- 2 days ago
In this month's Stay Well Health Chat, Andrew Salciunas sits down with Juan Ortega-Legaspi, MD, PhD, FACC, a board-certified heart failure specialist at Virtua Health, to discuss living life with heart failure. Dr. Ortega specializes in heart failure and heart transplantation, and he explains the condition in a way that is easy for patients and families to understand.
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00:01Hello, everybody, and welcome into this month's Stay Well Health Chat with me, Andrew Salchunas,
00:07and of course, the team at Virtua Health.
00:09Each month, we attack different sort of topics in terms of our body, our health, our well-being
00:15moving forward.
00:16And this month is really special to me and my life because I had a friend that suffered
00:23through heart failure, living heart failure at a very young age.
00:26So the fact that I get to talk to Dr. Juan Ortega today to talk more about living with
00:31heart failure and what we can do and how we can take those next steps moving forward,
00:35it's really special to me.
00:37So, Dr. Ortega, first off, thank you so much for coming on today and all that you do.
00:42Yes, thank you for having me.
00:43I'm happy to be here.
00:44You know, I already know just by looking at your resume in front of me that I'm in good
00:49hands.
00:50Like, if I ever needed to talk to somebody about any sort of medical ailment, it's talking
00:55to you, MD, PhD, FACC, board-certified cardiologist dedicated to caring for adults with heart
01:02conditions and improving quality of life.
01:04You've studied in Mexico.
01:06You've studied in the States, Emory University School of Medicine.
01:09You did cardiovascular disease fellowship at the University of Washington.
01:13You've been here locally, advanced heart failure and transplant cardiology fellowship at the
01:18University of Pennsylvania Parliament School of Medicine.
01:21You've served on the faculty at the University of Washington.
01:23You've served on the faculty at the University of Pennsylvania Parliament of Medicine.
01:27I mean, you've been everywhere.
01:28And the fact that I could do all this and I could speak to you in English, Spanish, and
01:33French because you are lingual in all those languages, I feel like I'm in good hands with
01:39you, Doc.
01:39So, thank you for all that you've done in your life.
01:44All right.
01:44So, let's talk about it.
01:45Living with heart failure.
01:47First off, what is heart failure?
01:49When I hear that or when I think a lot of people that don't know, I've dealt with it differently.
01:53I've had somebody close to me that did deal with it.
01:55They might think, all right, heart's done.
01:57That's it.
01:58What is heart failure?
01:59Different types of it.
02:00I know it's not just one end-all be-all.
02:02So, can you explain it more?
02:03Yes, of course.
02:04So, heart failure, I mean, the heart, it's ultimately a pump.
02:08You know, it's intended to pump blood and make it reach our bodies for oxygen and nourishment
02:14and just so that, you know, that blood provides all the energy and everything, the tissue, the
02:19muscles, the other organs, the brain needs to work.
02:22So, when that pump is not efficient, then that's when we start basically entering the
02:29church of heart failure.
02:31I mean, that's kind of a broad, you know, very broad way what it is.
02:36Now, of course, it's not as simple.
02:38It's not just the pump is on or off or it's, so when it starts failing or it starts being
02:44inefficient, fortunately, in fact, the heart has the capacity of continuing to provide enough
02:53blood and enough oxygen to all the periphery and to the lungs and to the brain and everything.
02:58But when it starts failing, sometimes it starts backing up some of that fluid.
03:04So, even though you're still, your brain is still seeing the blood, it needs to see, your
03:08kidneys are seeing enough blood, your muscles are still seeing it, it starts backing up
03:12some of that fluid.
03:13And that's why people can sometimes feel, for instance, the most common symptom that we
03:18in heart failure clinics are going to ask the patients is if they're short of breath
03:22because that backed up fluid increases the pressures inside the lungs and then the lungs
03:27cannot expand as easily and people feel short of breath.
03:33That's what it's not uncommon, that patients with heart failure develop swollen ankles or
03:38a bloated abdomen or feel bloated that the stomachs are full.
03:43And that's because that fluid gets backed up.
03:45So, that's that inefficiency.
03:46Now, as it progresses or if it becomes very severe, then you can start seeing a condition
03:52in which there is not enough blood moving forward.
03:55And that's when you start running into like a low cardiac output or a low blood flow state
04:00in which the organs start suffering.
04:03And that, well, that tends to be very late in the presentation or when it's very severe.
04:08So, so we see, we see that.
04:10So, that's very broadly speaking what heart failure is.
04:13Now, of course, heart failure can be caused by why.
04:16There has a number of reasons to happen.
04:18And, you know, I think you were asking about types of heart failure before we go into causes
04:23and how to prevent it.
04:25You know, the heart as a pump works by squeezing.
04:28It squeezes blood out.
04:29You know, it feels, it feels, it has a cavity, it has a chamber.
04:32The chamber just squeezes and it squeezes it out.
04:37So, the percentage of blood that comes out in a single beat every time the heart squeezes,
04:43that is what the ejection fraction is.
04:46And talking about types of heart failure, heart failure is generally divided in two very broad
04:51main categories, which is when the ejection fraction is low or when the ejection fraction
04:56is normal.
04:58So, again, that ejection fraction is that percentage of blood that comes out in a single beat.
05:02The normal is somewhere between 55 to 65%.
05:06It's never 100.
05:07So, with that ballpark, you know, somewhere in the mid-50s is considered normal.
05:12And then, you know, there are a number of conditions that can cause the heart usually to dilate
05:18and then to not squeeze properly.
05:19And when that ejection fraction is low, it's called heart failure will reduce ejection fraction.
05:24But there are conditions in which the heart can have a normal ejection fraction
05:29and still be very inefficient.
05:32And, in fact, this concept of ejection fraction is something that we see a lot
05:37and patients with heart failure tend to fix it a lot.
05:40But it's important to remember it doesn't tell the whole story.
05:43Because you can be in severe heart failure and that number be completely normal
05:47and you can be outside in the community very well compensated living with heart failure out and about
05:53and that number be quite low.
05:55So, it doesn't really tell the whole story.
05:57It does guide us on what we do because the treatment that we give to patients,
06:01depending on whether the ejection fraction is normal or low, is different.
06:06So, it's helpful.
06:07But it doesn't really tell the whole story.
06:10So, that's important to remember.
06:13So, Doc, I know you brought up symptoms.
06:15You know, shortness of breath is a key one to start looking at.
06:18I don't want to scare anybody, but these Stay Well Health chats that we do on a monthly basis
06:23are great because sometimes you need to be kind of scared a little bit
06:27and to get yourself checked out.
06:28I had a friend of mine.
06:29We were juniors in college, right?
06:31So, we were 20, 21 years old.
06:33He was very active, very much in shape.
06:36He had a heart transplant at 22 years old, right?
06:38And he felt shortness of breath, just like we all do when we exercise.
06:43But he was out at the gym every single day.
06:44So, if you could give me sort of levels to that.
06:48Like, is it just getting up off the couch, walking up the stairs,
06:53depending on different age groups, different lifestyles?
06:56Like, when you say shortness of breath, I witnessed a kid that exercised daily
07:01and then all of a sudden he's got a heart transplant at 22 years old.
07:04Yeah, no, you're right.
07:05Sometimes it's not very straightforward.
07:07Usually, when people, when the heart starts failing slowly,
07:11when it's a chronic process and it starts slowly,
07:13people will start with very subtle changes, with subtle symptoms.
07:21And you can start feeling things like, you know,
07:24perhaps feeling disproportionately out of breath when exercising
07:28or when going up the steps and things like that.
07:31And sometimes it's hard to tell because when it happens very slowly,
07:34sometimes people literally just get used to it.
07:37So, sometimes it does happen and sometimes you diagnose heart failure as a regular checkup.
07:41And then when you dig deeper into the symptoms, then you make people realize,
07:45oh, maybe I'm not performing as well as I should have or as I was before.
07:49Now, when it happens in young people, that's even more difficult.
07:52Young people can just tolerate a lot, have a lot of what we call cardiac reserve.
07:56So, the heart can be in pretty bad shape and people not feel anything.
07:59So, that's important to keep in mind.
08:00Now, when it happens very suddenly, when you develop a heart condition that happens within hours
08:06or just in a very acute, very quick, that's when people develop symptoms very, very dramatically.
08:13People pass out, people feel horrible, people feel dizzy, people are really gasping for air, things like that.
08:19So, in young people like your friend, you know, sometimes they have an acute condition
08:23and it changes their lives very, very suddenly and those situations are very dramatic.
08:29Fortunately, particularly in young people, those are quite rare.
08:32We hear about them.
08:34Of course, they tend to be out and people get very drastically scared about something like that.
08:41The good news is that something like that happening, well, of course, it does happen.
08:45It is quite rare.
08:47Heart failure is a condition that, well, it happens at any ages.
08:50You know, it can happen from, you know, people can be born with heart failure.
08:55But the majority of the cases we see are people above 50 or 60 years of age.
09:03So, it tends to be developed later in life.
09:06So, Doc, I think when people think of heart failure, they immediately go to heart transplant.
09:10Like, I was just telling you this story about my friend back when we were in our early 20s.
09:14Are there medications that can combat it, slow down heart failure, or is it, hey, at some point you're going
09:23to get that heart transplant?
09:24What kind of medications can help for heart failure?
09:28Right.
09:28Yeah, no, I mean, the vast majority of patients with heart failure will not need a heart transplant
09:33or will not need an artificial heart pump and all that.
09:36That's a really, really minority of patients.
09:41Fortunately, well, first of all, whether you're going to go in that direction or not depends on many, many factors,
09:47including how fast it happens and also what the cause might be.
09:51The most common cause by far of heart failure is atherosclerotic heart disease, which is fancy for, you know,
09:59your blood vessels get full of junk, cholesterol, calcium, and then they get clogged,
10:06and eventually the heart suffers from a lack of blood flow to itself.
10:11You know, while all the blood goes through the heart because it's pumping it,
10:14the heart has its own blood supply to fulfill its needs.
10:19So when these vessels get clogged, then that's by far the most common cause of it.
10:25The good news about that is that, first of all, there are a number of things that you can do
10:29to prevent it.
10:31It's not 100% preventable, but there are a number of things that people can do to decrease the risk
10:36of having atherosclerotic cardiovascular disease, having heart attacks, having coronary disease,
10:42strokes, things like that, which include a healthy lifestyle, a healthy diet, regular checkups,
10:47making sure that the cholesterol is in good shape, exercise is super important.
10:52So all those are things to prevent you from ever having heart failure.
10:58And then if you do develop heart failure because you either develop the more common cause,
11:02which is the satherosclerosis, or you could develop some other cause of heart failure,
11:07which is not associated to that, which can happen.
11:11Then over the last, particularly the last 25 years or so, there are a number of medications
11:18that have what we call in medicine, mortality, or I like it more to call a survival benefit,
11:25meaning that they reduce your chances of dying from heart failure.
11:29They reduce your chances of needing to be hospitalized for heart failure,
11:33and they improve quality of life with heart failure.
11:36While heart failure cannot be cured, it's very rare that you'll see someone that had heart failure and got cured.
11:42We usually, in fact, in the current semantics and definition of heart failure,
11:46once you have heart failure, you have it forever.
11:48But there are a number of things that can be done that include medications,
11:52and in certain cases, devices, particularly for the heart rhythm,
11:57that have that impact in survival, and people can live a long, reasonable life with a good quality of life
12:07for a long time.
12:07But it's on a case-by-case basis because there are, of course, like your friend,
12:11there are cases where you have to go pull the big guns and all that,
12:15and you end up with therapies like a heart transplant or a half-artificial heart,
12:22which is called a ventricular assist device,
12:25which needs to be used in cases of end-stage or advanced heart failure.
12:30Now, when you speak of medications, Doc, is it something where,
12:34hey, you take it for a week, you're good,
12:36or is that something that you're on for the foreseeable future?
12:40And just so that our audience has more of an idea,
12:43is that medication where you're taking it orally?
12:46Is it something where you're giving yourself a shot once a day or every other week?
12:50What types of medications are we talking about?
12:53Yeah, the medication.
12:54So to your first question, usually when you're diagnosed with heart failure
12:57and you get put on medications, the duration is usually indefinite.
13:01So it's not like when you get an infection that you're going to take it for one, two weeks,
13:06or a month or so, and then you complete a course, and then you're done.
13:10And this is more, with very few exceptions, it's usually quite indefinite.
13:15And this is a hard conversation to have because there are patients that really do get better.
13:22They get much, much better.
13:26And the heart function, for instance, from having a low ejection fraction,
13:30it can go back to normal in some cases, which is fabulous.
13:34But we know now from very serious, from very methodical studies,
13:39that if you suspend heart failure medications, there is up to a 50% chance of recurrence.
13:48So unless we have this conversation, particularly with younger patients
13:52that don't want to take medications, which I totally understand.
13:55That's normal.
13:56You know, if I were in my 30s, I wouldn't want to take pills.
13:59So we have this conversation, and depending on the cost,
14:03sometimes we run the risk of stopping medications,
14:07but in the vast majority of cases, we don't.
14:11Now, these, they tend to be well-tolerated.
14:14The vast majority of the treatments for heart failure are pills,
14:17so you just have to get used to taking your pills once or twice a day.
14:21And most pills are just once or twice a day.
14:27And, yeah, that's pretty much it.
14:30And like I said, there are other things that can sometimes be offered,
14:32like they're fancy, we call them,
14:34where they have, of course, official medical names,
14:39but there are things like fancy pacemakers and electronic devices
14:43that can sometimes help the heart that sometimes are implanted that can help a lot.
14:47So when it comes to reaching heart failure, I'm curious,
14:51is it you hit a line that means you have it,
14:53or is there ways to realize, are you heading in this direction,
14:57here's how we can combat that?
14:59And by combating it, is it the good old-fashioned good diet and good exercise?
15:05Yeah, no, that's a great question because, you know,
15:07in fact, it's a little misleading,
15:08but the American Heart Association actually,
15:11basically anyone with risk factors for heart failure
15:14basically categorizes you as stage A heart failure.
15:17But that, you know, even though it's a little extreme,
15:20it does, you know, it's to raise awareness that
15:23if you have risk factors even without having any sort of heart disease whatsoever,
15:27that's where you will need to act on preventing it.
15:30So you have high blood pressure, you have high cholesterol,
15:34if you are obese and your diet's not good,
15:37then you have to, that's the opportunity for you
15:40to prevent any structural damage to the heart,
15:43and those things do work.
15:45And that's why, you know, being conscious, you know,
15:49being aware of trying to live a healthy lifestyle
15:52and also seeing regularly a good primary care physician
15:57to identify these risk factors is really important
16:00because by far the biggest success in a treatment of heart failure
16:05is preventing it or at least delaying it, that's important.
16:10And this is something that's extremely common.
16:12I mean, heart failure happens in, I mean,
16:15there are somewhere in the ballpark of,
16:17I think it's between 8 and 10 million.
16:20I might be wrong with the number, blanking a little bit,
16:23but just in the United States,
16:24there are several new million cases per year.
16:30So it is really quite common.
16:33And half tend to have,
16:34about half tend to have low ejection fraction
16:36and another half to have a completely normal ejection fraction.
16:40So the treatment's different.
16:42So having a good relationship
16:44with your primary care physician is super important.
16:47Now, let's say you go to the doctor's office,
16:50you know, I'm meeting with you, Dr. Ortega,
16:52and you diagnosed me with heart failure,
16:54regardless of where we're at, right?
16:56Am I about to have to go to get a heart transplant
17:01or you're saying, hey, this is a risk that you're at?
17:03What kind of exercises can make the heart stronger?
17:07Even though I've already been diagnosed,
17:08is it I have to go out there and do wind sprints,
17:11you know, a hundred times a day,
17:12or is it as simple as just walking?
17:14Yeah, you know, it's honestly,
17:17I think that that question,
17:18I would answer it in two ways.
17:19One is a more regimented thing to answer it and say it,
17:23but the other one is a real life.
17:24You know, when I see patients,
17:28I always tell them, look,
17:30physical activity is important,
17:32it's very important,
17:32even in patients with heart failure,
17:34but do whatever you enjoy doing,
17:37because if people don't enjoy doing whatever,
17:40if you hate the gym,
17:41then you're not going to go to the gym.
17:42So most people walk,
17:44but people sometimes enjoy doing other things,
17:47like doing laps in a pool,
17:48some people do like the gym,
17:51things like that,
17:52going out in the woods, whatever,
17:54you know,
17:56as far as what helps,
17:57you know,
17:58a combination of aerobic and strength exercise is probably what I'd say the most.
18:02I mean,
18:02you definitely want to strengthen those muscles.
18:05So doing some,
18:06some weights and all that is beneficial,
18:08but also doing what we understand as cardio,
18:10right?
18:10Walking,
18:11perhaps like jogging or whatever you can,
18:14you can jog or bicycles,
18:16swimming,
18:17things like that.
18:17So a combination is usually what,
18:20what would probably bring the most,
18:24the most benefit.
18:25But again,
18:26I wouldn't be too strict about what to do other than doing it.
18:29That's why I just tell my patients,
18:30look,
18:30do whatever,
18:31whatever you enjoy doing with the sole purpose that it,
18:34because it has to be consistent.
18:36I mean,
18:36it's like,
18:36it's like back to your question about how long are the medications going to,
18:39uh,
18:40to be needed.
18:41Uh,
18:41physical activity is also indefinite,
18:43right?
18:43We don't recommend physical activity for a week.
18:45We recommend this forever for as long as you can do it.
18:48Um,
18:49uh,
18:50so that's why it's important to enjoy it and just make it part of your life.
18:53I love that.
18:54I think that's a beautiful message.
18:56Find something that you enjoy and the beauty of having you in this gigantic resume that I have in front
19:01of me.
19:02Uh,
19:02when you speak,
19:03I listen,
19:04I hope everybody's been listening close to this.
19:06What words of wisdom do you have about maintaining your heart function?
19:09You know,
19:10you just mentioned it doing,
19:11finding things that you like to do,
19:13but I also always know that there's people that go,
19:16what am I going to stop drinking now?
19:17Or what do I,
19:18what do I have to stop eating the red meat now?
19:20I know you still want to live your life,
19:22but,
19:22but what words of wisdom can you give somebody that might be on the verge of heart failure,
19:26or maybe they've just been diagnosed,
19:29but they're trying to find ways to extend their life.
19:31Yeah.
19:31I mean,
19:32you need to choose,
19:32you know,
19:33you need to choose which risk you're willing to take.
19:35There are certain things that we absolutely recommend stopping no matter what.
19:38The classic one and the obvious one is smoking,
19:41right?
19:41There's no,
19:42there's no safe degree in smoking.
19:43So our general recommendation across the board in cardiology is you should stop smoking.
19:48But of course,
19:48other questions do come up like,
19:50you know,
19:50my,
19:51my,
19:51my occasional beer or glass of wine or cocktail or whatever.
19:56And then,
19:56that we know we,
19:57we have a dedicated conversation with patients and we tell them,
20:00look,
20:01there's no,
20:01talking about alcohol in particular,
20:03there's no safe level of alcohol for the heart.
20:05You know,
20:06there's no,
20:07you know,
20:08the reality,
20:08as much as we'd like it to be the daily glass of wine,
20:11that's supposed to be beneficial.
20:13Unfortunately,
20:13as much as we keep trying to,
20:15to prove that true,
20:17the reality is that it's not there.
20:19So you need to be able to,
20:20um,
20:22to,
20:22to pick your risks.
20:23You know,
20:23how much do you value that play,
20:25that pleasure that's given to you by that drink versus the risk that you're carrying it.
20:29There are conditions in the heart.
20:31In fact,
20:32there is a condition called alcoholic harmopathy,
20:34which this conversation is a lot more strict.
20:36And when we say,
20:37you should not drink at all.
20:38So,
20:39so,
20:39so there are a specific subset of patients in which we recommend not drinking at all.
20:44In general,
20:45we also say that drinking is not in your favor.
20:48There's absolutely no benefit.
20:50And there is a potential for risk of reducing your,
20:52your healthy life years or your life in general by,
20:55by drinking alcohol.
20:56The same,
20:57the same goes with activity.
20:58You know,
20:59the amount of activity you can do,
21:01diet and red meat,
21:02you know,
21:02we know that red meat's not great.
21:04Should we say no red meat at all?
21:06Well,
21:06probably not,
21:07you know,
21:07having your occasional steak or burgers is probably fine,
21:10but you probably shouldn't be having steak dinners every day.
21:13Uh,
21:13and again,
21:14it's,
21:14it's a matter,
21:15you know,
21:16we,
21:16that's why,
21:17you know,
21:17we sit down with patients,
21:18we shut the door and we have very,
21:20uh,
21:20conversations about the very specific situation.
21:23Uh,
21:24for some people,
21:25that's very important for some people.
21:27When we tell them,
21:27look,
21:27you shouldn't eat red meat.
21:29They're like,
21:29I don't care.
21:29I don't even eat it anywhere.
21:30So,
21:31so,
21:31so it's,
21:31so it's very personal.
21:33Uh,
21:34and it's sort of about how much risk you're willing to,
21:36you're willing to take.
21:37Uh,
21:38and,
21:38and in general,
21:39you know,
21:39a small amount of red meat,
21:41um,
21:42a small amount of alcohol per month is probably not going to make a big difference.
21:47Uh,
21:48I love that.
21:49With exceptions,
21:49of course,
21:50but yeah.
21:50Yeah.
21:51I look at your messaging throughout this entire interview.
21:54I've been fantastic.
21:54Dr.
21:55Ortega,
21:55thank you so much for your time.
21:56If you want more information on everything,
21:59when it comes to heart failure and really anything with the team at Virtua,
22:02that they can offer you again,
22:03I've been doing this for a couple of years now on a monthly basis,
22:05speaking to different members of the Virtua team.
22:07And I've learned so much.
22:08I hope that you've learned a lot as well.
22:10Just go to Virtua.org slash heart care.
22:13That's go.
22:15Virtua.org slash heart care for more on heart care,
22:18more heart failure.
22:19But if you just go to Virtua.org,
22:21any sort of questions that you have,
22:22you'll be able to find the answers to Dr.
22:24Ortega.
22:24Thank you so much for the time today.
22:26I appreciate you.
22:28My pleasure.
22:31We'll see you next time.
22:32We'll see you next time.
22:33We'll see you next time.
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