[00:00:11] Speaker A: Hey, guys. Welcome to the Senior Care Conversation. I'm Hilary Bailey, and on this program, we give caregivers and seniors the clear, compassionate guidance they need to thrive. Our guest today is Dr. Yasir Sumbal, an interventional cardiologist known for pushing the boundaries of prevention. But precision medicine and tech enabled care from clinic to community. He's on a mission to keep heart strong at every age. Dr. Sombal, welcome.
[00:00:38] Speaker B: Hello, Hillary. Thank you for having me.
[00:00:40] Speaker A: Absolutely. I'm so excited to dive into this with you today. Heart health is so important, especially for our seniors, and I think when they get some kind of heart diagnosis, it can be very scary for them. So I am super excited to dive into this with you so you can educate our viewers.
So why don't you explain to us a little bit why does our heart change so much as we get older?
[00:01:02] Speaker B: Well, I mean, it's, you know, just imagine your heart is like your car, right? So as you drive your car enough, your engine wears out, and parts of your engine just start to break down at some point, whether it's your alternator, a fan, whatever it may be. So your heart is kind of the same concept, right? It's a. It's a motor, and it's a motor that runs more than your car engine, probably because it's running all day long for as long as you live.
So as we get older, you know, our heart just starts to deteriorate from certain things, whether it's an electrical problem with the heart, whether it's a plumbing issue with the heart, whether it's an architectural issue with the heart. Those are all the three kind of things that can affect your heart. So I like to think of your heart kind of like your house as well.
It has architecture, plumbing, and electricity. And so whenever somebody has a heart problem, that usually is caused by one of those three things, whether it's an abnormal heart rhythm, so they have things such as atrial fibrillation, which is a common abnormal heart rhythm that we see, or the common thing that always people think about is blockages in the arteries that go to the heart, or the other common thing that we see all the time is heart failure.
So all those three things are very common things that can happen in the elderly or just in general in people as they get older. And that's just the normal part of an aging process.
Now, obviously, certain things can accelerate it. Other risk factors, whether people are diabetic or have high blood pressure, have high cholesterol, sedentary lifestyle, tobacco use, heavy alcohol use, diet, all those things can be mitigating factors that may accelerate when and where, how our heart deteriorates.
Also, you know, genetics. Clearly we can't escape our DNA. And so when people have genetic predisposition to heart conditions, and they can be genetic predispositions in any one of those categories, whether it's your architecture, plumbing or electricity, it can predispose them to having heart disease.
[00:03:11] Speaker A: Well, thank you so much. So I wanted to ask you. So I'm a physical therapist assistant. Can you tell us, and I want to look at this from someone who's still pretty mobile and maybe someone who might be not as mobile and not able to walk and get their heart rate up. So what are some simply daily habits that can help seniors keep their hearts strong?
[00:03:32] Speaker B: Sure, yeah. I mean, obviously walking is, you know, one thing. If you can't walk, then you gotta find alternatives.
Sometimes riding a bicycle, even if it's a stationary bike, sometimes doing water aerobics. So it takes off the need to walk as long as you can stand and get in the water. That's probably an easy thing to do.
Even just things, doing things in place. You know, you can sit on a chair and do leg lifts, for example. That's one way to get your heart rate up. Or get one of those exercise bands and just kind of pull at it till your heart rate goes up.
So there's a lot of different things people can do even if they're not mobile, to try to maintain some sort of cardiovascular endurance.
Just the simple things they can do, even with sitting in a chair.
[00:04:23] Speaker A: Great. Thank you so much for that.
So how can family members help spot warning signs of heart trouble? I think when as lay people think about heart trouble, we think of maybe chest pain being the number one thing that we need to look out for. What are some maybe earlier signs that they can look for that maybe prompts them to take their loved one to come see you?
[00:04:46] Speaker B: Sure.
Definitely. You know, things like, let's just say lack of endurance. So you may be walking with your family member to a doctor's appointment and just notice that they're just kind of sluggish getting there, or a little bit more short of breath when they make that walk when they used to not be decrease in ability to do their daily activities? Maybe one.
So you want to ask them, are you unable to do them because maybe you're tired? Or are you unable to do them because something limits them? Like they're short of breath, they feel nauseous when they're doing it sometimes Chest pain isn't the only Symptoms. People can have atypical symptoms like shoulder pain or arm pain. Sometimes people get back pain. Actually, that's what we call an anginal equivalent. So it's a sign that you may have a blockage in one of the arteries going to your heart.
And so when you exert yourself, your heart demands more blood and more oxygen. And if it can't get to that part of the heart muscle, it causes that symptom.
Sometimes people can have abdominal pain, you know, and sometimes it could happen after they eat. So they. It may not necessarily be food related, but they can get this abdominal pain when they eat. That sometimes can be a cause of heart pain. If you're looking for things like palpitations, if somebody feels winded, for example, doing things or feels lightheaded or dizzy, it's a good idea to check their pulse and make sure that their heart rate isn't erratic or abnormal or not really fast.
Other signs, noticing swelling in the legs.
That's another sign that could be sign of heart failure. That's early on, heart failure.
You noticed your loved one, you go over there, they're always sleeping in a recliner rather than in their bed. And sometimes people do that because when they lay down to go to sleep and lay flat, they're short of breath because they're retaining fluid. But they may not realize, they think, well, maybe I'm just getting older. Maybe the chair is more comfortable and they decide to sleep in a recliner.
So those are all things, you know, to kind of keep in mind when you see your loved one kind of going through that.
A lot of people, as we get older, we just tend to say, you know, I'm doing something slower because I'm older. And that, that is a very common thing that people say to themselves.
Or I get up the stairs a little bit slower just because I'm older. Or. Or they may be limited by arthritic pain. So they have, you know, bad joints or a bad back or something. So their mobility is not quite there.
And so even it's even harder if they're having a heart problem that's contributing to that as well.
[00:07:23] Speaker A: I love that you said that. I have, in my practice and in my business, we always hear, oh, I don't have a lot of pain. It's just that old people pain. I'm just getting old. It's that old people pain. So.
So when someone does come to see you, when they've been prompted to come see you by just because they feel like. Or maybe their PCP sending them to you or kind of walk me through a typical first visit with you, if you don't mind.
[00:07:46] Speaker B: So, yeah, sure. So it really depends on what they're coming to see me for.
I get people come to see me, you know, in their mid-50s and 60s, for example, and sometimes older, that just want to be screened for heart disease and see, you know, what's depending on their risk factors, how much are they at risk for having heart disease? A lot of times when people come to see me, though, they come to see me because they have a specific complaint.
One they're either short of breath, they have chest pain, they have some sort of arm pain that they can't explain.
They could have swelling in the legs that they can't figure out why it's happening.
They may have been in the emergency room because they had an abnormal heart rhythm. So they went to the emergency room because they just kind of had the sudden onset of palpitations.
They went there, the emergency room, diagnosed them with an abnormal heart rhythm. And they come to see me and follow up to figure out what we're going to do about it.
I have people that come to see me just for their blood pressure. They're having a hard time getting their blood pressure controlled and want a different perspective on what medicines may work or not work.
Other people that come to see me because of cholesterol issues and want some help managing their cholesterol.
So in general, you have to figure out, they teach us this in medical school, that the history is really 90% of how you make a diagnosis. So just listening to people and what they're telling you is a way to kind of understand, you know, what in your mind you want to look into and what makes sense and what doesn't.
And based on the story, you know, it may determine what kind of testing they may need moving forward. Sometimes people just need some screening tests, and that doesn't necessarily mean they have to have a stress test, but there are other screening tests to just say, well, you're in this risk category for heart disease, whether it's low, medium or high risk and or if somebody has symptoms and you want to get imaging studies or testing that correlates with whether or not you can figure out if there's a heart issue that's causing their symptoms. So people that are short of breath, you know, you may want to get a stress test on them to make sure they don't have a blockage. You also may want to get an ultrasound of their heart to make sure they don't have any structural heart disease. Or valvular heart disease that's causing their symptoms, or they don't have heart failure.
People that come in with palpitations or, you know, they feel like their heart's beating funny or skipping beats or whatnot, then in that situation, you may consider putting a monitor on them to track their heart rhythms for a few days to see if you can identify an abnormal heart rhythm.
[00:10:13] Speaker A: So I know a lot of people are gonna want to know, because this is a question that even I get asked is, what is a good cholesterol level?
[00:10:23] Speaker B: Okay. So, you know, people get this. Ask me that question all the time, right? And so you.
You can't just look at numbers and just say, well, this is abnormal, because the lab really sets an abnormal number.
And so what you want to look at in the context of what their breakdown of their cholesterol is, so whenever people get their cholesterol checked, they get a total cholesterol. They get what's called an hdl, an ldl, and a triglycerides. And so me as a cardiologist, really what I'm looking at is not just treating the total number, because the total number may not be horrible, but what you want to look at is their HDL and their LDL and their triglycerides, because that's where really the therapy affects things. And so, for example, LDL is a marker of what we call bad cholesterol. So people have bad cholesterol. It's your ldl. And that number. We have guidelines that tell us where it's set at and what people should be at, depending on age, risk factors, etc. And it's mostly risk factors. So, you know, for example, somebody is a diabetic or has a history of heart disease, so they've had a heart attack, they've had a stent, they've had. You know, our LDL goal for them is less than 70.
So irrelevant of what their total cholesterol may be, my focus is, what's their ldl?
Another number that's important that I think people don't look at as often is hdl.
And HDL is really a good cholesterol. And we have data that shows that HDL is actually more protective against heart disease than LDL is bad for heart disease, meaning. So if you are somebody that has a high hdl, it really reduces your risk of having heart disease moving forward compared to somebody who has a high ldl, which is the bad cholesterol, for example, being at risk for having heart disease.
Unfortunately, we still haven't come to A point where we can find medicines that improve HDL or increase your hdl. And so the only way to do that is really through a good lifestyle, which is diet and exercise.
Now, there are populations in the world that are affected by low hdl. So there are subsets of populations that are just genetically predisposed to having low hdl.
And surprisingly enough, those are. Not surprisingly, but those people are actually at really high risk for having heart disease, and a lot of them do. So especially the Southeast Asian population, they are really high risk of having heart disease because they are a population that really carries a low HDL.
[00:12:57] Speaker A: Dr. Samuel, thank you so much. So for viewers who want to dig deeper right now, where can they connect with you online? Do you have a website? Social media, LinkedIn?
[00:13:07] Speaker B: Yes, we're actually
[email protected].
find us on Facebook. You'll find us on Instagram, YouTube.
I don't think I have a LinkedIn, actually. I've never used it.
[00:13:22] Speaker A: Okay. All right, well, thank you so much, guys. We'll be right back after this commercial break with more from Dr. Sumbal.
We'll be right back with more insight, expert advice, and stories that matter to every generation.
And we're back. I'm Hilary Bailey, and you're watching the Senior Care Conversation on NOW Media Television.
Loving what you're watching. Don't miss a moment of the Senior Care Conversation or any of your favorite NOW Media TV shows, live or on demand, anytime, anywhere. Download the free Now Media TV app on Roku or iOS for instant access to our full bilingual lineup. Prefer to listen on the go catch the podcast version right on the Now Media TV website at www.nowmedia.tv.
from business and breaking news to lifestyle and culture, Now Media TV streams 24. 7. Ready whenever you are.
Okay, guys, we are back with Dr. Yassir Sambal. And now we are tackling a silent threat. Nearly every senior faces high blood pressure.
So my very first question, which is not on our run sheet, is for you, Dr. Sumbalt, to please explain the top number of our blood pressure, our systolic, and the diastolic number on the bottom, because we know it as the top number and the bottom number.
[00:14:48] Speaker B: Sure.
So systolic blood pressure is correlated with, you know, when your heart pumps out, that's your systolic pressure.
Diastolic pressure is whatever's left over after the heart is pumped out. Okay. Let's just make it simple that way.
[00:15:05] Speaker A: Okay?
[00:15:05] Speaker B: So look at those two numbers and decide, do people have high blood pressure and sometimes people could have the upper number be high, but not the lower number. And sometimes it's the lower number that's high and not the top number. In either scenario, if one of those is high or both of them, they both need to be treated.
[00:15:26] Speaker A: Okay, gotcha.
So what exactly are some of the factors that make our blood pressure rise as we age?
[00:15:36] Speaker B: Okay, so that's a great question. And so your body is supplied by blood through pipes, basically, these arteries, right? And so your arteries are just like pipes, like the pipes that run through your house and provide water to every sink or every shower in your house.
So these pipes are made up of a muscle. It's called a smooth muscle in medicine. Okay. And that smooth muscle, as we get older, just like our joints develop arthritis, our arteries just get stiffer over time because they've just been used over and over again. Same with pipes in your house. Over time, you sometimes have to drain them out, you have to clean them, you have to replace them, et cetera. They can crack. Although the blood vessels in your body don't crack technically, but just kind of the metaphor that it could crack. And so over time and as we age, those arteries just get stiffer and stiffer, and so it makes it less elastic. Right. And so you're just think of the muscles in your heart just like the muscles in your vessels, they're supposed to be like a balloon. They're supposed to kind of expand to let blood in and flow through, and then they kind of compress and let, you know, squeeze blood out of the heart or, you know, get things back to the heart to get reoxygenated and come back out.
But over time, that smooth muscle or that elasticity goes away. And so it makes it harder for the heart to pump that blood through.
And because the blood vessel or that pipe doesn't expand appropriately, and so that raises the blood pressure when you check it. And so that's what really pretty much leads to high blood pressure. In addition to, obviously, dietary things like a lot of salt intake, tobacco use, alcohol use. All those things can raise your blood pressure because all those things put stress on your body and stress on those vessels, that raises your blood pressure.
[00:17:26] Speaker A: I want to talk about. I'm again going to deviate from the run sheet, but I want to talk about how does diabetes, how does that affect our heart?
[00:17:37] Speaker B: Right. So diabetes is technically considered to be a heart equivalent, so a heart disease equivalent. And I can't really tell you all the dynamics of the science behind it, but in general, just having abnormal blood Sugars just disrupts the cellular mechanisms in your body. And so it predisposes you to other diseases.
So it can predispose you to high cholesterol, it can predispose you to high blood pressure. And so in those scenarios, when people have diabetes, they are at high risk of having heart disease.
Because in general, if you take out type one diabetics, let's just put them in a different category because unfortunately they're born that way. And so diabetes wasn't a lifestyle that approached them, it was a genetic thing that caused them to be diabetic. And so they're even at higher risk because they end up being diabetic longer and having to maintain those blood sugars for a longer period of time. So that predisposition or that risk is with them for a longer time.
So let's just take type 2 diabetics, so we won't. Type 2 is non insulin dependent diabetes. So people that take pills to regulate the diabetes, that is a disease of older age and it's the disease of lifestyle. So as people get more overweight, they smoke more, they drink more, they don't exercise, they have an unhealthy diet, all these things can lead to what we call insulin resistance.
And so their body's making insulin, but it can't really use it very well. So it can't, you know, get rid of the sugar the way it's supposed to. So then what does it do? It ends up storing it as fat. And so the cycle continues.
And then people gain weight and it leads to a, you know, a sedentary lifestyle and unhealthy lifestyle. And so all those things combine together with diabetes. And so diabetes is, really leads to all this. And it's a, it's a very powerful disease, you know, and so it can lead to all these things together causing people to have heart disease.
[00:19:42] Speaker A: So I know from personal experience, my husband has made a lot of lifestyle changes and his blood pressure has really come down, he's lost a lot of weight, he's been working out six times a week. And so like, his blood work is now pristine. So I know that sometimes lifestyle changes can really help lower your blood pressure. Does that, can that happen for everyone or will certain people need medication to help with that?
[00:20:07] Speaker B: That's a great question. And I don't think I know the answer to that because, I mean, I've had patients who, the same as your husband, have lost weight, they've made significant lifestyle changes and get off the medicine. And I have people that have tried it, but still need a little bit of medicine to keep them going or keep their blood pressure under control.
The same with diabetics. There are some diabetics that no matter what they do, they still need to be on medicine for their blood sugars.
And that's just, unfortunately, it's hard to say from patient to patient, but it doesn't underemphasize the importance of lifestyle modification because regardless of whether or not you end up staying on the medicine, you may end up requiring less medicine. And so those healthy lifestyles and those healthy habits translate into better control of the disease.
So we don't have a cure for diabetes unless people get a pancreas transplant. That's one option. Yeah, but we don't, we don't have a cure for diabetes. We don't have a cure for high blood pressure. So me as a cardiologist or even a physician in general, you know, there's very few things that we actually can cure. We treat chronic illness, right? Whether it's blood pressure, diabetes, cholesterol, joint pain, you name it. So there's very few things in medicine that I do that are what I say, life changing or life saving events. Okay. And so if somebody's having an acute heart attack and I have to go in in the middle of the night and open up an artery, that is a life saving event. Because if we don't do that, we know that those patients will not do well. Right? But for diabetes, for cholesterol, for blood pressure, sure, you can give people all the pills you want, but the reality is, is if their lifestyle doesn't change with it and they don't adjust accordingly, it may lead to more pills because those pills have a hard time controlling it. And so that's why you see people on 2 and 3 and 4 blood pressure medicines or require multiple medications for their diabetes to be controlled. Now, we're getting better at it as far as the medications go and what we need to do. But lifestyle plays a huge role in how much medicine you need and whether or not you even need the medicine.
[00:22:21] Speaker A: Dr. Sumbal. I love that. I preach that every day, all the time. I love that.
So how often should seniors check their blood pressure at home? I know it's going to be different for everyone. And if they haven't had any heart issues, maybe they don't need to. But like, say if you have a client that has, I don't know, you know, chf, how often should they be checking their blood sugar? Excuse me, blood pressure?
[00:22:47] Speaker B: That's an excellent question because I go through This a lot in my office.
And so my rule of thumb is if you check your blood pressure 100 times a day, you will get a different number every single time you check it. It will never duplicate to be the same exact number. And blood pressure is dynamic, so it goes up and down depending on what you're doing, where you're at, what your stress level is, et cetera. So a lot of times people walk into my office, they gotta show up, they gotta find a place to park in those. Those garages. They got to walk down the hallway, come all the way down to the back of the hallway where my office is, wait, et cetera. They're rushed, so they come in, they get checked in, their blood pressure's high, even though they're on blood pressure medicine. So a lot of times I ignore that blood pressure when they come to the office in that situation, because what I'm looking for is a trend. What's the trend of your blood pressure? Is it always above the goal? Meaning which the goal is usually 140 over 90, or is it mostly below the goal? So, and then I have people that, you know, if I start them on medicine, they'll go home and they'll check their blood pressure three, four times a day. Well, that's not helpful because every time you check it, you're wondering whether or not that medicine is working and whether or not your blood pressure is under control. So in. And that in and of that situation itself can cause your blood pressure to go up because you're anxious about it.
So generally what I tell people is, look, keep checking your blood pressure twice a week, maybe three times a week is good enough because that gives you the trend. You're not going to be able to know what it's doing 24 hours a day, seven days a week, unless you are one of those ambulatory monitors. And even that in my situation, I don't think things helps your blood pressure. It's good for diagnosis for somebody, but it's not good to help bring your blood pressure down because you're constantly wondering whether the medicine is working or your blood pressure is under control.
So in general, the rule of thumb is if it's well controlled, whether it's. If you're not on medicine and it's well controlled, probably once a week is enough, maybe once every two weeks. If you're on medicine, maybe once or twice a week is enough. If you've had a change in your medication, maybe two to three times a week is probably enough. But every day, three times a day. You know that's not going to make a difference in how we manage your blood pressure.
[00:25:01] Speaker A: Dr. Sambal, that is awesome, powerful advice. Thank you very much. If viewers want your favorite at home blood pressure monitoring tips or meal plans, where should they follow you online?
[00:25:14] Speaker B: You can check out our
[email protected] we're on Facebook. Yasser Sombol MD There's a YouTube channel.
Yeah, I'm pretty easy to find.
[00:25:25] Speaker A: All right, thank you so much, guys. We're going to be right back with more from Dr. Sambal.
We'll be right back with more insight, expert advice and stories that matter to every generation.
And we're back. I'm Hilary Bailey and you're watching the Senior Care Conversation on NOW Media Television.
Loving what you're watching. Don't miss a moment of the Senior Care Conversation or any of your favorite NOW Media TV shows live or on demand, anytime, anywhere. Download the free Now Media TV app on Roku or iOS for instant access to our bilingual lineup. Prefer to listen on the go catch the podcast version right on the Now Media TV website at www.nowmediatv. from business and breaking news to lifestyle and culture, Now Media TV streams 24 7. Ready whenever you are.
Alright, guys, welcome back again. Our guest is Dr. Sumbal. He is a functional cardiologist and he has already given us some amazing information and tools to use in our daily life so surrounding heart health. So thanks for staying with us and we are going to turn the topic to saving lives and talking about chest pain a little more when it's an emergency, maybe when it's not.
So I guess let's start the conversation with how can someone tell the difference between harmless chest pain and maybe hey, I'm having a heart attack.
[00:26:52] Speaker B: That's a great question and I'm not sure there's an actual really right answer because any chest pain can be harmful. It just depends on how it presents, how long it lasts for, what does it feel like, et cetera. So in general, when you're having what we call angina, so this is chest pain related to somebody having a blockage inside the heart. And so that's usually defined as a discomfort in your chest that feels like a pressure elephant sitting on your chest that's associated, for example, with shortness of breath. It can radiate to your left arm or your neck or your shoulder.
It can be associated with nausea, sweating, all sorts of other symptoms. And usually it's brought on by exertion and goes away with several minutes of rest. Or sublingual nitroglycerin. Okay. So that's one way of describing chest pain. And if you're having those kind of symptoms, that is something that you want to seek immediate medical attention for, whether it's through your cardiologist, your primary care physician, or actually going to the emergency room and getting that care accelerated.
There's also what we call unstable angina, which means, again, it could be defined by exertional pain, but let's say some people have this pain where it wakes them up in the middle of the night. They're sleeping, and all of a sudden they get this sudden onset of chest pain that wakes them up, that lasts several minutes, that feels like this pressure makes them shorter breath, and then it goes away.
That's even worse because now you're having it at rest. So the heart's, when it's at least most comfortable state, is still being deprived of the nutrients and oxygens that it needs. And so it's warning you and telling you, hey, I need you to get this checked out.
It's different than people that are having. So those technically are not emergencies.
Those are people that can be evaluated in a non emergent fashion.
Different people that are having heart attacks, which I like to define as the bells and whistles. Heart attack, which means you got to get everybody ready to go, deploy the troops. It's time to take them to the lab and you have to fix it. Okay. Because time in this situation is muscle. And so we have guidelines that tell us when people present in these situations. We have about 90 minutes to get the artery open in that situation to restore blood flow and to have better outcomes and sometimes even less. And so that pain is really defined as a pain that won't go away. So you have this sudden onset or this chest pain that's really, really uncomfortable. You feel sweaty, you feel diaphoretic or sweat, nauseous, you're short of breath.
No matter what you do, you can't just seem to get this pain to go away. It's persisted for 5 minutes, 10 minutes, 30 minutes. You're onto an hour.
That kind of pain usually means you're having a heart attack and you need to seek immediate medical attention and call 911.
[00:29:44] Speaker A: Okay, so let's talk really quickly about what happens physiologically in the body when we're having a heart attack. What is actually happening in our heart?
[00:29:56] Speaker B: Okay. So your arteries, like we talked about, just like the arteries that go to your hands, your head, everywhere else, there's arteries that go to your heart that Feed that heart muscle. And so they're a pipe. And so over time, what can happen in there is you accumulate what we call plaque. So imagine like a pipe in your sink, over time, accumulates grunge. And you got to take Drano and pour it down it to release the grunge, so the pipe continues to flow.
So there's two types of way to think about a blockage. One is a chronic blockage that's accumulated over time, and one is an acute blockage that happens. Something happened in that plaque which may have been minimal at the time. So we define a blockage when we look at it on angio, on an angiogram. So when people have a heart catheterization and we look at it, there's a percentage that we give to a blockage, whether it's 10% or whether it's 90% or even 100%. So 100% is clearly bad. That means the arteries completely shut down and no flow is going down there. Now, having said that, there are people that have arteries that they're walking around, they're 100% closed and have no idea that it happened. And that can happen, too. Which means that artery shut itself down from a blockage, but never gave the patient symptoms because the heart has managed to compensate for it. So most likely, that has happened over a prolonged period of time and didn't happen abruptly and immediately, versus people that have to call 911 and get rushed to the cath lab.
They may have had, let's say, a 30% plaque. So that plaque is like this scab that sits inside the layer of the artery, and something physiologically changes in that plaque. What we call it ruptures, which means that plaque opens up like a wound. So imagine if you had a scab on your skin and you tear the scab off, it bleeds. So that's exactly what happens. So it leads to bleeding inside the artery. That's different than blood flow going through the artery. And so your body's natural response is it wants to cover the scab. It wants to form something on there to stop the bleeding. So it sends all these clotting factors towards that and forms a big clot over it in order to try to stop the blood, the bleeding from that wound. And so what ends up happening is you've immediately, abruptly stopped blood flow to that heart muscle. So, as if you take a pipe at your house and you take a sock ball and you shove it down there immediately, there's no water going through there. No matter how hard you Try. So that's exactly what happens in that situation.
So when people come to see me, for example, and they get a stress test because they've been having chest pain, well, the stress test may be normal, and the stress test is normal because they don't have a. They may have blockage, but it's not significant enough that it's limiting blood flow to the heart muscle at that time. That doesn't mean they can't walk out the next day, for example, and have a heart attack, an acute heart attack. So it's a different physiology that happens in that situation, that in an acute situation than in a chronic situation.
[00:32:51] Speaker A: Okay, gotcha. Thank you for that.
So what are some different symptoms that occur in women when they are having a heart attack versus when men have heart attacks? Are there differences?
[00:33:04] Speaker B: There are, there are definitely some differences. So women can present more with shortness of breath, they have more atypical chest pain symptoms, or, you know, they may present with right sided pain. They could present with right arm pain, they could present with neck pain or jaw pain. They don't always present in the classic fashion. And believe it or not, Hillary, it's interesting enough, they've looked at this, probably about 25% of patients that actually present with heart disease present in a classic fashion of this classic chest pain triad syndrome with shortness of breath, sweatiness, et cetera. Most people don't present in that fashion. And so you gotta have to kind of delineate through their history. And, and that's why initially, early on in the segment, I said history is really where you get the most information. And what's going to tell you what's your probability that this is really heart disease or it's not.
And so that's why figuring out functional status, exertional symptoms, etc. Is really important in figuring out is this chest pain related to heart disease or is it not? But going back to the women, yeah, shortness of breath, arm pain, neck pain, jaw pain, they could have, instead of left sided chest pain, they have right sided chest pain.
So yeah, they definitely present differently than men do.
[00:34:17] Speaker A: Okay.
So if someone starts to have symptoms at home, you know, the triad symptoms like that you just talked about, what are some things that the caregivers that are there with them say they're not trained, someone like me to know cpr. What are the things that they can do to stay calm and act fast in an emergency?
[00:34:38] Speaker B: Sure. So if you're ever in that situation, you think you know somebody's having a heart attack or you're Worried about it. I mean, the best thing to do is call 91 1, right? Don't try to drive them to the hospital, don't put them in your car, all those things. And because of what you talked about, right. So cpr, so people are having an acute heart attack, can actually decompensate really, really quickly. And that heart muscle is really, really irritable at that time and it can put them into a bad rhythm, what we call ventricular fibrillation or ventricular tachycardia.
And those rhythms are life threatening in that situation and they're deadly. And those are the rhythms that we shock people for. And so immediately call 911.
And the only thing you can do is call 911 and monitor the patient and wait for somebody to show up for professional help.
[00:35:22] Speaker A: Okay, gotcha. Are there any life saving tools or apps that every family should keep handy? I don't know about apps, but maybe you do.
[00:35:33] Speaker B: I don't know about any life saving apps, but going back to your previous question, you know, if you're worried about somebody and somebody decompensates in front of you, let's say they have a, they go into cardiac arrest.
The one thing that you can do that is helpful no matter what, make sure you call 911 first. So don't ever do anything before you call 911. But once you call 911, even just simple chest compressions may help that person. So you may not be trained, you may not know, but usually if you go into the mid part of the chest and you just do chest compressions, hopefully that keeps blood flow going through their body till somebody shows up to help you out.
[00:36:07] Speaker A: Okay, well, thank you for that awesome life saving information for downloadable emergency action checklists or recommended apps where families can reach you. Where can they reach you?
[00:36:20] Speaker B: They can check us out
[email protected] they can find us on YouTube, on Instagram, Facebook, anywhere else, any social media platform.
[00:36:32] Speaker A: All right, thank you again, Dr. Sambal. We are going to be right back with our last and final segment.
We'll be right back with more insight, expert advice and stories that matter to every generation.
And we're back. I'm Hilary Bailey and you're watching the Senior Care Conversation on NOW Media Television.
Loving what you're watching. Don't miss a moment of the Senior Care Conversation or any of your favorite NOW Media TV shows live or on demand, anytime, anywhere. Download the free Now Media TV app on Roku or iOS for instant access to our full bilingual lineup. Prefer to listen on the go catch the podcast version right on the Now Media TV website at www.nowmedia.tv. from business and breaking news to lifestyle and culture. And now media streams 247 ready whenever you are.
All right, guys, we are back with our last segment with Dr. Sambal and I'm going to be so sorry to see him go. He has been giving us such wonderful information.
So let's talk about the pillbox and what goes in the pillbox and all of those lovely heart medications that sometimes clients have to be on.
So I guess my first question would be why do heart patients end up on so many different pills. Pills at times.
[00:37:55] Speaker B: It'S a great question. And, you know, it just depends on the patient and what their actual heart problem is. It could vary from one pill to 10 pills. Right. So, you know, a heart transplant patient may be on a lot more pills than somebody who's had a blockage or had a stent.
In general, you know, not all of them are heart pills. So when you define heart pills, I like to define it as needing to take it related to an actual heart condition. So if somebody's on blood pressure medicine, I wouldn't technically say they're on a heart pill, they're on a blood pressure medicine, or if they're on a cholesterol drug, well, they may be on it to protect their heart, but it's really done to treat their cholesterol. And so when I think about heart medications that we really use, we use medicines that help with either, A, the structure of the heart, B, the plumbing of the heart, or see the electricity of the heart. And so that's where all those medicines, where you would technically call heart medicines, fall into. So somebody has heart failure, they may need to be on medicines that help the heart function either come back to normal so we can normalize it or at least keep it stable so it doesn't deteriorate any further.
So that may be one or two pills that they may require and sometimes more.
Let's just say somebody has a heart rhythm problem. Sometimes those heart rhythms require one or two medications in order to keep it under control so it doesn't interrupt with the patient or interfere with the patient's lifestyle.
Lastly, when you think about plumbing, the biggest issues with plumbing in the heart is that we have to protect the heart from attacking itself, actually. So when people get a stent, your body thinks of that as a foreign object and it wants to attack it. Just like that wound that we talked about or the scab that we talked about. In the artery.
So it wants to put clotting things on it because it thinks your artery is wounded and it wants to help it. And so we have to get people blood thinners in order to prevent those blood thinners from attacking the stent because then you can give somebody another heart attack. So that's why people that are, you know, have had a blockage out of stent or had a heart attack are required to be on what we call dual anti platelet therapy or two blood thinners, which is usually one is an aspirin and that's usually maintained lifelong. Then they can also medicine called Plavix or Berlanta or Effient. All three of those are different types of blood thinners that are used to help keep the stent open.
And so generally speaking, those patients need to be on those blood thinners for at least a year.
And then after a year they can technically stop them. But what does remain around, obviously is the aspirin, the cholesterol medicine and any other medications they're taking to modify the risk factors.
[00:40:36] Speaker A: So this is something that's very important for me personally to ask you because of the line of work that I'm in. So I have a lot of clients who may not have kids that can or loved ones that can go with them to the doctor and learn about their medication.
But maybe they're not really able to understand what they're taking when they're taking. Maybe they've gotten medicine from another doctor.
What kind of education is out there for seniors? And I understand we have a lot of stuff online. I get that. But a lot of seniors don't know how to get online. They don't know how to get on their phone and look things up.
Are there any education classes or anything available to them where they can go speak to someone after they've been given medication to learn about that medication, the side effects, maybe what they shouldn't take with it. Maybe medications that interact with one another.
[00:41:31] Speaker B: Sure. So first off, that starts in the office, right? So that starts with your physician who's prescribing the medication. You should be able to ask all the questions you want to ask about what's this medication for? What is it going to do? How many times a day do I have to take it? What can I take it with? Does it affect my other medications? All these questions should be answered by the physician that's actually prescribing the medication. When you get it, if that, if you get, you know, past that point and you still have more questions after you left the office and you want more. When you go pick up the medication, the pharmacist is responsible actually to answer any other questions you may have related to that medication. If you ever picked up a medicine from the pharmacy, there's always a big packet stapled to every bag they give you, right, that lists every possible side effect that that medication may give somebody. Now, I can't tell you the validity of all those side effects. I can tell you that drug companies are required to report anything that a patient, during testing, says maybe a side effect of this medication.
So those are at least three options other than online that allows you to kind of have an idea of what the medicine and, you know, what the side effects, etc. Are, you know, lastly, you know, if you get a medicine and you're just not really sure about what's going on or you have other questions about it, you can always go back and call your prescriber.
Most prescribers have somebody available, whether it's a nurse or somebody, a nurse practitioner or somebody, to be able to answer those questions for you or you have to make a follow up visit.
The most important thing I think, message I think I can send with this is everybody on medication should have a list.
People are seeing multiple doctors all the time.
And all of us are not on the same medical record system, unfortunately. And it's really, really hard to track sometimes what one person is doing versus what another person is doing.
So I always recommend to people to carry a list, a list of these are the current medicines I take and this is how many times a day I take it. And whenever you get a new medicine or a medicine is replaced, your job is to really replace that list with something else.
I have patients that come into my office with all their pill bottles. They bring, just bring them all with them and they're like, this is what I'm doing. And that's fine. That's actually helpful to me because at least I have it in front of me. And then I can say, okay, keep taking these, we're gonna stop this.
And I want you to take this one instead of once a day, twice a day. And I can actually write on the pill bottle for them two times a day. So then it clears things up for them and answers all their questions.
So, you know, part of taking medicines is on the patient as well. And that's a responsibility on them. And so I get it. It's tough when people are, you know, don't have access, don't know how to use the Internet, et cetera. But things like making a simple list should be easy for most people.
If your children can't come with you, they can at least type you up a list of your medications. And anytime you get something new, you can tell them what it is and they can edit your list and make sure that you have a copy.
So. And in this day and age, everybody's carrying around most people, I should say, sometimes the elderly aren't. I know, I realize that. But most people are carrying around smartphones where they can put that information in their phone and just edit it within their phone and bring it with them to the doctor's office.
[00:44:58] Speaker A: Absolutely. Absolutely. So I had a wonderful question that I wanted to ask you and it just left my brain. Oh.
Something that I hear sometimes is, especially when I was doing phys. Physical therapy work in home health, people would say, well, yeah, my doctor put me on this medicine, but it made me feel this way, so I just stopped taking it. Can you please stress how important it is to call your doctor when it makes you feel a certain way, or maybe it's supposed to make them feel a certain way for a little while and that they should continue to take it or when they should call?
[00:45:35] Speaker B: Right. So I think that's a really important thing. And I think if somebody's prescribing you something, there's a reason they're prescribing it to you. So if it's not working or you believe it's causing you a side effect, the first thing you should do, you may, you may stop it if the side effect is bad enough. Right. And it's really detrimental to you. And I can understand that. But if that's not the case, the best thing to do is to really call or come back to the office and discuss what's going on with that medication. It may not even be a side effect of the medication.
I, you know, I take care of a lot of people and a lot of people can come tell me, well, I think this medicine is causing this for me. And I could be like, well, you know, in my 20 years of practice, I've never heard somebody complain about that being a side effect of that medication.
And so you'd be surprised. You could go through, you know, every medicine has a class of drugs. So there's not one drug in that class, but there's several. So you start rotating through these class of drugs or the different medicines in that class of drug, and somehow every one of them gives them a side effect. Then you have to ask yourself, is it really the medication? Is there something else going on. So it comes back to the importance of having that discussion with your provider or the person that prescribed the medication for you to be able to understand.
Is that side effect related to the medicine? Is there an alternative to the medicine rather than, let's say it's a blood pressure medicine, you just decide not to take it and you're not scheduled to see that prescriber for another three or four months. Well, now you've sat three or four months without a blood pressure medicine. Your blood pressure is out of control. And. And you may not know it's out of control because like we said, blood pressure is a silent killer. Right. And so you have no symptoms. And the only presenting symptoms, you had a big stroke and you ended up in the emergency room because you didn't take your blood pressure medicine and didn't discuss that with your provider because of a side effect.
[00:47:21] Speaker A: Dr. Sambal, it has been a pleasure to have you. You have educated me big time. And I know our viewers as well. You know, I believe education is power and that when you have that education also can alleviate a lot of fear for family members and loved ones that are having issues. So thank you again for being on.
[00:47:40] Speaker B: Thank you for having me. It was a great time.
[00:47:42] Speaker A: Awesome.
So, guys, from walking stronger and breathing easier to lowering blood pressure and decoding chest pain, today's conversation proves that empowered care saves lives. And when it comes to medications, it's not just about taking pills. It's about taking control.
Thank you to Dr. Sombal for his wisdom, his warmth, and his vision of heart health that honors both science and the human spirit. To all the seniors, caregivers and families watching, you are not alone. With clear guidance, practical tools, and a little daily courage, you can navigate the path to better aging, stronger hearts, and peace of mind. I'm Hilary Bailey, and this has been the Senior Care conversation on NOW Media tv. Until next time, please take care of your loved ones and don't forget to also take care of you. Have a great day, guys.
