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Bill Klaproth: Heart health is especially important these days when we have seen the importance of eliminating underlying health issues that put us at great risk with viruses and other diseases, such as heart disease, diabetes, and obesity. So what can we do to keep our heart healthy? Let's find out with Dr. Brian Keeffe, a cardiologist at MarinHealth.

Host: This is the Healing Podcast from MarinHealth. I'm Bill Klaproth. Dr. Keeffe, thank you so much for your time. First off can you tell us what your practice focuses on?

Dr. Brian Keeffe: Sure. I am what's called a general cardiologist. So, I take care of patients with either heart disease or patients who are interested in trying to prevent heart disease, and that includes, evaluation and management., as well as, heart imaging tests.

Host: So then what types of heart health issues do you help people with?

Dr. Keeffe: I'd say when, people think of the term heart disease, they often think of what we call atherosclerotic cardiovascular disease. So when someone thinks of a heart attack or a clot in their artery or plaque in their artery, that's what atherosclerotic cardiovascular disease is, which can include heart arteries, as well as other arteries in the body, including neck arteries, sometimes the aorta, and arteries going down to our legs. Other very common conditions include heart arrhythmias, atrial fibrillation is a very common one, but there are a whole number of different abnormal heart rhythms that can occur. What we call congestive heart failure. Probably those three, atherosclerotic cardiovascular disease, arrhythmias and heart failure are the most common. And then trying to improve blood pressure and cholesterol levels. So, hypertension and hyperlipidemia are very common risk factors for the other conditions that we try to treat upfront, through either, lifestyle, diet, and exercise or medications to prevent some of the other heart issues.

Host: So then speaking of prevention, I understand you are also passionate about cardiovascular health, helping people in the prevention of heart disease is that right?

Dr. Keeffe: Yes, the time to get people thinking about heart health is early, and what I tell patients all the time is the two most important pills we have are diet and exercise those are the pillars of preventing heart disease.

Host: I like how you said that the two best pills we have are diet and exercise. So heart health is especially important these days, as we're dealing with a pandemic where we have seen the importance of eliminating underlying health issues. So what are the recommendations you most commonly make to your patients to help them reduce or even reverse the impact of their heart issues?

Dr. Keeffe: When people have gotten to the point where they've developed heart disease, which is again, a very broad term, but let's say we're talking about, atherosclerotic cardiovascular disease, congestive heart failure, or arrhythmias. It may include, medications that have proven benefit to, either help people live longer, prevent cardiac events or hospitalizations. but in every cardiovascular condition, diet and exercise are a part of it. So it's always a multifaceted process where it's medications, it may be diet and exercise. For some people, it's also mental health and, stress reduction and trying to find ways to relax in this very stressful environment we live in because there's a clear association of stress and heart disease. So although my interest and focus has been on exercise. I definitely recognize the importance of stress in heart disease as well.

Host: Such a great point about stress. I think that gets overlooked when it comes to heart health. So thank you for bringing that up. If you're concerned about your heart health, don't forget about your stress levels. So speaking of that, what are some of the key lifestyle changes we can make to improve our heart health?

Dr. Keeffe: Well, I, think, one of the most important things is to move our bodies. Humans were not meant to sit down all day, to sit at a desk, staring at a computer, we were meant to move. I really try to encourage my patients and I use that term, move your body. I say physical activity. I don't say exercise because sometimes exercise makes people think about going to a gym or something that they're not comfortable with. So, move your body and get physical activity and it really can be anything. It can be doing more walking, parking farther from your place of work or your house and walking and just taking breaks and getting up and moving around, that's the thing I talked to every patient about, but, taking a good history of someone's physical activity and exercise is really important because you need to understand what their starting point is. You need to understand the patient, get a history of how they move and then give a recommendation that's really specific to that person and sometimes it may benefit them to even talk with an exercise expert who can really help coach you on how to get yourself moving more often.

Host: So when you talk about recommendations and understanding someone's history. Are tests required for you to make a full recommendation for lifestyle and exercise changes?

Dr. Keeffe: Not necessarily. Sometimes they are. So, we have a whole variety of tests in our arsenal. We have exercise tests, we have exercise tests with imaging, so ultrasound, or we use nuclear medicine. We have echocardiograms of the heart at rest. We have cat scans of the heart. We have invasive heart tests. It starts, with a history and physical, where I talk to the patient, understand their history, what medical problems do they have? What is their current physical activity level? What is their family history? And then examining them, measuring their blood pressure or their heart rate, their weight, their BMI, listening to the heart to make sure that you don't hear any evidence of valvular abnormalities. And then it really is personalized. I usually on a first visit, we'll get just a simple EKG, which is, part of the algorithm to help make that decision. But I would say not everyone needs any heart testing to start exercising. A 25-year-old, healthy, woman, who has no cardiac complaints, and, has a normal heart exam and normal blood pressure. They don't need any hard testing to start exercising. Now a 65-year-old diabetic woman, who's never exercise and has a little abnormality on her EKG and has a heart murmur, she's going to need some testing before I'm comfortable giving her a good exercise. So it really is, and those are, a wide spectrum of patients, but there's everywhere in between as well. So it's the old history and physical, you start with that.

Host: All right. So that's really good, Dr. Keith. So let's take your example again, our healthy 25-year-old woman with no heart health issues and our 65-year-old woman who has a history of diabetes. Is there a general course of exercise or let's not call it exercise, just getting out and get moving? As you said, is what's important. Is there something general we all can do just to get moving? What is your recommendation for that?

Dr. Keeffe: The simple answer, if someone is just starting, is start slow and start easy. A lot of the benefits of physical activity have been seen in a low-intensity exercise. And so, if someone's starting at zero minutes per week, I wouldn't say jumped to 150, the first week, but, walk for a few minutes every day and then increase its weekly. And it really can be at the beginning, just, you know, very low intensity. Brisk walking is the easiest thing for most people to do. Certainly, you know, something like a stationary bicycle or an outdoor bicycle, it can be an easy thing for people to do at the beginning and start slowly and work your way up.

Host: I think that's great advice. Start slowly and work your way up. So for someone who does have a level of concern for their heart health, and once they see their physician first, what is the process? Primary care physician first. And then if there is a question or a problem, then that person is referred to a cardiologist. Is that the normal path?

Dr. Keeffe: Yes. You're exactly right. One of the standards in the primary care world has been the annual physical, so, they're going to screen for a lot of different things, when they see adult patients for their annual physical. But exercise is certainly one of the things that the primary care physician will talk with the patient about. And usually, that's the place where if there is a red flag based on the exam, or if an EKG is done or, the history of symptoms that the patient may be giving the doctor, that's when they might get the referral to the cardiologist. So it usually does start with the primary care physician.

Host: Well, Dr. Keeffe, thank you so much for your time. So I've been taking notes. We need to pay attention to our diet, exercise. Don't forget about stress and we need to get moving. Exercise is so important and starts with low intensity. Even a brisk walk is a good way to start. Any final thoughts on heart health?

Dr. Keeffe: Absolutely. As, a cardiologist interested in prevention, I'd say start early. Don't wait until we develop glucose intolerance or diabetes or, heart disease. Let's aim at prevention. So start young, get those good habits in place of moving our body, doing physical activity, eating well, keeping a healthy weight. And then, we prevent rather than treat something that's already manifest.

Host: Great advice, start early prevention before treatment. That makes a lot of sense. Well, Dr. Keeffe, thank you so much for your time. This has really been informative. We appreciate it.

Dr. Keeffe: Thank you.

Host: That's Dr. Brian Keeffe. And for more information, please visit MyMarinHealth.org. And if you found this podcast helpful, please share it on your social channels and check out the full podcast library for topics of interest to you. This is the Healing Podcast brought to you by MarinHealth. I'm Bill Klaproth. Thanks for listening.