13: The Cardiology Connection, Part 1

In Vital Visions' first cardiology episode, the Vedalas speak to Norman Regional’s Archana Gautam, MD. As an interventional cardiologist, Dr. Gautam’s years of experience and accomplishments are evident in this episode. She talks to the brothers about cholesterol, statin medications, coronary calcium scans, AFib, WATCHMAN devices, SGLT2 inhibitors and GLP 1 medications. This episode is full of useful information that our listeners  of all ages should absolutely hear!

Guest Bio:
Archana Gautam, MD, is board certified in Cardiovascular Disease, Internal Medicine, Echocardiography, and Nuclear Cardiology. She is an interventional cardiologist who completed her residency at the University of Texas Southwestern Medical School and her fellowship at the University of Oklahoma Health Sciences Center. Dr. Gautam was also an assistant cardiology professor in academic medicine at OUHSC. She has conducted numerous research studies and been published multiple times.
Dr. Gautam's special interests include coronary artery stent, peripheral artery angioplasty and stent, carotid angioplasty and stent, atrial septal defect repair, patent foramen ovale closure and varicose vein treatment.

Links:
Archana Gautam, MD
Heart Care at Norman Regional
Heart Plaza location page
Norman Heart & Vascular Associates, Heart Plaza
Norman Heart & Vascular Associates, Heart Plaza (Cardiovascular Surgery)
Blog - Patient Living With Less Worry, Medication After WATCHMAN Procedure

This podcast is for educational purposes only. The information in this show is not to be used as medical advice. If you are needing medical care, please consult with your physician.

Norman Regional is hiring! See all our open opportunities here: https://careers.normanregional.com/careers-home/

Transcript

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Welcome, friends.

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Dr. Veer Vedala here.

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And I'm Dr.

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Krishna Vedala, and.

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We are. The Vedala Bro's.

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Welcome to season
two of our podcast, Vital Visions,

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where we delve into all things
vital, empowering our community.

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One health topic at a time. Absolutely.

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And to our returning listeners,
it's fantastic to have you back

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and to our new listeners.

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Buckle up, because in this podcast
we explore emerging medical research,

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the latest in technology

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and crucial health care topics
that resonate with our community here

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at Norman Regional.

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Plus, we also sprinkle in some health
and wellness tips for good measure.

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That's the spirit.

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In each episode,
we're also joined by incredible guests,

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from medical professionals
to local community leaders

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and even some of our friendly neighbors.

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Together, we tackle various issues
affecting our community.

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So whether you're a health enthusiast
or just looking to stay informed

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about healthy living trends,
consider this podcast to

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be your ultimate go to resource.

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So join us as we navigate the journey
to healthier lives

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and explore
the latest trends in wellbeing.

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Welcome to Vital Visions
Where Health meets Community.

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Welcome back, my friends. Dr.

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Veer Vedala again
here, joined by my co-host.

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Dr. Krishna Vedala.

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And we are the Vedala Brothers.

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thank you again for joining us for yet

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another episode of Vital Visions,
where we discuss all things vital.

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COVID-19 brought about revolutionary change,

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introducing most people
to their first pandemic in their lifetime.

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It had significant global impacts

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on health, economics
and even social and behavioral changes.

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In 2021, the number of COVID 19

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deaths reached 415,000,

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making it the third leading cause of death
in the United States.

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Naturally, everyone knew about it.

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It was all over media and politics.

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However, there were two other leading
causes of death that topped it.

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Can you guess what they were?

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Cardiovascular disease.

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And cancer.

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You're absolutely right.

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In 2021, the death rate from heart disease
was 693,000 people,

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costing about 219 billion health
care dollars.

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Despite all of its impacts,
most people did not know

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that heart disease
was the number one cause of death.

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In fact, the survey done in Cleveland

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Clinic in 2019
showed that the majority of Americans

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thought they didn't even know, and 68% did
not know there was a leading cause.

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And in millennials, that number reached up
to 80%, and only 88% of Americans

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knew that heart disease had modifiable
or controllable risk factors.

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So to educate ourselves,
our peers in our community,

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and to discuss all things

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heart related, we have our cardiologist
extraordinaire, Dr.

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Archana Gautam I go with him here.

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Dr. Gautam,
thank you so much for being here.

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Well,
thank you for having me in this episode.

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I'm excited to give or educate 
everyone about the cardiovascular disease.

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As we heard that it is a number one
cause of death.

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Actually all over the world.

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Cardiovascular disease
tops over the years, many years.

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And a cancer is coming close to it.

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But overall mortality or the death from
the cardiovascular disease has gone down.

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So that's the good news.

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And now we know much more about

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the factors
that causes the cardiovascular disease

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as we as opposed to 20 years ago,
what we knew.

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Right. Well,
thank you again for being here.

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And, Krishna,
do you want to introduce our guest too?

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Yes. So for everybody here today, Dr.

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Archana Gautam, we've known her
for a long time, even when we were kids.

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And now that we're finally getting

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a chance to work with her,
it's incredible seeing how committed

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and how dedicated
she is to the field of cardiology.

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And we're amazed every day
at what keeps her going.

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And Dr.

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Gautam is very, very busy.

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She's had a very hectic schedule,
but she made time for us today.

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And so thank you so much, Dr. Gautam.
Really appreciate you being here.

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We really do.

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Thank you. Well,
thank you for giving me opportunity.

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I think as primary care docs,
we have so many questions.

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So... A lot. 

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You want to start off Krishna? 

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Sure, the first question
that we wanted to ask you

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today is
what got you interested in cardiology?

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Well, actually, my interest in cardiology
started early in medical school.

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I had family members who had early onset
of heart disease back home in India.

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So I already had an interest in learning
about cardiovascular disease.

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And when I was in medical school
and my cardiology rotation,

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I noted that how cardiologist can make
a profound difference in [the] patient's life

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and not only in patient's life, but also
among family members by educating them.

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So when life threatening emergencies
happens, that's the perfect time

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to educate the patient
and the family members.

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So that profound effect
that I saw among family members

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really motivated me
to pursue my career as a cardiologist.

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And also
when we treat cardiovascular disease

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and patient comes with life
threatening emergencies

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and making them feel better right away.

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In the next few minutes
after doing a procedure

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and walking along with them
for many years to come,

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that gives us satisfaction
and it keeps you motivated

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and also makes you feel understanding that

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practicing medicine is a privilege.

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Yeah. Wow.

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Wow. That's.

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That's, That's amazing.

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And that's a,
thank you for sharing that with us. Sure. 

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Indeed, it is a it is a privilege.

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and so I think,

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some people,

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for us in medicine,
there's, there's something that

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deeply personal that motivates

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us to get into medicine and,

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and to keep going in medicine.

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And to keep going.

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That's right.

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I think medicine is a field
you have to have a calling for. Yes.

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Otherwise you cannot do this.

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Yeah, well, I think just moving along,
I think, you know, we'll take

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a little bit of breaks and we'll ask non
cardiology related questions too.

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But but, you know, like I said earlier,
we have we have a ton of questions,

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something that in primary care
we run into a lot is management of,

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of you know, dyslipidemia, you know,
hypertriglyceridemia and stuff and,

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and a lot of patients out
there are initially hesitant

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when it comes to statins
and we were wondering what your thoughts

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on statin therapy is
and if you could explain

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to our, our patients
like why it's indicated and

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and why actually it's beneficial
in reducing cardiovascular risk.

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I agree,

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statin therapy is one of the challenge
that we come across over primary care.

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And as a cardiologist,
there is a lot of myth about statins

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because someone had the side effect

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from that medicine and they think that
that side effect will happen to them.

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Also, as we know, this is actually

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one of the most studied drugs that we have

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and has proven that it decreases the death
from cardiovascular disease.

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And there are not very many things
that can decrease the

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that and cardiovascular disease,
but instead it's all one of those,

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they decrease overall risk of having

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heart attack,

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stroke or death about 20% or so.

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Yet people think that this is just
a cholesterol lowering medication.

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This is not just a cholesterol
lowering medication, what we call it,

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nootropic effect.

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That means it's not only just to lower
the cholesterol number,

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but to reduce the event rate of heart
attack and stroke.

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And the way this works,
I usually explain to my patients,

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just imagine that you have a pipeline
and pipeline has mud in there.

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So whether that mud, mud lining is
a smooth surface is lumpy, bumpy.

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So if it's a smooth and water is flowing
or the blood is flowing through

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that it's not
going to break any particles.

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But if it's a lumpy bumpy,
then it's going to break the particles

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and it will go down a stream.

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And that's how the heart.

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attack and stroke happens.

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And a lot of times I hear that,

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"oh my cholesterol is normal, so I don't need
to take cholesterol medications."

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Well this is not just the number game
and cholesterol,

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how low we want to go in the cholesterol,
it depends

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what kind of conditions they are in,
what are the other diseases they have.

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So a lot of time patients
or they think that I looked at my lab

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and my cholesterol number is within normal
limit and I don't need to take it.

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but that's not true.

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Everybody has a different threshold.

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So if someone's cholesterol is normal
and they have already had a heart attack,

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that means that even low number
of cholesterol is not good for them.

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So let your doctor decide.

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And then not just to believe that
my friend or my mom or dad, brother,

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sister had decided effect and you're going
to have it really major or

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that the
side effect that we are worried about

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those risks are really less than 1% or so
and all those side

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effect or adverse effect even that happen
you can start the medicine

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and they'll go away.
So they are not permanent.

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There are a lot of fear about memory
that it changes.

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The memory it has been is studied
and thousands of patients.

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Now that it does not decrease
your memory level,

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it does not cause permanent muscle damage,
just a little bit of muscle ache.

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And you should make every effort
to take the medication.

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If it's higher doses not working,
try to take a smaller dose.

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If a smaller dose is not working,
try to take even every other day.

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So there are a lot of ways if
if one is studying in work, you can try.

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There are four or five different settings
you can try to go there.

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But I think we everyone
should make an effort to be on a statin,

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especially if you are diabetic

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or you already had a stroke,
you already had a heart disease

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or you have already high
calcium in your heart.

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And then those are the people will really
benefit from be digging is statin.

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So yes, it is one of the drugs
that we spend most of the time.

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Yeah.

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Talking guided
and you actually mentioned this

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just in just now, the high calcium
already have had calcium.

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You are you talking about the corinary
calcium scans and.

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That's right. Okay.

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Yeah.
Could you talk to us more about that?

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Because, you know, I think we're we're
trying to use that more in primary care

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now, especially, you know, we we order
our lipid panel, we do our CVD risk score.

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It comes up a little elevated
past that 7.5%, sometimes 10%.

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But our patients are hesitant
for the statin.

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And so now we are encouraging those
calcium scans because in Norman it's $50.

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Yeah, it's $50.

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And so
and that plus the lung cancer screening.

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Yeah. The CT scan too.

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So very affordable rates
And so Yeah, please, if you can, Dr.

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Gautham, please emphasize a little more
on the coronary calcium scans for us.

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Yeah, I'll be happy to talk about calcium
scan.

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Actually, this is really a very important

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step forward as far as early diagnosing
coronary artery disease.

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It has helped us quite a bit, 
making a risk stratification

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or you know like educating patients
that what it means.

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So if someone let's say
that has a cholesterol mildly elevated

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and we are trying to tell them
that you need to take

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your cholesterol medication and
you don't want to take it, that's fine.

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I think we have now another tool
in the box by taking a calcium scan.

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So if you have a positive calcium scan,
even if it's number is one, zero is normal.

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So even if it's one, it's telling you
that there is a process

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of cholesterol deposition

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that has started years ago
and it started to turn into calcium.

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So that's eye opening that once
you have a calcium

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that is telling you that
you have already cholesterol deposited.

225
00:11:57,700 --> 00:11:59,899
So who should take the calcium scan?

226
00:11:59,899 --> 00:12:03,666
Usually it's recommended to anyone

227
00:12:03,766 --> 00:12:08,265
from 40 years of age to 70 years of age
should get the calcium scan done.

228
00:12:08,332 --> 00:12:11,098
And if they have additional risk factors

229
00:12:11,098 --> 00:12:13,098
like if they have a history of smoking,

230
00:12:13,098 --> 00:12:17,530
if they have a family history
of heart disease, or they are obese

231
00:12:17,530 --> 00:12:20,897
or a history of smoking, alcohol intake
and things like that.

232
00:12:20,897 --> 00:12:23,929
So if there is any risk factor
and anyone is more than 40 years

233
00:12:23,929 --> 00:12:29,329
old, should get a scan, heart
scan done. It's very little radiation

234
00:12:29,395 --> 00:12:33,828
and it could be beneficial in preventing

235
00:12:33,828 --> 00:12:37,894
a future heart attack or diagnosing severe
coronary artery disease.

236
00:12:37,994 --> 00:12:38,494
Okay.

237
00:12:38,494 --> 00:12:40,927
I've just already learned so much
from this one.

238
00:12:40,927 --> 00:12:43,293
Just this one concept for you,
because can I ask you,

239
00:12:43,293 --> 00:12:45,093
do you mind if I ask you further
follow up questions?

240
00:12:45,093 --> 00:12:48,893
So basically, you're telling us before
we had to think like O zero 100,

241
00:12:48,959 --> 00:12:50,359
it's not a big deal, right?

242
00:12:50,359 --> 00:12:51,359
But now you're saying

243
00:12:51,359 --> 00:12:55,192
even one gives you data saying that, hey,
there is some calcium buildup.

244
00:12:55,258 --> 00:12:58,091
And so just for our listeners,
so could you explain a little bit more

245
00:12:58,091 --> 00:13:01,757
about that scoring
what it is like above 100, above 300?

246
00:13:01,757 --> 00:13:05,057
And then I've seen people come back
and tell me was 3000.

247
00:13:05,124 --> 00:13:06,024
Sure.

248
00:13:06,024 --> 00:13:08,790
So when we say that you have a calcium

249
00:13:08,790 --> 00:13:12,056
zero to 100 is considered low risk,
but it's all relative.

250
00:13:12,056 --> 00:13:15,989
So once you have a calcium
of even one or two,

251
00:13:16,089 --> 00:13:19,055
you already have at least 1 to 2 times

252
00:13:19,055 --> 00:13:22,055
higher risk than the normal person
who didn't have a score.

253
00:13:22,188 --> 00:13:24,788
That makes sense.
The score of zero, right?

254
00:13:24,788 --> 00:13:26,321
So once you have more than three

255
00:13:26,321 --> 00:13:29,987
or 400, especially 400,
then it's considered high risk.

256
00:13:30,054 --> 00:13:33,986
So high risk
then if your primary care physician

257
00:13:33,986 --> 00:13:36,186
or cardiologist can make a decision
whether you need

258
00:13:36,186 --> 00:13:39,519
to have a further investigation,
like doing a stress test or not,

259
00:13:39,619 --> 00:13:42,618
depending on their symptoms
and other risk factors.

260
00:13:42,618 --> 00:13:48,018
So once you have above zero, yes,
and especially if it's above 100, then

261
00:13:48,084 --> 00:13:52,184
these are the patients
who can get benefit from aspirin therapy.

262
00:13:52,184 --> 00:13:56,783
Also, because their risk of heart disease
is higher than usual because nowadays

263
00:13:56,783 --> 00:13:58,583
we don't recommend the aspirin
for everyone.

264
00:13:58,583 --> 00:13:59,816
Primary prevention. Right.

265
00:13:59,816 --> 00:14:01,483
So this can help you.

266
00:14:01,483 --> 00:14:03,949
So basically calcium scan is very helpful now.

267
00:14:03,949 --> 00:14:07,115
You can make a decision
who will need a stress test.

268
00:14:07,115 --> 00:14:10,548
You can make a decision who's
going to benefit from this certain therapy

269
00:14:10,781 --> 00:14:15,747
and who will need or who will get benefit
from the aspirin treatment.

270
00:14:15,847 --> 00:14:20,413
So calcium scan is a very,
very important to step forward.

271
00:14:20,547 --> 00:14:22,280
Is it covered by insurance yet?

272
00:14:22,280 --> 00:14:24,113
Unfortunately, no. Okay.

273
00:14:24,113 --> 00:14:28,212
But it's only $50. Everyone go do it.

274
00:14:28,279 --> 00:14:29,979
I learned a lot from that. Sorry Krishna,

275
00:14:29,979 --> 00:14:30,978
I'm taking up all the questions.

276
00:14:30,978 --> 00:14:31,645
Oh no, it's okay.

277
00:14:31,645 --> 00:14:33,845
This is so interesting and I'm learning so much.

278
00:14:33,845 --> 00:14:34,278
It's fine.

279
00:14:34,278 --> 00:14:36,811
I can't really say anything. It's okay.

280
00:14:36,811 --> 00:14:39,711
So one of the topics 
I thought would be beneficial

281
00:14:39,711 --> 00:14:41,910
if we discuss today is atrial
fibrillation.

282
00:14:41,910 --> 00:14:45,343
I think it's something
that people may hear of here and there,

283
00:14:45,343 --> 00:14:47,776
but a lot of people
don't really know what that is.

284
00:14:47,776 --> 00:14:50,609
Would you mind just kind of giving us
like a brief explanation of what

285
00:14:50,609 --> 00:14:54,942
atrial fibrillation is and,
how we can treat it.

286
00:14:55,008 --> 00:14:57,708
So atrial fibrillation as V

287
00:14:57,708 --> 00:15:01,841
or some people know
that it's a irregular heart rhythm.

288
00:15:01,907 --> 00:15:06,274
There is a misconception,
they think that any irregular heartbeat

289
00:15:06,274 --> 00:15:09,040
is atrial fibrillation
because a lot of people think,

290
00:15:09,040 --> 00:15:12,639
when I was 20 or 30 years old,
I was told I had irregular heartbeat

291
00:15:12,873 --> 00:15:16,305
and now they are 60 years old
and we are trying to explain them

292
00:15:16,305 --> 00:15:19,172
that you have irregular heartbeat,
but it's a fib.

293
00:15:19,172 --> 00:15:20,938
So it's a confusion.

294
00:15:20,938 --> 00:15:23,671
So irregular
heartbeat is a very vague term.

295
00:15:23,671 --> 00:15:26,037
So when someone says,
I had irregular heartbeat,

296
00:15:26,037 --> 00:15:28,004
it could be just
the heart is throwing extra beat.

297
00:15:28,004 --> 00:15:30,070
And that is very common.

298
00:15:30,070 --> 00:15:33,236
In 30 years old or 40 years old,
if you have excessive coffee,

299
00:15:33,236 --> 00:15:36,236
caffeine or sometimes for no good reason.

300
00:15:36,469 --> 00:15:39,236
So that is very different
than atrial fibrillation.

301
00:15:39,236 --> 00:15:42,635
So atrial fibrillation
is actually a irregular heartbeat,

302
00:15:42,635 --> 00:15:46,568
but it can go very fast or it can be slow.

303
00:15:46,668 --> 00:15:52,334
And unfortunately,
atrial fibrillation can cause a stroke.

304
00:15:52,400 --> 00:15:56,100
But the good thing with AFib is it's
not a life threatening rhythm.

305
00:15:56,200 --> 00:15:59,333
So that's the one

306
00:15:59,399 --> 00:16:02,832
that people get concerned
that once they have AFib, is it life

307
00:16:02,832 --> 00:16:03,199
threatening?

308
00:16:03,199 --> 00:16:06,199
So it's not life threatening,
but risk of a stroke is there.

309
00:16:06,398 --> 00:16:10,498
And then we decide
how we are going to treat it.

310
00:16:10,565 --> 00:16:15,930
If someone has atrial fibrillation,
we try to maintain them in normal rhythm.

311
00:16:16,030 --> 00:16:19,130
So you want to give the advantages
the first time happened.

312
00:16:19,130 --> 00:16:23,929
Let's do the start the medications
and do the lifestyle modification.

313
00:16:23,929 --> 00:16:28,229
If there is any risk factors
like drinking alcohol, excessive coffee,

314
00:16:28,229 --> 00:16:33,028
caffeine and all that, if that brings them
back to normal rhythm, good.

315
00:16:33,028 --> 00:16:35,861
If it's not,
then we try to do the cardioversion.

316
00:16:35,861 --> 00:16:39,727
That means we sedate the patient
and give the shock

317
00:16:39,727 --> 00:16:41,560
and try
to bring back to the normal rhythm.

318
00:16:41,560 --> 00:16:45,226
So we'll decide then what kind of
medications or what will be the process.

319
00:16:45,460 --> 00:16:48,559
But depending on the risk factors

320
00:16:48,559 --> 00:16:52,459
being on the blood thinnger medicine
is one of the most important thing.

321
00:16:52,525 --> 00:16:58,091
So that's how you start
that atrial fibrillation treatment.

322
00:16:58,158 --> 00:16:59,091
Well,

323
00:16:59,091 --> 00:17:02,457
yeah, a lot lot to uncover there
with A-fib.

324
00:17:02,457 --> 00:17:06,657
And I mean, it's just fascinating
that you can there's

325
00:17:06,757 --> 00:17:08,823
curative treatments now, right?

326
00:17:08,823 --> 00:17:10,523
And now actually atrial ablation,

327
00:17:10,523 --> 00:17:13,522
We know that ablation has a much better
success rate.

328
00:17:13,589 --> 00:17:17,489
So if someone is going in atrial
fibrillation and they are symptomatic,

329
00:17:17,722 --> 00:17:19,422
they are having

330
00:17:19,422 --> 00:17:23,421
a feeling of that their heart is beating
fast irregular or they're fatigued,

331
00:17:23,421 --> 00:17:26,721
tired, short of breath,
then yes, there are other processes.

332
00:17:26,721 --> 00:17:29,187
If medicine is not working,
then we can do the ablation.

333
00:17:29,187 --> 00:17:32,420
Ablation is just a procedure
that takes about two, three hours.

334
00:17:32,420 --> 00:17:37,619
So it is a cardiac procedure that we they
burn the spots where this atrial fibrillation

335
00:17:37,619 --> 00:17:43,385
or the electricity starts in the heart
and it has a success rate about 80% or so.

336
00:17:43,385 --> 00:17:44,485
80, 90%.

337
00:17:44,485 --> 00:17:47,318
Wow. So that well,
but still is recommended

338
00:17:47,318 --> 00:17:50,317
you still may have to be on the blood
thinner medicine.

339
00:17:50,317 --> 00:17:53,884
So the other thing that we've recently
kind of learned more about

340
00:17:53,884 --> 00:17:59,216
is the watchman device is that used to
I don't think it's used to treat a afib.

341
00:17:59,216 --> 00:18:01,249
It's mostly to prevent strokes or.

342
00:18:01,249 --> 00:18:03,482
Yeah, from patients with afib.

343
00:18:03,482 --> 00:18:04,549
Correct? Right.

344
00:18:04,549 --> 00:18:08,948
So watchman devices
it is now one of the new tool

345
00:18:08,948 --> 00:18:12,348
or equipment that we have that we can use.

346
00:18:12,414 --> 00:18:16,780
It is done in a patients
like we were talking about all

347
00:18:16,814 --> 00:18:18,913
AFib patients need to be,
if they have a risk

348
00:18:18,913 --> 00:18:21,313
factor,
need to be on the blood thinner medicine.

349
00:18:21,313 --> 00:18:24,179
But if for some reason
they cannot be on blood thinner

350
00:18:24,179 --> 00:18:26,546
medicine like if they had a stroke
or they had, 

351
00:18:26,546 --> 00:18:31,212
I'm sorry they had a bleed in the brain
or they have a GI bleed,

352
00:18:31,278 --> 00:18:34,578
have a blood in the stool
or they are bleeding for whatever reason

353
00:18:34,578 --> 00:18:37,244
and they cannot be on blood
thinner medicine,

354
00:18:37,244 --> 00:18:40,077
then watchman device
is a very good option.

355
00:18:40,077 --> 00:18:44,510
It has shown that
the risk of a stroke is same

356
00:18:44,510 --> 00:18:49,009
whether you were taking blood thinner medicine
or you got the watchman device.

357
00:18:49,009 --> 00:18:52,742
So once you have a watchman device,
then you don't need to be on the blood thinner medicine.

358
00:18:52,742 --> 00:18:54,175
You just take aspirin.

359
00:18:54,175 --> 00:18:56,508
But it is a procedure. Right now,

360
00:18:56,508 --> 00:19:00,641
it is recommended for other people
who cannot be on blood thinner medicine.

361
00:19:00,708 --> 00:19:02,907
But hopefully in the near future,

362
00:19:02,907 --> 00:19:07,007
I think we are hoping,
based on the other studies and trials

363
00:19:07,007 --> 00:19:11,939
that we may be able to offer as an option
to the patients, whether they want

364
00:19:11,939 --> 00:19:15,106
to take a blood thinner medicine
or they want to have a watchman device.

365
00:19:15,106 --> 00:19:19,972
But currently it's indicated whoever
cannot be on the blood thinner medicine.

366
00:19:20,172 --> 00:19:22,038
Is it a simple procedure?

367
00:19:22,038 --> 00:19:23,571
Relatively simple procedure.

368
00:19:23,571 --> 00:19:25,571
So it's not an open heart procedure.

369
00:19:25,571 --> 00:19:27,171
It is done under anesthesia.

370
00:19:27,171 --> 00:19:30,737
We go through the groin site
and the like to where the hip joint

371
00:19:30,737 --> 00:19:35,669
is going to the right side of the heart,
cross to the left side of the heart,

372
00:19:35,769 --> 00:19:40,069
and then this device is like a apple
shaped device or marshmallow.

373
00:19:40,069 --> 00:19:42,402
And then we have a small chamber
in the heart.

374
00:19:42,402 --> 00:19:44,568
What I usually describe is like appendix.

375
00:19:44,568 --> 00:19:47,634
basically this small
chamber of the heart

376
00:19:47,634 --> 00:19:51,101
doesn't do anything and there is a risk
of having a clot formation.

377
00:19:51,101 --> 00:19:54,667
So we close the mouth
of that small chamber

378
00:19:54,900 --> 00:19:58,266
so that way
blood cannot go in and out of the chamber

379
00:19:58,266 --> 00:20:01,432
and it prevents the formation of blood
clot. Wow.

380
00:20:01,466 --> 00:20:03,366
Okay. Yeah, that's,

381
00:20:03,432 --> 00:20:04,265
pretty deep.

382
00:20:04,265 --> 00:20:04,832
Yeah.

383
00:20:04,832 --> 00:20:08,631
And then just for, like, our student
listeners or resident listeners,

384
00:20:08,631 --> 00:20:10,964
I mean,
I think the you're attributing the risk

385
00:20:10,964 --> 00:20:13,531
by doing like a chest tube
mask and a HAS-BLED score right? Yeah.

386
00:20:13,531 --> 00:20:16,130
So we do the chest to chest risk score.

387
00:20:16,130 --> 00:20:19,763
If their score is two or three
then they need a blood thinner medicine

388
00:20:19,830 --> 00:20:21,430
and if their HAS-BLED score,

389
00:20:21,430 --> 00:20:25,629
that means there's a bleeding score
that we do, if it's three or more

390
00:20:25,629 --> 00:20:29,295
then you, you are at higher
risk of the bleeding.

391
00:20:29,362 --> 00:20:33,395
And procedure time
it takes about an hour or less to do it.

392
00:20:33,395 --> 00:20:37,261
And recovery time is really
they go home the next day.

393
00:20:37,361 --> 00:20:38,127
Wow. It's amazing how,

394
00:20:38,127 --> 00:20:41,160
technology's come by so fast and so far.

395
00:20:41,227 --> 00:20:43,727
So speaking of irregular
heart rhythms,

396
00:20:43,727 --> 00:20:46,926
there's one thing that 
I wanted to ask you regarding,

397
00:20:46,926 --> 00:20:50,659
and I know we've mentioned COVID-19 
already, but it seems like

398
00:20:50,726 --> 00:20:55,125
irregularities or palpitations 
in patients after having COVID infection.

399
00:20:55,125 --> 00:20:58,458
And sometimes there's like there's talks
out there related to the vaccine.

400
00:20:58,458 --> 00:21:01,457
And have you seen any patients
like that that you think that,

401
00:21:01,491 --> 00:21:03,924
is there a correlation
that you come across?

402
00:21:03,924 --> 00:21:06,923
Yes. Actually,
we have seen a lot of patients that after

403
00:21:06,923 --> 00:21:10,790
the COVID, they have complained
of palpitation, chest pain.

404
00:21:10,856 --> 00:21:16,555
And when we have placed them on monitor,
really didn't see arrhythmias,

405
00:21:16,555 --> 00:21:19,755
but it's more what we call
the extra beats from the heart,

406
00:21:19,755 --> 00:21:25,154
like PACs or PVCs,
and also the complain of chest pain.

407
00:21:25,221 --> 00:21:26,954
We really don't know for sure.

408
00:21:26,954 --> 00:21:30,520
It's a really minor myocarditis versus

409
00:21:30,587 --> 00:21:32,986
it's just an inflammatory response
to the heart.

410
00:21:32,986 --> 00:21:34,020
No one really knows.

411
00:21:34,020 --> 00:21:38,019
But yes, we have seen a lot of patients
with complaint of palpitation

412
00:21:38,019 --> 00:21:43,885
and chest pain, but luckily not increased
risk of stroke or heart attack,

413
00:21:43,952 --> 00:21:48,051
except during the period of when they were
sick with the COVID-19 itself.

414
00:21:48,051 --> 00:21:50,884
But afterwards,
we haven't seen any increases.

415
00:21:50,884 --> 00:21:53,550
Symptoms just get better on their own.

416
00:21:53,550 --> 00:21:54,150
Yes. 

417
00:21:54,150 --> 00:21:55,817
Unfortunately, in some patients

418
00:21:55,817 --> 00:21:58,816
can take up to six months to a year
or even longer.

419
00:21:58,883 --> 00:22:03,582
Wow. So it's mostly a reassurance
that it's there,

420
00:22:03,582 --> 00:22:08,648
but it's not going to cause damage
as far as we know.

421
00:22:08,748 --> 00:22:10,381
Right.

422
00:22:10,381 --> 00:22:13,714
Does that also include with infection
or just with also possibly

423
00:22:13,714 --> 00:22:15,647
with vaccination also?

424
00:22:15,647 --> 00:22:17,347
So with vaccination,

425
00:22:17,347 --> 00:22:21,146
we have seen some myocarditis,
especially in young population.

426
00:22:21,146 --> 00:22:25,612
chest pain, palpitation,
Not that, not so much.

427
00:22:25,779 --> 00:22:27,012
Just with the vaccination.

428
00:22:27,012 --> 00:22:29,245
I think the vaccination is more
myocarditis.

429
00:22:29,245 --> 00:22:34,511
The risk that we see
within a couple of weeks of vaccination.

430
00:22:34,578 --> 00:22:37,944
Right. Okay. It's very interesting.

431
00:22:38,011 --> 00:22:38,777
Another topic

432
00:22:38,777 --> 00:22:42,743
that we wanted to touch today is about, 
congestive heart failure.

433
00:22:42,810 --> 00:22:44,177
And so there's a lot of,

434
00:22:44,177 --> 00:22:47,909
I think, confusion sometimes when,
when we use the phrase heart disease,

435
00:22:48,009 --> 00:22:52,642
whether it's referring to heart failure
or, coronary artery disease.

436
00:22:52,709 --> 00:22:54,075
So would you mind just,

437
00:22:54,075 --> 00:22:57,841
kind of explaining to
us what congestive heart failure is, is

438
00:22:57,841 --> 00:23:01,707
and how is it different
than the coronary artery disease?

439
00:23:01,774 --> 00:23:06,707
Yes. So congestive heart failure is,
again, a kind of a vague term nowadays.

440
00:23:06,707 --> 00:23:09,706
So if you say congestive heart failure

441
00:23:09,773 --> 00:23:14,239
in general, people think that their heart
muscle is weak or anytime

442
00:23:14,239 --> 00:23:18,238
someone sees swelling in their legs
and they think this is a heart failure.

443
00:23:18,338 --> 00:23:21,838
So the coronary artery disease is
blockages in the heart.

444
00:23:21,838 --> 00:23:24,904
So if you want to divide
the heart as a pump

445
00:23:24,904 --> 00:23:28,037
or as a pipeline,
and so you have a plumbing system.

446
00:23:28,037 --> 00:23:31,670
So plumbing system is the point
where that coronary artery disease starts

447
00:23:31,670 --> 00:23:34,436
because you have a cholesterol deposition
in that line.

448
00:23:34,436 --> 00:23:37,969
And heart
failure is more a issue with the pump.

449
00:23:38,202 --> 00:23:42,568
So there's the heart
muscles, heart failure is

450
00:23:42,635 --> 00:23:43,568
usually two

451
00:23:43,568 --> 00:23:46,801
different types, whether it's a diastolic
congestive heart failure

452
00:23:46,801 --> 00:23:51,834
or it's a systolic heart failure,
or it's called diastolic heart failure.

453
00:23:51,900 --> 00:23:55,267
diastolic heart
failure is more a stiffening of the heart.

454
00:23:55,267 --> 00:23:57,833
So the heart muscles are not weak,
but they are a step.

455
00:23:57,833 --> 00:24:02,799
So nowadays is called heart failure
with preserved ejection fraction

456
00:24:02,899 --> 00:24:06,165
so that your muscles are too strong,
but your heart is a step

457
00:24:06,165 --> 00:24:10,165
so patients get more short of breath,
have swelling in the legs,

458
00:24:10,231 --> 00:24:14,331
and then you have a heart failure
with the reduced ejection fraction,

459
00:24:14,331 --> 00:24:18,630
That means your heart muscles are weaker
and so preserved ejection fraction.

460
00:24:18,630 --> 00:24:20,730
Nowadays, new treatments are emerging.

461
00:24:20,730 --> 00:24:22,796
So that's very exciting.

462
00:24:22,796 --> 00:24:28,095
As probably you all know that SGLT2 
inhibitors are recommended for that.

463
00:24:28,162 --> 00:24:29,329
We do beta blockers.

464
00:24:29,329 --> 00:24:33,695
It's mostly changing the life style. 
Preserved ejection fraction,

465
00:24:33,828 --> 00:24:37,861
the heart failure with
Preserved ejection fraction is more a

466
00:24:37,961 --> 00:24:40,760
indication of other comorbidities.

467
00:24:40,760 --> 00:24:43,727
So usually you see with the patients
with the high blood pressure,

468
00:24:43,727 --> 00:24:46,726
diabetes, high BMI.

469
00:24:46,893 --> 00:24:51,659
And so if you control those symptoms,
the heart failure symptoms get much better.

470
00:24:51,759 --> 00:24:52,992
As opposed to heart failure

471
00:24:52,992 --> 00:24:56,758
with reduced ejection fraction,
most common causes stuck on artery disease

472
00:24:56,825 --> 00:24:58,258
that if you have a blockage in the heart,

473
00:24:58,258 --> 00:25:01,557
the heart muscles are not getting enough
blood supply, it causes it.

474
00:25:01,624 --> 00:25:05,290
And for that also, first,
we make sure that we are fixing

475
00:25:05,290 --> 00:25:08,656
all the blockages and then treating
with adequate medications.

476
00:25:08,756 --> 00:25:12,423
So speaking of SGLT2s,
I mean, there's also a lot of talk

477
00:25:12,423 --> 00:25:14,822
about GLP1 analogs
having cardiovascular

478
00:25:14,822 --> 00:25:18,255
mortality benefit too, in addition
to weight loss and diabetes treatment.

479
00:25:18,455 --> 00:25:20,355
Can you talk about
those new emerging drugs?

480
00:25:20,355 --> 00:25:23,354
I mean, they're very
popular now in the media.

481
00:25:23,421 --> 00:25:26,521
Yes. So SGLT2 inhibitors or you're
talking

482
00:25:26,521 --> 00:25:27,554
about.

483
00:25:27,554 --> 00:25:31,387
GLP1. Oh okay Ozempic and Victosa
I think, in all those things.

484
00:25:31,387 --> 00:25:34,353
Right. Right. So,

485
00:25:34,353 --> 00:25:37,586
Yes, now we have weight loss medications
and they started with

486
00:25:37,586 --> 00:25:39,286
as a diabetes medications.

487
00:25:39,286 --> 00:25:44,185
They have been very helpful
in reducing the weight.

488
00:25:44,251 --> 00:25:46,251
Once your body weight or BMI

489
00:25:46,251 --> 00:25:49,651
has gone down overall,
it reduces the cardiovascular mortality.

490
00:25:49,651 --> 00:25:53,717
Your risk of diabetes is less
and cardiovascular disease

491
00:25:53,717 --> 00:25:55,583
risk will also be low.

492
00:25:55,583 --> 00:25:58,250
So those drugs have helped.

493
00:25:58,250 --> 00:26:01,249
Also, it can be used as a congestive heart
failure purpose,

494
00:26:01,249 --> 00:26:04,982
but usually the SGLT inhibitors are the.

495
00:26:05,082 --> 00:26:06,148
The preferred.

496
00:26:06,148 --> 00:26:08,281
Preferred ones.

497
00:26:08,281 --> 00:26:13,447
Yes.

498
00:26:13,514 --> 00:26:15,214
Sure. Yes.

499
00:26:15,214 --> 00:26:19,680
So just for our listeners,
SGLP two inhibitors or oral medications

500
00:26:19,680 --> 00:26:24,246
that are initially developed
for diabetes, and what they do is they,

501
00:26:24,346 --> 00:26:26,612
they make you secrete
glucose out in your urine.

502
00:26:26,612 --> 00:26:30,012
But now further studies wise,
they have had, mortality benefit

503
00:26:30,012 --> 00:26:33,145
and patients with cardiovascular disease,
specifically with heart

504
00:26:33,145 --> 00:26:36,844
failure, with reserved, preserved
ejection fraction or reduced both.

505
00:26:36,944 --> 00:26:37,277
Right.

506
00:26:37,277 --> 00:26:40,977
And then now one of them in particular
Farxiga, has been shown to be

507
00:26:41,010 --> 00:26:43,410
nephro-protective
in chronic kidney disease as well.

508
00:26:43,410 --> 00:26:48,376
The difference between them
and the GLP one analogs is they SGLT2’s

509
00:26:48,576 --> 00:26:51,609
where traditionally oral medications
and the GLP ones

510
00:26:51,609 --> 00:26:52,975
were traditionally injectable.

511
00:26:52,975 --> 00:26:56,575
So they were the daily injections
or once a

512
00:26:56,741 --> 00:27:00,008
now once a week injections
with, with Wegovy.

513
00:27:00,008 --> 00:27:01,507
And Ozempic.

514
00:27:01,507 --> 00:27:06,107
And now the new GLP one GIP
Mounjaro is out too.

515
00:27:06,107 --> 00:27:11,306
But now they have an oral GLP
one with the oral simaglutide Rybelsus.

516
00:27:11,373 --> 00:27:11,806
Yeah, yeah.

517
00:27:11,806 --> 00:27:12,339
Rybelsus.

518
00:27:12,339 --> 00:27:16,905
And so, that's, that's the thing
they, they work in different mechanisms

519
00:27:16,905 --> 00:27:22,838
for, to help with diabetes in
the body, but they both have,

520
00:27:22,904 --> 00:27:23,071
they're

521
00:27:23,071 --> 00:27:26,071
both up and coming and new
and have several uses

522
00:27:26,204 --> 00:27:28,904
that are making them really good meds
to be on.

523
00:27:28,904 --> 00:27:30,637
It's pretty, pretty revolutionary.

524
00:27:30,637 --> 00:27:31,637
And it comes with the GLP.

525
00:27:31,637 --> 00:27:32,770
One Analogs and weight loss.

526
00:27:32,770 --> 00:27:35,036
In the weight
loss world, it's been it's been crazy.

527
00:27:35,036 --> 00:27:37,036
Some of those medications have been shown
to have

528
00:27:37,036 --> 00:27:41,235
at least 20% reduction in weight
loss reaching bariatric surgery levels.

529
00:27:41,235 --> 00:27:44,935
And so we'll have to we'll have to see.

530
00:27:45,035 --> 00:27:48,867
Well, Dr. Gautam, the one thing that we're
trying to do is trying to, like,

531
00:27:48,967 --> 00:27:51,634
get to know our providers at Norman
Regional personally, right?

532
00:27:51,634 --> 00:27:55,100
And so outside of the,
you know, when you're not doing cardiology

533
00:27:55,100 --> 00:27:58,733
and saving lives and doing open heart,
open heart procedures,

534
00:27:58,799 --> 00:28:01,799
what do you like to do for fun
with your family or.

535
00:28:01,832 --> 00:28:06,465
SO Yes, it is a good question
and difficult question to

536
00:28:06,532 --> 00:28:07,965
being a cardiologist.

537
00:28:07,965 --> 00:28:12,331
It is at times very difficult
to balance the work life.

538
00:28:12,331 --> 00:28:16,664
Of course,
at times work takes the priority,

539
00:28:16,730 --> 00:28:21,130
but definitely
I do like spending time with the family.

540
00:28:21,196 --> 00:28:24,396
It could be just sitting with them
watching movie or

541
00:28:24,396 --> 00:28:28,129
sit down and just talking
and spending time with my son.

542
00:28:28,129 --> 00:28:31,128
I have one son who is in college now,

543
00:28:31,395 --> 00:28:36,128
so I try to spend as much time as I can
if I can.

544
00:28:36,194 --> 00:28:39,027
And I like to play tennis.

545
00:28:39,027 --> 00:28:42,493
Well, that's awesome,
but don't get much opportunity.

546
00:28:42,560 --> 00:28:43,527
Have you tried pickleball?

547
00:28:43,527 --> 00:28:46,826
No I haven’t tried,

548
00:28:46,893 --> 00:28:49,292
and I do enjoy reading.

549
00:28:49,292 --> 00:28:53,825
It could be anything,
reading any articles or read newspapers

550
00:28:53,825 --> 00:28:57,858
and trying to keep myself updated in U.S.

551
00:28:57,858 --> 00:29:01,624
and across the world what's going on

552
00:29:01,724 --> 00:29:02,824
and traveling.

553
00:29:02,824 --> 00:29:07,423
I do like to travel to different countries
and to learn about their cultures.

554
00:29:07,423 --> 00:29:09,923
But of course
this has been getting hard to do that.

555
00:29:09,923 --> 00:29:14,122
So, one of the things that we want to do
is, with any of our guests

556
00:29:14,122 --> 00:29:15,155
is just kind of,

557
00:29:15,155 --> 00:29:18,455
see if you have any words of wisdom, 
for anybody that wants to go into

558
00:29:18,455 --> 00:29:19,522
the field of cardiology.

559
00:29:19,522 --> 00:29:23,788
you know, because we do have,
we are expecting a few of our listeners

560
00:29:23,788 --> 00:29:25,921
to be, incoming medical students

561
00:29:25,921 --> 00:29:27,854
or those who are interested
in getting into medicine.

562
00:29:27,854 --> 00:29:29,753
So any words of wisdom for anyone

563
00:29:29,753 --> 00:29:33,186
looking into going into medicine
and specifically cardiology?

564
00:29:33,253 --> 00:29:35,953
Yes, I would highly recommend cardiology.

565
00:29:35,953 --> 00:29:37,552
It is as we know,

566
00:29:37,552 --> 00:29:41,585
that our population is aging,
so we need more and more cardiologists.

567
00:29:41,585 --> 00:29:43,418
So I would definitely recommend it.

568
00:29:43,418 --> 00:29:48,951
This is something that
I would do it over again. And

569
00:29:49,051 --> 00:29:49,484
if you

570
00:29:49,484 --> 00:29:53,384
decide to go for cardiology,
definitely it is a challenging field.

571
00:29:53,384 --> 00:29:57,483
It, it is a demanding, your timings.

572
00:29:57,650 --> 00:30:01,616
You're work hours are long,
so you have to be mentally ready for that,

573
00:30:01,616 --> 00:30:04,415
that you can do that
and always your patient comes first

574
00:30:04,415 --> 00:30:07,782
because these are like you're
dealing with life threatening emergencies

575
00:30:07,848 --> 00:30:10,914
and in very time sensitive manner.

576
00:30:11,148 --> 00:30:14,047
As we all know
that time is a heart muscle.

577
00:30:14,047 --> 00:30:18,113
So if you have a emergency, you're going
to have to drop everything and go.

578
00:30:18,213 --> 00:30:22,280
So I would say,
but it is very satisfying, feel demanding.

579
00:30:22,280 --> 00:30:25,246
But at the same time
it is very satisfying.

580
00:30:25,246 --> 00:30:26,979
So I would highly recommend to

581
00:30:26,979 --> 00:30:30,912
if you want to pursue
a career in cardiology, you should.

582
00:30:30,978 --> 00:30:31,545
Think you Dr. Gothum.

583
00:30:31,545 --> 00:30:33,945
Like we were lucky to have cardiologists
like yourself.

584
00:30:33,945 --> 00:30:39,110
Yeah, at Norman Regional and so receptive
and so collegial

585
00:30:39,110 --> 00:30:42,110
to US primary care providers
answering our questions at.

586
00:30:42,177 --> 00:30:43,210
Any and every time.

587
00:30:43,210 --> 00:30:45,576
And it's never been a
no it's always been Yeah, yeah.

588
00:30:45,576 --> 00:30:46,843
Give me a few minutes. Yeah.

589
00:30:46,843 --> 00:30:48,276
And we really appreciate that.

590
00:30:48,276 --> 00:30:48,609
And it's,

591
00:30:48,609 --> 00:30:51,142
it's a huge relief for us knowing that,
you know,

592
00:30:51,142 --> 00:30:53,475
we have someone
that we can always lean towards do.

593
00:30:53,475 --> 00:30:55,742
And so thank you so much, Dr. Gautam,
and really appreciate everything.

594
00:30:55,742 --> 00:30:56,775
That you joining us today.

595
00:30:56,775 --> 00:31:00,174
And for our listeners out there,
this will not be the last time that Dr.

596
00:31:00,174 --> 00:31:01,041
Gautam joins us.

597
00:31:01,041 --> 00:31:05,807
We will have you come back and discuss
specific disease processes in detail.

598
00:31:05,807 --> 00:31:09,740
But, thank you to our listeners
for joining us today on our podcast of

599
00:31:09,806 --> 00:31:11,739
Vital Visions.

600
00:31:11,806 --> 00:31:13,739
And as always, you stay classy.

601
00:31:13,739 --> 00:31:14,706
And stay out of trouble.