- February is American Heart Month, and tonight, two Central Illinois cardiologists explain how we can prevent cardiovascular diseases and treat problems before it's too late.

(subtle bright music) (subtle bright music continues) Good evening, and thanks for joining us for WTVP's "Docs on Call."

I'm Mark Welp.

Heart disease is the leading cause of death in the US, with nearly 2500 Americans dying from cardiovascular disease every day.

The good news is most cardiovascular disease is preventable.

Tonight we have Dr.

Sudhir Mungee, he's an interventional cardiologist, and Dr.

Marco Barzallo is a cardiologist, both are with OSF HealthCare.

Thank you, gentlemen, for coming in.

Appreciate it.

- Thank you.

- Yeah, it's a privilege.

- Well, first of all, let's talk about, you know, what is heart disease, for folks out there.

What can we tell them about it?

Either one of you, jump in.

- Go ahead.

- So, I mean, it's a spectrum of problem, heart disease.

But for our folks, the common entity is what we understand, heart attacks.

Heart attacks is basically because of blockages in the heart arteries, which leads to symptoms of chest pain, heart attack, which can cause other problems that can lead to it, such as heart failure.

Because when you're having a heart attack and if it's not treated in the right timeframe, you can have loss of heart muscle.

And loss of heart muscle leads to heart failure.

It can also create scar in the heart.

Because when the muscle is kind of dead because it's not getting enough supply of oxygen and blood, it can create scar.

That scar can also cause electrical disturbances in the heart.

So it's a plethora of problem.

So what is heart disease?

It's a combination of many things that can happen.

It could be a plumbing problem of the heart, it could be an electrical problem of the heart, or it could be a pump problem of the heart.

So, you know, I think that's the best way I can explain what comes under the umbrella of heart disease.

- Sure.

And doctor, when it comes to heart disease and the causes of it, you know, what kind of percentage are we looking at in terms of, well, we are causing these problems by our bad habits?

Or maybe talk about folks that are born with heart issues.

- Well, there's a big separation of what are the risk factors or what cause heart disease.

We have, as you mentioned, small percentage of people that were born with some sort of heart disease.

But throughout the life, there are different types of heart problems that could present, depending on many factors.

One of those is family predisposition.

And usually, that's aligned with problems with the cholesterol, or predisposition to have high blood pressure throughout the years.

There's a obviously lifestyle impact throughout all the decades of life, the ability for the heart to maintain its health.

And all the management of diet, exercise, eat right, that is something that it's not has to be managed at age 40 or plus; it's something that have to be managed from the early 20s.

And that's the way to prevent.

As we said, the good news is that it's prevention.

And that's where we have to work in our community.

I think in the last few decades, we kind of forgotten how important this is.

And society unfortunately goes now in, have many commodities, and those commodities make life easy.

And life easy sometimes means that we don't do many things that we used to do in the past that are actually healthy for our bodies.

- Sure.

- Yeah, if I may just add on to that.

You know, this is a common thing that, oh, it's a bad luck that you had heart disease.

It's not a bad luck.

It's lifestyle plus time.

So if you have a poor lifestyle and that continues for a long time, that's when it can cause the heart disease.

I mean, we typically are sitting more, moving less, and certainly not eating a healthy diet.

And you put that together.

You know, the CDC just came out, it's the obesity percentage.

Prevalence is about 48%.

Hypertension is about 42%.

And diabetic or prediabetic state by itself is about 38%.

And these are kind of the big threes when it comes to heart problems.

So I think lifestyle is a huge problem, and we tend to kind of not talk enough about it.

But we should talk more about it, without a doubt.

- Yeah, let's talk about some of those things.

I think most people watching this probably know what's good for them and what's bad, but we probably need to reiterate it for some people.

Let's talk about smoking first.

- No smoking.

That's the key.

Smoking is probably a single-most risk factor, which is equal to having three risk factors.

Smoking alone is equal to having three risk factors.

So if you had a balance, you can put smoking on one side and you could put high blood pressure, diabetes, and high cholesterol on one side.

That's the impact of smoking.

The good news is when you stop smoking, your risk reduction is by more than 50% in less than two years.

So I think, you know, yes, I mean, it's not easy to give up, but understand the impact when you give up.

So smoking is, yeah, I mean, it causes a lot of inflammation in the body, which is the leading cause of heart problem.

- And it's good to know that it's never too late to stop smoking.

- Absolutely not.

- And one of the things that I usually tell my patients, to make it simple to understand what tobacco does, is imagine you have high cholesterol, you have high food intake, a lot of processed foods; what tobacco does is make your arteries sticky.

So if you have high volume of cholesterol and you have sticky arteries, the cholesterol is going to stick to your arteries and create problems: stroke, heart attack, problems with your legs and elsewhere.

So that's kind of an easy way to see it.

Another point that I want to make about tobacco products is that we don't know anything about the substitutes for smoking, which is the smokeless tobacco.

- Vaping.

- Vaping.

We don't know much about it.

We don't know that it's not healthy neither.

And I think that the industry has shifted from smoke, away from traditional cigarettes to this, initially seen as a way to quit smoking.

But the reality is not.

- [Mark] Trading one vice for another?

- That is correct.

Yeah.

Nicotine in any form causes the inflammation.

- Sure.

And let's talk about sedentary lifestyles.

You know, a lot of us, myself included, are stuck at a desk for eight hours a day and don't get as much exercise as we should.

What is a good amount of exercise, or even just movement that people should be getting?

- Yeah, I mean, actually, American College of Cardiology has put down very clearly what is the expectation to decrease the risk.

And that recommendation is 150 minutes a week of moderate exercise.

So if you were to break it in, 30 minutes of walking a day, five days a week, will do it for you.

That'll reduce the risk of cardiovascular disease by 20, 30%.

Intense exercise could be up to 70 minutes in a week.

But typically, what we talk to our patients is 30 minutes a day.

If you can do it for five days a week, it's good.

Seven days is even better.

- Okay.

- Yeah.

- Just, you know, sit less, walk more.

And that's enough.

- Yeah, walking is a great exercise, but not everybody likes or has the time to do it.

What I usually say to my patient is find something that you enjoy doing.

Because consistency is important.

You don't want to do it a month or two months after a certain commitment, but you want to do it for a prolonged period of time.

And that's equally important.

You want to change your lifestyle, not just change two, three months.

And that is also important to stress in everybody.

- Are there any kind of early detection tests for heart disease?

I mean, a lot of times, you know, people, it's too late.

They have a heart attack and then they realize, oh, I have heart disease.

But is there any kind of a test or any signs people should be looking for before something bad happens?

- Yeah, it's interesting you ask that, because I think the one is the big three, which is get your blood pressure checked, know your cholesterol number, and know your sugars, you know, blood sugar.

And it's pretty clear out there that if your blood pressure is less than 120/80, that's good.

If your hemoglobin A1C is less than 5.7, that's good.

And if your bad cholesterol is less than 100, that's good.

So that's the easy, that's just getting numbers done.

Once a year is plenty.

But what I really pay or let my patients know is everybody has a measuring tape at home.

Measure the waist length, you know, the waist size.

If you're a male and your waist size is more than 40 inches, it's a risk.

And if you're a female and the waist size is more than 35 inches, that's a risk.

And, you know, we all know that obesity is a problem, but the bigger problem when it comes to heart disease is where the distribution of the fat is.

So abdominal fat is way more atherogenic, more inflammatory to cause heart problems.

So abdominal obesity is kind of the worst.

That's why the importance of waist circumstance.

It's a bigger entity called as metabolic syndrome that we talk about.

But, you know, these are simple things, the three things and a measuring tape, and you can define what is your risk over the next 10 years.

- Besides the measuring tape, should we be looking at BMI numbers too?

- Yes.

- Of course.

- So when you are overweight, is the the bad part of that that you're putting stress on your heart because you're carrying around those extra pounds?

Or is it even more than that?

- What I usually tell my patients is imagine yourself, you're overweight 10 pounds, imagine yourself, you're walking with a bag in your back that is extra 10 pounds.

If you are overweight 50 pounds, you're carrying an extra bag of 50 pounds with every single step.

And it's not just your heart; it's stressing your heart, your lungs, your body, your knees, your hips, everything.

The heart, the body is a total.

And everything impacts your lifestyle.

- Yeah, and again, you know, obesity I think is the central mechanism through which other disease processes, you know, take origin from; high blood pressure, you lose weight, you're gonna drop your blood pressure; you lose weight, you're gonna control your sugar; you lose weight, you're gonna get your lipids under control.

But one thing that we don't talk about is obesity is directly related to sleep apnea.

And sleep apnea, you know, lack of seven to eight hours of sound sleep has been associated with cardiovascular disease.

And so obesity at the same time is associated with sleep apnea.

So if you don't have a restful sleep for seven to eight hours, that increases, you know, the hormonal cortisol levels in the body.

That's inflammatory too.

So, I mean, we are going back to what are simple things to do, what is more important things to do of weight control, good sleep, good diet.

And as Dr.

Barzallo said, it's not just for a few months; that's the way you live.

- Yes.

Unfortunately, the commodities of our modern life make it difficult to really put that in.

And I think in the past, you look at the activity, it was integrated into daily lifestyle, starting from a kid.

All the kids walked to a bus, to school.

Now they probably don't walk more.

Kids walk out, used to play outside.

Now, how many kids do that?

They're in a TV or a phone.

So yes, there are commodities, but with those commodities we have different type of problems.

And less activity, more eating, more sedentary lifestyle, you eat more.

And if you sleep less, actually, you eat more.

And that is another... It just becomes a cycle.

And it's very difficult to change.

So it has to be a multitude of changes to be healthier.

- Let's talk a little bit about heart attacks.

What should people be looking for in terms of symptoms?

Is it different between men and women?

- Yeah, I mean there are differences.

I mean, one is women tend to have heart problems a little later in life compared to men, but they catch up pretty fast.

And actually, you know, the leading cause of death in women is heart disease.

It's not cancer.

You can put all cancers together and heart disease on one side, heart disease is the leading cause of death in women.

Typically, men have the symptoms of heaviness in the chest while they're doing something, break into a sweat or get pain in the arm, elephants sitting on the chest: those are typically the symptom of a acute heart attack.

Women, they tend to have more heart problems after their menopause, because there is a protection of hormones while they're in the menstrual phase.

But postmenopausal, they can have symptoms that may not be classic like men.

They may just say jaw pain or a back pain or just fatigue.

Or feeling like may throw up.

So we call them not very classic anginal kind of symptoms, but in the right setting they could be the warning sign of a heart attack.

- And if you feel like you are having a heart attack, doctor, besides getting into the hospital as soon as possible, is there anything else people can do in that short time period?

- Well, obviously, you have to try to get as soon as possible to a healthcare facility.

But, I mean, baby aspirin seems to be helpful in the early stages of any acute event.

But not all the other things probably are... Locally, we have a good system that usually tends to take the people rather quickly to a facility.

But apart from a baby aspirin, I don't think there's anything in that particular time that needs to be attention.

Once you get to the hospital, obviously, there are multiple of things that need to be done.

But yes, call 911 as soon as you have any suspected symptoms of that.

That's probably have to be the the number one thing to do.

- Don't drive yourself.

- Don't drive yourself.

- Don't drive somebody else.

Call the ambulance.

- Yeah, sure.

Totally.

- You mentioned baby aspirin.

Tell us exactly how that helps.

And I know, in the past, cardiologists and physicians have prescribed that to people, to take a baby aspirin every day.

Is that still something that's done?

- Well, I mean, that's a big topic.

But baby aspirin uses for primary prevention versus somebody who has a heart disease is a whole different ballgame.

Aspirin, what it does, I mean, you have to understand that it's like you have a normal tissue in the artery of the heart, and suddenly there is a small disruption.

That disruption just makes the artery become very angry.

And all the blood factors which cause clot, they tend to form a clot at that spot.

And what aspirin does, especially the chewable aspirin, it'll reduce the progression or formation of that clot.

I think that is the message to be given.

The earliest symptoms if you have, the taking of aspirin may delay the progression of clot formation.

And I think that is the first thing that could be done while the EMS is arriving or you're getting to the hospital.

- Sure.

We have a lot of good cardiology programs here in Central Illinois, and I know at OSF HealthCare, you've got something called TAVR, which is the transcatheter aortic valve replacement.

Just did your 2,000th.

Tell us about that and and why it's a big deal for patients.

- Well, over the past 15 years, probably, there has been a dramatic change in how we deliver care for patients that have valve disease.

We're switching topic a little bit.

We're talking about blood flow to the heart.

Now we're talking about the valves that are in the heart are part of the structure of the heart.

The heart has four valves.

and over the last decade and a half, there has been a switch to repair those valves that are part of heart disease too.

Or replace those valve via percutaneous means, meaning without having to do open-heart surgery.

So TAVR was originally developed, and TAVR stands for transcatheter aortic valve replacement.

And now we are working on replacement, percutaneous of all the other valves of the heart.

But this is the one more prevalent, especially in adult people.

It was developed originally with the idea that there's a lot of people that needed the valve replace but could not get it because they are inoperable or too high risk for surgery.

So that was the original idea, and slowly has become approved for people that is less, that had less risk to, now we have this as a comparable result to what traditional has been open-heart surgery without the trauma in the body, which means an open-heart surgery.

So that's why this technology has allowed us to take care of people that in the past we couldn't take care of, and allow us to take care of a good percentage of the population that now develop this at late stages in life, that are not ideal candidate for surgery.

And even if they're a candidate for surgery, they are candidates to get this type of therapy too.

- Yeah, I mean, all these valve problems come under the umbrella of structural heart intervention.

So when you have aortic stenosis, as Dr.

Barzallo mentioned, the blood is not going out of the heart, people get short of breath or they get chest pain or they can just pass out.

The only option was open-heart surgery.

And now, you know, we go from the leg artery, do the valve, and patients go home the next day.

Then came the mitral clip, which is for the mitral leakiness: it's on the top upper chamber.

And then the tricuspid is on the right side.

So all these valvular procedures, which otherwise only were to be done by open-heart surgery, are now done percutaneously through a catheter.

And, you know, we started this project, first patient was actually December 12th, 2012 here in Peoria.

And so now, you know, we have done 2,000 of aortic valves, more than 150 of mitrals.

And, you know, we must say that it's been quite a journey.

Lot of team that is needed: imaging specialists, surgical specialists, cath lab technician staff, you know, lot of support.

It takes a village to get where we are with this now.

- When it comes to treating the heart, you know, after we have issues with it, you know, besides what you just mentioned, what are some of the more common either surgeries or replacements that you're seeing in patients?

- Meaning common problems that you're seeing?

- Yeah.

- Well, I mean, one thing is percutaneous interventions have certainly reduced, you know, the number of surgeries that were done before.

But still there is, we have a very comprehensive surgical program which performs open-heart surgeries, LVAD, and transplant.

We are a transplant center here in Peoria.

So, you know, that's main of the surgical model.

The electrical problems of the heart comes within electrophysiology division.

And that is where, you know, patients have atrial fibrillation, irregular heart rhythm of the top chamber of the heart.

You can get that ablated and not have palpitation.

It can be lower chamber of the heart where electricity is a problem.

It can cause certain cardiac death.

That can be ablated.

Then you have pacemaker or defibrillators.

All those things come under the umbrella of electrophysiology.

So I would say, you know, all divisions of cardiac interventions, whether stents, valves, electrical procedures or surgery, up to transplant, are, you know, we are really blessed to be doing this at OSF Saint Francis here in Peoria with an excellent team of physicians and staff.

- Yeah, good to know we have those facilities and people here locally, and you don't have to go to Chicago for it.

When someone does have a heart attack, you know, you hear about heart attack, you get scared, but you also hear about mild heart attacks, you hear about widowmakers.

When someone does have a heart attack, what is their life like afterwards in terms of, if they survive the heart attack, rehabilitation and getting back to whatever normal may be for them.

- Well, I would say that, yeah, there's a little difference between a big heart attack and a small heart attack.

But every heart attack could be potentially dangerous, the degree of insult to the heart.

Heart attack is the heart feeds by blood.

The blood is supplied by arteries.

The heart has three major arteries.

So if you have one of those arteries blocked, all the area of the heart that is not getting blood is a jeopardy.

The faster you open that blood vessel, the better the outcome.

And the larger the artery that has the insult, the larger the heart attack could be.

So time is extremely important when you have a heart attack, especially if it's a large artery.

And that's what the people commonly say is a widowmaker.

The idea of having a fast treatment, we say time is muscle, is the shorter the amount of time from the moment the patient start having chest discomfort to the diagnosis or to open that artery, the better the outcome.

And the goal for all of us is to get to that person that had a heart attack, to get them back to live exactly the same type of life, if not even better, than what it was before.

So it could be a scary moment to have a heart attack, but it could be a life-changing moment, a moment for the that patient to be more aware of his risk factors, to be more aware of diet, exercise, be compliant with his medications, with his follow-ups, and see that the heart attack is not a near-death experience, but it's actually, it's a life-changing experience to live better.

The overwhelming majority of the people that have heart attacks actually recover and go back to their normal lives, depending on what they need.

But normal lives just, there will be a certain amount of medications that will be necessary in the future.

But I would say that the quality of life should get close to what it was or better.

- A big wake-up call, that first heart attack, I'm sure.

Well, gentlemen, I appreciate you coming on today.

And it's good to know that we have, again, cardiologists in these facilities and all these treatments here in Central Illinois.

But I guess the big thing is to try and not get to the point where you need them.

- Yeah.

- Absolutely.

- I read a very interesting one-liner, is that genetics loads the gun, but it's the lifestyle that triggers it.

So, you know, lifestyle is in our hand, and, you know, we can avoid to trigger it.

And don't come and see us for that, right?

So I think we'd be happy with that (chuckles).

- All right, well, Dr.

Sudhir Mungee and Dr.

Marco Barzallo, both cardiologists with OSF HealthCare, thank you very much for all your tips.

We appreciate it.

- Thank you very much.

- All right, and thank you for joining us.

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