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Bill Klaproth (Host): Whether you're a professional athlete or a weekend warrior, your cardiovascular health has a direct impact on your performance, and here to talk with us about cardiovascular performance and health is Dr. Brian Keeffe, cardiologist at MarinHealth Cardiovascular Performance Center | A UCSF Health Clinic. Dr. Keeffe, thank you for your time. So MarinHealth has a cardiovascular performance center. Why the need for personalized cardiovascular care for athletes and active individuals?

Dr. Brian Keeffe, MD, FACC (Guest): Athletes have specific concerns and questions about their exercise, their performance, and their symptoms. A lot of the symptoms can be similar to what non-athletes have, but kind of understanding it in the context of exercise and sports can be really useful and can really individualize the evaluation of patients based on their symptoms in the context of what they're doing athletically.

We’re based, as in Marin County which is a very active community. We have beautiful environment here, the mountains, the ocean, a lot of people out running, biking, rowing and hiking doing all kinds of athletic endeavors.

Bill: Right, people want to be active. So, who is a good candidate then to utilize the Cardiovascular Performance Center?

Dr. Keefe: anyone who's interested in either having symptoms assessed that could potentially be cardiovascular symptoms when they're exercising. Or even people who are inactive who want to be screened for heart disease risk prior to starting an exercise program. We also will see competitive athletes who need to be cleared for specific events or activities, and that can include younger people in their twenties, all the way up to people in their fifties, sixties, seventies, and eighties might want to do a running race, or a Century cycling event. So really kind of anyone who is an athlete or wants to be an athlete who has either concerns about risk or concerns about symptoms.

Bill: So you just mentioned screening and evaluation. What other services do you provide?

Dr. Keefe: at a basic level it's a history and physical by a doctor. So that's kind of the basic screening is you talk to an athlete understand what their concerns are, what their symptoms may be. You examine them and do an EKG. I mean, that's- that's kind of the basic starting point.

We have a broad range of exercise testing that we do. We can do, walking protocols, running protocols, cycling protocols and depending on what the concern is, we can just do the EKG we can do cardiac imaging like echocardiography, or nuclear imaging and then we can also do what's called cardiopulmonary exercise testing where we measure oxygen uptake and CO2 and inspired air and expired air secondly using a mask, and really get a comprehensive evaluation on performance. Things like VO2 max, which people have heard of.

We can screen for heart disease, but also give people information that they can then take out and use to improve their performance if we don't find the problem. And even if we do, we can use that information to help guide their exercise program.

Bill: So Dr. Keeffe, if I want to run a marathon, or really be active in biking, and I want to make sure my cardiovascular health is up for it, so I come to you in the center. How do you test me? I know you talked about EKG, imaging, screening. So you do the tests, and if I'm lacking in cardiovascular health, do you prescribe treatment, or an exercise or fitness plan to address the issue?

Dr. Keefe: Exactly those people who need medications are discovered heart disease, high blood pressure, diabetes, high cholesterol, things like that. The way that we can help our cardiovascular health would be exercise, aerobic exercise nutrition stress management. That's a big thing as well.   and on the exercise end we can really give an individualized exercise program that we do specific kinds of exercise tests, where we really understand, 'What are you currently capable of? What's safe? And then how do we improve it?'

Bill: And Dr. Keeffe, for someone who has had a heart attack, or a heart event, or maybe someone with a-fib that still wants to be active, I imagine the MarinHealth Cardiovascular Performance Center can be very beneficial for them as well, and help erase or inform any fears or concerns they have. Is that right?

Dr. Keefe: that's right, so people who had a heart attack - a myocardial infarction -   we will work closely with we also have a cardiac rehabilitation the starting point will often be the Performance Center where a few weeks after a myocardial infarction or heart attack, we'll do an exercise test. And it may not be a full maximal test, but what we're doing there is developing an individualized exercise plan for that patient to take into cardiac rehabilitation. So people with either heart attack and stents, bypass surgery, or valve surgery will first stop into the Cardiac Performance Center, and get an exercise test and then move onto cardiac rehab, and that's really the safest place to improve outcomes and improve exercise.

If someone has had arrhythmias like atrial fibrillation they don’t typically qualify for cardiac rehab, but we can test them to make sure that at a basic level we're not seeing arrhythmias induced by maximal exercise. and then there's a number of ways that we can monitor the heart when they're out doing their thing to determine if they are making intermittent performance stops, whether that's related to atrial fibrillation or other arrhythmias, and then we have an advanced cardiac electrophysiology, we can help those people with either medication or fibrillation procedures.

So the Performance Center works with different, facets of our cardiology medical world. it can be like a one-stop place for the person who is having some potential symptoms, that doesn't have manifest heart disease, but it can also be kind of a component of a program like cardiac rehab or cardiac rhythm management.

Bill: So this sounds like you've had a very specialized staff. Can you talk about the training your doctors have in treating athletes and individuals with cardiovascular conditions?

Dr. Keefe: sports cardiology is kind of a new field. So specific training in it hasn't really existed. I think there is one fellowship program right now at Harvard that I know of. so for cardiologists like me, it's really been an on-the-job training going to conferences individual learning, and then just experience working with athletes. We have exercise physiologists in our labs who have specific training; exercise testing, athletic training programs and then a lot of experience taking care of heart patients. a stress test on someone who just had major valve surgery is very different than doing a stress test on a twenty-one-year-old college athlete. You need to understand how to- how everyone should be evaluated. Staff is really critical. We've got great nurses exercise physiologists who have a lot of experience working with both athletes and older patients with heart disease.

Bill: Well, the staff training is so important, as you mentioned. And Dr. Keeffe, thank you so much for your time today and talking with us. For more information, please visit mymarinhealth.org. That's mymarinhealth.org. This is The Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth, thanks for listening.