Cardiologist Answers Heart Questions From Twitter | Tech Support | WIRED

I'm Sunil Rao, cardiologist at NYU Langone Health. Let's answer some questions from the internet. This is Heart Support. At Thiggy Man asks, A, what heart rate is considered too high? There's no one number that's considered too high for everyone. If you have a fever, if you have the flu, your heart rate may go up to 120, 130, and that's probably, quote, too high for you. Let's say you're on the treadmill and you're wondering, gosh, how high should my heart rate get? Well, there's a rule of thumb that you can remember. 220 minus your age. So let's say you're 40 years old. That would equal 180 beats per minute, which would be really the maximum heart rate that you're aiming for. Really what you want to do is try to get to about 70 to 85% of that heart rate, which would be somewhere between 145 and 155 beats per minute while you're exercising. If you notice that your heart rate's going above 180, it probably ought to cut back a little bit. Teresa asks, I need a doctor to tell me medically what is happening in my chest when my heart skips a beat while reading a cute romance manga. Occasionally what will happen is that the heart will have a beat that occurs prematurely. Well, the heart has a way to compensate for that. It has a pause and then it gets back on rhythm. It's that pause that you're feeling when you say your heart is skipping a beat. Many of us have occasional skip beats that happen. Maybe we had a little too much caffeine that day. Maybe we were nervous about a job interview, nervous about a first date. That's very, very common. But if you notice that your heart is skipping beats a lot, you may have what's called an arrhythmia. Arrhythmia is just a general term that said there's something wrong with the electrical system. Atrial fibrillation, atrial flutter, ventricular tachycardia. There are a whole bunch of other things that can be diagnosed very, very easily by getting an EKG. Okay, so next question. EKGs, how do they work? EKG is an electrocardiogram. Here's a normal EKG. And you can see that these lines are occurring at a very regular interval. And the baseline has a few curves on it. But those curves are pretty much the same with every single beat that's happening. That's a normal EKG. And what does an abnormal EKG look like? First of all, these deflections that are going up and down are occurring very, very irregularly. Look at the spaces between these deflections. You see how there's so many different waveforms here. There are lots of lumps and bumps. This is an EKG of a person who has something called atrial fibrillation. And that's when the top chambers of the heart beat irregularly. So let's go to our heart model. So there are the upper chambers of the heart and there are the lower chambers of the heart. When someone has atrial fibrillation, the top chambers of the heart stop beating. And that's that irregular waveform that you pick up on the EKG. The problem with that is that the blood can pool in parts of the heart. And if it forms a blood clot, no matter how tiny it might be inside the heart, and that blood clot travels to your brain, it can put you at risk for having a stroke. At Chicago CV asks, guys, I can hear my heartbeat without a stethoscope. Is that normal? It's very, very common to hear your heartbeat in your ear. So a lot of people can hear it when they're laying down and when they're going to sleep. You may be even be hearing the blood going through the blood vessels in your neck. Some people hear it, some people don't. That's a very, very common finding and really nothing to worry about. At BaseballMers7 asks, true or false? You can restart the heart with a defibrillator. Well, that's true. You can't. Now, there are a couple of things that are important to keep in mind here. Oftentimes on television, they show, for example, a patient's heart who stopped and the monitor shows a flat line. You actually can't use a defibrillator to restart a patient's heart if they're flat. What you do use it for is when the bottom part of a heart, these chambers of the heart, go into something called ventricular fibrillation. In other words, they're not beating, they're just quivering. And because these chambers are responsible for pumping blood to the rest of the body, if they're not pumping, the rest of the body ain't getting any blood. And so the external defibrillator that we use when someone has a cardiac arrest can basically restart the heart and get it pumping again. But you can't do it if the person's flatline. At Deerapops asks, is broken heart syndrome a real thing? Absolutely it's a real thing. In fact, I just treated a patient with broken heart syndrome this morning. It's a situation where the heart, all of a sudden, stops working normally because of some kind of psychological stress. Even on the EKG, it can look like someone's having a heart attack. And when we look for blockages, we find they don't have any blockages. But the good news is that that recovers over time. These patients often go on to have normal lifespans. But absolutely, yes, broken heart syndrome is a thing, and we're seeing more and more of it just because of life stresses that people are having these days. At Kjule71 asks, will we ever learn what happened to DeMar Hamlin? Exactly what caused his cardiac arrest? So DeMar Hamlin is a professional football player. He unfortunately had cardiac arrest during a game. And what happened to him is that he was hit in the chest at exactly the right time during the electrical activity of the heart so that his heart stopped. It has to happen in such a specific time of what we call the cardiac cycle or during the normal heartbeat that is a very, very rare phenomenon. And thankfully, he's really become an advocate for community education around CPR so that if someone does have a cardiac arrest, they can be resuscitated very, very quickly. It's really important for all of us, really, to get educated about basic life support and CPR. So Rolls asks, I train and work out a ton. Why is my resting heart rate still fast as F? First of all, it may be that even though you're hitting the gym a lot, maybe you're not doing enough cardio. Your heart rate when you're just resting should be somewhere between 60 and 100. Anything below 60 is probably a little too slow, but keeping in mind, marathon runners, for example, they'll have very, very slow heartbeats, and that's normal for them. So to find your own resting heart rate, what you want to do is sit in a quiet room, feel your pulse in your wrist or in your neck, and count the beats for six seconds. Multiply what number you get by 10, and that'll give you what your resting heart rate is in beats per minute. If you're in pretty good shape, you're exercising regularly, and your resting heart rate still is high, it's probably a good idea to see your doctor and just get checked out. It's case shoe asks, hey guys, what are the signs of a heart attack? I can't feel my arms. Well, I'm not sure that if you can't feel your arms, that's really the sign of a heart attack. The classic symptoms of a heart attack are chest pressure or chest tightness. You may feel shoulder pain, either in the left shoulder or both shoulders. It may radiate to your jaw. You may feel jaw pain. Women may have symptoms that are a little bit different from men. They may feel shortness of breath. They may feel profound fatigue that's really abnormal for them. A heart attack is when part of the heart muscle dies because the blood supply to that heart muscle has been choked off. I have a picture for you here that shows the blood vessels that supply the heart muscle. What you see here is there's a narrowing in that blood vessel, and that blood is not able to get past that blockage. That's what causes the pain that people are feeling in their chest. And our job as cardiologists is to diagnose this as quickly as we can, go in there and actually open that blockage, which is exactly what we do with balloon angioplasty and stents. At Chica from the Shy asks, so does low-dose aspirin help prevent heart attacks or not? If you don't have manifest cardiovascular disease, it's really not recommended that you take an aspirin specifically if you're trying to prevent heart disease. It doesn't prevent heart attacks and does put you at risk for bleeding complications because aspirin can be directly irritating to the lining of the stomach. Aspirin is a blood thinner, and because a heart attack involves blood clots that are occurring inside the blood vessels of the heart, aspirin can actually address those blood clots by actually breaking them up and reestablishing flow to the heart muscle. If you have cardiovascular disease already, aspirin can prevent future heart attacks by gently thinning your blood. Or if you're actively having a heart attack, it can treat a heart attack by breaking up the blood clot that's causing it. But if you don't have either one of those things, low-dose aspirin really is not gonna prevent you from having a heart attack. At dogs move silent says, you get served this for breakfast, what's your reaction? My reaction is I probably didn't order this, but let's take a look at what's on this plate. Processed meats can be very, very high in saturated fat, but they also might be high in salt. So for example, the beans, which are a great source of protein and fiber, you know, these beans might be from a can. And canned vegetables and canned beans do have a lot of salt in them. For most of us, salt is fine, but some of us do have what's called salt-sensitive hypertension. And minimizing the amount of salt or sodium in our diet can certainly protect you from developing high blood pressure. Eggs are perfectly fine for you. They're a great source of protein. You should eat the yolk. You know, one of the reasons that people said that eggs were bad for you because they said it was high in cholesterol, it turns out that dietary cholesterol contributes very, very little to your blood cholesterol. What does contribute to your blood cholesterol is saturated fat. And prepared appropriately, eggs can be very low in saturated fat. I'll confess, I love French fries. But anything that gets fried can increase saturated fat. Saturated fat, in and of itself, can increase your blood cholesterol. And blood cholesterol is directly linked with the development of heart disease like heart attacks. At BettyFuck9 asks, how does COVID affect your heart? Well, COVID has a lot of effects on the heart. The viruses can infect the lining of the blood vessels, leading to blood clots forming and an increased risk of heart attack. COVID-19 can also affect the heart muscle itself and weaken the heart muscle. During the pandemic, we saw an increased risk of heart attacks. So it's really, really important to try and avoid COVID-19 and prevent it if at all possible. At Botlogie asks, a 45-year-old close relative has found 195% blockage in two arteries and they're exploring options between stents and bypass. Can someone suggest what's less risky? Well, I'm sorry to hear that your relative's having issues. I certainly can't comment on their specific case, but let's talk a little bit about stents and bypass surgery and what they do. So a stent is just a wire mesh tube that's made out of a specific type of metal that goes inside the arteries of the heart muscle and props open blockages. It may be a blockage that's filled with cholesterol, for example. So the stent is this metal part and it comes crimped on this balloon. And this red tip is the end of the balloon catheter itself. Once we position this on the x-ray in the right spot, we can use this device and push saline, which is salt water, and expand that balloon. What I'll do is I'll turn this device and push that saline into this balloon. There it goes. And it pops open that stent. I can then deflate the balloon and remove the balloon catheter and then leave this stent behind. So that's how stents work. But how does bypass surgery work? A surgeon will take blood vessels, oftentimes from your legs or maybe from your arm, and attach them to the aorta here and put it into an area that's past the blockage. Think of it as a blocked highway. So if the highway is blocked, oftentimes there's a bypass that goes around it. Around 12% of the patients with atherosclerosis affecting the heart get bypass surgery. About 65% or so get stents. AtcatgirlGail says, WTF is a cholesterol. Well, cholesterol is just a substance in your body that's all over your body. It's an integral part of the cell membranes that make up your body. But cholesterol also can float around in your body and cause blockages in the blood supply to the heart muscle, the blood supply to your brain, the blood supply to your legs. There are different types of cholesterol. There's good cholesterol and there's bad cholesterol. Bad cholesterol is the one you really ought to pay attention to. It's also called LDL cholesterol. That's the cholesterol that if it's too high can cause heart attacks and strokes. It's important to minimize the amount of LDL cholesterol that's measured in your blood. Exercise, minimizing the amount of saturated fat. There are some very, very good and very, very safe medicines that will allow you to lower your blood cholesterol. One of the more common medications for cholesterol is something called Lipitor. The generic name is atorvastatin. It's a very cheap drug. It's incredibly effective and has been shown not only to lower cholesterol safely, but also prevent heart attacks. LazyPoo asks, how does the human heart just do that? The human heart is really pretty amazing. It does a lot of things. It pumps 100,000 times a day. It pumps 2,000 gallons of blood through nearly 60,000 miles of blood vessels. It's got these blood vessels that are going into it and coming out of it. Now, they're not really this color inside the body, but these blue blood vessels are carrying blood that needs oxygen. The organs in your body have already used the oxygen. They're sending it back to the heart. It comes in through this right side of the heart. And these white structures here are valves that open and close and allow the blood to flow through. And then it pumps through the right side and goes to the lungs where it can pick up the oxygen that we're breathing. And that blood then comes back to the left side of the heart. And the left side of the heart pumps it through this giant blood vessel that you can see here called the aorta. From the aorta, there are all kinds of branches that go to all the organs throughout the body. And they can then get the oxygen that they need for normal functioning. At Sarah Barley MC asks, can anyone tell me how heart rate variability impacts on your health? Heart rate variability is just the normal variation in our heart rate during the day. A lot of consumer goods are measuring things like heart rate variability. The reason that heart rate variability is important is that it's an indicator of a healthy heart because if you're getting excited, for example, your heart rate should go up. If you're relaxed, your heart rate should come down. If your heart rate is unable to maintain that kind of variability, it's a sign that something may be abnormal with your cardiovascular health. Probably the thing that matters a little bit more than heart rate variability is what's called heart rate recovery. So for example, if you're exercising, how fast does your heart rate return back to normal? Your heart rate probably should come back to 90% of your resting heart rate after you stop exercising within two to three minutes. If it's taking longer than that, you can actually improve your heart rate recovery by continuing to exercise. At Rosa Marie asks, WTF is a heart murmur and why do I have it? Well, a heart murmur is just a sound that your cardiologist or your doctor hears when they listen to your heart with a stethoscope. Here's what a normal heartbeat should sound like. And if you have a heart murmur, that's an extra sound. So if you have aortic stenosis or a narrowing of the aortic valve, for example, that sounds a little bit like this. Some murmurs do develop when you're a child and they go away. Some murmurs you may not have until you get older. As we get older, our heart valves, they're just a little bit stiffer than when we were younger and that can cause a heart murmur. But again, it's completely normal in that particular setting. At Evie McLevin asks, how do pacemakers work? So your heart itself has pacemakers. The muscle of the heart has in it electrical fibers. So it can continue to beat regularly to pump the blood to the organ so that they can get the blood that they need. Sometimes as we get older, for example, those pacemakers stop working and we have to put in what's called an external pacemaker. This is a pacemaker and as you can see, it's very, very small. These wires will plug into this pacemaker battery and it goes just under your skin on the left side of your heart and then those wires will actually go inside the heart. The pacemaker itself will take over the pacing function of the heart. It will actually send out a regular electrical signal through these wires and those wires will deliver that electrical signal to the heart muscle itself and allow the heart to beat normally. At Carper G64 asks, how do fit athletes have heart attacks at 23, yet people drink, eat badly and live to 90 plus and never have a heart problem? The reality is some of heart disease is determined through genetics and we can't choose who our parents are and heart disease does run in families. Some of the reasons why a young person could have a heart attack could be because they have some genetic issue with their cholesterol, something called familial hypercholesterolemia. That just means that there's a genetic abnormality that makes their cholesterol really, really, really high. There are some other very rare conditions, something called spontaneous coronary artery dissection where the linings of the blood vessels that supply the heart muscles themselves tear and that can cause a blockage in the blood flow. Those are really unusual circumstances and really for all of us we should be following a healthy lifestyle. At user one underscore one asks, is it true that there's a correlation between gum health and heart health? Yes, there is a correlation between gum health and heart health. We know that patients who have terrible gum disease are at a higher risk for having cardiovascular disease. Might just be coincidence, but it's probably a good idea to maintain both good cardiovascular health and good gum health. At Irene Chosen asks, what diet is best for reversing heart disease? There are some studies that suggest a plant-based diet can reverse heart disease. The downside with a plant-based diet is it can be very, very difficult to follow and adhere to, but there are some principles that are important to follow. Increasing the amount of fiber in your diet is really, really important. Try to make sure that you have four grams of fiber for every hundred calories that you're eating. Minimizing the amount of saturated fat so that it makes up less than 20% of the overall caloric intake. At that, Kate Burdian says, show me how alcohol and cigarettes affect the heart. Well, I can't really show you because alcohol and cigarettes affect the heart really over a lifetime of use. If you're someone who's really drinking a lot, that can affect the heart abnormally because it can weaken the heart muscle itself and predispose you to having something called congestive heart failure. Alcohol itself in large doses is toxic to the heart muscle. Cigarettes work a little bit differently. At least seven years of smoking is really what it takes to really affect the heart. And what cigarettes do is the nicotine itself can directly damage the lining of the blood vessels. Then cholesterol starts getting attracted to that area and it starts building up and it can predispose you to having a heart attack. Cigarettes also can increase your blood pressure and increased blood pressure makes it harder for your heart to pump its blood to the organs that need the oxygen. At Eli Gant says, high blood pressure means your heart pumps harder to circulate blood. Exercise means your heart pumps harder to circulate blood. I'm confused. Why is one bad and the other good? When your blood pressure goes up during exercise, after you stop exercising, it comes back down to normal. In fact, if you exercise regularly, long-term your blood pressure is actually lower because it's good for your heart. The other term for high blood pressure is the silent killer because you feel fine, but your blood pressure is high and it sets you up for all kinds of bad things. A stroke, it can lead to heart failure because your heart is pumping so hard and eventually just sort of tires out and weakens. High blood pressure as a disease is very, very different from blood pressure transiently going up and coming back down during exercise. So those are all the questions for today. Thanks for watching Heart Support.