Recap: Longtime Lawrence cardiologist discusses heart health

February 2, 2012

This chat has already taken place. Read the transcript below.

Dr. Michael Zabel

Dr. Michael Zabel, of Cardiovascular Specialists of Lawrence, will discuss heart disease — America’s No. 1 killer — in recognition of American Heart Month.
Zabel earned his medical degree from Washington University School of Medicine in St. Louis in 1988. He completed a residency in internal medicine and a fellowship in cardiology at Duke University Medical Center.
Zabel is a clinical associate professor at the University of Missouri Kansas City School of Medicine. He has done a variety of research on heart disease and treatments.

Moderator:

I would like to welcome Dr. Zabel to The News Center. I am health reporter Karrey Britt and will be moderating this chat. Let's start with how long have you been a cardiologist and what prompted you to go into heart disease.

Dr. Michael Zabel:

Thanks Karrey. I appreciate the opportunity to participate in this forum. I've been practicing cardiology in Lawrence since 1995 and was at Duke University prior to that. I decided to go into cardiology while doing my Internal Medicine residency training at Duke largely because it is such a dynamic field. There is always something new in cardiology.

sunflower97:

How important is exercise to heart health, particularly for someone who has had a heart attack and subsequent blockage? and what are some techniques that one can use to convince a loved one to include regular exercise in his/her daily routine?

Dr. Michael Zabel:

Regular exercise is important for everyone and particularly those with a history of heart disease. Some people find the concept of daily exercise overwhelming but it is important to realize that the exercise does not have to be overly strenuous or uncomfortable to be beneficial. A brisk 40 minute walk every day is one of the best exercise programs around.

kbean:

I've just started exercising more regularly. How can I find out what my heart rate should be during exercise and rest for a woman in her late 20s?

Dr. Michael Zabel:

First find your predicted maximum heart rate which is 220 minus your age.Your target exercise heart rate is then 70 to 85% of that maximum.

aliedwards:

What's the number one thing I can do to keep my heart healthy?

Dr. Michael Zabel:

The number one thing to keep your heart healthy is to take care of your whole body. Don't use tobacco of overuse alcohol. Maintain a healthy weight. Exercise and eat a healthy diet. OK, technically that is more than one thing but it all works together. If your body is healthy then your heart has a much better chance of staying healthy.

kansasplains1:

What are the treatment possibiltiies today for atrial fibrillation? I know that a lot of people have it with no difficulties, but under what circumstances might this lead to stroke, and what can be done to prevent that?

Dr. Michael Zabel:

Atrial fibrillation (AF) can indeed cause strokes. There are specific risk factors for stroke that your doctor can help you identify (diabetes, hypertension, age over 75 are a few). For those at increased risk of stroke the most beneficial treatment are blood thinners such as warfarin (Coumadin) or Pradaxa. There are new drugs and new ablation techniques that can help those who have a lot of bad symptoms from AF but, as you mention, many people have few or no symptoms and can lead normal lives with AF.

AlexParker:

Are aches and pains in the chest area normal, or a sign of something to be concerned about?

Dr. Michael Zabel:

It depends greatly on what type of pain and under what circumstances it occurs. Many types of chest pain are not dangerous but in general pain in the chest region should be evaluated by a physician.

Moderator:

What are the signs or symptoms that something might be wrong with your heart?

Dr. Michael Zabel:

Some of the most common cardiac symptoms are pain or pressure in the chest or neck region, unusual shortness of breath with exercise or at rest, blackout or fainting episodes, feelings of palpitations (heart beating irregularly or rapidly at rest or minimal exertion). Some cardiac diseases cause no symptoms however until they become dangerous. Regular physical examinations can pick up many of these.

bambi:

I've been seeing stuff about Wear Red day and ads with men wearing red high heels, and I get that its for women's heart awareness. But why is there such an emphasis on women's heart all of a sudden? Have men stopped having heart attacks?

Dr. Michael Zabel:

Unfortunately no, men still have plenty of heart attacks. There is renewed emphasis on women and heart disease though. This is partially because many women do not know that heart disease is the #1 killer of women as well as men and partly because women are more likely to have heart disease and have unusual symptoms (exercise associated nausea or shortness of breath rather than chest discomfort, for example) or even no symptoms. Tomorrow is national Wear Red Day in recognition of the importance of women's heart disease prevention and treatment.

Moderator:

My grandfather died of a heart attack while mowing the lawn about 30 years ago. My mother says that there are treatments available today that weren't available then that may have saved his life. Is this true?

Dr. Michael Zabel:

That is true. Cardiac care has progressed tremendously in the past 30 years and I have many patients leading active productive lives that wouldn't have had that opportunity 20 or 30 years ago.

Moderator:

How do you know when it's time to call 911? Do people tend to wait too long?

Dr. Michael Zabel:

Some do and the result can be tragic. Most people know their bodies and typical aches and pains pretty well. When there is a sudden and dramatic change (pain, breathing, level of alertness, etc.) then people should seek immediate medical attention. We have a great ambulance system here and very effective and efficient emergency room services at Lawrence Memorial Hospital so I encourage people with new and sudden symptoms to call 911. We would rather err on the side of caution rather than miss treatable problems like heart attacks, arrhythmias, and strokes.

oldrunner:

Hi Dr. Zabel. I've been an avid runner for 13+ years and have completed 3 marathons and lots of half-marathons. Some recent research studies, however, seem to be suggesting the possibility of long-term heart damage, including right ventricular dysfunction, from marathoning and other endurance activities. Would love to hear your thoughts on this, since you are apparently a runner yourself. In particular, what do you recommend to your patients in terms of running, marathons, etc.? Thanks!

Dr. Michael Zabel:

Congratulations on your running accomplishments!. I have been running distance events for 7 years now and will run in my third Boston Marathon and 10th marathon overall in April. You are correct that some research has suggested RV and LV scarring from endurance running activities. I think the jury is still out on whether or not the actual marathon races are healthy or harmful but the weight of the evidence shows that the TRAINING for races is healthy and decreases the risk of hypertension, lipid problems, and heart disease. Perhaps the best recommendation is to train regularly but race relatively infrequently (or "race" with a controlled effort rather than all out).

Great running weather we've had lately, isn't it? So much easier to get up for a run in the morning when its not 5 below and icy!

oldrunner:

Doctor - one other question. What type of diet do you believe is ideal for heart health? Paleo? Vegetarian? There is so much conflicting information on the internet on this topic that it is difficult, as a layperson, to know what to think. Thanks.

Dr. Michael Zabel:

I think the best heart healthy diet overall is a Mediterranean diet. A former partner of mine wrote a book on this called Forever Young Diet and Exercise. It's available locally and a good read.

Moderator:

What is a Mediterranean diet?

Dr. Michael Zabel:

One rich in whole grains, fruits and vegetables, lean protein (including lean meats), olive oil rather than vegetable oil. It also minimizes processed foods and foods that have a high simple sugar content (white rice, white bread, white potatoes, etc). Avoiding trans fats is also important and getting a little easier to do than it used to be.

oldrunner:

Thanks for your answers, Dr. Zabel.

bambi:

I understand the Eudora school district is considering adding some heart and concussion testing to their pre-sports physicals. Why would we need to test a high school student's heart?

Dr. Michael Zabel:

Fortunately significant heart disease in the young is rare but when it occurs the outcome can be devastating. A group of us from KU, LMH and St Lukes hospital in KC have been working on new cardiac screening methods to more accurately identify young athletes at risk of sudden death or other complications. These methods are quick and appear to be very accurate. The research is ongoing.

kansasplains1:

This is not a question - it's just thank you for your time on this very important subject. Lawrence Morgan

TJP:

do stent's ever have to be replaced? If so how is that done?

Dr. Michael Zabel:

Stents placed to treat blockages in coronary arteries do not need to be routinely replaced but they can develop blockages. The risk of that is decreased with aggressive treatment of cholesterol and blood pressure, with regular exercise, and by avoiding tobacco. If it does occur, it can usually be treated with balloon procedures and sometimes by placing a second stent inside the first one.

kbjohnson51:

I have a history of heart disease in my family. I had the test with the dye and the treadmill about 3 years ago and all was fine. With my family history do I need to repeat the test every few years?

Dr. Michael Zabel:

If your risk factors (blood pressure, cholesterol, blood sugar) are under good control and you are physically active with no cardiac symptoms it is probably not necessary to have an imaging treadmill (one with dye or nuclear tracers) on a regular basis but you should be seen by a physician at least yearly for a complete exam.

Moderator:

There are screenings for cancers, such as a mammogram at age 40 and a colonoscopy at age 50. What are some tests or screenings that you would recommend for heart disease and at what age?

Dr. Michael Zabel:

This depends greatly on a persons individual risk factors so would need to be discussed with your personal physician. In general every adult should have a blood pressure screening performed at least annually and a cholesterol level every 3-5 years. Beyond that it varies based on family history, level of activity, presence or absence of symptoms and other factors.

Marilyn_Hull:

I have low blood pressure. Do I still need to limit my salt intake?

Dr. Michael Zabel:

If your BP is always low and you have no medical problems you probably do not have to worry too much about your salt intake right now but BP can change over time and needs to be checked at least annually even in those without any history of BP problems.

Moderator:

Thank you so much for taking time out of your busy day to answer questions. We greatly appreciate your time and expertise.

Dr. Michael Zabel:

It was my pleasure. There were a lot of very good questions today.

Comments

MaleMatters 3 years, 1 month ago

A good interview -- until this: "partly because women are more likely to have heart disease and have unusual symptoms"

Women are LESS likely to have heart disease.

And here are MEN'S unusual symptoms: men in general incur heart disease about ten years sooner than women and die of it at a much higher rate at every age.

This morning, as every morning, I did a news search of both “women's heart disease” and “men's heart disease.” Today's results at 8:45 a.m.: 31 items for the former, zero for the latter.

During America's pre-1960s racism, society focused almost exclusively on improving life for whites, even though blacks as a group were far worse off.

Similar to this component of racism is today's new sexism:

When it comes to heart disease (and 13 other leading causes of death; see http://tinyurl.com/3g9c3oe), society has become almost exclusively focused on women, even though men as a group, especially black men, are far more vulnerable to the disease in every age bracket. Even thousands of men, including many male doctors such as CNN's Sanjay Gupta and ABC TV's Dr. Oz, take part in the fight against women's heart disease but not against men's. How many women campaign against the disease in the group that is actually more at risk? How many reports, commentaries, and editorials on women's heart disease speak as if men literally did not exist?

If you don't think that's sexism, what would you call it if women developed heart disease about ten years sooner than men, incurred 70% to 89% of the sudden cardiac events (http://tinyurl.com/3rg27qw), died of it at a higher rate at every age, and everyone focused on men's heart disease?

See:

"Women's Advocates Wrong About Why More Women Than Men Die of Heart Disease" at http://malemattersusa.wordpress.com/2012/01/08/womens-advocates-wrong-about-why-more-women-die-of-heart-disease-than-men/

“Men's heart disease is far worse than women's but gets far less attention” at http://malemattersusa.wordpress.com/2011/07/10/mens-heart-disease-is-far-worse-than-womens-but-gets-far-less-attention/

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