December 15, 2022
Dr. Joe DeStefano of Urgent Care 24/7 discusses Heart Disease.
Heart disease is a very important subject, because it's your heart, your heart starts beating your dead. So, heart disease generally, when we first talked about heart disease, we talked about hardening of the arteries, coronary artery disease, heart attack. This happens with the three main arteries of your heart. They start to get plaque inside them, and it starts to interfere with the blood flow in those arteries.
Those plaques can rupture. When that happens, you get a clot. And suddenly, a large portion of the heart does not get blood, and you get a heart attack, myocardial infarction. When this happens, you have a window to get to the emergency room and to the path lab, and for the cardiologist to do his magic with his catheters, and get a stent in there, and get that artery back open, and that blood flowing, so you don't have permanent damage to the heart.
The risk factors for this hardening of the arteries and plaque formation, eventual rupture, the plaque and the clot formation, the risk factor, this is genes, genetics, are huge, and if you have a family history of heart attacks, family history defined as a first degree relative in their 50s, who had a heart attack, that is huge. In Dr. DeStefano's clinical experience, and in the literature, family history beats almost every other risk factor in this. You are what your genes are in this disease to a large extent. Another thing is smoking. He tried to get all my patients to quit smoking, they all focus on lung cancer, or COPD. He explained to them that lung cancer and COPD will kill you only if the heart attack does not kill you first.
Smoking is a huge risk factor for getting those plaques in your arteries. plaques in other major arteries in your system, and causing strokes, heart attacks, erectile dysfunction, smoking, just ruins your whole vascular system, including the arteries that supply your muscle of your heart. None other risk factors high cholesterol, or what we call coronary artery equivalents, which is type two diabetes. So high cholesterol is a big risk factor, especially if you combine it with the other risk factors. If you have a family history of heart disease, and you smoke, and you have high cholesterol, you're just hitting all the buttons to die of heart attack. Diabetes is what we call a coin disease equivalent for working everything else.
That means if somebody is diabetic, you just treat them like they already have hardening of the arteries, you give them the stack, and this lowers their LDL less than 100. You put them on a medication and protect the arteries, such as a low dose A or B. You keep the blood pressure controlled. These are the things when we're talking about heart attacks and heart in the arteries that matter. T
The other causes of heart disease are hypertensive heart disease. This is the heart is a muscle, like your bicep, like your thigh muscle. If you have high blood pressure, it's more effort for that heart muscle to pump that blood against that pressure head. So your heart muscle gets big, it gets tired, you get enlarged into the heart. So we call that hypertensive heart disease. hypertensive heart disease, it's important to control the blood pressure. Having good blood pressure control with that type of heart disease, if the blood pressure is controlled, and the lifestyle modification is done, that heart disease can actually improve and regress.
Whereas if you do not take care of your high blood pressure and you get hypertensive heart disease, especially ones with high blood pressure, it starts to affect your kidney function. You will start to have congestive heart failure. We call diastolic heart failure from the heart pumping too hard. So, that is another aspect of the subject of heart disease that ties in to high blood pressure control. Another type of heart disease you can have is what we call systolic heart failure. This is poor pump weak heart weak pump function, a normal heart will inject about 60% of its blood in one beat.
If it only injects 30% of the blood, that means the heart has to pump twice as hard to get the blood out twice as many times. That is a way to think about it. It's 50% less effective than a normal heart, you're doing its job. How do you get an ejection fraction of only 30%? Well, you could have had heart attacks, and part of your heart has died, and you have less heart muscle, and that muscle does not come back.
So you have now done what we call an ischemic cardiomyopathy. You have a weak heart due to lack of blood supply. All these things are important in heart health. And all this stuff is something that we monitor in our primary health care plan at Urgent Care 24/7.
Thank you for taking this time to listen to our chat on this.
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