So, good afternoon everybody.
My name is Dr. Marvin Kaji.
I'm a cardiologist at the Heart and Vascular Institute.
Um, Dr. Tom Davis was supposed to be here.
Unfortunately, he was pulled away for an emergency.
He's helping a patient right now. He asked me to volunteer.
I was happy to volunteer. Aww, that was nice of you.
You great. So, we're all here together
to talk about coronary art disease.
So coronary art disease at its most basic fundamental level
is narrowing or blockage of heart arteries,
limiting blood flow to the heart, muscle itself.
And one blood flow is limited to the heart.
Muscle symptoms will manifest.
And we'll talk about these symptoms.
So, what is heart disease in the us?
Heart disease is leading cause of death for women, men,
and people of most racial
and ethnic groups in the US and worldwide.
One person dies every 34 seconds
from cardiovascular disease.
Wow. In 2023,
approximately 900,000 people died
from cardiovascular disease.
That's equivalent to one every three deaths caused
by coronary artery disease.
So, uh, uh, heart disease has economic, uh, burden as well.
Approximately $400 billion were lost
because of, uh, the, uh, problems that were caused
by coronary disease in terms of healthcare providers,
medication had to be given
and loss of work days by the patient.
So how is, uh, coronary art disease distributed in the us?
So our Southern France are,
have high prevalence of coronary disease,
as you can imagine, from the fried foods.
But Michigan is right up here.
We're not that, uh, we're not that, uh, uh, blank as well.
So we're pretty close to our Southern France. Pretty red.
Yeah. So when we talk about coronary art disease,
there are modifiable risk factors
and non-modifiable risk factors.
So non-modifiable risk factors are things that we are born
with, things we cannot change, things we have to deal with.
So what are certain non-modifiable risk
factors for coronary art?
Disease? Number one, age.
No matter what we do, we all get older. Older.
And as we get older, uh, inherently our risk
for coronary art disease increases.
What another modified non-modified risk factor.
Another non-modifiable risk factor is gender.
Males are traditionally at higher risk than females. Yeah.
And the risk of a female developing, uh,
heart disease increases after the age about 50 to 55.
This is the, happens
after a woman goes through menopause at a stop.
That estrogen that is relatively prevalent in a woman's
early age, early half of life,
is provide some protective factors
to the heart once they go through menopause.
Estrogen level declines
and risk factors for coronary disease
increases certain risks.
Certain races are increased risk for coronary disease.
For example, people who are middle Eastern descent tend
to have high cholesterol in their blood
and high cholesterol can accumulate
and heart arteries, which predisposes to blockage formation.
Also, family history.
No matter what we, what we, uh, try to do,
we cannot change the family we were born into.
So if you have a mom, dad, siblings
who have early onset heart disease,
early onset heart attack, that that, that's something
that puts you as an individual at higher risk
than the average person.
So these are the things that we cannot modify.
We, we we're basically destined with this.
So what now let's talk about things
that we can do something about.
Number one, type two diabetes or type one diabetes.
High blood sugar, uh, causes inflammation
in the heart arteries,
and that increases risk of developing blockages.
So, and it's absolutely, absolutely, absolutely important
to control your blood sugar.
Number two, high blood pressure. Everybody.
When you go to your doctor, ask them,
what is my blood pressure reading today?
Ideally, your blood pressure target should be under
one 30 over 80.
That is your goal. You need to memorize that number
and ask your doctor, is my blood pressure
under one 30 over 80?
Number three, smoking, absolutely.
Number one modifiable risk factor I talk about
with my patients is, you have to quit smoking
one cigarette a day or one cigarette a month.
Even one cigarette a year is not good for you.
Again, this increases inflammation in the heart arteries,
and, uh, leads to blockage, disformation in the heart,
arteries, hyperlipidemia, or high cholesterol.
Um, fatty foods increases risk
for cholesterol buildup in the, uh, in the heart arteries.
Chronic kidney disease.
For example, if you or you have friends
or family who are on dialysis, uh, dialysis, uh,
puts excessive strain onto the heart,
excessive strain on your blood vessels, that, again,
causes inflammation
and leads to blockages forming in the heart.
There, there are some seats in the back. Take your time.
You wanna sit here? Close eye? Uh, no. Okay.
Up to you. Thank
You.
And another risk factor is obesity.
Uh, we have, uh, people who have, uh, increased body weight,
body mass, uh, especially central adiposity, uh,
increases risk for development of heart disease.
More and more research has shown that fat,
fat in the belly is not just an, uh, a dormant organ.
It's an active metabolic organ.
Fat secretes, uh, uh, enzymes secretes hormones that dispose
to inflammation, predisposed
to blockages forming of the heart.
So how does, uh, blockage, how do blockages
and the heart arteries come about?
So, we talked about certain causes.
For example, high fatty diet, ary risk factors,
high blood sugar, high, uh, uh, cholesterol, high,
high blood, uh, high blood pressure.
That is the substrate on which, uh,
coronary artery disease will build itself.
Then, uh, cholesterol will form
and, uh, cholesterol will form on the
walls of the blood vessels.
The, the cholesterol will form manifest
as something called a fatty streak.
Then once the fatty, once the, basically it's a line
of fat along the blood vessel wall.
The, the, the blood, the blood, blood cells
in the blood will recognize the abnormal fat on the
cholesterol or of the cholesterol,
and that will cause inflammation, uh, leads
to more white blood cell coming into the blood vessel wall
and formation of a plaque.
And I'll show you what a plaque looks like.
And eventually, more and more plaque will build up
and lead to a blockage, partial blockage
or complete blockage within the heart artery itself.
Yeah. So we talked about how, what the risk factors are for,
uh, of, of blockages.
And we talked about how blockages form.
Now let's talk about what are the symptoms
of somebody having a blockage or coronary heart disease?
By far, the most common cause
cals are the most common symptom of,
of coronary art disease is angina,
chest pain or chest discomfort.
This is classically manifest, uh,
when you do heavy exertional activities, for example, uh,
uh, when you try to clean your house, do household chores
try to mow the lawn, try to shovel the snow.
People typically manifest
of chest discomfort when they do these, uh,
exertional activities.
Then when they stop, the chest discomfort goes away.
Uh, unfortunately for, uh, for some people,
the first manifestation of, uh,
blockage in a heart artery is a heart attack.
Symptoms of a heart attack is something very important
that we all have to recognize.
This can be, uh, chest pain, chest discomfort, symptoms
of weakness, lightheadedness, nausea, feeling sick
to the stomach, uh, feeling cold, sweat clammy,
just feeling unwell.
And sometimes it associated with symptoms of going
through the arms or to the shoulder or to the jaw.
Uh, these are all symptoms of heart attack.
We should all be able, able to learn and recognize.
Now, there are other symptoms, um, especially in females.
They tend to have atypical symptoms of a heart attack.
The sym, when you think of somebody who has a heart attack,
classically, you think of patient who has chest pain,
feels sweaty climbing, uh, the chest, chest pain goes
to the, uh, left shoulder, left, uh, sorry to to the jaw.
This is the symptom typically manifests in males.
Females tend to be more complex.
Perhaps the wiring is a little bit different than, uh,
than their male counterparts.
Women tend can tend to have symptoms of fatigue, um,
shortness of breath, um, nausea, not, not,
not many people will, will think of it as, Hey,
this woman is having a heart attack.
So especially with our female friends, we have to be,
we have to have a hyphen awareness when they have these
atypical symptoms.
So let's say you have any
of those symptoms that I talked about.
You decide to go to a cardiologist.
What are you, what is the cardiologist going to do with you?
What is he or she going to talk to you about?
So, with every cardiologist visit,
with every doctor's visit, everything starts with history,
uh, and physical exam.
Well, for the history, we're going to talk, uh, talk
to you about what symptoms you're having.
We'll discuss your past medical history, uh,
past surgical history, family history,
what medications you're taking, uh,
what you're doing right now for employment, what you used
to do, uh, why are you currently smoking,
are using alcohol and you use of drugs.
These are all factors that affect how the heart functions
and how the heart will behave.
Uh, we will measure your blood pressure, obviously, uh,
measure your, uh, heart rate, we'll examine your chest,
listen to the any abnormal heart sounds.
Listen to your lungs.
If you have, if you have congestive heart failure,
fluid can back up into the lungs, can cause crackles.
We can hear that when we use our stethoscope.
And sometimes when you have congestive heart failure,
after fluid backs up into the lungs, gravity takes the fluid
to under the lights, and we can see
leg swelling after physical exam.
So we, we do have our, uh, history.
We do our physical exam,
and then we go through our checklist.
My colleagues and I, we go through
a checklist when we all see a patient, uh,
we talk about controlling cholesterol.
If you have a history of a heart attack, if you have history
of a blockage, history of stent, history of,
of open heart surgery that acquired bypasses,
it is absolutely, absolutely necessary for you
to have your cholesterol under control.
Uh, we, we do blood testing on people every year
to make sure they have a target cholesterol.
Uh, some guidelines suggest less than
70 milligrams per deciliter.
Our European counterparts are very
aggressive, which is a good thing.
They take the cholesterol down even lower
to 55 milligrams per deciliter.
We manage your blood pressure.
We'll take a look at your blood pressure, uh, in our office.
We'll look at your blood pressure medications,
and this is the the number I ask you guys to memorize.
When you go to your doctor's office, ask them,
what's my blood pressure today?
If you are a diabetic, uh,
blood sugar control is your number one goal every
single day of your life.
If you're a diabetic, absolutely, uh,
controlling your blood sugar should be your number one
goal every single day.
Uh, how so Hemoglobin a A1C, do we all know
what hemoglobin A1C is?
Yes. Yes. So for the people that don't,
may not know hemoglobin A1C, it represents an average, uh,
blood sugar measurement over the, uh, past three months.
So your goal is to get your hemoglobin A1C less than 7%.
Uh, I've seen people with hemoglobin a one Cs
of 8, 9, 10, 14.
That's bad. That's bad news.
Uh, high blood sugar, uh,
affects not only the heart affects the
kidneys, affects the brain.
So absolutely have
to get your blood sugar under well control.
We talked about diets.
So typically from a cardiology standpoint, ideally
we would recommend to everybody to be on a plant-based diet.
No meats, ideally. Why is that?
Because meats tend to have a lot
of inflammatory molecules at increased risk of heart attack,
stroke, and even some cancers.
But I know we live in America, we live in the 21st century.
Everybody wants to eat meat.
So if you have to eat a meat,
we typically recommend eating white meat.
So for example, like chicken, Turkey, tuna, uh, fish.
That's good. Try to stay away from red meats, for example,
pork or beef.
Those, those meats have a lot of inflammatory molecules.
And again, resource for heart, heart attack, heart disease,
stroke, all bad stuff.
Physical activity is the next point We talk about.
Uh, try to try to do 30 minutes
of physical activity every day if you can.
I'm not asking you to go out there
and run a marathon, that's not the goal.
Try to do some walking, even light walking every single day,
uh, uh, gets the heart pumping, gets the buffalo moving.
And physical activity is actually the best medicine
that we can prescribe as doctors.
Physical activity is better as as, uh, the diet, uh,
physical activity and weight loss is best medicine
that a doctor can prescribe it.
It's better, it's better than the blood
pressure medication that we give you guys.
Absolutely. And ob obviously, if you're a smoker,
we gonna talk to you about, uh, reducing, uh, smoking.
So after we check our risk, fa
after we do our checklist with you,
we check out your ch risk factors, then we can go
through our coronary art disease evaluation.
So when you come to a cardiologist, what may, what's uh, uh,
do you think a cardiologist will do
to evaluate your symptoms?
Number one, we typically start out with an EKG.
So this is a, a basically a, a, a process
where they put stickers onto the chest
and they do an EKA heart tracing to see, uh,
what the al rhythm is.
If you have abnormalities in your heart
conduction, we can see that.
And coronary artery disease can cause
abnormalities on the EKG.
Another thing we may do is look at a chest x-ray.
For example, if you look on, uh, the left side
of the screen, this is a, a x-ray
of a normal individual look.
Notice how, uh, small the heart is.
Now look at the other side.
This is a chest x-ray of a sick individual.
Notice how big the heart is.
So these are all things that can help us evaluate, uh,
patient having heart disease.
Another thing we may do is something
called an echocardiogram.
So for example, this is a, uh, a process
where we use an ultrasound probe.
We put on the patient's chest, or we put gel on
and we take pictures of the heart.
This will help us evaluate the heart function,
heart valves, uh, the heart muscle.
And if there is anything abnormal
with the heart function, we can detect it there.
Now, if you have symptom, if you have symptoms
of chest pain, chest discomfort, shortness of breath,
we may like to do something called a stress test.
A stress test is, uh, something to try to provoke, uh,
your symptoms of chest discomfort under, uh,
medical observation conditions.
So we'll connect you to monitors
where we'll measure your, uh, blood pressure.
We'll connect you to, uh, monitors to measure your,
your heart rate through continuously.
Uh, sometimes we do the stress test under a treadmill
where we ask the patient to run, uh, uh, at a,
a certain intervals at certain speeds,
and we'll, we will, uh, collect their heart tracing.
Sometimes if patients cannot run, they, we can subject them
to a chemical stress test.
We give them an injection through the iv,
and that can, that can help mimic,
uh, exercise of the heart.
And if there's anything abnormal caught, uh, on the, uh,
stress test, that will prompt further evaluation.
So you may wonder what further evaluation could that be?
So one evaluation could be a,
a coronary angiogram.
So I, I wanna direct your attention
to this picture over here.
So this is a picture of the right coronary artery.
So if, if you look over here where the red arrow is, uh,
this is a cholesterol, this is a blockage that this,
this person has chest pain because of this blockage.
Now, a heart catheterization is a minimally invasive
procedure where we use a catheter
to go either from the wrist artery or the groin artery.
We would take the catheter all the way to the heart artery,
and we die to see if there are any blockages.
And in this case, in this, uh, individual,
we were able to find the blockage.
So let's say we take the individual to the cath lab, we, uh,
uh, shoot the angiogram.
We, we take pictures, we find a blockage.
What do we do with that? So
after we find the blockage,
there are certain things that can happen.
Number one, we can fix the blockage right then and there.
For example, if I direct you a picture to this cartoon,
the imagine this yellow area as the, as the blockage.
We can try to fix it using stenting method.
Well, so by stenting it, well, we, in order
to stent the blockage, we pass a wire across the blockage,
then we take a balloon to try to open up the blockage.
And then afterwards we deploy a stent
to hopefully keep the blockage open as long as possible.
And this is what happened with this patient.
For example, remember I showed you the cholesterol buildup
and this patient's right coronary artery.
This, this patient's blockage was opened up
and a stent was put in.
So this happens typically,
if your blockage is relatively simple,
relatively straightforward,
if we can fix it using catheters, balloons, and stents.
If your blockage is quite complex, then uh, we have
to discuss other options.
Other options include open heart surgery, bypass surgery.
For example, if I direct your attention here,
you can notice this patient had a blockage here
and another blockage here.
Sometimes patients may be better served
with open heart surgery.
I a stenting. So we send it to open heart surgery.
And this is where the bypass graft was created here
to bypass this blockage in the, uh, right coronary artery.
And another bypass was created here
to bypass the blockage in the left
anterior descending artery.
So even though we may fix a blockage using stenting,
using open heart surgery, that's fine,
but the journey doesn't stop there.
A lot of my patients tell me, uh, doc, you fix me.
I feel great. Uh, do I still have to take my medications?
Do I still have to control my blood sugar?
Do, can I, can I go back to smoking?
And absolutely, absolutely, you have to control your,
me control your blood sugar, uh, blood, uh,
blood pressure, cholesterol.
The jury doesn't stop after we fix you up.
'cause even though we put a stent in there or,
or we, uh, put bypasses there, how good, how,
how well the stent lasts,
how well the bypasses last all depends on you, the patient.
It's basically when you buy a car,
how well do you maintain it?
Do you, do you change the oil regularly?
Do you change the air filter? Do you change the tires?
So, uh, you have to maintain an eye on your blood pressure,
blood sugar, uh, cholesterol.
Make sure you continue exercise.
Stay away from the smoking, maintain your activity
because this is absolutely paramount.
Um, and that's all I have. Do you guys have any questions?
Thank you.