Heart Disease – Basic Heart Functions

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That’s coming next week because there is a lot to talk about.

What I really want to get out of all this… oh and of course there is drugs. You can have drug-induced cardiac problems, whether alcohol or even some benign other type of drug you may not know about. So my job today is not to have you remember everything I say. It’s to let you know that I have a varied knowledge in cardiac disease, specifically advanced cardiac disease, because that is what I see all day.

And there are ways to improve your quality and lengthen your life, even with advanced disease, and that’s the point. Have quality and good life, and that starts with knowledge of your disease. And that’s why this is Part 1 – basic knowledge of your disease. Some of you will have that answer better today, others maybe not: but that’s the goal. Let’s learn what you have, so you can be proactive and go to your doctor with a set of lists that make you feel comfortable with the plan that is your health.

So, that kind of goes to understanding the diagnoses. So, we are gonna talk a little bit more about hypertension first but I am gonna give you a quick physiology lesson and anatomy lesson; and just, you know, I hope you don’t go to sleep, but I will try to do the best I can with this. I am going to mention words and if you don’t understand them raise your hand but simply put, the heart is a pump. So if you think about a pool pump or a water pump. There is something going into it, and there is something coming out of it. Pretty basic, but that actually has a lot of physics involved.

There are flow rates and resistance. All those things. Well you don’t have to care about that right now, but I think in general, you can get the idea. Let’s say the pump had a filter in it. If that filter was dirty, what’s coming to the pump would have resistance, and you would have back resistance. There would be pressure. So one thing, if that pump has back pressure to what is going into it then it is not that efficient. I’ll mention some diseases that do that type of thing. It’s not a filter per se, but if it’s a weak pump, there is back pressure because it does not pump everything out. There is back pressure.

Similarly, there are problems with resistance at the end of the outflow of that pump. So, if I pinch my fingers on the outflow of the pump, it might want to pump but it hits that resistance and again there is back pressure. One comes after the heart, one comes before the heart, but nonetheless the pump is not efficient.

There are many things that make that pump not efficient. And medicines are very specific to either the pump efficiency, the load coming to the pump or the resistance coming out of the pump. And those are really all your cardiac meds. So it’s important that you understand your med, because if you know it works on the pump before the pump, after the pump or on the pump, you can be aware of the symptoms if it is working or not.

And that’s a big deal. And you don’t need to be a rocket scientist to determine that “Hey, this isn’t working for me”. And that’s another thing I want to instill in you, that’s an open minded skepticism about the medicines you take and the risks you take by changing them, not taking them or adjusting them. You have to have the power to understand your disease.  Very simply, but you all have the capacity to do that. So, we will talk about the pump and the vessels that come to it and from it. 

So how many here, and you do not have to raise your hand, I have to ask this because it would not be a lecture if you did not raise your hand once. Right? Which is kind of ridiculous, but I know all of you know someone with high blood pressure.  Nod your head or raise your hand, but if you or someone you know has high blood pressure, I definitely will raise my hand. I mean obviously we all do. 

That is really one of the biggest issues, because we don’t feel it in general. You can have it for decades and if you have pressure – high blood pressure. Think about that pump. If I have a lot of resistance to that pump, it’s hard to get blood out and the pump has to work harder. You need a bigger, stronger pump. Well, when you lift weights – I run which is why I am skinny – but if I lift weights I may actually look better. I’m sorry I don’t, but I do some. I do yoga, so that’s ok. But if I workout, my muscles get bigger. Well that’s a real problem. That’s a good thing that your muscles get bigger when you exercise, but if you have a lot of resistance to that pump, the heart gets bigger. The heart gets fat. It’s called hypertrophic cardiomyopathy. Big word! Who care! But that’s hypertensive heart disease.

You don’t treat it over years, not like in one week necessarily. Obviously we are talking about a compensation of the pump to pump against big resistance so the muscle has to be big. That sounds like that’s great.  My heart is strong at working out. It’s a big old muscle. Well the problem with a big muscle is that it requires more oxygen. The big muscle requires more blood.  So you end up having a relative ischemic or lack of oxygen heart potentially because it’s a really thick walled heart because it has to squeeze like crazy. So, it gets too big for us to maintain and that’s a problem. And that’s one of the main causes of CHF. And we will talk about that Congestive Heart Failure. We will talk more about that but hypertension, you don’t notice your heart changing like that because your body is compensating. We are meant to live, breathe, run, do all sorts of things and we don’t even notice.

So this ‘silentness’ of heart disease is really where we have power. And I talk about early symptoms and recognizing them.  All of today is about what we don’t know, what we don’t see and what we don’t have with the people we love and that is, you got to determine if you have high blood pressure.

One of the ways you do it is to ask yourself – give a family history. Do you have three or four family members that we have high blood pressure medications on board? Did your Mom or Dad have that?  All of a sudden, they had CHF. I get it all the time. We never had heart problems before and I go in my head… “Well, probably when they were 30 or 40, if they got checked, they probably had hypertensive disease – just nobody told them.”

It is true however, and I do want to say this, hypertension (high blood pressure) if very high from a usual little lower level – you can get symptoms. There are symptoms of profound high blood pressure. Not the subtle one that you miss for years, but a pretty significant (“you better get to your doctor”) is if – even if you have high blood pressure. Well, you wake up one morning and your vision is not quite so good, and it’s a sudden change that could be absolutely nothing. Could be that you notice one day that you are older, like me. And you realize, I need to wear my glasses, even though I refuse to. And that would be great. But still, you don’t always notice these subtleties. So are you seeing better or worse? Is it different than it was six months ago?

Usually, your eyes don’t change in a week. So you’re waking up and it’s a little blurry today. Do you have little bit of a headache and are you tired? Well it really advanced high blood pressure, or high blood pressure that is often undiagnosed or even treated poorly, can have those symptoms and usually it’s quite high if you have those symptoms. It’s not just a little bit high; it’s hypertensive urgency with that. Not emergency, but it is urgent. You probably should get the medication pretty quickly.  But that’s very unlikely. Usually you are walking around feeling normal. You go to the doctor. “Wow! My pressure is high”.

One reading at your doctor isn’t necessarily reason to get a bunch of medicines either. It depends how high it is – you have dialogue with your doctor. You go back and you confirm, and you make sure you pick the right treatment course for yourself. We track, because you could be nervous or you could be sick and then you could be over medicated which isn’t good either. You don’t want to have too low a pressure. It is a nuance and your doctor knows this. So we are just talking about high blood pressure today.

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