January 22, 2023 • 26 mins
01/22/23
The Healthy Matters Podcast
Season 2 - Episode 04 - Stayin' Alive! A Q&A with a Cardiologist
There's been a lot of talk about cardiac arrest in the past few weeks, and well, it turns out our hearts are pretty important to us! But what actually happens when things go wrong? Does a daily aspirin really help? And what's the best disco song to perform CPR to?
From Damar Hamlin's on-field scare, to cholesterol, to emergency procedures, there's certainly no shortage of things to talk about when it comes to the heart. In episode 4, we'll talk with Dr. Lou Kohl, an interventional cardiologist at Hennepin Healthcare, to go over the basics of heart function, ways to keep our hearts healthy, the wide world of stents, and whole lot more. Join us!
Got a question for the doc? Or an idea for a show? Contact us!
Email - healthymatters@hcmed.org
Call - 612-873-TALK (8255)
Twitter - @drdavidhilden
Find out more at www.healthymatters.org
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:04):
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:20):
Hey there, it's Dr.
David Hilden.
When it comes to issues with ourorgans, perhaps the most common
ones we hear of are related toour heart.
It's a pretty long list when youthink about it.
The heart is a complex organ,and thankfully with me today
I've got Dr.
Lou Cole, interventionalcardiologist at Hennepin
Healthcare.
He's gonna help clarify a fewthings.
Dr.
Cole, welcome to the show andthanks for being here.
Thanks
Speaker 3 (00:40):
For having
Speaker 2 (00:40):
Me.
Absolutely.
Let's start with a big case inthe news lately.
So, DeMar Hamlin, a healthyyoung man who plays for the
Buffalo bills of the NationalFootball League, has a collapse
on the field.
I'm also aware that there was aDanish soccer player, you know,
Christian Erickson.
He had that in a soccer game acouple years ago.
So it's a really scarysituation.
These are young, healthy people,and it doesn't appear to be
(01:02):
isolated.
It's happened again a couple oftimes.
So, could you break down for uswhat maybe happened to these
athletes?
Speaker 3 (01:08):
Yeah, it's a good question.
I think there have been a numberof collapses on the field.
The athletic put together a nicelist of incidents like this that
have happened during livesporting events.
I, I agree with you completely.
The Christian Erickson episodeis probably as close as we have
to.
What happened to DeMar Hamlin inDeMar Hamlin's case?
He seemed to get hit in themiddle of the chest by the
(01:31):
receiver's shoulder, stood upfor a sec, and then fell over
backwards.
Something that would look to usas a physician, a cardiologist,
as probably a cardiac arrest,that's a signal that something
terrible is going on, and thebody's not getting enough blood
Speaker 2 (01:47):
Flow just going down uncontrolled.
That's so scary for in front ofa stadium, fool.
It,
Speaker 3 (01:51):
It's super scary.
It's super
Speaker 2 (01:54):
Scary.
So, I know we don't know theparticulars of these athletes
and their health conditions, andwe won't speculate on, on about
their personal healthconditions.
You know, they have a right tosome, some privacy as well.
But what do you think happened?
Why would someone's heart juststop like that?
Speaker 3 (02:10):
The thing that makes the most sense for DeMar Hamlin
is he experienced this thingcalled commotio cordes.
And it is the most unlucky ofmost unlucky circumstances.
It is a condition where if youget hit square in the center of
the chest, just at the rightmoment in your heartbeat cycle,
the electric cardiac cycle, itcan cause your heart to
(02:34):
transition from a normalcoordinated pumping motion to
what we call ventricularfibrillation.
The heart just quavering therenot pushing any meaningful blood
out to the body.
There's a couple reason wespeculate, we don't know, but we
speculate that that's the casefor Mr.
Hamlin.
The first is that he wasactually able to get up and he
(02:57):
stood up after the day.
He stood up and was, you know,normal, got up, just made a
tackle, 4, 2, 3, 4 seconds.
And just like the hose at yourhouse, when you turn it off at
the spigot, there's still alittle residual pressure in the
hose and a little bit of alittle bit of water.
In this case, a little bit ofblood flow is still coming out,
even if the tap is off.
(03:19):
And that is really common forone of these ventricular
arrhythmias and a rhythmmediated cardiac arrest in that
there's a very brief period oftime when you still have
consciousness, and then theblood pressure, in this case,
the water pressure in the caseof your hose turns off and then
without blood flowing to thebrain, eventually the brain
says, I'm gonna shut off.
Speaker 2 (03:40):
So it sounds like Lou , you're saying, is that he had
an electrical problem of hisheart, which then leads in a
couple seconds to, its notpumping.
Could you say more about that?
What the, what is the electricalversus the, I'll call it the
plumbing part of a heart'sfunction?
Speaker 3 (03:53):
The plumbing of your heart, uh, kind of works in two
ways.
Do you have pipes that feed yourheart muscle with oxygen?
When one of those pipes getsplugged, you have a heart
attack.
And usually that's not a cardiacarrest.
Usually don't fall over dead.
Usually folks have chest pain orchest pressure or, uh, squeezing
sensation or an elephant sittingon their chest.
(04:14):
That's sort of our usual kind ofclassic way.
Uh, heart attack presents.
And
Speaker 2 (04:19):
These are your coronary arteries.
Speaker 3 (04:20):
Coronary arteries, yeah.
So
Speaker 2 (04:22):
People tell me sometimes, well, doesn't the
blood, doesn't the heart getblood from that's inside of it?
And that's not how it
Speaker 3 (04:29):
Works.
That is not exactly, that is notthe case.
Your heart actually is the firstoff-ramp is your pumping chamber
pumps blood out of the heart,but that big vessel, the aorta
that pumps to the rest of yourbody, supplies'em all.
Mm-hmm.
.
But the, the heart does not getblood from the pumping chamber.
It's got its own little set ofarteries.
And when those get blocked, thatcauses a heart attack.
You know, only a very smallportion of heart attacks.
(04:52):
Less than 5%.
Do folks have a cardiac arresttoo?
Does the lack of oxygen make theheart muscle electrically
unstable?
So
Speaker 2 (05:00):
The electrical, the electrical activity continues on
after a heart attack.
It does.
Speaker 3 (05:04):
Usually most people continue living their life.
We hear all the time about folkswho've had chest pain at home
for hours and sometimes days,and do all sorts of stuff.
Continue to go to work, continueto, but it
Speaker 2 (05:15):
Can't be good
Speaker 3 (05:16):
No, it's bad.
If you,
Speaker 2 (05:18):
If you think you're having
Speaker 3 (05:19):
A heart attack, you should call EMS and get to the
hospital.
Speaker 2 (05:23):
Don't be like driving in.
Call nine one one,
Speaker 3 (05:25):
Call nine one one for sure.
Speaker 2 (05:26):
So that's the, that's the plumbing, the, the heart,
the blood supply that goes toyour heart.
Right.
Tell me about the electricalsystem.
Speaker 3 (05:33):
So the, for the heart to pump blood out to the body,
uh, is actually a very, uh,elegant, coordinated electrical
dance that causes the wholeheart to squeeze in unison and
pump blood out to the body.
There's a whole host ofdifferent reasons why that can
go awry, but in the case ofDeMar Hamlin, probably the
(05:53):
Danish soccer player, somethinghas gone horribly wrong and the
heart has gone from beatingnormally in a matter of seconds
to beating in a totallyuncoordinated fashion that
doesn't result in any meaningfulpumping out to the body.
Could
Speaker 2 (06:09):
This have been predicted or is this something
so out of the blue that there'sno, there's no way we could have
known?
Speaker 3 (06:15):
Probably not predictable.
There are a series of geneticconditions, things like
hypertrophic cardiomyopathy, avery thickened heart muscle,
some other things that theyactually screen some European
soccer players for, especiallyin Italy.
Speaker 2 (06:31):
Um, they, they check for'em before
Speaker 3 (06:32):
They, they check for 'em with echoes and MRIs and all
sorts of other heart imaging.
But as far as we know, DeMarHamlin had a totally normal
heart.
Speaker 2 (06:40):
Could we talk a little bit about what was done
on that football field on Mondaynight?
Yeah.
To that young man.
What were those first respondersdoing?
Speaker 3 (06:50):
You know, I think that's probably the most
important thing that happenedfor DeMar Hamlin.
Uh, folks could tell of widevariety of folks from his
teammates and the opposing teamto trainers and medical staff on
the sidelines.
They could tell immediatelysomething was seriously wrong.
They rushed out in the field,they assessed him, checked out
if he was breathing, if he had apulse.
(07:11):
And when they found that hedidn't have a pulse, they
started cpr.
CPR is just pushing hard andfast a hundred times a minute on
the center of someone's chest tomove a little bit of blood
around the body while theheart's not beating.
That is purely a temporizingmeasure until we can do
something more to restart theheart.
(07:31):
In the case of Mr.
Hamlin, it sounds like they alsoused an a e d.
This is a, an electrical devicethat sometimes you'll see on the
wall at stadiums and shoppingmalls and office
Speaker 2 (07:44):
Office buildings office, the gym
Speaker 3 (07:45):
All
Speaker 2 (07:45):
Over, all over the
Speaker 3 (07:46):
Place.
They are great.
They're super smart these days.
It's the equivalent thing to thepaddles in er,
Speaker 2 (07:52):
Like when you see it on the TV show, get the
Speaker 3 (07:54):
Paddles.
It is that just in an, anautomated version, if you're
somewhere and someone go has awhat looks like what you saw
with DeMar Hamlin, they pass outbackwards.
They look like they're notmoving or breathing.
Someone tells you they can't seea pulse other than calling 9 1
1.
If you see an a e d thingaround, go grab it off the wall,
you can put those patches righton the person.
(08:16):
You don't have to be a medicalperson at
Speaker 2 (08:18):
All.
It tells you how to do it.
Speaker 3 (08:20):
It, it, it is totally automated.
It will analyze the heartrhythm.
And if it finds a limited subsetof heart rhythms, including this
ventricular fibrillation onethat we think occurred to DeMar
Hamlin, as well as some otherones that are treated by an
electrical shock, it will figurethat out.
It will tell you to get out ofthe way so you don't get shocked
yourself and it will deliver ashock.
We understand that that isprobably what happened to, to
(08:42):
DeMar Hamlin on the field.
And once they were able to resethis electrical system with that
electrical shock, it started,electrical rhythm is back
working normally and pumpingsome blood to the body.
Speaker 2 (08:53):
So it was likely that those first responders on that
football field by doing chestcompressions and by delivering
shocks through an a e D, that iswhat led to his outstanding
recovery and the fact that hewas a healthy guy.
Yeah, but those two things
Speaker 3 (09:08):
Were 24 year old professional athlete.
But yes, those are the thingsthat kept him alive.
The C p R got enough blood withoxygen in it, moving around his
body so that his brain and therest of his body could continue
to live while he didn't have aheartbeat.
Folks out in the community, thisis where you can be heroes.
If someone has a cardiac arrestand you're waiting five minutes
(09:29):
for the paramedics to get there,even if you've never had a c p
class, push hard on the centerof their chest.
It's scary.
Speaker 2 (09:37):
And push
Speaker 3 (09:38):
Fast and push fast a hundred times a minute.
The thing that we coach peopleis the song Staying Alive.
Speaker 2 (09:43):
Staying alive.
I was wondering if get a breakstaying
Speaker 3 (09:45):
Alive that the beaten , that song's about a hundred a
minute.
So if you can, if you can pushsome blood around their body
right in the center of theirchest, over their sternum, until
folks are able to get there, youcan save someone's life.
You can keep their organs andbrain oxygenated enough that
after, in some cases a short, inthe case of DeMar Hamlin,
(10:06):
sometimes a little longerhospital stay during which time
everything else gets to recover,they can walk outta the
hospital.
Yeah,
Speaker 2 (10:12):
Yeah.
Now what about everybody'sremembering the old days in the
old mouth to mouthresuscitation?
Yeah.
And everybody's squirmed aboutthat.
And do we still do that or is itjust literally you come up to'em
and start doing chest
Speaker 3 (10:22):
Compressions?
We do it in the hospital, butout in the world, we've taken
that out of the guidelines.
Just push on their chest.
Don't worry about trying tobreathe into their mouth.
Don't worry about any of that.
Um, if someone has had a cardiacarrest and they don't have a
pulse, start out by pushing hardand fast on the center of their
chest, the medical personnel whorespond will take care of the
breathing portion.
(10:42):
But 99% of the time, unless youthink someone's choking on a
hotdog, and, and the issue isthat you need to give'em the
heim lick and get the hotdogoutta their throat, you should
just push hard and fast on thecenter of their chest.
Speaker 2 (10:52):
You mentioned that anybody can do this, and I wanna
make sure people hear thatanybody can start bystander cpr.
What do you think about actuallygoing to a CPR course and
getting a little more skills?
Do you recommend that?
Speaker 3 (11:03):
I think in an idealized world, everyone would
take a CPR class, kids wouldtake it in school, adults get it
with their driver's license orsomething.
But I think it's really a, avery helpful skill for any adult
to
Speaker 2 (11:14):
Have.
Yeah.
And as one who's done it, and Iknow you have as well.
Yeah.
Um, largely in hospitalsettings, but both of you and I
have probably done CPR a lot.
Right.
Um, you are literally pumpingthat blood for that person.
And, and I like the word youused.
You're you're gonna be a hero inthat case.
Yeah.
It really truly does matter.
It does.
Time matters and doesn't it,
Speaker 3 (11:31):
It time is the hugest part of this.
Speaker 2 (11:33):
I mean, don't wait around, get going.
Yeah,
Speaker 3 (11:35):
Yeah.
Immediately Call 9 1 1.
Or even better, ask someone elseto call 9 1 1.
Will you start CPR if you'resure that that person doesn't
have a pulse?
Speaker 2 (11:44):
I I I would assume it's relatively easy to find a
place where you could learn todo cpr.
Speaker 3 (11:48):
Yeah.
I mean, you can go on theinternet and American Heart
Association.
A lot of local organizationshave CPR classes.
Speaker 2 (11:55):
Maybe your local health club offers a
Speaker 3 (11:57):
Class even.
Speaker 2 (11:58):
Exactly.
If it's been a while sinceyou've done it, maybe, maybe
take a class again, maybe learnagain.
If it's been 2, 3, 4, 5 years,do it.
The guidelines change.
It isn't, you know, you're notgonna have to learn how to do
mouth to mouth, for instance.
Exactly.
So if you haven't done it for awhile, maybe it's a great time
to get relearn it.
But even if you haven't taken acourse, you can still do CPR and
chest compressions.
Speaker 3 (12:18):
So you can be the difference between someone
getting enough oxygen to theirbrain until the medics get there
to be the difference betweensurviving or not
Speaker 2 (12:26):
Really important and life-saving tips there.
So now we'll take a short breakand when we come back, I'm going
to continue the conversationwith Dr.
Luke Cole, who is aninterventional cardiologist at
Hennepin Healthcare.
And we're gonna talk about waysto keep your heart healthy.
Stay with us.
Speaker 1 (12:41):
You are listening to the Healthy Matters podcast with
Dr.
David Hilden.
Got a question or comment forthe doc, email us at Healthy
matters hc m e d.org or give usa call at six one two eight
seven three talk.
That's[inaudible] 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (13:04):
And we're back.
We're talking about your hearthealth with Dr.
Luke Cole, who is a cardiologistand a colleague of mine here at
Hennepin Healthcare.
So Dr.
Cole, let's talk about ways tokeep your heart healthy.
First of all, what aboutcholesterol?
What's the role of cholesterolin heart health?
Speaker 3 (13:17):
Cholesterol's a big part of heart health.
I think of it as almost like athree prong set of risk factors
for clogging up the arteries.
As we talked about earlier, theplumbing, half of the equation
that leads to blockage of bloodflow.
And then sometimes symptoms.
Those three are smoking,smoking, smoking, smoking.
Don't do it.
If you are smoking, work on notsmoking or call quit plan or
(13:41):
talk to
Speaker 2 (13:42):
One of the, and keep trying.
Many times you can quit and youshould,
Speaker 3 (13:46):
You can.
And it takes the average person,seven tries real tries to quit
smoking.
So if you've tried three timesand you gotta, you had a
cigarette again, that makes younormal.
Try
Speaker 2 (13:56):
Again.
It's a great point.
It makes you normal.
Keep trying.
Speaker 3 (13:58):
Yes, there's, there's probably nothing out there, no
medicine we're gonna talk about,not cholesterol as much as I
hate to say it, not any bloodpressure medicines that I can
prescribe as a cardiologist thatare as important to keeping your
heart and your brain and yourwhole body healthy as just not
smoking.
Speaker 2 (14:13):
Okay.
So that's number one.
Risk.
Speaker 3 (14:16):
Yep.
Number two, cholesterol andblood pressure go together.
But we're gonna focus oncholesterol cuz your blood
pressure, think of it as pushingcholesterol into the walls of
the artery.
So cholesterol itself, ourbodies actually make it.
We eat it.
Some people are more prone tohave high levels, some people
are not.
Anyone who's 40 or over shouldcheck in with their doctor and
(14:39):
get a cholesterol check.
And if you, uh, have highcholesterol, depending on your
other risk factors, your doctordoesn't have to be a
cardiologist.
It can be an internist, a familypractitioner, any primary care
doctor should help you work ongetting your cholesterol down.
Usually that's with a medicinecalled statin.
There's a wide variety of'em.
(15:00):
They've got a bad rap in thepress, but we've studied them
more than any medicine period.
And they work, they reduce heartattacks, they reduce strokes,
and they bring your cholesteroldown.
Speaker 2 (15:11):
So if your doctor or other healthcare practitioner
advises you to take a statin,consider it.
Consider it, consider itstrongly.
Yes,
Speaker 3 (15:20):
You very much, if you have concerns about statins,
express them to your doctor,your, your nurse practitioner,
your physician's assistant,whoever that person is, talk to
'em about it.
But from a medical scientificstandpoint, they work and they
work really well.
And the side effects that areoften ascribed to statins are,
to be perfectly honest, is justas common in those same clinical
(15:40):
trials among folks who aretaking a placebo sugar
Speaker 2 (15:44):
Pill.
Yeah.
So it wasn't necessarily thestatin.
People got muscle aches, didn't
Speaker 3 (15:47):
They do it?
Turns out people get muscleaches, whether you're taking a
statin or you know, drinking avitamin water or whatever you
are doing.
Speaker 2 (15:54):
Okay.
So risk factors don't smoke.
Get your blood pressure andcholesterol under control.
What else?
Speaker 3 (15:59):
You know, I think being physically fit and active
is a good thing for your body asa whole.
We would love that.
We could say as confidently aswe do about statins, that being
fit prevents heart attack,prevents strokes.
I'm not sure if we can say thatto the same degree of
confidence, but it's justhealthy for your whole body.
And selfishly, as acardiologist, I love it when
(16:20):
people are fit.
It's like they're doing theirown stress test every day.
Right.
And they can tell me, you know,I used to be able to run five
miles, but now when I get tothree I'm really short winded or
I'm starting to have thisdiscomfort in my chest.
That is so helpful.
And for folks who are not fit,you're not asking much of your
heart.
And so it's really hard to getthat advanced warning of
something's wrong if you're notdoing much.
(16:42):
And there's a lot of folks outthere who have a lot of
limitations.
Speaker 2 (16:44):
What about aspirin?
It used to be that we want thatwe practically put it in the
water supply and we toldeverybody, ah, take an aspirin.
You're gonna live forever.
You'll never have a heartattack.
That is no longer the case.
Is it?
That's not the guidelines.
Speaker 3 (16:55):
That is not the guidelines.
And, and I think a couple yearsago there was a new guideline
put up by the US PreventativeServices task force and it was,
could have been done a littlebetter.
Um, a lot of folks came to ourclinics who should be on an
aspirin and said, Hey, I heardin the news and I'm not supposed
to be on aspirin anymore.
And that was the message thatwas put out.
But really what that guidelinewas discussing was should people
(17:18):
who've never had any heartthing, never had a stroke, never
had a, what we call peripheralarterial disease or a stent in
their leg.
Or should people who arehealthy, should they be taking
an aspirin to prevent heartattacks in stroke?
And it turns out that except fora very, very select subset of
people who have super high risk,you probably shouldn't be taking
(17:40):
an aspirin every day.
Not because it doesn't decreasethe risk of heart attack and
stroke a little bit.
It actually does.
But like all medicines and allthings in life, there's a flip
side in that aspirin is also avery mild anti-platelet
medicine.
Uh, think of it like a bloodthinner and it also increases
your risk of bleeding a littlebit.
And so for healthy folks, itactually, the bleeding risk
(18:02):
offset the, the good that theaspirin was causing.
Speaker 2 (18:05):
So the average person, now we can't say
specifically Yeah.
Right now what everybody shoulddo.
But the average person maybedoesn't need an aspirin.
Is there somebody that should betaking a daily aspirin?
Speaker 3 (18:15):
Yeah.
So what that guideline did notchange at all is if you've had a
heart attack before or you'vehad a stent or you've had a
bypass or you've had a stroke,you've had a leg artery issue or
a carotid artery issue, in thatcase, your risk of having
another event is much, muchhigher.
And the risk benefit balance isvery different.
And they should very much stayon aspirin
Speaker 2 (18:38):
.
So if you are listening to thisand you're not sure, talk to
your doctor.
Yeah.
Talk to your cardiologist.
You may or may not need to be onone, but it, it's a little bit
more nuanced then everybodyshould or everybody shouldn't.
Speaker 3 (18:47):
Yeah.
It, it used to be really easyfor us.
Yeah.
Just as you see that be on anaspirin, it'll help you.
It's risk free.
I think we've, we've grown up alittle bit in medicine and
starting to acknowledge thateverything, even aspirin does
carry a little bit of risk andwe want to use it in a way that
helps people and doesn't causethem harm.
Speaker 2 (19:05):
Right.
You know, it came from the barkof a willow trees.
It's so long ago that thereweren't any like regulations for
approving it.
If aspirin were invented today,would've to go through some
trials and there'd be likesafety warnings and things.
All
Speaker 3 (19:16):
Those things.
Yeah.
Speaker 2 (19:17):
Yeah.
Can I ask you one other thingcuz I can't resist.
You're an interventionalcardiologist.
This is an opportunity to askthe guy who actually does it.
When you put a stent in aperson, whether it's for chronic
angina, chronic chest pain, orwhat we do a lot of here, if
you've had a heart attack and anarteries blocked, can you just
briefly explain to us whatyou're doing?
Speaker 3 (19:37):
Absolutely.
In the cath lab, the cardiaccath lab where I work and I do
my interventional cardiologywork, we start by taking x-ray
movie pictures of a person'sheart arteries.
Once we get those pictures,sometimes we see a severe
narrowing or a blockage.
If we do find a blockage, we'llsay in the case of an acute
heart attack, we actually take atiny little wire, 14,007 inch,
(20:01):
we wiggle it down the arterythrough a small tube that
extends from either your wristor the creas, your hip up to
your heart.
We take that wire, we wiggle itthrough the clot that is
blocking off the heart artery.
And then we start out by using aballoon of all things.
It runs over that wire, justlike a train on a train track.
In this case it'd be a monorail,but a single hole in that
(20:24):
balloon slides over our wire andwe inflate the balloon and the
balloon pushes aside the clot orin some cases
Speaker 2 (20:30):
To the sides Yes.
Speaker 3 (20:32):
Pushes it to the sides.
And I think the question wealways get is, well, did you
take the stuff out?
Did you like suck it out with avacuum cleaner ro aro or
whatever?
And, and it turns out we don'tbecause your body is really
amazing.
Really what we need to do isrestore blood flow.
The body's blood circulatorysystem is full of enzymes that
(20:52):
dissolve blood clot, but theonly work, if a fresh supply of
blood is able to flow by thereand attack that clot.
So we just push the stuff to theside enough to start restoring
blood flow.
Once we get that going, that'sgreat.
Ultimately we stabilize thingsby putting in this metal mesh
tube called a stent that getspushed up with another balloon,
essentially into the sides ofthe arteries.
(21:13):
And that becomes like a scaffoldor like the two by four is
inside your wall and your bodyactually heals over it.
So that six months to a yeardown the pike, if you could
miniaturize yourself like RickMorans and Yeah.
Honey or
Speaker 2 (21:25):
Shrunk the kids imagine school
Speaker 3 (21:27):
Bus.
Exactly.
Go inside your artery and lookaround.
You wouldn't necessarily see anymetal.
Your the skin lining, theendothelium inside your heart
artery would've healed over thatstent and it's just in there
holding the whole thing open.
Yeah.
Speaker 2 (21:39):
Okay.
I have seen you, I've seeninterventional cardiologists do
it.
I've actually seen Dr.
Colder, I've stood over yourshoulder because he's been very
kind and allowed me to standthere and watch this.
Explain to us how you inflatethat balloon.
What are you talking about?
You have, is it like playing avideo game?
Do you have instruments or howdo you inflate the balloon?
How do you
Speaker 3 (21:56):
Do that?
Yeah.
We have, we have this devicethat's actually filled with
fluid cuz we can control it moreprecisely than blowing up air
or, you know, helium.
It's almost like a hydraulicdevice that very precisely adds
fluid to the balloon and thenmeasures the pressure inside the
balloon.
And it actually, when we deploya stent, we use quite high
(22:20):
pressures.
12, 16, 18 atmospheres worth ofpressure.
Wow.
To really push it into the sideof the artery.
It's gonna stay there once youget a stent put in.
And it is there forever.
Speaker 2 (22:31):
It's yours for life.
Part of you now.
But it, it strikes me as, uh,dangerous if you're, if you're
blown up a balloon in there,aren't you clogging the artery
Speaker 3 (22:40):
Temporarily?
Speaker 2 (22:41):
So you, you're, you're not in there for a long
time.
Speaker 3 (22:44):
No, in modern days.
Maybe a minute.
Yeah.
Do we have the balloon up?
Mm-hmm.
to implant thatstent.
Usually more like 30 seconds.
Yeah.
And the, the body's amazing.
The body's very tolerant and itcan tolerate 20, 30 seconds of
impaired blood flow.
In the case of a heart attack,you started out with a blocked
off artery.
Speaker 2 (23:01):
It was blocked already.
It
Speaker 3 (23:03):
Was blocked already.
And so we're it's all, it's allgravy from there.
We're gonna get it.
Speaker 2 (23:06):
Exactly.
Hey, before I let you go, let's,I wanna just circle back one
more time to the importance of CP r.
Briefly.
What should people do if theyare the first one on the scene
with someone in a cardiacarrest?
Because I don't want this pointto get lost.
Speaker 3 (23:18):
Again, if you come upon a person who is passed out,
they're, they're not responding.
Shake'em hard, yell at'em.
See if they respond.
If they don't, the first thingyou should do is probably call 9
1 1.
Or if there's another personwith you, ask that person to
call 9 1 1.
That activates the medicalsystem.
That gets paramedics, some firstresponders there on the scene as
(23:39):
soon as they can.
The second thing you should do,if you know how to do it, check
if they have a pulse.
Feel it, their wrist feel on theside of their neck.
Especially if you have somemedical training and you have a
reasonable sense of where tofind a pulse and it's not there.
Start c p r push hard and faston the center of their chest.
Folks might wonder, well, whatif, what if I just didn't find
(23:59):
the pulse?
Does it happen?
Absolutely.
It happens among medicalprofessionals.
Turns out, if that person isawake at all, you are not gonna
hurt them by doing cpr R they'regonna sit up and they're gonna,
Speaker 2 (24:10):
They're gonna let you , you know, uh, no, I was just
resting.
Yes,
Speaker 3 (24:12):
Exactly.
.
So err on the side of doing it.
Someone who is awake is notgonna let you do CPR on them.
Speaker 2 (24:18):
.
Yep.
You know that's true.
Okay.
So prompt c P r if you can findan a, e d to defibrillate, do
that.
That's what helped the are theathletes that we started this
show with.
And so I wanna end on a positivenote.
If you do those things are theoutcomes, can they be okay?
Speaker 3 (24:35):
We have folks who come to our facility after
having cardiac arrests at theirworkplaces downtown at US Bank
Stadium across the street, allmanner of places who have very
much walked out of the hospitalas normal human beings without
any deficit.
Does that happen 100% of thetime?
I wish I could say that.
It does not, but it does happen.
(24:56):
And the common theme among thosefolks who, who walk out of the
hospital with normal brains andnormal hearts and
well-functioning bodies, isusually that they got prompt
medical attention.
Many times they got CPR eitherfrom a medical professional who
is nearby or a bystander.
And then we were able to figureout what was going on and
address it rapidly.
Speaker 2 (25:16):
Great information for all of us.
Lou, thanks for being here.
Speaker 3 (25:19):
Thanks for having me.
David.
Speaker 2 (25:20):
We've been talking with Dr.
Luke Cole, interventionalcardiologist here at Hennepin
Healthcare with me in downtownMinneapolis.
I hope you've learned somethingfrom this show as I have.
It's been a great episode.
Thanks for tuning in and I hopeyou'll join us for our next
episode.
And in the meantime, be healthyand be well.
Speaker 1 (25:38):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
You got a question or a commentfor the show?
Email us at Healthy Matters hc me d.org or call 6 1 2 8 7 3
talk.
There's also a link in the shownotes.
(26:00):
And finally, if you enjoy theshow, please leave us a review
and share the show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
Jonathan Comito and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
(26:21):
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
Welcome to the Healthy Matters podcast with Dr.
David Hilden, primary carephysician and acute care
hospitalist at HennepinHealthcare in downtown
Minneapolis, where we cover thelatest in health healthcare and
what matters to you.
And now here's our host, Dr.
David Hilden.
Speaker 2 (00:20):
Hey there, it's Dr.
David Hilden.
When it comes to issues with ourorgans, perhaps the most common
ones we hear of are related toour heart.
It's a pretty long list when youthink about it.
The heart is a complex organ,and thankfully with me today
I've got Dr.
Lou Cole, interventionalcardiologist at Hennepin
Healthcare.
He's gonna help clarify a fewthings.
Dr.
Cole, welcome to the show andthanks for being here.
Thanks
Speaker 3 (00:40):
For having
Speaker 2 (00:40):
Me.
Absolutely.
Let's start with a big case inthe news lately.
So, DeMar Hamlin, a healthyyoung man who plays for the
Buffalo bills of the NationalFootball League, has a collapse
on the field.
I'm also aware that there was aDanish soccer player, you know,
Christian Erickson.
He had that in a soccer game acouple years ago.
So it's a really scarysituation.
These are young, healthy people,and it doesn't appear to be
(01:02):
isolated.
It's happened again a couple oftimes.
So, could you break down for uswhat maybe happened to these
athletes?
Speaker 3 (01:08):
Yeah, it's a good question.
I think there have been a numberof collapses on the field.
The athletic put together a nicelist of incidents like this that
have happened during livesporting events.
I, I agree with you completely.
The Christian Erickson episodeis probably as close as we have
to.
What happened to DeMar Hamlin inDeMar Hamlin's case?
He seemed to get hit in themiddle of the chest by the
(01:31):
receiver's shoulder, stood upfor a sec, and then fell over
backwards.
Something that would look to usas a physician, a cardiologist,
as probably a cardiac arrest,that's a signal that something
terrible is going on, and thebody's not getting enough blood
Speaker 2 (01:47):
Flow just going down uncontrolled.
That's so scary for in front ofa stadium, fool.
It,
Speaker 3 (01:51):
It's super scary.
It's super
Speaker 2 (01:54):
Scary.
So, I know we don't know theparticulars of these athletes
and their health conditions, andwe won't speculate on, on about
their personal healthconditions.
You know, they have a right tosome, some privacy as well.
But what do you think happened?
Why would someone's heart juststop like that?
Speaker 3 (02:10):
The thing that makes the most sense for DeMar Hamlin
is he experienced this thingcalled commotio cordes.
And it is the most unlucky ofmost unlucky circumstances.
It is a condition where if youget hit square in the center of
the chest, just at the rightmoment in your heartbeat cycle,
the electric cardiac cycle, itcan cause your heart to
(02:34):
transition from a normalcoordinated pumping motion to
what we call ventricularfibrillation.
The heart just quavering therenot pushing any meaningful blood
out to the body.
There's a couple reason wespeculate, we don't know, but we
speculate that that's the casefor Mr.
Hamlin.
The first is that he wasactually able to get up and he
(02:57):
stood up after the day.
He stood up and was, you know,normal, got up, just made a
tackle, 4, 2, 3, 4 seconds.
And just like the hose at yourhouse, when you turn it off at
the spigot, there's still alittle residual pressure in the
hose and a little bit of alittle bit of water.
In this case, a little bit ofblood flow is still coming out,
even if the tap is off.
(03:19):
And that is really common forone of these ventricular
arrhythmias and a rhythmmediated cardiac arrest in that
there's a very brief period oftime when you still have
consciousness, and then theblood pressure, in this case,
the water pressure in the caseof your hose turns off and then
without blood flowing to thebrain, eventually the brain
says, I'm gonna shut off.
Speaker 2 (03:40):
So it sounds like Lou , you're saying, is that he had
an electrical problem of hisheart, which then leads in a
couple seconds to, its notpumping.
Could you say more about that?
What the, what is the electricalversus the, I'll call it the
plumbing part of a heart'sfunction?
Speaker 3 (03:53):
The plumbing of your heart, uh, kind of works in two
ways.
Do you have pipes that feed yourheart muscle with oxygen?
When one of those pipes getsplugged, you have a heart
attack.
And usually that's not a cardiacarrest.
Usually don't fall over dead.
Usually folks have chest pain orchest pressure or, uh, squeezing
sensation or an elephant sittingon their chest.
(04:14):
That's sort of our usual kind ofclassic way.
Uh, heart attack presents.
And
Speaker 2 (04:19):
These are your coronary arteries.
Speaker 3 (04:20):
Coronary arteries, yeah.
So
Speaker 2 (04:22):
People tell me sometimes, well, doesn't the
blood, doesn't the heart getblood from that's inside of it?
And that's not how it
Speaker 3 (04:29):
Works.
That is not exactly, that is notthe case.
Your heart actually is the firstoff-ramp is your pumping chamber
pumps blood out of the heart,but that big vessel, the aorta
that pumps to the rest of yourbody, supplies'em all.
Mm-hmm.
But the, the heart does not getblood from the pumping chamber.
It's got its own little set ofarteries.
And when those get blocked, thatcauses a heart attack.
You know, only a very smallportion of heart attacks.
(04:52):
Less than 5%.
Do folks have a cardiac arresttoo?
Does the lack of oxygen make theheart muscle electrically
unstable?
So
Speaker 2 (05:00):
The electrical, the electrical activity continues on
after a heart attack.
It does.
Speaker 3 (05:04):
Usually most people continue living their life.
We hear all the time about folkswho've had chest pain at home
for hours and sometimes days,and do all sorts of stuff.
Continue to go to work, continueto, but it
Speaker 2 (05:15):
Can't be good
Speaker 3 (05:16):
If you,
Speaker 2 (05:18):
If you think you're having
Speaker 3 (05:19):
A heart attack, you should call EMS and get to the
hospital.
Speaker 2 (05:23):
Don't be like driving in.
Call nine one one,
Speaker 3 (05:25):
Call nine one one for sure.
Speaker 2 (05:26):
So that's the, that's the plumbing, the, the heart,
the blood supply that goes toyour heart.
Right.
Tell me about the electricalsystem.
Speaker 3 (05:33):
So the, for the heart to pump blood out to the body,
uh, is actually a very, uh,elegant, coordinated electrical
dance that causes the wholeheart to squeeze in unison and
pump blood out to the body.
There's a whole host ofdifferent reasons why that can
go awry, but in the case ofDeMar Hamlin, probably the
(05:53):
Danish soccer player, somethinghas gone horribly wrong and the
heart has gone from beatingnormally in a matter of seconds
to beating in a totallyuncoordinated fashion that
doesn't result in any meaningfulpumping out to the body.
Could
Speaker 2 (06:09):
This have been predicted or is this something
so out of the blue that there'sno, there's no way we could have
known?
Speaker 3 (06:15):
Probably not predictable.
There are a series of geneticconditions, things like
hypertrophic cardiomyopathy, avery thickened heart muscle,
some other things that theyactually screen some European
soccer players for, especiallyin Italy.
Speaker 2 (06:31):
Um, they, they check for'em before
Speaker 3 (06:32):
They, they check for 'em with echoes and MRIs and all
sorts of other heart imaging.
But as far as we know, DeMarHamlin had a totally normal
heart.
Speaker 2 (06:40):
Could we talk a little bit about what was done
on that football field on Mondaynight?
Yeah.
To that young man.
What were those first respondersdoing?
Speaker 3 (06:50):
You know, I think that's probably the most
important thing that happenedfor DeMar Hamlin.
Uh, folks could tell of widevariety of folks from his
teammates and the opposing teamto trainers and medical staff on
the sidelines.
They could tell immediatelysomething was seriously wrong.
They rushed out in the field,they assessed him, checked out
if he was breathing, if he had apulse.
(07:11):
And when they found that hedidn't have a pulse, they
started cpr.
CPR is just pushing hard andfast a hundred times a minute on
the center of someone's chest tomove a little bit of blood
around the body while theheart's not beating.
That is purely a temporizingmeasure until we can do
something more to restart theheart.
(07:31):
In the case of Mr.
Hamlin, it sounds like they alsoused an a e d.
This is a, an electrical devicethat sometimes you'll see on the
wall at stadiums and shoppingmalls and office
Speaker 2 (07:44):
Office buildings office, the gym
Speaker 3 (07:45):
All
Speaker 2 (07:45):
Over, all over the
Speaker 3 (07:46):
Place.
They are great.
They're super smart these days.
It's the equivalent thing to thepaddles in er,
Speaker 2 (07:52):
Like when you see it on the TV show, get the
Speaker 3 (07:54):
Paddles.
It is that just in an, anautomated version, if you're
somewhere and someone go has awhat looks like what you saw
with DeMar Hamlin, they pass outbackwards.
They look like they're notmoving or breathing.
Someone tells you they can't seea pulse other than calling 9 1
1.
If you see an a e d thingaround, go grab it off the wall,
you can put those patches righton the person.
(08:16):
You don't have to be a medicalperson at
Speaker 2 (08:18):
All.
It tells you how to do it.
Speaker 3 (08:20):
It, it, it is totally automated.
It will analyze the heartrhythm.
And if it finds a limited subsetof heart rhythms, including this
ventricular fibrillation onethat we think occurred to DeMar
Hamlin, as well as some otherones that are treated by an
electrical shock, it will figurethat out.
It will tell you to get out ofthe way so you don't get shocked
yourself and it will deliver ashock.
We understand that that isprobably what happened to, to
(08:42):
DeMar Hamlin on the field.
And once they were able to resethis electrical system with that
electrical shock, it started,electrical rhythm is back
working normally and pumpingsome blood to the body.
Speaker 2 (08:53):
So it was likely that those first responders on that
football field by doing chestcompressions and by delivering
shocks through an a e D, that iswhat led to his outstanding
recovery and the fact that hewas a healthy guy.
Yeah, but those two things
Speaker 3 (09:08):
Were 24 year old professional athlete.
But yes, those are the thingsthat kept him alive.
The C p R got enough blood withoxygen in it, moving around his
body so that his brain and therest of his body could continue
to live while he didn't have aheartbeat.
Folks out in the community, thisis where you can be heroes.
If someone has a cardiac arrestand you're waiting five minutes
(09:29):
for the paramedics to get there,even if you've never had a c p
class, push hard on the centerof their chest.
It's scary.
Speaker 2 (09:37):
And push
Speaker 3 (09:38):
Fast and push fast a hundred times a minute.
The thing that we coach peopleis the song Staying Alive.
Speaker 2 (09:43):
Staying alive.
I was wondering if get a breakstaying
Speaker 3 (09:45):
Alive that the beaten , that song's about a hundred a
minute.
So if you can, if you can pushsome blood around their body
right in the center of theirchest, over their sternum, until
folks are able to get there, youcan save someone's life.
You can keep their organs andbrain oxygenated enough that
after, in some cases a short, inthe case of DeMar Hamlin,
(10:06):
sometimes a little longerhospital stay during which time
everything else gets to recover,they can walk outta the
hospital.
Yeah,
Speaker 2 (10:12):
Yeah.
Now what about everybody'sremembering the old days in the
old mouth to mouthresuscitation?
Yeah.
And everybody's squirmed aboutthat.
And do we still do that or is itjust literally you come up to'em
and start doing chest
Speaker 3 (10:22):
Compressions?
We do it in the hospital, butout in the world, we've taken
that out of the guidelines.
Just push on their chest.
Don't worry about trying tobreathe into their mouth.
Don't worry about any of that.
Um, if someone has had a cardiacarrest and they don't have a
pulse, start out by pushing hardand fast on the center of their
chest, the medical personnel whorespond will take care of the
breathing portion.
(10:42):
But 99% of the time, unless youthink someone's choking on a
hotdog, and, and the issue isthat you need to give'em the
heim lick and get the hotdogoutta their throat, you should
just push hard and fast on thecenter of their chest.
Speaker 2 (10:52):
You mentioned that anybody can do this, and I wanna
make sure people hear thatanybody can start bystander cpr.
What do you think about actuallygoing to a CPR course and
getting a little more skills?
Do you recommend that?
Speaker 3 (11:03):
I think in an idealized world, everyone would
take a CPR class, kids wouldtake it in school, adults get it
with their driver's license orsomething.
But I think it's really a, avery helpful skill for any adult
to
Speaker 2 (11:14):
Have.
Yeah.
And as one who's done it, and Iknow you have as well.
Yeah.
Um, largely in hospitalsettings, but both of you and I
have probably done CPR a lot.
Right.
Um, you are literally pumpingthat blood for that person.
And, and I like the word youused.
You're you're gonna be a hero inthat case.
Yeah.
It really truly does matter.
It does.
Time matters and doesn't it,
Speaker 3 (11:31):
It time is the hugest part of this.
Speaker 2 (11:33):
I mean, don't wait around, get going.
Yeah,
Speaker 3 (11:35):
Yeah.
Immediately Call 9 1 1.
Or even better, ask someone elseto call 9 1 1.
Will you start CPR if you'resure that that person doesn't
have a pulse?
Speaker 2 (11:44):
I I I would assume it's relatively easy to find a
place where you could learn todo cpr.
Speaker 3 (11:48):
Yeah.
I mean, you can go on theinternet and American Heart
Association.
A lot of local organizationshave CPR classes.
Speaker 2 (11:55):
Maybe your local health club offers a
Speaker 3 (11:57):
Class even.
Speaker 2 (11:58):
Exactly.
If it's been a while sinceyou've done it, maybe, maybe
take a class again, maybe learnagain.
If it's been 2, 3, 4, 5 years,do it.
The guidelines change.
It isn't, you know, you're notgonna have to learn how to do
mouth to mouth, for instance.
Exactly.
So if you haven't done it for awhile, maybe it's a great time
to get relearn it.
But even if you haven't taken acourse, you can still do CPR and
chest compressions.
Speaker 3 (12:18):
So you can be the difference between someone
getting enough oxygen to theirbrain until the medics get there
to be the difference betweensurviving or not
Speaker 2 (12:26):
Really important and life-saving tips there.
So now we'll take a short breakand when we come back, I'm going
to continue the conversationwith Dr.
Luke Cole, who is aninterventional cardiologist at
Hennepin Healthcare.
And we're gonna talk about waysto keep your heart healthy.
Stay with us.
Speaker 1 (12:41):
You are listening to the Healthy Matters podcast with
Dr.
David Hilden.
Got a question or comment forthe doc, email us at Healthy
matters hc m e d.org or give usa call at six one two eight
seven three talk.
That's[inaudible] 8 7 3 8 2 5 5.
And now let's get back to morehealthy conversation.
Speaker 2 (13:04):
And we're back.
We're talking about your hearthealth with Dr.
Luke Cole, who is a cardiologistand a colleague of mine here at
Hennepin Healthcare.
So Dr.
Cole, let's talk about ways tokeep your heart healthy.
First of all, what aboutcholesterol?
What's the role of cholesterolin heart health?
Speaker 3 (13:17):
Cholesterol's a big part of heart health.
I think of it as almost like athree prong set of risk factors
for clogging up the arteries.
As we talked about earlier, theplumbing, half of the equation
that leads to blockage of bloodflow.
And then sometimes symptoms.
Those three are smoking,smoking, smoking, smoking.
Don't do it.
If you are smoking, work on notsmoking or call quit plan or
(13:41):
talk to
Speaker 2 (13:42):
One of the, and keep trying.
Many times you can quit and youshould,
Speaker 3 (13:46):
You can.
And it takes the average person,seven tries real tries to quit
smoking.
So if you've tried three timesand you gotta, you had a
cigarette again, that makes younormal.
Try
Speaker 2 (13:56):
Again.
It's a great point.
It makes you normal.
Keep trying.
Speaker 3 (13:58):
Yes, there's, there's probably nothing out there, no
medicine we're gonna talk about,not cholesterol as much as I
hate to say it, not any bloodpressure medicines that I can
prescribe as a cardiologist thatare as important to keeping your
heart and your brain and yourwhole body healthy as just not
smoking.
Speaker 2 (14:13):
Okay.
So that's number one.
Risk.
Speaker 3 (14:16):
Yep.
Number two, cholesterol andblood pressure go together.
But we're gonna focus oncholesterol cuz your blood
pressure, think of it as pushingcholesterol into the walls of
the artery.
So cholesterol itself, ourbodies actually make it.
We eat it.
Some people are more prone tohave high levels, some people
are not.
Anyone who's 40 or over shouldcheck in with their doctor and
(14:39):
get a cholesterol check.
And if you, uh, have highcholesterol, depending on your
other risk factors, your doctordoesn't have to be a
cardiologist.
It can be an internist, a familypractitioner, any primary care
doctor should help you work ongetting your cholesterol down.
Usually that's with a medicinecalled statin.
There's a wide variety of'em.
(15:00):
They've got a bad rap in thepress, but we've studied them
more than any medicine period.
And they work, they reduce heartattacks, they reduce strokes,
and they bring your cholesteroldown.
Speaker 2 (15:11):
So if your doctor or other healthcare practitioner
advises you to take a statin,consider it.
Consider it, consider itstrongly.
Yes,
Speaker 3 (15:20):
You very much, if you have concerns about statins,
express them to your doctor,your, your nurse practitioner,
your physician's assistant,whoever that person is, talk to
'em about it.
But from a medical scientificstandpoint, they work and they
work really well.
And the side effects that areoften ascribed to statins are,
to be perfectly honest, is justas common in those same clinical
(15:40):
trials among folks who aretaking a placebo sugar
Speaker 2 (15:44):
Pill.
Yeah.
So it wasn't necessarily thestatin.
People got muscle aches, didn't
Speaker 3 (15:47):
They do it?
Turns out people get muscleaches, whether you're taking a
statin or you know, drinking avitamin water or whatever you
are doing.
Speaker 2 (15:54):
Okay.
So risk factors don't smoke.
Get your blood pressure andcholesterol under control.
What else?
Speaker 3 (15:59):
You know, I think being physically fit and active
is a good thing for your body asa whole.
We would love that.
We could say as confidently aswe do about statins, that being
fit prevents heart attack,prevents strokes.
I'm not sure if we can say thatto the same degree of
confidence, but it's justhealthy for your whole body.
And selfishly, as acardiologist, I love it when
(16:20):
people are fit.
It's like they're doing theirown stress test every day.
Right.
And they can tell me, you know,I used to be able to run five
miles, but now when I get tothree I'm really short winded or
I'm starting to have thisdiscomfort in my chest.
That is so helpful.
And for folks who are not fit,you're not asking much of your
heart.
And so it's really hard to getthat advanced warning of
something's wrong if you're notdoing much.
(16:42):
And there's a lot of folks outthere who have a lot of
limitations.
Speaker 2 (16:44):
What about aspirin?
It used to be that we want thatwe practically put it in the
water supply and we toldeverybody, ah, take an aspirin.
You're gonna live forever.
You'll never have a heartattack.
That is no longer the case.
Is it?
That's not the guidelines.
Speaker 3 (16:55):
That is not the guidelines.
And, and I think a couple yearsago there was a new guideline
put up by the US PreventativeServices task force and it was,
could have been done a littlebetter.
Um, a lot of folks came to ourclinics who should be on an
aspirin and said, Hey, I heardin the news and I'm not supposed
to be on aspirin anymore.
And that was the message thatwas put out.
But really what that guidelinewas discussing was should people
(17:18):
who've never had any heartthing, never had a stroke, never
had a, what we call peripheralarterial disease or a stent in
their leg.
Or should people who arehealthy, should they be taking
an aspirin to prevent heartattacks in stroke?
And it turns out that except fora very, very select subset of
people who have super high risk,you probably shouldn't be taking
(17:40):
an aspirin every day.
Not because it doesn't decreasethe risk of heart attack and
stroke a little bit.
It actually does.
But like all medicines and allthings in life, there's a flip
side in that aspirin is also avery mild anti-platelet
medicine.
Uh, think of it like a bloodthinner and it also increases
your risk of bleeding a littlebit.
And so for healthy folks, itactually, the bleeding risk
(18:02):
offset the, the good that theaspirin was causing.
Speaker 2 (18:05):
So the average person, now we can't say
specifically Yeah.
Right now what everybody shoulddo.
But the average person maybedoesn't need an aspirin.
Is there somebody that should betaking a daily aspirin?
Speaker 3 (18:15):
Yeah.
So what that guideline did notchange at all is if you've had a
heart attack before or you'vehad a stent or you've had a
bypass or you've had a stroke,you've had a leg artery issue or
a carotid artery issue, in thatcase, your risk of having
another event is much, muchhigher.
And the risk benefit balance isvery different.
And they should very much stayon aspirin
Speaker 2 (18:38):
So if you are listening to thisand you're not sure, talk to
your doctor.
Yeah.
Talk to your cardiologist.
You may or may not need to be onone, but it, it's a little bit
more nuanced then everybodyshould or everybody shouldn't.
Speaker 3 (18:47):
Yeah.
It, it used to be really easyfor us.
Yeah.
Just as you see that be on anaspirin, it'll help you.
It's risk free.
I think we've, we've grown up alittle bit in medicine and
starting to acknowledge thateverything, even aspirin does
carry a little bit of risk andwe want to use it in a way that
helps people and doesn't causethem harm.
Speaker 2 (19:05):
Right.
You know, it came from the barkof a willow trees.
It's so long ago that thereweren't any like regulations for
approving it.
If aspirin were invented today,would've to go through some
trials and there'd be likesafety warnings and things.
All
Speaker 3 (19:16):
Those things.
Yeah.
Speaker 2 (19:17):
Yeah.
Can I ask you one other thingcuz I can't resist.
You're an interventionalcardiologist.
This is an opportunity to askthe guy who actually does it.
When you put a stent in aperson, whether it's for chronic
angina, chronic chest pain, orwhat we do a lot of here, if
you've had a heart attack and anarteries blocked, can you just
briefly explain to us whatyou're doing?
Speaker 3 (19:37):
Absolutely.
In the cath lab, the cardiaccath lab where I work and I do
my interventional cardiologywork, we start by taking x-ray
movie pictures of a person'sheart arteries.
Once we get those pictures,sometimes we see a severe
narrowing or a blockage.
If we do find a blockage, we'llsay in the case of an acute
heart attack, we actually take atiny little wire, 14,007 inch,
(20:01):
we wiggle it down the arterythrough a small tube that
extends from either your wristor the creas, your hip up to
your heart.
We take that wire, we wiggle itthrough the clot that is
blocking off the heart artery.
And then we start out by using aballoon of all things.
It runs over that wire, justlike a train on a train track.
In this case it'd be a monorail,but a single hole in that
(20:24):
balloon slides over our wire andwe inflate the balloon and the
balloon pushes aside the clot orin some cases
Speaker 2 (20:30):
To the sides Yes.
Speaker 3 (20:32):
Pushes it to the sides.
And I think the question wealways get is, well, did you
take the stuff out?
Did you like suck it out with avacuum cleaner ro aro or
whatever?
And, and it turns out we don'tbecause your body is really
amazing.
Really what we need to do isrestore blood flow.
The body's blood circulatorysystem is full of enzymes that
(20:52):
dissolve blood clot, but theonly work, if a fresh supply of
blood is able to flow by thereand attack that clot.
So we just push the stuff to theside enough to start restoring
blood flow.
Once we get that going, that'sgreat.
Ultimately we stabilize thingsby putting in this metal mesh
tube called a stent that getspushed up with another balloon,
essentially into the sides ofthe arteries.
(21:13):
And that becomes like a scaffoldor like the two by four is
inside your wall and your bodyactually heals over it.
So that six months to a yeardown the pike, if you could
miniaturize yourself like RickMorans and Yeah.
Honey or
Speaker 2 (21:25):
Shrunk the kids imagine school
Speaker 3 (21:27):
Bus.
Exactly.
Go inside your artery and lookaround.
You wouldn't necessarily see anymetal.
Your the skin lining, theendothelium inside your heart
artery would've healed over thatstent and it's just in there
holding the whole thing open.
Yeah.
Speaker 2 (21:39):
Okay.
I have seen you, I've seeninterventional cardiologists do
it.
I've actually seen Dr.
Colder, I've stood over yourshoulder because he's been very
kind and allowed me to standthere and watch this.
Explain to us how you inflatethat balloon.
What are you talking about?
You have, is it like playing avideo game?
Do you have instruments or howdo you inflate the balloon?
How do you
Speaker 3 (21:56):
Do that?
Yeah.
We have, we have this devicethat's actually filled with
fluid cuz we can control it moreprecisely than blowing up air
or, you know, helium.
It's almost like a hydraulicdevice that very precisely adds
fluid to the balloon and thenmeasures the pressure inside the
balloon.
And it actually, when we deploya stent, we use quite high
(22:20):
pressures.
12, 16, 18 atmospheres worth ofpressure.
Wow.
To really push it into the sideof the artery.
It's gonna stay there once youget a stent put in.
And it is there forever.
Speaker 2 (22:31):
It's yours for life.
Part of you now.
But it, it strikes me as, uh,dangerous if you're, if you're
blown up a balloon in there,aren't you clogging the artery
Speaker 3 (22:40):
Temporarily?
Speaker 2 (22:41):
So you, you're, you're not in there for a long
time.
Speaker 3 (22:44):
No, in modern days.
Maybe a minute.
Yeah.
Do we have the balloon up?
Mm-hmm.
Usually more like 30 seconds.
Yeah.
And the, the body's amazing.
The body's very tolerant and itcan tolerate 20, 30 seconds of
impaired blood flow.
In the case of a heart attack,you started out with a blocked
off artery.
Speaker 2 (23:01):
It was blocked already.
It
Speaker 3 (23:03):
Was blocked already.
And so we're it's all, it's allgravy from there.
We're gonna get it.
Speaker 2 (23:06):
Exactly.
Hey, before I let you go, let's,I wanna just circle back one
more time to the importance of CP r.
Briefly.
What should people do if theyare the first one on the scene
with someone in a cardiacarrest?
Because I don't want this pointto get lost.
Speaker 3 (23:18):
Again, if you come upon a person who is passed out,
they're, they're not responding.
Shake'em hard, yell at'em.
See if they respond.
If they don't, the first thingyou should do is probably call 9
1 1.
Or if there's another personwith you, ask that person to
call 9 1 1.
That activates the medicalsystem.
That gets paramedics, some firstresponders there on the scene as
(23:39):
soon as they can.
The second thing you should do,if you know how to do it, check
if they have a pulse.
Feel it, their wrist feel on theside of their neck.
Especially if you have somemedical training and you have a
reasonable sense of where tofind a pulse and it's not there.
Start c p r push hard and faston the center of their chest.
Folks might wonder, well, whatif, what if I just didn't find
(23:59):
the pulse?
Does it happen?
Absolutely.
It happens among medicalprofessionals.
Turns out, if that person isawake at all, you are not gonna
hurt them by doing cpr R they'regonna sit up and they're gonna,
Speaker 2 (24:10):
They're gonna let you , you know, uh, no, I was just
resting.
Yes,
Speaker 3 (24:12):
Exactly.
So err on the side of doing it.
Someone who is awake is notgonna let you do CPR on them.
Speaker 2 (24:18):
Yep.
You know that's true.
Okay.
So prompt c P r if you can findan a, e d to defibrillate, do
that.
That's what helped the are theathletes that we started this
show with.
And so I wanna end on a positivenote.
If you do those things are theoutcomes, can they be okay?
Speaker 3 (24:35):
We have folks who come to our facility after
having cardiac arrests at theirworkplaces downtown at US Bank
Stadium across the street, allmanner of places who have very
much walked out of the hospitalas normal human beings without
any deficit.
Does that happen 100% of thetime?
I wish I could say that.
It does not, but it does happen.
(24:56):
And the common theme among thosefolks who, who walk out of the
hospital with normal brains andnormal hearts and
well-functioning bodies, isusually that they got prompt
medical attention.
Many times they got CPR eitherfrom a medical professional who
is nearby or a bystander.
And then we were able to figureout what was going on and
address it rapidly.
Speaker 2 (25:16):
Great information for all of us.
Lou, thanks for being here.
Speaker 3 (25:19):
Thanks for having me.
David.
Speaker 2 (25:20):
We've been talking with Dr.
Luke Cole, interventionalcardiologist here at Hennepin
Healthcare with me in downtownMinneapolis.
I hope you've learned somethingfrom this show as I have.
It's been a great episode.
Thanks for tuning in and I hopeyou'll join us for our next
episode.
And in the meantime, be healthyand be well.
Speaker 1 (25:38):
Thanks for listening to the Healthy Matters podcast
with Dr.
David Hilden.
To find out more about theHealthy Matters podcast or
browse the archive, visithealthy matters.org.
You got a question or a commentfor the show?
Email us at Healthy Matters hc me d.org or call 6 1 2 8 7 3
talk.
There's also a link in the shownotes.
(26:00):
And finally, if you enjoy theshow, please leave us a review
and share the show with others.
The Healthy Matters Podcast ismade possible by Hennepin
Healthcare in Minneapolis,Minnesota, and engineered and
produced by John Lucas AtHighball Executive producers are
Jonathan Comito and ChristineHill.
Please remember, we can onlygive general medical advice
during this program, and everycase is unique.
(26:21):
We urge you to consult with yourphysician if you have a more
serious or pressing healthconcern.
Until next time, be healthy andbe well.
Popular Podcasts
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
24/7 News: The Latest
The latest news in 4 minutes updated every hour, every day.
Therapy Gecko
An unlicensed lizard psychologist travels the universe talking to strangers about absolutely nothing. TO CALL THE GECKO: follow me on https://www.twitch.tv/lyleforever to get a notification for when I am taking calls. I am usually live Mondays, Wednesdays, and Fridays but lately a lot of other times too. I am a gecko.