Name: Dr. Craig Smith - Who Is a Candidate for a Heart Transplant?
Uploaded: 2012-11-12T14:22:22.154Z
Duration: 30 s
Description: A variety of medications and other treatments can do wonders for a failing heart, but there are times when they're not enough. In this video, cardiothoracic surgeon Craig Smith explains when a heart transplant is the only option.

English

Well Carotid Artery Disease means that it's a disease or plaque build up of the Carotid, and if you look at your neck, there're two Arteries right here at the beginning that are called Carotid Arteries that bring the majority amount of blood to the brain. So again if you think of it like plumbing, the pipes or the Arteries have to be open to allow blood to get to the brain, and what we've become concerned about is that if the Carotids becomes narrow less blood gets into the brain, and that increases someone's risk of stoke. 

So Carotid Artery Diseases means a narrowing of the pipe or in this case the artery, not allowing enough blood to get to the brain and therefore increasing someone's risk of stroke. 
   

Stroke neurologist Carolyn Brockington, MD, explains what carotid artery disease is. Watch this video for important tips and information about the health of your brain.

What Is Carotid Artery Disease?

Men and women have differences with their hearts, women's arteries are smaller than men's, and the way that actually coronary artery disease forms in the arteries are different. Women tend to get atherosclerosis or plaque in the arteries throughout the vessel, and men tend to get it in one discreet area, this makes it more difficult to diagnose in women. 

Symptoms are also more subtle and instead of having that clashing chest pain that we always think of as being heart disease, women can have other symptoms, shortness of breath, fatigue, flu-like symptoms, jaw pain, back pain, nausea, vomiting, so the symptoms aren't often as clear. It is very challenging for not only a patient to know if she is having symptoms of heart disease, sometimes it's also difficult for the doctor to know as well. 



Cardiovascular disease is different in women and men in that women's arteries are smaller, the way plaque develops in the arteries is different, and symptoms are more subtle. Watch cardiologist Suzanne Steinbaum, DO, discuss these disparities.

How is cardiovascular disease different in men and women?

Women tend to get atherosclerosis, or plaque in the arteries, throughout the vessel. And men tend to get it in one discrete area. 

Men and women have differences with their hearts. Women's arteries are smaller than men's. 

And the way that actually coronary artery disease forms in the arteries are different. 

This makes it more difficult to diagnose in women. Symptoms are also more subtle. 

And instead of having that crushing chest pain that we always think of as being heart disease, women can have other symptoms-- shortness of breath, fatigue, 

flu-like symptoms, jaw pain, back pain, nausea, vomiting. 

So the symptoms aren't often as clear. It is very challenging for not only a patient 

to know if she's having symptoms of heart disease. Sometimes it's also difficult for the doctor to know as well. 

In January of 2012, the American Heart Association said that sex is associated with an improved quality of life. Not only that, having sex increases the immune system, it decreases inflammation, and it actually helps us in maintaining healthy and loving relationships. If you've had heart disease or you're trying to prevent heart disease, I will tell you, having regular sex with a loving partner, it's part of the deal. 

As women get older, sex tends not to be the first thing on their minds, but what studies has shown if women actually just start trying to have sex with their partners, they are actually happy they did it because there is an increase in oxytocin and all these feel good hormones, and it can actually increase your immune system and decrease inflammation in the body. But as we age, and for those women who are in their 70s and 80s, I know you're having sex, but if you don't feel like it, it doesn't mean that close contact in physical touching doesn't give you the same benefits that intercourse does. 

Part of being human is really touching each other, loving each other and sex is part of that, so go ahead, just go do it. 
  

Sex is associated with a better quality of life; it increases immunity, decreases inflammation and helps us preserve loving relationships. Watch cardiologist Suzanne Steinbaum, DO, explain why sex is an important part of maintaining a healthy heart.

What role does sex play in heart health?

Having sex increases the immune system, it decreases inflammation. 

And it actually helps us in maintaining healthy and loving relationships. [MUSIC PLAYING] 

In January of 2012, the American Heart Association said that sex is associated with an improved quality of life. 

Not only that, having sex increases the immune system, 

it decreases inflammation. And it actually helps us in maintaining healthy and loving 

relationships. If you've had heart disease, or you're trying to prevent heart disease, I 

will tell you, having regular sex with a loving partner, it's part of the deal. As women get older, sex tends not to be 

the first thing on their minds. But what studies have shown, if women actually just start 

trying to have sex with their partners, they're actually happy they did it because there's an increase in oxytocin 

and all these feel good hormones. And it can actually increase your immune system and decrease inflammation in the body. 

But as we age, and for those women who are in their 70s and 80s, I know you're having sex. 

But if you don't feel like it, it doesn't mean that close contact and physical touching doesn't give you the same benefits that intercourse does. 

Part of being human is really touching each other, loving each other, and sex is part of that. 

High-intensity interval training (HIIT) can be more beneficial for heart health than sustained exercise. In this video, cardiologist Suzanne Steinbaum, DO, discusses how HIIT works, and why it can be a great option for a strong, healthy heart.

How Is High-Intensity Interval Training Beneficial for Heart Health?

There's been some new research out there saying that 

high-intensity interval training actually can be more beneficial for your heart than sustained exercise. 

Now, here's the thing. You have to really get into some shape in order to do high-intensity interval training. 

But it's important to start. When you start with this, what you do is get your heart rate up to about 65% to 75% 

of predicted maximum. That's based on your age. And then you really, really push it for 30 seconds or one minute 

and drop it back. What happens is that we see that people get into shape quicker, faster, and easier. 

It's heart health month, but why is talking about heart health so important right now in particular?

Why heart health really matters during COVID-19

Español (US)

Fifty thousand Black women die every year from heart-related complications.

Heart disease: why women (especially Black women) need to act now

Would you know what to do if you witnessed someone having a heart attack?

Heart health: learning this one thing could save a life

In fact, for some, coffee might actually help reduce the risk of arrhythmias!

Caffeine may actually help calm your heartbeat, study says

Heart failure self-management is possible, but one key to that management is understanding the role of sodium intake. Talk with your providers to know what's best for your health journey.

Understanding sodium and heart failure

The goal of the new guidelines is to help everyone make better decisions and communicate more clearly when it comes to chest pain.

Guidelines to help diagnose chest pain

Remove tension and focus on a healthy heart with this meditation led by Jacqui Barnett.

6-minute meditation for your heart

Bronny was working out, when he suffered sudden cardiac arrest.

Bronny James, 18-year-old son of LeBron James, suffers cardiac arrest during workout

Do you have high blood pressure or high cholesterol? Here's a tip to help.

Too much sugar is bad for your blood pressure and cholesterol

Heart failure patient Nefertari shares her experience feeling dismissed by healthcare providers while seeking treatment.

Feeling dismissed while seeking heart failure treatment

Sleep duration is now included in the AHA's "Life's Essential 8", to help determine one's cardiovascular health.

Sleep duration affects heart health, recommendations suggest

Here are a few examples of when you should contact your physician while living with heart failure.

When to call your physician while living with heart failure

For those living with heart failure, there are a few things you should be aware of that might signal you need to call your healthcare 

If you notice any of these symptoms, call your health care provider. A consistent cough, especially if you're producing 

a white or pink tinged mucus. This could indicate fluid is building up in the lungs. 

You gain 2 to 3 pounds overnight, up to 5 pounds in a week, or notice swelling such as in your legs. 

This could indicate you are retaining fluid as your heart is not pumping properly due to heart failure. Your healthcare provider can give 

you specific guidance around weight-related changes to look for. You feel short of breath, and it feels like it's getting worse. 

You feel weak. You develop any new symptoms you haven't experienced before, or the symptoms you typically experience become worse. 

You should also call your healthcare provider if you experience any issues with your medications. 

However, certain symptoms should be dealt with immediately. If you experience any of the following symptoms, call 911. 

You lost consciousness. Your heart is beating fast and irregularly. 

You gained more than 5 pounds in a week. You can't lie down flat, or if you have chest pain. 

Heart failure does not have a single cause, but high blood pressure and other health conditions are contributing factors. Join Dr. Jen Caudle on a virtual look at the heart and how it pumps.

A virtual look at what causes heart failure

 Heart failure is a serious condition, affecting over six million people in the United States alone. [MUSIC PLAYING] 

Heart failure occurs when the heart is weakened and loses its ability to deliver a sufficient amount of blood and oxygen to meet the needs of the body. 

There's not a single cause for heart failure, but conditions such as high blood pressure and various diseases contribute to the gradual progression 

of a weakened heart. Most often, heart failure involves the left side of the heart, where a large chamber called the left ventricle ejects oxygen-carrying blood 

for circulation throughout the body. In order to better understand what happens during heart failure, we must go inside and actually 

look at how this marvelous pump sends oxygen-rich blood out to the body. The ventricle walls, which are made of muscle 

receive blood from the chamber above and then rapidly contracts to force blood out of the heart. This all happens very quickly. 

So now watch in slow motion. Notice that not all of the blood leaves the chamber. Some stays behind and waits for the next cycle. 

In fact, in a healthy heart, a little over half is ejected with each contraction. So it makes sense to call this amount the ejection fraction. 

A normal ejection fraction is between 50% to 70%. When a person has heart failure, the muscles of the ventricle chamber experience 

damage due to stress from any number of causes, including high blood pressure, diabetes, and cardiovascular disease. 

The heart response to these challenges in different ways, but ultimately, the muscle is weakened, and the heart's ability to pump blood is reduced. 

In some cases the chamber walls become stretched and thin. In this weakened state, the walls cannot contract with 

enough force to eject a normal amount of blood. In this type of heart failure, the percentage of blood ejected 

is less than 40%. Normal was over 50%. This condition is called heart failure 

with reduced ejection fraction. You'll see it in writing as HFREF. In another type of heart failure the heart muscle 

becomes thickened and stiff. When the walls are stiff, the chamber can't feel completely, so it holds less blood. 

In this case, the amount of blood ejected is less than normal because it starts with less to begin with, 

but the percentage is the same as normal, over half. And that's why this condition is called heart failure 

with preserved ejection fraction, or HFPEF. It's estimated that preserved ejection fraction accounts for as much as 54% of heart failure patients. 

At this time, there is no cure for heart failure. However, many people with this condition are able to live normal lives through a combination 

of medical treatments and changes to lifestyle. Talk with your doctor to learn more. [WHOOSH] 

Heart failure patient Nefertari shares the stigma she faced while seeking a heart failure diagnosis.

Facing stigma while seeking a heart failure diagnosis

Heart failure patient Tricia shares how she advocates for herself and her health.

Advocating for yourself with heart failure

Heart failure patient Tricia shares the challenges she has faced while seeking care for heart failure.

Challenges accessing care for heart failure

Heart failure patient Tricia shares the barrier she has faced while seeking heart failure resources as a person of color.

Access to heart failure resources as a person of color

Heart failure patient Nefertari shares how she lives with heart failure as a person of color.

Living with heart failure as a patient of color

Patricia Geraghty shares the importance of adhering to your prescribed heart failure medications.

How to manage heart failure medications

If you're living with heart failure, it's imperative you manage your medications effectively. 

Following the treatment plan set forth by you and your health care providers can help you improve your quality of life 

While these medications cannot cure heart failure, they can help slow its progression and manage 

your symptoms. Know what medications you're taking and why you're taking them. Ask your health care providers if you have any questions. 

You should know the doses you need to take for each medication and how frequently you should be taking them, 

whether the medication should be taken with or without food, anything you should avoid after taking it, 

what you should do in case you miss a dose, any signs or symptoms you should be aware of that indicate the medication is working 

or not. It can be helpful to create a list of your medications so that you can write these dosing instructions down. 

Make sure you take these medications exactly as they are prescribed, even if you start feeling better. 

Never stop taking your heart failure medications without talking to your health care provider first and confirming it's OK. 

If you feel like your medication is not working or your symptoms are worsening, contact your health care 

provider. You should also make sure your providers are aware of everything you are taking, including over-the-counter medications 

and supplements, as some of these may negatively affect your heart failure. Sometimes, it can be easy to forget to take your medications, 

especially if you need to take several. You should take your medication at the same time each day 

to help establish a routine. You might also set reminders in your phone or leave notes on your fridge or use a divided pill 

container to help you remember. You should also keep track of how much medicine you have on hand and be sure that your regimen won't 

be interrupted. Your health care provider will be the best source of information for your unique situation. 

Being in relatively good shape, Ed was shocked when he was diagnosed with systolic heart failure. Learn how extreme fatigue led him to talk to his doctor and hear what he wants people to know about this condition.

My Story: Ed and congestive heart failure

[MUSIC PLAYING]  I'm 68 years old, never had any kind of health problems. Then one day I got a shocking diagnosis in actually March 

of 2019, where I began to get very, very tired. I was very fatigued. 

And I just had no energy whatsoever. I went to my regular physician. She did a series of tests. But at the end of it all, she kind of trended towards, 

I think you may be having a problem with your heart. We just have to keep an eye on that. And I didn't expect to hear that at all. Good Friday of 2019, I woke up in the morning, 

and I was having tremendous heart fluttering, I guess is the best word that I can come up for with it. I was having a real difficult time breathing. 

And I had never had any difficulty with breathing before. So my wife and I went to the ER. And they admitted me into the ER. 

And I was rather quickly diagnosed as having systolic heart failure. So it was kind of unexpected to me, and very 

frightening to hear that. The result of my not tending to it can end up being sudden cardiac death. 

That has a tendency to get your attention really quick. The left ventricle of my heart chamber is not beating properly. 

It turns out that I was actually operating at about 18% volume, where the normal is 55% volume. 

18% is very low. They think that my heart problems came as a result of a viral attack. They recommended that I get a implanted cardiac device put 

in, a CRT-D, which essentially is a pacemaker, and a defibrillator, and a cardiac regulator. 

Once that went in, I began to start to feel dramatically better, much better than I had in a very long time. 

I do continue to take regular medications. Good. There's no doubt that the medications and recommended 

therapies that the doctor has are critical to me. It's not something that I can just simply let go off to the side. 

[INAUDIBLE], come on. I have a relatively new relationship after my late wife passed away. 

And then I met Sheila, my new wife. We have a great relationship. I have a great new family down here in Georgia. 

As long as I continue to do my job, which is medications, and exercise, and paying attention to what I'm doing, hopefully I can go 

Ed and his wife share the ways in which they support one another, as well as the support they've found online that has helped them maintain a positive attitude after Ed's diagnosis with congestive heart failure.

Why support is important when living with congestive heart failure

SHEILA: When I found out about Ed's diagnosis, inside I was panicking; outside I was composed. 

Both of us recently in 2016 lost our spouses to cancer. 

Neither one of us expected to ever meet anyone again. It was definitely true love. 

Very shortly thereafter, Ed moved down to Georgia from New Jersey. ED: I came from a pretty big family up in the New Jersey 

area. So coming down here, I was worried about having no family around. Thought it was wonderful and they've been so open 

and so accepting of everything, so I feel blessed for that.  My father towards the end of his life had heart failure. 

So I was a little bit familiar with how things could happen. We educated ourselves, got as much information 

as we could find, and we hoped he would get better. He did everything that the doctors recommended. 

Immediately reduced sodium, was good about exercising, which at that time was just walking short distances. 

We thought, well, if you walk three miles a day, will you get better faster? And they said, it doesn't work that way. 

 Luckily I don't have to walk three miles a day every day.  I think the advice I would give to others is to help them find good options. 

Eating out is more difficult. We look at the menu, we have apps on our phone where we can look up the sodium content. 

ED: And some of your alternatives, like you can have a grilled chicken instead of having a fried chicken piece. Big difference in sodium. 

Where'd it go?  Uh oh.  Uh oh. Not the first, won't be the last one. 

SHEILA: You know, there are options out there. Some of it tastes good even though they are low in sodium. 

And also to find a support system for yourself, too. Luckily for Ed and I, the communication is open, 

so we're able to provide that to each other. Not everybody has that. We were very impressed with some of the online support 

available. But I think my real value is going along on the doctor's visits, because I'm a little bit better 

about anticipating questions. We remind each other about medication. 

We both think it's critically important that you follow your medication schedule as prescribed. He has to be aware that he has some restrictions, 

but I think it's important to focus on what you can do.  Right, I agree.  Not what you can't do.  I agree. 

In this video, Ed shares the important lifestyle changes he's made after his diagnosis, from paying attention to food labels, to getting more active, to changing the musical instrument he plays.

Living your best life with congestive heart failure

 Well my heart was beating normally, I-- my heart kind of felt like-- [BASS NOTES] like that, like a normal everyday heartbeat 

like everybody else has. And yet when I got the congestive heart failure and I started having issues, it was a lot-- 

[BASS NOTES] jumping all over the place, no normal rhythm at all. And once it got fixed, it felt like-- 

once I got it fixed up, so I was feeling good. I grew up right outside of New York City on the New Jersey side. To New York City people that's New Jersey, but to New Jersey, 

we call ourselves New Yorkers to a degree. Attended Juilliard. After my schooling was over, I was a journeyman musician. 

And I did that for my entire lifetime. I played upright bass, stand-up bass. As soon as I had my heart problems, 

I found that I could not physically play the instrument any longer. I do find that being able to play an electric bass as 

compared to an upright bass is rewarding in and of itself. Considering the consequences, I'll take it. Pretty exciting, huh? 

My doctor told me that in order to get better, that in addition to a dietary adjustment, which took, honestly, 

some changes, anything that had salt added to it, you really can't have anything that has high salt content. And it's not just a question of a salt-shaker, 

it is paying attention to food labels. I never thought that I would ever be looking at labels on cans and boxes to see what I could eat, 

but here it is. Yes, so it's definitely my new normal, is making sure that my sodium counts stay low. 

I do have to walk and make sure that I walk every single day. If for some reason you find out you have congestive heart failure, listen to what the doctor says. 

My primary care physician who found this first put me on the right track right away. You'd also need to make sure that your medication 

intake stays on track. There's a reason these doctors provide these things to you. So pay attention to what the doctor says, and also take 

a really, really long look at the type of food that you ingest. I didn't ever really think about it. Honestly I just didn't until I found out what I had to eat 

and what I could eat and what I shouldn't eat. And the list of shouldn'ts was considerably longer than the list of coulds. 

Doctor, diet, and finally, just make sure you're getting that routine exercise whatever that may be. It doesn't mean you have to do a 100-yard dash every five 

minutes, but you do have to stay active. [MUSIC PLAYING] 

What is a patent foramen ovale?

Merle Myerson, MD, explains what to expect with a CT scan.

How does the coronary calcium scan work?

MERLE MYERSON: Doing the coronary artery calcium test is actually pretty easy. 

It takes about 10 to 15 minutes. [MUSIC PLAYING] 

What a patient does is they go into a special room where there's a CT scanner. That's a computed tomography scanner, 

CT scan as most people know it. There's a technician there to help the patient. And what they'll do is lie down on like a gurney 

that slides into a donut hole. The machine has this cavern in it, but you are placed partially in it. 

Your head is not covered, and you're not completely enclosed. Most people feel that it's very comfortable. 