Valentine’s Day is around the corner and what better way to celebrate than by asking the right questions about your heart. To get some answers to questions you should ask about your small but mighty organ, we sat down with Joshua Buckler, M.D., chief of Cardiovascular Services at Swedish Medical Center and former president of the Board of the American Heart Association Puget Sound. His thoughts are interesting and actionable. Here’s what we discussed:
Q: What should prompt me to see a cardiologist? When should I think about seeing a cardiologist?
A: The heart is a complicated but incredible organ. It is a constantly running machine with electrical wiring, plumbing and structures (valves and walls). We ask a lot of our heart, and we don’t always treat it like we should. Cardiologists see patients both for preventative maintenance around how to avoid heart disease and also for treatment of active problems. Keeping in mind that the heart is complex, any signs of possible heart trouble should prompt evaluation. But what do those look like? Some examples of symptoms include unusual racing or irregular heart rates, chest tightness or shortness of breath when you exert yourself, unusual fatigue, dramatic decrease in exercise tolerance, problems breathing when you lay down at night or significant leg swelling.
For the sake of wellness, some cardiologists focus on prevention, particularly when significant personal concern or risk factors exist. The common approach is to evaluate your individual risk and then aggressively control conditions or behaviors that increase the incidence of heart disease, including cholesterol levels, diabetes, blood pressure, smoking, diet and exercise.
Q: What are some recommendations you’d offer for preventive care? Should people be screened for cardiovascular disease?
A: When we talk about screenings and prevention, we are talking about getting ahead of any heart problems. Why? Once someone starts having symptoms, the conversation shifts focus.
Actual prevention revolves around controlling a person’s risk factors. In this regard we most commonly discuss high cholesterol, diabetes, high blood pressure, smoking, obesity and family history. We use tools such as diet, exercise and medication to modify those risk factors, although not all of them are modifiable – we can’t just change your genetic makeup.
There is a lot we still don’t know about what brings on heart disease. We try to do the best we can in terms of making as much impact as possible on people’s lives by influencing them to maintain a heart-healthy lifestyle. If you haven't already discussed your heart health with your primary care physician, schedule a checkup and ask which screenings they'd recommend for you.
Q: We've heard that heart disease symptoms can be different for men and women. How do they differ?
A: Let me first clear something up. When we talk about “heart disease” in the media what we are typically referring to is coronary artery disease, or CAD. This is the blockage of blood vessels going to the heart (the “plumbing,” if you will) that leads to heart attacks. There are many other heart “diseases” but for our discussion here we will talk about CAD and related symptoms.
Classically it was taught that when a person has a heart attack, they grab their chest and feel “the weight of an elephant siting on them.” The problem is, there are many other symptoms for a heart attack and coronary disease, particularly in women.
It took us many years to recognize that heart disease can present in many ways and that everyone is wired differently. Women in particular can experience symptoms such as heartburn, shortness of breath and nausea, although many men can experience these as well. Regardless of the quality of the symptoms, there are a few things that should raise alarms that this could be heart disease:
- If the symptoms are exertional, meaning they come on with activity and then resolve with rest, that should raise suspicion.
- Symptoms that radiate, or move, toward the jaw or arm are also more likely to be heart related.
- Symptoms that last for a matter of minutes continuously, rather than fleeting symptoms lasting a second or less, suggest a cardiac cause. This is in contrast to situations where symptoms only occur randomly but never with exertion, or symptoms that last for days, continuously and without interruption.
When you are concerned, you should always seek medical attention. There is no substitute for urgent evaluation when you feel you may be having a heart attack.
Q: When it comes to the risk of heart disease, there are different preventive measures for different age groups. What would you recommend for millennials or Gen Xers?
A: Know your numbers, know your risk – your blood pressure, your cholesterol levels, your family history. Get screened for diabetes if you’re at risk. If you address those risk factors—and in addition do not smoke, eat a heart-healthy diet and exercise—that is as good as prevention gets. Knowing oneself goes a long way, regardless of what generation you happen to have been born into.
Q: Can you talk about the other types of heart disease that you referred to previously?
A: As mentioned before, we talk a lot about heart disease, and what’s interesting about that is when someone says “heart disease” the implication is coronary disease (blockages of the arteries), which is common—1 in 4 people will die from it.
But really, heart disease, or more broadly “cardiovascular disease,” means a lot more. If you have something wrong with your heart, it could be an electrical problem, a plumbing problem, a structural problem (like a valve problem). But you can also have blockages of other arteries in the body. We don’t talk about these things enough, specifically when it comes to strokes. Let’s start with strokes.
Stroke: A stroke is a sudden loss of neurological function. Think of it as a “brain attack.” You suddenly can’t talk or walk. You can’t move your arms or legs. Recognizing a stroke quickly is critical. This is where the concept of FAST, as developed by the American Stroke Association, comes into play. FAST stands for:
- F, face drooping
- A, arm weakness
- S, speech difficult
- T, time to call 911
The problem with a stroke is that it’s often partially or completely irreversible and life-devastating. Time is of the essence in treating a stroke, but prevention and recognition of the risks are critical. In the past, many strokes were believed to be due to buildup of plaque within the arteries going to the brain. This is caused by the same process that causes blockages in the heart and has the same risk factors.
We now also recognize that a large number of strokes come from an irregular heart rhythm called atrial fibrillation. This abnormal rhythm causes blood clots to form in the heart and even a small clot can be ejected from the heart and head to the brain, causing a stroke. Certain patients are at higher risk for this than others: older patients, women, people with diabetes, patients with high blood pressure or heart failure, and patients with other vascular problems. One of the strongest predictors is whether you have already had a prior stroke or mini-strokes called TIAs. If you are concerned that you may have an irregular heart rhythm, you should discuss this with your physician.
Valve disease: Unlike a heart attack, most valve problems come on very slowly over time. The valves in the heart are there to help move blood through the heart in one direction but these valves can fail. They can leak and they can also become narrow, obstructing blood flow. The symptoms often are shortness of breath, leg swelling, dizziness and a decline in exercise tolerance, to name a few. Often your physician will hear a “murmur,” which indicates turbulent blood flow through the heart. Some murmurs are benign due to a very vigorous, healthy heart, but some are due to valve abnormalities. If you have symptoms that concern you for valve disease or if you have a heart murmur, you may want to consider further evaluation.
Heart failure: This is a collection of several processes but briefly, the term “heart failure” indicates that you are retaining fluid because your heart isn’t working efficiently. This can be due to a weak heart muscle, a stiff heart muscle, heart arrhythmias or valve problems. The symptoms are often shortness of breath with exertion; a feeling of “drowning” when lying down, prompting one to sleep sitting up; leg swelling; and unexplained weight gain, typically in association with one of the other symptoms and not in isolation. If you have any of these symptoms, discuss them with your physician.
Heart rhythm problems: I touched on this in the stroke section but there are many different heart arrhythmias, or abnormal heart rhythms, that can be symptomatic or problematic. Symptoms can be from fast heart rhythms or slow heart rhythms. Symptoms to watch for are racing heart rates, regular or irregular; significant unexpected dizziness; and loss of consciousness. Many patients have frequent symptoms of “skipped beats,” which are typically more benign. But if the symptoms are significant, it probably warrants further evaluation.
Q: Recently, we’ve heard that you really can have a broken heart. The case of Carrie Fisher and Debbie Reynolds has been cited as an example. What’s your take?
A: A broken heart is very real and it’s quite fascinating. The general belief is that a broken heart is associated with a surge of stress hormones from the brain that then affect the heart muscle. But they affect the heart muscle in a very particular way. The heart is affected globally, or across the entire organ, not just in a specific area, which might be seen in a heart attack.
The term for this is takotsubo, which means "octopus pot" in Japanese. This is due to the shape the heart takes on when it pumps, which resembles a Japanese octopus pot. The top of the heart’s pumping chamber continues to work fine—even harder than it was working before —but the entire middle and bottom of the heart stop working altogether. This can lead to very profound, very sudden heart failure. It isn’t commonly fatal, but can it be. More commonly, people become acutely short of breath and may have chest pressure. If treated appropriately and aggressively, a person typically recovers fully.
Q: With Valentine's Day right around the corner, are there any recommendations you’d offer for couples to ensure a healthy heart?
A: Couples should communicate about their health. Talk about your health, talk about your feelings, talk about what worries you, talk about your health care wishes and goals.
The more we get comfortable and talk about these things with our people in our lives, the better we get at understanding our own health, our partner’s health, and how to communicate symptoms and needs to a physician.
When issues relating to the heart arise, our advice is to listen and engage your partner.
Q: What’s your one core piece of advice for patients?
A: I can’t tell you how many times I have had patients, in my office because their spouse was concerned, even if they weren’t, and we discover significant heart disease. As humans we tend to downplay our own symptoms, often finding justification for otherwise concerning signs. The outside observers in our lives, significant others, children, parents, friends, often recognize the signs of heart disease before we are willing to acknowledge them ourselves. So my advice is to be a guardian of people in your life. Speak up when concerned and also listen when others are concerned about you. You may just save a life, and it may be your own.
If you or a loved one is concerned with heart health, contact your primary physician today. Thank you, Dr. Buckler, for your insights.