LMH cardiologist to chat about heart health
February 9, 2011
This chat has already taken place. Read the transcript below.
Dr. Roger Dreiling has been a cardiologist since 1984 and joined the Lawrence team in 2008. He specializes in clinical cardiology, interventional cardiology and treatment of acute myocardial infarction (heart attack). Dreiling is board certified in internal medicine, cardiovascular disease and interventional cardiology.
Dreiling works in the Heart Center at LMH, which was ranked No. 1 in heart attack care among 949 hospitals by the American College of Cardiology.
Welcome Dr. Dreiling to The News Center and thank you for taking time to answer questions about heart health. I am health reporter Karrey Britt and will be moderating this chat.
Thank you Karrey, happy to be here.
How concerned should I be about having a heart attack if my brother had one at age 61?
Traditional risk factors for "heart attack" are family history of premature atherosclerosis (defined as 1st degree relative male age less than 55 or female less than 65), hypertension, diabetes mellitus, smoking history, and cholesterol status. There are of course other not yet identified risk factors as well. Roughly 30% of all patients I see with a heart attack have no risk factors. So, while your risk is slightly elevated because of your family history, it is more important to limit any risks that you have control over. You control what you eat, how much you exercise, whether you smoke. We have more control than we wish to admit. You should also know your cholesterol and talk to you physician as to whether your numbers are satisfactory for you. Recognizing that heart disease kills more Americans than any other disease should make us all concerned about healthy life choices.
How has technology changed the way you do your job over the years? What's the difference between having a heart attack in 1984 and having one in 2011?
Great question! The medical management of coronary disease has changed dramatically with the introduction of medications to control our cholesterol. We have a much better understanding of the significant impact diabetes mellitus has on the development of coronary artery disease, and as such we should do all we can to limit our development of that disease - primarily diet,exercise, and weight management. In 1984 patients were treated (and depending on where they live -urban or rural- we treated heart attacks with blood clot dissolving medications - because heart attacks are due not only to cholesterol plaque, but also to blood clot formation on that plaque. These medications decreased the average mortality from 13% to around 10%. Our current treatment of acute myocardial infarction (and this is how it is done here in Lawrence) is percutaneous coronary intervention, usually with a coronary stent, but occasionally with just a balloon angioplasty. Mortality from MI with this procedure as with the blood clot medication regiment depends on how quickly the patient can get to the hospital and the artery opened. We measure this as door to balloon times. The national average for D-2-B is 63 minutes. The D2B at LMH is currently 46 minutes. National average in hospital mortality(death) is 5-7%. Our mortality rate at LMH is less than 1-2 % for acute infarctions presenting within 2 hours of onset. Lastly, the post infarction management in 2011 is different than 1984. The use of cholesterol lowering agents (statins), remodelling agents (ACE inhibitors and beta blockers), as well as platelet drugs to prevent further infarction (aspirin, sometimes plavix) is much greater.
I am a man approaching 50. What three or four things can I do today to have immediate impact on becoming more heart healthy?
Another great question. I am 59, and this is what I have done.
1. Weight management -- This is usually the most difficult. There are two ways to do this. Caloric restriction with exercise program (20 min walking briskly everyday) or carbohydrate restriction (<35 gram/day) also with and exercise program. The carbohydrate restriction works best for me but not for everyone. 2. Have your cholesterol measured and discuss with your doctor your numbers. the "bad" cholesterol is LDL, and the lower you can make this number the better. Below 120 is preferred unless you have other risk factors (smoking, diabetes), then the number for LDL should be less than 100. The good cholesterol HDL, should be as high as we can get it, but to date the only way to elevate HDL is exercise. We do not yet have pharmacology to raise our HDL. 3. If your weight and cholesterol are a problem, then you must be on a regular exercise regimen. I suggest you build this into you daily regimen -- early morning before work,or after work before supper. The daily schduled regimen is important. 4. See your doctor about your Blood pressure. Is it normal or does it need attention. 5. Your yearly physical will assess your blood sugar (to check for diabetes) as well as your blood pressure. As a general rule, BP increases with age. Lastly it is a misconception that everyone needs a screening treadmill exercise test -- this is definitely not recommended unless you have symptoms referable to the heart.
Speaking of door-to-balloon time, how important is it to get treatment and not wait? I've heard that patients tend to wait too long to seek help. Is this true?
The average time from symptom onset to seeking help is 2 hours. If you are having an acute infarction, you are at risk for sudden death from ventricular fibrillation. In fact it is estimated that about 1/2 of all patients with acute MI die prior to coming to hospital -- from ventricular fibrillation (sudden death). So, if you think you might be having a heart attack (chest heaviness, chest pressure, associated shortness of breath, or sweating), call 911. We would rather care for 100 patients who think they are having a heart attack and they aren't rather than miss a single person who is and who doesn't make the call. If you are unsure, call 911.
The longer it takes to get the artery open, the more heart damage there is. "TIME IS MUSCLE". That is why we work hard to decrease our "door to balloon" times within our LMH system.
I keep hearing that heart attack symptoms for women are very different from symptoms for me. But I'm still not sure exactly what they might be. Can you tell me what women need to look for? And at what point should you call 911?
Men with heart disease as a statistic present with Angina pectoris -- chest pressure with exertion. Women, for reasons unknown, are less likely to have the "classic" warning sign of exertional angina. Exertional sweating, exertional fatique, exertional shortness of air have all been touted as being the women's "anginal equivalent". However, the reality is that many patients, both men and women have no symptoms of occlusive coronary artery disease. AS mentioned above, about 30% of the heart attack patients I see have no preceeding symptoms. This is why prevention is so important. Do all you can do to lessen your risk. Weight management, no smoking, proper diet, know you cholesterol and get it to goal by whatever means you can (diet+statin usually required), proper management of diabetes. Your doctor monitors these issues during your annual examination.
Lastly, if you are having significant symptoms in your upper chest as pressure, heaviness, sweating that does not abate, severe shortness of air -- you call 911, and we can sort it out in the emergency room. We would rather see a bunch of "false alarms" than miss a single acute heart attack.
About how many patients do you see for heart disease in your office? How about in the emergency room?
Because we are a cardiovascular specialty office, almost all of our patients are "heart patients". Many of these are follow up visits for us to monitor their cardiovascular condition. We do this in conjunction with the Family Practice Specialist or the Internal Medicine Specialist. The best care of a cardiac patient is coordinated care between the primary physician and the cardiologist. Last year we saw about 60 heart attacks in the emergency room. The catheterization lab at LMH did between 550 and 600 catheterizations to identify and treat cardiac disease. We did 170 coronary interventions, about 60 of those were acute in nature to stop or prevent a heart attack. Our cath lab is available to our community 24/7/365. Our door to balloon times are have been recognized by the American College of Cardiology as the best in the country for similar sized hospitals.
Here's a question from a reader that was e-mailed to me: I have heard that women's heart attack signs can include nausea/vomiting. Can nausea also be associated with male heart attacks?
Nausea and vomiting are not unique to either men or women. N/V is a common symptom in patients who have a particular type of heart attack -- inferior MI. Usually N/V is not the only symptom however. Patients with inferior MI's usually also have other symptoms such as chest discomfort, sweating. I mention this so that anytime we have nausea/vomiting we don't think "heart attack" first -- gastroenteritis is still the leading cause, as is a problem with the gallbladder. BUT, if unsure, an ER visit via 911 will sort this out. A 19 year old with N/V is not most likely not having an MI. A 78 year old with chest discomfort with N/V should call 911.
Does the amount of sodium we consume play a factor in heart disease?
Our intake of sodium has a rough correlation with our blood pressure. Because high blood pressure (hypertension) is the leading cause of congestive heart failure in this country, limitations on our salt intake, to limit our blood pressure and prevent congestive heart failure should be a goal of all Americans -- easier said than done.
The Dr. Roger Dreiling Low Sodium Diet
1: if it comes out of a box or a sack and you can sit in front of a TV and eat it -- it has too much salt (chips, crackers, pretzels, etc)
2: No prepared frozen foods (TV dinners, frozen pizza, pot pies, lasagna, etc)
3: No processed meats - bologna, salami, ham, bacon
4: No canned goods (almost) such as soups, vegetables
5: No added salt
Salt substitutes in moderation if your kidney function is normal is okay. Spices such as Mrs. Dash is okay. Garlic powder, but not garlic salt okay.
Low salt, sea salt, and these products still contain natural salt, so should be avoided.
With this recommendation now online, I will anticipate the hate mail from angry husbands with heart failure and hypertension whose wives have read this!
Thank you for coming in today and providing such valuable information. We really appreciate your time and effort.