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My name's Dr. Allen Taylor
And i'm the Chief of Cardiology at Medstar Georgetown University Hospital
My interests here include the general care of all heart patients,
cardiovascular prevention and imaging, new ways to image heart disease,
and then the treatment of advanced heart disease -heart failure, cardio-oncology.
So, diverse interest related to heart disease.
I was in the army for twenty years during which time I was the
Chief of Cardiology at Walter Reid and did research with the University
of the Uniformed Services, the University at Bethesda,
and after retiring in 2008 joined Medstar, and it's been a great several years
working in the research institute at Medstar, and now here, at Georgetown.
Cardiology is the best field in medicine because we have great ways to diagnose
patients problems and treat their problems to help them live longer, full lives.
And at Georgetown, the best thing is the environment of care we provide.
With a ??? tradition of compassionate healing of the whole person,
and patients really appreciate the opportunity to be helped.
A patient who leaves the hospital, or leaves your care feeling better.
That you've made really good decisions, that are based on the best evidence,
with treatment you know are going to help them,
and you've done that in this friendly, caring organisation.
In a teaching organisation, one where while delivering that care,
we're also teaching the next generation of physicians.
And we really have pretty much everything a patient would need.
A full range of services for everything, from prevention, through treatment
of advanced heart disease within a network within the Medstar system,
where we have even complex levels of care, all the way to heart transplantation.
So when they come to Medstar Georgetown University Hospital, they have got
everything they can possibly ever need for their heart care available to them.
Medstar Georgetown University Hospital is a special place.
It starts with it's history. Alot of the cardiovascular inventions
we use today, were pioneered or tried here first, and there's a great history here,
of excellent clinical diagnostic cardiovascular care.
Physicians with great acumen to diagnose and treat your problem.
And that's really where it starts. In the patient-physician relationship,
which I think is very special here. Once here, we work with an institute
across the region where we have got every possible treatment available.
From the best preventive and screening tools, to the best treatment approaches
for acute heart problems - like heart attacks.
To chronic heart problems, like heart failure.
artificial hearts and heart transplants, to the best heart arrhythmia specialists.
And now even to surgeons that work closely with our cardiologists to do, for example,
Valve insertion without surgery.
So, there's a broad range of treatments we have for prevention,
To even the treatment of the most advanced heart disease available to us
Within a compassionate, caring environment.
Heart disease is a problem. It's not caused by any one factor.
Many risk factors - from high blood pressure to cholesterol problems.
Diabetes, overweight, inactivity. So many risk factors.
That we can actually treat - to reduce risk of heart disease.
There are also things that we can't treat. Things like genetics, inheritance and gender.
And so, while there's things that we can't treat there are so many
things that we can treat that are risk factors,
and they are easily measurable. You can measure your blood pressure.
You should know your blood pressure.
You can measure your cholesterol. You should know your cholesterol numbers.
You should know whether you do or don't have diabetes.
And if you're smoking or overweight, or inactive, those are things
that you should correct.
And so, there's many risk factors for heart disease
and so many are treatable.
Heart disease develops over decades. From the risk factors patients have,
To the ultimate manifestation with symptoms or problems
of the heart and the blood vessels. Between that period of time, there
is a long silent phase when artery problems will develop.
Arthosclerosis with buildups will occur and those eventually can lead to
things like chest pains when the arteries are clogged.
Or heart attacks when the arteries become suddenly clogged,
leading to the damage of the heart muscle. And with enough heart damage,
or with enough stress or strain, with something such as hypertension
or high blood pressure, heart failure, or the weakening of the heart muscle
can occur leading to problems with breathing.
So there's a whole range of symptoms which can occur as signs of
heart disease, affecting the heart, the blood vessels,
that have developed over decades from risk factors.
So it all comes back to risk factors. Treating those early in life
and then watching for those symptoms that are sign
that the heart and blood vessels have been affected.
A heart attack is when the blood flow to the heart muscle through the artery
that bring oxygen to the muscle, becomes suddenly blocked.
And the muscle becomes damaged. It dies. Or a portion of it dies
because of lack of oxygen.
That can be manifest by chest pains or breathing troubles.
And it can be determined by or diagnosed by looking at the Electrocardiogram
or measuring blood tests for signs of that heart damage.
So a heart attack is a sudden change in blood flow to the heart muscle
leading to heart muscle damage.
Cardiac arrest is when the heart beating suddenly stops.
Leading to collapse, loss of consciousness and is a true medical emergency.
Within four minutes there is irreversible brain damage.
And that's where a community based CPR, rapid activation of 911,
and defibrillators in the community, have been so life saving.
Exercise is the wonder drug.
Exercise reduces blood pressure, cholesterol, body weight, blood sugar.
Does all these great things to risk factors which in the end
wind up to a remarkably lower risk for future heart disease.
Even if you've had heart disease, patients who exercise,
are at much lower risk for subsequent or later on heart problems.
In fact, we want them to exercise. They should exercise.
It's safe to exercise. Of course, after a heart event,
we often monitor people in rehabilitation programs
for a brief period of time to make sure it's safe to exercise,
but ultimately, the goal of cardiology is to prevent heart disease
and when it occurs, to get people back to full functioning.
And that includes exercise.
Diet is so important. Diet includes the fats you eat,
the amounts of salt you eat. And the types of foods you eat.
Whether they are processed or natural.
Diets that are high in processed foods or high in sodium raise blood pressure.
Diets that are high in fat, raise cholesterol.
So a healthy diet is a balanced diet.
Not one that restricts all fats. Not one that avoids everything.
But includes modest amounts of fruits and vegetables.
Limits saturated fats and meats. Limits fried foods.
And tries to avoid salt and processed foods.
Diet is incredibly important as a way to prevent heart disease.
One of the things we do the best is measure cholesterol
and determine who needs treatment.
Very clear guidelines tell us when a patient needs drugs
and what drugs are effective and what our targets are.
And this has all been established through very careful science.
So you should know your cholesterol numbers.
You should know your bad cholesterol - your LDL.
An optimal should be below 100 for all people.
Certainly below 130.
And the more risk factors for heart disease you have,
the lower it should be.
You should know your good cholesterol - your HDL number.
It should be over 40 if you're a man and 50 if you're a woman.
and exercise, modest alcohol consumption and drugs will help increase that if it's low.
So, blood cholesterols are very important risk factor for heart disease.
High levels of bad cholesterol, low levels of good cholesterol
increase your risk for heart disease.
Both are very measurable and very treatable.
Heart attacks occur because buildups have occurred and developed
in the arteries over decades.
It starts in teenage and young adult years.
Through high blood pressure, cholesterol, poor diets, inactivity.
Those build-ups accumulate until ultimately,
They cause a sudden drop in blood flow to the heart and muscle.
It's that period of time between having risk factors,
through build-ups, to heart attack, that we can act
to prevent heart attacks by measuring risk factors.
To predict future risks for heart disease.
The more risk factors you have, the more at risk you are.
And in many cases, to actually measure the arteries.
And assess if they are or are not developing build-ups,
faster than they should for age.
So, we can measure build-ups. We can predict future heart risk.
And we can treat future heart risk.
Diabetes is an important risk factor for heart disease.
As is the precursor to diabetes. A syndrome known as
Metabolic Syndrome, when the blood sugar can be
a little abnormal. In other words, the risk factors
are occurring with high blood sugar.
So, we know that high levels of blood sugar,
whether diabetes, or Metabolic Syndrome are important heart disease
risk factors.
For example, a patient with diabetes has the risk of a heart attack
as if they'd already had a heart attack.
It's called the Risk Equivalent.
Diabetes is a diagnosis which carries the same risk
of someone who's already had a known heart attack.
So, it's a very important risk factor.
So we treat patients with diabetes very aggressively.
As if they'd already had a heart attack.
Even if they haven't.
To achieve low levels of cholesterol, low levels of blood pressure.
To use aspirin to prevent clotting. Making sure they are exercising.
And on a good diet.
Through this approach we can reduce the risk of
heart disease for diabetics.
Diabetes is not a death sentence from heart disease.
But, it's an important risk factor.
If we identify diabetes, we treat the diabetes and the other risks
associated with it.
We can actually improve patient's outcomes.
Patients with diabetes have not just the diabetes
which leads to the promotion of artery buildups,
but diabetes occurs within a common clustering of other risk factors.
High blood pressure, abnormal blood levels of blood cholesterol.
And so it's not just the diabetes per se which leads to the heart disease.
But it's the other risk factors in association.
And it's like gas on a fire. If the fire is the diabetes,
the other risk factors are the gas.
And the two are worse from the standpoint view of
developing heart disease.
So, it's not just a one problem that diabetics have.
It's treating the diabetes and everything else
that comes with it.
Including being commonly overweight which can often lead
to physical inactivity. So, it's very important for diabetics
to get control of their body weight. To be active.
And to know all the risk factors to optimally treat the risk for heart disease.
Family history is an extremely important part of knowing
your heart risk.
Risk factors explain perhaps one third for the risk for
heart disease. The other two thirds comes
from factors we can't measure.
And a lot of that can be judged through family history.
So what's abnormal family history?
Well, strictly speaking, it's when a man,
A first degree relative, your father or a brother,
has a heart attack prior to the age of 55.
Or, a woman - mother/sister before the age of 65.
But, you may have had an uncle, that had a heart attack
at aged 70. Is that a family history?
Well, it is. But it's a weaker one.
What if all the uncles on your father's side had heart attacks?
To me, that's a little stronger signal of a family history
of heart problems. So, it's not a clear definition
of a family history, but the aggregate of
looking at everybody that shares genes with you,
and leads to that assessment of what your family risk is.
It's, in a sense, a poor man's genetic test.
What are the genes that lead to heart disease?
Well, they haven't really been identified yet.
Family history is the clue.
And patients with family history with the same risk factors
versus those who don't have a family history,
are two to three times more likely to develop heart disease in the future.
Really, in this day and age, nobody should be smoking.
Because it's a very clear risk factor for heart disease.
When you stop smoking, as hard as it can be,
your risk for heart attack goes down immediately.
And within two to five years becomes that of a non smoker.
Which is really pretty fascinating. And it relates to the fact that
smoking damages the artery walls.
Creates the potential for clotting and increases
the risk for heart attack.
Importantly, even second hand smoke increases the risk
for heart attack.
Countries that have banned smoking in public places
have seen 20% reductions in the population incidents
of heart attack. From simple second hand
smoke exposure. That old sitting on the airplane
breathing in second hand smoke, sitting in a restaurant breathing
in second hand smoke, that was dangerous for you.
So, kudos for public health people for getting rid
of second hand smoke in the community,
because even that's dangerous.
So, if you're a smoker, you're not just damaging
your own health, and increasing a risk for heart attack.
But that of the people around you.
Anyone who smokes today, should stop smoking.
Heart attack symptoms are important to identify.
Because early treating leads to better outcomes.
Symptoms of a heart attack include chest pain
and shortness of breath.
Now, the classic chest pain for a heart attack,
is a central or left-sided chest pain. A pressure, a weight sensation.
That can radiate up into the neck,
or the shoulders, the left arm, and is associated with
sweating or nausea. That's the classical presentation.
The thing we learn about heart disease
and heart attack is that not everyone presents in
the same way.
Which is why, we cast a broad net to catch a few fish.
That is to say- be attentive of chest symptoms.
Patients feel their own personal sensation of heart disease differently.
Older women particularly. Women often feel heart attacks
and chest pain in different ways.
Back pain, fatigue, can be symptoms of heart disease, particularly in older women.
The symptoms of heart attack are not always different in men and women.
The classical symptoms of heart attack - the central chest pressure.
The radiation to the neck, breathing, nausea, sweatiness,
can occur in men and women. It's just that women,
sometimes more commonly than men, will present in atypical or not classical ways.
They might feel fatigue. pain in their back, have pain that comes and goes.
as that classical pressure sensation.
When a heart attack begins, which is when an artery becomes blocked
by a clot over a plaque, heart muscle damage starts within about twenty minutes.
Or becomes irreversible within about twenty minutes.
And it progresses. After about six hours it's complete.
But there's a window of time when a heart attack can be stopped.
Through clot busting medications or direct approaches to re-establish blood flow
down the artery. Time is of the essence.
The earlier the presentation, the earlier treatment starts.
The earlier treatment starts, and treatment is designed to reopen arteries.
So, we have a few delays we can try to get rid of to improve outcomes
in heart attack. One is the time that patients take
to recognize their symptoms and present. The second is once patients get the care.
How quickly we act. For example, in our center we have a goal
of ninety minutes. From the time someone
hits the door, their artery should be opened within ninety minutes.
Those are the national standards. And we achieve that.
But the biggest delay we can face, is the delay of patients recognizing
their symptoms. Chest pain, breathing trouble,
unusual presentations. Get to care early.
Cause early care means better chance of survival.
We know it reduces the risk for heart attack by about a quarter.
And if you're having a heart attack, it reduces the risk of having
a fatal heart attack by about the same amount.
So Aspirin, as simple as it is, is a very important drug for us.
That said, Aspirin has it's risks. It increases the risk for bleeding.
In the stomach and in the brain, for example.
So we have to use Aspirin in the right patients.
So if you're home and you're having chest pain, is an Aspirin a solution for you?
Well, maybe, maybe not. Taking an Aspirin probably isn't harmful
in that setting. But delaying care to take an Aspirin, would be.
So, you've seen the commercials. I'm having chest pain, I took an Aspirin.
Is that a solution? It's not a solution.
The best solution is to call 911, get to care and get under treatment.
Ultimately, when there's a buildup in the artery,
what happens is there's a turbulent blood-flow, abnormal bloodflow
a rupture of a plaque, and a clot occurs.
And that's why Aspirin as preventive medicine can be so
effective for heart disease. It prevents the clotting.
But it doesn't prevent the buildups. And so the fundamental problem
is risk factors leading to buildups. And while we prevent heart attack,
in part by using Aspirin to prevent clotting, we really need to treat the root cause.
Which is preventing buildups by treating risk factors.
Heart disease is still the number one killer of men and women in this country.
And is gaining as a cause of morbidity and mortality, death and problems
around the world. We can prevent heart disease.
And the nice thing about cardiology these days, is, we've got new treatments
to prevent, and new treatments to treat, once the problems do occur.
The future is, that we can take care of patients who have established
heart disease from preventing more heart attacks, treating heart failure,
artificial hearts, heart transplantation and treating every possible heart rhythm
problem that a heart can develop these days, with catheters and surgery.
So we've got every possible treatment available for patients who already have
heart disease, but also on the front end,in prevention.
We've got treatments that we know work.
That if we can just apply more fully will prevent patients from having heart attacks.
That lead to heart failure and death. So, it's a treatment of risk factors,
good control of blood pressure, good control of cholesterol,
eliminating smoking, treating diabetes - are so important.
While we also encourage patients to eat well, lose weight and exercise.
New technologies are coming up all the time in cardiology.
Which is one of the things that make it so exciting.
On the prevention side, new imaging techniques,
To image the arteries in the neck or image the arteries in the heart.
To see if buildups are occurring long before they develop symptoms.
It's an exciting way to help our predictive capabilities and get the right patient
the right treatment at the right time.
Once patients do develop heart disease, all sorts of new treatments,
new stents that secrete drugs to prevent buildups from occurring.
Once heart muscle damage occurs, gene and stem cell therapies to
regenerate heart muscle are in development.
If heart failure gets really advanced, artificial hearts that can prolong
your life to the point where you can get a heart transplant.
And all sorts of new devices to prevent fatal heart rhythm problems.
From implantable defibrillators, that are now moving to ones that
don't even have to go through your veins.
So there's all sorts of technical developments from prevention,
to treatment, to the treatment of very advanced heart disease
and ultimately the prevention of death.
Some of the latest, most exciting things are artificial heart valves.
New heart valves. That can be inserted without surgery.
So, it's a pretty exciting time. Where treatments are getting better.
And less invasive. While we're also at the same time
preventing more heart disease.
Heart failure is the most common discharge diagnosis for patients
admitted to hospital - costing billions and billions of dollars a year.
Heart failure arises because there's been heart disease
that's developed across decades and now the heart is failing.
Unable to pump enough blood to support the body.
And that's the problem known as heart failure.
It's a problem treated with medications.
And treated well with medications if the right medications.
But what's new and exciting there, are advanced treatment options.
To mechanically support the failing heart through insertion of artificial hearts,
that now have become very commonplace.
For example, Vice President Chaney recently had an artificial heart
and then survived to get a heart transplant.
Very commonplace these days. And so, heart failure is an exciting area.
Because it's such a common problem. While we're trying to prevent heart failure
by preventing heart disease in general.
Once it occurs, we've now got everything.
From drugs, to devices, to surgery, to help the problem.
So, you've come to the doctor. You've been given a diagnosis.
And you receive a prescription. Then what?
Well, the best drug not taken, is completely useless.
And what we've learned, is that, if we don't take the medicines
that are provided, that we know work.
We actually fall short of our goals of trying to prevent heart disease.
So there's a chain of responsibility. To get the right treatment identified.
To get the right treatment provided.
But then, for the patient to adhere to that treatment program.
And then the non-adherence - for example, if you stop your
cholesterol pills, your risk is far higher of a heart attack than if you don't.
If you don't take your blood pressure pills and your blood pressure is higher.
You have a higher risk of a stroke or heart attack than if you don't.
So, while there is this great search for new medicines
that are going to solve heart disease, you know, we've got alot of the answers now.
And if we can get the right patient the right treatment at the right time,
We're going to do a really good job at preventing future heart disease.
You know, the great problem is that alot of these risk factors are silent.
You don't feel your cholesterol. You don't feel your blood pressure.
But, they take their toll over time.
Through adverse effects on the blood vessels and the heart.
And so there is this long period of time we have to act.
And only if we act, can we prevent heart attacks,
heart failure, sudden death, stroke. The things we're trying to prevent
down the line. And these risk factors develop early in life.
At age 30-40 you should know your risk factor profile.
Because your lifetime risk of heart disease as a 40 year old man,
is still about fifty percent. And so knowing your risk factors
early on in life gives you a long time to prevent heart disease in the future.
And it's lifestyle first. It's a good diet.
It's exercise, it's avoiding tobacco, maintaining a good body weight.
Those go a long way towards optimizing heart health.
But when that doesn't work for a problem, your blood pressure's too high.
Your cholesterol's out of control. We have great drug treatments that work.
But they only work when you take 'em.
And it's important to be educated about the symptoms that can be developed.
If you're at risk for heart disease, know the possible symptoms.
Chest pain, breathing troubles, and not everyone reads a text book.
Not everyone develops the classic symptoms. So, if you're concerned, seek attention.
We have great diagnostic tests to identify heart disease.
And when identified, great treatments to get you back going again.
Alot of heart diseases now arising as a secondary condition of other problems.
Like sleep apnea and cancer treatment. And so, what's new is
there's increased collaboration between specialists.
Not working in your ?? but working in collaboration.
And people specializing in this. People specializing for example in cardio-oncology.
Cardiologists who know the cardiac consequences of oncological treatment.
Drugs and radiation - look for those, and treat those when they occur.
It's an unfortunate thing. A patient with a cancer gets a drug
they need to treat their cancer, and develop heart disease.
But by working together to identify these patients,
study the new drugs, to do clinical trials and studies.
Know which drugs have higher consequence for heart disease.
And then treat them when they occur, you know, it's important.
So, it's a new field in cardiology, cardio-oncology, as well as other
shared disciplines like pulmonary or sleep medicine in cardiology.
People with sleep apnea have a higher risk for high blood pressure,
heart attack and stroke. And when they get identified and use
their C-pap or other treatments to reduce sleep apnea,
actually the risk goes down. And so, we're seeing this connection
between other problems and heart problems.
And by working together to take care of these patients
with other specialists, we can take best care of the patient.