By Dave Gardner
America’s men may be their own worst enemy with heart health, but they also are benefiting from advancements in cardiac science that resembles technology from science fiction.
Men are often resistant to reporting heart symptoms and their compliance with physician instructions may lag, but all patients are enjoying superior diagnostic technologies such as MRI movies of blood flow within the heart. Genetic scientists are also “reading” individual DNA codes that identify higher risk factors for cardiovascular disease, which may avoid cardiac events.
On the treatment front, cardiac electrical problems that cause atrial fibrillation can now be treated by a technique known as ablation. During this procedure physicians heat or freeze problem tissue in heart with a catheter inserted through an artery, thereby curbing the troublesome electrical impulses.
Through related technology, pacemakers have been reduced to the size of a coin and may include a monitor that activates the device only when it is needed. External vests can also be used by a patient after the heart’s electrical system malfunctions. Stents placed through arteries in the wrist or groin to open blocked heart arteries are bio-absorbable and have a medicated coating to prevent further blockage at the site, and heart valve implants are accomplished through an artery without open heart surgery. This exciting procedure, known as transcatheter aortic valve replacement (TAVR), uses a collapsible valve that expands when in place and presses the malfunctioning natural valve against the sidewall of the heart.
Big news also marks physician efforts to lower patient harmful cholesterol, known as LDL. This involves the administration of new drugs, known as PCSK9 inhibitors, that work by inactivating a specific protein in the liver and requires only a simple injection in the thigh twice a month.
For the cardiologist, men can still be frustrating to diagnosis. David Fitzpatrick, M.D., cardiologist with Great Valley Cardiology, confirms that both sexes can benefit from the new global cardio technology, but men may avoid contacting a physician even though they are experiencing classic cardiac symptoms such as pressure or tightness in the central or left chest, neck or arm discomfort, shortness of breath, nausea and sweating.
According to Fitzpatrick, diabetes can also cause heart problems to be “numbed” because the associated nerves which would communicate symptoms to the brain have been blunted.
“Anyone can present with a silent attack, but diabetes is frequently behind a lack of symptoms,” Fitzpatrick said. “From the standpoint of risk factors, smoking still tops the list, but diabetes from obesity is definitely a problem.”
Compliance in post cardiac event patients is another problem, with men making up a large percentage of those patients who do not follow the instructions of their cardiologist. Fitzpatrick explained his caregiving team emphasizes the importance of proper compliance after surviving an event and the caregivers seek to motivate the patient to exercise and consumer a healthier diet.
“Some patients do change their ways, but various degrees of compliance exist and most patient behavior involves various shades of grey,” he said
Alfred Casale, M.D., cardiovascular surgeon and chair of the Geisinger Heart & Vascular Institute, said many men may hesitate to seek care despite the onset of classic heart attack symptoms. For these men, their responses may include only taking an antacid because they believe they are still physically bullet-proof.
“Martyrdom is really an over-rated behavior,” Casale said. “Pseudo-bravery kills.”
He urges anyone with cardiac symptoms considering calling an ambulance to do it. Medical science can only fix what it becomes aware of and even though death from heart attack used to happen 25 to 30 percent of the time, survivor numbers are now booming.
Casale emphasized that because of the recent boom in cardiac science, no single physician can keep up with all of the progress. Therefore, a team approach has become the norm, as input is attained from various cardiac specialists.
“Often one clear-cut treatment approach will emerge,” said Dr. Casale. “In other cases, where multiple possibilities exist, the patient must make decisions about which path to follow.”
When it comes to training tomorrow’s physicians to handle cardiac problems, student time spent in clinical interaction with patients is vital, according to Sridhar Sampath Kumar, M.D., assistant professor of medicine with the Geisinger Commonwealth School of Medicine. Substantial practice is needed for a physician to effectively learn how to recognize a patient’s body language and detect subtle clues to disease.
“It takes years to hone these observational skills,” Kumar said. “Just because a patient is in the office does not necessarily mean they have a cardiac problem. Anxiety, depression and poor coping skills can mimic heart problems and male patients are definitely included in this.”
He also described how women, as a group, participate in more physician visits than men, and often serve as the catalyst to nudge a male into a doctor’s office. When this happens, the physicians receives an opportunity to make an intervention, but must act like a friend of the patient and definitely not a superior.
Controllable risks may become the focus of the patient and physician interaction, as the doctor helps the patient understand the realities of their situation. By time they are 50, many men have been long-term smokers and may have diabetes due to obesity.
When heart disease has been established, the cardiologist’s goal is to reduce the progression of the disease. In the case of openly self-destructive patients, the physician must recognize that root problems are at work and then play the role of psychologist to identify problems with work, spouse, children or possibly parents.
“It’s not always easy to achieve patient compliance,” Kumar said. “If we ask a patient to give up red meat, it may come down to simply telling them they’re not 19 years old, not still growing and don’t need all of that protein.”