Life After a Cardiac Event: An Athlete’s Story

Intro: This is weekly Dose of Wellness, brought to you by Memorial Care Health System. Here's Deborah Howell.

Deborah Howell (Host): Welcome to the show. Athletes need a strong heart to maintain the high level of physical activity they perform, but heart disease, including those passed down from family, can prevent them from doing so. Today, we'll explain how diagnostic imaging can help find heart disease to eliminate risks sooner, including a recent cardiac case involving a Long Beach marathon runner.

Our guest is Dr. Christina Rodriguez, a fellowship-trained, board-certified cardiologist who specializes in advanced cardiac imaging and serves as medical director for advanced cardiac imaging at Memorial Care Heart and Vascular Institute at Long Beach Medical Center.

Deborah Howell (Host): Welcome, Dr. Rodriguez.

Christina Rodriguez: Hi, Deborah. How's it going?

Host: What a pleasure. I'm so happy to be talking to you today because there's so many questions. Shall we dig in?

Christina Rodriguez: Definitely. Happy to be here.

Host: All right. So, how does diagnostic cardiac imaging help find heart disease sooner?

Christina Rodriguez: So, we have to break down this question a little bit into what is actually diagnostic cardiac imaging and what is heart disease, right? There's different types for both of those. And diagnostic cardiac imaging can be anything from a stress test, an electrocardiogram, a coronary CT, which will dive into a little bit deeper later, and any functional nuclear stress test. You know, heart disease is also kind of complicated. You can have coronary heart disease, which is the development of plaque in your coronary arteries usually, right? And you get like a heart attack when it becomes obstructive. There's also heart failure and there's also valve issues. So, it's an amalgamation of things. And so, we use a lot of tools in cardiology, thankfully, to help diagnose and treat cardiac disease. So, amongst those, I kind of mentioned them, but we can dive in further later.

Host: Yeah. So, what kind of diagnostic cardiac imaging does Memorial Care Heart and Vascular Institute at Long Beach medical Center offer?

Christina Rodriguez: We offer a lot of very cool tools. The one that I kind of read is the coronary CTs, which is what we call anatomical testing. So, the gold standard for diagnosing coronary artery diseases has usually been invasive coronary angiography. That's when people have heart attacks or they're complaining of chest pain. Usually, we take them to a catheterization lab and we inject some dye on their arteries, either through their femoral artery or radial artery, and we take a picture, and that's how we determine if the patient has stenosis in their coronary arteries, which of course are the arteries that feed the heart. And that's the mainstay of cardiology. But thankfully, we have other modalities such as coronary CTs that are non-invasive, that we don't have to go in and stick your arteries or anything like that to get pictures. We just get a CAT scan as people say or big a x-ray machine. And we take a series of pictures and we can see literally the anatomy of your heart in like a five to ten-minute scan, so that's something that we offer here.

Host: And none of this hurts, right?

Christina Rodriguez: No, it doesn't. It does take some prep. You know, the heart is a moving structure and sometimes we have to give you medications or give the patient medications so the heart rate can be a little bit lower. And so, that's the most involved part of the test for sure.

Host: And Dr. Rodriguez, why does this advanced screening make diagnosis of heart disease easier?

Christina Rodriguez: Yeah. So, because we get to see the coronary arteries noninvasively with that CAT scan, that picture that we're taking, we're getting to see a few things. We're getting to see where the coronary arteries are emerging from. You know, is it from the right origin? Sometimes people have different congenital anomalies that we can catch with that scan. And also, we can actually detect plaque before it ruptures. And I describe it to my patients as kind of a kitchen pipe. You know, with time, we develop plaque in all of the arteries of our body. It all depends on risk factors, which is very important. If we're smoking cigarettes, if we have hypertension, our age plays into that tune. But it takes decades to develop plaque in our coronary arteries for us to have an obstruction. And so, what I say to my patients is like, you have a kitchen pipe that has been getting gunk all around it across time, decades usually, unless you have a genetic predisposition. And some of that gunk, when it's fluffy, it flips off and obstructs the artery, and that's when you get the chest pain, if that makes sense. And so, our CT scanner kind of detects that plaque without it being a ruptured plaque. And we can tell you, "Hey, you have plaque here. You are at higher risk for this plaque to continue to grow or to advance. And we want to give you medications or kind of lead you towards having a better diet, lifestyle, exercise a little bit more." And so, that's kind of the utility of that scan.

Host: Okay. I'd like to put the spotlight on a specific case right now. Last year, the Memorial Care Heart and Vascular Institute provided care to a Long Beach marathon runner who collapsed on the course. How did diagnostic cardiac imaging help find the cause of Mr. Pham's heart problems?

Christina Rodriguez: Yeah. So, this is such an interesting case that we had. You know, in his case, because he collapsed while he was in a marathon, we take those a little bit more aggressively. What I mean with that is that we definitely go to our guideline-directed diagnostic imaging test, which is the coronary angiogram, to detect if he has any coronary artery disease. And so, the important thing is, I think, he was more than 35 years of age, you collapse suddenly when you're exercising, that's definitely dangerous and we have to act accordingly based on that information. Usually when you're more than 35, you're an athlete, you're running, the likelihood of having coronary artery disease more than anything else or plaque rupture is higher than being a younger athlete, right? And so, when he collapsed, that's a very high suspicion, and that leads us to our diagnostic testing. So, why is he collapsing? He might have had a bad arrhythmia because he had an acute blockage, right? We get an electrocardiogram, we get this diagnostic testing, an echocardiogram, which is basically a sonogram of the heart to make sure his walls are moving, or if any walls are not moving correctly. And also, ultimately, we get our kind of gold standard diagnostic test with a coronary angiogram, which is the invasive diagnostic testing that I described in the beginning to ultimately diagnose him with what he had, which was multivessel coronary artery disease.

Host: All right. So, that's his case. But what are some signs or symptoms people should look for to see if they have heart disease?

Christina Rodriguez: Yeah. That's such a good question. I think, you know, it all starts with prevention. Heart disease can feel a little bit overwhelming because people can complain of a bit of chest pain and they think, "Okay, it's my heart." But you have to look at it in a scale. And that's how we as cardiologists interpret chest pain with probability. Is it higher risk of you having an obstruction in your coronary arteries based on chest pain or are you at a lower risk, right? That's how we describe these things. And so if you're having chest pain when you are exercising or more fatigue, or you have squeezing pressure, heaviness, and you're starting to feel that a little bit more, that might be a sign that you do have obstructive coronary artery disease and might need a checkup sooner rather than later.

There's also some symptoms in women and elderly patients, especially those who are diabetic, who don't feel the classic symptoms of coronary artery disease. Some people can feel epigastric pain or nausea, especially in the woman population. And so, we have to look out for things that are mostly exacerbated during exercise. But also look at your profile yourself, "Do I have a family history of my parents or my uncles and aunts collapsing suddenly or them having a heart attack at the age of 50, 40 you know, maybe I'm at a higher risk and should get checked sooner rather than later for this," or if you have a smoking history, hypertension, diabetes, inflammatory disease. All of that kind of boxes you into that. We have to be more aware of your prevention.

Host: Sure. And you say get checked. So, are there standard screenings or preventative measures you should take based on your risk factors or age?

Christina Rodriguez: Oh yeah, 100%. You know, after you're 35, you should have an idea of what your lipid panel or cholesterol panel is, especially if you have a history of what call premature family history of coronary artery disease. If one of your parents had a heart attack really soon, you should be asking your cardiologist or primary care, you know, "I have this concern. I would want a cholesterol test." Sometimes an Lp(a) is another adjunctive test to that cholesterol panel that would direct you towards genetic testing, you know, genetic causes for coronary artery disease and such. So if you are more than 35, I think that's the right age to start looking for these things, especially if you have some family history involved.

Host: Okay. And when should people contact their doctor to ask about these screenings?

Christina Rodriguez: It's interesting in the case where we're talking about athletes or just general population, there's not really a recommendation when you're more than 35 and you're starting to exercise. You want to do at least 150 minutes a week of moderate intensity exercise. But you know, there are, like I said, some risks that you have to be looking out for. Hey, if you were a smoker during your 20s, like a heavy smoker during your 20s and 30s, like I said, coronary artery disease is accumulative, right? It happens through years. And so if you have a family history, if you have high blood pressure or you're in the more obese side of the scale, then you should be asking your doctor, "Okay, should I get screened? You know, I think I'm at a higher risk. Even though I don't have chest pain right now, what are my risks of having coronary artery disease moving forward?" is such a valid question for any patient. And we do have some calculators that we're working on as a cardiology society all across the world. And also, really cool tools such as calcium scoring we can also provide for patients who are asymptomatic and have like an intermediate risk of having coronary artery disease.

Host: Okay. Dr. Rodriguez, is there anything else in general you'd like to add to our conversation?

Christina Rodriguez: Prevention is key in all of these things. A very important part of avoiding cardiovascular disease in general, heart failure, coronary artery disease is you taking care of yourself very early on. And in general, that means you're having a good diet. We recommend a Mediterranean diet with legumes, not a lot of meat, good fats, avoid saturated fats. And, you know, a healthy dose of exercise. And your body's going to be thankful for it. The more you exercise, the more you eat healthy, you're going to feel better. It's going to prevent other diseases such as cancer, Alzheimer's, all these other chronic diseases that are, unfortunately, kind of a product of our current way of behaving, but I just really stress that prevention is key. Knowing your risks, it's very important. Like I said, if you were a smoker, if your mom and dad or uncles kind of, "Oh, people in my family have been dropping like flies," it's a good moment to check with a doctor. "Okay, should I get some screening sooner rather than later" is kind of the way to go.

Host: Yeah. Very well said. Well, it's just been such a pleasure, Dr. Rodriguez. Thank you so much for your time and your expertise today. We really enjoyed having you on the show.

Christina Rodriguez: Thank you so much for the opportunity. Have a good rest of your day.

Host: And for more info or to listen to a podcast of this show, please call the Memorial Care Heart and Vascular Institute at Long Beach Medical Center at 562-933-3370 or visit memorialcare.org/lbheart. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.