Valvular Heart Disease

SARA LOMAX-REESE: Today we are going to start things off talking with the Einstein docs, talking about a particular kind of heart disease, valvular heart disease. We will be joined by Dr. Donee Patterson as always and today we will speak to Dr. John Cardone, a cardiothoracic surgeon, about this particular form of heart disease. Later in the show we will be joined by Jim PathFinder Ewing to talk about a new revolution. He is the author of a new book called Conscious Food: Sustainable Growing, Spiritual Eating. Right now we are joined in the studio by Dr. Donee Patterson and Dr. John Cardone, both from the Einstein Healthcare Network. Welcome and Happy Holidays.

DONEE PATTERSON, MD: Thank you.

JOHN CARDONE, MD: Thank you.

PATTERSON: Thank you so much.

LOMAX-REESE: Thank you for being here. I love talking about the heart during this time of the year because it is the center of love and compassion and courage and all those things that we are meant to celebrate during this season, but we won't start with the metaphysical stuff. We will get to that a little later. First off, let's get to the basics. Dr. Donee, I find this really fascinating because I am familiar, and I think a lot of people are familiar, with the term heart disease, and even coronary heart disease, but this is a little twist. We are talking about valvular heart disease today. Do you want to give us a lay of the land as to why valvular heart disease is on the docket for the day?

PATTERSON: Sure. We wanted to talk about this today because it is a little bit different. A lot of people have heard of coronary artery disease and that's referring more to when the arteries are clogging up to the heart and can cause blockages and damage to the heart muscle, but this, the valves, there's four valves in the heart and they are very important and some of the latest statistics say about five million people in the U.S. have valvular heart disease, some years are a little bit different, but it is still very important for us to think about this topic. There's four parts of the heart. We call them chambers, four chambers of the heart, and at the exit of each section of the heart there are valves. There are supposed to be one-way valves that let blood flow only one way. Sometimes these valves get too stiff or sometimes they don’t close properly and they allow blood to whoosh back into the previous section of the heart and it can really cause damage to the heart and we want to talk about that today because we want all of your heart to be healthy, not just the muscle, not just the blood vessels, but the valves as well. We brought one of our cardiothoracic surgeons today because he sees this often and he is the one that if there is damage to the heart valve, he will help us to repair it, but as always, Sara, we want to talk about prevention. We will talk always about prevention first, but if in fact you find yourself in the case of having valvular heart disease then there's way to repair it and we want to talk about that too. 

LOMAX-REESE: Excellent. Dr. Cardone, welcome. Thanks for being here. First let's explain what exactly is a cardiothoracic surgeon. 

CARDONE: A cardiothoracic surgeon is a surgeon who has gone on to specialize in surgery in the chest, and in my particular case, surgery for the heart, both the arteries on the outside, the coronary arteries that we've touched on, and the valves inside the heart, as well as the large blood vessels that take blood to and from the heart. It is basically that whole section of the circulatory system in the chest. 

LOMAX-REESE: You know I recently just was listening to my son's heart. I just had my head to his chest and it just kind of hit me how amazing the heart is, that our entire life it is beating, non-stop, our entire lives, and it seems like what do we need to do to really take care of this amazing muscle and piece of equipment that is really our life blood. Why don't you guys give us some general tips for just really taking care of our heart so that it can beat for many, many, many, many years. 

PATTERSON: Sure. I was amazed to really do the numbers and think about that our heart beats about 46,000 times a day and we don’t think about it. That's pretty amazing. It is very important for us to take care of the heart muscle, the heart valves, and the arteries that surround our heart. We talk about heart disease being the number one killer of men and women, both African American and Caucasian, in the U.S. and so it is very important for us to be talking about this. Some of the things that we can do, as always, watch our blood pressure. If you don’t know your blood pressure numbers, if you haven’t had them checked in the last six months, then you need to know your numbers. Some people have to have them checked more often then that. It is not okay just to have borderline blood pressure anymore. It is not okay to say, oh, we are just going to let it go at 140/150 and just say it's okay. Know your numbers and make sure that you are within goal and know your cholesterol number.

LOMAX-REESE: What is the goal? 

PATTERSON: Ideally we would like people's blood pressures to be 120 at the top number and the bottom number 80 or lower and even lower then that in some cases.

CARDONE: Those are fairly new recommendations. For years there was a thing known as borderline hypertension, that was watched, but not necessarily treated. The American Heart Association has really gotten, and doctors in general have gotten, very aggressive about treating blood pressure. Mostly from observational studies of patients who have problems with their heart, that really you only need enough blood pressure to get you through the day. You don’t need a blood pressure of 120. Some people do just fine with a blood pressure of 110 on the top number, or even 100, and if that's what you need, if you can get by with that, it's that much less work that your heart has to do to push against that blood pressure. As we alluded to, because it beats every minute of every day, each little bit of work adds up over the weeks, months, and years and it is just that much less work that we have to force our heart to work against. 

LOMAX-REESE: Dr. Donee?

PATTERSON: A lot of people ask me, which is the more important number? They're both important. The top number tells us about the top number of your heart and the bottom number tells you about the bottom part of your heart so they're both very important numbers, and as Dr. Cordone was saying, the harder our heart works, we really want to take a burden off of our heart and have it not work so hard. People that walk around with blood pressures, 160, 170/100, their heart is working so hard and this is after years after years after years. Those people who say I don’t want to take blood pressure medicines, we are never here at Einstein to push any medicines. Never. But sometimes people need medications to help their heart not work as hard and that does extend life. 

LOMAX-REESE: The thing I think that's kinda scary about high blood pressure is there really are no symptoms so you can feel absolutely fine and your pressure could be through the roof. 

PATTERSON: Absolutely.

LOMAX-REESE: And until you have an event, a catastrophic event, you might not really even be aware so your point of really keeping track of what your blood pressure is every six months is vital, especially as we age.

PATTERSON: Absolutely. Absolutely.

LOMAX-REESE: Dr. Cordone, I want to ask you in terms of if we talk specifically about the valvular heart disease and blood pressure, is there something specific to high blood pressure and valvular heart disease, or is it the same no matter whether it is coronary or valvular in terms of the blood pressure impact?

CARDONE: Well, the valves are affected by the end resulting blood pressure that your heart has to work against, but also it is all a spectrum of the same problem. A lot of the valve disease that we are seeing is valve disease that was once termed senescent, it was in old people, and as our population gets older, and I hate to say that because I am one of those people getting older.

LOMAX-REESE: We're all getting older.

CARDONE: As we are all approaching the older years, our valves begin to age and they all age a little differently and one of the more common problems that we see now, that we are probably going to talk about some, is aortic stenosis, which is inability of your aortic valve, the last valve that the blood travels over before it goes out to your body, the inability of that valve to open completely and it causes your heart muscle to work even harder to push blood through a tight constriction on the way out of the heart. With that problem becoming a problem of increasing age and with a population that's getting older because the baby boomers are going into their golden years, myself included, it's a problem of growing national public concern, as well as individual health problems. 

LOMAX-REESE:  You mentioned age, but are there other things that lead to valvular heart disease? Can it be genetic? Can it be kind of just physiological? You just have a malfunctioning valve system. What are the things that you can do to prevent it and to treat it? I will start with you Dr. Cordone. That's a bunch of questions in one.

CARDONE: Sure. Valve disease has many causes. Aging is just one of them. There are abnormal valves that you can be born with that usually present themselves early in life, sometimes a little later in life. That's why we sometimes see children that who valve replacement or surgeries at an extremely young age. There are problems that can occur with infections in the valves, both direct infections of the valves themselves from bacteria that get introduced through various means or a secondary cause like a Strep infection that goes on to cause rheumatic heart disease, which can affect the valves especially in the left side of the heart. Then as a result of coronary artery disease or blocked arteries, with heart attacks, you can damage or affect the way that the mitral valve, which is one of the valves in the heart, functions and it can be damaged so severely that it needs to be repaired or sometimes even replaced in an emergency situation from a valve that's badly malfunctioning. There are lots of causes and it is a wide spectrum of problems so it is hard to put your finger on one thing.

LOMAX-REESE: That's kind of, I think, health in general. Diagnosing anything can be very complicated because there are so many variables. Dr. Donee, you wanted to add something?

PATTERSON: A lot of people may be wondering well how do I know if I have this? Well, that's why it is important to see your doctor and we recommend a physical at least once a year and for some people who have been really healthy, twice a year is okay, but your doctor will listen to your heart and if your valves aren’t closing properly you will hear an extra flow and that's what your doctor is listening to. We call it a murmur. You may have heard that word, a murmur, that's extra sound going backwards, either forward or backwards through those valves and there are some normal murmurs. Some people that have been told that they have murmurs, they don’t have to panic. There are some murmurs that we consider benign, but there's some more serious murmurs, the louder ones or ones that are associated with different valves, they can be quite serious. Please, if you haven’t seen your physician, please make sure that you do see your physician and I do want to add that I am also Medical Director of Special Olympics Philadelphia and we do sports physicals and it reminds me to say that don't just take your child's sports physical just lightly. So don’t just take them to someone who is going to do a two second sports exam and just sign the paper and clear off because sudden cardiac death happens in young people as well. Take them to a doctor that is going to take the time and really examine them and really make sure that they're not at risk for concussions or risks for hernias, but also at risk for heart disease or needs further evaluation of the heart. Please take that serious as well.

LOMAX-REESE: I have a personal experience because my middle son, when he was very, very little, our pediatrician, who is fabulous, thought she heard something. So we had to take him back and back and back to get his heart evaluated, and it turned out to be an innocent murmur, that's what they called it, and thankfully, but she was hearing something that didn’t sound quite right and she just picked it up with her stethoscope. It's…

PATTERSON: It's important.

LOMAX-REESE: It's really an interesting process. I didn't know it was potentially valvular heart disease at that point and thankfully it is not. This is the question. How do we prevent it and how do we fix it? Let's start with prevention first because we all are trying to put into practice things that will not just make our heart function better, but make our entire bodies, and if our heart is functioning better, chances are everything else is going to be functioning better as well. Let's talk a bit about prevention.

PATTERSON: Sure. Again, let's make a commitment right now, to all of us on air, to say at least every six months you are going to know your blood pressure and if it is high we are not going to ignore it. If it is even borderline high, which is not a real word anymore, but if it is, we are going to take care of it. We are going to talk to someone and we are going to limit our salt. We are going to make sure that we exercise. Let's make sure that we are keeping our weight down. Continue to exercise, but exercise still has benefit even if you don’t lose all the weight that you want. Exercise still has benefit, but I do want to caution people not to exercise when their blood pressure is too high because when we exercise our blood pressure is supposed to go up, but then if your blood pressure is really high, say 180 the top number and then you exercise on top of that, you could put yourself into a stroke range. Make sure you know your numbers. If it is a little high ask your doctor what to do about it and make sure that exercise is safe for you. Know your cholesterol numbers because cholesterol is what clogs up the artery and often stiffens arteries and stiffens the valves. We need to know our numbers and this is coming to the end of the year and often a time of resolutions so I want people to make that commitment to say I can do things better. My motto is I wish you the best of health, but if you can't be the best, you can be better. We can be better, all of us. Even if we exercise every day, there are things that we can be doing better for ourselves. Aspirin is another thing, you can ask your doctor if you are a good candidate for aspirin. Everyone is not, but some people it is very important. Now we also…

LOMAX-REESE: Why? Because it thins your blood?

PATTERSON: Yes, aspirin thins your blood and it keeps the cholesterol from clogging up your arteries. Now for people who have massive clogging, aspirin may not do the trick and they may need something else, but that's why you need to talk to your doctor. If you are having any symptoms, especially for our guys out there, not just our guys, but often they ignore symptoms. So if they are having chest pain or numbness or tingling in their arm or jaw pain, they often ignore it and don’t have time. We are going to make time for ourselves and I hope that this year and next year we are going to take ourselves seriously.

LOMAX-REESE: Dr. Cordone, I want to ask you around treatment. What are the things that people can do if they are diagnosed with valvular heart disease?

CARDONE: Well I think first off the good news is if there is a question of a valve problem that's picked up just on a routine physical, the first test that's often done is an echocardiogram, which we can both tell you is completely painless. There is no needles involved. It's usually a brief procedure that's done with a technician and an ultrasound probe on your chest. The first step going down that path is fairly benign and painless. If they do hear a murmur that needs to be taken care of then there is really no reason to be concerned about going to the next step and a good echocardiogram can answer most of the questions about what needs to be done on a valve. As far as the treatments itself, it depends on the valves and the situation. They are all a little different.

PATTERSON: Some may need surgery, which may sound scary, but it is important because, again, it helps your heart not to work so hard, but there's other times you just watch and wait. Right, Dr. Cordone? 

CARDONE: Yeah, over the years there have been some very good studies telling us which patients need surgery urgently, which patients need to just be watched with follow-up echocardiograms, and there are new options in surgeries out there that weren't even available say five years ago, certainly maybe even three years ago in some situations. There are a number of options out there now that weren’t even there a few years ago that are less invasive and in some cases don’t even require opening of the chest. 

LOMAX-REESE: Well, we are going to go to the phones. We've got Phil from north Philly who is patiently holding. I just want to reintroduce our guests. We have Dr. John Cordone, and he is a cardiothoracic surgeon at Einstein, and we also have Dr. Donee Patterson, who is a family medicine physician with the Einstein Department of Medicine. Welcome, Phil. How are you?

PHIL: Okay, pretty good, Sara. Thank you for taking my call. 

LOMAX-REESE: Sure.

PHIL: And good morning to your guests, Dr. Cordone and Dr…

PATTERSON: Dr. Donee, good afternoon.

PHIL: Dr. Donee, good afternoon. 

CARDONE: Hello.

PHIL: I am going to give you what's going on in my age here.

LOMAX-REESE: Do you have a question, Phil? Because we don’t have that much time.

PHIL: Yeah, just a quick question.

LOMAX-REESE: Okay, great.

PHIL: I had a perfectly good heart until I got into this fight. I think they sat on my chest and my heart rate dropped from 60 beats a minute to 40 beats a minute. Which way should I go?

LOMAX-REESE: What do you mean which way should you go?

PHIL: I don’t know, I mean, if it dropped to 40 something beats. Is that bad or good?

LOMAX-REESE:  Okay. Dr. Donee?

PATTERSON: A normal heart rate, there is a wide range of a normal heart rate. It can be anywhere between 60 and 100. 100 is a little high for a resting heart rate, but it is possible, and we have some athletes that normally have very low heart rates, sometimes into the 40s and 50s. That's normal for an athlete, however, you need to see your doctor. You need an EKG. You need to see your doctor and so your doctor can help you figure out what's going on. Sometimes we often put on what's called a 24-hour Holter monitor. It is a painless thing. It is like an EKG that you have on for 24 hours and then your doctor can see what's going on throughout the rest of the day.

PHIL: Oh. Yeah, yeah, I seen one of those. 

PATTERSON: Yep, that's what you need. You need to see your doctor so they can listen and check your blood work. Make sure that nothing is going on in your blood work and probably do an ultrasound, make sure the echocardiogram, like Dr. Cordone was saying to make sure that you don’t have any damage.

LOMAX-REESE: Thanks for your call, Phil.

PHIL: Okay, thank you, Sara. Keep up the good work!

LOMAX-REESE: Okay, good luck.

PATTERSON: I wanted to make sure that I got in that dental health is closely related to heart health, very closely related, because we get bacteria on our teeth and we often swallow that bacteria and that bacteria can go to our heart and infect our hearts. What we want to make sure is that people are getting regular dental evaluations every six months and I know people sometimes hate the dentist or are afraid of the dentist, but it is very closely. They're lots of studies. It is very closely related to heart disease.

LOMAX-REESE: I mean, really, to take good care of yourself it is a full-time job.

PATTERSON: Full-time job.

LOMAX-REESE:  All I can say is I really want a place, a one-stop shop where you can get your dental care, your eye care, your echocardiogram, everything in one place. Is there anything place like that right now?

PATTERSON: I don’t know about a one-stop shop, but we have got to work on it.

LOMAX-REESE: We've got to get a one-stop shop because it's like you need, if you could block out one day and get everything done, instead of like every two seconds, especially as you get older, you've got to get this and you've got to get that. Anyway, I digress. We've got Bill from North Philly.  Welcome to the show.

BILL: Yes, good morning.

LOMAX-REESE: Good morning.

BILL:  Yes, I heard you mention something about tingling in the fingers. What does that come from?

LOMAX-REESE: Tingling in the fingers? It could come from a lot of different things.

PATTERSON: Oh, a lot of different things. Particularly, if it is related to chest pain, if you have numbness in your left arm it could just be a sign that something is going on with your heart and I was trying to encourage people not to ignore those symptoms. 

BILL: What about both hands? Both fingers.

PATTERSON: Both hands probably is not directly related to your heart. It could be something in your neck. It could be carpal tunnel. It could be nerve damage from a number of things. Again, I would definitely make sure you talk to your doctor about getting checked out.

BILL: Okay, I thank you.

 LOMAX-REESE: Thanks, Bill. Our final caller for this segment is OBM from North Philly. Welcome to the show.

OBM: Yes, good afternoon to everyone. I have had 27 hospital stays in the last three years. I have had leaking heart valves. I've been to Einstein and Jefferson, everywhere. I keep containing water on my legs. I come home and I am right back in the hospital. I'm out three weeks, two months, and finally after a statement that was just made by one of you guys about your teeth, I knew this here when I was a child. Your teeth is connected to your organs in your body. You hear talk about your eye tooth, this tooth and that, I just had all of my teeth removed like seven months ago, and I am finally beginning to recuperate, to fight, and get better, but I am still containing water on my legs. My doctor tells me if I be on the table and they fix my heart valve, the weakness of my heart at this time is so weak that I probably won't leave off the table. Is there anything I can change in my diet? I am home with oxygen. I am a shut-in. I have a hospital bed. I have someone coming to clean for me. Is there anything I can do? I feel great, but I can't accumulate no energy. I take three steps and I am tired. 

PATTERSON: Well I thank you for calling in. It sounds like there is a couple of things going on and without knowing more information I will tell you what I think. You are absolutely right that dental health is connected. If you think about we wake up with filmy mouths, I am sure it is not just me. We wake up with filmy mouths and we brush that away and some of that we swallow and it does go to our heart. Sometimes people have to get very extensive dental cleaning to clean away that bacteria so that it doesn't get into our bloodstream. As far as the swelling in your legs and the shortness of breath it sounds like you may have something called congestive heart failure. Often, if the heart is damaged or the valves are damaged, the heart takes on something that we call congestive heart failure, where it doesn’t pump out blood as well anymore, and so blood starts to back up into the lungs and then eventually back up into the legs because everything is connected. So you have constant swelling and shortness of breath, sometimes problems laying flat on your back. You get short of breath. You have to sit erect. Those things can be treated. Those things can be treated, but once the heart is very damaged, it is harder to treat. That's why we wanted to come on today just to again encourage people to take steps before these things happen, to get regular dental cleanings, to watch your blood pressure, etcetera, etcetera, to really think about things before so that we are not backtracking and trying to help people down the line, which is possible, but prevention is key.

LOMAX-REESE: Thanks for your call, OBM. So we are just about out of time, but you cannot escape without my mind body connection question because I know that there is a lot of physiology involved. Got that, but I also wonder how our emotions affect our heart. Again, when you think about the heart, for me, I think about it is the seat of compassion. It's the seat of love. It is the seat of courage and all of those things and I am wondering if you see in your medical practice any connection between bitterness and anger and hostility and stress and heart malfunctions and heart disease? I am going to start with you, Dr. Cordone, as the cardiothoracic surgeon. Is there any connection between the mind and the body in your practice?

CARDONE: Well, I think on a couple different levels there is definitely some connection. Just as an observation over the years, and I have been doing heart surgery for about 17 or 18 years now, you would be surprised how many times someone comes in with a heart attack and it is in so many days plus or minus of their birthday. I am always shocked at that, at how many people will come in literally within a month either way of their birthday. Oftentimes, they will have a birthday party while they're in the hospital recuperating from my surgery. It happens often enough that I've noticed it over the years. The other thing that I have noticed is…

LOMAX-REESE: What do you think that's about?

CARDONE: My wife is a psychologist and she says there are a number of different stressors in our lives and for some reason life events like birthdays are a stress and a lot of times we try to pretend that they're not stress and try not to make a big deal out of them, but they are and different people react differently and it is one of the things that we just see very commonly. The other thing that I have noticed is that patients who end up needing surgery, the ones who go in with a good attitude, the folks who come in and they just know that they're going to do all right, they've got a really positive attitude going in. Those folks always seem to just cruise right through and it is a rare bird indeed with someone like that who comes in and struggles afterwards. Most of the time if they had the right attitude going in they are going to be on autopilot the whole time. There's very little that we have to do. I just sort of guide them along the way. It is the ones that go in, "No, I am only doing this because my grandkids want me to do it." Those are the ones that I worry about. They are the ones I really sit down and try to have a good talk with them before we do any big operation on them.

LOMAX-REESE: And, Dr. Donee, your thoughts?

PATTERSON: I definitely think it is related. There are definite studies that show that people, when they are stressed out or they're angry or they have road rage, that they tend to have heart incidents more commonly, angina, which is frequent chest pain, more commonly. There is a chemical that's in our body called cortisol and when we are stressed that cortisol level is up. It is just supposed to be up for short amount of times throughout a person's life, but when it constantly stays up that cortisol makes your heart work harder and again the harder your heart works, the more heart attacks and heart incidents you can have. I wrote a paper on faith in medicine, spirituality in medicine, and in that study it showed how people who, it doesn’t matter what faith by the way, but when they have a faith or when they have that positive image in their head of being healthy and continuing to live healthy, they actually have better health outcomes. It is well-documented in the literature. 

LOMAX-REESE: Well, we are out of time. I want to thank both of you so much for being here. This is really important information. I know that there is lots of different ways to contact you and the Einstein network. Why don't you give us that information?

PATTERSON: Yes, if you need a doctor or a cardiologist, you can call 1-800-EINSTEIN and as typical for our show, Sara, we are offering a $25 gift card for the first person who answers very simple questions on our Facebook page, which is EinsteinHealth, our Facebook page, and there is also a heart health assessment tool. I have a whole bunch of stuff I want to say. A heart health assessment tool that you can also download to kind of see if you are at risk for heart disease, but nothing replaces seeing your doctor and I just want to leave people with the thought of what are you willing to do to live well. We have to answer those questions for ourselves.

LOMAX-REESE: Absolutely. I wish both of you a wonderful holiday and, Dr. Donee, I look forward to seeing you.