Following is part one of a two-part column about heart disease prevention and treatment.
Although the work of a cardiologist is centered on the heart beating in the chest, it turns out that an essential piece of that work centers on the figurative heart, as well. There’s a great deal that happens around the heart which has nothing directly to do with the pumping of blood to our brain and vital organs, but which has an enormous amount to do with our overall well-being and the health of our hearts. In the end, it’s all interrelated, in the way of the old song ‘Dem Bones’: ‘…the foot bone connected to the ankle bone, the ankle bone connected to the shin bone, the shin bone connected to the knee bone…’ until, you get to the heart bone.
To find these vital clues, the cardiologist (and all physicians) must engage in active listening. This requires experience in the world, an understanding of the context of a person’s life and empathy. My own life experiences, both good and bad, help guide me in that work. They help me validate a person’s stress and perhaps uncover other, very important health related issues. These range from depression to sleep deprivation to eating disorders, and might include family, work and general life stressors which may also, ultimately, create stress on the heart. These situations often take me beyond the bounds of my training as a cardiologist. When I identify them, I usually refer the patient back to their primary doctor for further care and intervention, if needed.
Self-empowerment is an essential part of my work. In our culture, a pill, or some other simple solution which doesn’t require much work, is often what people want. Unfortunately, it is not usually what’s most important or what works. While the range of issues a cardiologist confronts is broad, and sometimes off the beaten path, still, there are ‘bread and butter’ problems we deal with more commonly. Among those are a few general issues: heart failure (a poor and non-descriptive name, often, the heart isn’t actually ‘failing’), coronary artery disease and heart attacks. What is difficult to accept in these situations for many (patients and physicians alike) is that what the science is able to do is generally not curative, only palliative (putting a Band-Aid on something). This generally includes, with some exceptions, stents, bypass surgery and other procedures. The problem is that the procedures don’t address the fundamental issue of why the condition developed in the first place. It turns out that the most powerful intervention in these situations is ‘risk factor modification.’ That is, if you’re heavy, work on weight loss; if you’re sedentary, get more exercise; if you smoke, don’t; if you eat heavily salted foods, stop, etc. All of these, of course, are so easy to say, but not so easy to do. The cardiologist, in this way, becomes a life coach.
Heart disease is the most common killer in our country and causes a great deal of morbidity (sickness and disability). I often hear from patients that it’s not important to them how long they live. That is clearly their choice. But what they don’t often realize is that the lifestyle choices they make may not only shorten their lifespan but, more importantly, may, and mostly likely will, have a severe impact on their quality of life. For many of us, it’s not necessarily the length of the journey, but the quality of the ride. The illnesses and ailments which arise from putting stress on the heart by being obese, for example, not only increase a person’s risk for heart attack, but also increase the chance of many types of cancer, kidney failure, stroke, arthritis, and dementia, among many other problems.
As a cardiologist, an important role is to answer questions and to allay concerns. When a person who is otherwise healthy comes in because of a false alarm or because they have a family history of heart attacks or because they’re just worried, it’s an opportunity for me to reinforce the importance of lifestyle to their well-being. It’s very satisfying that instead of delivering bad news, I can reassure them that they’re healthy and taking good care of themselves.
But even if people take care of themselves, life is still a tremendous bank of uncertainty. There are no guarantees, even if you do everything right. For that reason, cardiologists are here to provide the remedies and treatments that modern medicine and technology provide, while also giving those who come to us a healthy dose of self-empowerment.
Mark Burke, MD is a board certified cardiologist at the Center for Cardiovascular Health, a department of Brattleboro Memorial Hospital.