Changes in Treatment of Heart Diseases | On Call with the Prairie Doc | February 14, 2019

Changes in Treatment of Heart Diseases | On Call with the Prairie Doc | February 14, 2019

August 16, 2019 0 By Bertrand Dibbert


>>IT SOMETIMES SEEMS LIKE CHANGES IN HEALTHCARE ARE MOVING AT THE SPEED OF LIGHT. WE SLOW THINGS DOWN A BIT AND LOOK AT “CHANGES IN TREATMENT OF HEART DISEASES.” IT IS OUR VALENTINE’S GIFT TO YOU, TONIGHT, “ON CALL WITH THE PRAIRIE DOC.”>>GOOD EVENING AND WELCOME TO “ON CALL WITH THE PRAIRIE DOC.” WE THOUGHT IT WAS APPROPRIATE TO HAVE A PROGRAM ABOUT QUESTIONS OF THE HEART ON VALENTINE’S DAY. FIRST, LET’S TAKE A LOOK AT THIS WEEK’S PRAIRIE DOC QUIZ QUESTION. PICK THE BEST ANSWER. WHAT IS THE MOST POWERFUL AT REDUCING VASCULAR AND HEART DISEASE PROGRESSION? 1) A STATIN CHOLESTEROL REDUCER. 2) A ONE-MILE WALK EVERY DAY. 3) AVOIDANCE OF FATTY FOODS LIKE EGGS AND BACON. 4) THE REGULAR INTAKE OF FISH OIL CAPSULE. OR 5) STOPPING SMOKING. VIEWERS WHO CALL IN THE CORRECT ANSWER WILL BE ENTERED INTO A DRAWING TO WIN A SIGNED COPY OF OUR BOOK, “THE PICTURE OF HEALTH.” EACH OF MY ESSAYS, ORIGINALLY WRITTEN FOR THIS SHOW, COMES WITH A WONDERFUL ACCOMPANYING PHOTOGRAPH BY DR. JUDITH PETERSON. WE WILL ANNOUNCE THE ANSWER AND THE WINNER AT THE END OF THE SHOW. REMEMBER, YOU ONLY HAVE 10 MINUTES TO GET YOUR ANSWER IN!>>>WE ANSWER YOUR QUESTIONS ABOUT HEART DISEASE AS THEY ARE CALLED IN OR SENT TO US VIA FACEBOOK OR EMAIL. CALL IN QUESTIONS TO 1-888-376-6225 OR SEND US AN EMAIL TO THE ADDRESS ON THE SCREEN. I’VE WRITTEN A SONNET FOR THE LOVE OF MY LIFE, MY WIFE. YOU SHOULD KNOW THAT GRADY IS THE NAME OF THE HOSPITAL IN WHICH WE MET, AND THE SIGN OF Q IS TO SAY THE PATIENT IS VERY SICK. HAPPY VALENTINE’S DAY, JOANIE. WHILE CHALLENGED ALL ABOUT THE GRADY LIFE AND LEARNING HOW TO LISTEN, HOW TO CARE, I LEARNED TO POKE WITH NEEDLES, SCALPEL, KNIFE, AND HOW TO TREAT SOMEONE IN DEEP DESPAIR. THE LECTURES, CHAPTERS, ESSAYS DO EXPLAIN HOW BEST TO BRING THE PATIENT BACK TO HEALTH. WHEN PATIENT COMES WITH HEART ATTACK AND PAIN, HOW ASTHMA, BOILS, AND CHILLS CAN STRIKE WITH STEALTH. SO, ON A CANCER FLOOR WITH SIGN OF Q, I MET A NURSING STUDENT ON THE WARD. SHE HAD A GOLDEN HEART. WAS KIND AND TRUE. WE SHARE OUR LIVES, OUR QUEST, A SMORGASBORD. DAKOTA SEASONS, CHILDREN, FOUR, BEST FRIEND.NO MATTER WHAT. OUR LOVE WILL NEVER END. WELL, ANYWAY, ENOUGH OF THAT. JOINING US TONIGHT ARE DR. BRUCE WATT AND DR. MICHAEL HIBBARD OF NORTH CENTRAL HEART IN SIOUX FALLS. THANK YOU, BOTH, FOR JOINING US.>>THANKS FOR HAVING US, RICK.>>VALENTINE’S DAY, THE HEART IS THE CENTER OF THE UNIVERSE, RIGHT? I MEAN, ISN’T IT THE MOST IMPORTANT ORGAN OF THE BODY?>>OF COURSE.>>ABSOLUTELY.>>I WOULD LIKE TO TAKE THIS TIME TO TALK TO MY — NO.>>YOU DID AWESOME. THAT’S INCREDIBLE FOR VALENTINE’S DAY. THAT WAS VERY GOOD.>>SHE MADE A GREAT SUPPER FOR US TONIGHT.>>AWESOME.>>I DIDN’T BUY HER CANDY. I SAID I WROTE HER A POEM.>>GREAT.>>SO YOU ARE BOTH GENERAL CARDIOLOGISTS OR VASCULAR CARDIOLOGISTS, I KNOW YOU’VE HAD A SPECIALTY IN VASCULAR WORK. HOW DO YOU DEFINE YOUR WORK?>>WELL, BOTH MIKE AND I ARE INTERVENTIONAL CARDIOLOGISTS, MIKE, MY INTERVENTIONAL TRAINING CAME OUT OF THE MAYO CLINIC AND DID AN INTERVENTIONAL YEAR. BACK IN THE OLD DAYS THERE WAS ONLY A FEW PLACES THAT WERE DOING THAT, AT THE UNIVERSITY OF WISCONSIN, WHERE I WAS, THEY DIDN’T HAVE THAT, SO WE KIND OF TRAINED AND DID IT THERE BECAUSE WE DIDN’T HAVE INTERVENTIONAL. BUT THEN PROGRESSED IN IT, LEARNED THROUGH STEWARDSHIP WITH MIKE AND OTHER CARDIOLOGISTS. YOU TAKE BOARDS IN INTERVENTIONAL CARDIOLOGISTS. A GREAT DEAL OF OUR PRACTICE IS GENERAL CARDIOLOGY.>>YOU HAVE TO REALIZE HOW OLD WE ARE, RICK. WE’VE BEEN AROUND EVER SINCE THEY DISCOVERED FIRE. IT IS SOMEWHAT TRUE, IS THAT THE WHOLE DEVELOPMENT OF ANGIOPLASTY, THE VERY FIRST ONE THAT WAS EVER DONE, WE TAKE IT AS COMMONPLACE NOW, THE FIRST ONE WAS IN 1978.>>AT EMORY. NO. [ OVERLAPPING CONVERSATION ]>>WHO DIED IN A PLANE CRASH, ONLY TWO, THREE YEARS LATER, HE STARTED THIS WHOLE GENRE OF INTERVENTION. AND EVEN WHEN I STARTED DOING INTERVENTION, THE STENTS THAT EVERYBODY HEARS ABOUT NOW, WE DEVELOPED THOSE DURING MY TRAINING YEARS AND THEY WEREN’T AVAILABLE JUST ANYWHERE. AND IF YOU WOULD HAVE BEEN AROUND IN SOME OF THE EARLY DAYS, YOU WOULDN’T HAVE WANTED ONE BECAUSE THEY DIDN’T HAVE THEM PERFECTED THE WAY THEY ARE NOW.>>RIGHT. SO EXPLAIN WHAT A STENT IS OR AN ANGIOPLASTY AND A STENT IS. BRUCE.>>WELL, I USUALLY EXPLAIN IT LIKE YOU REMEMBER THOSE OLD CHINESE FINGER TRAPS YOU USED TO GET YOUR FINGER IN, KIND OF A CROSS-HATCH DESIGN, SIMILAR TO THAT. IT’S MOUNTED ON A SMALL, SMALL, VERY SMALL BALLOON LIKE A HOT DOG SHAPE. AND THEN THAT SLIPS INTO THE ARTERY OVER WIRE. AND THEN THE BALLOON IS INFLATED. AND THEN THE SCAFFOLDING OF THAT STENT GOES OUT JUST LIKE A CROSS-HATCH DESIGN, LIKE, YOU KNOW, THE FENCE, CORRUGATED FENCING. POPS. IT STAYS, THE BALLOON COMES OUT, THE WIRE IS PULLED OUT, THE STENT IS LEFT INSIDE. A LOT OF PEOPLE WORRY, IS IT GOING TO MIGRATE, IS IT GOING TO SHIFT, IS IT GOING TO FALL OUT. IT GETS EMBEDDED WITHIN TWO WEEKS, WITHIN THE ARTERY, THERE’S A NICE SMOOTH LINING OF CELLS THAT HAS INCORPORATED THAT AS A STRUCTURE TO HOLD THE ARTERY OPEN.>>BUT NOW THERE’S DRUG ELUTING STENTS BUT THEY DON’T ALWAYS PUT IN THE DRUG ELUTING STENT, IS THERE A REASON WHY YOU’D PICK ONE WITH A LITTLE BIT OF CHEMOTHERAPY ON IT OR DRUG ELUTING? WHERE ARE WE AT WITH THAT?>>THE DEAL IS IS THAT THE LORD DID NOT INTEND FOR US TO GO IN AND INFLATE BALLOONS INSIDE OF YOUR BODY. SO MOTHER NATURE WANTS TO HEAL THAT JUST LIKE ANY OTHER WOUND. AND THE WAY THE ARTERY GETS BIGGER, A LOT OF PEOPLE HAE THE IDEA THAT WE TAKE THE BLOCKAGE OUT, BUT, ACTUALLY, WHAT WE DO IS WE STRETCH THE ARTERY AND THE ARTERY WALL ACTUALLY TEARS. AND THE EXAMPLE I USE IS WHEN YOU MAKE THOSE DINNER ROLLS THAT YOU WHACK ON THE SIDE OF THE COUNTER, IT SPLITS OPEN, YOU KNOW, TO GET THE ROLLS OUT. THAT’S BASICALLY WHAT HAPPENS TO YOUR ARTERY SO IT CAN EXPAND. AND THEN THE STENT PROVIDES A SCAFFOLDING FOR THE NEW WALL TO GROW.>>DEVELOP.>>AND WE WANT THAT TO BE ENOUGH TO COVER THE STAINLESS STEEL, BUT WE DON’T WANT IT TO GROW ALL THE WAY BACK TO THE MIDDLE. SO THE DRUGS THAT ARE ON THE STENTS ARE USED, LIKE CHEMOTHERAPY FOR CANCER, TO KEEP TOO MANY CELLS FROM GROWING IN THERE. AND IT’S PRETTY AMAZING PHYSICS, ACTUALLY, BECAUSE THOSE DRUGS ELUDE OFF THE FIRST TWO TO THREE WEEKS WHEN THEY’RE PUT IN, AND THEN THEY’RE GONE. SO THEY GO IN, THEY TAKE CARE OF THE OVERDRIVE STIMULATION OF HEALING, THEY GET IT TO HEAL JUST ENOUGH. IF IT WORKS OUT, WHICH IT DOES 94% OR SO OF THE TIME, 6% OF THE TIME, MAYBE THERE’S TOO MUCH SCAR TISSUE BUILDS UP, THEN WE HAVE TO GO BACK AND REDO SOME WORK. BUT IT’S A PRETTY EXCELLENT SOLUTION, CONSIDERING SOME OF THE TYPE OF PROBLEMS THAT PEOPLE GET.>>RIGHT. AND THEY’RE DOING IT NOW IN ARTERIES, GOING TO THE LEGS, WHEN THEY HAVE PARTICULARLY DIABETICS HAVE LEG BLOOD FLOW PROBLEMS AND THEN ULCERS.>>YOU MIGHT BE AMAZED TO REALIZE, AND I’D BE SURPRISED IF YOUR VIEWERS KNOW, THAT IN YOUR BODY YOU HAVE 60,000 MILES OF BLOOD VESSELS. IN THE HUMAN BODY, BETWEEN THE SOLES OF THOSE SHOES YOU’RE WEARING TONIGHT AND YOUR HAIRCUT. AND THE HEART PUMPS 2,000 GALLONS THROUGH THAT 60,000 MILES EVERY DAY OF YOUR LIFE.>>THAT’S AN AMAZING –>>AND YOU’RE IN CHARGE OF THE HIGHWAY DEPARTMENT.>>YEAH. [ Laughter ] IT’S HAPPENING AUTOMATICALLY. I HAVE NO IDEA WHAT’S GOING ON. BUT, NOW, THE ANGIOPLASTY FIRST DEVELOPED AND THEN THE STENTS TO IMPROVE THE ANGIOPLASTY, BUT BEFORE THAT AND SINCE, PEOPLE HAVE BEEN DOING BYPASS SURGERY.>>RIGHT.>>EXPLAIN THAT. AND WHAT HAS IMPROVED ON THAT? HOW HAS THAT CHANGED? >>WELL, THE CORONARY ARTERY BYPASS GRAFTING IS STILL UTILIZED, A LOT LESS THAN IT WAS IN THE PAST. BUT BYPASS GRAFTING IS UTILIZED FOR COMPLEX ANATOMY. NOT EVERYBODY’S ARTERY IS NICE AND STRAIGHT WITH A FOCAL LITTLE AREA THAT YOU CAN PUT A STENT IN AND HAVE A NICE RESULT. THERE’S A MASS OF DIFFERENT COMPLICATING BIFURCATIONS, THERE’S ARTERIES THAT WE PREFER NOT TO, LIKE A LEFT MAIN ARTERY.>>RIGHT.>>ALL OF THEM REALLY TECHNICALLY, EVERY SITUATION COULD BE ATTEMPTED WITH A STENT, BUT WHAT WE DECIDE TO ATTEMPT WITH A STENT VERSUS WHAT WE DECIDE TO GO TO SURGERY WITH THERE’S A LOT OF FACTORS THAT WEIGH INTO IT. AGE AND ABILITY OF THE PATIENT, ABILITY TO GET THROUGH AN OPERATION, THE COMPLEX FACTORS OF MEDICATION COMPLIANCE, A LOT OF DIFFERENT ISSUES. BUT STILL UTILIZED. VERY GREAT OPERATION. I ALWAYS TELL MY PATIENTS WHEN WE’RE MAKING THE TOUGH DECISION GO TO A STENT OR MAYBE WE SHOULD GO TO BYPASS SURGERY IS, IF I COULD WAVE A WAND AND HAVE AN INTERNAL MAMMARY ARTERY, WHICH IS TAKEN OFF OF THE CHEST WALL, A LIVE ARTERY, AND IT CAN LAST FOR 30, 40 YEARS, WAVE MY WAND, HAVE THAT PUT IN YOU, I’D LIKE THAT. BUT THE BIG WAND TO WAVE, SOMETIMES WE HAVE ISSUES THAT WE’VE GOT TO DEAL WITH IT, PREFER STENT OVER SURGERY OR SURGERY OVER STENT.>>AND THE WAY THEY USED TO DO IT EARLY ON, BEFORE THE INTERNAL MAMMARY WAS FROM GRAFTS FROM THE VEINS OF THE LEGS.>>EXACTLY.>>BUT VEINS AREN’T AS STRONG AND TOUGH AS ARTERIES.>>RIGHT. THE VEINS, YOU KNOW, THEY INCORPORATE VESSELS THAT FEED THEM AND KEEP THEM ALIVE. LITTLE VESSELS. AND THEY GET CUT WHEN IT’S PUT IN.>>YEAH.>>IT’S MORE OF JUST A GRAFT. AND THEY CAN DEGENERATE OVER TIME. WHEREAS, IF YOU HAVE A LIVING ARTERY THAT IS HOOKED TO THE HEART, THAT IS INTACT AND IT STAYS ALIVE.>>YEAH. WE’VE GOT SOME QUESTIONS. THERE WAS A QUESTION ABOUT LISINOPRIL. SIDE EFFECTS FROM LISINOPRIL. MIKE?>>WELL, FIRST, LET ME SAY THAT ALL DRUGS HAVE SIDE EFFECTS. IF YOU GOT OUT THE GOOGLE MACHINE AND YOU LOOKED UP ASPIRIN, YOU PROBABLY WOULDN’T TAKE ONE BECAUSE OF ALL THE THINGS THAT YOU CAN HAVE. LISINOPRIL ACTUALLY IS A VERY COMMONLY USED DRUG IN CARDIOLOGY BECAUSE IT HAS TREMENDOUS ADVANTAGES IN HEART FAILURE, IT DECREASES LEFT VENTRICULAR HYPERTROPHY.>>GREAT DRUG.>>CHEAP, GENERIC. FOR PEOPLE THAT DO HAVE — 92 MILLION PEOPLE IN THE UNITED STATES HAVE HYPERTENSION, AND THERE’S ONLY 347 MILLION IN THE COUNTRY. AND, SO, — AND THEY JUST CHANGED THE GUIDELINES, AS BRUCE WAS SAYING, SO NOW 40% OF THE UNITED STATES POPULATION HAS HIGH BLOOD PRESSURE. AND THEY DON’T UNDERSTAND THE RAMIFICATIONS OF THAT. WHAT I TELL PEOPLE, IF I WAS LIFTING BARBELLS, 100,000 TIMES A DAY, WHAT DO YOU THINK MY MUSCLES ARE GOING TO LOOK LIKE? AND THAT’S WHAT HAPPENS TO YOUR HEART MUSCLE. SO TO GET AN IDEA WHAT YOUR HEART DOES DURING YOUR LIFETIME, FORGET ABOUT HEART PHYSIOLOGY, FORGET ABOUT MEDICAL SCHOOL, ONLY THING YOU GOT TO DO TO STAY ALIVE IS HIT A TENNIS BALL OFF THE WALL 100,000 TIMES A DAY. DO YOU THINK YOU WOULD GET TENNIS ELBOW, RHEUMATISM, ARTHRITIS? SO, YOUR HEART MUSCLE GETS LIKE POUND STEAK INSTEAD OF FILET MIGNON, WHEN YOU’RE YOUNG, IT SUCKS THE BLOOD OUT OF YOUR LUNGS, WHEN YOU GET OLD, IT GETS STIFFER, JUST LIKE GETTING GRAY HAIR AND WRINKLES LIKE EVERYBODY GETS, SO YOU NEED THE LISINOPRIL TO KEEP YOU FROM GETTING THAT.>>IT HAS SIDE EFFECTS.>>THE MOST COMMON ONE I WOULD SAY IS COUGH, ACE INHIBITOR COUGH IS WHAT IT’S CALLED, IT HAPPENS ABOUT 7% OR SO OF PEOPLE. THERE’S A SECOND GENERATION OF THOSE DRUGS THAT YOU CAN TAKE, IT AFFECTS SOME HORMONES IN YOUR LUNGS THAT MAKES YOUR BRONCHIAL TUBES IRRITATED. YOU GET WHAT I REFER TO AS THE OPERA COUGH. [ IMITATING ] BEFORE THE MOVIE STARTS, YOU CLEAR YOUR THROAT, BEFORE YOU SPEAK. IT’S THAT KIND OF A COUGH. YOU’RE NOT GOING TO GET CANCER OR ASTHMA, IT’S A NUISANCE, AND THEY DO HAVE SOME OTHER SOLUTIONS YOU CAN USE.>>ALTERNATIVES.>>ALTERNATIVES, RIGHT.>>HAVING HEART PROBLEMS IS A SCARY SITUATION. THAT STRESS IS INCREASED WHEN YOU HAVE THOSE PROBLEMS WHILE AWAY FROM HOME AND ARE TRAVELING. HERE IS A STORY OF JUST THAT SITUATION.>>THERE WAS SIX OF US. SOME FRIENDS AND SOME RELATIVES, BOTH. AND WE WERE ABOUT FIVE DAYS INTO THE VACATION. AND EVERYBODY HAD BEEN SICK, EXCEPT ME AND MY BROTHER-IN-LAW. ON ABOUT THE FIFTH MORNING, I WOKE UP, GOT UP AS NORMAL, READ THE PAPER. I WAS GETTING READY FOR THE DAY. AND STARTED FEELING STRANGE, VERY STRANGE. STARTED HAVING PAIN UP ACROSS MY CHEST, UP ACROSS THE UPPER PART OF IT, ABOVE MY BREAST BONE, RADIATED TO MY SHOULDERS. AND THEN ALSO SOME FEELING LIKE I WAS GOING TO THROW UP. AND THE FACT THAT EVERYBODY HAD BEEN SICK MADE ME THINK MAYBE IT WAS JUST MY TURN TO BE SICK. SOON IT WAS PRETTY OBVIOUS THAT IT WAS MORE THAN THAT. AND DECIDED THAT MAYBE WE SHOULD HAVE IT CHECKED OUT AT AN EMERGENCY ROOM.>>IT WAS A LITTLE BIT CHALLENGING TO FIGURE OUT WHERE TO GO. AND I WOULD SAY TO ANYBODY THAT TRAVELS, IF YOU HAVE GOOGLE, AND GOOGLE MAPS ON YOUR PHONE, IT LITERALLY COULD BE A LIFE SAVER. SO, AFTER WE BELIEVED BRIAN, THAT HE REALLY NEEDED TO GO TO THE EMERGENCY ROOM, BECAUSE WE HAD ALL BEEN SICK, AND WE TRULY DID THINK IT WAS JUST HIS TURN, BUT HE WAS VERY SMART AND KEPT SAYING, I HAVE TO GET TO A HOSPITAL. THEY WERE TOP NOTCH AND THEY TOOK ONE LOOK AT BRIAN AND KNEW EXACTLY WHAT WAS GOING ON. AND THINGS JUST KIND OF FLEW, THEY DID THE APPROPRIATE TESTS RIGHT THEN. AND SAID THAT HE WAS HAVING A HEART ATTACK AND THAT HE NEEDED TO GET TO THEIR MAIN FACILITY, DOWNTOWN HONOLULU TO HAVE A STENT PUT IN, TO GET INTO THE CATH LAB AND HAVE A STENT. AND WE’RE, LIKE, WOW, THE TRAFFIC HERE IS SO BAD, HOW IS THAT GOING TO HAPPEN. AND THEY ASSURED US THAT WITH THE AMBULANCE, ALL THE LIGHTS AND SIRENS, THAT THE WATERS PART AND THEY DO. >>THEY JUST WENT AHEAD AND TOOK CARE OF ME. FIGURED OUT I HAD A BLOCKAGE, WHERE THE BLOCKAGE WAS, AND PUT IN A STENT. AND SLAM, BAM, IT WAS OVER.>>I HAVE BEEN ON ONE OTHER SHORT TRIP SINCE THIS ALL HAPPENED. AND, HONESTLY, I DO PAY ATTENTION TO WHERE THE H SIGNS ARE NOW. YOU KNOW, YOU DRIVE DOWN A HIGHWAY AND THERE’S A NICE BLUE SIGN WITH A WHITE H ON THERE, AND I DO HAVE TO SAY, I PAID A LITTLE MORE ATTENTION THIS TIME. I REMEMBER ON THE DRIVE, I KEPT THINKING, BOY, I WISH I WAS GOING TO THE BROOKINGS HOSPITAL. BECAUSE, YOU KNOW, IT’S RIGHT HERE IN TOWN, THE SYSTEM KNOWS US, WE KNOW THEM.>>IT WASN’T A TERRIBLE EXPERIENCE. IT WAS PROBABLY MORE DIFFICULT FOR LYNN THAN FOR ME. AND MAYBE SOME OF OUR FELLOW TRAVELERS, HAVING TO — KIND OF MESSED UP SOME OF THEIR PLANS A LITTLE BIT. CHANGED THEIR PLANS A LITTLE BIT. BUT FOR MYSELF I RECEIVED GREAT CARE. FELT LIKE I WAS IN COMPETENT HANDS AND I THANK THEM FOR ALL THEIR EFFORTS. >>THANK YOU, BRIAN AND LYNN. DEAR FRIENDS. AND THEY HAVE CARDIOLOGISTS NOW IN THE STATE, ONE OF WHICH IS IN THE ROOM WITH ME RIGHT NOW TAKING CARE OF AND LOOKING OVER HIM. THIS IS YOUR PROGRAM. AND YOUR QUESTIONS ARE KEY TO THE DIRECTION OF OUR DISCUSSION. SO PLEASE CALL IN YOUR QUESTIONS TO 1-888-376-6225, OR SEND US AN EMAIL TO [email protected] AND WE’VE GOT SOME QUESTIONS. A WOMAN SAYS, I’VE HAD TWO STRESS-RELATED HEART ATTACKS IN THE LAST 11 YEARS. BUT NO BLOCKAGES WERE FOUND AND NO STENTS WERE REQUIRED. STRESS RELATED. WHAT COULD BE CAUSING THESE HEART ATTACKS? COULD A GALLSTONE STUCK IN A BILE DUCT BE ENOUGH STRESS TO CAUSE A HEART ATTACK? WHAT HAPPENED BEFORE THE SECOND HEART ATTACK? SO, YOU KNOW, THERE USED TO BE PRINZMETAL ANGINA, RIGHT?>>YEAH.>>TELL ME WHAT THAT IS. NO BLOCKAGE.>>RIGHT, RIGHT. WE’VE HAD A NUMBER OF PATIENTS THAT HAVE CORONARY ARTERY SPASM WHERE THE ARTERY HAS A REAL NICE LINING OF SMOOTH MUSCLE AROUND IT, AND UNDER CERTAIN CONDITIONS, MENTAL STRESS, TEMPERATURE STRESS, BREATHING IN COLD AIR CAN RESULT IN SOME CORONARY SPASM. BUT THERE’S A PATTERN OF REAL REPETITIVE, SEVERE CHEST PRESSURE TIGHTNESS IN THESE PATIENTS. OFTENTIMES AT REST. IT’S NOT EXERCISE RELATED BECAUSE THE BLOCKAGE ISN’T FIXED. BUT THE TRIGGERING MECHANISM SOMETIMES IS EMOTIONAL STRESS. AND IT CAN BE CAUSING THE CONSTRICTION OF THE ARTERY, WHICH LIMITS THE BLOOD FLOW AND CAN RE-CREATE ANGINA. IT HAS CHARACTERISTIC CHANGES ON AN ELECTROCARDIOGRAM, THAT’S WHY IT’S IMPORTANT IF YOU’RE HAVING THOSE KINDS OF EPISODES, WELL, A, IF YOU HAVE ANY CHEST PAINS LIKE THAT, GET TO THE EMERGENCY ROOM. BUT TO ACTUALLY DOCUMENT AND TELL WHAT’S GOING ON WITH PARTICULARLY THE PRINZMETALS ANGINA OR CORONARY SPASM, YOU NEED THE EKG SHOWING THE CHARACTERISTIC EKG CHANGE ASSOCIATED WITH IT.>>DO YOU USE NITROGLYCERIN, WHAT DO YOU DO FOR PRINCE METALS ANGINA THESE DAYS?>>NITROGLYCERIN IS A GOOD THERAPY. LONG-TERM MANAGEMENT, THE CALCIUM CHANNEL BLOCKERS LIKE AMLODIPINE, THINGS LIKE THAT SEEM TO HAVE A REAL GOOD RESPONSE. AND SOMETIMES, YOU KNOW, I’VE HAD PATIENTS THAT HAVE PUT UP WITH IT THEIR WHOLE LIFE, THOUGHT IT’S JUST ANXIETY AND IT TURNS OUT IT WAS CORONARY SPASM ALL THAT TIME.>>WOW. YEAH. ALL RIGHT. YOU KNOW, THERE’S OTHER EMOTIONAL THINGS THAT CAN CAUSE HEART TROUBLE. TELL ME ABOUT TAKOTSUBO.>>JAPANESE TERM, THEY USED TO USE THESE POTS TO CATCH OCTOPUS. AND THEY HAVE A NARROW NECK, THE OCTOPUS GOES IN, GETS STUCK, CAN’T GET BACK OUT. WHAT HAPPENS, YOU GET THIS, BIG EMOTIONAL SURGE, TERRIBLE NEWS, I SAW SOMEBODY THAT IN THE OLD TIMES USED TO DO ECT WHERE THEY WOULD DO ELECTROSHOCK THERAPY, I SAW SOMEBODY AFTER THAT, SHOCK ON THE SYSTEM, AND IT HAS TO DO WITH NEURAL DISCHARGE, AND THE CAPILLARIES DON’T GET THE CIRCULATION LIKE THEY SHOULD AND IT LOOKS EVERYTHING LIKE A HEART ATTACK, EXCEPT IT DOESN’T FOLLOW THE USUAL ANATOMY OF THE ARTERIES THAT SUPPLY THE HEART, WHICH IS THE CLUE THAT IT’S TRULY A STRESS CARDIOMYOPATHY, WHICH IS A LITTLE BIT DIFFERENT THAT PRINCE METALS ANGINA THAT YOU WERE TALKING ABOUT, WHICH IS THE MAIN PIPE ARTERY BEING IN SPASM.>>ISN’T IT INTERESTING THAT THE EMOTIONS, YOU KNOW, REALLY DO –>>HERE WE ARE ON VALENTINE’S DAY TALKING ABOUT EMOTIONAL AFFAIRS.>>THAT’S RIGHT. A WOMAN FROM WALL IS WONDERING, HOW MANY TIMES CAN THEY DO A CARDIOVERSION ON A PERSON THAT HAS ATRIAL FIB? ATRIAL FIB, FIRST, WHAT IS ATRIAL FIB?>>WELL, ATRIAL FIBRILLATION, I LIKE TO EXPLAIN IT, THE ATRIUM, OR THE ATTIC OF THE HEART, TWO ATRIUM, TWO UPPER CHAMBERS, TWO LOWER CHAMBERS, THE VENTRICLE.>>TWO BEDROOMS UPSTAIRS. >>THEY’RE THE RECEIVING END, GET THE BLOOD BACK FROM THE HEART, BLOOD BACK FROM THE LUNGS. BUT THEY BEAT IN COORDINATION WITH THE LOWER CHAMBERS. BOOM BOOM, BOOM, BOOM. NICE REGULAR RHYTHM. ATRIAL FIBRILLATION, THE UPPER CHAMBERS ARE FIBRILLATING, VERY FAST, A THOUSAND BEATS A MINUTE, JUST VIBRATING, SENDING A VERY EAR RATTIC SIGNAL. STILL GETS FROM THE ATRIUM BELOW, BUT FAST, SOMETIMES 170, 180 BEATS PER MINUTE, LIKE A FISH FLOPPING OUT OF WATER. NOT BOOM BOOM BOOM.>>I NEVER HEARD FISH FLOPPING.>>BUT, ANYWAY, IT CAN CREATE HAVOC. SOME PEOPLE HAVE THIS FOR TWO, THREE MONTHS AT A TIME. THEY COME IN, THEY’RE SHORT OF BREATH. IT’S LIKE THEY’VE BEEN RUNNING A RACE FOREVER. BUT THE ATRIAL FIBRILLATION IS WHAT’S CAUSING THE SHORTNESS OF BREATH.>>AND SHE WAS ASKING ABOUT DOING CARDIOVERSION FOR ATRIAL FIB. HOW MANY TIMES?>>RIGHT.>>YOU KNOW, THERE’S A LOT OF DEBATE ABOUT JUST LEAVING IN THE MATTER FIB, ANTICOAGULATE, YOU’RE GOING TO ANTICOAGULATE THEM ANYWAY. YOU’RE GOING TO START THEM ON A SLOWER-RATE DRUG ANYWAY.>>RIGHT.>>SOME PEOPLE SAY YOU DO JUST AS WELL NOT CARDIOAVERTING THEM.>>ABSOLUTELY, YOU’RE ABSOLUTELY RIGHT BUT A LITTLE BIT OFF. IF YOU TAKE TWO GROUPS OF PEOPLE, HAVE ATRIAL FIB, AND YOU SPEND A LOT OF EFFORT TO GET ONE GROUP TO GO REGULAR LIKE THE LORD INTENDED AND THE OTHER GROUP YOU LEAVE LIKE YOU SAID, IN ATRIAL FIB WITH ANTICOAGULANTS. THEY BOTH WIN THE LOTTERY THE SAME NUMBER OF TIMES. THEY HAVE THE SAME NUMBER OF DATES, SAME NUMBER OF SPEEDING TICKETS, EVERYTHING IS THE SAME, EXCEPT THE REASON YOU GO THROUGH A LOT OF EFFORT TO CONVERT ONE IS BECAUSE THEY HAVE SYMPTOMS. THEY’RE OUT OF BREATH, THEY’RE DIZZY, THEY’RE LIGHT-HEADED, THEY DON’T LIKE THE PALPATIONS IN IRREGULARITY. BUT FUNCTIONALLY THEY COME OUT THE SAME AS FAR AS PROGNOSIS. IT’S JUST THAT THEY FEEL POORLY. THAT’S WHY WE EXHAUST EFFORTS TO GET THEM REGULAR.>>WHERE YOU LOSE 10% EJECTION FRACTURE.>>ACTUALLY, IF YOU HAVE A STIFF HEART, WHICH IS THE MAIN CAUSE OF THIS, YOU CAN LOSE UP TO 25% OF YOUR CARDIAC OUTPUT BECAUSE THAT STIFF VENTRICLE THAT I TOLD ABOUT FROM HYPERTENSION, WE TALKED ABOUT TAKING CARE OF THAT, PROBABLY THE MOST COMMON CAUSE IS HYPERTENSION FOR ATRIAL FIB. AND THAT’S BECAUSE HYPERTENSION IS SO COMMON, COME BACK IN 15, 20, 30 YEARS, AND THEN YOU’RE GOING TO DEVELOP THE ATRIAL FIB.>>YOU KNOW, THE NEW ONE THAT REALLY CAME UPON OUR REALITY MAYBE FIVE OR TEN YEARS AGO IS SLEEP APNEA BEING A BIG CAUSE FOR ATRIAL FIB.>>YOU SLEEP A QUARTER OF YOUR LIFE OR 20%, IT HAS TO BE HIGH QUALITY, LIKE EVERYTHING ELSE TO MAKE IT.>>YEAH, YEAH.>>THAT’S AN INTERVENTIONAL CARDIOLOGIST, 20%.>>20%.>>SHOULD BE SLEEPING 33%. EIGHT HOURS A DAY. [ Laughter ]>>33%.>>THAT’S RIGHT, 33%.>>CARDIOLOGIST, 20%.>>THAT’S RIGHT. [ Laughter ]>>ALL RIGHT. A PERSON FROM SIOUX FALLS IS RECENTLY DIAGNOSED WITH AN ENLARGED AORTIC ROOT. 41 MILLIMETERS. WHAT CAUSES THAT? AND AT WHAT POINT DOES THE PROBLEM NEED TO BE ADDRESSED? AND HOW CAN IT BE FIXED? HOW COMMON IS THIS?>>SO, AN ENLARGED AORTIC ROOT, WE KNOW ABOUT A DILATED AORTIC BEING AN AORTIC ANEURYSM. BUT THIS IS — THAT’S LIKE IN THE ABDOMEN. BUT IT’S ALL THE WAY UP TO WHERE THE AORTA EXITS FROM THE HEART. WHAT’S THAT?>>AGAIN, YOU KNOW, IT’S ON A CONTINUUM. 41 MILLIMETERS, YOU KNOW, OUR ROOT SHOULD NUMBER THAT 37 TO 38 MAXIMUM. AND OVER TIME, THE MOST COMMON CAUSE IS, AGAIN, HYPERTENSION. THE POUNDING OF THE SYSTOLIC BLOOD PRESSURE AGAINST THAT ROOT.>>YEAH.>>THERE ARE OTHER CONDITIONS THAT CAN BE CONGENITAL, AORTIC VALVE ABNORMALITIES, AND PEOPLE WITH ACTUAL CONDITIONS THAT WEAKEN THE COLLAGEN WITHIN THE AORTA, THE SIDEWALLS, CAN WEAKEN IT, CAUSE THEM TO BE SUSCEPTIBLE TO ENLARGEMENT. BUT A LOT OF THOSE THINGS HAVE TO BE FACTORED INTO IT. BUT IT NEEDS TO BE WATCHED ON A REGULAR BASIS. SEE IF IT’S STABLE OR UNSTABLE. IF IT’S GROWING AT A RAPID RATE OR APPROACHING FIVE CENTIMETERS, YOU’RE TALKING ABOUT GETTING CLOSER TO AN OPERATION. AND IT DEPENDS UPON WHAT THE VALVE LOOKS LIKE. A LOT OF THINGS. BUT IT’S WORTH WATCHING. IT’S WORTH TREATING YOUR HYPERTENSION, IF YOU HAVE IT. 41 IS JUST KIND OF THE ENTRY POINT OF ABNORMAL. AND IT NEEDS TO BE WATCHED.>>I HAD A 78-YEAR-OLD GENTLEMAN HAVE QUITE A LARGE DILATION OF HIS AORTIC ROOT, AND I SENT HIM TO YOU GUYS. I THINK YOU MIGHT HAVE SEEN HIM, MIKE. I CAN’T REMEMBER. IT MIGHT HAVE BEEN YOU, BRUCE. BUT YOU GUYS ELECTED TO WATCH HIM. AND HE DIED JUST RECENTLY AT 94 OR SOME DARN THING. YOU KNOW? FROM SUDDEN DEATH. BUT IT WAS CERTAINLY THE AORTIC ROOT WASN’T THE PROBLEM. IT WAS A MONITORED DEAL.>>THE REPAIR AND THE THING WE TALKED ABOUT, ABOUT THE SIZE WHERE YOU WOULD CONSIDER INTERVENING, USUALLY THE ANEURYSM WILL ENLARGE ABOUT A TENTH OF A MILLIMETER — ABOUT A MILLIMETER, I SHOULD SAY, A YEAR OR EVERY TWO YEARS. [ OVERLAPPING CONVERSATION ]>>ABDOMINAL AORTA, TOO?>>NO. THE DEAL IS, YOUR BLOOD VESSEL SYSTEM IS NOT THE SAME EVERYWHERE. AND THE REASON THAT THIS AORTIC ROOT ANEURYSM TAKES ON A LOT MORE SIGNIFICANCE IS BECAUSE IT’S RIGHT NEXT TO THE BUSINESS END OF THE VALVE.>>YEAH.>>SO SOMETIMES THE ENLARGEMENT OF THE AORTA IS NOT THE THING THAT DRIVES THE DECISION ABOUT WHETHER TO OPERATE BECAUSE IF THE VALVE GETS PULLED APART TOO FAR, THEN IT STARTS TO LEAK. AND IF IT LEAKS A LOT, THEN THE HEART TRIES TO THROW THE BLOOD UP, IT’S KIND OF LIKE PUNCHING THE OLD CISTERN, WATER RUNNING BACK DOWN THE WELL, YOU’RE GOING LIKE THIS, THE HEART HAS TO DO ALL THIS EXTRA WORK. SO THAT MAKES THE THING DILATE EVEN FASTER AND THE MORE THE DILATION, THE MORE IT LEAKS, AND SO THEN YOU NEED A VALVE PLUS A CONDUIT TO REPAIR THE ANEURYSM AND THE VALVE.>>BOY, THAT’S A –>>VERY BIG OPERATION, WHICH IS WHY THEY MIGHT HAVE ELECTED AT A CERTAIN AGE TO SAY, YOU’RE BETTER OFF JUST WATCHING THIS THAN TO DO A BIG SURGERY.>>YEAH. WHAT ABOUT — I THINK WE’LL TAKE THIS OPPORTUNITY TO TALK ABOUT ABDOMINAL AORTIC ANEURYSM. PEOPLE TALK ABOUT SCREENING, THESE ULTRASOUND SCREENING THINGS, PEOPLE COME INTO TOWN, I THINK THAT’S — THE ONLY GOOD THING ABOUT THOSE IS TO DO A SCREENING ULTRASOUND OF THE ABDOMINAL AORTA, BUT YOU SHOULD BE DOING THAT WITH WHAT? ANY PERSON WHO HAS SMOKED EVER, PARTICULARLY IF YOU’RE A MAN, AT THE AGE OF 60 TO 70 OR SOMETHING LIKE THAT. WHAT’S THE SCREENING — DO YOU REMEMBER?>>THE MEDICARE GUIDELINES, THEY’LL COVER, YOU’RE WELCOME TO MEDICARE SCREENING AT AGE 65, ANY MALE SMOKER, OR HYPERTENSIVE.>>YEAH.>>OR IF YOU HAVE A PRIMARY RELATIVE THAT’S HAD AN ABDOMINAL AORTIC ANEURYSM. I AGREE WITH YOU. THESE SCREENING EXAMS, REALLY, THEY’RE MARKETING PLOYS.>>YES.>>BUT I FIND IT VERY ADVANTAGEOUS AS A VERY REASSURING MECHANISM FOR ME WHO’S SEEN PATIENTS THAT ACTUALLY HAVE THESE DISEASES, NOT THE GENERAL POPULATION, TO SAY, WELL, YOU’RE A SMOKER, LET’S SEE WHERE YOUR CAROTIDS ARE, PLAQUE BURDEN, LET’S LOOK AT THE AGGRESSIVENESS OF THE LEVEL OF TREATMENT. BUT WE HAVE TO BE CAUTIOUS WITH THE SCREENINGS. CAN GET OUT OF HAND.>>I AGREE. WHAT IS THE TIME THAT AN ABDOMINAL AORTA NEEDS TO BE APPROACHED? AND WE CAN DO IT NOW, ALMOST WITHOUT — LIKE A HEART STENT THING.>>RIGHT. WE’VE GOTTEN VERY GOOD ABOUT PUTTING THESE THINGS CALLED ENDOLUMINAL TO REPAIR THE AORTAS. USUALLY AROUND THE SIZE OF FIVE OR SO CENTIMETERS. BUT THE THING IS, YOU HAVE TO TAKE INTO ACCOUNT HOW BIG THE PERSON IS. SO IF YOU’RE ONE OF THESE 6’8″ LINEBACKERS FROM THE NFL, FIVE CENTIMETERS ISN’T SO BIG FOR YOU. BUT IF YOU’RE A 5-FOOT-INCH WOMAN, THAT MIGHT BE A VERY BIG ANEURYSM SO YOU HAVE TO TAKE INTO ACCOUNT WHAT THE SIZE OF THE PERSON IS. IT’S NOT LIKE A COOKBOOK OR A CALIPER DEAL.>>YOU’RE NOT GOING TO GIVE ME A NUMBER.>>THE AVERAGE, 180, 6-FOOT, FIVE CENTIMETERS IS ABOUT THE TIME. THEN IT DEPENDS ON WHAT OTHER THING, WHAT OTHER RISKS AND A VARIETY OF OTHER THINGS. BUT THAT’S IN GENERAL THE SIZE WHERE YOU START TO NEED TO THINK ABOUT DOING SOMETHING.>>IT’S AMAZING HOW SMOKING IS A BIG, BIG FACTOR ON ABDOMINAL AORTIC ANEURYSMS. I LOST A DEAR FRIEND, AND HE WAS A SMOKER, AND, YOU KNOW, I’M FOLLOWING HIM, I’M FOLLOWING HIM FOR YEARS AND YEARS, WE WERE DEAR FRIENDS. HE CAME IN THE EMERGENCY ROOM ONE NIGHT. IN DISTRESS. OF COURSE, GOT SHIPPED, AND THEY OPENED HIM UP AND THEY JUST DIDN’T GET IT EARLY ENOUGH AND HE DIED ON THE TABLE.>>THE THING IS ABOUT NOW, IF YOU HAVE AN ANEURYSM THAT’S RUPTURING, AND WE REPAIR A LOT OF THESE IN SIOUX FALLS, BEFORE THEY HAD THESE ENDOLUMINAL GRAFTS, IF YOU RUPTURED YOUR ANEURYSM ON THE STREET, 50% DEATH. JUST DEAD. THAT DOESN’T COUNT LIVING WITH A LOT OF DISABILITY. I MEAN, DEAD. AND NOW THEY CAN GO IN WITH A BALLOON RIGHT AWAY AND TAMPONADE THE BLOOD FLOW AND GIVE PEOPLE TIME TO — THEY CAN PUT IT SO THE KIDNEYS CAN STILL GET THE BLOOD. THEY DON’T HAVE TO DO A BIG OPEN PROCEDURE ANYMORE. THEY DO IT ALL THROUGH YOUR LEGS. AND THEY CAN ISOLATE THE BLEEDING AND SEVERAL AMAZING SUCCESS STORIES OF PEOPLE THAT HAD RUPTURING ANEURYSMS, MADE IT TO THE HOSPITAL AND BECAUSE OF THE TEAMS THEY HAVE THAT THEY CAN GET IT REPAIRED WITHOUT GETTING A BIG OPERATION.>>TREMENDOUS ADVANCE IN MEDICINE.>>YEAH.>>THE CHANGES IN HEART CARE THAT HAVE HAPPENED OVER THE YEARS ARE AMAZING TO ANYONE, BUT TO THOSE DOCTORS WHO HAVE TO LEARN THE NEW TREATMENTS IS EVEN MORE PROFOUND.>>CARDIOLOGY IS A FIELD OF MEDICINE IN WHICH TECHNOLOGY HAS PLAYED AND CONTINUES TO PLAY A LARGE ROLE. Dr. OLSON, WHAT WOULD YOU SAY IS THE BIGGEST TECHNOLOGICAL ADVANCE YOU’VE SEEN IN THE YEARS THAT YOU’VE BEEN PRACTICING CARDIOLOGY?>>I STARTED PRACTICING IN 1991, AND IN THE FIELD I WORK IN, HEART RHYTHMS, WE WORK WITH DEFIBRILLATOR DEVICES, AND INITIALLY THESE ARE DEVICES THAT CAN TREAT OR SHOCK A RAPID HEART RHYTHM BACK TO NORMAL, IN PEOPLE THAT HAVE HIGH RISK FOR LIKE A CARDIAC ARREST. SO INITIALLY THEY REPLACED THROUGH A SURGERY, THERE ERE PATCHES PLACED ON THE OUTSIDE SURFACE OF THE HEART. THE DEVICE WAS VERY LARGE, PLACED IN THE ABDOMEN. PERSON WAS IN THE INTENSIVE CARE UNIT FOR A COUPLE DAYS OR SO. AND IN THE HOSPITAL FOR ABOUT FIVE TO SEVEN DAYS. NOW IT’S EVOLVED THE DEFIBRILLATORS ARE GENERALLY PLACED UNDER THE SKIN UNDER THE COLLARBONE AREA, THE LEADS ARE PLACED IN THE HEART, PRIMARILY. PEOPLE CAN COME IN ONE DAY AND HAVE IT DONE, AND THEN OFTEN GO HOME THE NEXT DAY. RESUME NORMAL ACTIVITIES WITHIN A FEW DAYS. SO THERE’S BEEN DRAMATIC ADVANCES. A LOT OF PROGRAMMING FEATURES THAT ARE AVAILABLE TO TREAT RAPID RHYTHMS FOR PACING, BEING ABLE TO PACE THE LEFT SIDE OF THE HEART, ALONG WITH THE RIGHT SIDE OF THE HEART TO IMPROVE THE HEART FUNCTION IN CERTAIN PEOPLE THAT HAVE HEART WEAKNESS, CERTAIN ELECTRICAL PROBLEMS.>>AND Dr. ADAMS, THE GENERAL TRAJECTORY, WE MENTIONED, HAS BEEN SMALLER DEVICES, LESS INVASIVE PROCEDURES. YOU BROUGHT AN EXAMPLE OF A NEW PACEMAKER, WHICH LOOKS A LOT DIFFERENT FROM THE OLD TRADITIONAL DEVICES.>>YEAH.>>YEAH. ARE THERE OTHER THINGS COMING DOWN THE LINE OR WHAT’S NEXT, DO YOU THINK, WITH CARDIOLOGY AND TECHNOLOGY?>>SO THERE’S A LOT OF THINGS GOING ON IN ALL OF CARDIOLOGY, SO EVERYTHING, LIKE YOU SAY, IS SMALLER, LESS INVASIVE, THEY’RE PUTTING IN VALVES NOW. INITIALLY STARTED WITH AORTIC VALVE, DONE THROUGH THE ARTERY. USED TO BE — WELL, IT STILL IS, BUT YOU’D HAVE TO ALWAYS OPEN THE CHEST FOR THAT. WE’RE NOW DOING MITRAL VALVES, SOME TALK ABOUT TRICUSPID VALVES. AS FAR AS ABLATION IS CONCERNED, THERE HAVE BEEN SOME NONINVASIVE VENTRICULAR ABLATIONS THAT HAVE BEEN DONE WHERE THEY DO IT WITH LIKE RADIATION TYPE OF TECHNOLOGY. SO COMPLETELY NONINVASIVE. PATIENT COMES IN, GETS THEIR TREATMENT, GOES HOME THE SAME DAY. SO, EVERYTHING IS GETTING SMALLER, SMARTER, AND LESS INVASIVE, LESS TIME IN THE HOSPITAL WITH CARDIOLOGY.>>YEAH. EXCITING FIELD TO PRACTICE IN FOR ALL THESE YEARS AND SEE THAT. THANKS. >>WE REALLY APPRECIATE YOUR QUESTIONS. KEEP CALLING THEM IN. WE HAD ONE QUESTION ABOUT STEROIDS, PREDNISONE BURSTS, MAKING THE HEART POUND. IS THAT AN UNCOMMON THING? IS IT DANGEROUS? AND WHAT WOULD BE YOUR THOUGHTS?>>AGAIN, I CAN’T SAY I’VE ENCOUNTERED THAT A LOT OF TIMES, BUT, YOU KNOW, THEORIZING WHAT COULD HAPPEN, PREDNISONE CAN MAKE YOU RETAIN A LITTLE BIT MORE SODIUM WHICH CAN LEAD TO A LITTLE BIT HIGHER BLOOD PRESSURE. A LITTLE MORE FORCEFUL BEATING OF THE HEART, MIGHT JUST BE MORE COGNIZANT OF IT. ESPECIALLY PEOPLE THAT MAYBE HAVE MITRAL VALVE PROLAPSE.>>WHAT HAPPENS I THINK HERE A LOT OF THE TIME, THE REASON YOU’RE GETTING THE PREDNISONE, THERE’S SOME DISTURBANCE IN THE FORCE. YOU KNOW, YOU HAVE ASTHMA ATTACK OR YOU HAVE INFLAMMATION OR YOU HAVE ARTHRITIS OR THERE’S SOME OTHER DISRUPTION IN THE BODY SYSTEM. AND, SO, WHAT THAT DOES, IT PUTS EVERYTHING UNDER STRESS AND THEN YOU PUT SOME DRUGS INTO THE MILIEU, SO IT’S NOT TOO SURPRISING THAT YOU WOULD HAVE SOME HARD HEART BEATING OR SOME PALPATIONS AND YOU HAVE TO REALIZE THAT THOSE PEOPLE ARE GETTING THOSE DRUGS SUPERIMPOSED ON HOWEVER OLD THEY ARE AND HOW MUCH THEY’VE USED THEIR HEART, AND WHATEVER THE OTHER ISSUES ARE THAT THEY HAVE.>>MAY NOT JUST BE THE PREDNISONE, IT MAY BE THE OVERALL — [ OVERLAPPING CONVERSATION ] — OVERALL EFFECT THAT IT’S HAVING.>>PALPATIONS CAN WAX AND WANE. WE’LL SEE PATIENTS ONE YEAR, NOT SEE THEM FOR SIX YEARS. YOU GET TO THE CRUX OF WHAT’S GOING ON, THERE’S SOMETHING — [ OVERLAPPING CONVERSATION ]>>I HAVE HAD BURSTS OF PREDNISONE WITH CHEMO. SO THAT THE PREDNISONE WOULD COME WITH THE CHEMO. I WENT, I DON’T LIKE THIS NOT SLEEPING FOR TWO DAYS. LET’S TRY HALF THE DOSE, SEE HOW I DO. WELL, HALF THE DOSE, FELT BETTER, BUT, STILL, HOW ABOUT QUARTER OF THE DOSE. HOW ABOUT NONE. AND I WAS MORE COMFORTABLE WITH THE SIDE EFFECTS THAT WERE BEING COVERED UP BY THE PREDNISONE THAN WITH THE SIDE EFFECTS FOLLOWING THE PREDNISONE. [ OVERLAPPING CONVERSATION ] >>DO YOU OFTEN TREAT YOURSELF? [ Laughter ]>>I ASKED THE ONCOLOGIST. AND HE WOULD SAY, NO, OKAY, HE CAN CUT IT BACK. I DIDN’T DO THAT ON MY OWN. THANK YOU, DOCTOR. OKAY. WE’VE GOT GREAT QUESTIONS. I WAS TAKING LISINOPRIL AND MY DOCTOR SWITCHED ME OVER TO LOSARTAN AND I WAS WONDERING IF IT’S BETTER THAN LISINOPRIL.>>IT’S BASICALLY SIMILAR. THIS GOES TO THE QUESTION WE TOOK EARLIER, I DON’T KNOW IF THIS PERSON WAS WATCHING THEN. THIS IS THE DRUG THAT’S COMMONLY GONE TO, IF LISINOPRIL GIVES YOU THAT COUGH, THE MOST COMMON SIDE EFFECT FROM THAT. THEY WOULD USE THIS LOSARTAN, HAS DIFFERENT HORMONE ACTION. VERY SIMILAR ACTION. >>IT DOESN’T HAVE THE COUGH BUT DOES CONTROL THE BLOOD PRESSURE. IT IMPROVES THE HEART FUNCTION AND EVERYTHING. I HAD AN ALLERGIST, HOWEVER, SAY TO ME ONE TIME, THERE IS A SIGNIFICANT LISINOPRIL RISK, YOU KNOW, THIS ATYPICAL REACTION TO DRUGS WE HAVE WITH EVERY DRUG, YOU KNOW, THAT THIS COULD BE AN ATYPICAL THING THAT LISINOPRIL HAS A SIGNIFICANT AMOUNT OF THAT. AND I’VE HAD A FEW PATIENTS JUST GET SICK ON THE LISINOPRIL. SO I THINK SWITCHING TO LOSARTAN IS A GOOD IDEA. SPEARFISH WOMAN SAYS I HAVE AN APPOINTMENT WITH A HEART SPECIALIST FOR THE FIRST TIME NEXT WEEK. WHAT KIND OF INFORMATION SHOULD I BRING WITH ME, LIKE PRESCRIPTIONS OR MEDS OR MEDICAL HISTORY?>>GREAT QUESTION. I THINK, AS ALWAYS, WE LIKE PATIENTS TO ACTUALLY BRING THEIR MEDICINES BECAUSE SOMETIMES A LOT GETS LOST IN TRANSLATION SO IT IS NICE TO HAVE THE PILL BOTTLES THERE.>>PUT THEM IN A BROWN PAPER BAG.>>BRING THEM WITH YOU. RIGHT, RIGHT. THINK OF, WE ALWAYS ASK OUR PATIENTS TO THINK OF THREE QUESTIONS, AT LEAST THREE QUESTIONS THAT YOU WANT TO ASK AND HAVE ANSWERED, WRITE IT DOWN SO YOU DON’T FORGET IT, IF THERE’S SOMETHING YOU’RE REALLY TROUBLED ABOUT, DEPENDING ON HER COMPLAINT.>>YOU KNOW, DOCS REALLY TRY TO TAKE, I THINK, TIME WITH THEIR PATIENTS, MOSTLY, BUT IT’S SO COMPRESSED NOW. SO A DOCTOR VISIT IS SOMETHING I THINK YOU SHOULD REALLY PREPARE FOR. AND, SO, WHEN YOU GO, WRITE DOWN THE QUESTIONS BECAUSE YOU KNOW HOW IT IS WHEN YOU SEE YOUR NEIGHBOR, OH, GEEZ, I FORGOT TO ASK YOU THIS. AND THEN YOU JUST WALK OUT OF THE ROOM AND YOU FORGOT. SO DON’T BE AFRAID TO WRITE THINGS DOWN. SO THAT WHEN YOU COME IN AND YOU HAVE YOUR TIME WITH THE DOCTOR, YOU REALLY GET THE POINT ACROSS.>>I THINK THAT’S REALLY IMPORTANT. I TOTALLY AGREE WITH YOU, ALTHOUGH IN MED SCHOOL SOME PEOPLE SAID BEWARE OF THE ONE WHO COMES IN WITH QUESTIONS. I NEVER WAS BEWARE — >>IT JUST SHOWS YOU YOU’RE ORGANIZED.>>THEY’RE ORGANIZED. IT’S AN APPROPRIATE THING. BROOKINGS MAN ASKS, CAN YOU EXPLAIN CONGESTIVE HEART FAILURE?>>YES. THAT’S A GREAT QUESTION. I LIKE THAT ONE. CONGESTIVE HEART FAILURE, PEOPLE — I JUST HAD TODAY AN EXAMPLE. A LADY WANTED THE DIAGNOSIS OF CONGESTIVE HEART FAILURE TAKEN OFF OF HER CHART BECAUSE SHE DIDN’T THINK SHE HAD IT BECAUSE HER HEART PUMPS FINE. AGAIN, IT GETS BACK TO THE QUESTION AS MIKE WAS ALLUDED TO, THE HEART MUSCLE CAN LOSE ITS ELASTICITY IN THE PRESENCE OF HAVING HYPERTENSION. AND THAT’S JUST ONE FORM OF IT. WE CALL IT DIASTOLIC, LIKE THE DIASTOLIC, OR LOWER NUMBER ON THE BLOOD PRESSURE, BUT THAT’S THE RESTING PRESSURE INSIDE OF THE HEART IS HIGH AND THAT PRESSURE GETS EXERTED EVERY TIME THAT VALVE OPENS TO LET THE BLOOD IN, GETS EXERTED BACK TO THE LUNGS. AND IF THAT PRESSURE GETS UP AS HIGH AS 25 OR 30 MILLIMETERS OF MERCURY, THAT’S ENOUGH TO MAKE THE CAPILLARIES AND THE LUNGS START TO WEEP A LITTLE BIT OF FLUID AND YOU GET SHORT OF BREATH AND THEN YOU GET THE RIGHT SIDE OF THE HEART GETS UNDER PRESSURE AND VENOUS CONGESTION, START TO GET SWELLING, A LOT OF TYPICAL SYMPTOMS OF CONGESTIVE HEART FAILURE. YOU CAN GET THE SAME PROCESS IF THE PUMP DOESN’T WORK WELL OR IF IT’S NOT PUMPING WELL. THAT’S SYSTOLIC. SO THAT PUMP IS NOT WORKING GOOD, IT’S UNDER HIGH PRESSURE BECAUSE IT’S OVERLOADED. AND THAT SAME PRESSURE EXERTS BACK TO THE LUNGS AND MAKES YOU SHORT OF BREATH.>>I DON’T LIKE THE WORD “FAILURE.”>>YES.>>I WISH WE SAID HEART PUMP WEAKNESS, I LIKE THE WORD WEAKNESS, NOT FAILURE. ONE VIEWER WONDERS, WHAT EFFECT DOES EXTENDED CHEMOTHERAPY HAVE ON THE HEART? MIKE.>>THERE IS A WHOLE NEW SPECIALTY OF CARDIOLOGY THAT’S JUST GETTING STARTED. THEY JUST DEVELOPED THE FIRST JOURNAL OF WHAT THEY CALL CARDIOONCOLOGY, BECAUSE ALL THESE CHEMOTHERAPY DRUGS GO INTO THE BODY AND THEY CREATE DAMAGE. THEY’RE BASICALLY TRYING TO KNOCK OFF THE CANCER CELLS THAT THEY WANT TO GET RID OF, BUT THERE’S ALL THIS COLLATERAL DAMAGE THAT CAN TAKE PLACE TO OTHER ORGANIZE DEMANDS BECAUSE THESE DRUGS ARE TOXIC. THE PEOPLE THAT DELIVER THEM COME WITH GLOVES AND THEY HAVE IN BROWN BAGS THE CHEMOTHERAPY.>>THAT’S NOT COMFORTING TO THE GUY GETTING CHEMOTHERAPY.>>NO, NO, THE THING IS, I DON’T WANT TO PUT ANYBODY OFF ABOUT GETTING THE CHEMOTHERAPY BECAUSE THERE’S ALL KINDS OF SAFETY, WHICH IS WHERE THIS WHOLE GENRE OF CARDIAC ONCOLOGY COMES FROM, AND THEN SOME OF THOSE PEOPLE GET RADIATION AS WELL AND OTHER DRUGS THAT THEY’RE TAKING ANYWAY. AND, SO, ALL OF THAT CAN CREATE SOME TROUBLES AND DIFFICULTIES FOR THE HEART AND THEN HAVING SOMEBODY WHO’S KNOWLEDGEABLE ABOUT ALL OF THOSE COMPLEX INTERACTIONS TO SEE TO IT THAT YOU GET THROUGH WITH YOUR CHEMO UNSCATHED SO YOU DON’T TRADE ONE PROBLEM FOR ANOTHER.>>THAT’S REALLY TRUE. BEING THE WORST HEART DRUG.>>ONE OF THE WORST.>>WE’VE GOT 18 QUESTIONS, EIGHT MINUTES, WE GOT TO REALLY SCRAMBLE. QUICK ANSWERS. MY HUSBAND HAD CHEST PAINS AND SHORTNESS OF BREATH, WENT TO THE ER, REFERRED TO A CARDIOLOGIST, NO BLOCKAGES WERE FOUND, DISCOVERED AN AORTIC VALVE LEAKAGE, CARDIOLOGIST SAID AORTIC REGURGE. THEY SAID IT’S NOT SEVERE. WHAT DOES THE FUTURE HOLD FOR A PERSON WITH A.I., OR A.R.?>>AORTIC REGURGE.>>TYPICALLY IF IT’S A MILD AORTIC REGURGITATION, THAT’S TOLERATED QUITE WELL. BUT WHY DO THEY HAVE THE REGURGITATION? GETTING BACK TO WHAT MIKE SAID, AORTIC ROOT IS DILATED, THE VALVE IS LEAKING, BE SURE YOUR HYPERTENSION IS CONTROLLED AND THAT THE A.I. IS MONITORED. YOU DON’T WANT TO WAIT UNTIL THE HEART MUSCLE IS STARTING TO WEAKEN. IT’S A LITTLE TOO LATE.>>YOU WANT TO WATCH IT AS LONG AS THE HEART FUNCTION IS GOOD AND YOU’RE WATCHING THE SEVERITY AND CONTROLLING THE BLOOD PRESSURE, THAT’S A GOOD WAY TO WATCH IT.>>WOMAN ASKS, HOW COMMON IS IT TO HAVE A FAILED STENT?>>IT’S ONLY ABOUT 6% OF THE TIME. AND A FAILED STENT, WE USUALLY TALK ABOUT IS THAT IT BUILDS UP WITH SCAR TISSUE. ON THE AVERAGE NOW, THOSE ARE THE STATISTICS. IT DEPENDS ON HOW BIG THE VESSEL IS. YOU HAVE A GREAT BIG VESSEL, THEY COME OUT BETTER. THE SMALLER THE VESSEL, THE HARDER THEY ARE TO WORK ON. WHICH IS IN GENERAL TERMS WHY WOMEN ARE WORSE OFF WITH HEART DISEASE BECAUSE IN GENERAL THEY’RE SMALLER.>>SIOUX FALLS WOMAN SAID, KEEPING MY BLOOD PRESSURE REGULATED IS AN ISSUE, COMMONLY 150, 160 OVER 60 TO 70, PULSE IS 60 TO 80, CARDIAC OUTPUT IS 65%, ON XARELTO, NOW HAVE A CPAP, IS THERE ANY WAY TO LOWER THE SYSTOLIC NUMBER, I WORRY ABOUT EVENTUALLY DEVELOPING HEART FAILURE, THE FATIGUE IS REALLY REALLY ANNOYING. DO I JUST HAVE TO LIVE WITH THIS?>>SHE WON’T HAVE TO LIVE WITH THE SYSTOLIC PRESSURE. THAT CAN BE EFFECTIVELY CONTROLLED. HAVE YOUR DOCTOR REALLY LOOK AT THE MEDICATIONS. THERE’S SOME THAT WE’RE HOLDING ON TO IN CERTAIN SITUATIONS, PROBABLY AREN’T AS GOOD AS FIRST LINE CHOICES BUT MORE ALONG THE LINES AS VASODILATORS, LISINOPRIL, EVEN SOME OF THE AMLODIPINE. KIND OF TENDING TO GET AWAY FROM THE BETA BLOCKERS, BUT WE LIKE THEM AS CARDIOLOGISTS FOR OTHER REASONS.>>ONE VIEWER SAID, YOU MENTION A STIFF HEART. WHAT IS A STIFF HEART? SAY IT AGAIN, EXPLAIN.>>THE DEAL IS, EXAMPLE I USE, THE BLOOD PRESSURE BALL THAT WE ALL REMEMBER WHEN THEY TAKE YOUR BLOOD PRESSURE, SO EVERYBODY UNDERSTANDS THE SQUEEZING PART, THAT’S HOW THE BLOOD GETS PUMPED AROUND, BUT WHAT THEY DON’T FORGET IS THAT — OR WHAT MOST PEOPLE FORGET IS THAT THE HEART HAS TO GO BACK. SO YOU JUST CAN’T SQUEEZE, IT HAS TO GO BACK. SO WHEN YOU’RE YOUNG, THE HEART SUCKS THE BLOOD RIGHT OUT OF YOUR LUNGS, JUST LIKE — FILET MIGNON, SO ELASTIC, WHAT HAPPENS, WHEN IT GETS STIFF, IT’S LIKE TAKING THE BALL IN THE 30 BELOW WINDCHILL, YOU SQUEEZE IT, IT DOESN’T WANT TO COME BACK, BECAUSE OF THAT, THE PRESSURE GOES ON YOUR LUNGS AND YOU’LL GET SHORT OF BREATH.>>YEAH. THE QUESTION ABOUT BLOOD PRESSURE, VERY QUICKLY. IN THE ELDERLY, LIKE, WHAT, 65 OR OLDER –>>OOH. [ Laughter ]>>THE BLOOD PRESSURE OFTEN IS HIGH WHEN YOU’RE SITTING THERE BUT IT GETS LOW WHEN YOU STAND UP, YOU GET LIGHT-HEADED WHEN YOU STAND UP, THERE’S A PROBLEM. DO FISH OIL TABLETS REALLY LOWER CHOLESTEROL?>>COMPLICATED QUESTION. YOU KNOW, THE FISH OIL CAN WORK ON TRIGLYCERIDES A LITTLE BIT. AND THERE’S A LITTLE BIT POSSIBLY FALLEN OUT OF FAVOR.>>BUT THEY DO HELP WITH DRY EYES.>>THERE YOU GO.>>I HAVE AN APICAL ISCHEMIA, DO I NEED TO WORRY ABOUT IT, WHAT ARE THE RISKS ASSOCIATED WITH IT, WHAT IS THE PROGNOSIS?>>IT’S DIFFICULT TO SAY BECAUSE YOU DON’T KNOW WHERE THE BLOCKAGE IS THAT CAUSES THAT. IF IT’S JUST OUT AT THE TIP OF THE HEART, IT WON’T CAUSE ANY TROUBLE, BUT IF IT’S UP AT THE PROXIMAL PART, IT WOULD BE A BIG DEAL. SO IT’S KIND OF LIKE THE FUSE BOX IN YOUR BASEMENT. YOU GO IN THE BASEMENT, YOU CUT ONE OF THE WIRES, YOU GET THE TOASTER. AND YOU CUT ANOTHER WIRE AND YOU GET THE DINING ROOM LAMP. BUT IF YOU CUT THE RIGHT WIRE, THE HOUSE GOES DARK. AND THAT’S A LITTLE BIT THE WAY IT IS TO THINK ABOUT WHERE IS THE BLOCKAGE THAT’S CAUSING THAT. SO YOU NEED SOMEBODY TO HELP YOU –>>YOU NEED TO KNOW THE REAL ANATOMY.>>YEAH, EXACTLY.>>IF THEY’VE DONE THE ANATOMY AND IT’S OKAY, THEN IT’S OKAY.>>HOW CAN A PERSON DETERMINE IF THEY’RE IN ATRIAL FIBRILLATION? IS THERE A WAY TO MONITOR THIS AT HOME YOURSELF OR IF YOU’RE OUT AND ABOUT?>>ANOTHER GREAT QUESTION. I TELL SOME OF MY PATIENTS, IT’S JUST A GOOD IDEA, JUST WHEN YOU TAKE YOUR MEDICINES IN THE MORNING OR YOU DO YOUR DAILY CHECK THAT YOU LEARN HOW TO CHECK THE RHYTHM OF YOUR HEART. SOMETIMES IT CAN BE AS EASY AS THAT. THERE’S CERTAINLY NUANCES OF CERTAIN TYPES OF RHYTHMS YOU WOULDN’T PICK UP THAT WAY. THERE’S A LOT OF GREAT APPS AND A LOT OF GREAT TECHNOLOGY COMING OUT, SMARTPHONE APPS, CARDIO APPS. YOU CAN EVEN LOOK AT YOUR RHYTHM. YOU NEED TO HAVE A DOCTOR HELP YOU LEARN A LITTLE BIT ABOUT IT. THERE ARE WAYS YOU CAN MONITOR.>>WE WERE LOOKING AT THAT NOW. SORRY FOR INTERRUPTING YOU. >>NO, THAT’S FINE.>>THE DEAL IS, THEY HAVE A LITTLE THING, IT’S LIKE A WAFER, IT STICKS ON THE BACK OF YOUR CELL PHONES, YOU PUT YOUR THUMBS ON THERE. YOU HAVE ONE? THERE THEY ARE. THIS IS WHAT IT LOOKS LIKE. I DON’T KNOW IF YOU CAN SEE THAT. YOU LAY THAT ON THE TABLE, YOU PUT YOUR THUMBS ON THERE, YOU CAN MONITOR YOUR OWN RHYTHM, IT COSTS ABOUT 60 BUCKS THAT YOU WOULD GET ONE OF THESE. AND WE’RE LOOKING — AND THE CELL PHONE INDUSTRY IS NOW GOING TO BE GETTING INTO HEALTH CARE.>>YEAH. >>AND MONITORING YOUR HEART RHYTHM AND ALL THE ISSUES THAT COME WITH THAT CAN BE VERY CONVENIENT.>>THE ATRIAL FIB IS AN IRREGULARLY IRREGULAR. LUB-DUB LUB-DUB LUB-DUB LUB-DUB LUB-DUB. SO THAT’S NOT ATRIAL FIB. IF YOU CAN CATCH A REGULAR RHYTHM IN THERE, YOU TAP YOUR FOOT, TAP YOUR FOOT, BUT NOT BEING ABLE TO TAP YOUR FOOT TO IT IS THE CLUE I HAVE.>>RIGHT, RIGHT.>>IF THE STOOL IS DARK, YET THERE IS NO VISIBLE BLOOD, IS THERE STILL CONCERN THAT THERE’S AN ANEURYSM LEAKING IN THE DIGESTIVE TRACT?>>ANEURYSMS ALMOST NEVER — NOT NEVER — BUT ALMOST NEVER LEAK INTO THE DIGESTIVE TRACT. THAT’S A SEPARATE ISSUE THAT USUALLY HAS 98% OF THE TIME IS FROM BOWEL BLEEDING AND NOT RELATED TO — [ OVERLAPPING CONVERSATION ]>>THAT’S ANOTHER STORY.>>THAT’S A DIFFERENT STORY. THANK YOU.>>>AND, NOW, FOR THE WINNER OF TONIGHT’S PRAIRIE DOC QUIZ QUESTION. PICK THE BEST ANSWER. WHAT IS THE MOST POWERFUL AT REDUCING VASCULAR AND HEART DISEASE PROGRESSION? 1) A STATIN CHOLESTEROL REDUCER. 2) A ONE-MILE WALK EVERY DAY. 3) AVOIDANCE OF FATTY FOODS LIKE EGGS AND BACON. 4) THE REGULAR INTAKE OF FISH OIL CAPSULE. OR 5) STOPPING SMOKING. AND THE ANSWER IS NUMBER 2! A REGULAR EXERCISE PROGRAM. THE ONE-MILE WALK. IN A 1998 LIFESTYLE HEART TRIAL COMPARING EXERCISE AND NO CHOLESTEROL DRUGS VERSUS STANDARD MEDICAL CARE WHICH INCLUDED ADMINISTERING CHOLESTEROL DRUGS FOUND 45% FEWER HEART ATTACKS IN THE LIFESTYLE GROUP COMPARED TO THE STANDARD TREATMENT. SO, HIT THE TREADMILL OR TRACK OR WALK AROUND THE NEIGHBORHOOD, WHATEVER WORKS BEST FOR YOU. IT WAS HILLBERT VANDERWILDE WHO ANSWERED THE QUESTION CORRECTLY. THANK YOU FOR PARTICIPATING, A BOOK WILL BE IN THE MAIL TO YOU SOON. WE’LL BE RIGHT BACK AFTER THIS.>>FOR MORE THAN 16 YEARS, THE PRAIRIE DOC ORGANIZATION HAS ENDEAVORED TO ENHANCE HEALTH AND DIMINISH SUFFERING BY PROVIDING USEFUL INFORMATION BASED ON HONEST SCIENCE IN A RESPECTFUL AND COMPASSIONATE MANNER. PRAIRIE DOC PHYSICIANS AND HEALTH PROFESSIONALS CONTINUE TO ANSWER YOUR QUESTIONS EACH WEEK CREATING A VAST PRAIRIE DOC LIBRARY OF MEDICAL INFORMATION AVAILABLE TO YOU AND YOUR FAMILY 24 HOURS A DAY. MAKE SURE YOU DON’T MISS A THING. FOLLOW THE PRAIRIE DOC ON FACEBOOK AND YouTube FOR FREE AND EASY ACCESS TO THE ENTIRE PRAIRIE DOC LIBRARY.>>A BEAUTIFUL 90-YEAR-OLD WOMAN CAME INTO THE EMERGENCY ROOM AFTER ANOTHER FALL. THE LAST YEAR HAD BEEN TOUGH FOR HER AS SHE HAD DEVELOPED DIASTOLIC HEART FAILURE. HER WEAKNESS AND BREATHLESSNESS WAS HELPED SOME BY DIURETICS, BUT SHE WAS TROUBLED BY EXTREME VARIATIONS IN BLOOD PRESSURE, HIGH ONE MOMENT AND DANGEROUSLY LOW THE NEXT. ALSO, SHE HAD A CALCIFIED AND SOMEWHAT TIGHT AORTIC VALVE AND WAS ON A BLOOD THINNER FOR ATRIAL FIBRILLATION. HEART DISEASE IN THE ELDERLY INCLUDES A WIDE VARIETY OF CONDITIONS. THE FOLLOWING IS A PARTIAL LIST. AGING CORONARY ARTERIES WITH BLOCKAGE AND SUBSEQUENT HEART ATTACK CAN BE CHALLENGING TO DIAGNOSE BECAUSE OLDER PEOPLE DON’T ALWAYS HAVE SYMPTOMS TO ALLOW INTERVENTION. CALCIFICATION OF HEART VALVES, ESPECIALLY THE AORTIC VALVE, CAN OCCUR WITH AGE WHEN TIGHTENING OF THE VALVE CAUSES PROGRESSIVE FAILURE OF THE HEART’S CAPACITY TO PUSH PAST THAT OBSTRUCTION AND DO ITS WORK. HEART PUMP WEAKNESS INVOLVES BOTH THE SYSTOLIC SQUEEZE, WHICH PUSHES BLOOD FLOW OUT OF THE HEART THROUGH ARTERIES, AND DIASTOLIC RELAXATION, WHICH ALLOWS BLOOD FLOW, FROM VEINS, BACK INTO THE HEART. HEART WEAKNESS CAN RESULT FROM EITHER ONE OR BOTH, AS AGING HEART MUSCLE IN THE ELDERLY BECOMES REPLACED BY SCAR TISSUE. EXTREME VARIATION IN BLOOD PRESSURE, HIGH ONE MOMENT AND DANGEROUSLY LOW THE NEXT CAN BE A SIGN OF DIASTOLIC HEART PROBLEMS. THE “BROKEN HEART SYNDROME,” CAN BE A REVERSIBLE SYSTOLIC HEART WEAKNESS CAUSED BY SEVERE AND PROLONGED SORROW. OVERACTIVE BLOOD CLOTTING CAN DEVELOP IN THE ELDERLY CAUSING DANGEROUS BLOOD CLOTS TO THE CORONARY ARTERIES, THE BRAIN OR ANYWHERE. EXPERTS SAY THAT UP TO 80% OF ALL DEATHS IN NURSING HOMES RESULT FROM BLOOD CLOTS. FALLING CAN CAUSE BLEEDING AND FRACTURE. FALLING IS OFTEN THE RESULT OF HEART DISEASE IN GENERAL AND CAN HAPPEN WHEN THE BLOOD PRESSURE DROPS JUST AFTER STANDING. FALLS CAN ALSO OCCUR DUE TO NEUROLOGICAL CONDITIONS, JUST PLAIN INACTIVITY OR TOO MANY MEDICINES. IF YOU GET LIGHT-HEADED WHEN STANDING, TELL YOUR DOCTOR, AND ASK HER OR HIM TO CONSIDER YOU MIGHT BE ON TOO MANY MEDICINES. THE RISK OF FALLING WAS SIMPLY TOO HIGH TO CONTINUE MY 90-YEAR-OLD PATIENT ON BLOOD THINNERS. I STOPPED THEM AND BACKED OFF A LITTLE ON THE DIURETIC WHICH COULD HAVE BEEN WORSENING HER BLOOD PRESSURE DROPS AND CAUSING THE FALLS. THE AGE-OLD ETHIC CAME TO MIND, “FIRST OF ALL, DO NO HARM.” BALANCING THE ADVANTAGES AND HARMS OF MEDICINES IN THE ELDERLY REQUIRES CAREFUL CONSIDERATION, AND SOMETIME LESS IS BEST. >>A BIG THANK YOU TO OUR GUESTS BRUCE AND MICHAEL FOR VOLUNTEERING TO COME TO OUR STUDIO IN YEAGER HALL ON THE CAMPUS OF SOUTH DAKOTA STATE UNIVERSITY. THERE WERE MANY GREAT QUESTIONS WE WERE NOT ABLE TO GET TO DURING OUR BROADCAST TIME. WE WILL CONTINUE TO ANSWER THOSE QUESTIONS ON OUR FACEBOOK PAGE FOLLOWING THE PROGRAM TONIGHT. GO TO THE PRAIRIE DOC FACEBOOK PAGE. WE’LL BE THERE SHORTLY AFTER THE BROADCAST ENDS. THIS ADDITIONAL SEGMENT WILL ALSO BE POSTED ON OUR WEBSITE, PRAIRIEDOC.ORG IN THE COMING DAYS.>>>THE FLU HAS COME TO SOUTH DAKOTA WITH OVER 2,600 CASES THIS SEASON AND ALMOST 950 THIS WEEK. FOUR PEOPLE HAVE DIED SO FAR THIS YEAR. THE FLU IS DANGEROUS. PROTECT YOURSELF AND GET THE FLU VACCINE. IT IS IMPORTANT NOT JUST FOR YOU BUT TO HELP PROTECT THOSE AROUND YOU.>>>THAT DOES IT FOR TONIGHT. FROM ALL OF US HERE AT “ON CALL WITH THE PRAIRIE DOC,” HAPPY VALENTINE’S DAY, AND UNTIL NEXT TIME, STAY HEALTHY OUT THERE, PEOPLE. >>LOTS OF THINGS CHANGE AS WE GROW OLDER, ESPECIALLY OUR EYES. “THE AGING EYE” NEXT TIME “ON CALL WITH THE PRAIRIE DOC.”>>FOR MORE THAN A DECADE, Dr. HOLM AND HIS ROLE AS THE PRAIRIE DOC HAS EMERGED AS A LEADER OF HEALTH CARE EDUCATION AND COMMUNICATION IN SOUTH DAKOTA AND ACROSS THE COUNTRY. EVERY WEEK Dr. HOLM AND OTHER MEDICAL PROFESSIONALS VOLUNTEER MANY HOURS TO SHARE SCIENCE-BASED TRUTHS ABOUT HEALTH CARE ON PUBLIC TELEVISION, ON THE RADIO, IN OUR NEWSPAPERS, AND ONLINE. AND, BEST OF ALL, EVERYONE HAS FREE, EASY ACCESS TO THE ENTIRE PRAIRIE DOC LIBRARY. HI, I’M JENNIFER MAY OF RAPID CITY. AS A BOARD MEMBER OF THE HEALING WORDS FOUNDATION, I ASK YOU TO CONSIDER MAKING A DONATION. PLEASE HELP US CONTINUE THIS IMPORTANT WORK. GO TO PRAIRIEDOC.ORG AND MAKE A DONATION TODAY.THANK YOU.