Disability and Progress-March 27, 2025-Adult Heart Conditions

[00:00:00] Speaker A: KPI it this is Disability in Progress, where we bring you insights into ideas about and discussions on disability topics. My name is Sam. I'm the host of this show. Thanks so much for tuning in. Erin is our podcaster. Charlene Dahl is our research PR woman. Hello, Charlene. [00:01:14] Speaker B: Good evening, everybody. [00:01:16] Speaker A: I want to remind you that if you want to be on our email list, you can email me at disabilityandprogressamjasmin.com that's disability and progress all written out at SAM. This week we'll be speaking with Dr. Jeremy Van Toff. Dr. Van Toff is an assistant professor of medicine at the University of Minnesota Medical School and a cardiologist with m Health Fairview. Dr. Van Toff, research interest involves improving cardiovascular disease detection and and early intervention. Thank you for joining us, Dr. Van Toff. [00:02:03] Speaker B: Yeah, thank you very much for having me. It's a pleasure. [00:02:07] Speaker A: I want to start out by asking you, what are the most common heart conditions that affect adults? [00:02:15] Speaker B: Yeah, I think you can think about this in a few different ways. One of the most common things that can happen to kind of injure someone's heart is a buildup of cholesterol plaque in the heart arteries that supply blood and oxygen to the heart muscle, and that can weaken the heart muscle, and over time, that can result in chest pains or a decreased pumping function of the heart called heart failure. What I'm talking about here is called ischemic cardiomyopathy. And I think another very common, more electrical problem that can happen with the heart is a arrhythmia called atrial fibrillation. So between ischemic cardiomyopathy, heart failure, and atrial fibrillation, I think that covers some of the most common things you'll find with heart disease. [00:03:16] Speaker A: So when you get something like that, how does these kind of heart conditions impact daily life and overall health? [00:03:27] Speaker B: Yeah, good question. It can vary quite a bit from person to person depending on how severe the disease is or how active of a life that they're used to. The impact, I think, can vary quite a bit, but symptoms can include chest discomfort or shortness of breath with minimal activity or lightheadedness or palpitations or just general fatigue. [00:04:03] Speaker A: What are some of the things that can make someone develop heart disease? [00:04:12] Speaker B: So the most common risk factors for heart disease in general and specifically for that cholesterol, you know, buildup or type of heart disease, I consider, I think about them in three or four major categories for traditional risk factors, which include high blood pressure, elevated cholesterol, history of diabetes, and smoking Ah. But I think it's really important to acknowledge that there are a lot of other factors that could contribute to heart disease, including what underlies much of those risk factors that I discussed, which is how you eat, how much you move, how much chronic stress you might experience. We are kind of recognizing. Acknowledging the impact of poor sleep on heart health. So there are many factors. [00:05:12] Speaker A: What about family history? How does that affect the likelihood of developing heart disease or heart condition? [00:05:22] Speaker B: Yeah, good question. Genetics certainly play a role in. In the likelihood of someone developing disease. However, I think it's really important to note, and we've. And there are studies that show that by. By maintaining a healthy lifestyle, one is able to offset much of the impact that the genetics might have on their risk. [00:05:51] Speaker A: Oh, that's a nice idea. [00:05:54] Speaker B: Yeah. So I think it is hopeful that this isn't, you know, a hopeless. You're destined to have heart disease. People are actually able to offset a. [00:06:02] Speaker A: Lot of that risk by exercise and eating. Right? [00:06:07] Speaker B: Correct. [00:06:09] Speaker A: So it sounds like. I mean, you know, what I hear is like, exercise plays into so much. Does it really play that much into. Let's say, like, I. You have a family history of. Maybe your grandparents had several heart attacks, but they were smokers and they drank. And how much does that play into, you know, them having that heart disease? And then how much can you avoid that just by exercise? Sounds like, you know, that would be hard to measure, but is it? [00:06:49] Speaker B: Yeah, it is hard to measure, I would say. But certainly if your grandparents had a lifestyle or risk factors like smoking or, you know, like an unhealthy diet that you are able to not participate in, not, you know, not become a smoker or stop smoking. If you do smoke and start eating healthy, especially at a young age, and continue maintaining that through adulthood, you are able to offset much of that. That risk that might be related to genetics. [00:07:29] Speaker A: Excellent. I want to address that. I have heard a lot in the news lately about alcohol increasing cancer rates, which I might tell you, disappoints me greatly because I like my glass of wine once in a. How much does alcohol increase heart problems? [00:07:57] Speaker B: Yeah, I think that's. That's a really good question. And I think in the past, you know, people may have heard that maybe red wine is good for the heart or certain. [00:08:08] Speaker A: Yeah. [00:08:08] Speaker B: Certain ways to consume alcohol are beneficial. And as you said more lately, the messaging is that no amount of alcohol is safe. Right. I think that's what we're hearing a. [00:08:19] Speaker A: Little bit more often. [00:08:21] Speaker B: And it is. It's difficult to, you know, assess that with heart disease because we're never going to have a study where you tell one group to drink and one group not to drink alcohol. [00:08:33] Speaker A: Right. Boy, wouldn't that be interesting. [00:08:37] Speaker B: So it's difficult to assess, but I think one thing that we do see that's clear is excess amounts of alcohol can increase risk of heart failure specifically. And this is a problem where the actual alcohol that is in your body is toxic to the cells of the heart. And again, I'm sure that it's clear that some people are more susceptible to that and others are not. And that's, we're not very good at predicting that type of susceptibility at this time. But I would say that excess is, is a risk for heart failure. What is the safe amount? I don't think it's very clear. A lot of, I think that's why we kind of start to hear that the best amount is zero because there's safety in that. [00:09:43] Speaker A: Right. What about other populations or demographics? Are there certain populations of people that are more prone to heart conditions than others? How does that work? Or what are you seeing? [00:10:03] Speaker B: Yeah, so we collect a lot of data on what. And by we, I mean the CDC and American Heart association and others collect data on who gets heart disease over time. And we observe patterns in different populations of higher, where we notice higher amounts of heart disease. But I think it's important to note that much of the time these patterns of higher heart disease in different races or ethnicities is a result of non genetic or non race based issues like do you have access to healthy food, what is your economic status? Are, do you live in a, in a high stress situation, do you have stable housing? You know, these, these determinants is what we call social determinants of health. [00:11:05] Speaker A: Right. [00:11:06] Speaker B: Are important and are, are not necessarily the same amount of a problem across all race ethnicities. So I think that when thinking about patterns of disease, that's an important, that's an important factor to consider. We do know that there are certain genetics, specific genetic heart diseases that can be found in different, you know, specific populations. One people group that is getting a little more attention in terms of heart disease risk is a Southeast Asian population where we tend to see higher risk of diabetes and high blood pressure at younger ages. [00:12:00] Speaker A: Really? Huh. And how about gender, like females or, or males? There is there a higher risk in certain diseases for heart problems for females as opposed to males or vice versa? [00:12:16] Speaker B: What we tend to see is that women develop heart disease specifically, you know, blood vessel heart disease a little bit later in life. Than men. And that's thought to do that. That's thought to be due to different hormones. And so after menopause, you really see that the cardiovascular risk in women catches up to men. [00:12:47] Speaker A: Oh, I see those darn hormones. What are some of the early warning signs of a problem or a heart disease that people should be looking out for? [00:12:59] Speaker B: Yeah, that's a great question. And what that looks like maybe different for different people. So the, you know, the most classic sign of heart disease or decreased blood flow is chest chest pain. Right. Often it's a pressure in the chest, specifically with activity, and it goes away when you rest. And now that is the majority. That is the most common symptom of blood flow restrictions to the heart muscle. But there are many other things, many other ways that it can manifest, like shortness of breath or a decrease in exercise tolerance. That is kind of unexpected. Or it could be gradual over time. You know, last summer you could bike 10 miles. This summer you can only go two and you have to stop for rest. You know, those might be signs of a heart related problem. Other people have discomfort in other areas besides the chest, like their back or their arm or their neck. So. So it's hard to pinpoint, you know, a specific symptom because many of those things also come and go from people that are not related to heart disease. [00:14:16] Speaker A: Right, right. [00:14:18] Speaker B: And I think. Oh, go ahead. [00:14:20] Speaker A: No, go ahead. [00:14:22] Speaker B: But I think if it's something that a symptom that's new and especially a symptom that's related to exercise or physical activity is something that, that you should pay attention to. [00:14:34] Speaker A: And I'm wondering, like, you know, you gave an example where it was, you know, a more extreme example where somebody might be biking one summer at 10, you know, for several miles, and then the next summer they can't make it near as far. Do you think that that more goes for, you know, when the weather's nice, everyone gets out and does stuff. And then for those people who live in colder climates, if they hunker, that has time to have issues set in and then they notice it the next summer. Or can it really come upon you that quickly? [00:15:16] Speaker B: Oh, you can certainly have changes in symptoms from one year to the next that's due to progression of heart disease. Yes. One thing I tell patients is if, if you're worried that you're just out of shape. Right. And that's why you feel, why you feel poorly, then you should start to feel better and better as you do more and more exercise, right? [00:15:43] Speaker A: Yes. [00:15:44] Speaker B: That's an Indication that, okay, there's some deconditioning here. I'm getting stronger now. I'm going further and feeling better. But if you continue to hit a wall, or especially if it gets worse as you continue to exercise, then that's a. Then that's something that you should, you know, you should pay attention to. [00:16:01] Speaker A: Can you talk about some heart conditions that could be asymptomatic? [00:16:06] Speaker B: Yeah. So even with the most common. The most common heart disease, which is the cholesterol buildup resulting in decreased blood flow and oxygen to the heart muscle, even that, you may not have any symptoms of that cholesterol buildup for years and years until it becomes quite significantly, you know, narrowed. Which is why I think in my clinic and in general, I think it's super important to talk about prevention. Ah, yes, because often once. Once there are symptoms, the disease has progressed quite, you know, quite significantly. But if we're able to start making changes earlier in life, then you can slow down that progression of disease. Most heart disease develops slowly over time. It doesn't often just zero yesterday and severe today. The prevention part is a very important part of managing heart disease and heart disease risk and heart health. I like to talk about heart health rather than heart disease and maintaining health rather than treating disease. [00:17:27] Speaker A: So obviously, when you've been diagnosed, depending on the severity, it could limit, lead to limits of mobility or a disability. Can you talk a little bit about that? [00:17:43] Speaker B: Yeah, certainly that's true. Most of the time the symptoms would be related to fatigue or shortness of breath. That would be the most common limitation versus, like a weakness or something like that. But yeah, I would say it would be kind of a conditioning or a fatigue issue that we'd see most commonly that could really restrict people's ability to function. [00:18:18] Speaker A: You know, and this leads me to somewhere I've always been curious about, is about when people have a heart attack. You know, you hear about that and then. And then what? I feel like there's a recovery time, there's rehab or physical therapy that they might do. Or can they get back to what they were? Is there. Can they get back to better than they were? Can they or will they always be hindered because of that, that heart attack? It's like that that's pushing them over the boundary of ever being able to be and do what you used to do? [00:19:01] Speaker B: Yeah, great question. So again, very variable for different people and different. And people are going to have different experiences with this. But I would say that the earlier that we can cat that we can catch a problem the more likely that someone will come back to their full, you know, full potential or full capacity. Specifically with heart attacks treatment now where we can go in and open up vessels and use that to, you know, to make sure those vessels stay open. When that happens quickly, much of the of the at risk muscle cells of the heart can recover function. And as you pointed out, sometimes people can even come back to a higher level of functioning because, you know, this sometimes is a wake up call that, okay, this, you know, this major event just happened, I'm going to get out and exercise a little bit more, I'm going to change my diet, I'm going to, you know, cut out some of these bad habits and they could potentially come back to an even better place. On the other hand, there, there are people who, you know, have significant damage to the heart muscle and they develop problems with the pump function of the heart and it can lead to long term, long term problems. So I think it is very, it's variable and, and you know, I think it's, it's good to acknowledge that different people have, you know, experienced this different ways. [00:20:41] Speaker A: So it sounds like it just depends how much damage that particular instance may cause. [00:20:49] Speaker B: That's right, yeah. And the speed at which you work to fix it. Right. So the longer the symptoms go on and maybe aren't taken care of or aren't acknowledged, I think the higher risk you are at long term damage. [00:21:05] Speaker A: Since we're on the topic of heart attacks right now, there are differences, I'm told, between what symptoms a male might have when they're having one and what a female might have. Are you in a position to go through that? [00:21:20] Speaker B: Yeah, sure. That, that is true. I would. [00:21:26] Speaker A: It's not guaranteed. Right. But it's common that that can happen. [00:21:30] Speaker B: Right. And still the most common symptom of heart attack for men and for women is chest discomfort. So that's important, you know, because you don't want to go the other way and say, oh well, women don't as often get chest pain. So if it's chest pain, it's something and blow it off. So it's really important to still acknowledge that chest pain is the most common symptom. However, you're right in that women are more likely than men to have a different type of symptom than chest discomfort. And this could include neck pain, back pain, arm pain, jaw pain, fatigue, shortness of breath, palpitations, you know, which is a big list. Right. So. [00:22:16] Speaker A: Right. [00:22:17] Speaker B: Other things that should be considered or when those symptoms happen. Heart disease should be considered And I think too often it's not considered. [00:22:31] Speaker A: I don't want to risk that someone's going to every little pain say, oh my God, am I having a heart attack? So what should they like, let's say you're having some neck pain or arm pain. What does that feel like? Kind of like what else besides that they might have a pain somewhere? What should they watch for next that might say, oh, you know, this is something more than just a stiff arm or a pain in my neck? Pardon? [00:22:59] Speaker B: Yeah, yeah. I don't want to cause mass panic, of course, but so I would say that, you know, pain or discomfort, that, that, that changes with, you know, your position or with a certain movement or it gets worse when you stretch a certain way. You know, all of these that indicate more of a musculoskeletal issue. You know, less like, like less likely to be the heart if, if, if the symptom gets worse when you do activity and it gets better with your, when you rest. That's more indicative of a cardiovascular related symptom when it's accompanied by other more traditional heart related things like shortness of breath or you get really sweaty, you know, when the pain comes on. Those are, those are things to keep in mind if you're thinking about heart disease. [00:24:03] Speaker A: Could you have had a heart attack before and not know it or realize that that's what it was and then carry on, so to speak? Or is it something that if you have it, you're gonna know and you're gonna, it's not gonna get better? Like, you know what I mean? [00:24:24] Speaker B: Yeah, most people, most people have symptoms. Most people have something that they experience that's new and is, and is resulting from, you know, the heart attack. There are some people who either have no symptoms or have such minor symptoms that they kind of ignore it and you know, and it can cause some, some damage to the heart muscle. Usually this occurs when the amount of heart muscle that's affected is small. You know, the bigger the area that's affected, the more muscle that's not getting enough blood and oxygen, the more likely you're going to have significant symptoms. So we do certainly see what we. There's been a term called silent heart attacks that does happen, but most of the time there will be symptoms. [00:25:18] Speaker A: What are some misconceptions about heart disease? [00:25:25] Speaker B: Good question. Well, I might turn it to you. Are there things that you've heard that you wonder about? [00:25:34] Speaker A: I think for me, the biggest thing I've heard was that, you know, the couple biggest things and you did Address was like, well, if you have this, that run in your family, you have a pretty high chance of having the same things or in, in regards to heart stuff or that once you do have a heart attack that pushes you over the edge and you'll never be the same. Those, those couple things are what I feel like I've heard. I don't know, Charlene is on here with us, my PR person. I don't know if you've hear anything different that you wonder about Charlene, but, you know, those are the couple things I have. [00:26:19] Speaker B: Yeah. To that point, I think, you know, heart disease is not inevitable for everyone just because your parent or your grandparent or someone, you know, had a heart problem. There's a really, it's kind of hard to explain without, you know, graphs, but there was a really nice study that split people into three groups of genetic risk risk and people who are at the highest group of genetic risk. They looked at kind of three tiers of lifestyle, like healthy lifestyle and those who had the best lifestyle but highest genetic risk had the same risk of heart disease as the people with the lowest genetic risk and the worst lifestyle. Oh my. So I think what that can kind of tell you is that if your genes are good, but you know, you don't take care of yourself, you're, you're at high risk of having problems. If your genes are bad and you take really good care of yourself, you know, you're at a much lower risk. So I think I, I take that as, yes, genetics play a role. No, there's nothing that we can do about that right now, maybe in the future. But what we can control is, is, is how we live and, and how much we move and how we eat and the choices that we make. So I, so I, I tend to have people focus on that because that, that's obviously something that's within our control. [00:27:47] Speaker A: And I want to confirm that. I think people get nervous about why can't. I can never have any fun anyway if I have to eat so perfectly. But it's, I want you to confirm if you feel this way that it's overall good eating. Right. Do you have a decent breakfast? Do you have in general good lunches or dinners or X amount of fruits and vegetables a day? Not if you sneak off one weekend and have a plate of nachos. That's maybe not going to kill you. I just want to make sure that that's not, you know, that's what you're talking about is just overall good, healthy, a mostly balanced diet. [00:28:28] Speaker B: And yeah, no, very good point. And, and maybe that's a really good misconception that you have this perfect diet and if you can't maintain it, what's the point? No, I don't believe that. I, I think that everyone has room in their current diet. Everyone has room for improvement. Right. And so. [00:28:49] Speaker A: Yes, yeah. [00:28:51] Speaker B: So, and I, and I, in my visits, I, I go through a, you know, a full day's diet, typical breakfast, lunch, dinner, and we look at things where, you know, may, what are one or two things that could be adjusted to give the most benefit, you know, and everyone has something and usually what we try to find is something that's not too painful for them to give up, but it's still, you know, healthy, a healthy choice. So I think it doesn't, certainly doesn't have to be an all or nothing. I think that eating is so much more meals, sharing meals with others is so much more than just, you know, getting your calories for the day. You know, it's part of society, it's part of our culture. And how you share meals with others and what you enjoy is, is also important. And being miserable and eating perfectly, I, I don't know that that's a healthy, you know, happy way to live. So I never advocate for that. I always, you know, talk with people, come up with a plan, a compromise where, you know, we can get the most benefit with, with, without, you know, compromising happiness. [00:30:02] Speaker A: I'm wondering if heart disease, can it lead to cognitive impairment? [00:30:09] Speaker B: It can, yes. So especially with the heart failure type of heart disease. And this is where your heart acts as a pump, right? [00:30:19] Speaker A: Right. [00:30:20] Speaker B: And it's not, in heart failure, it's not pumping as efficiently and strongly as it's supposed to. So when that happens, you're not moving as much blood and oxygen through the body. And different organs can suffer from, from, not from, not enough blood flow. And you know, the brain is one of those organs. So sometimes people with heart failure can feel kind of groggy or, or brain fog or, or things like that. That's certainly related to their heart failure, their heart disease. [00:30:53] Speaker A: Ah. And so how do you know if it's just like a maybe dementia type thing or something or if it's really heart disease, you go to your doctor and get it checked. [00:31:08] Speaker B: Yeah. And the way that dementia presents is, is often different than the way a heart failure type of cognitive issue would present. Dementia is there's a lot of short term memory, you know, loss with dementia, whereas with the decreased blood flow, it's kind of just a Global more confused or feeling slower than usual. [00:31:34] Speaker A: Ah, yes. And so what role do medications then and treatments play in treatment of diseases? I'm wondering, because I think that you hear sometimes about, well, you may have to go to medications and then there's these side effects. And that scares me. You know, the idea everything has a side effect. And how do you balance those side effects with what you want to get out of your treatment? So can you talk a little bit about that? [00:32:05] Speaker B: Sure, yeah. You know, one of the benefits of being in cardiology and working with the heart is that we have a lot of data to support the decisions that we make. So there are a lot of conditions where there are very clear benefits with certain classes of medications. Heart failure is one where we have multiple medications. If there's a blocked artery or a narrowing in the artery, we have several medications that have been shown to slow down that progression. If there's a heart arrhythmia, we have medications that help decrease those arrhythmias and help people feel better. So there's a lot of good data supporting a lot of these treatments. But as you said, medications come with potential side effects, and that has to be balanced with the benefit that you receive from them. The majority of people can find, you know, a regimen that can provide them with benefit without, you know, lifestyle limiting side effects. Sometimes it can take a few different trials and dose adjustments and multiple visits over time. I think that's important to acknowledge that all of our bodies are different, how we metabolize medications is different. The effect of one medication on one person isn't the same as the other. So it does take sometimes multiple attempts and adjustments. So it's important to find, you know, a cardiologist or a provider who can go through all those changes, you know, with you as a patient, and then also, you know, as a patient, understanding that, you know, if there are side effects, to advocate for yourself and let them know that this is what you're feeling. But then also, you know, being patient with a process and going through and trying different options. Because at the end of the day, the goal is, you know, not only to help people live longer, but to help them live well. And often we can find, you know, we can find a balance. [00:34:27] Speaker A: Can you talk about some of the advancements in technology that you're seeing come up? You know, we have the pacemaker, we have. Now I'm hearing, you know, more about, like, is there is the. How close are we to really perfecting the pig heart, to being. To be able to be a Heart transplant and how are the heart transplants doing? Talk a little bit about the medical, the technology side. [00:34:55] Speaker B: Yeah, yeah, that's, you know, it's a very exciting area, you know, to be in and, and to talk about. I think some of the advancements that we've seen over the last, you know, several years are different options for heart valve replacements, different types of valves, less invasive ways to, you know, fix a heart valve, which can be more attractive for, for folks who are maybe a little more sick or are really hesitant to go through a big, you know, cardio cardiac bypass, open chest surgery. So I think we've seen a lot of development in the, in valves. Heart transplant is always in a, an important field where things like finding different methods to help maintain the, the new heart that's coming from one place to another, that's an important thing because time is always of the essence there, right there. So there are advancements there. I, I think routine use of, you know, non human hearts for transplants is probably quite as far away still. I'll admit that is not my area of expertise. I'm not a transplant doctor. But I think we're still ways away from that. What we are seeing more of and we've seen over the past, you know, several years are different artificial heart pumps. Ah, yes, that kind of take over the pumping function of the heart and you know, are implanted in, in a person's body and, and it's, it's like a little motor. So we've seen developments in that over time, which is a, you know, an amazing technology. [00:36:54] Speaker A: And they work well. [00:36:58] Speaker B: Not as well as a, as a human heart. [00:37:00] Speaker A: Right, right. [00:37:03] Speaker B: But, but better than, you know, better than a heart that isn't pumping at all. And then of course, you know, there it's, it's, it's not a simple technology and it's not a simple process. So it's something that should be very carefully considered with a specialist. [00:37:24] Speaker A: I'd like to take a step back. I hear about situations where people throughout their life, they get sick, maybe they get cancer, maybe they go through a treatment. I'm thinking about even certain chemotherapies that totally help the person go into remission or recover from whatever they do. But then the person gets told, oh, by the way, this particular treatment carries long term possibility of you having heart problems later because of how it changes maybe the mitochondria or whatever in your heart. Can you talk a little bit about that? How does that happen? And if a person hears that, what can they do to change or Help themselves not fall into being that possibility of it doing something bad to your heart. [00:38:21] Speaker B: Yeah, yeah. Really important question, especially as. As the treatments for cancer have rapidly advanced over time and many options are available, acknowledging that there are risks to that as well. And, you know, heart related risks are certainly present. Some of the older chemotherapy medications were notorious for causing weak heart or heart failure. I think that risk is pretty well recognized now. And we can monitor people very closely, getting ultrasounds of the heart to make sure that the heart function is still normal. Other medications can cause heart arrhythmias or they can increase blood pressure, you know, which can lead to heart disease over time. So I think the most important thing is to, you know, partner with a physician who's able to monitor for those. Those side effects and those risks. And if you're a person who, you know, has had heart disease in the past or is at high risk for heart disease for any number of reasons, there are specialists in cardiology who actually specialize in the interaction between cancer, cancer treatment, and heart disease. It's a field called cardio oncology. There are specialists who spend extra time with those patients and help understand the risks involved. [00:39:56] Speaker A: Okay, then that's good to know. What advice do you have for caregivers who are. Who might be supporting somebody with a heart condition? [00:40:11] Speaker B: Yeah, I think that, you know, going back to the lifestyle kind of adjustments that we talked about, I think it's really important, especially if, you know, the caregiver is someone who lives with the patient, that kind of everyone is on board with a heart healthy approach to life. Right. Because if, if, if the heart patient is trying to make changes, it can be really difficult if the person across the table is not making those changes. [00:40:43] Speaker A: Right. [00:40:43] Speaker B: So I really encourage families to make changes together. You know, whether it's eating patterns or activity or, you know, or your, your roommate smokes, you know, it's important that, yeah, you know, you approach this as a team. So that's one. I think another point going back to your question about misconceptions is that there's. It's. The vast majority of people with heart disease, it's safe for them to do activities. Having a heart disease diagnosis does not mean that you are destined to, you know, sit, sit quietly for the rest of your life. It's often very safe and actually beneficial and important for people with heart disease, you know, to get up and keep moving and maintain strength and endurance. There are certainly exceptions, and heart patients should talk with their doctors about, you know, what, what they can and cannot do. But the vast majority can still, you know, could still do activities. So I think as a, as a caregiver, that's often a concern or a worry that I hear that, oh, you know, you know, so and so tried to go out and do this activity today, and I was really worried about it. And I told, I told them to go back in the house and sit down. And often actually what they're doing is. So I think that's an important thing to remember. [00:42:24] Speaker A: And I feel like sometimes there can be a crossover too, where the person who is recovering from the heart condition, they're nervous, so they might limit themselves because they feel like, oh, if I could have this happen again anytime, what should I do? Maybe I shouldn't overexert, maybe I shouldn't, you know, so there must be some kind of careful balance. How can people find out more about what to do, what not to do? Where can they go for good information? [00:42:54] Speaker B: Yeah, great. I think this is a great opportunity for me to plug cardiac rehabilitation because this is something that's offered to anyone who has a heart attack, who has a stent placed, you know, who has to be in the hospital for heart failure, you know, would qualify or have chest pain that isn't going away. They would qualify for cardiac rehabilitation. And what this means is this is a structured, organized rehabilitation program with exercise that where the patient is monitored. They wear heart, you know, heart leads so you can monitor their heart rate and monitor their blood pressure that you look at their heart rhythm. And what they can do is slowly advance you over time to make sure that as you get. Do more and more rigorous activity, everything still looks safe and good. So I think cardiac rehabilitation is a super helpful resource for people with heart disease. [00:43:59] Speaker A: I just, if I can just stick one more thing in real quickly, I. I feel like, you know, people think of themselves. If I have heart, high blood pressure, I may have heart problems. If I have really good blood pressure, I'm not going to have any problems. Is that really true or can they still have heart conditions with good blood pressure? Is it more dependent on how they're, you know, how the numbers are for them? [00:44:27] Speaker B: Yeah. So what I like to talk about with patients in clinic is that when we think about heart health and risk, we have to consider the bit, the whole picture. I think it's easy to narrow in on one specific. What is the cholesterol number, what is the blood pressure number, what is the blood sugar number? And really focus in on that. But risk and future cardiovascular health really has to do with everything considered together. Let's say someone has perfect blood pressure. You know, it's always under control, but they have diabetes and have a really hard time controlling their blood sugar. That person is at high risk, right? Or vice versa. Their blood pressure is great, no diabetes, super active, but they have a gene mutation that causes their cholesterol to be, you know, three or four or five times the normal limit. You know, that person has a high risk. You know, so I think you really need to take in the whole picture. And it's great if some of the risk factors are well controlled, but if the others are not, you know, you may still be at high risk. [00:45:46] Speaker A: Well, Dr. Van Doff, I want to just thank you so much for giving us your time today and speaking with us on this important topic. Is there anything you'd like to leave us with? [00:45:58] Speaker B: Thank you so much for inviting me, Sam. I think that what I would say is that as we started off, heart disease is not inevitable. There's always something that someone can do to set themselves up for a better heart health in the future. And if there are questions about that, there are those of us out there who are interested in helping out. [00:46:24] Speaker A: Thank you again so much for being on with us. [00:46:28] Speaker B: Thank you. [00:46:28] Speaker A: You've been listening to KFAI 90.3 FM, Minneapolis, and KFAI.org this is disability in Progress. The views expressed on this show are not necessarily those of KFAI or its board of director. We've been speaking with Dr. Jeremy Van Toff. Dr. Van Toff is an assistant professor of the University of Minnesota Medical School and a cardiologist of of M Health Fairview. Dr. Van Toff also has research interest involved in improving cardiovascular disease detection and early intervention. My name is Sam. I've been the host of this show. Thanks so much for tuning in. If you'd like to be on my email list, you can email me at disabilityandprogressumjasmine.com and you can also suggest ideas for future shows. Charlene Dahl is my research PR person. Bye, Charlene. Bye. Aaron is my podcaster. Thanks so much for what you do, Aaron, and thank you, listener, for supporting us.