February 14, 2025 • 30 mins
Dr. Maryam Mohammadi is a board-certified Cardiologist with Johns Hopkins Community Physicians…Dr. Hanghang Wang is a Cardiothoracic Surgeon at Suburban Hospital and Assistant Professor of Surgery at the Johns Hopkins School of Medicine. February is Heart Month and they joined us to talk about the various types of cardiac diseases, prevention, and the role of Artificial Intelligence in cardiac care.
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Episode Transcript
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Speaker 1 (00:05):
Good morning, and thanks so much for listening to Community
DC on this iHeart Radio station Jenny Chase here. February
is Heart month. JOHNS Hopkins Medicine is raising awareness about
heart health across the Greater Washington area. For tips and
resources to protect your heart, you can visit Hopkins HEARTDC
dot org. Today I'm joined by doctor Maria mohammedi aboard
(00:27):
certified cardiologist JOHNS Hopkins Community Physicians, which is now seeing
patients at the newly opened Arlington Clinic. With so much
advanced training, years of clinical experience, and a very compassionate,
patient centered approach to care. Doctor Mohammeddi is going to
share practical tips and insights to help us all maintain
a healthy heart. Doctor Mohammadi, thanks for being here.
Speaker 2 (00:47):
Good morning, Thank you for having me.
Speaker 1 (00:49):
Can we start by you giving us a little bit
of your background?
Speaker 3 (00:53):
Doctor Yes.
Speaker 4 (00:54):
I grew up in Vancouver, Canada, Okay and completed my
Masterfl's degree and University of British Columbia. Then I had
my medical degree from Ross University School of Medicine and
then moved to Hershep, Penn State and completed internal medicine residency,
followed by Carriebasco Fellowship. I've been practicing for eight plus
(01:20):
years in carreology in different states Pennsylvania, Maryland, DC.
Speaker 2 (01:26):
And now Virginia.
Speaker 3 (01:27):
Excellent. Okay, we have a lot to get to today.
Speaker 1 (01:29):
Let's start with the basic terminology though, of heart disease.
Can you give us a broad spectrum of what all
that can encompass?
Speaker 4 (01:37):
Yes, So, heart disease refers to a range of conditions
that affect the heart structure and function in a general
term that includes various types of heart conditions, most of
which are related to narrowing or blockage of blood vessels
that supply blood to the heart coordinary arteries, as well
as problems with hearts, rhythm, valves, and structures.
Speaker 1 (01:57):
Can you speak to the prevalence of heart disease DAEs
here in the US and around the world.
Speaker 2 (02:02):
Yes.
Speaker 4 (02:03):
According to World Health Organization WHO, Cardiovascu disease accounts for
an estimated seventeen point nine millions deaths annually, which is
about thirty two percent of all global deaths. In the
United States, heart disease remains the leading cause of death.
Was around six hundred and ninety seven thousand deaths from
(02:24):
heart disease recorded.
Speaker 2 (02:26):
In twenty twenty.
Speaker 4 (02:27):
According to Centrum Disease Control and Prevention, this makes cardiobasco
This is the leading cause of death in the United States.
Approximately one in every three deaths is due to cardiobascula disease.
Speaker 1 (02:40):
Doctor Mohammad, I hope you can forgive me if I
get a little emotional during this discussion. I lost my
father about six months ago to congestive heart failure. So
spreading this this awareness, letting folks know about what is
available as far as treatment and prevention, it hits home
with me. So any apologies if I kind of take
a moment to pop. I don't know that a lot
(03:01):
of folks realize the importance of heart health until it
affects their family directly. Let's educate folks on the different
types of cardiac issues and there are many.
Speaker 4 (03:10):
Yes, I appreciate you sharing that with me, and I'm
sorry for your loss absolutely. I'm sure that affects you
and your family and it's on your mind. And yes,
heart failure is one of the heart conditions that affects
a big population of patients. It's a condition that the
heart is unable to pump blood efficiently to meet the
(03:31):
body's needs, and it can result from other heart disease
like cornery disease or high blood pressure, and it has symptoms,
then I would go over during this talk so patients
are aware when to seek medical attention.
Speaker 2 (03:49):
But the most.
Speaker 4 (03:49):
Common heart disease is cornary art disease, and that is
when the cornery art is the blood vessels to the
heart get blocked and narrowed due to build up of
plaque or called atheroskleurosis, and that leads to chest pain
or angineae and.
Speaker 2 (04:08):
Leads to heart attack or heart failure.
Speaker 4 (04:11):
Heart attack happens when blood flow to the part of
the heart muscle is blocked causing damage or that's sort
of muscle, and that often results.
Speaker 2 (04:19):
From a rupture plaque or blood clot and again this
two condition can lead to.
Speaker 4 (04:24):
Heart failure and some of the signs of heart failure
is fatigue, shortness of breadth, and fluid retention. Arrhythmias is
another important heart disease that we see a lot of
patients with coming to the office with regular heart beats.
Speaker 2 (04:39):
Either the heart beats too quickly it's called a.
Speaker 4 (04:42):
Tachycardia or too slow braiding parity or irregular such as
atual fibrillation, and some of these arrhythmias can lead to
stroke or heart failure.
Speaker 2 (04:51):
Heart disease. It's the next heart disease that we want
to focus on and can give some attention to.
Speaker 4 (04:57):
And that's when the heart bals, which we have four
of them, or damage or disease, and either they're narrow
or sonatic, or they're leaking blood backwards which is called regurgitation,
and that can affect the heart function and patient can
have symptoms from that country the heart disease. In adult world,
we still deal with those patients that have heart defects
(05:20):
present at birth. With all this new technology and science,
they do get surgery early on and we do follow
them up once they're eighteen and older in adult world
of cardiology, and they may require surgical correction early on
or even later in life and need lifelong management. Cardiomyopathy
(05:42):
is a heart muscle becomes enlarge, thicken, or stiff, and
that impresibility of heart to pump blood effectively again leads
to heart failure or al rhythm yes, and it goes
into different multiple types of cardo myopathy dilated, higher, trophic,
or restrictive, and some of these are hereditary and genetic richarditis.
Speaker 2 (06:07):
Again, we see this in young patients as well.
Speaker 4 (06:09):
Inflammation of the lining, the member and the member around
the heart can get inflamed and cause chest pain.
Speaker 2 (06:18):
And it can be.
Speaker 4 (06:20):
Caused by infection, viral infection, the common common one injury
or auto immune disease.
Speaker 1 (06:26):
Okay, our next topic is aortic disease. What is that
all about?
Speaker 4 (06:31):
Yeah, So, aortic disease the effects that order the main
large aready that carries blood from the heart to the
rest of the body.
Speaker 2 (06:38):
This is such as anaurysm, which is enlargement or bulging of.
Speaker 4 (06:41):
The aorda dissection or tear in the urtic wall, which
both these conditions can lead to life threatening complications complications.
Speaker 2 (06:50):
So knowing this ahead of time helps treat those patients.
Speaker 4 (06:53):
Then the common ones that patients come to office with
high blood person, it's called hypertection.
Speaker 1 (07:01):
Unfortunately, Yeah, I am familiar with that one.
Speaker 2 (07:05):
It's called the silent killer.
Speaker 5 (07:06):
Because patients feel good, they feel okay, may not have symptoms,
but an un control blood pressure for a long time
can lead to heart conditions heart attack, heart failure, or stroke.
Speaker 1 (07:20):
So yeah, I mean, obviously I monitor my blood pressure
every day, and I am just so aware of this
issue in my life. And you know, we talked about
the statistics earlier. How many people this affects. Can we
talk about the risk factors what folks need to know?
Speaker 4 (07:38):
So overall respectors for heart disease include high blood pressure, hypertension,
high cholesterol, hyperlipidemia, smoking, diabetes, obesity with BMI of more
than thirty, physical inactivity for diet, excessive alcohol consumption, from
(07:58):
a history of heart.
Speaker 6 (07:59):
Disease as you meant, and age engender.
Speaker 4 (08:02):
Men are likely at higher risk at earlier age, but
the risk for women increases after menopause.
Speaker 1 (08:08):
Yay heart disease. Yeah, I'm I have gotten past that point,
doctor Muhammad. Can we talk a little bit more about
the cholesterol factor, because that is also something I am
dealing with and I'm sure I am not alone.
Speaker 4 (08:22):
Yes, So checking a fasting blood cholesterol part of regular
lapse is one screening for high cholesterol, and the recommendation
for American Heart Association is adults starting at age twenty
and definitely by age forty and checking that every four
(08:46):
to six years.
Speaker 2 (08:49):
The LDL, which is about.
Speaker 4 (08:50):
Cholesterol, the goal is to keep that under one hundred
and keeping a good cholesterol the HDL more than forty
for men and more than fifty for women, and keeping
a traversory less than one fifty and keeping.
Speaker 2 (09:06):
A healthy weight.
Speaker 4 (09:07):
Eating heart healthy diet which includes mainly Mediterranean diet with
low salt and focus on protein and vegetables is key.
And exercise on a regular basis, which the ACC ANDHA
recommend moderate exercise intensity five times a week.
Speaker 1 (09:29):
That was my next question, how much do we need
to incorporate that because I know a lot of people
I have myself included very sedentary literally five times a week,
no joke.
Speaker 4 (09:40):
Ideally, yes, you know, moderate intensity aerobic to get your
heart rate up, and that's what's been shown to have
benefits for cordniobasco health long term.
Speaker 1 (09:51):
When something is going wrong, when we feel off, what
are like the specific signs we need to be aware
of if something if we're having some sort of hardiact issue.
Speaker 4 (10:01):
Common warning signs of heart disease is feeling of a
chest pressure tightness.
Speaker 2 (10:08):
Some people can mistake it.
Speaker 4 (10:09):
For indigestion or heartburn, but that can be a sign
of heart attack and sometimes the pain even radious.
Speaker 2 (10:16):
To arm, neck, back, jaw, or the stomach.
Speaker 4 (10:21):
Next is the difficulty breathing or shortness of breath, especially
with activity or when lying flat, and that could indicate
heart disease, including heart failure, which may occur if you
have a fluid build up in the lungs and the
heart is not pumping effectively. Unexplained fatigue with normal activity
(10:41):
can also be inside of a heart that's struggling to
supply oxygen rich blood to the body, and the symptoms
happen in patients with heart failure or cornary disease. Next
would be you know, feeling faint, dizzy, or light at it,
especially when standing up quickly, can indicate a problem with
heart rhythm, arrhythmia or insufficient blood float to the brain
(11:04):
due to heart disease. Swelling in the feet, ankle, legs,
or abdomen can also be a sign of heart failure
and fluid building up in the body where the heart
is not effectively pumping blood raising the fluttering.
Speaker 2 (11:19):
The irregular heartbeat can be a.
Speaker 4 (11:22):
Sign of arrhythmia and sometimes can be dangerous and it
can lead to stroke or heart failure. You know some
other vague symptoms which can or more common in women,
or you know nausea or indigestion, even vomiting as a
sign of heart attack. Persistent coughing or wheezing that has
(11:47):
some white mucus and it's not really responsive to inhalers
that's prescribed by lung specialists. Could also mean there's fluid
in the lungs and it's and it's signs of heart
failure on spain. Excessive sweating, you know, especially when not
physically active like a cold sweat, can also be signs
(12:07):
of heart disease or cardiac event.
Speaker 1 (12:09):
I meet a lot of that criteria, so obviously I'm taking,
you know, the preventive steps that I can. But when
is it time to call nine to one one to
go to the hospital?
Speaker 2 (12:18):
Absolutely, you know, I would sell my patients.
Speaker 4 (12:21):
You know your body best, so you know what's abnormal
for you. So some of the vague symptoms that I mentioned,
maybe the sweating, whatnot. If a woman is you know,
metopolsle may experience it, but if that's not part of
their norm and it's been going on for a while,
that could be their sign to seek medical attention. But definitely,
(12:43):
you know, midsternal chess pain lasting a few minutes, comes
and goes.
Speaker 2 (12:50):
Pain that radius to armor jaw.
Speaker 4 (12:52):
You know, all of a sudden short of breath, competent
with chess spain, or feeling pale, feeling you're about to
pass out.
Speaker 2 (13:00):
These are these are red flags and.
Speaker 4 (13:02):
You gotta you know, these are warning signs, and you
gotta seek medical attention. And time is critical, especially when
treating heart conditions, especially heart attack or.
Speaker 1 (13:13):
Stro Right now, we do have a lot of tools
to help us diagnose these issues. Let's talk about cardiovascular
disease preventative measures and the tests that you can run
on us.
Speaker 4 (13:25):
Yes, of course, so in a nut show, there are
key screening tools and tests that commonly you see abuid
cardiovascular health and identify individuals at risk before symptoms appear.
Speaker 2 (13:38):
Blood pressure screening is one.
Speaker 4 (13:40):
You know, the goal for blood pressure is let's on
one hundred and thirty over eighty for majority of patients,
So that gets checked once you come out to a
doctor's office, including cardiologists.
Speaker 2 (13:53):
Lipid panel we kind of touched on.
Speaker 4 (13:56):
It's a fascting lipid that is recommended before to six
years if you have a family history. The earlier the better.
Blood glug cose tests as a screen for diabetes also
plays a role in assessing cardiovascular risk. Patients with diabetes
(14:16):
have an increased risk of heart disease and normal fasting
glog coles is less than one hundred.
Speaker 2 (14:24):
Next would be measuring the body.
Speaker 4 (14:27):
Mass index, which is height over weight, and that's one criteria.
It's useful tool to estimate body fat and also gear
some treatment towards patients for overweight or obese. There's this
Framingham risk coore calculated that I use in the office
all the time, and that gives me a ten year
(14:48):
risk of It's.
Speaker 2 (14:49):
An assessing tool to estimate ten year.
Speaker 4 (14:51):
Risk of developing cardiovascular disease based on age, gender, blood pressure,
cholesterol level, smoking status, diabetes status, and if whether the
patients are taking blood pressure or cholesterol medications, and based
on the categorized patient in low model or high risk
for heart disease and gear their treatment and prevention towards that.
Speaker 2 (15:17):
Cordinara A calcium score.
Speaker 4 (15:18):
It's a low dose CT scan that we have the
patients complete with radiology and it looks into detect calcium
deposit in a cordinary arteries zero calcium, zero cholesterol plaque
built up is a lowest patient anyone more than four
hundred calcium is a high risk patient than we kind
(15:42):
of treat with medications and further procedure if needed. A
basic twelve lid EKG in the office can also detect
any arrhythmia as previous heart attack or any abdomal in
part structures. Further testing that we offer in our office
is also ecocardiogram, which the ultrasound wave that we take
(16:02):
to take pictures of the heart helps u success the
heart size of function and deteke an evalve issues or
signs of heart pump failure.
Speaker 1 (16:16):
And you also have something called an A B I.
I'll be honest, I'm not familiar with that. Could you
please share, yes.
Speaker 2 (16:21):
So that's ankle break or index.
Speaker 4 (16:23):
It's a screening for prefer artery disease, you know, with
cardiovasca health. Besides the heart and the A order, I
do focus on the rest of the arteries and blood
vessels in the body, the blood vessels in the legs
and neck, to the abdomen to the kidneys. So there's
a quick test.
Speaker 2 (16:44):
That we can do.
Speaker 4 (16:44):
Just like how we measure blood pressure in the system,
we can measure compare that blood pressure in the arms
with the legs and kind of give us an estimation
of if you have any plaque build up in the
arteries in the legs, and that's a condition prefer ardery
disease that we can screen for and it also increases
risk of cardiovascular events.
Speaker 2 (17:06):
Next would be stress.
Speaker 4 (17:07):
Testing and they will be screening for cornary r A
disease or any arrhythmias with that.
Speaker 2 (17:16):
There's different types exercise and a.
Speaker 4 (17:18):
Treadmill or a nuclear or a stress echo cardiogram. Yes, yes,
so we we do offer all these screening testing in
our office and all these cardiovascular testing with Johns Hopkins
Community Physician hardcare. So I encourage patients to you know,
seek medical attension or talk to a primary and kind
(17:41):
of get these tests appropriately completed.
Speaker 3 (17:45):
I think that is what I need.
Speaker 1 (17:46):
So I, you know, in hearing everything that you've been sharing,
I feel like, you know, I'm taking the small steps,
but I really think I need to see somebody with
your level of expertise. And just as you were talking,
like bulbs are going off and I'm just thinking about
all these different things that I experienced. So early screening
you recommend between ages forty and.
Speaker 3 (18:06):
Forty five to start, really.
Speaker 1 (18:09):
You know, kind of putting some focus on this. What
are some other things we need to keep in mind?
Speaker 4 (18:14):
If you have a strong family history, we usually as
like a rule of thumb, you know, ten years earlier
than that family member that got the disease or diagnosed
with it. It's what's recommended, you know, going back to
your dad's case, obviously, with you, it would be prevention, prevention,
prevention and be able to get identified as risk factors
(18:36):
besides genetics and hereditary that we cannot change much, but
there's lifestyles that we can, you know, focus on and
prevent so this does not happen.
Speaker 2 (18:45):
To you once you get older, you know. So those
are things that with.
Speaker 4 (18:50):
The the medications we have, the testing and the screening
that we have nowadays, that we can potentially prevent that.
Speaker 1 (18:58):
Well, ma'am, we just can't thank you enough for sharing
all of this with us this morning.
Speaker 4 (19:02):
Thank you for you for the time, and I appreciate
the opportunity, and we'll welcome any new patients referrals.
Speaker 2 (19:10):
I'll be happy to see you as well, and we'll
talk to you on the phone whichever you prefer.
Speaker 4 (19:14):
In Part month is coming up in February, and so
I encourage everyone to think about the heart disease and
think about the next step in prevention.
Speaker 1 (19:24):
Okay, we just heard from doctor Merriam mohammedy with Johns
Hopkins Community Physicians which are located here in the DC area.
Doctor Mohammedi is now seeing patients at Johns Hopkins Medicine's
new Arlington Clinic and the Boston Quarter Mall and visit
Hopkins Medicine dot org slash Arlington. And for more heart
health resources and information about the Johns Hopkins Heart and
Vascular Institute in the Greater Washington area, please visit HOPKINSHEARTDC
(19:49):
dot org. Now we're going to switch gears a little
bit and talk about the role of AI in cardiac care.
Speaker 3 (19:54):
Artificial intelligence.
Speaker 1 (19:55):
Doctor Hong Hong Wong is a cardiothoracic surgeon at Suburban Hospital,
Assistant Professor of Surgery at the Johns Hopkins School of Medicine.
Speaker 3 (20:04):
Doctor Wang Hi, good morning.
Speaker 1 (20:06):
We have some really interesting stuff to cover with you
this morning, the role of AI in cardiovascular medicine. We
hear a lot about AI in the news. How is
it transforming what you as a doctor do on a
daily basis?
Speaker 6 (20:19):
So I really perform heart surgery and AI is really
changing the ways we plan the operation, the way we
do the operation, and the way we take care of
patients afterwards. So starting from planning the operation, it helps
us analyze the patient's history and then their lab results
to determine the best approach for the patient. We can
(20:41):
use AI to analyze their images and to help us
better make a surgical plan. And then during the surgery
we're able to have real time data on the patients
and have AI help us analyze things that we need
during the operation as well. And then after surgery. It's
also it helps us predict how well the patients are
going to do based on data or information from similar patients.
(21:04):
It can tell us do we think this patient needs
a little bit more support or more rehab afterwards, or
do we think this patient's going to do well without
any additional support. So it's really helping us in multiple ways.
Speaker 1 (21:18):
What about you as a surgeon and your skills? Is
there a role that AI is playing in how what
you do is evaluated?
Speaker 6 (21:27):
Yes, we are actually leveraging AI to help us determine
how well the surgeons are performing and training, So that's
one of the projects we're doing. It happens is where
now we have robotic surgery that we do on patients
and that gets recorded automatically, so we can use AI
to analyze the clips of surgeons learning how to do
(21:49):
an operation, for example, and then give them feedback about
what they should be doing, what they shouldn't be doing,
are they doing it well enough? So it actually helps
us get better.
Speaker 1 (22:00):
Really unbelievable, but I mean, I guess with all the
advances we've seen over the years, it's natural that we
would get to this point. Let's talk about the difference.
What are the differences between AI and robotics.
Speaker 6 (22:10):
Yeah, it's actually two completely different things. Okay, So you
can think of AI as a brain that helps understand
what's going on. It's the brain behind.
Speaker 3 (22:19):
The whole thing, okay.
Speaker 6 (22:20):
And then robotics right now, it's still very much as
a set of advanced tools. So it's like the hands
of the surgery.
Speaker 3 (22:27):
Okay.
Speaker 6 (22:27):
So right now, robotic surgery actually is not automatic yet,
so until we I think in the future, we'll be
able to combine robotic surgery with AI where the surgeon
doesn't even need to be doing the maneuvers anymore. But
as of right now, there's still you still need a person.
It's kind of wizard of Oz, right. You still need
(22:48):
a person there to actually maneuver the robotic arms to
be able to perform the operation. So the surgeon is
actually still performing the operation, it's just we're using better
instruments the robotic arms.
Speaker 1 (23:00):
Are we going to see a point where robots replace
qualified skilled surgeons like you, who've been doing this forever
and you study years and years and years and you
hone your craft. Will robots ever affect what you do
every day?
Speaker 6 (23:15):
Yes? I think so in the future. Probably not in
the next five to ten years, but maybe in twenty years.
I think there is because robots are now able to
do repetitive or really highly technical tasks. I think in
the future they'll be able to sow blood vessels together,
They'll be able to hold tissues. I think it's all
(23:36):
in the works. So I think a lot of what
we do will eventually be replaced by robots. I don't
think we're quite there yet, because I think that's the
idea of really marrying robots with AI. Right, So, now
we have the hands, you still need the surgeon to
provide the brain. But when AI is able to really
(23:56):
take over the thinking then AI can be the robots.
So I think that's when we'll get there. You know,
there are already hey I programs. I know at Hopkins
there's a group in the Applied Physics Lab where there
they have robotic dogs and they can already go into
the field and perform ultrasounds on people. So so yeah,
(24:21):
the technology is isn't getting there? I think.
Speaker 1 (24:25):
I mean, obviously you want what's best for you know,
your patients and for all of mankind when it comes
to medicine.
Speaker 3 (24:31):
But when you think about that, what does it make
you feel.
Speaker 6 (24:33):
I think it's great. I think we are responsible for
pushing this forward, and I think right now, you know
there there's still so many uncertainties, and I think doctors
are still going to be around. I think for we're
needed for creativity. For example, right now, the robots can
do highly repetitive tasks, but they need to be trained
(24:54):
and they but right now the person has to perform
the operation behind the robot. But I think it'll get
to a point where the robots can do the repetitive
task by themselves, but they're not at the point where
they have the creativity for sudden changes or new scenarios.
Or not situations that they're unfamiliar with, so we're not
(25:15):
at that.
Speaker 1 (25:15):
Point, kind of like them being able to fly by
the seat of their pants is not a thing yet,
not there yet, so you can't really allow for contingencies.
Can you tell us about any projects that you are
working on, any research that you're really fired up about.
Speaker 6 (25:30):
Yes, there are several things we're working on. One of
the things, as I mentioned briefly, is we're using AI
to analyze videos of surgeons operating. So we're trying to
really utilize this AI to be able to analyze how
so surgeons are doing and then we'll eventually be able
(25:50):
to help surgeons improve. So that's something I'm very passionate about.
Other things we're working on or trying to develop more
minimally invasive monitoring devices for patients after the operation, because
we want to know how the patients are doing, but
it's very difficult to get the information without right now
(26:12):
placing the catheters and wires directly in their hands and
in their arms and in their in their arteries. So
it's it'll it's something we really hope to do, is
something that's minimally invasive, something that's patched, for example, you
can place on a person and then we'll be able
to tell how their heart is functioning. So that's something
(26:34):
we're very passionate about as well. And then the other
aspect is to be able to predict how patients are
going to do and signal any problems that they might
have before they even have any symptoms. So we are
for example, in patients with aneurysms, which is it old
in their arteries? We want to know if is it
(26:57):
going to get bigger or is it going to be
stable for a long time, Do they need an operation
early or not? And it's right now, it's very comfortsome
that we have to do serial scans on these patients,
get a cat scan or get an ultrasound every few
months to see if it's growing. We're trying to do
(27:18):
is trying to figure out are their ways, Are their markers,
for example, in their blood that we can detect, so
you go get a blood test and that, coupled with
other information in their medical records, can we actually tell
are they going to have a problem in the future
or not. Then they don't have to get scans every year.
And so these are several things we're working on actively.
Speaker 1 (27:40):
It must be just a super exciting time in medicine
with these advancements.
Speaker 6 (27:45):
Yes, it is a very exciting time and the ultimate
hope is of course, to help the patients and whatever
tools we have.
Speaker 1 (27:55):
It is just absolutely incredible. Thank you to both doctor
Wong and doctor Homedy for being here this morning. You
can't find more heart health resources this Heart month February
and details about JOHNS Hopkins Cardiac Services right here in
the Greater Washington area by logging onto Hopkins HEEARTDC dot org.
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They need nourishment to ensure they grow healthy and strong.
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(29:37):
orthodonic and dental care to make sure their smiles light
up the room as brightly as possible. Visit SmileTrain dot
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smile at a time.
Good morning, and thanks so much for listening to Community
DC on this iHeart Radio station Jenny Chase here. February
is Heart month. JOHNS Hopkins Medicine is raising awareness about
heart health across the Greater Washington area. For tips and
resources to protect your heart, you can visit Hopkins HEARTDC
dot org. Today I'm joined by doctor Maria mohammedi aboard
(00:27):
certified cardiologist JOHNS Hopkins Community Physicians, which is now seeing
patients at the newly opened Arlington Clinic. With so much
advanced training, years of clinical experience, and a very compassionate,
patient centered approach to care. Doctor Mohammeddi is going to
share practical tips and insights to help us all maintain
a healthy heart. Doctor Mohammadi, thanks for being here.
Speaker 2 (00:47):
Good morning, Thank you for having me.
Speaker 1 (00:49):
Can we start by you giving us a little bit
of your background?
Speaker 3 (00:53):
Doctor Yes.
Speaker 4 (00:54):
I grew up in Vancouver, Canada, Okay and completed my
Masterfl's degree and University of British Columbia. Then I had
my medical degree from Ross University School of Medicine and
then moved to Hershep, Penn State and completed internal medicine residency,
followed by Carriebasco Fellowship. I've been practicing for eight plus
(01:20):
years in carreology in different states Pennsylvania, Maryland, DC.
Speaker 2 (01:26):
And now Virginia.
Speaker 3 (01:27):
Excellent. Okay, we have a lot to get to today.
Speaker 1 (01:29):
Let's start with the basic terminology though, of heart disease.
Can you give us a broad spectrum of what all
that can encompass?
Speaker 4 (01:37):
Yes, So, heart disease refers to a range of conditions
that affect the heart structure and function in a general
term that includes various types of heart conditions, most of
which are related to narrowing or blockage of blood vessels
that supply blood to the heart coordinary arteries, as well
as problems with hearts, rhythm, valves, and structures.
Speaker 1 (01:57):
Can you speak to the prevalence of heart disease DAEs
here in the US and around the world.
Speaker 2 (02:02):
Yes.
Speaker 4 (02:03):
According to World Health Organization WHO, Cardiovascu disease accounts for
an estimated seventeen point nine millions deaths annually, which is
about thirty two percent of all global deaths. In the
United States, heart disease remains the leading cause of death.
Was around six hundred and ninety seven thousand deaths from
(02:24):
heart disease recorded.
Speaker 2 (02:26):
In twenty twenty.
Speaker 4 (02:27):
According to Centrum Disease Control and Prevention, this makes cardiobasco
This is the leading cause of death in the United States.
Approximately one in every three deaths is due to cardiobascula disease.
Speaker 1 (02:40):
Doctor Mohammad, I hope you can forgive me if I
get a little emotional during this discussion. I lost my
father about six months ago to congestive heart failure. So
spreading this this awareness, letting folks know about what is
available as far as treatment and prevention, it hits home
with me. So any apologies if I kind of take
a moment to pop. I don't know that a lot
(03:01):
of folks realize the importance of heart health until it
affects their family directly. Let's educate folks on the different
types of cardiac issues and there are many.
Speaker 4 (03:10):
Yes, I appreciate you sharing that with me, and I'm
sorry for your loss absolutely. I'm sure that affects you
and your family and it's on your mind. And yes,
heart failure is one of the heart conditions that affects
a big population of patients. It's a condition that the
heart is unable to pump blood efficiently to meet the
(03:31):
body's needs, and it can result from other heart disease
like cornery disease or high blood pressure, and it has symptoms,
then I would go over during this talk so patients
are aware when to seek medical attention.
Speaker 2 (03:49):
But the most.
Speaker 4 (03:49):
Common heart disease is cornary art disease, and that is
when the cornery art is the blood vessels to the
heart get blocked and narrowed due to build up of
plaque or called atheroskleurosis, and that leads to chest pain
or angineae and.
Speaker 2 (04:08):
Leads to heart attack or heart failure.
Speaker 4 (04:11):
Heart attack happens when blood flow to the part of
the heart muscle is blocked causing damage or that's sort
of muscle, and that often results.
Speaker 2 (04:19):
From a rupture plaque or blood clot and again this
two condition can lead to.
Speaker 4 (04:24):
Heart failure and some of the signs of heart failure
is fatigue, shortness of breadth, and fluid retention. Arrhythmias is
another important heart disease that we see a lot of
patients with coming to the office with regular heart beats.
Speaker 2 (04:39):
Either the heart beats too quickly it's called a.
Speaker 4 (04:42):
Tachycardia or too slow braiding parity or irregular such as
atual fibrillation, and some of these arrhythmias can lead to
stroke or heart failure.
Speaker 2 (04:51):
Heart disease. It's the next heart disease that we want
to focus on and can give some attention to.
Speaker 4 (04:57):
And that's when the heart bals, which we have four
of them, or damage or disease, and either they're narrow
or sonatic, or they're leaking blood backwards which is called regurgitation,
and that can affect the heart function and patient can
have symptoms from that country the heart disease. In adult world,
we still deal with those patients that have heart defects
(05:20):
present at birth. With all this new technology and science,
they do get surgery early on and we do follow
them up once they're eighteen and older in adult world
of cardiology, and they may require surgical correction early on
or even later in life and need lifelong management. Cardiomyopathy
(05:42):
is a heart muscle becomes enlarge, thicken, or stiff, and
that impresibility of heart to pump blood effectively again leads
to heart failure or al rhythm yes, and it goes
into different multiple types of cardo myopathy dilated, higher, trophic,
or restrictive, and some of these are hereditary and genetic richarditis.
Speaker 2 (06:07):
Again, we see this in young patients as well.
Speaker 4 (06:09):
Inflammation of the lining, the member and the member around
the heart can get inflamed and cause chest pain.
Speaker 2 (06:18):
And it can be.
Speaker 4 (06:20):
Caused by infection, viral infection, the common common one injury
or auto immune disease.
Speaker 1 (06:26):
Okay, our next topic is aortic disease. What is that
all about?
Speaker 4 (06:31):
Yeah, So, aortic disease the effects that order the main
large aready that carries blood from the heart to the
rest of the body.
Speaker 2 (06:38):
This is such as anaurysm, which is enlargement or bulging of.
Speaker 4 (06:41):
The aorda dissection or tear in the urtic wall, which
both these conditions can lead to life threatening complications complications.
Speaker 2 (06:50):
So knowing this ahead of time helps treat those patients.
Speaker 4 (06:53):
Then the common ones that patients come to office with
high blood person, it's called hypertection.
Speaker 1 (07:01):
Unfortunately, Yeah, I am familiar with that one.
Speaker 2 (07:05):
It's called the silent killer.
Speaker 5 (07:06):
Because patients feel good, they feel okay, may not have symptoms,
but an un control blood pressure for a long time
can lead to heart conditions heart attack, heart failure, or stroke.
Speaker 1 (07:20):
So yeah, I mean, obviously I monitor my blood pressure
every day, and I am just so aware of this
issue in my life. And you know, we talked about
the statistics earlier. How many people this affects. Can we
talk about the risk factors what folks need to know?
Speaker 4 (07:38):
So overall respectors for heart disease include high blood pressure, hypertension,
high cholesterol, hyperlipidemia, smoking, diabetes, obesity with BMI of more
than thirty, physical inactivity for diet, excessive alcohol consumption, from
(07:58):
a history of heart.
Speaker 6 (07:59):
Disease as you meant, and age engender.
Speaker 4 (08:02):
Men are likely at higher risk at earlier age, but
the risk for women increases after menopause.
Speaker 1 (08:08):
Yay heart disease. Yeah, I'm I have gotten past that point,
doctor Muhammad. Can we talk a little bit more about
the cholesterol factor, because that is also something I am
dealing with and I'm sure I am not alone.
Speaker 4 (08:22):
Yes, So checking a fasting blood cholesterol part of regular
lapse is one screening for high cholesterol, and the recommendation
for American Heart Association is adults starting at age twenty
and definitely by age forty and checking that every four
(08:46):
to six years.
Speaker 2 (08:49):
The LDL, which is about.
Speaker 4 (08:50):
Cholesterol, the goal is to keep that under one hundred
and keeping a good cholesterol the HDL more than forty
for men and more than fifty for women, and keeping
a traversory less than one fifty and keeping.
Speaker 2 (09:06):
A healthy weight.
Speaker 4 (09:07):
Eating heart healthy diet which includes mainly Mediterranean diet with
low salt and focus on protein and vegetables is key.
And exercise on a regular basis, which the ACC ANDHA
recommend moderate exercise intensity five times a week.
Speaker 1 (09:29):
That was my next question, how much do we need
to incorporate that because I know a lot of people
I have myself included very sedentary literally five times a week,
no joke.
Speaker 4 (09:40):
Ideally, yes, you know, moderate intensity aerobic to get your
heart rate up, and that's what's been shown to have
benefits for cordniobasco health long term.
Speaker 1 (09:51):
When something is going wrong, when we feel off, what
are like the specific signs we need to be aware
of if something if we're having some sort of hardiact issue.
Speaker 4 (10:01):
Common warning signs of heart disease is feeling of a
chest pressure tightness.
Speaker 2 (10:08):
Some people can mistake it.
Speaker 4 (10:09):
For indigestion or heartburn, but that can be a sign
of heart attack and sometimes the pain even radious.
Speaker 2 (10:16):
To arm, neck, back, jaw, or the stomach.
Speaker 4 (10:21):
Next is the difficulty breathing or shortness of breath, especially
with activity or when lying flat, and that could indicate
heart disease, including heart failure, which may occur if you
have a fluid build up in the lungs and the
heart is not pumping effectively. Unexplained fatigue with normal activity
(10:41):
can also be inside of a heart that's struggling to
supply oxygen rich blood to the body, and the symptoms
happen in patients with heart failure or cornary disease. Next
would be you know, feeling faint, dizzy, or light at it,
especially when standing up quickly, can indicate a problem with
heart rhythm, arrhythmia or insufficient blood float to the brain
(11:04):
due to heart disease. Swelling in the feet, ankle, legs,
or abdomen can also be a sign of heart failure
and fluid building up in the body where the heart
is not effectively pumping blood raising the fluttering.
Speaker 2 (11:19):
The irregular heartbeat can be a.
Speaker 4 (11:22):
Sign of arrhythmia and sometimes can be dangerous and it
can lead to stroke or heart failure. You know some
other vague symptoms which can or more common in women,
or you know nausea or indigestion, even vomiting as a
sign of heart attack. Persistent coughing or wheezing that has
(11:47):
some white mucus and it's not really responsive to inhalers
that's prescribed by lung specialists. Could also mean there's fluid
in the lungs and it's and it's signs of heart
failure on spain. Excessive sweating, you know, especially when not
physically active like a cold sweat, can also be signs
(12:07):
of heart disease or cardiac event.
Speaker 1 (12:09):
I meet a lot of that criteria, so obviously I'm taking,
you know, the preventive steps that I can. But when
is it time to call nine to one one to
go to the hospital?
Speaker 2 (12:18):
Absolutely, you know, I would sell my patients.
Speaker 4 (12:21):
You know your body best, so you know what's abnormal
for you. So some of the vague symptoms that I mentioned,
maybe the sweating, whatnot. If a woman is you know,
metopolsle may experience it, but if that's not part of
their norm and it's been going on for a while,
that could be their sign to seek medical attention. But definitely,
(12:43):
you know, midsternal chess pain lasting a few minutes, comes
and goes.
Speaker 2 (12:50):
Pain that radius to armor jaw.
Speaker 4 (12:52):
You know, all of a sudden short of breath, competent
with chess spain, or feeling pale, feeling you're about to
pass out.
Speaker 2 (13:00):
These are these are red flags and.
Speaker 4 (13:02):
You gotta you know, these are warning signs, and you
gotta seek medical attention. And time is critical, especially when
treating heart conditions, especially heart attack or.
Speaker 1 (13:13):
Stro Right now, we do have a lot of tools
to help us diagnose these issues. Let's talk about cardiovascular
disease preventative measures and the tests that you can run
on us.
Speaker 4 (13:25):
Yes, of course, so in a nut show, there are
key screening tools and tests that commonly you see abuid
cardiovascular health and identify individuals at risk before symptoms appear.
Speaker 2 (13:38):
Blood pressure screening is one.
Speaker 4 (13:40):
You know, the goal for blood pressure is let's on
one hundred and thirty over eighty for majority of patients,
So that gets checked once you come out to a
doctor's office, including cardiologists.
Speaker 2 (13:53):
Lipid panel we kind of touched on.
Speaker 4 (13:56):
It's a fascting lipid that is recommended before to six
years if you have a family history. The earlier the better.
Blood glug cose tests as a screen for diabetes also
plays a role in assessing cardiovascular risk. Patients with diabetes
(14:16):
have an increased risk of heart disease and normal fasting
glog coles is less than one hundred.
Speaker 2 (14:24):
Next would be measuring the body.
Speaker 4 (14:27):
Mass index, which is height over weight, and that's one criteria.
It's useful tool to estimate body fat and also gear
some treatment towards patients for overweight or obese. There's this
Framingham risk coore calculated that I use in the office
all the time, and that gives me a ten year
(14:48):
risk of It's.
Speaker 2 (14:49):
An assessing tool to estimate ten year.
Speaker 4 (14:51):
Risk of developing cardiovascular disease based on age, gender, blood pressure,
cholesterol level, smoking status, diabetes status, and if whether the
patients are taking blood pressure or cholesterol medications, and based
on the categorized patient in low model or high risk
for heart disease and gear their treatment and prevention towards that.
Speaker 2 (15:17):
Cordinara A calcium score.
Speaker 4 (15:18):
It's a low dose CT scan that we have the
patients complete with radiology and it looks into detect calcium
deposit in a cordinary arteries zero calcium, zero cholesterol plaque
built up is a lowest patient anyone more than four
hundred calcium is a high risk patient than we kind
(15:42):
of treat with medications and further procedure if needed. A
basic twelve lid EKG in the office can also detect
any arrhythmia as previous heart attack or any abdomal in
part structures. Further testing that we offer in our office
is also ecocardiogram, which the ultrasound wave that we take
(16:02):
to take pictures of the heart helps u success the
heart size of function and deteke an evalve issues or
signs of heart pump failure.
Speaker 1 (16:16):
And you also have something called an A B I.
I'll be honest, I'm not familiar with that. Could you
please share, yes.
Speaker 2 (16:21):
So that's ankle break or index.
Speaker 4 (16:23):
It's a screening for prefer artery disease, you know, with
cardiovasca health. Besides the heart and the A order, I
do focus on the rest of the arteries and blood
vessels in the body, the blood vessels in the legs
and neck, to the abdomen to the kidneys. So there's
a quick test.
Speaker 2 (16:44):
That we can do.
Speaker 4 (16:44):
Just like how we measure blood pressure in the system,
we can measure compare that blood pressure in the arms
with the legs and kind of give us an estimation
of if you have any plaque build up in the
arteries in the legs, and that's a condition prefer ardery
disease that we can screen for and it also increases
risk of cardiovascular events.
Speaker 2 (17:06):
Next would be stress.
Speaker 4 (17:07):
Testing and they will be screening for cornary r A
disease or any arrhythmias with that.
Speaker 2 (17:16):
There's different types exercise and a.
Speaker 4 (17:18):
Treadmill or a nuclear or a stress echo cardiogram. Yes, yes,
so we we do offer all these screening testing in
our office and all these cardiovascular testing with Johns Hopkins
Community Physician hardcare. So I encourage patients to you know,
seek medical attension or talk to a primary and kind
(17:41):
of get these tests appropriately completed.
Speaker 3 (17:45):
I think that is what I need.
Speaker 1 (17:46):
So I, you know, in hearing everything that you've been sharing,
I feel like, you know, I'm taking the small steps,
but I really think I need to see somebody with
your level of expertise. And just as you were talking,
like bulbs are going off and I'm just thinking about
all these different things that I experienced. So early screening
you recommend between ages forty and.
Speaker 3 (18:06):
Forty five to start, really.
Speaker 1 (18:09):
You know, kind of putting some focus on this. What
are some other things we need to keep in mind?
Speaker 4 (18:14):
If you have a strong family history, we usually as
like a rule of thumb, you know, ten years earlier
than that family member that got the disease or diagnosed
with it. It's what's recommended, you know, going back to
your dad's case, obviously, with you, it would be prevention, prevention,
prevention and be able to get identified as risk factors
(18:36):
besides genetics and hereditary that we cannot change much, but
there's lifestyles that we can, you know, focus on and
prevent so this does not happen.
Speaker 2 (18:45):
To you once you get older, you know. So those
are things that with.
Speaker 4 (18:50):
The the medications we have, the testing and the screening
that we have nowadays, that we can potentially prevent that.
Speaker 1 (18:58):
Well, ma'am, we just can't thank you enough for sharing
all of this with us this morning.
Speaker 4 (19:02):
Thank you for you for the time, and I appreciate
the opportunity, and we'll welcome any new patients referrals.
Speaker 2 (19:10):
I'll be happy to see you as well, and we'll
talk to you on the phone whichever you prefer.
Speaker 4 (19:14):
In Part month is coming up in February, and so
I encourage everyone to think about the heart disease and
think about the next step in prevention.
Speaker 1 (19:24):
Okay, we just heard from doctor Merriam mohammedy with Johns
Hopkins Community Physicians which are located here in the DC area.
Doctor Mohammedi is now seeing patients at Johns Hopkins Medicine's
new Arlington Clinic and the Boston Quarter Mall and visit
Hopkins Medicine dot org slash Arlington. And for more heart
health resources and information about the Johns Hopkins Heart and
Vascular Institute in the Greater Washington area, please visit HOPKINSHEARTDC
(19:49):
dot org. Now we're going to switch gears a little
bit and talk about the role of AI in cardiac care.
Speaker 3 (19:54):
Artificial intelligence.
Speaker 1 (19:55):
Doctor Hong Hong Wong is a cardiothoracic surgeon at Suburban Hospital,
Assistant Professor of Surgery at the Johns Hopkins School of Medicine.
Speaker 3 (20:04):
Doctor Wang Hi, good morning.
Speaker 1 (20:06):
We have some really interesting stuff to cover with you
this morning, the role of AI in cardiovascular medicine. We
hear a lot about AI in the news. How is
it transforming what you as a doctor do on a
daily basis?
Speaker 6 (20:19):
So I really perform heart surgery and AI is really
changing the ways we plan the operation, the way we
do the operation, and the way we take care of
patients afterwards. So starting from planning the operation, it helps
us analyze the patient's history and then their lab results
to determine the best approach for the patient. We can
(20:41):
use AI to analyze their images and to help us
better make a surgical plan. And then during the surgery
we're able to have real time data on the patients
and have AI help us analyze things that we need
during the operation as well. And then after surgery. It's
also it helps us predict how well the patients are
going to do based on data or information from similar patients.
(21:04):
It can tell us do we think this patient needs
a little bit more support or more rehab afterwards, or
do we think this patient's going to do well without
any additional support. So it's really helping us in multiple ways.
Speaker 1 (21:18):
What about you as a surgeon and your skills? Is
there a role that AI is playing in how what
you do is evaluated?
Speaker 6 (21:27):
Yes, we are actually leveraging AI to help us determine
how well the surgeons are performing and training, So that's
one of the projects we're doing. It happens is where
now we have robotic surgery that we do on patients
and that gets recorded automatically, so we can use AI
to analyze the clips of surgeons learning how to do
(21:49):
an operation, for example, and then give them feedback about
what they should be doing, what they shouldn't be doing,
are they doing it well enough? So it actually helps
us get better.
Speaker 1 (22:00):
Really unbelievable, but I mean, I guess with all the
advances we've seen over the years, it's natural that we
would get to this point. Let's talk about the difference.
What are the differences between AI and robotics.
Speaker 6 (22:10):
Yeah, it's actually two completely different things. Okay, So you
can think of AI as a brain that helps understand
what's going on. It's the brain behind.
Speaker 3 (22:19):
The whole thing, okay.
Speaker 6 (22:20):
And then robotics right now, it's still very much as
a set of advanced tools. So it's like the hands
of the surgery.
Speaker 3 (22:27):
Okay.
Speaker 6 (22:27):
So right now, robotic surgery actually is not automatic yet,
so until we I think in the future, we'll be
able to combine robotic surgery with AI where the surgeon
doesn't even need to be doing the maneuvers anymore. But
as of right now, there's still you still need a person.
It's kind of wizard of Oz, right. You still need
(22:48):
a person there to actually maneuver the robotic arms to
be able to perform the operation. So the surgeon is
actually still performing the operation, it's just we're using better
instruments the robotic arms.
Speaker 1 (23:00):
Are we going to see a point where robots replace
qualified skilled surgeons like you, who've been doing this forever
and you study years and years and years and you
hone your craft. Will robots ever affect what you do
every day?
Speaker 6 (23:15):
Yes? I think so in the future. Probably not in
the next five to ten years, but maybe in twenty years.
I think there is because robots are now able to
do repetitive or really highly technical tasks. I think in
the future they'll be able to sow blood vessels together,
They'll be able to hold tissues. I think it's all
(23:36):
in the works. So I think a lot of what
we do will eventually be replaced by robots. I don't
think we're quite there yet, because I think that's the
idea of really marrying robots with AI. Right, So, now
we have the hands, you still need the surgeon to
provide the brain. But when AI is able to really
(23:56):
take over the thinking then AI can be the robots.
So I think that's when we'll get there. You know,
there are already hey I programs. I know at Hopkins
there's a group in the Applied Physics Lab where there
they have robotic dogs and they can already go into
the field and perform ultrasounds on people. So so yeah,
(24:21):
the technology is isn't getting there? I think.
Speaker 1 (24:25):
I mean, obviously you want what's best for you know,
your patients and for all of mankind when it comes
to medicine.
Speaker 3 (24:31):
But when you think about that, what does it make
you feel.
Speaker 6 (24:33):
I think it's great. I think we are responsible for
pushing this forward, and I think right now, you know
there there's still so many uncertainties, and I think doctors
are still going to be around. I think for we're
needed for creativity. For example, right now, the robots can
do highly repetitive tasks, but they need to be trained
(24:54):
and they but right now the person has to perform
the operation behind the robot. But I think it'll get
to a point where the robots can do the repetitive
task by themselves, but they're not at the point where
they have the creativity for sudden changes or new scenarios.
Or not situations that they're unfamiliar with, so we're not
(25:15):
at that.
Speaker 1 (25:15):
Point, kind of like them being able to fly by
the seat of their pants is not a thing yet,
not there yet, so you can't really allow for contingencies.
Can you tell us about any projects that you are
working on, any research that you're really fired up about.
Speaker 6 (25:30):
Yes, there are several things we're working on. One of
the things, as I mentioned briefly, is we're using AI
to analyze videos of surgeons operating. So we're trying to
really utilize this AI to be able to analyze how
so surgeons are doing and then we'll eventually be able
(25:50):
to help surgeons improve. So that's something I'm very passionate about.
Other things we're working on or trying to develop more
minimally invasive monitoring devices for patients after the operation, because
we want to know how the patients are doing, but
it's very difficult to get the information without right now
(26:12):
placing the catheters and wires directly in their hands and
in their arms and in their in their arteries. So
it's it'll it's something we really hope to do, is
something that's minimally invasive, something that's patched, for example, you
can place on a person and then we'll be able
to tell how their heart is functioning. So that's something
(26:34):
we're very passionate about as well. And then the other
aspect is to be able to predict how patients are
going to do and signal any problems that they might
have before they even have any symptoms. So we are
for example, in patients with aneurysms, which is it old
in their arteries? We want to know if is it
(26:57):
going to get bigger or is it going to be
stable for a long time, Do they need an operation
early or not? And it's right now, it's very comfortsome
that we have to do serial scans on these patients,
get a cat scan or get an ultrasound every few
months to see if it's growing. We're trying to do
(27:18):
is trying to figure out are their ways, Are their markers,
for example, in their blood that we can detect, so
you go get a blood test and that, coupled with
other information in their medical records, can we actually tell
are they going to have a problem in the future
or not. Then they don't have to get scans every year.
And so these are several things we're working on actively.
Speaker 1 (27:40):
It must be just a super exciting time in medicine
with these advancements.
Speaker 6 (27:45):
Yes, it is a very exciting time and the ultimate
hope is of course, to help the patients and whatever
tools we have.
Speaker 1 (27:55):
It is just absolutely incredible. Thank you to both doctor
Wong and doctor Homedy for being here this morning. You
can't find more heart health resources this Heart month February
and details about JOHNS Hopkins Cardiac Services right here in
the Greater Washington area by logging onto Hopkins HEEARTDC dot org.
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cleft into a smile for life. But at smile Train,
we understand that most children.
Speaker 3 (29:14):
Need a little extra care.
Speaker 8 (29:17):
They need nourishment to ensure they grow healthy and strong.
They need a confident voice so they can express themselves clearly.
They need emotional support and counseling to help them navigate
the challenges of school and home life. And they need
(29:37):
orthodonic and dental care to make sure their smiles light
up the room as brightly as possible. Visit SmileTrain dot
org to learn how smile Train is supporting the cleft
community with lifelong smiles. Smile Train changing the world, one
smile at a time.
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