Podcast: A cardiologist answers: Can stress kill? | Novant Health

Dr. Frederick Meine III will ask his sufferers what their stressors are to allow them to work on decreasing stress or figuring out wholesome coping methods, resembling rising train.

On this episode of Significant Medication, Dr. Meine explains the hyperlink between stress and coronary heart well being, and methods to cut back danger components of growing coronary heart illness. Dr. Meine, an interventional heart specialist with Novant Well being Coronary heart & Vascular Institute, additionally talks about therapies for coronary heart blockages.

Dr. Mike Smith (Host): Welcome to Significant Medication, the Novant Well being Podcast that connects you with high docs, docs desperate to reply the questions they need you’d ask. I am Dr. Mike. And right this moment, I’m joined by Dr. Frederick Meine, an interventional heart specialist at Novant Well being in Wilmington. Collectively, we’ll discover the compelling query, “Can stress kill?” And focus on the hyperlink particularly between stress and coronary heart well being? Welcome to the present.

Dr. Frederick Meine: Thanks for having me, Mike.

Host: I feel most individuals are aware of the concept, in case you have a household historical past of coronary heart illness, proper? Strokes, coronary heart assaults, what have you ever, there’s elevated danger there. I feel most individuals perceive that. However docs like your self usually speak about modifiable danger components. Might you focus on what which means, and what are these type of danger components for coronary heart illness?

Dr. Frederick Meine: Certain. So, I all the time inform sufferers once I see them within the workplace which you can’t do something about who your mother and father are for good or for unhealthy, however there’s an terrible lot of different issues in our lives that contribute to your coronary heart well being, each good and unhealthy, and people are the issues that you simply actually bought to give attention to.

And most of them are issues that all of us type of behind our thoughts know we do not essentially wish to cope with, however we all know. I imply, as simple as realizing what your blood strain is, realizing what your ldl cholesterol is, and treating your ldl cholesterol if mandatory, treating your blood strain if mandatory, realizing what your blood sugars are, and whether or not you are in danger for diabetes or whether or not you’ve diabetes. And people are those which can be actually fairly simple and straightforward to placed on paper.

I feel those which can be somewhat harder for us are the softer ones, the extra amorphous ones. Issues like how usually do you train and how much train do you do? How do you deal with the stress that you simply simply talked about a couple of minutes in the past. These are those which can be somewhat bit harder, as a result of they are not as simple to place down on a chunk of paper, like, my ldl cholesterol is 220, however they’re each bit as vital and their each bit is modifiable in the case of controlling your coronary heart well being and ensuring that all of us reside to a ripe previous age.

Host: Yeah. So, we’ll be speaking about stress particularly, and that is one of many modifiable danger components. However as you stated, I imply, who would not have stress? How do you actually rank that stress? How does that actually affect coronary heart well being? So we’ll speak about that stuff. However the title of this present right this moment is “Can Stress Kill?” Let me ask you, can stress kill?

Dr. Frederick Meine: Completely. Not solely can, however does. And there is a bunch of various ways in which it does that. And I feel the best manner to consider it’s that whenever you’re pressured, you’ve the identical type of struggle or flight response. And ask your coronary heart to do issues that it should not in any other case need to do. It has to go sooner, it has to pump more durable, it has to work more durable. And all of these issues over time contribute to extra stress, pressure in your coronary heart. And in these methods, definitely stress can and does kill. I feel that is the unhealthy half, the unhealthy information for all of us, proper? As a result of as you stated, everyone has stress.

I all the time joke about household mates I do know. The husband is an funding banker in New York and the spouse’s a yoga teacher, and so they argue each time I see them about which one has a extra disturbing job. So, I do not assume it is essentially solely disturbing jobs which have stress. All of us have it, proper? That is, as I stated, the unhealthy information.

The excellent news is all of these issues that lots of people do to alleviate stress can really not solely relieve stress however can relieve different strains in your coronary heart as effectively. I imply, I feel everyone would agree that getting out and doing a little type of train outside is a stress reliever. And as well as, it type of works double to lower your coronary heart danger. So, I all the time inform individuals, I am unable to inform you methods to lower your stress. Solely you’ll be able to inform me what issues you are able to do to lower your stress. However I assure you, we will all discover issues that lower your stress which can be good in your coronary heart.

Host: No, that is incredible. So, exercising helps each. That is a simple one, proper? Get outdoors each day as a lot as you’ll be able to. Earlier than we dive into somewhat extra element right here, I do wish to speak about extra of that affiliation although between stress and coronary heart well being. How sturdy is that affiliation? Is there quite a lot of proof that stress may very well be unhealthy for my coronary heart within the literature?

Dr. Frederick Meine: A whole lot of proof, and truly we see it a pair alternative ways within the cardiovascular realm. One, we see precisely what you talked about, type of what you alluded to, is the type of extra persistent, long-term strains from stress, each with rises in catecholamines and rises in adrenaline and all these issues we see that trigger improve in coronary heart charges and improve in coronary heart work. And there is excellent proof that that stress contributes to untimely coronary heart illness.

There’s additionally rising proof for a extra acute episode, one thing referred to as takotsubo cardiomyopathy or damaged coronary heart syndrome, which is increasingly more widespread yearly. And it is an acute occasion the place you find yourself with very decreased coronary heart operate and also you really assume you are having a coronary heart assault. And it usually comes from a really acute onset stress, just like the loss of life of a cherished one or the loss of life of a household pet, or a home fireplace or one thing that places excessive stress on the center all at one time. And we’re seeing that increasingly more over the previous few years. It was described about 20 or 30 years in the past in Japan within the first, and that is why it had type of an attention-grabbing identify. It is the Japanese identify for an octopus entice, imagine it or not, as a result of the center takes on the form of this ceramic octopus entice referred to as takotsubo. That is an acute manner that we see stress on the center inflicting decreases in coronary heart operate. However as you stated earlier than, there may be actually good proof that long-term stress causes elevated coronary heart assaults and elevated stress on the center.

Host: What precisely is occurring although? What’s it concerning the stress response itself, particularly the persistent stress we cope with that is impacting the center? Is it the adrenalines and is it irritation? I imply, what’s really happening, do you assume?

Dr. Frederick Meine: I feel quite a lot of it’s simply what you stated. It is these chemical compounds that we excrete, these struggle or flight chemical compounds, adrenaline, you talked about, that actually are asking your coronary heart to do one thing that they are not designed to do long run. that your coronary heart will not be designed to be underneath that quantity of chemical stress for prolonged durations of time. And from that standpoint, the extra we will do to type of calm all the physique to be able to calm the center is basically useful.

Host: Yeah. So if anyone comes into your workplace, they’re displaying indicators of some coronary heart points, no matter which may be. And you’ve got already type of checked out, you understand, blood strain, that type of ldl cholesterol, perhaps it is being managed, however they’re nonetheless having points. When do you begin occupied with stress in that affected person, like perhaps there’s stress right here that is driving quite a lot of the problems?

Dr. Frederick Meine: So, yeah, I feel that is a very good level. After we speak about issues from a cardiac standpoint, there’s acute issues and there is persistent issues, proper? So, the very first thing you wish to do is you wish to just be sure you deal with the acute issues. Does the individual have an acute coronary heart artery blockage that we have to care for earlier than coping with persistent circumstances? And also you already talked about a few of these persistent circumstances.

However actually, it begins from minute one coping with stress. There’s actually good proof, for instance, submit coronary heart assault sufferers that melancholy and stress trigger worse outcomes. So, the identical coronary heart assault that two individuals have, certainly one of them has melancholy or nervousness the opposite one would not. The individual with the melancholy or nervousness really does worse, each brief and long run. So, as soon as we get previous the acute section of caring for coronary heart issues, when you get previous, for instance, the acute coronary heart assault, it is actually, actually vital that we deal with these extra persistent issues, not solely the hypertension and the excessive ldl cholesterol that you simply talked about, however the psychological issues like nervousness, melancholy are each bit as vital. The exhausting half for us as cardiologists is that that takes somewhat little bit of everyone, proper? That is the place your main care doctor, or your therapist, or your strolling associate, or your canine, or your husband or spouse, are each bit is vital in managing your stress as I’m.

Host: Yeah. Superb.

Dr. Frederick Meine: So, it is really– I do not wish to say it takes a village, however it takes a village.

Host: No, I like that. I feel quite a lot of, the stress, the persistent stress that we regularly really feel, it is not only one factor, proper? There’s a number of issues occurring in our lives, a number of individuals, a number of interactions. And I feel if that is the trigger, the answer’s usually going to be a village to assist with that. So, we type of already hinted at your reply to this query, however I’ll ask it in any case. What do you suggest for individuals to cut back stress?

Dr. Frederick Meine: So, I feel the very first thing I ask individuals is what’s your stressor, proper? and in a number of the circumstances, it is one thing that is momentary, and it is already going to get higher by itself, proper? And in some, you’ve got bought a sick member of the family at residence and that individual’s recovering and also you’re having to assist care for them for six weeks. And as that will get higher, you imagine your stress goes to get higher.

However I feel the toughest half for me has all the time been making individuals type of work out for themselves what their stressors are, as a result of lots of people have by no means actually thought through– and also you and I are most likely the identical way– we’ve on a regular basis stressors that we simply consider as a part of life, proper? However the query is what are they? If mandatory, put them down on paper and say, these are the 5 issues that the majority stress me each day. A few of them are utterly reversible, proper? Like I’ve bought that annoying coworker that I simply have to relocate my desk to the opposite a part of the constructing. And a few of them are usually not as simply eliminated, proper? I haven’t got sufficient time to train each day. After which, I like to take a look at these issues and say, which of them of these issues are really modifiable? That means which of them can we make higher, you understand? Should you inform me your stress is that you simply’re getting older, I’ll inform you, I am unable to make you not become old, proper? Should you inform me your stress is, I am getting older and I haven’t got as a lot time to go stroll the canine each afternoon as I did earlier than, then we sit down and speak about what we bought to do to seek out you 15 extra minutes each afternoon to stroll the canine, proper? So, it is lots about with the ability to acknowledge what your private stressors are and why they’re the best way they’re. Is it simply that you simply agreed to have a 5:30 assembly each afternoon at work whenever you used to go work out? And what we have to do is work out methods to make that assembly both not occur or be quarter-hour shorter. Or is it that it actually is not modifiable? After which, we have to consider coping methods. And once more, it is not one thing that your heart specialist goes to resolve for you, proper? It should be that that your heart specialist may also help you determine what they’re. However every certainly one of us wants to determine not solely what they’re, however how we handle them. And it would not all the time imply make them go away. It means handle them.

Host: Proper. Modifying them in such a manner the place perhaps they are not so disturbing. One thing like that. I’ll change subjects just a bit bit right here as a result of I am curious. And I feel quite a lot of different viewers listeners are too. What precisely is the position of an interventional heart specialist?

Dr. Frederick Meine: Certain. So, Cardiology has a bunch of various subsets. So, with out getting too deep into coaching, after faculty, you go to medical faculty. After medical faculty, you do inside drugs for 3 years. After which, you do three years of common cardiology and that qualifies you to do see sufferers, do cardiology points, learn echocardiograms, do stress checks, even do coronary heart catheterizations.

Past that, there’s extra coaching you are able to do in quite a lot of totally different fields in cardiology. One in every of which is, as you talked about, interventional cardiology. It is usually an additional 12 months, and to be quite simple, it is doing balloons and stents for occluded arteries. So, I spend about half of my time in a cardiac catheterization lab the place we do coronary heart catheterizations, angiograms, after which open up occluded or blocked arteries with balloons and stents. And that usually takes an additional 12 months of coaching past common Cardiology.

Host: Now, do most interventional cardiologists nonetheless observe simply the essential cardiology too, or is that this simply your focus?

Dr. Frederick Meine: So for me, it is about 50/50 and that is type of normal within the nation. Only a few of us are within the cath lab all day, each day. For many of us right here at Novant and across the nation, it is a couple of 50/50 combine. So, I am in clinic about half the time and within the cath lab about half the time.

Host: So whenever you speak about occluded arteries, all that type of stuff, what does that imply to the listener? Like, so what are these circumstances that you simply’re treating?

Dr. Frederick Meine: Certain. So, the obvious one is coronary heart assaults, proper? So, you’ve a coronary heart assault from a very blocked artery. You come into the cath lab emergently. We do a coronary heart catheterization, we discover a blocked artery, and we open it with balloons and stents. As well as, we’ve people who find themselves not fairly to the extent of coronary heart assault but the place they have {a partially} blocked artery and so they’re having chest ache, what we name angina, proper?

So, they’ve chest ache with exertion. They see their physician who sends them to their heart specialist. Their heart specialist does, for instance, a stress check and finds the concern that they have {a partially} blocked artery. After which, we do a coronary heart catheterization, discover an artery that is partially blocked, and we open that to alleviate their signs.

Host: Yeah. That is actually fascinating, I feel, for lots of people. Your huge selections are you’ll be able to place stents in to open up these arteries, proper? Or there’s additionally what everyone most likely has heard bypass surgical procedure. How do you resolve between a stent and one thing that is way more invasive, like bypass surgical procedure?

Dr. Frederick Meine: Certain. Nice query, and I am going to put a 3rd class in there, which is you’ll be able to have {a partially} blocked artery and be capable of deal with with medicines alone, proper? So after we do a catheterization, you are pondering, does this individual want medicines solely? Does this individual want medicines and a stent? Does this individual want bypass surgical procedure?

They’re totally different, and I am going to take these type of individually. Medicines versus stent has traditionally been type of how severely an artery was blocked. And that is all the time been type of a troublesome transferring goal in cardiology, as a result of it is a very subjective eyeball measure. I have a look at an artery and I say, oh, it seems to be 90% blocked, it wants fastened. And that is all the time type of bothered us in drugs, primarily as a result of most of us are very type of scientific individuals who do not just like the subjectivity of that.

Over the previous 5 to 10 years, we have developed very goal measures within the cath lab the place we will inform for positive if an artery is healthier handled with opening it a technique or one other versus medicines. Particularly, we put a wire simply as if we have been going to stent it, simply as if we have been going to repair it. We put a wire down previous the blockage and we measure the share of blood circulate that that narrowing takes away from the artery. And simply for instance, we put a wire down. And if a narrowing takes away greater than 10% of the blood circulate previous that space, then we all know that you’re higher off and prone to reside longer with stenting than you’re with medicines alone.

So, that is actually been an exquisite change within the cath lab since I began doing this 20 years, some odd years in the past, that we have gone from a really subjective measure of, I am a health care provider and I am fairly positive that that wants fastened, to with the ability to say, I’ve very, very clear proof that if I repair that artery, you are going to be higher off than if I depart it alone.

The query between stents and bypass surgical procedure has traditionally been when you’ve blockage in a number of arteries that may not be as effectively suited to stents. That is been a transferring goal as effectively over the previous few years. As stents have developed and grow to be higher and higher, we’ve extra potential to stent extra issues that do not have to go to bypass surgical procedure. However usually, we meet with the surgeons after doing a catheterization and seeing that anyone has blockage in a number of arteries. At Novant, we’ve a program the place we’ve convention with the open coronary heart surgeons, the bypass surgeons, and the cardiologists. And we overview the circumstances and the movies, the catheterization movies, in addition to the entire image of the affected person, how sick they’re, how previous they’re, what different danger components they’ve, make a willpower whether or not these arteries are higher suited to a number of stents or whether or not these arteries are higher suited to bypass surgical procedure.

As a common rule of thumb, in case you have blockage of 1 or two arteries, you are usually higher off with stents. You probably have blockage of all three of your main coronary heart arteries, then that opens the door for bypass surgical procedure and we are inclined to have that back-and-forth dialogue with our surgeons about what is healthier suited to that affected person.

Host: So, you’ve got been training and doing this for a very long time, so I am curious to listen to what you must say about this. And you’ve got alluded somewhat bit to the concept stents have gotten higher. What does that imply? How have stents improved the 20 years or so you’ve got been training?

Dr. Frederick Meine: Certain. So, I may spend hours doing this and I might most likely put you and everyone else listening to it to sleep. However the common historical past catheterization and stents goes one thing like this. So, within the late ’80s, early ’90s, the balloon angioplasty was developed and that meant that the heart specialist had the power to go in and balloon a blockage open. And that sounds superior. It had a pair issues. One, it had someplace round a 5% danger of acute closure of the artery requiring emergent bypass surgical procedure, and it had a couple of 50%, 40% chance that over the following few months, that artery that you simply had ballooned open would collapse again down smaller than it was whenever you began. So, it nonetheless was the suitable factor to do for a very blocked artery, however you have been including in a couple of 5% danger of needing emergent process and a couple of 40% or 50% danger of needing increasingly more balloon angioplasty. So clearly, not an incredible choice.

Within the mid ’90s, about ’95, ’96, stents have been developed and what that meant was mainly a stent seems to be simply very very like the spring on the within of your ballpoint pan, a small metallic scaffolding that holds an artery open. That did type of two issues. One, it eradicated principally that 5% danger of acute vessel closure as a result of the stent holds the artery open. And it decreased that chance that the artery may collapse again down as a result of the stent is mainly stronger than the wall of the artery. And so, it eradicated that 40% or so danger of vessel recoil is what we name it. So, all that sounds good. The issue was that you simply now have added within the physique’s want to type of overheal that. And we added in a couple of 20-25% danger of what we referred to as re-stenosis, the place you overgrow the scar tissue on the within of the stent, closing off the artery once more.

So once more, higher than balloons solely, however nonetheless a couple of 20-25% danger of needing repeat procedures with one thing referred to as re-stenosis. And mainly, I all the time inform individuals, you are purported to heal your stent similar to you are purported to heal the scar on the again of your hand. It’s best to get a really skinny layer of tissue on the within of that stent whenever you heal it up. All of us have scars the place it seems to be nice. After which, different ones the place it is a huge, raised–

Host: It seems to be unhealthy.

Dr. Frederick Meine: Yeah. And it was a raised welt. Should you get that on the within of that stent, that closes the artery again off. Then in about 2004, 2005, the following huge new factor got here alongside and that was referred to as drug coated stents. And what that meant was they have been the identical bare-metal stents that we had within the ’90s, however the firms have been capable of put very small little microchannels within the metallic of the stent. and so they put in these microchannels medication that slowly leaked off the stent over the primary month or so, and retarded that therapeutic course of. So, it eliminates most of that overgrowth of tissue on the within of the stent. And that actually took that 20-25% re-stenosis fee all the way down to about 1%. So mainly, you virtually eradicated that drawback with re-stenosis. So, you’ve got gotten rid of the acute drawback, you’ve got gotten rid of the elastic recoil drawback, and now you’ve got gotten rid of the re-stenosis drawback. And that is drug coated stents, and that actually revolutionized every little thing.

Now, over the following 20 years, the stents have gotten higher in that the metallic has gotten thinner and thinner. The medication have gotten higher and higher. There hasn’t been a type of sea modifications that occurred, which was life-altering for us like stents or like drug-coated stents, however the stents have continued to get higher and higher.

Host: Evolving themselves inside that, the medication, the metallic, all that type of stuff.

Dr. Frederick Meine: Yeah.

Host: That is incredible. That did not bore us. I feel that was fairly cool. That is good. To type of summarize, so we lined quite a lot of stuff right here. We talked about coronary heart, we talked concerning the affect of stress, somewhat little bit of what you do, the stents. However bringing it again to the principle subject right here, the stress kills, the affiliation of stress on the center. What final phrases do you’ve for the listening viewers about that?

Dr. Frederick Meine: So, I feel it is the identical factor I would say about all the opposite modified danger components. Crucial factor individuals can do is know what your danger components are, proper? So, know what your ldl cholesterol is, know what your blood strain is, know whether or not you are in danger for diabetes, and actually be keen to know and cope with the truth that you’re underneath some type of stress and be keen to deal with that along with your heart specialist, along with your common practitioner, with your loved ones. Ignoring your stress ranges is simply as unhealthy as ignoring your levels of cholesterol or your blood strain.

Host: Yeah. Superb. Incredible info. Thanks for approaching right this moment. That was Dr. Frederick Meine sharing his worthwhile insights on coronary heart well being and stress administration. For extra details about discovering a doctor, you’ll be able to go to novanthealth.org. Should you loved this episode, please contemplate sharing it in your social channels. And do not forget to discover our podcast library for a lot of extra well being subjects that matter to you. You’ve got been listening to Significant Medication. I am Dr. Mike. Thanks for listening.