American Heart Month Podcast 1 – Learn About Heart Disease

SUMMARY
As a contractor for Medicare, Kepro serves as the Beneficiary and Family Centered Care Quality Improvement Organization, also referred to as a BFCC-QIO. While Kepro provides BFCC-QIO services in 29 states, the general information is relevant to everyone who has Medicare (including Medicare Advantage) and everyone who works with people who have Medicare. 

This episode is a conversation with our guest, Jessica Whitley, MD, MBA, Chief Medical Officer for Kepro.

In this podcast, Dr. Whitley will share information about different types of heart disease and symptoms of the different types. 

For more information about Kepro BFCC-QIO, please visit www.keproqio.com.

KEY TOPICS

00:29: Overview, introduction of guest, Jessica Whitley, MD, MBA
 04:01: General information about the heart
 08:02: Heart attack information

15:08: Atrial fibrillation information
 17:38: Congenital heart defect information

19:10: Cardiomyopathy information

21:03: Heart valve disease information
 23:20: Final thoughts

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RESOURCES

BFCC-QIO Information for stakeholders: www.keproqio.com/partners

BFCC-QIO Information for people who have Medicare: www.keproqio.com/bene

Resources for heart disease: 

https://www.cdc.gov/heartdisease/prevention.htm

https://www.heart.org

Music: Motivational Upbeat Corporate by RinkevichMusic
https://soundcloud.com/rinkevichmusic
Video Link: https://youtu.be/U78mgVaM12M

Transcript

Welcome to Aging Health Matters, a podcast from Kepro, a Beneficiary and Family Centered Care Quality Improvement Organization. We plan to cover healthcare topics for the Medicare population. Information in today’s show may help you or someone you know in their healthcare journey. Thanks for joining us. Now let’s get started.

Scott Fortin   
Hello everyone and welcome to another edition of our podcast, Aging Health Matters. This is Scott Fortin, Senior Director of Communications and Outreach,
 here to introduce today’s topic. As a reminder, being the QIO for 29 states, we have three key services for people who have Medicare: appeals, quality of care complaints, and Immediate Advocacy services. However today we won’t be talking about any of those things, and we won’t be talking to partners as we have in some of our more recent podcasts. Today we are going to be talking about an important topic for the month of February, and that is Heart Month. We are going to be talking in a two-part series, which is a little different for us as well, with Dr. Jessica Whitley, Chief Medical Officer from Kepro. Hi doctor, how are you today?

 Jessica Whitley   
 Hi Scott, I'm doing well. How are you today?

 Scott Fortin   
 It's great to talk to you again and especially on such an important topic for our audience, Dr. Whitley. And so could you tell me a little bit about the topic of heart health and why it's important to Medicare beneficiaries? I mean I know that people age 65 and older are much more likely than younger people to suffer a heart attack or to develop coronary heart disease. So why is this topic important to people as their health changes and as they age?

 Jessica Whitley   
 Scott, I'm really, really, excited that we're talking about this topic this month. I hope that it will help our audience to educate themselves and know either how to
 manage their own heart disease better or if you don't have heart disease, how to try to prevent heart disease. And if you don't have heart disease, you may know someone, your family, your friends, who may have heart disease, and some of what we may talk about today hopefully will help you to be able to help them to navigate their own health.

One of the main reasons that this topic is so important is because heart disease is the leading cause of death in the United States. Let's just put an exclamation point there. In my practice as a physician, I'm an internal medicine doctor, and that means I take care of adults and their medical problems.

This is really important for me because in my profession as a physician, when I'm actually taking care of patients, I work in a hospital setting, so I only take care of patients that come into the hospital. So of course, I see a lot of patients with heart disease coming into the hospital, and a lot of times, they're very, very ill.
I love to try to empower patients to prevent illness and disease. So I'm looking forward to our discussion Scott.

 Scott Fortin   
 Absolutely. Thanks Dr. Whitley. And when I think of heart disease, the word that always jumps out at me whenever I've had conversations with people or have seen it as far as information out there in the environment is risk because that's truly what I feel. We're all at risk of developing heart disease, and I think that with some of the causes being build-up of deposits on the walls and arteries over the course of time, and as we age, the risk is what comes to mind. So I guess when it comes to common problems with the heart that affect that risk element, Dr. Whitley, what are some of the signs of heart disease that you know we should look at whether it's developing kind of slowly or whether it's something that comes on quickly as you see in the hospital setting?

 Jessica Whitley   
 Some people tell me I should have been a teacher. I like to teach, and so I want to start with the essentials of what patients need to know. Most people know what the heart is, but I'm going to say it anyway. So the heart is really about the size of a fist. It sits kind of to the left of the center of your chest. It is the hardest working muscle in the body. I don't care about bodybuilders and how they power lift, and you might think they're taking a lot of effort. Well, let me tell you the heart is working much harder. So it's the hardest working muscle in the body, and with every heartbeat, that heart is pumping blood throughout the body. This blood that goes throughout the body is very important because it carries the oxygen and the nutrients that every part of our body needs to be healthy and to survive. Our body cannot survive without oxygen, and that oxygen is delivered through the blood. The way that this blood that the heart pumps reaches all of our different body parts is through what we call the vascular system.

 Scott Fortin   
 OK.

 Jessica Whitley   
 And that's a big term. You don't have to remember the vascular system. Just know that the vascular system is like this network of arteries and veins, and simply put, arteries and veins are like tubes. They're tubes. They're made of muscle, and they carry blood away from the heart to parts of our body, and they carry blood from those parts of the body that the oxygen has gone to. They take it, and they bring it back to the heart. So arteries are what brings the blood from the heart to your body parts, and veins are what take that blood that's been used by your body parts, and it carries it back to the heart. When we think about heart disease, that term actually is referring to a number of medical conditions 

 In the United States, the most common type of heart disease is called coronary artery disease, and coronary artery disease can lead to a heart attack. There are two different progressions. The worst progression of coronary artery disease is a heart attack, but a heart attack is not the same as coronary artery disease. So let's start with coronary artery disease and what it is. Just like I said, the arteries, the blood that goes from the heart, goes through the arteries to different parts of the body. Well, that's the same thing. The heart pumps blood, and it goes through these arteries that also brings oxygen and nutrients to the heart itself. So if these arteries start to get narrow, and Scott, you just mentioned how with age you get things like the build-up of fatty deposits in the walls of the arteries.

 Well, that's one of the things that can cause a narrowing of that artery. And so when you have a narrowing, think of it like a traffic jam, not as much flow of blood is going to come through to nourish that very important heart muscle, and depending upon how severe the narrowing is and how much blood is getting to the heart, that's going to determine what your symptoms would be of that coronary artery disease.
 But it's very important to know the heart needs that oxygen and the nutrients that that blood delivers through the arteries to keep it healthy.

 Sometimes people don't have symptoms of coronary artery disease. You may feel fine, and unfortunately, your first sign that you have coronary artery disease is a heart attack. So the difference between coronary artery disease and a heart attack, coronary artery disease is the narrowing of those arteries. So not as much blood is getting to the heart muscle, but if you actually have a heart attack, that means that there's been a complete cut off of the blood going through that artery. What causes the cut off? Sometimes you can have a clot that's suddenly just clots it off.
 
Sometimes you can have just the gradual worsening of narrowing that just keeps building, building, building over time and then cuts off. But when you have a heart attack, it's usually caused by something that's more sudden. You could have these deposits and the blood flow kind of makes little tears or ruptures in these deposits. And then all of a sudden you have these things in our bodies called platelets that form these clots to try to repair these ruptures. And then all of a sudden, your arteries just completely blocked off.
 
 And then in that case, whatever part of the heart that that blocked artery, whatever part of that muscle that's being nourished and fed by that artery, well, it's not getting the nourishment anymore. And that part of the heart muscle can die. We have a lot of different arteries to the heart. Depending upon what artery gets blocked off, that part of the heart can die. One of the reasons that it's so important that we're having this conversation is because in order to prevent and control heart disease, if you have it, is to know what the symptoms are, and even like I said, sometimes with coronary artery disease, you don't have symptoms.

 We're going to talk later about risk factors and about things that need to be monitored at the doctor so that you can either know you're at risk for having coronary disease, and they can do tests to see if you have coronary disease, even if you're not having certain symptoms. But all of these things are going to help us to live healthier lives. So let's just talk about coronary artery disease and not necessarily the heart attack. What are some of the symptoms that patients may be feeling if they have coronary artery disease?

I will tell you that most of these symptoms that you're going to get happen with exercise, and that doesn't mean you're running a mile. This could mean activities such as vacuuming the floor. It could be walking up the stairs, so pay attention to how you're feeling when your body is moving, and if you have coronary artery disease when you're moving, you can feel things such as pain or pressure in the center of your chest. This type of pain with movement is called angina. So that just means the pain in the center of your chest that comes with movement, and then once doctors kind of take a look at it and try to figure out why it's happening, they notice that it's coming because you have some narrowing in the arteries that are feeding the heart.
 
You can also feel some pain or tingling or some type of discomfort in other parts of the body. It doesn't have to just be in that area where the heart is located. You can feel this pain or tingling in your arms, sometimes in your back, your neck, your jaw. Sometimes you can even have stomach pain, and the final big symptom for coronary artery disease is feeling short of breath. And again, these are typically when you're moving, when you're exercising. If ever you feel this, you definitely want to discuss this with your physician, fairly quickly. One thing to really pay attention to is these symptoms can also occur when you're having a heart attack.

So the symptoms, yes are similar, but there are a couple of differences. One of those differences is a heart attack, you can get these symptoms when you're just at rest, when you're not moving around, so that's an important thing.

 Scott Fortin   
 OK.

Jessica Whitley   
 It could come when you're moving around and exercising, or when you're at rest. So again, if you feel that pain or pressure in the center of your chest, if you feel pain, tingling, or discomfort in some other parts of your body, like the arms, the back, the neck, the jaw, sometimes the stomach. If you feel short of breath, sometimes if you're having a heart attack, you can feel nauseated; you can vomit. You can feel like you're having some bad heartburn.
 
Another symptom is you can start to sweat. You're not really doing anything that should cause you to sweat. But all of a sudden, you're really sweating. Another symptom is that you can feel like your heart is racing like it's going fast or that when the heart beats, it's like a regular drum beat. It's like a regular cadence. Boom, boom, boom, boom. But if your heart starts to beat and then it's not that regular, it's like a boom and a boom, boom, boom, boom, boom, boom, boom.
 
That's irregular. You can also feel dizzy or like lightheaded, like you feel like you could pass out. The key when you get these symptoms in knowing, you know could this be a narrowing of my vessels? And this is something I need to get to my doctor and have an appointment with quickly. Or could this be something that is really serious, and I need to go to the emergency room. 

If these symptoms last more than 10 minutes or if they keep coming and going, they may not last for 10 minutes, but they just keep coming throughout the day, you need to go and seek emergency care, and that doesn't mean taking yourself to the hospital. That means calling 911 because if your heart is lacking that blood supply, there are things that could happen suddenly. You could suddenly pass out, and that's not a good thing. If you're driving in a car, even if somebody is driving you, you want to call the ambulance because they have equipment that can help take care of some of the problems that may happen if you're having a heart attack. Those are the biggest two heart diseases, types of heart disease that I really wanted to spend some time covering because as I said, heart disease is the number one cause of death in the United States, and coronary artery disease is the most common cause of heart disease.

There are other types of heart disease. You can have heart disease that's associated with irregular heartbeat. I kind of talked about that a little bit before. Your heart is supposed to have a regular rhythm, a pattern. If that heart starts to go out of that pattern, that can be an irregular heartbeat. An irregular heartbeat can be too fast. It can also be too slow, and you can get different symptoms depending on if it's too fast or too slow. You can also have a heartbeat that's not irregular, but it's too fast or it's too slow. 

So those are an example of a heart disease that would fall in this category is called atrial fibrillation. If you have a heart disease that's causing your heart to beat in an irregular fashion, too fast, too slow, or not on that normal pattern, what you can feel from that, you could feel chest pain. You could feel that lightheadedness or dizziness. You could actually faint or come close to fainting. Sometimes you can feel like this fluttering sensation in your chest, almost like there are butterflies flying around in there.
 
Sometimes you can feel that your heart is going really fast, like if you were to run really fast, and you can feel your heart going fast. But it comes on, and you're not doing any running or anything that should make your heart go faster. You could also feel short of breath if you have some of these heart diseases caused by irregular heartbeat, or sometimes you could feel just really tired. Or you could feel that things in your heart may be beating really slow.

One thing that I recommend for everyone is to try to look at a video of how to take your pulse. Usually, the best way for somebody to take their pulse is to feel it on your wrist. It's kind of right on your wrist if you follow your thumb down and get to the point of your wrist, where it joins the hand. If you press there, you can feel a pulse.
 But if you don't feel it, go to the internet, watch a video on it, know how to check your pulse. And I know I'm talking a lot, Scott,  but there are a number of heart diseases. So I'm going to move through these without having any dialogue, and then I'll wait for you to see if I missed anything and need to fill anything in.

 Scott Fortin   
 All right.

Jessica Whitley   
You can also have heart disease that's caused by what we call congenital heart defects. These are defects usually in the structure of your heart that are present from birth. Now when people have serious congenital defects or heart issues that are present at the time of birth, if they're serious, it's usually going to be detected very soon after birth and if children, babies have these congenital heart defects, you usually see that their skin is like a pale gray color or bluish color. Also you can see that they have swelling in the legs or in the stomach area, or sometimes even around the eyes.

But in our audience, it's important to also talk about these congenital heart defects, because if it's not really a severe congenital heart defect, you can go into adulthood before these defects are detected and the symptoms of that, if it's going to be detected when you're older and when you're an adult, it's getting short of breath easily during exercise or activity or you feel tired really easily when you're trying to do some type of exercise or activity. And you could also notice some swelling in your hands or feet. Now we're going to go to a whole different category of heart disease, and that's heart disease because the muscle of the heart is is diseased or damaged. The medical term for that is called a cardiomyopathy.
 
Myopathy is like muscle, so it's a disease of the heart muscle. One of these types of diseases of the heart muscle usually causes heart failure, congestive heart failure, and it's caused by a disease of the muscle. That heart muscle is not pumping, is not as strong as it should be. So therefore it's not pumping as well as it should. Symptoms of this, initially, when it's not so weak, you may not feel any symptoms, but when the weakness gets to a point that you're really not pumping enough blood forward or the heart is not filling with the blood that's returning back to the heart well enough, you'll get symptoms like dizziness and lightheadedness. You could also faint. You can feel really tired.
 
You'll feel short of breath during activity, or you can even feel short of breath at rest.
 Sometimes you'll notice that this shortness of breath gets worse if you lie flat down, and you'll find yourself having to sit yourself up in bed. You also may feel irregular heartbeat, and you can notice swelling in your legs and feet. So definitely look for those signs and symptoms. And as you may start to be recognizing, even though they're different types of diseases of the heart, a lot of the symptoms are similar because they're all related to that function of the heart that's to push blood forward and to bring oxygen to all the organs that we may need oxygen to, including the heart itself.
 
I think the last category that we have of heart disease is heart disease that is caused by damage to the valves of the heart. The heart has four different chambers, and each chamber has an opening, and so the opening, it's kind of like a door, is called a valve. You can get diseases of these valves and depending on which valve like I said, there are four different valves. Well, these valves are like doors. They open and close to move blood through the heart, and so there's certain things that can damage heart valves. Coronary artery disease can cause damage to a heart valve because the arteries supply oxygen, the blood containing oxygen, to these valves. These valves can become narrow where the door doesn't open wide enough, so it causes, it's difficult to get the blood through, or the doors can become leaky where the blood doesn't go through because it's falling back in.

Again, some of the symptoms here are you can have chest pain. You're going to hear some of the same symptoms. You can faint. You can be really tired. You can get an irregular heartbeat, and you can feel short of breath, and you can also get that swelling of your feet or ankles. One thing that I want to talk about in particular, that's a different type of disease of the valve. You can get an infection on one of your valves, and this would be called endocarditis. And so you really want to if you're having some of those shortness of breath symptoms or you're having very high fevers, or you're persisting with a cough and then you're getting heartbeat changes or you see these unusual skin rashes or spots, be aware that sometimes you can get an infection in your heart valve. It's not as common as some of the other heart diseases, but I wanted to mention it here just for completeness sake. So I think I covered the main types of heart disease and the symptoms associated with those different types. What else would you like to talk about, Scott?

Well it cetainly was interesting that Dr. Whitley asked me what else I would like to talk about. However, I really feel like she has outlined some great steps for us to understand the elements about heart disease, so with that, we will conclude our first podcast. Stay tuned for the next one where Dr. Whitley gives us some information on how we can move forward in having a better lifestyle to help prevent some of these heart conditions that we face. Happy Heart Month everyone. We will talk to you in the next podcast.

 End of Part 1