Dr. Mac Sheridan joined hosts Shannon O’Kelley, Physical Therapist and President of Integrated Rehabilitation Group, and Maury Eskenazi, radio personality from Fox Sports radio on Health Matters radio, KRKO 1380am, with thanks to Integrated Rehabilitation Group physical and hand therapy. He talked about heart health.
Read the transcript of Dr. Sheridan’s talk with Health Matters radio or listen here
Health Matters: Dr. Mac Sheridan interventional cardiologist from The Heart and Vascular Center at The Everett Clinic. So, let's go through this. What is cardiovascular disease?
Dr. Sheridan: Cardiovascular disease is really any kind of disorder that affects the system of the body that has to do with the pump of the heart. The heart is a bag of muscle. It's pumping blood through miles of arteries through our body. So, any disorder that would have to do with that pump not working right or the blood vessels that come out of that pump not able to carry the blood to the rest of the body.
Health Matters: We are talking about the heart as a muscle and then these arteries and veins which is the plumbing of the heart, but what about the electricity part of the heart? Is that problematic and can it be cardiovascular disease or is that a result of having bad health?
Dr. Sheridan: No, the heart, for a simple pump, it is really kind of like your car. It has a power system which is the pump, but the way it forms its heartbeat is an electrical impulse that goes through the heart over and over again. Our hearts beat about 100,000 times a day. That electricity can get disordered and some very common abnormalities like atrial fibrillation hits probably about a quarter to almost a third of us as we get older and that is a disordered rhythm of the heart and we have treatments for that. Then, the heart, like an automobile, has valves in it. The valves are these little one-way doors that let the blood go from chamber to chamber and make sure it is always going forward. Those can become defective or injured or diseased. There are a lot of moving parts about the heart even though it is a fairly simple pump and tubes. It is plumbing.
Health Matters: It must be hard nowadays with the way the world is — fast pace and stress to keep this thing working the way it should work, you know what I mean?
Dr. Sheridan: I am not sure the fast-paced world makes it harder. Our diets make it a lot harder. Interview: Well, there some studies out there where some countries suffer less of this cardiovascular disease than others.
Dr. Sheridan: You may have heard of the Mediterranean Diet, and that comes from cultures around the Mediterranean that have a diet high in vegetable oils. They are probably a little higher in wine than the rest of the world and a lot of vegetables mixed in their foods. Just looking at communities and surveying how they do, that diet seems to have a little lower heart disease risk than the more traditional American diet that is higher in fats and has fewer vegetables. If you keep it pretty simple, a diet that is close to being a vegetarian and fish eater as you can be is going to be good for you, but most of us Americans like our meats. You want to minimize those and don't feel bad about throwing some wine in every once in a while and olive oil and those good kind of oils.
Health Matters: So, I'm curious, we were talking off air and you were describing kind of how you ended up at The Everett Clinic. You started out by teaching cardiology in the university system. You had to have seen some changes in the field of cardiology: now you have interventional cardiologists, you have electrophysiology cardiologists. How does a person know the right cardiologist to get to?
Dr. Sheridan: You are right. I have seen a lot of changes in cardiology. You can tell that just by looking at my gray beard, I suppose. So, most of us cardiologists...let's take our Everett Clinic group, of 13 doctors. Four of us do interventional cardiology, three of us do electrophysiology.
Dr. Sheridan: They are the electricians of the heart. We are the plumbers of the heart, but all of us are general cardiologists and we have partners who specialize in heart failure. They know and keep up with the latest in heart failure therapies, and there are other cardiologists who are extra good at doing these procedures called echocardiographs. Some of them we go down the esophagus, the swallowing tube, and look at the heart from in there. There are lots of specialties. But the fact of the matter is that all of us pretty much are general cardiologists. You could start with any of us, and we will refer you to our partners who do these specialty works. If you were looking, you would just get a referral from your primary care doc and go from there.
Health Matters: Is there an age range or a group of people that automatically your family physician should be ordering a stress test just to kind of rule out any heart pathology or cardiovascular disease?
Dr. Sheridan: Generally, the recommendation these days is not to do routine screening stress tests. It did become fashionable to do that for high-end executives that had high life insurance policies, but there is really no data that doing a screening stress test does any good. Stress tests really are valuable in trying to sort out what your symptoms are. If you have shortness of breath or if you have some pressure in the chest or the throat or the back or the arm that you cannot explain, some dizzy spells, lightheadedness, fatigue, those are reasons to then start doing testing to look and see if the heart is working well and a stress test might be part of that to make sure that the blood flow is okay. A stress test is really specialized in looking at the blood flow to the heart and trying to decide if there might be any blocked arteries that we need to look for further.
Health Matters: It is interesting because a stress test picks up blockage based on electrical signals that are impaired as your exercise requirement goes up and they do it by EKG. So, they are looking at the electricity part of the heart that identifies there might be a blockage. Describe how that works.
Dr. Sheridan: Yes, there are several different types of stress tests. A basic stress test, if your electrocardiogram is relatively normal, then there will be electrical signal changes as the blood flow decreases to the heart. That is a basic exercise, EKG, kind of treadmill stress test. But, we also have a lot of people whose electrocardiograms we cannot interpret very well or they have changes in their EKG that we cannot tell. Then, we will add some sort of imaging to that — echocardiography, we call that a stress echo, which is an ultrasound of the heart. Then we look at how the walls of the heart are moving before you start exercising and after you are done to see if there are any changes. Or, we do a lot of what are called nuclear stress tests.
Dr. Sheridan: It is a small amount of radioactivity that then goes to the heart in proportion to blood flow so we can put you under a special camera that is sort of like a Geiger counter and we can see sort of how the blood distributes to the heart muscle and if there is a gap in that, that would indicate a lack of blood flow. So, there are several different types of stress tests, and, of course, a lot of our patients cannot walk on a treadmill either.
Dr. Sheridan: They have arthritis or some other problem that does not allow that. So, we can do stress tests where we give medications just to dilate the blood vessels. So, if you can exercise, what happens is your heart asks for more blood and dilates maximally. But, if you cannot exercise, we can give a short-acting drug in an IV and it dilates your arteries maximally for a short period of time and then we give the tracer, the radioactive tracer, and image you under a camera and that works just as well.
Health Matters: How do you make the determination on what the intervention is going to be?
Dr. Sheridan: A lot of that depends on what a person's symptoms are and how scary their stress test might look. Medical therapy we know works in fairly simple blockages as well as angioplasty if you are just looking at...angioplasty is the word we use for a balloon or a stent...as far as decreasing the chance of dying. But we know that opening up the artery with a stent or doing bypass surgery is a better way to relieve symptoms. So, you could try medical therapy on people first and see if it works.
Health Matters: And medical therapy would be...?
Dr. Sheridan: Would drugs that slow the heart rate down lower the blood pressure, lower the cholesterol. Those are sort of our...
Health Matters: Step one.
Dr. Sheridan: Step one is to do that, and making lifestyle changes like trying to exercise more and eat right and lose the weight and things like that.
Dr. Sheridan: But we know in all of the big randomized trials that if symptoms recur that the best therapy is to try to get more blood flow either by going inside the artery with a balloon and then a little metal scaffolding that we call a stent and that is the kind of thing that an interventional cardiologist like I do. Health Matters: Besides feeling chest pain, is there anything else that if somebody was going a blockage that they should be aware of?
Dr. Sheridan: The word chest pain throws a lot of people off because the feeling that the heart gets when it is not getting enough blood is generally not described by most people as a pain but more of a tightness or a pressure or a squeezing, but there are a whole lot of people, and sometimes women more than men, who might feel only shortness of breath or fatigue or lightheadedness or things like that or even discomfort in places they do not think are their heart..the arms, the neck, the throat, the back...
Health Matters: And you mentioned that sometimes those symptoms are different women versus men.
Dr. Sheridan: Correct. In general, women's most common symptom of blocked arteries is chest discomfort, but if you look at proportionally men and women as far as having unusual symptoms like shortness of breath or fatigue or things like that, women have a higher proportion of that. We try to get the word out so that people will look for those symptoms. Quite honestly, women actually present a little bit later in their disease than men do. This may be a social thing, women are taking care of their families and they are...
Health Matters: Always tired.
Dr. Sheridan: ... not necessarily looking at their own symptoms.
Health Matters: In the world that we live in, medicine is advancing so fast, it is pretty phenomenal. Now you are doing these procedures basically through these small veins and inserting this catheter up through your vascular system. Don't they have some kind of medicine that you can just give them via pill that would kind of get rid of these blockages?
Dr. Sheridan: That would be a wonderful development and, of course, we will always be looking for that. The drugs called the statins like Lipitor, Crestor, Zocor all of those, have really, in my career, helped a lot to sort of level off the disease. It does not stop it but can help decrease the progression somewhat so that we do not see people coming back over and over again. But it does not really clear the vessels out. It probably just settles the plaques down so they are not as friable. They are not as able to get a clot on top of it.
Health Matters: How do the statins work?
Dr. Sheridan: Well, it is actually affecting the liver. The liver is the one that sends out the cholesterol, the LDL and the HDL and all those ones we talked about. The LDL is the bad guy and HDL is the good guy. It decreases the production of LDL so that we have less of the bad cholesterol in our body floating around. We need some cholesterol because all of our membranes are made out of cholesterol. But you want to decrease that bad guy called LDL and increase the good guy called HDL and that just helps the plaques not be so inflamed and gummy.
Health Matters: So, exercise, diet, what else? Quit smoking. I think that is the key right there, right?
Dr. Sheridan: If you are going to list the real strong risk factors, really smoking and diabetes are two real strong ones that cause inflammation. Smoking is just something everyone should try to quit as best they can and get the help from their docs. There is help to quit nowadays. That's a big one.
Health Matters: As we wrap, I just have to ask, in today's world, in medical advancements in minimally invasive surgery, is there a need for a patient to actually have bypass anymore? Can you do all of this through the procedure, the scope?
Dr. Sheridan: No, there is still a need for bypass. Just last Friday, I think I did eight heart catheterizations and I sent four to bypass because when patients have disease all through the vascular tree of the heart, really bypass works much, much better than anything else.
Health Matters: Dr. Mac Sheridan from The Everett Clinic. For more information, go to everettclinic.com. Thanks so much for coming on with us.