signs of a heart attack

are you at a risk for a heartattack? do you know all of the signs andsymptoms? do you have a family history ofcardiovascular disease? do you know how to minimize yourrisk? that's our topic today onhealthwatch, and please pardon

signs of a heart attack, the pun, but as we engage insome very heartfelt and insightful discussion oncardiovascular disease and heart health, i thought i'd invite ahealthwatch veteran back to the show, a seasoned and giftedcardiologist.

it gives me great pleasure towelcome dr. keith newby back to healthwatch.dr. newby received a bachelor of science in biology from norfolkstate university and later earned a doctor of medicinedegree from the eastern virginia medical school.he completed an internship and residency at the emoryuniversity school of medicine and completed a fellowship inclinical training in cardiology with an emphasis in invasiveelectrophysiology at the duke university medical center.he is, in fact, board certified

in cardiovascular disease andclinical cardiac electrophysiology.that's a tough word. in september 2010, he foundedand opened the fort norfolk medical plaza.welcome back to healthwatch, keith.how you doing? >> dr. newby: i'm doing well.>> terrance: electrophysiology. what is that anyway?>> dr. newby: that is the study of heart rhythm disturbances.we all have to study general cardiology, you spend a coupleyears with that, but in

cardiovascular training, youusually now it's more of a four-year fellowship trainingprogram. you have to do your medicalschool, which is four years, and you have to do three years ofinternal medicine and four years of cardiology training, so twoyears of general cardiology training and then two years ofelectrophysiology. >> terrance: electrophysiology.and that has to do -- i'm not trying to pressure you, but thatis to do with arrhythmias? >> dr. newby: yes and when i'mtalking to people about heart

disease, i like to use analogiesto help people understand better.one of my favorite one is a house, your heart is like ahouse. you have the foundation,ceilings, walls, rooms, doors from room to room and your heartis structurally like that as well.you have heart chambers. >> terrance: with the chambers,yes. >> dr. newby: they're like roomsand the doors are like valves that separate the chambers likeroom to room in your louse.

you have plumbing in your house,cut on a faucet, you expect the water to come out.that's like the coronary arteries supply oxygenated bloodto different areas of your heart, much like an irrigationsystem innar garden, but you also -- in your garden, but youalso have electrical circuits in house.you flip the switch and lights come on and your heart that iselectrical sir cuts as well that makes the heartbeat.when you're talk about electrophysiology, that's thestudy of how electrical circuits

flow through the heart.>> terrance: i always knew you were an againus, but did you --genius, but did you come up with this analogy by yourself?>> dr. newby: i actually did. if you talk to people in termsthat are familiar to them, the heart is not a hard organ tounderstand, but you have to be able to find similarities and ithink when you develop the similarities, it just helpspeople to understand it better. i just happened to stumble -- ithink i was trying to explain the heart one day to somebodyand they just couldn't get it

and i sat there and thought,wait a minute, there has to be some way i explain this so theyunderstood and it just popped in my head, the analogy -- i thinki looked at something, looked at a sing and i saw that foss -- asink and i saw that faucet and it just dinged something and ithought let me try this. and it has worked for me evervince. i use that all the time.>> terrance: you should someone to do an animation of a heartthat looks like a house. >> dr. newby: that's a goodidea.

>> terrance: the last time youwere on the show, it was some time ago, back in february 2013,and at that particular time we talked about something i neverheard of before, broken heart syndrome.>> dr. newby: right. >> terrance: and i'd like foryou to just briefly describe that, but in doing so, if youcan make the distinction between cardiovascular disease and heartdisease and tell us a simple layman's definition.>>. >> dr. newby: well, all brokenheart syndrome is is a disease

entity, i will say for lack of abetter term, and that's usually in the form of some heart attackor heart failure-like symptoms that people have as a result ofsome stressful situation in their life.you think about some life-changing events, death of aloved one or, you know, maybe some financial failure that --and everybody is different how they deal with stress.people manage their stress in certain ways and others do itother ways. broken heart syndrome can reallyshow signs of a heart attack

without them actually havingblockage in the heart. what happens this, and i seethis because you have ekg changes and everythingconsistent with that, clot formation can come into theheart as a result of increased stress and that can cause ablockage of an artery transiently.usually when we get people n we see the heart attack evidence,the ekg changes. we sometimes see the enzymeelevations in the bloodstream, but when we take them to thecatheterization lab, nothing is

there and that is welldocumented. i've had several people myselfwith that. you find out there's been somestressful situation in their life, either, again, the deathof a loved one or some other entity that they're dealing withthat is, to them, extremely stressful.>> terrance: that's very interesting.cardiovascular disease. >> dr. newby: essentially,they're kind of interchangeable in some degree.if you look at the definition of

heart disease, all that is isanything that affects the heart or the great vessels.the great vessels are the big arteries that come out of theheart and the veins that bring blood back, so when somebodysays, well, you've had a stroke. a stroke is blockage of bloodflow to the brain. that's considered heart disease.why is it considered heart disease?because the arteries that supply blood to the brain are connectedto the heart. >> terrance: sure.>> dr. newby: same thing if you

talk about vascular disease.you have blockage in a leg artery, same difference.it's considered heart disease even though the blockage may bewell down in the leg, it's considered heart disease becausethe heart is connected to those vessels.>> terrance: understood. >> dr. newby: so it's reallyjust anything that affects the heart or those great vessels,the aorta, the arteries going out to the legs or the veinsbringing blood back to the heart that is considered heartdisease.

cardiovascular disease is justmore of an interchangeable term of heart disease.>> terrance: that's kind of a global -->> dr. newby: yeah, both of them are global terms and they'reused interchangeably, but cardiovascular meaning heartvessels, heart disease, heart vessels, so they'reinterchangeable, but that's more of a broad term.i look at this almost like if you say the term car and say,okay, i bought a car. >> terrance: that's anotheranalogy.

>> dr. newby: if you look at theterm car, you have different types of cars.you have a lexus, a pinto, a gremlin, a chevy, a ford.there are different formats of cars, different forms of cars.the question is, what form are you referring to andcardiovascular disease is the same thing.if you look at the heart or the great vessels, we talked aboutthat issue of electrical circuits plumbing, a structuralproblem. if there's a structural problemin the heart, that's considered

cardiovascular disease or heartdisease. all those are interchangeablypart of it, but you can single out and go down to the finitedetails. you have an arrhythmia.well, superventricular in the bottom change ber or a bottomchamber rhythm disturbance? is it atrial fibrillationdisorder, an atrial tachycardia, you have different forms ofarrhythmia, so you can really drill down to the nth degree onmany of these things. coronary disease, there aredifferent formats of that as

well.>> terrance: with all the identification of heart disease,i think it's probably a good idea just to take a look at someof the numbers. i did some research and i'mgoing to have them put them up on the screen here, thatsuggests the incidence of heart disease and how we are dealingwith that. and if you could put that up onthe screen for me. with the 635,000 people in theu.s. have a new heart attack every year, and these are yearlynumbers.

some 300,000 americans have arepeat heart attack. one out of every seven americandeaths is related to heart disease?>> dr. newby: it is still the number one killer.despite the research, despite the advances we've made, heartdisease is still number one. it probably will always benumber one for various reasons we can talk about.but i found that by far, you know, that aspect of the 635,000is probably pretty accurate number, you think about, youknow, new cases every year, and

that's why it's number one.but it's all based on risk and the risk factors to developheart disease is where, to nee, our focus needs to be.because it should be all about prevention.>> terrance: let's talk about this.i know that there is a distinction between major riskfactors and contributing risk factors.can you talk a little bit about the major risk factors?>> dr. newby: the major ones are typically the broad-basedchronic illnesses, hypertension,

diabetes, hypercholesterolemiaor high cholesterol levels and family history of heart disease.i want to emphasize on family history, a lot of people don'tunderstand, when we say that, what that really means.some people may think of their cousin bob two sometimes removedbecause they had a heart attack at 92 years of age, that that'sa family history. that's not what the situationis. premature cardiovascular diseaseis genetic predisposition, so if your father, mother, brother,sister, first-degree relative,

age 55 or less, having a heartattack or some form of heart disease, that's considered afamily history. a significant family history.>> terrance: significant. >> dr. newby: yes, so those arethe people with again neck predispositions -- geneticpredispositions for heart attack and heart trouble.if you're older, 75, 80 years old, that's different.those patients or individuals, you know, they're at riskregardless, but it doesn't mean that you as a family member hasa genetic predisposition for

heart disease.so that's one of the other major risk factors.tobacco use, you know, some of the newer ones that arecontributing, i think, other types of things, obesity thatcan contribute to the formation of hypertension or diabetes, youtalk about stress levels in people who can be a contributor.some people who are highly stressed out will eat more, eatmore to gain weight, gain weight and they develop these otherthings, so you talk about contributing, those are thingsthat can contribute to the major

risk factors that can lead toheart disease. >> terrance: and today'spolitical climate. [ laughter ]would lead people to a fair amount of stress.what i want to deuce just take a very -- do is just take a veryquick break and when we come back, i want to stalk more aboutthe symptoms and so forth, the signs and symptoms because youmade a reference to the vascular -- the symptom that youexperience in your leg could be heart disease.>> dr. newby: yes, yes.

>> terrance: so we're going tocome right back in just a second.i want to thank you so very much for joining us.we'll come back after this very brief break.stay with us. >>> any questions?>> what kind of service plan does this come with?>> unlimited. >> ky keep the same phonenumber. >> yes.>> it does have a camera, does it come in silver, does it a3.50 millimeter head set jack?

you ever get those phantomvibrations in your pocket? >> any questions?>> no. >> are you sure?>> yes. >> ask questions.for the ten questions everyone should know, go to ahrq.gov.>> terrance: some time ago, we talked about something calledscad. spontaneous coronary arterydissection. i got it right, didn't i?>> dr. newby: yes, you did. >> terrance: can you tell uswhat is that?

that's not heart disease.>> dr. newby: it is a form of heart disease.anytime there's a tear in the stressful, a spontaneous tear, idon't know if you heard the term aortic dissection, that's a tearin the main artery that comes out of the heart.coronary artery dissectionz just a tear in the coronary arteriesand there's a host of possibilities.usually you see it and it's more common in women than men.you usually see it in an age range of 40-plus, but you cansee it in a younger population

as well.i've had a few 20-plus-year-old people with spontaneous coronaryartery dissection. essentially it's a tear in thevessel and the tear can go down the length of the vessel and asthe tear is going down, it creates an accumulation of clotin the material that can lead to heart attack.and you can have somebody die from coronary artery dissection.especially if they're not really discovered early enough, andearly detection is always key. now, the whys, we still don'talways know.

there are some disease processesthat are -- you do see with that.sometimes the stressful things we talked about, stressfullifestyles. some people who have connectivetissue disorders such as lupus, rheumatoid arthritis, anythingcan that affect the connective tissue can do it as well.you know, so there are ankylosing spondylitis, some ofthe rheumatoid terms you see. >> terrance: sounds like you'redoing profanity. >> dr. newby: i'm trying to seewhat i can do to catch you off

guard with some of the terms.>> terrance: that always happens.i don't want to catch you off guard, but we had someconversation before we began to tape and i'd like to get tothat, but before we do that, let's talk about the symptoms,the signs and symptoms and then i always tell folks -- notalways, but traditionally, i'll say we'll into off script andwe're going to definitely go off script talking about the signsand symptoms because the conversation we were havingearlier is something that's very

important to us.signs and symptoms. >> dr. newby: typically youthink about the heart works on supply and demand basis, so themore you do, the more blood flow is required.if somebody has an occlusion of blood flow, look at one of myanalogies again. you think about a car steppingon the accelerator, say you're in a residential neighborhoodgoing 10 miles per hour. you have the carburetor with aclogged fuel line, at 10 miles an hour, the car might workfine, but the car speeds up to

the point you're sure pausingthe amount of -- surpassing the and of gas in the engine, thecar can sputter. and people do the same thing.chest discomfort, i use that term because a lot of peopledon't call it pain. they call it discomfort,tightness, squeezing, burning in the chest, and some people getshort of breath with that. some people become diaphoretic,sweating and perspiration and some people just feel bad.the hardest thing when you're trying to get information fromsomebody, i feel bad.

what does that mean?i don't know, i just feel bad. what i try to do when i hear thesymptoms, try to ascertain how are these symptoms beingmanifested. is it exercise, at rest?then i start looking at -- they look at us like a detectives inever watch -- i don't think i've ever watched a doctor slowin my entire life. i try to watch e.r. once ortwice, but i never could get into it because it's toodramatized and not realistic in terms of delivery of medicalinformation, so i can never

watch it, but crime dram dramas?law and order? that was my show back in theday. you look at us as detectives.we have to take information you provide, look at the entire firand we're trying to see does this picture fit what we'relooking to try to prove or disprove?do they have coronary artery disease, do i have to worryabout a heart condition? i'm looking at things like howdo the symptoms occur? what are their other medicalproblems?

if i have somebody who's 18years of old and with no medical condition or nothing, i'm goingto be less concerned than i am with somebody who's 65, hashypertension, diabetes, high cholesterol and they smoke.i'm going to look at them different ways.you take everybody seriously because, again, that youngpeople could have a coronary artery dissection, but you haveto look at the entire picture and you do the cursory exammeaning you always want to talk to the patient, get an ekg, youknow, physical exam.

you look at the entire picture.then you see does this fit, you know, what we think would beassociated with heart disease? and that's how we make thedetermination. >> terrance: so the signs andsymptoms are heart disease for someone like yourself that'sdoing the detective work, it could be like incriminatingevidence to the crime scene. >> dr. newby: exactly and someof it is age dependent. an older person -- say somebodywho's 85 or 90 years of age who may come in, they may notmanifest chest discomfort.

they may not manifest shortnessof breath. what i have found, i've seenpeople where they just, i had a son or daughter who brings themother or elderly parent to the emergency room and say shedoesn't look right to me anymore, she's become lethargic,she's not talking like she used to.and you do an ekg and see some massive heart attack occurring.you know, it's more -- you have to look at it in its entirety.the way i kind of view the world is you always look at thingsfrom a worst best case scenario.

look for the worst initially,get that off the table. then you have time to workthrough the other things. some people try to do theopposite. oh, it's nothing, and blow themoff and next thing you hear, they go home and die of a heartattack. no, that's not happening on mywatch. although i know this is callhealth watch, part of my watch in the hospital is to say i'mlooking for the -- you're looking for that clinical kindof scenario that fits the mold

of this situation and i look ateverything from how they look, how they feel, what their healthproblems are, and all that in conglomeration does help toguide you one way or the other in terms of your diagnosis.>> terrance: let's talk now about what we were discussingearlier. i made a reference to some ofthe statistics that we put up on the screen, but there is anumber of these people, 635,000 people every year with a newheart attack. some of these people, thoseheart attacks can be avoided by

better health maintenance.>> dr. newby: right. >> terrance: and we were talkingearlier about people not doing what it is that they should doto take care of themselves. and i'd really like to -- wedon't have a whole lot of time here, of course, not enough timeto resolve that, but i'd like to talk about that.what are you seeing? >> dr. newby: a lot of it, i'vefound, is a compliance issue problem.>> terrance: not complying to your -->> dr. newby: yeah, what you try

to advise them to do.if you look at some of the chronic illnesses that causeheart disease to occur, hypertension, diabetes,cholesterol problems. think about it, most of thosepatients have very limited to no symptoms at all.if you have an infection, say you have pneumonia, a urinarytract infection, you're probe going to have some symptomsassociated. you have an affect joint, it'sgoing to hurt, you want to feel better.you have 104 fever arc hot joint

that's hurting like all get-out,somebody sells you, okay, you -- tells you, okay, you take thisantibiotic, you're going to get better.you're going to take it, typically until you startfeeling better. you get ten days of antibiotics,by day five, you feel better, i guarantee you probably won'tfinish the ten-day course. the problem with diabetes andhypertension, these are typically asymptomaticprocesses. you don't feel the cholesterolbeing highs.

most people don't feel the bloodpressure being high. most people don't feel theirdiabetes. some do, but usually don't.if i ask you to take a medicine for something you don't feel,what's the likelihood that you're going to take thatmedicine every day? some will, but a lot more won't.and people tell you, i feel fine, doc.that's not the point. your blood pressure is 150/100.if you continue down this path, it's going to lead to a strokepotentially, kidney failure,

heart attack, or sudden death.>> terrance: pardon me, but you're not saying that themajority of people don't do what they're supposed tos do 'fessthat a disheartening minority that -->> dr. newby: oh, if you look at the data, it says -- and this ispretty well documented -- that compliance issues occur about30% of the time. >> terrance: wow.>> dr. newby: if so you got 100 people, 70 are not going to doright and 30 are and that is a real problem we have.unfortunately there's no way to

really define are you takingyour flez? i had patient -- medicine?i have patients, they look me right in the eye and say they'retaking the stuff and they're not.i found ways -- i don't want to divulge all of my secrets how ifigure that outing but there are ways that i can figure out ifyou are compliant and i tell people all the time, listen,lying to me is not helping your situation.fly job is to be here for you to live a healthier live and liveas long as you can.

telling me something that's nottrue is not helping your situation at all.that's not going to make me feel better about the world if you'relying to me. i'm here because i care aboutunion i want to make sure you have all you have to have, sothat compliance issue is a major, major, major problem werun into. unfortunately, so if peopledon't do right, you know, it's going to be hard to really helptake care of them if they don't. and unfortunately, so what i'mrunning into, they will do right

after bad things happen.it's an unfortunate reality that goes back to the healthcaredisparity issue we brought up earlier, that yoourl see.if you go into a dialysis center here in norfolk or go into mostplaces that are big metropolitan cities, you're going to see aproportionately larger african american population in thatdialysis center than any other population.>> terrance: and that's getting what i'd really like for us toget into, to have some very genuine real discussion about.regrettably, we're about to run

out of time and i would like foryou to provide folks with information as to how they canreach that incredible building that you -- that new facilityyou put up. >> dr. newby: thank you.the fort norfolk building, we're on the fifth floor of the fortnorfolk building. we have a primary care andurgent care as well as cardiology practice and we tryto -- i try to develop an all in one inclusive facility that wecan, you know, if you needed somebody that's in an urgentcare situation, we're really the

only urgent care that hascardiovascular attachment to it, so we can do a lot of work-upthat otherwise is going into the emergency room and we can do itthere and get you pretty much well situated with what the nextsteps should be, but our office number is 757-624-1785 and we'relocated right across the street from sentara norfolk generalhospital. >> terrance: you're being veryhumble when you mention the office on the fifth floor.you put the building up, sir. >> dr. newby: well, thank you.i look at myself as a humble

public servants.i try to be there to deliver the best cake that's available.anything else i do for the community, so i don't -- youknow me, man, i'm not a big talker about what i do and how ido things. >> terrance: if people knew moreof what it is that you did, they would probably try and encourageyou to go into politics, but we won't have that discussion.>> dr. newby: i'll leave that to other people to do.>> terrance: keith, thank you so very much for coming on to theshow.

i really truly appreciate it.and of course, we want to thank you for joining us for today'sedition of healthwatch. remember, you can always watchprevious editions of healthwatch online atwww.norfolk.gov/healthwatch. if you'd like to drop me a line,you can email me at terrance.afer-anderson@vdh.virginia.gov. of course, you can always callme at 757-683-8836. that's 757-683-8836.for the norfolk department of public health, i'm terranceafer-anderson and this has been

healthwatch.