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Heart Disease – Blood Pressure

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Dr. Dauwalder: Do you have or know someone with high blood pressure? Get your pressure taken and keep a log of that pressure it’s that simple. And then if it’s a problem talk to your doctor about it and I know it sounds simple, if you have these knew symptoms I discussed go to your doctor and check it again even if you didn’t have those a few months ago. Another thing, so, how many of you have questions briefly about the introduction or what it is to be a Hypertensive Person.

Question: I do have a question about how there are different symptoms in different populations for example over young to older?

Dr. Dauwalder: There are, most of those symptoms are determined by a lot of the …. I guess the elasticity or the resilience of the individual. Healthier younger individuals mask symptoms better sometimes because there strong and they don’t notice, they can walk around with pneumonia for example, they are tougher and so it can be ignored sometimes.

The older population can often times … they have less resilience so they can often crash and burn a little bit more quickly. But hypertensive all by itself it’s usually about the process of changing your heart muscles and your vessels overtime that give you the symptoms. So the symptom is not hypertensive directly it’s usually a cardio myopathy, or heart pump problem because you had so many years of undiagnosed hypertension, that’s more common.

So the symptoms you see are really heart pump problems, they are vascular, there origin was vessel first. So it just depends on your story but yes I think the biggest thing with symptoms is unusual fatigue, now your heart gets oxygen and blood to your body so if your unusually fatigued and you just don’t feel like you are you, you go get your vital signs checked. They are called vital signs for a reason, get them checked.

Older folks …just because we have insufficient vessels sometimes we have swelling of our feet, right? And that can be a relative benign normal situation. It could be very much a significant sign of your pump not doing well and early disease symptoms are functionally and possibly nearly reversible. The disease isn’t reversible the symptoms are and we will talk about that. But a lot of people have problems with high blood pressure that are young. Before we went on this campaign that Cardiac Disease is the number one killer in America and it’s the number one killer in women in a America we use to think it was a men’s disease, it is not. So it is anyone’s disease. It’s very equal opportunity, African Americans have a different risk factor with kidney and blood pressure issues than Caucasians or more than Europeans.

Everybody is different genetically so we have to be sensitive of what drugs we pick, your doctor has to know these things otherwise you may not be in control. So blood pressure is a tricky issue, I want you to be managed well, be diagnosed early, listen to those symptoms but in young folks as I was saying, one of the biggest problems is they take a medicine, their blood pressure is normal and this happens to young folks too.

You know I don’t need it, my pressure is normal. Now it’s normal because you’re taking the medicine and that seems very basic but it’s our natural instinct to think that we have cured things. Cardiac Disease and Vessel Disease is a management disease, it’s like diabetes. If your diabetic, your diabetic period. If you were diagnosed and you met the parameters your diabetic, even if you control your blood sugar and keep the diet along your still diabetic. You have to own it. If you don’t own it and make it apart of your identity you will have a symptom from it.

So denial doesn’t help. So heart disease is very easy to deny until you have functional deficit and functional deficit some of that damage is irreversible. We can manage the symptoms but you have a modified vascular system and very often by the time you are symptomatic. So I have a lot to say, maybe about nothing, but I think it’s about something that’s relevant so you know I really don’t mind your questions at all so if you have a question about specifically CHF or I’m not sure what that means or I have congested heart failure and I take a water pill, why do I take a water pill, what is the risk of a water pill? Great, ask me.

Question – Could you explain what a heart murmur is and if that’s dangerous?

Dr. Dauwalder: Sure, yeah, I mentioned it under physiology of heart problems in a broad sense but that’s the pump and the pump has valves and the valves depending on where you’re at in the heart makes sounds when the blood passes and it opens and closes. And like any valve or gate our heart sounds are the opening and closing, the lub and the dub of the heart sounds.

And each valve has a different location has a different sound and that’s a doctor’s job. But a murmur there are different types if I have a door or a valve that doesn’t close all the way and I have blood flow through it I hear like a door in the wind, there are little whistle sound, it’s not closed well. That can be one type of sound or murmur and the other type could be that the door so it doesn’t close properly. Another could be there a little floppy, it could have different flow control and that’s a murmur, different types of murmurs sound different depending on what valves indicated in the disease.

You have four chambers to your heart, so the bottom part is the ventricle, they get all muscular. That’s the part that’s muscular, the ventricle or the atrium, the top part doesn’t have the thick muscle part that changes with high blood pressure it’s like a balloon. It fills up and then there is valve separating it from the pump part, because through those valves into the pump part it squeezes. So we have four chambers and two sides of the heart and I will draw a picture next time or have one to show you that because it’s very relevant. So valves in general control the flow between those chambers.

Question: So the murmur comes from one of those valves being leaky. So is it treated surgically or is it treated …?

Dr. Dauwalder: That depends. Many people have a benign murmur. It just it’s a sound that is made it doesn’t cause disease. Other people have murmurs that are symptom of disease or sometimes a structural defect congenitally or otherwise and other times you can have a damage to a valve for many reasons. One could be you have a little heart attack and these little muscles that help those valves and one of those little muscles can die. So it doesn’t close well.

If you have long standing high blood pressure and strain to those valves which again controls the strength and flow between chambers, that’s what their job is. So a door that has a little whistle through it can generally and doesn’t really manage to interrupt flow may be benign.

One that is larger that doesn’t allow the squeezing of blood without leaking out the wrong way that could give you a symptom, the blood is going the wrong way. It’s regurgitating and that’s what they call it. Goes the wrong way and in that case we have medicines to help that usually it’s not surgical. But in older folks, we have a valve called the aortic valve which I think most of you heard of it’s one of the outflows to the heart and no one gets calcified real normally and older folks, the more hypertensive you are, the more irritated those vessels get and you can get calcium deposits. Then you will have scoring and calcium scoring to check your vessels for this calcium deposits because it’s a sign of inflammation.

Another test we will talk about next time. So these valves can be replaced. There are many, many elderly folks seventies, eighties sometimes even close to nineties now that get aortic valve replacements because it’s so calcified and is called aortic stenosis. That’s when it doesn’t open up all the way cause the door is rigid with all that calcium deposit. So valves can be rigid, the can be floppy they can be insufficient and they can make a weird sound.

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