Heart-to-Heart With World-Renowned Heart Surgeon Dr. Mandeep Mehra: On Silent Heart Attacks and More

Welcome to Indian Union News. Our guest today is Dr. Mandeep Mehra, world-renowned expert on heart and cardiovascular diseases. He is Director of Heart and Cardiovascular at Brigham and Women's Hospital and a distinguished professor at Harvard Medical School. On November 15th, he will be honored as a healthcare pioneer at the Newland Choice Awards Gala. Mandeep, welcome to our studio. Thank you so much. It's a pleasure to be with you. Excellent, and I'm very excited to talk about heart. And my understanding is that every human being is also a doctor of heart. And you are the lucky one to be the doctor of heart from the romantic side in human life as well as a real expert on the heart. So before we get into the seriousness about how the treatment of heart has evolved, how the heart failure, you know, the future, the prospects look like, and all the advances we have made, let us first start with where this symbolism of the romance and love comes, why is it related with the heart? Well, I think there are two aspects to life, right? One is intellectualism, and the seat of intellectualism is in the brain. And the second is the soul, which connects us to a much higher alternative to our life, right? And where is the seat for the soul? And I think that the seat for the soul is in the heart. That's why the heart is always considered the epicenter of romance or connectivity. Now, the reason why it is so is, in my opinion, because it creates a pulse. And this pulse is a rhythm. And it actually connects to the rhythm of life. There is almost nothing that is alive which is without a rhythm. We have a day and we have a night. We have high tides and low tides. We have a universe that's expanding and a universe that's contracting. We have music that has a rhythm to it. And similarly, we as human beings have a rhythm. And that rhythm is exemplified in our pulse. And the seat of generation of that pulse is our heart. And that's why the heart carries this important symbolism. This is a wonderful explanation. I really am totally stunned because, you know, I never thought that, and now it makes so much sense, you know, because if you, again, you go by the Indian mythology, it's awful that, you know, all the gods, everything, just they live inside your heart. So, but your scientific explanation is absolutely wonderful. Thank you. So now, how did you get interested in the heart business? Well, I initially wanted to become a neurologist. I thought that I would actually go into the intellectualism component. And after I got through medical school, as I began to look at diseases and patients, I realized very quickly that in the 80s, when I was just entering into my life as a physician, there were so many innovators and advances that were happening in the cardiovascular arena that I took a immediate shift into this arena. And I remember very vividly when I had the opportunity to first see something that absolutely stunned me, which was a fight against nature, where a patient with a diseased heart had his heart taken out, and then a new one put in from someone else. And it worked. And it gave life to that individual, a heart transplant. And I was immediately sold into it. And I immediately pivoted, and I said, this is where I want to drive my passion in discovery, science, and in clinical care. So now, you know, most of our viewers are, you know, the common people, they are not, you know, just like, you know, who know basic things, but, you know. So what you would tell them, for example, I know that you were one of the best known experts in this cardiovascular and heart and transplant, et cetera. But tell us what you do exactly that so a common person can understand. Well, what I do is to alleviate human suffering, okay? And human suffering comes either from the genes that are handed down to us, or from the lifestyle changes that we undertake, or from the influences of our environment that are independent of some of our lifestyle changes. The coalescence of all of these three things then creates a situation where this pulsatile organ starts to become less and less pulsatile over time, and then shortens our lifespan. So what I do day in and day out is to try and prolong the human existence by improving longevity and reducing suffering from the reduction in quality of life that happens in patients when they develop heart disease. So now, you know, the heart disease is so common, you know, in India also at that time, people didn't know, but now, you know, everywhere, worldwide, you go, it is happening there. So if you go, say, let's start in 1980s. Since then, what are the advances we have made in terms of heart care? Well, I'll take you back even a few more decades, right? So let's talk about the 1960s. So what was happening in the 1960s in this world? There were probably three sentinel things that happened in this world. In the 1960s, the first was that we went to the moon. The second was that the first human heart transplant was done. The third was that the scourge of smoking in the world actually started to see a decline. Just to add one more, I was born in 1960s too. Wonderful. So see, I took you back right to your birth. So you were born at a sentinel moment in this world when diseases, both cancer from smoking-related illnesses and a solution to heart disease was found in the 1960s. From then on, we as a medical community have been striving again and again to A, alert people on the consequences of negative lifestyle changes, smoking, obesity, high cholesterol, things like that, but B, also to try and define diagnostics with which we can quickly diagnose disease. One of the biggest challenges, and I speak mostly to the Indian community here, is that the Indian community has a genetic tendency to develop heart disease much earlier than most other communities. We are genetically programmed, in fact, to have heart disease at decades earlier. The problem is that if you're going to develop heart disease in your 30s and 40s, you are more apt to ignore it. And so what I do is I like to improve awareness in patients of the consequences of heart disease. I like to work on discovery science to, in fact, increase the ability to diagnose and treat heart disease. And then I like to find solutions, whether they be in the form of drugs or in the form of devices or in the form of biological heart replacements. And that's what I do for a living. And so let's, again, coming back to my question is that, so how, say, from 60s till now, all the advancements which have been made in the treatment of heart and cardiovascular, how, in terms of in approximate years, how many years we might have added to the life, or how challenging it is, without these devices, what would have happened to the normal human life? Sure, so knowing what we know, with all of the advances that have been made in cardiovascular medicine as a whole, if we inculcate lifestyle modification, we apply all the treatments, including medications and devices, our life has been prolonged by decades, actually. However, I will caution us that in the last few years, there has been a reversal of that trend. And this was actually noticed very much in the last five years, where these tendencies where we were seeing a massive decline in cardiovascular-related deaths are starting to stave off and plateau. One of the consequences of that is the rising rates of obesity. And in fact, just this past week, we saw data for the first time that even the obesity epidemic may have peaked and might have started to decline, perhaps because of the widespread use of certain drugs that are designed for obesity reduction now. So now, coming back to the heart again, so I know you alluded to this earlier. So why does heart really fail? Why it happens? Yeah, so the heart is, from an engineering principle standpoint, a spontaneous pump, right? However, in order for it to work 24-7, as it does, it requires a steady stream of nourishment. And that's provided through its blood vessels. If we do anything to interrupt the blood supply of the heart, or we do anything that interrupts the functioning of the heart muscle, in both consequences, the heart is going to start to fail over time. The third reason is that due to some infections or due to degenerative conditions of aging, some of the valves that provide a important conduit to ensure the right direction of blood flow start to fail as well. So between these categories of diseases, one can actually see why the heart, over time, can fail in a substantial number of patients. Can it be prevented? Oh, yes. So what are some of the prevention mechanisms? So the first and most important prevention mechanism is to know what the risk factors of heart disease and failing hearts are, right? Things that cause blockages in the heart arteries, for instance. So stopping smoking, controlling your weight, making sure that you treat your high cholesterol and not just measure it, are just some simple things that can be done. The next is to know how to identify when heart disease might be manifest. One of the biggest problems that happens is that as we age, some of the syndromes that determine the symptoms of heart disease are very synonymous with aging. So for example, some people develop shortness of breath or their functional capacity starts to reduce. They can't climb up stairs as much as they could before. And very easily, some people say, oh, you know, I'm just getting old. Yeah, and that I would caution people that if you see a constellation of such symptoms, one then has to bring it back and ask the question, is it fundamentally due to an organ defect rather than just simply aging? So now talking about that, I had a personal experience. So my experience was that I started to develop a little bit muscle pain here on the left side. So I take care of my health. So I got a little bit scared. So I wanted to see my doctor. And the doctor said, you know, let's get everything done. So they said, you know, everything is fine, but still I'm going to refer to a cardiovascular expert. So I go and see her. She looks at all the tests and everything. And her first question to me was, oh, when did you have a heart attack? And I said, I never had a heart attack. I don't remember anything like that. So my question to you is, is that possible? And why it happens? And then is it serious? Yeah. So the first point I'll make is that you use the term when I developed a muscle pain. Well, how do you know it was a muscle pain? So right here, you have an example of denial that is a psychological construct in each of us, right? So we will never say I developed heart pain. We'll always say I developed bone pain, or I developed muscle pain, or I had something in my skin. So the first thing I always tell my patients is please do not start to identify or anchor yourself into a diagnosis because you'll make a mistake. Now, silent heart attacks occur all the time. And particularly in patients who are so predisposed, for example, diabetics, for instance, if you have high blood sugars, these patients often will have defects in the nerve supply that goes from the heart to the brain, as a result of which the warning signal of pain from the heart is lost. So you can, in fact, have a silent heart attack. The other way in which you have a silent heart attack is exactly based on what you said, which is that you attributed a symptom to something else. Some people might say, oh, I'm feeling nauseated, or I'm just very sweaty today. Oh, maybe I went out in the sun, or I got some heat stroke or something. And they don't realize that the real problem might actually be that the heart is giving you a warning signal that it's starving for blood. So now, what are the couple of advice you would give to deal with these type of, and I mean the bold advice? Well, the first thing is that do not be in a state of denial, number one. Second, I always tell people, know your numbers. And what I mean by knowing your numbers is get yourself checked, particularly the Indian community, because we have high cholesterol, and the level of cholesterol that is considered high for an Indian is very much considered normal for a non-Indian, as a result of which even physicians might miss the opportunity to diagnose heart disease in Indian subjects in particular. There are many tests that can be done. Getting a routine electrocardiogram is one. If you have any atypical symptoms, and you have any concern, and you have risk factors such as diabetes, or you're a smoker, or you're obese, or you have high cholesterol, you should always get some form of testing done to look at the heart. One easily available test, which is easy to do, can look at calcium deposition in the blood vessels of the heart. And this is done through a CT scan that's very, very easy to obtain. It's very non-invasive. And if in partnership with your cholesterol levels, you actually see calcium depositing in the blood vessels, that's a harbinger of bad things to come, and should signify that you need to get on medications to control your risk factors. So now, again, coming back to my case, so the cardiologist told me that there was one thing with the calcium buildup, and she said it was because I'm taking statins or something like that for a long time. So what is the thing? I'm sorry, I'm getting there in the medical. No, no, no, no, no, this is great. Because, so first of all, if you were taking statins for a long time, that's a good thing. Second, when calcium does build up, it means that the lesions in the coronary arteries have now healed by deposition of calcium. That means that there were some lesions that were active. In fact, the most active lesions that cause blood clots to develop in the blood vessels are not calcified. They are actually like pimples, okay? They have some inflammation around them, they swell up, and then they burst. And when they burst, they attract the blood to coagulate, and a blood clot is formed, as a result of which blood cannot flow any further, and then you have a heart attack. And very often, the symptoms of that are either classical pain, where you have what's called a Levine sign, where patients will come like this and say, I feel like there's an elephant sitting on my chest. That can never be ignored. Or, in other cases, maybe in yours, where you say, oh, I have some muscle pain, or some sweatiness, or some tiredness, or I am nauseated right now. These are all signals that there might be something going on, and they cannot be, and should not be ignored. Now, let's move to part two of having some fun, okay? So, I'm going to start with, who is Mandeep? I know you're not prepared for this, but. Of course I'm not prepared for this. You know, I am basically a family person. That's who I am. Mandeep is actually a family man. A man who cherishes his wife, his children, his parents, and his community around him first. But Mandeep was also influenced by a number of people. And in science, you always have people you look up to. And so Mandeep has learned scientific rigor, and has become an intellectual scientist with perseverance and resilience by looking at some of his mentors. Mandeep has also spent five years in Sevagram Ashram, where Mahatma Gandhi was. Really? And you didn't know this. And which year was that? In the 80s. In the 80s, okay. Yeah, 83 to 88, I actually was in Sevagram Ashram, where I was doing my medical school and spent time. I, in fact, used to sweep Gandhiji's cottage every evening in a situation called Shramdhan, you know? So we were always taught that you must always do something for the community. So you might be studying medicine, you might be becoming a doctor, but what's your contribution to the community? So every day we used to sign up to do something. So I guess that Gandhi must have significant influence on you. Of course. In fact, empathy, compassion, social justice, equity, these are all traits that were principled through my time at Gandhiji's ashram. So earlier you mentioned the family is so important, which is great. Most of us have, you know, of course, the basic. So how did you meet your wife? I met my wife in the US. In the US, okay. So after finishing my medical training in India, I moved to the United States, to Columbus, Ohio, and I met my wife there. She was a banker, and I met her through that process. We then got to know each other. I guess that was the bank you were banking with, huh? It was. And in fact, it's how serendipity takes you to a certain course, and it was just destined that I would bank there and meet my future wife. So now, you know, many times it happens, you know, it's usually the young and early age. We become so focused on our career, we get so focused on the goals we have to do in your life, and many of us, I'm guilty of that too, we start ignoring the basic things about the family. How dangerous is that? I think it's very dangerous. I think if I were to do anything again, I would probably strive for a better work-life balance and more attention to my children. I think I missed a number of moments of greatness in seeing the children grow. My mother, who knew that I was very intellectually focused in scientific discovery, in fact, came and spent time with us so that she could immunize me from any family duties. That was what Indian mothers do. And so she came and my wife and my mother together brought up the children while I was allowed to tirelessly go about and do the things that now I sometimes am being celebrated for. But I actually look back and I sometimes ask myself, what am I being celebrated for? For missing those moments of greatness in seeing my children grow up? So I would say to you that this is a challenge in life that anyone who is young, a mentee of mine, I always tell them, please do not sacrifice the important things in life, which is watching the evolution of life around you and your family. So since you mentioned your mom, I have to ask this question. What is the one thing you have learned from her? Oh, I learned sacrifice from my mother. She was always, she always put others above herself. But the other thing I learned from my mother was a very important life issue. My mother died 18 years ago. She died in my arms. Oh, sorry. I was a cardiologist. She came and she said, Mandeep, I'm not feeling good. Collapsed. I tried to resuscitate her. I couldn't. And this happened here in Boston? Happened in New Orleans. In New Orleans. Yes. And we moved away from New Orleans after that happened. I went to Baltimore. But I couldn't resuscitate her. At that point, I realized that I was searching and discovering and saving lives every day. And I could not save my own mother's life. Say the heart attack or? We don't know. It was sudden death. But it also made me realize that how could I have missed that? Obviously, there were two reasons I missed that. One is that I wasn't paying attention to my own family. Two, she probably didn't want to bother me. But maybe the more important reason, as I thought through it, was that women may present with cardiovascular disease in a different manner than men. And so it turned my attention to women's health and cardiovascular medicine in some ways. And I actually helped develop programs where I was in ensuring that women and their symptoms were not ignored by clinicians. And it turns out that in many cases, I can give you examples, particularly in Baltimore, there were many situations where women had been ignored with their symptoms. This still happens to this day, where we diagnosed substantial cardiac disease and cured them. What about your dad? My dad is with us now. He, in fact, just had his 89th birthday. So he's entered his 90th year. He is an incredible influence on the family. He's a Libran, a September-born individual, who, as you know, Libra is the balance. He is the perfect balance of charm, of class, of quietness, and is an incredible influence on the family. We live as a three-generation family, even today. And the family values that my mother left for us are still with us today, where my son still stays with us because he is so closely connected with his father. And how old is your son? How many kids do you have? I have three children. Are they boys or girls? No, no, my oldest is a boy, and I have two girls. The two girls have said, dad, we're done with you, we're going to New York. So they're going to New York. But my son, he's a Harvard lawyer, and I'm so proud of him. He is, in fact, an intellectual property lawyer, and finds his passion in doing deals where he is moving cancer therapeutics to the commercial sector through an academic medium. Now, let's come back to your father again. So what have you learned from him as well? There are one thing that says, oh my God, this is the greatest teaching he has taught me. The greatest teaching that my father has taught me is balance, balance. It is not to tilt a thinking too heavily in one direction. Always recognize that everything has another side to it. And I think more often than not, we develop dogma by tilting ourselves to one side and not the other. And I think that one of the values that we often don't invoke adequately enough is to always know the balance between conversations, the balance between things that we do in our lives. So now, can we have some fireside chat? Ready? So with you, I have to start. So whenever, let's say, when I say heart, what comes to your mind? Soul. Nothing medical, nothing, just soul? Soul, pulse. Love? Romance. Wife? Romance. Wife. That's amazing, that's a very good compliment. Excellent, your wife must be very lucky. We've been married for 33 years and have been just so happy with each other. And we are basically not two people, we are one. That's a fantastic compliment, I must say. What about courage? Courage, resilience is the word that comes to mind. Perseverance, fearlessness. All of these are important attributes that combine with courage to create an individual who can move things forward on paths that are not yet treaded on. Life. Life, self-realization comes to my mind. Is the purpose of life? What's the purpose of life? To self-realize. Attain the understanding of your consciousness. Now, generally I don't talk about this, but we are talking off the camera, so I have to ask you about Rajneesh and Osho. I like him, I like his philosophy, I like his style. I'm one of the biggest fans of Rajneesh. So I am really glad. So I would like to get your view. You seem to be also quite influenced or impressed by Rajneesh. Well, I'm impressed by many people. I don't have one person who I follow. I'm not a cultist by any means. So let me reframe my question. So when I say Rajneesh, what comes to your mind? Intellectualism that is self-realized. So when I listen to Rajneesh, he represents the ultimate component of what you and I refer to as enlightenment, but it's an enlightenment of awareness of your environment and the ecosystem in a way that I've never seen people express clearly. He's a very clear expressionist, and he seems to have a very clear understanding of things. He can cut right to the chase, but with allegorical tales. Mandeep, thank you so much for your time. Really enjoyed chatting with you, and we are looking forward to seeing you on November 15th. I look forward to it. Thank you so much. Excellent. Thank you.