnostic test like usually 130 140 beats a minute.

And so then we add imaging or or nuclear medicine or other uh imaging.

There's also um stress MRI which you know is performed at some centers and and then fancier PET scans and things uh that look at the heart muscle.

the you know for many years the plain old treadmill exercise test was sort of the test of choice for determining if someone's symptoms were related to their heart or not and that's always an option uh to start with.

Okay, agreed.

All right.

Can you talk about broken heart syndrome?

Yeah.

Um so originally it was described in Japan and which is where the traditional name takubo comes from.

um over my career and and it's evolved into basically what it comes down to is the heart reacts uh improperly or kind of um uh in a very dramatic way to a sudden surge of adrenaline.

And so the it was tied to u you know a loved one their family member died in front of them and that was how it was first described but actually any stressful event and sometimes just acute illness can lead to a bro bro bro bro bro bro bro bro bro bro bro bro bro bro bro bro bro bro bro bro broken heart syndrome or takasuba cardiammopathy generally it's reversible um there are very specific medications that we use to treat that the interesting part about takubo at least from my point of view is that the heart actually um never fully normalizes even though the function of the heart can normalize but it never really normalizes um if you look at it kind of from a microscopic point of view.

Um this has been demonstrated in cardiac MRI and so those medications that we prescribe actually turn out to be more and more important to continue long term despite the function normalizing and then once a patient has it they're more predisposed to have it again and so we have to keep that in mind.

So typically my patients that have that I see them in clinic or we have them follow up annually after they get over the thing.

But the my my counseling revolves around it's probably pretty important that you continue to take the medicines that we gave you in the time period to allow your heart to heal up.

It's also to try to prevent this from happening again and maybe not as severely.

Are they predisposed to all heart conditions like heart attacks everything?

Well, not necessarily.

I mean you typically to be honest you know txubo patients usually get a coronary angiogram at the time of the because the most likely cause of their heart failure because they'll be presenting with heart failure.

The most uh uh common cause would be coronary disease.

So they get uh any typically an antiogram at that time their ECGs tend to be pretty abnormal.

Um but we document you know what do they have coronary or not and often I mean we find it because a lot of patients tend to be a bit elderly and and but that's kind of bystandard disease or stable disease relative to the actual uh takubo piece or the broken heart syndrome piece and we'll treat both depending on what the scenario is.

What it predisposes patients more to is just this this having this recur and each time it's could be worse and worse depending on whether they were taking their medicines.

They're also predisposed to dysriythmias depending on how bad the the cardiamopathy actually turns out to be and and this I think generally happens a little bit more in women.

So again looking at you know February being women's heart disease month is a condition that does tend to affect women more uh significantly.

I have I have one patient who's had it three times.

Wow.

And I think stress uh how you deal with stress is really important and making sure that uh you're you managing stress and and having um you know these are usually very stressful events like the death of a loved one um major life events but they can happen on more minor occasions as well and so having good coping mechanisms is really important.

So as usual harder on people that don't have adequate housing jobs all so some people are vulnerable.

One of my most memorable patients had it at a Twins game.

So that if that says anything about the Minnesota Twin, I don't know, but it's but it's true.

Okay.

What does the Watchman procedure do?

Oh boy.

We could share this.

All right.

So, so I think the the Watchman procedure is a um it's a special device that goes in the heart called the left atrial appendage to help reduce the risk of stroke for patients who have uh atrial fibrillation which is a rhythm we talked about that is more of a nuisance rhythm but can increase your risk of stroke depending on what your risk factors are.

And generally speaking people should be on a blood thinner like uh something like uh Eloquis or Zorelto or Warerin.

But there are people who have bleeding issues or can't be on it and a watchman is a procedure that is an alternative to be on antiquagulation.

Yeah.

And the studies would show that basically it's at least equivalent to the antiquagulants um and and may be better.

There's trials, research trials that are going to be published actually are presented at ACC in March in particular um that is comparing this very specific question is is it better is it not everything up until the point this point is asked as if it is the same from a stroke risk point of view.

Um typically the traditionally we reserve this procedure for people who have excessive bleeding risk.

It's kind of morphed over the last few years into patients that are a little bit more lifestyle oriented.

So frankly, lots of my patients that um you know do heavy duty downhill skiing or from a job point of view taking an anquagulin is actually possibly life-threatening.

Lumberjacks come to mind, you know, things like that or work on the ships and and we will put a watchman in for patients like that that we've kind of honed in and said, you know what, while you haven't had any bleeding events, overt bleeding events, you know, your lifestyle is such that you're really at high risk for trauma or something like that.

and then we will um which is a nice option um for for those patients.

It's not for everybody but it it certainly is a nice uh tool to you know in our in our toolbox for those for our patients.

There are some patients who are very very high risk of of having strokes and um you stop their antiquagulation within three days they have another stroke and so we're actually doing a research study right now looking at putting in a watchman it's called the Laos for study in addition to being on antiquagulation versus just antiquagulation alone.

So I think there's still a lot we're learning about watchmen and anticulation and kind of who's the best population that would benefit.

But definitely you're probably hearing and seeing more of of it because atrial fibrillation is very common in people as they get older.

Yeah.

There there's actually a trial that was just uh published um right before Christmas right around Thanksgiving uh out of Germany that highlighted that very point and that the very very high-risisk patients um uh when you put a watchman in um have the same basically the same rate but high rates of stroke and what that taught us or we should take the message is is that this is a systemic disease.

It's not just one anatomic structure that we're putting the plug in.

Now for most patients that's okay but that'll be a very interesting trial to see the uh the results of.

So all right speaking of atrial fibrillation what um this person has a daughter with cardiomyopathy and she has to have an ablation.

Would they'd like to know more information on ablation surgery?

Yeah ablation is a special procedure that our colleagues who specialize in the heart rhythm electrophysiologists perform.

They do this on a regular basis for people who have these arrhythmias specifically atrial fibrillation is the most common one.

Uh and they there also is a heart rhythm called atrial flutter and they can do uh they go in and they can kind of burn the part of the heart where these rhythms come from and uh and hopefully reduce the risk of recurrence.

Often people still need to be on anti-coagulation or or get a watchman if if they have high you know risk.

uh there is it's not always 100%.

Uh but I think it's it does if you're symptomatic with these heart rhythms and you're ending up in the ER a lot and getting cardio versions, I think usually we say more than once in in 12 months.

Uh probably earlier thinking about ablation earlier is better.

Okay, good.

That's true.

Yeah.

And we would you say that's true?

Yeah, she's telling I mean the thing is it's good for that she knows this stuff but she I've never known her to be wrong.

Um the issue is is that we used to use medications to try to control rhythms uh a little bit more aggressively than we do now.

And there's two reasons for that in my mind.

Number one, the the ablation procedure has become much more safe over the last say three five years something like that.

Certainly in the last two years and and the second piece of the puzzle is the medications are not without reasonable risk of in actually inducing other rhythms uh rather than just taking uh control of aphib.

And so it it it actually is a really nice tool, especially now that the risk has dropped enough that um you know, I feel more comfortable sending my patients for that sort of thing at a younger age and not just the the worst of the worst.

Um it is not 100%.

And that's the thing about the ablation procedure and I counsel my patients on it's even though they're very good at it, it's not 100% that it'll stick and sometimes they have to go back for kind of a touch-up procedure kind of how they describe it.

So good.

Yeah.

All right.

going to try to get through these questions for our audience.

PFO, what is it?

Is it genetic?

Uh, everyone is born with a a hole in their heart when they are in uterero so that the blood can go from the right side to the left side and usually it closes and a subset of patients it stays open throughout their life.

And if you have a recurrent strokes under the age of 60 and you're found to have this hole in your heart, there's a possibility that they would recommend closing that hole as a potential cause of of your strokes if they don't have any other cause.

Strokes in older people, uh we often will do an imaging procedure called a transissophageal echo to look for this and other causes of their possible stroke.

And you know in older adults is it's more likely at fibrillation I would say is the is the cause than than the PFO.

It's just it is a common thing but in young people uh there there are some patients where it could be problematic and need closure.

All right.

Yeah.

Up to 30% of the population have it.

Um it's a large amount.

And so what I counsel my patients on and talk to them about if you have a just because you have a PFO doesn't mean you're going to have a stroke.

And then there's anatomic features, physiologic features of a PFO that'll make you a patient more predisposed to have a a stroke.

And the age is really quite important in in that analysis.

Um but it's not traditionally thought of as a genetic condition.

To add on that I have heard of family clusters in that regard.

Um but it's not like we haven't figured out the gene.

We don't know anything about it.

It's just kind of sporadic and that the the fossil or fraalis didn't close.

Yeah.

So so don't always assume it's a genetic.

Yeah.

All right.

Here's a good one.

Does the cold weather pose an issue on heart health?

you know, when we have these really cold snaps that are, you know, well below zero.

Um, I do think that there is some vasoc constriction, right?

That happens when you go out in the cold and we definitely with the snow and people doing more heavy exertion outside in the cold see, I think like two to four days after uh definitely an uptick in people having chest pain and heart attacks and uh other symptoms.

So I think you have to just pay attention to your body and any symptoms you're having and talk to your doctor if uh going out in the cold has been causing you any chest discomfort.

I think it's twofold.

Um cold air in particular very very much causes vasa constriction and I see a increase in the patients that come back with anga not not heart attacks but anga um but then the the snow piece is is very important and typically that shows up in more November October November December when the people you know that haven't done any physical activity for you know a long period of time all of a sudden they're you know lifting 40 pounds of snow and they oh I can do it you know be that's where the heart attacks but it's kind of both um but it's it's an interesting phenomenon when we drop that cold that the engine just skyrockets and and it is really alarming to them and it really it's breathing the cold air in and usually usually I'm not saying you shouldn't see your doctor but usually it's okay and it's the cold air itself.

This might be the last one and a good one to end on.

Does cannabis use pose an issue to heart health?

I think there is increasing evidence that anything that you inhale and substances you put into your body are related to inflammation and can contribute.

Uh because it was a banned substance for a long time, we don't have as much robust research evidence like we do for tobacco.

Uh but I think everything in in moderation.

I the way I look at it is if you're inhaling smoke or some gas, that's bad.

Yeah.

You're changing their lungs.

Yeah.

And and and there's usually stimulants or other stuff in there.

Bad chemicals.

You don't know what's in it and it's dangerous for the vessels, dangerous for the heart and bad for the lungs.

All right, we are close 30 seconds to closing here.

Anything to add that you want your uh want the audience to know?

I think prevention is the key to staying healthy.

And so make sure that you talk to your doctor, know what your numbers are, your blood pressure, your cholesterol, your blood sugar, make sure you don't have diabetes.

Uh try to get 30 to 60 minutes of physical activity a day and then you'll never have to come see either one of us.

And you've um mentioned women.

We h we haven't we don't know enough about how heart disease or women aren't aware of how heart disease or heart attacks present in women, but men just don't go enough, do they?

Oh, you don't want my opinion on that.

We we we have frontal lobe issues sometimes.

So, I want to thank our panelists, Dr.

Scott Micasel and Dr.

Katherine Benziger.

Please join doctors on call next week where Dr.

Dr.

Ryan Harden will be joined by regional experts for a panel discussion about common upper and lower gastrointestinal re diseases from reflux and swallowing issues to gallbladder, liver, and bowel disorders with an emphasis on prevention, diagnosis, and treatment with a panel of experts from around the region.

And if you're looking for more tips, tricks, and conversation around health and wellness in the Northland, make sure to check out Northern Balance on PBS North YouTube channel.

Thank you for watching and for joining us for season 44 of Doctors on Call.

Good night.