well hello and welcome to HealthLine Tuesday evening.

I'm Jennifer Blomquist.

I have the privilege of hosting the program and I'm so glad you joined us if you're one of our regulars, you know the the routine we are live here in the studio and that's why we keep our phone number at the bottom of the screen for you throughout the show because we welcome any questions you may have for our guests tonight we have a cardiologist just in time for National Heart Month so that worked out really well.

We welcome any questions you may have want to tell you have a few choices as far as how to get your questions answered.

So my favorite one is if you just call a phone number (969) 27 two zero it's still toll free if you're outside of Fort Wayne, just put an 866- in front of there and we'll get you through to a call screener.

They don't just throw you on the air and you can ask a question live.

That's a great way to get your answer because you can interact with our guest and he can maybe he needs to ask you some questions, give you a better answer.

So that's one choice.

The other option you have is you can still call in to the call screener and just give the call screener your question and I'll ask it for you.

So that's another option and then this is kind of brand new.

We've only been doing this maybe a few weeks now texting which is great.

We've had a lot of people take advantage of that.

So the phone number is a little different though if you're going to text it's still the two area code but (969) 27 three zero go ahead and put your question in and if you feel comfortable, why don't you give us your name and maybe what town you're from?

We do not share your phone number so that all stays private.

I just want to make sure you know that.

So that's a great way to get your question in as well.

So let's go ahead and meet our guests tonight.

Somebody new to our program never done it before so I told them we go easy.

So this is Dr.

Luke Thompson and you are a cardiologist.

>> Yeah.

Thanks for having me.

So thank you for coming in.

We want to focus tonight on cardiac imaging which I feel like the technology in cardiology even just in the past twenty , twenty five years is so different than what it what it used to be the capable ladies.

>> So we're going to start talking about that.

But if you have something cardiology related, maybe it's not specific to the you the imaging that we're going to be talking about feel free to call at any time.

Why don't we go ahead and just start with some of the basics.

You know, when somebody comes in to see you, you know, what are some basic tests or, you know, modalities that you can turn to to get maybe some better answers?

>> Sure.

So it kind of all depends on the presentation, right.

Are we talking more of a preventative aspect?

Is there a symptomology going on?

Yeah, something that we're looking to intervene on.

So there's kind of there's multiple different not invasive tests that you can do across all the imaging spectrum.

So ultrasound technology that your echocardiogram typically done across the chest with ultrasound we call that a trans thoracic echo.

We can also do those from the esophagus for looking for specific valvular pathology.

So trans esophageal echo other testing involve your traditional stress test EKG with and without imaging and there's multiple different types you could do there.

So cardiac MRI you can add on to that spec imaging pet imaging a lot of different nuclear cardiology techniques and then kind of a growing area of focus has become the coronary artery CTA which is a specialized CT that looks at the anatomy of the the coronary vasculature.

It's a great rule out test.

It gives the advantage of disease burden and things like that.

All of this as a precursor to should somebody need like a cardiac cath or something like that to follow up.

>> And there's also incorporations of newer technologies like EHI to help assist with that which yeah, Happy to talk about.

>> Yeah I was going to say I think everybody is excited but some people are a little concerned and rightfully so about I although I would say it seems the most promising in medicine.

You know there are other aspects of it that I think people are a little scared about cybersecurity and just robots taking over the world, you know things like that so we can get into the aspect of it.

But you know, in terms of the tests like you know, unfortunately both of my mom's parents had a lot of long history of heart issues and it was really difficult.

>> I mean this is back in the 80s in the 90s where you didn't get answers very quickly and you know I mean if you needed a test you had to be sent to maybe a different facility or and now a lot of stuff is even in office right in the doctor's office.

So I feel like we can get answers quicker and everything is just obviously probably more sophisticated I would think.

>> Yeah.

The turnaround has gotten a lot better on a lot of the testing and then with advances in technology to you know, our sensitivity to pick up a lot of disease states has improved.

So if you take traditional stress testing, you know the sensitivity on that varies on patient characteristics, the effort given on stress test as well as the lab tech kind of the technique of lab expertize so you could see anywhere of a false negative meaning a test that came back reassuring but there was actually underlying disease, you know, as high as 30 50 percent depending on the lab.

Now with the advent of coronary CTA, that accuracy for rule out has improved dramatically with a negative predictive value which you know, what are the odds that if this test comes back reassuring I don't have the disease exceeding ninety nine percent so see and I'm thinking people probably you know, they would a cardiologist once they have an issue you know but people probably don't think a whole lot about imaging in terms of prevention.

You know I and I don't know if that's something that you want to talk about.

Most people you hope would go to see their their primary care doctor once a year.

But I don't know how much of of a focus is on the heart or if there are tests if you're maybe predisposed to have a family history, maybe things maybe some imaging things that you might want to ask your doctor about.

>> Absolutely.

So would you talk about cardiovascular risk from a prevention standpoint?

It comes down to patient characteristics.

So we're talking genetic makeup.

Age is a big factor lifestyle and when you look at traditional risk assessment tools so classically refer to the Framingham risk, that's a tool that we use to calculate kind your risk going over the next ten years of an unplanned event, an MRI for example.

You know, we're kind of seeing that that isn't as individualized as we like.

You know, that was derived from large populations of patients that we kind of generalize to the population.

I feel like it tends to underestimate your own individual risk.

So now they're becoming frequently more utilized and that is the coronary artery calcium score which is a a quick CT scan.

There's no contrast dye or advanced techniques involved.

It's a quick in and out and what that looks is for calcification of a coronary artery.

So you have three main arteries that sit on top of the heart.

Their job is to supply blood to the to the heart and keep it pumping.

What are the markers of disease that we can pick up with a screening test is calcification.

We know the extent of calcification you have can either classify your risk or down classify your risk based on a lot of technical things but essentially it helps further individualize your personal risk.

>> So that's one of the imaging modalities that's becoming more popular.

>> Some practitioners are starting to use coronary CTA to kind of help guide disease burden and things on top of that now whether or not to do that in asymptomatic patients is still being debated.

If you look at our large guidelines that kind of dictate when certain tests are kind of justified right now we don't have the evidence to back it up but it's something that might be coming down the future for more individualized risk.

>> And do you feel like men and women have an equal risk of having heart issues?

I mean there's always I think that you know, I used to see them out of public service announcements about women ignoring their heart health .

You know that typically it's more men you think of more men having heart attacks and women.

But I guess the point they were putting out to women was, you know, you're at risk of a heart attack too.

You may not have the same you may not experience the symptoms the same as a man.

So I don't do you feel like women need to maybe pay more attention?

>> Yeah, and that's that's a big point that you bring up that when you look at the traditional risk factors, the traditional symptoms for for women with cardiac disease, a lot of it can fall under the radar because they don't to present the typical features of cardiac pain.

So it's definitely important to get involved early in the preventative stages before disease progresses.

>> All right.

Great advice.

I didn't want to forget that we did have somebody text in a question for you, Dr.

Thompson.

So it was Wesley and he was asking if is a high heart rate or is your heart rate high during an asthma attack?

>> Would that be normal?

So the short answer is probably yes.

So heart rate is a response that we normally have physiologically.

So when you are under stress or in a relaxed state, your heart rate should reflect that.

So that's our fight or flight or fight or flight system kicking in.

So our adrenaline.

So if you have something else going on it could be anything medically infection, asthma attack for sure you would expect your heart rate to go up to compensate for that.

Now there are some arrhythmias that kind of go hand in hand with pulmonary disease.

You can get atrial tachycardia, atrial fibrillation.

So it does depend on the rhythm the rate itself is kind of hard to make a call.

It's certainly something that you could you could pursue noninvasive monitoring.

So cardiac monitors we have wearable devices to see what the rhythms doing but usually your heart rate does go up with asthma exacerbations.

All right.

Well, Wesley, thank you for texting in that question and just want to remind everybody watching you do that too.

You can be just like Wesley you can text in your question again that number is (969) 27 three zero.

And again a reminder we don't share your phone number.

It stays private and then you can also call in your questions.

So it's (969) 27 to zero again put in 866- in front there and it will be a toll free call.

You can also just really the question to the call screener and they can give it to me and I could ask Dr.

Thompson that way.

So of course we you kind of touched on this earlier artificial intelligence which is really in its infancy and I I feel like you we've already maybe experienced it to a certain degree in the medical world.

You know, we've done numerous programs with all different kinds of medical specialties whether they're using the robotics to to actually perform a surgery.

It's not the doctor's hands actually working on the patient.

So I don't know if you want to talk about it in terms of maybe how it's going to help in the world of cardiology.

>> Yeah, absolutely.

So it's it's definitely in the infancy but it's going to be incorporated eventually and it's starting to be used pretty routinely now with one of the modalities that we use.

So coronary Seeta.

So that's the that's the specialized CT scan that defines the anatomy of the of the vascular system that that feeds the heart.

So you typically have three major arteries that come off and we we use a contrast dye to go into those arteries and we time the CT scan with the heartbeat.

>> There's a certain point in the cardiac cycle where the heart is very still and if you can time up your CT pictures with that area in the cardiac cycle you can get very good images now where a guy comes in is it starts kind of the preliminary read, OK, so it can analyze and give you things like plaque characteristics, plaque volume and it also is kind of a sensitivity enhancer .

So where am I right now kind of falls short as it tends to overcall things which is kind of what you want from an initial screen because you're trying not you're trying to capture disease and this disease with this.

Right.

So we'll get a preliminary read and you can match that up with your own individual read.

Obviously you correct any type of technical things that could have caused the A.I.

to make it think that it's a blockage when it's not actually there or it tends not to miss tends to overcall if it's going to make an error but it's going to get to the point to where it can read almost as good as the human eye and is it gives you information that you have to interpret maybe with with your colleagues or sometimes is the AI going to give us information that we normally would be able to come up with on our own.

>> So the things that it's looking at and that they're they're trying to elucidate is what are the characteristics that are high risk?

Right.

So we know that from looking at older data that the more disease you have the higher risk of having an event is OK.

So let's do a hypothetical where you've got two different blockages.

You have one that is 70 percent and one artery and then you have 20 percent and a different artery right now it's hard to say regardless of severity which one may end up causing the MRI.

You know, they're looking at things like the the technical aspects of that plaque composition to investigate to see do we know which ones are higher risk for rupture and when should we intervene sooner .

I is going to help us with that from the CT aspect that that's where I see it being the biggest benefit going forward because right now it's pretty difficult to to discern what with the eye all right.

>> Now it'll be it'll be fascinating.

It's I mean there's already so much information out there but then it's hard to believe that it's like you said to start we're just starting to touch the surface of artificial intelligence.

So I didn't want to skip another text that we received so it says women have cardiac ah a woman called Insys has cardiac calcium scored of of a thousand of one thousand.

So the doctors say is it typical for her age or is that doctors say it's typical for age asking for advice about yet so whether or not you should do additional testing on top five.

>> I see OK sorry I couldn't see that other screen so is high ok.

Yeah when you when you look across age categories there's kind of a threshold of risk that escalates once you cross one hundred four hundred and definitely a thousand and an asymptomatic patient with a calcium score above a thousand we know that your your risk of a coronary event over the next ten years is is much higher than obviously having no calcium.

>> There are some societies that would recommend following that up with a stress test with imaging.

So to look at is there any kind of ischemia or lack of blood flow that is being affected because of these calcifications and that can further risk stratify, it's not saying that you need to have an intervention done but it helps add to your individual risk and then what you do with that information is how aggressive you should target things like blood pressure, what you should have for your cholesterol targets because that's all individualized when you look at some of the the guidelines that the American guidelines tend to wait for a lot of data which is they have the reasons for it before they make aggressive recommendations.

So the cholesterol guidelines tend to lag probably a little bit behind but we should individualizing cholesterol targets based on individual risk and with a with a calcium score above a thousand, I would be pretty aggressive about getting the LDL down and looking at other things like advanced profiles.

>> I mean it sounds like you know, it's like when we do shows with the orthopedics surgeons, you know, they always talk about taking really simple steps.

You know, not I think some people are concerned they're just going to be thrown on the operating table right away.

But being very conservative and I assume that's kind of how it is in cardiology and one thing builds on another.

So if you're having one test chances of having needing more in the future or even more at that time to get a better answer is that typical of so getable test it in theory.

>> You know the the CTA you know, if you look at our guidelines the way the studies were working constructed we have some large trials and one of them is the ischemia trial they looked at what do you do with these stable patients that don't have symptoms and they have coronary disease?

>> How do we manage it?

You know, the data shows that you should be able to manage them with aggressive risk factor modification now in and kind of America's practice if you look at it, it probably leads to some layering of testing.

But I think that's going to start changing as more data comes out ,especially with some of the CT scans that they tend to overcall lesions.

You know that that can sometimes lead to later testing followed up by Cathe but that it's something we're sorting out.

>> All right.

I just want to remind everybody we do have a few minutes left in the show but there's plenty of time to get some more questions in.

So again, you have the option of texting it you you'd call it and you can talk to the call screener and just relay the question to them.

That's why the phone numbers are at the bottom of the screen.

So please take advantage.

We don't often get a cardiologist on our program so we only have them for a short time so feel free to give us a call at any time we continue our discussion.

>> Do you feel like there's a lot of research being done and more on the preventative side with cardiology because I feel like so many people will say I mean I meet people all the time that say gosh, you know, my dad died of a heart attack when I was when he was forty seven and they feel like they're going to be doomed to have that same fate.

And so I don't I don't know if you want to talk about that like more of the there's a lot of research going on in the preventative side, especially if you have a family history of it or is it all more lifestyle and environmental?

You know, just because maybe somebody in your family had an episode it doesn't necessarily mean that you're predisposed.

It's super individualized.

So there's a lot of factors at play.

Genetics is a huge component believe it or not.

For example, you know, we always wonder how much of your cholesterol you can control with lifestyle modifications.

You know, they've looked at that.

They've looked at twenty two different diets and I'm one of the larger studies where they looked at everything from Quito to Atkins' to Mediterranean and Dasch diets across all those diets about five to 15 percent LDL reduction so you can do the math on that so the remainder of that is all genetic.

So it's important based on your family history and based on other risk factors like diabetes, tobacco use those things all enhance your risk of disease and it's very important to get on top of it early.

I think that that's key, you know, because there are a lot of preventable things that we can dial in from a cardiac standpoint that if you look at our numbers across the country, maybe we're missing out on a lot of opportunities like blood pressure control and cholesterol control.

>> Yeah.

All right.

I want to turn to the screen because we did get another text message that people really like texting so I'm glad to see that.

Let's see.

This was what is a difference between heart pain and digestive issues.

>> So this is a tricky one.

So the nerves in the chest aren't as specific as the peripheral nervous system.

So if you pinch yourself on the back of the hand, you know where you got pinched sometimes you can have referred pain so all those organs in their it's difficult to tease out because the nerves are so entwined.

>> Is that so for example, sometimes very bad reflux can present similar to a heart attack.

Right.

But that's why it's key to to die on on the specifics the pretest probability meaning you know what your what your genetic history, what your other risk factors diabetes, smoking, hypertension and you kind of have to to set a gauge for what the pretest probability is by kind of like a big overview.

Typically cardiac pain is a pressure like retros internal meaning behind the chest wall that is made worse with things like stress exertion, relief with rest.

But there's a big spectrum and especially like we were talking about earlier, you know, women patients with diabetes on insulin, they don't have those typical features but it's pretty hard to to tease out sometimes and that's where additional testing like stress testing or coronary may sometimes add some benefit to that.

>> Yeah, I I guess I do hear the one commonality I've had you know other cardiologists refer to or say that a patient will say it feels like an elephant is stepping on their chest at least that's what men say.

Yeah I've heard women say it's more in the arm in arm pain.

>> Yes yeah yeah sometimes die for resus I've seen it where patients just have just weakness so there's a lot of different things.

So that's why it's important if you're concerned that something's going on to seek some medical care.

>> I want to say I worked with a man years ago that he actually had after the fact realized that he had had a heart attack at work and didn't know it.

>> You know, you always think somebody is going to collapse.

He just felt really sick.

But then it ended up months of recovery after that.

But you know, we were just floored because I mean he was at work doing his normal thing and kept working but it wasn't until he went home and they just felt so sick, you know, after the fact found out.

So it's not like you said there's no cookie cutter.

>> Yeah.

You know, form for everybody.

So we only have a minute or two left.

So I was just going to ask you a couple of things related to Heart National Heart Month which is February of course.

So years ago I remember a cardiologist referring to the heart as a sympathetic muscle like it really you know there's something about a broken he said there's truly you can feel a broken heart if you're going through something stress or something traumatic and I don't really want to talk about that like you can present symptoms based on just an experience, not something physical but emotional.

>> Yeah.

So there is a rare disease stress cardiomyopathy where where the heart muscle can become very weak can present exactly like a heart attack.

Not exactly sure what causes it.

We know it has to do with kind of some mis regulation of adrenaline.

>> There are some patient features typically it can be associated with women but you know it's important to get checked out if you think something's going on.

>> So we do see it quite often.

You know your body better than anybody.

So something doesn't seem quite right.

You should definitely get some help.

So unfortunately our time is up.

Dr.

Thompson, thank you so much for coming in tonight.

Really appreciate it.

So thank you for having me.

Thank you and many thanks to everybody who texted and questions.

Really appreciate that as well.

So we are done for here tonight but we will have another HealthLine coming up next Tuesday.

So take care.

Have a great evening and happy Valentine's Day to everybody.

Good night