Your heart and you

East Carolina Heart Institute aids in the recognition and care of hearts, lungs and blood vessels

Cardiac patient Leonardo Perez's heart is monitored Monday March 31, 2014 at University Hospital after an implant device was placed inside his body. Perez is the first University Health Care patient to receive a new implant device made by Boston Scientific called a subcutaneous internal cadioverter-defibrillator. (AP Photo/San Antonio Express-News, John Davenport)

GREENVILLE  — Your heart. You probably don’t think about it as often as you should. You’ve had a long day, you are tired and so you skip that 20-minute walk around the neighborhood. You have a craving for a cheeseburger and French fries, and know how easy it is to swing through the drive thru. You’ve smoked for 20 years and think it’s too late to quit now.

You probably aren’t thinking about what those things do to your heart, but your heart is continuing to think about you. Your heart continues to beat on, faithfully pumping blood through your body.


Understanding the Heart

When people think of care to the heart, they often think of heart attacks, or the blockage in the coronary artery that threatens to do damage to the heart muscle, or heart failure, which is essentially the failure of the heart to pump blood adequately around the body. There’s more to it than just that. Many diseases in cardiology are systemic, which means that it is not only unique to the heart.

“If you develop fluid around your heart, it does not mean it’s due to a cardiac problem. The manifestation was cardiac because you got fluid around your heart. Why that fluid got there was due to some other reason, such as rheumatoid arthritis or lupus. A lot of these diseases are intertwined with a lot of cardiac manifestations,” said Dr. Adeel M. Siddiqui, cardiovascular disease fellow at East Carolina University’s Brody School of Medicine.

Troponin, an enzyme in the heart, is only released when a cell dies. Bloodwork allows cardiologists such as Siddiqui to see the levels of troponin in your blood. If the levels are high, then death to the heart cells have occurred and have therefore damaged the heart.

“Once that has been determined, we must discover if it was a blockage that led to lack of blood flow which lead to a heart attack, meaning the cells died and then enzymes were released,” said Siddiqui.

You are having chest pains, but you’re not sure why. If you go visit your doctor, here’s what happens.

“We’ll do a stress test, and if we determine, non-invasively — through cameras and radioactive material — there are parts of the heart not getting good blood supply, we know there is likely a blockage that is causing the heart muscle to not get good blood flow,” said Siddiqui.

“These patients don’t necessarily have heart attacks, they have areas in their heart that are not getting good blood flow and that’s why they are getting chest pain when they exercise or exert themselves.”

Is there a blockage leading to this? Meaning, do the vessels supplying blood to the heart have any blockages?

This is where a person may have a cardiac catherization, which is the gold standard to looking at blood flow to the heart. If a blockage is discovered, a stint may be put in to open it. However, the most important thing to remember is, “the key to cardiology is prevention,” said Siddiqui.

Knowing the Risk Factors

Heart disease is the leading cause of death in America. Smoking, diabetes, hypertension, obesity, and abnormal cholesterol levels are all leading factors causing cardiovascular disease.

“Cardiovascular disease is a hundred diseases, not just one. People think of heart diseases and think of atherosclerosis or the narrowing or hardening of the arteries. Every organ has its own blood supply, and the arteries leading to that organ can become narrow by cholesterol buildup which can eventually lead most devastatingly to heart attacks and strokes,” said Dr. Blase Carabello, professor and chief, Division of Cardiology.

Obesity is a growing epidemic making the effects of becoming overweight a major risk factor for developing diabetes.

“The American Heart Association no longer considers diabetes a risk factor for heart disease. It is heart disease. If you have diabetes, then you should assume you have some form of heart disease or atherosclerosis. You might not, but we start off assuming you already have it. The most important way of preventing diabetes is to not gain weight,” said Carabello.

Along with weight gain comes sleep apnea which brings its own set of negative factors to the heart. High blood pressure adds its own set of problems.

“The American public becomes hypertensive at the rate of one percent per year of life. By the time you are 75 years old, 75 percent of Americans have high blood pressure,” said Carabello. “The average patient can’t know if they have high blood pressure as its de-symptomatic unless something happens. A patient can’t know if cholesterol levels are elevated without it being measured.”

But patients can know if they are smoking, exercising, or gaining weight. All are choices he or she makes. If you’re a homemaker and sweep the floor regularly, but most recently have become out of breath during the task; if you have unexplained pain or pressure in the chest; or if you have the inability to lie down flat in bed at night without coughing or feeling smothered.

“By the time those things have happened,” said Carabello, “you may already have heart disease.”

“People do what they do. If you’ve grown up in an environment where everybody you know smokes, you are probably more likely to smoke. If you’ve grown up in an environment where nobody exercises, you are likely to not exercise yourself. We learn our behaviors from the people around us,” said Carabello.

“A lot of this is lifestyle and genes. You can’t change your parents, you’re stuck with that. Maybe 50 years from now, if we have this conversation, we might be able to alter genes. For now, you can only alter the things you can alter,” he added, “If you are the patient, the best thing is preventative medicine and preventative medicine actually works. The most important thing a patient can do for him or herself is to try to prevent heart attacks and strokes.”

Compiling the treatment options

The East Carolina Heart Institute is a partnership between the East Carolina University’s Brody School of Medicine and Vidant Health Systems. Through this partnership, the Institute is the first in North Carolina devoted to the education, research, treatment and prevention of cardiovascular diseases.

“Cardiovascular disease also has an impact on lung cancer, esophageal disease, even something as simple as reflux disease to hiatal hernia, all of those things are benign diseases that affect quality of life and can set people in the doctor’s office or worse care in the emergency room. The reason why it feeds into cardiovascular health is that many of the behaviors and habits that contribute to the benign diseases or lung cancer are also risk factors for cardiovascular health,” said Dr. Aundrea L. Oliver, assistant professor, Division of Thoracic and Foregut Surgery.

“Every person is a unique design. Our goal is to make you the best you that you were designed to be,” said Oliver. “Medicine is becoming more tailored to the individual.”

The Institute offers an array of therapies for heart diseases from the implementation of pace makers and defibrillators, to advance care of heart failure and coronary disease, to imaging techniques and more. The Institute trains physicians from across the globe to perform robotic cardiac and mitral valve repair procedures.

“In our region, a better name for this Institute would have been the heart, lung and blood vessel institute, and that way people would understand that when you come here, you can be diagnosed and treated for all three phases of the disease,” said Dr. Steven Powell, professor and chief, Division of Vascular Surgery.

Your heart, lungs and blood vessels need you. They need you to know the risk factors for cardiovascular disease. They need you to take the walk, forgo the cheeseburger and neglect the cigarette.