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Welcome to this

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next installment of

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Live Well with UCI Health.

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I'm Ryan Manno from KOST 103.5

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and iHeart Radio.

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Today

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we're putting the heart

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in iHeart Radio.

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I would like to welcome Doctor

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Ailin Barseghian

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and board-certified

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cardiologist here at UCI Health.

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Welcome. Thank you.

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Thank you for having me.

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It is lovely to meet you.

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And I want to just

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I want to come up like straight out

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and just front load it

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with some really with

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some really intense facts

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that I didn't know until we sat down.

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Heart disease, the number one

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killer of men and women

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in the United States.

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That's right.

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Listen to this.

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Every 40 seconds someone in the U.S.

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has a heart attack.

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Every 40 seconds. Every 34 seconds

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someone dies of

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cardiovascular disease.

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I know it affects men

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more than women.

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We're going to talk about both.

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Let's just start with

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what are the symptoms

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of a heart attack?

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Most of the time, classically,

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we think of the chest

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tightness, chest pressure,

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elephant sitting on the chest.

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Radiating to the arm.

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But oftentimes

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that might be a description for men.

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But for women it could present

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not only as chest pain

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but sometimes just jaw

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pain or back pain.

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Neck fullness.

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And these are very atypical symptoms.

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The other

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non typical symptom is indigestion.

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Now typically if you eat

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and you have heartburn

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30 minutes after a meal,

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that's probably real indigestion.

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But if you have indigestion

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after exertion

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that might be a red flag

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for a heart disease.

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That's really good to know.

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Yeah,

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and sometimes there's

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extreme fatigue.

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And nausea

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can also be

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a presenting symptom for women. Yeah.

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Why is that not more widely known?

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Because you do.

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Like you said,

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you only think about,

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like, the arm, right?

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Like it's just kind.

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Yeah.

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We discover these things

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when we have research

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that includes a broad

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spectrum of people, including women.

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We realize that the symptoms

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presentation are different,

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but we have to study them

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to really pick up on these cues.

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Yeah.

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Are you finding

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that heart disease

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is becoming more common in women

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then than it was ever before?

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Heart disease has been prevalent.

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What's different about heart

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disease in women

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is that we're protected

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up until menopause.

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After menopause,

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we catch up to men in terms of the

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amount of heart disease

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that affects women as it does in men.

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Why? Why is that?

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That's fascinating.

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Yeah, estrogen is protective.

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It keeps our vessels pliable,

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keeps good

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cholesterol up

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and bad cholesterol down.

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It keeps blood

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glucose in check

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and insulin resistance at bay.

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But once

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perimenopause or menopause

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hits, estrogen declines.

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And so now we have

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a risk of stiffening

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of the heart vessels.

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We have an increase

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in bad cholesterol LDL.

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We have a decrease

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in the good cholesterol.

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There's an increase in belly fat,

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which is visceral fat

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and visceral fat

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has been described

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as metabolically active,

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which means it's inflammatory.

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And that's a risk factor

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for heart disease.

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Yeah. So, things change.

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When estrogen declines.

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That is interesting.

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Okay.

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So what,

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what questions should

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someone that's

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watching this right now

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that, you know,

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I don't know if it's

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runs in the family

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or they have concerns.

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What questions

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do you think are good to start with?

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You go to your primary care provider.

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Right.

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Like what do you

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what do we want to know?

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Well, I think asking

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those questions are so important.

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Ask your primary care provider

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what is my risk of heart disease?

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Am I at

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increased risk

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because of a family history?

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You can ask them,

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is there any testing

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I could do

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to check for early buildup of plaque

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or atherosclerosis?

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And if you have any symptoms

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like shortness of breath

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with exertion or chest

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tightness, chest pressure,

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ask what tests

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you can do to get those assessed.

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If you smoke,

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ask for ways to help you quit.

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That's very valuable.

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There are a lot of resources

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for this.

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If you're thinking about conceiving

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or pregnancy, we've identified that,

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maybe we're not risk stratifying

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patients who are becoming pregnant

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and they're going into pregnancy

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with high risk features.

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And ask your doctor,

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what are my risks

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when it comes to pregnancy and

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what can I do to improve them? Yeah.

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What are,

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the biggest risk factors

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for cardiovascular disease?

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High blood pressure,

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high cholesterol.

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Diabetes, smoking and family history.

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These are the main five.

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There's additional

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risk enhancing factors,

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but these are the ones

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we focus on primarily.

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What is, microvascular disease?

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Microvascular disease is an area of,

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interest of mine.

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So there is an entity of angina

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or chest pain

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that comes from the heart,

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but it's not from the typical heart

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arteries that form plaque.

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These are the tiny little blood

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vessels that go inside

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the heart muscle.

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And when they don't provide

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enough blood

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flow to the heart muscle,

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you get chest

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pain and chest tightness,

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just like you do

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when the big arteries clog.

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So we are looking for ways

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to identify

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this type of heart disease.

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And we do that

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through specialized testing.

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Particularly at UC Irvine,

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we do the specialized testing,

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but just recognition

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that if don't stop at

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just looking for blockages

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in the big heart vessels,

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if you have persistent pain,

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and sometimes this pain just goes on

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for months or years

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and never gets identified,

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we want to look for other causes.

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Do you find that a lot of,

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patients that, you know, end up

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having something

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wrong, a delay coming

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to, to get tested?

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In fact? Yes, absolutely.

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Women in particular.

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Why?

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They're looking for the typical chest

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pain symptoms that we put out there.

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Chest tightness

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radiating into the arm.

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But with these non-standard

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chest pain

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or atypical symptoms,

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there may be a denial in that

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their symptoms

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are coming from their heart.

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And so there's a delay

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in seeking care.

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And that is one of the major

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delays in the care in women

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and also in elderly and diabetics.

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They also have

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atypical presentations.

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But once you hit the door

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in that emergency room

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and we suspect

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you're having a heart attack,

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we are working

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really hard

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to get you to a cardiac cath

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lab to do an angiogram and open up

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that blood vessel within 90 minutes,

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because time matters.

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Yeah, and the preserving

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heart muscle matters.

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You mentioned the testing part of it.

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Can you talk about what

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that testing entails,

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like the testing

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you guys do here at UCI health?

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Like what?

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What is it? What is the test? Sure.

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If, we always start with a history,

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getting a proper history

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and really seeing

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if there is elevated

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concern for heart blockage

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and if there is

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a pretty standard test,

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is this is a stress test

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and that comes in

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different modalities,

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but the appropriate

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stress tests for you.

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And of course, if that's abnormal

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the next step is the gold standard

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which is a cardiac catheterization

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to look for a heart blockage.

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So let's say we do that test

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and there is a heart blockage.

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Then we would put a stent,

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which opens up the blockage.

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But if we're really convinced

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you're having

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chest pain from the heart

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and we don't see a blockage,

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then we can move on

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to that additional testing

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that we do

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to look for things

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like microvascular disease

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or vasal spasm

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of the heart arteries.

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These are all

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causes of

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angina or chest pain,

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but not due to obstruction. Yeah.

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I work with a

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there's a guy that works on our show.

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He's like a hypochondriac, I think.

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I don't know,

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but he's always talking about, like,

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I feel like I'm shaking and,

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you know, it's like, symptom.

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And then I go and wait, does my,

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you know, it's like.

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Like it's a weird thing

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sometimes if you get in your head

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about it, too,

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you're like,

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I should go get checked,

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but I think everyone should go

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get checked if it's a concern. Yes.

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I think,

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one way I, I advise patients is

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if you go for a walk and go

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exert yourself

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and you feel good

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or better, it's

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probably not coming from your heart.

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Okay?

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Because the way we check for heart

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related

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pain is by

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getting your heart

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rate up on a treadmill, for example.

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So if you can exert yourself

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and your pain is improved,

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it's probably a good sign.

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Okay, so that's a great tip.

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That's really fascinating.

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What kind of care

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do you guys offer here?

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At UCI Health?

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You know, that

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that other that other places

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don't or can't,

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you know, as an academic center,

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we have a wide spectrum of

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not only specialists, but programs.

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So we can treat

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patients from advanced heart failure

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to cardio obstetrics,

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which is in partnership

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with our ob gyn.

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So that's very related

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to women's heart health

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as well as integrative cardiology,

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preventive cardiology.

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And we partner

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that up with our research.

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We have cutting edge research.

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We have innovation incentives.

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We look for the latest tools

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and the best treatments

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that are out there.

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Yeah.

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Give to our patients I love that.

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Let's talk about prevention.

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What can people do to obviously

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not smoke. Right.

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but what other things can

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someone just do day to day,

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you know, to

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get ahead of it?

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The easiest thing

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that I've learned is,

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making a healthy choice

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every time you're faced

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with a choice.

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Oh, my God. Yes.

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Look, you have two choices.

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You know, you've got the vegetables

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or the fried food.

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Take that vegetable

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over the fried food.

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Just make those simple steps,

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make healthy decisions every day.

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And, we always recommend,

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regular exercise, moderate intensity,

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at least 30 minutes a day,

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five days a week.

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That is an American Heart

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Association recommendation

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and widely,

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recommended.

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Also, it's important

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to know your numbers,

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know your blood pressure,

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know your cholesterol numbers,

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your glucose numbers.

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So once you quantified these

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and you put a label on them,

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I think it's easier to work

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towards improvement.

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Of course.

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If you're overweight

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or obese, weight loss is recommended.

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And then the rising concerns

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are things

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like better sleep

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reduction of stress,

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which are bigger things to battle.

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But, definitely

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something to keep an eye on.

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Yeah, the sleep

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and the stress are probably the

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Yeah, like the hardest ones

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to control, right?

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You can eat the vegetable,

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but you know, if you're stressed

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and not sleeping.

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That's right.

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And again, labeling these things

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and recognizing the stress

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at least lets you work on it.

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Sometimes we're just not aware

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as someone in your position,

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how do you eat?

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Like, how is your heart?

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I'm serious.

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Do you do like,

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do you take extra

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good care of your heart?

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I really do my best.

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I check my cholesterol regularly.

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I try to make healthy choices,

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but I'm not perfect.

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I think that's the difference.

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Is that

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I'm constantly

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trying to learn ways to get around

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sort of the mental pressures

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to make bad choices.

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Yes.

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And so,

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so it's hard work, but,

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I try to live a healthy life

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and that's just

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important to do.

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Yeah.

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Because you see everything. Right?

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So you see it, I see everything.

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And to be honest,

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sometimes I'm just wondering,

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what do my arteries look like

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when I see.

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Yeah, when I do a procedure

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of cardiac cath or.

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Yeah, get a test done.

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Let's talk about

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familial heart disease.

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Just a quick, story.

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One of our colleagues,

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our coworkers,

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his mother

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passed from a heart attack, at 41.

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He was eight. He's become

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very passionate,

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we'll say,

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to make sure that his heart

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is not at that same risk.

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Gone through so many tests.

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But what about somebody

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who's not doing all of that?

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What are some things to know

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about the familial risk?

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The definition

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for premature

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heart disease

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in the past

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has been considered

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any male family member

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that had a heart attack

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at less than 45 years of age,

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or any female family member

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first degree relative

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that's had a heart attack

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under 55 of age.

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Okay, so 45, 55, 45, 55

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so if you have those,

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parameters in your family,

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then we recommend early assessment

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for heart disease.

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That being said,

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if there's a first degree relative,

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a male, for example,

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a brother or a father

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that's had a heart attack

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at less than 55 years of age,

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or a female less than 65 years of

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age, I would consider that,

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to be on high alert.

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Okay, we already know what to do.

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So same things,

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that you could do

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is make sure you've

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had your cholesterol

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checked, your blood pressure checked,

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and there are imaging modalities

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that can be done.

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For example,

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a coronary calcium score has been

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well validated to risk stratify

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a patient into either low, medium

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or high risk.

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And this is a CT scan.

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It's a very quick CT

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scan of the chest

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looking for calcium

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in the heart arteries,

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which is a surrogate

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or a marker of heart plaque buildup.

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And if you have the presence of that

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it essentially just means

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that you would treat

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your risk factors

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more aggressively

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and perhaps get on cholesterol

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lowering therapies earlier.

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And this test has been validated

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for those 40 and above.

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So if you're 40 and above

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and you have a family

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history of early

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heart disease,

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consider discussing that

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with your primary care doctor.

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Really good.

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Thank you so much Doctor Barseghian.

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We appreciate the time. Thank you.

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Thank you so much for having me.