Search for tag: "heart disease"

Interviewer: Do you have chest discomfort, or are you short of breath when you're walking from the parking lot to the grocery store or maybe taking a flight of stairs? Dr. Steven Lofgren, what could be causing that?

Dr. Lofgren: One of the potential causes of these symptoms would be coronary disease or heart disease. That can be caused by a restricted amount of blood flow to the heart muscle itself.

Interviewer: And if somebody's suffering from these symptoms, what do you recommend that they do?

Dr. Lofgren: We would absolutely want to have a patient with these symptoms have what's called a stress test done. A stress test is nothing more than putting the body under some degree of stress and seeing how the heart performs. Benefits of doing this test is you can have an immediate diagnosis of a potential blockage in one of these coronaries, which then can be fixed very simply with a process called angioplasty. If you find that you have these symptoms, it is absolutely critical that you go in and see your doctor for further testing.

updated: March 23, 2021
originally published: April 1, 2019

Announcer: Health tips, medical news, research and more for a happier, healthier life. From University of Utah Health Sciences, this is The Scope.

Interviewer: The current medical guidelines for systolic blood pressure are between 140 to 150 but new research indicates that reducing that to 120 can drastically reduce the chance of heart disease and death for adults 75 or older even if they are considered frail elderly. Dr. Mark Supiano is a geriatrician and the executive director of the University of Utah Center on Aging. This study, is this a new revelation that lower could be better with systolic blood pressure especially for elderly adults?

Dr. Supiano: Yes, Scott. This is exciting new information that came out of the systolic blood pressure intervention trial otherwise known as SPRINT. The trial ended late in 2015, earlier than anticipated because of these very dramatic benefits.

Interviewer: When it initially ended early, a lot of people speculated that that meant bad news but it actually meant quite the opposite.

Dr. Supiano: Yes and particularly for the 28% of the SPRINT subjects who are over the age of 75 there were some concerns, myself and other geriatricians, that the very intensive systolic blood pressure target of 120 might not be safe for older people. When we first got news of the trial ending early I first thought that it was possible that older people had more side effects or more injurious falls or other complications of the very low blood pressure and that was why the data safety monitoring board might have ended the study early. In fact, the results were just the opposite.

Interviewer: Like a revelation almost it seems like.

Dr. Supiano: It really was a surprise to be honest. Not so much as a surprise that the benefit but the surprise that the benefit was of this magnitude and that this occurred this early on on the trial.

Interviewer: So the current guidelines are between 140-150. This study points out that 120 can drastically reduce the chance of heart disease and death. How drastic are we talking?

Dr. Supiano: I'll focus on the population 75 and older as I said, this is 28% of the SPRINT cohort and in that group there was a 33% reduction in the cardiovascular outcomes. This is primarily a myocardial infarction or heart attack or congestive heart failure and stroke and then in addition overall reduction of 32% in mortality.

Interviewer: That's pretty substantial.

Dr. Supiano: It is. To be honest there are very few treatments I can recommend for people over the age 75 that can have this dramatic impact on those outcomes.

Interviewer: So if you're going to do one thing, according to the study so far, it would be try to get that blood pressure down to 120. Now, does that mean taking medication? Does that mean lifestyle changes?

Dr. Supiano: All of the above. On average, the people in the intensive group who are managed to a blood pressure of 120 or taking one additional anti-hyperintensive medication relative to people on the standard arm.

Interviewer: Of course your eyes looking at the risk benefits and something like this. So the benefits are tremendous. Are there risks?

Dr. Supiano: Absolutely. The good news was, and again focusing on those 75 and older population, our major concern would have been there were higher rates of injurious falls or what's called orthostatic blood pressure - a reduction of blood pressure when the people first stand up and get light headed or dizzy. First, there was no increase in serious adverse events between the intensive and the standard arm. Second, and again very reassuring, there was no high rate injurious falls in the intensive group, nor were there serious rates in the intensive group. The intensive group did have higher rates of low blood pressure, of electrolyte abnormalities, largely low sodium levels which was to be expected because of the medications that were used and some other adverse events. But when we weigh though over the benefit of preventing heart attack, stroke, heart failure and death, most believe that those benefits outweigh those risks.

Interviewer: That number of 120, can you go lower than that and get more benefits or is there a point where no?

Dr. Supiano: That would be another study. And it's important to point out the one on average for 75 and older group achieve of systolic blood pressure of just under 122. That meant that half the people had a systolic blood pressure above 122. So 120 maybe recommended as a target blood pressure. That doesn't mean everyone is going to get there. Nor does it mean that the benefit won't accrue if you don't get exactly to that target. I think the take home message is, it seems to be that the lower, the better.

Interviewer: So is this something that if somebody does fall under this group or somebody has a grandparent or parent that's in this group that you would recommend that they go to their doctor and say, "I would like to try for a blood pressure of 120"? Because this isn't the guideline yet.

Dr. Supiano: So important point, the guidelines are being written down or likely incorporate this new information but those guidelines won't be out until later this summer. Even with that guideline, like everything we do in medicine and particularly in geriatric medicine we have to be patient-centric. So we need to weigh someone's benefits and risk of their elevated blood pressure and incorporate that those at greater risk are likely to have greater benefit. So it needs to be an informed decision with patient who discussed the pros and cons and determine their level of interest in trying to achieve this lower target and recognize those benefits.

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Dr. Miller: Congenital heart disease, what is that exactly? We're going to talk about that next on Scope Radio.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: Hi. I'm here with Dr. Colin Cowley and he is a Professor of Cardiology at the University of Utah and he also practices at Primary Children's Hospital. Colin, tell us a little about what congenital heart disease is.

Dr. Cowley: Congenital heart disease is a form of heart disease present when a child is born. Congenital just simply means present at birth. There's a large spectrum of diseases that we see, ranging from very mild that essentially heal themselves to life-threatening forms of heart disease the require multiple surgical procedures and other types of interventions.

Dr. Miller: Do you have any estimate as to how often a child might have congenital heart disease out of the population?

Dr. Cowley: It happens in about 1% of all live births. There's a large spectrum, as I've just said, from very mild to immediately life-threatening.

Dr. Miller: And so I would think, with modern medicine since the '50s probably, a lot of these kids are alive now and living into adulthood. Is that correct?

Dr. Cowley: That is correct and that's one of the important changes in medicine, at least from my perspective. Many of these forms of heart disease, historically children at a very short live, many of them didn't survive the newborn period. Others survived into childhood very handicapped as a result of their heart disease. But with advances in surgical intervention and catheter-based intervention and imaging and medications, the vast majority of these children now survive into adulthood.

Dr. Miller: Which then presents a new set of problems, I believe. So that they need to be managed lifelong it sounds like.

Dr. Cowley: Exactly.

Dr. Miller: And it's not just regular care, they need specialty care I would assume, right?

Dr. Cowley: This is very specialized care. There are now more adults in the United States with forms of congenital heart disease than there are children. There are well over 100 large centers around the country that provide care for children with congenital heart disease and very few centers that are now prepared to take care of adults with congenital heart disease.

Dr. Miller: And my understanding is you run of these centers of Primary Children's, is that correct?

Dr. Cowley: Correct. It's a collaborative program working with people at the university hospital as well as Intermountain Medical Center.

Dr. Miller: And this involves multiple specialties or a multi-specialty orientation so you've got cardiology, thoracic surgery and pulmonary medicine.

Dr. Cowley: Yes, there are a large number of sub-specialties that become involved with these patients. In addition to heart disease, there is a very high instanced of associated diseases, kidney disease, lung disease, neurologic disease and a variety of psychosocial issues that have the potential to very seriously affect these patients.

Dr. Miller: How does a patient get into your program? How do they seek out and receive that specialty care that seems so important to their longevity?

Dr. Cowley: Many of them have been within our program throughout their life. We estimate there are about 8,000 adults in Utah alone with some form of significant congenital heart disease.

Dr. Miller: That's a lot.

Dr. Cowley: It is. Many of those have been lost to follow up and we are in the early stages of really formalizing our program and we will reach out to everybody any way we can to make sure the people realize we now have the infrastructure set up to provide them with comprehensive care across the board.

Dr. Miller: So for a patient who's involved in comprehensive specialty care, can they expect to live a pretty full life, and work, and is that generally the case?

Dr. Cowley: Many of them. It depends on the severity of the underlying heart disease. Some of these children are born essentially with half a heart and they undergo a series of operations where they have one pumping chamber that pumps blood out to their body and the blood flow to their lungs, instead of being pumped essentially has to go there through gravity. That's associated with many negative consequences including, for many of them, serious liver disease. But the expectation is that the majority of those patients will go on to need cardiac transplantation and some of them, liver transplantation at the same time.

Dr. Miller: Now that would be the minority of the patients in your group?

Dr. Cowley: That is the minority, so most of the patients that make it to adulthood with congenital heart disease have what we would call two ventricle physiologies. So they have two pumping chambers and they have problems with valves or other issues. But there are those with the more complex forms of heart disease that represent a minority.

Dr. Miller: So for patients who have congenital heart disease that live at a distance, how often would you see them and also would you transfer some of their care back to their physicians wherever they're from, say if they're from the different part of the state or a more rural part of the state? How do you deal with that, do you have outreach clinics?

Dr. Cowley: Yes, so we have outreach clinics, in fact, we're reaching into Idaho as well we have a formal clinic in Saint George and we're actually reaching into Alaska now. There's a large population up there that will benefit from our services, but we do . . .

Dr. Miller: So you have an outreach clinic in Anchorage?

Dr. Cowley: Yes, we do. Depending on the patient we might just need to see them once a year, sometimes twice a year. If they're much sicker, more frequently than that. We try to partner with their primary care physician to provide them with support to minimize the number of times they actually have to make the trip to see us, especially if they are remote.

Dr. Miller: What would be the average age of the patient that attends your adult congenital heart clinic?

Dr. Cowley: Probably in the mid-30s at this point.

Dr. Miller: Why is it important that these patients with congenital heart disease contact your clinic?

Dr. Cowley: Well, I think prevention is key here. If we can anticipate problems for some of these patients we can potentially prevent many, many downstream problems. There's a very high rate of associated problems for these patients, some of them cardiac, some of them non-cardiac. The cardiac disease can become progressive. So if they have rhythm problems, which a large percentage of these patients do, they may not know it.

Dr. Miller: You mean abnormal heart rate?

Dr. Cowley: Exactly. Abnormal heart rates or abnormal heart rhythms. There are some excellent providers in the community that can provide very good care, but the complexity for some of these adults really requires sub-sub-specialty care that I think there's nobody else really adequately qualified to provide.

Dr. Miller: So whom should they contact if they were to call Primary Children's Hospital?

Dr. Cowley: If they called Primary Children's Hospital or the university hospital operator, either number will get them, and ask for the adult congenital heart disease program. They will get put through to us and we have a team of people prepared to provide care for you.

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Interviewer: Did you know that when women have heart attacks the symptoms are different from men? True. You're going to find out more about that next on The Scope.

I was surprised to find out that heart attack symptoms are actually different in men and woman. We're going to learn more about that right now with Dr. John Ryan, he's the director of the Dyspnea Clinic at the University of Utah. Men and woman, heart attack symptoms are different, is that true?

Dr. Ryan: It's true to a certain extent, so the traditional concept we have of heart attacks being the crushing chest pain, hand on your chest, sweating, vomiting and presenting to the emergency department and be found to have a heart attack, is seen more commonly in men, however, part of the issue is is that women also experience these, but tend to ignore them more. So yes, they have the symptoms, but they just tolerate them better or dismiss them as being a heart attack, because many women don't feel that they're predisposed to a heart attack.

Interviewer: So for example if you were to ask somebody what kind of pain you're feeling, one person might say it's a level ten, same amount of pain...

Dr John Ryan: Yes, exactly.

Interviewer: ...number five, women are doing the same thing with these symptoms.

Dr. Ryan: Exactly, yeah, so there's a tendency to dismiss the symptoms, so therefore the symptoms often times need to be more severe or more advanced before woman present with them and then by the time they're more severe and more advanced, they're then different, so instead of having left sided chest pain or pain radiating down the left arm, they now have central chest pain and it's radiating down both arms. So that's what ultimately can make the syndromes different. Also, women often don't feel that they should have heart attacks.

Interviewer: They don't have time.

Dr. Ryan: Not only do they not have time, but it's a problem that men have. And this is a serious misconception because cardiac heart disease is the biggest cause of death of women in the United States.

Interviewer: Which is a surprise to a lot of people.

Dr. Ryan: Surprise to a lot of people and it's an important public awareness issue so therefore when women again, when they get their chest pains, or their symptoms from the heart attack, not only do they tolerate it more than men, but also they dismiss it as being a heart attack, sure, sure, why would I be having a heart attack, I'm a woman.

Interviewer: Sure.

Dr. Ryan: I don't have heart disease.

Interviewer: Why do women dismiss, I mean, what is it about a woman's body that they tolerate it more? Any idea?

Dr. Ryan: Probably a pain threshold issue.

Interviewer: We've heard that before.

Dr. Ryan: Exactly, yeah, women often claim to have a higher pain threshold than men, and that's probably true and in this, and that's a very, that's an advantage, but ultimately that ends up hindering people in terms of presenting when they are having their heart attack. So that's probably the issue.

Interviewer: The symptoms are the same but different, they experience them differently, but at the end of the day, are heart attacks different?

Dr. Ryan: So the heart attacks are still associated with significant morbidity, significant mortality and so in that regard they are just as ominous and just as sinister. And the pains, again, the classical pains that people get or that people are taught, is that the central chest pain or the left sided chest pain, radiating down into the left arm, woman often times don't describe this as pain but will describe it as a pressure or a tightness in the chest, all of which are various adjectives that really impact how you perceive pain and again that reflects how you perceive pain. But ultimately the prognosis is still serious, still ominous, and still needs to be treated, taken very seriously and women need to be aware of the fact that they are as likely to experience cardiovascular events as men.

Interviewer: Is there a take away that you would have?

Dr. Ryan: Although we want to see patients when they're having heart attacks, we want to prevent patients from having heart attacks all together, so the more important aspect would be for women to be proactive in order to preventing events, so doing exercise, eating healthy, having heart smart diets and trying to, staying on top of their blood pressure, cholesterol and so on so that we don't end up seeing them when they've had a heart attack.

updated: February 23, 2022
originally published: February 7, 2014