Dr. John Winterton Discusses Coronary Artery Disease on KTBS Healthline 3
Dr. John Winterton Discusses Coronary Artery Disease on KTBS Healthline 3
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Content
1.68 -> Hello and welcome to HealthLine3. I'm
Terri Simmons. Today we're talking with
5.58 -> Dr. John Winterton with Pierremont Cardiology.
We're talking about coronary artery disease.
25.62 -> Doctoe, thank you so much for being here.
I appreciate the opportunity.
35.4 -> I like that we're focusing on the coronary
health, artery health rather than the disease.
42.36 -> I think it's important to understand a
couple of things relative to coronary
46.26 -> artery disease. We talk about that in general
terms and patients hear that when they go to
50.88 -> the doctor's office. I think there's often a
misunderstanding of what that really means.
57.3 -> In general the heart itself is a muscle just like
other muscles in the body . The heart has its own
63.9 -> blood supply which is principally constituted
of three little arteries. They're about three
70.62 -> millimeters in diameter. Those arteries run on
the surface of the heart and then have little
76.56 -> branches that that help supply the heart muscle
itself with blood to do its work. The heart does
82.56 -> not get its blood from the blood that's in
the chamber of the heart which is often a
87.84 -> misunderstanding a lot of people have. It's those
little arteries that run on the surface of the
92.7 -> heart that that are referred to when we talk about
coronary artery disease or heart artery disease.
98.82 -> Those are the arteries that get affected by
cholesterol plaque which builds up over a
106.32 -> period of time which actually begins probably at
a very astonishingly early age, perhaps as early
114.54 -> as 18 months in some people and it progresses to
a point that at around age 32 in people who are
122.1 -> going to develop heart artery disease would begin
to see evidence of that in pathologic specimens
129.24 -> and not very far after that that we begin to see
the manifestation of disease itself in other words
135.6 -> heart attacks and if you wanted to broaden it and
talk about strokes. All of those things begin to
141.6 -> happen shortly thereafter. Coronary artery disease
or blockage of the arteries supplying the heart
148.44 -> occurs for lots of reasons but we do know that
there are six major risk factors that affect the
155.64 -> development of cholesterol plaque in the arteries.
Those being diabetes and high blood pressure,
160.56 -> high cholesterol, smoking, being overweight or
having a so-called sedentary lifestyle meaning
169.44 -> not active, and family history or genetic history
of coronary artery disease. Those are the factors
178.38 -> that that we know with a great deal of certainty
are related to the development of blockage or
187.08 -> cholesterol plaque in the arteries. It's therefore
we're able to have a treatment plan for patients
196.8 -> who have those problems. You first have to
recognize though that you do have a problem.
202.98 -> Folks who have those risk factors diabetes, high
blood pressure high cholesterol, smoking, etc.
208.14 -> need to be aware that they are at risk for heart
disease. If then during activities or otherwise
216.9 -> you develop pain or pressure or tightness in your
chest, you develop shortness of breath or actually
223.68 -> something as simple as just hey I don't tolerate
doing what I want to do. Folks come to the office
231.12 -> often and say well I just don't feel good. I'm
tired but I'm getting old and and I I'm often
238.08 -> careful to point out we don't make excuses.
It's probably something that's driving the
243.78 -> the symptoms and so you have to be attentive to
your body's signal to you that there's a problem.
254.22 -> If that's true that needs to be brought to the
attention of your doctor and in that case we have
260.34 -> a lot of options in terms of making the diagnosis
and certainly lots of options in terms of the way
265.44 -> we treat it. Simple things such as stress tests
and you know if necessary imaging procedures
272.7 -> such as cardiac catheterization where we put an
IV in the artery either in the wrist or the leg
279.48 -> and run up to the heart and put some dye in the
arteries and actually take a picture of them.
284.82 -> Sometimes we can do that with a CAT scan
and if you have blocked arteries then
291.06 -> the carry-on from that is that we have some
options to treat it mechanically with stents
295.92 -> and and certainly bypass surgery
in the in the proper circumstances.
301.26 -> And lastly we know that that if you take care
of those six risk factors that is you treat your
307.8 -> diabetes or do things to modify your blood sugar
and your metabolism, you take care of your blood
314.7 -> pressure . Roughly 50 million people in the
United States have unrecognized hypertension.
321 -> You take care of your cholesterol and we have
guidelines for this and a lot of medications
332.22 -> and above all, don't do things that
make make it worse . Don't smoke.
337.38 -> There's just no way in the world you can smoke
and and think that it's not going to have effect
342.6 -> on on your heart and your lungs. So being
attentive to what heart artery disease is,
351.12 -> am I at risk for it, could what
I feel be my heart be a problem
358.68 -> and then get attention, get proper attention
with your family doctor and/or your cardiologist.
365.16 -> These risk factors it can be just
one of them. It doesn't have all of
369.06 -> them? Say you're a smoker and isn't it heavy
smoking is it just smoking, at all smoking?
378 -> To answer your question in a
little little different way,
380.28 -> as I mentioned there are six major
risk factors for coronary disease.
385.56 -> I like to think that if you want to list them
number one is smoking. Number two three four
390.66 -> and five are smoking! That alone is enough and
it's true of high cholesterol and blood pressure.
396.96 -> Scott's on the line for
you. What is your question?
402.48 -> I just wanted to let the doctor know that at age
eight years old in 1968 I had a massive attack.
411.12 -> They sent me to Houston Texas under Dr Denton
Cooley and I spent a year under him then finally
418.26 -> they decided to go in and see what happened to
me. I was born without half of the left artery
425.34 -> and they did surgery on me in 1969 and I'm 65
years old today so I'm going pretty strong.
437.16 -> It's pretty amazing the benefits that we've
seen from the advancements in all elements
444.24 -> of of cardiology and cardiovascular surgery.
What you're referring to is an abnormality, a
451.14 -> congenital abnormality of heart arteries in other
words not having the usual type of anatomy and you
459.6 -> certainly landed in good hands. Dr. Cooley had a
terrific reputation at the Texas Heart Institute
466.08 -> and at St Luke's Hospital in Houston. It was
certainly arguable that they were early pioneers
475.2 -> in in cardiac surgery. You're very fortunate and
and I'm glad to hear that you are doing well.
484.92 -> My cardiologist today is Dr
Brent Robinson in Texarkana
490.38 -> well good and and you should stay with him.
Your story it's remarkable.
518.1 -> Thank you so much for calling
and let us know your story.
532.62 -> It sounds like he was born without one of
the arteries that supply the heart being in
537.78 -> the proper location and so they I would guess
had to maneuver circulation around to protect
545.58 -> that side of his heart . We call them anomalies or
abnormal location of arteries that occur about 10
555 -> to 15 percent of patients. Most of them are not as
dramatic as that suchh that would require surgery
561.54 -> or some intervention. Nineteen sixty-nine is in
the beginning of of cardiac surgery as we know it.
570.24 -> Certainly things have advanced substantially from
that period of time and we've learned quite a lot
577.62 -> about what we can and what we can't do , and what
we can and cannot expect from heart surgery but
583.98 -> tremendous advancements in that period of time.
That's incredible, we have Jennifer on the
589.62 -> line for you. Thank you for
calling. Wat's your question?
595.8 -> I have a question regarding the imaging
that is done on the heart versus cardiac
603 -> catheterizatioon to you know inject
dye. I have a friend that had that done
609.66 -> and how effective is that regarding
potential need for a stent?
616.44 -> We were just talking about the developments
of heart surgery and it was not long after
623.58 -> heart surgery was developed in the
late 60s that cardiac catheterization
630.12 -> became much more prevalent. Why? Because we
had to have a way to identify patients who
635.16 -> had blocked arteries and so the technique was
pioneered by a physician in France initially
644.46 -> in his garage using some materials that would
probably stun most people, it's gone from that
653.64 -> point to the to this point where we are today.
Cardiac catheterization is a term that implies
660.24 -> putting a small IV in an access port usually
the femoral artery the artery in the groin or
668.34 -> the radial artery one of the in your wrists and
from that access point we have catheters that are
678.24 -> many centimeters long that will reach from the
access point so from the wrist or the groin all
683.82 -> the way up to the arteries, the little arteries
that supply the heart. We can then under x-ray
689.4 -> guidance put those catheters in the arteries,
inject contrast material and take pictures with
695.34 -> the X-ray camera from about six or eight angles
so we get a really good idea of what's there
702.24 -> from a visual perspective. What we can't do
is look down the bore of the artery and tell
708.42 -> you hey this is with absolute certainty this
artery is 72 percent blocked. We can't do that.
715.5 -> In the last 10 to 15 years the technology
has evolved so that we can put a through
720.96 -> that catheter a small wire that is
capable of measuring electrical impedance
728.04 -> which translates to the amount of
blood flow on either side of a blockage
734.58 -> and we can then conclude whether a blockage
is significant or not. Yet another advance.
741.54 -> Those images allow us to see the arteries and then
know what territories, what parts of the heart are
747.9 -> struggling for blood flow, and if there's a
significant blockage and it's appropriate we
754.44 -> can then in many cases fix that problem with a
balloon and stent angioplasty or stent placement
763.26 -> and the way that works through the same equipment
with those tiny little wire that we advance into
770.1 -> the artery itself that is not quite two tenths
of a millimeter in diameter and then track over
778.8 -> that a balloon, inflate the balloon which cracks
open the cholesterol plaque and then we go back
786.72 -> with a stent which is a piece of wire mesh looks
something like window screen rolled into a tube
793.5 -> if you will and that is used as a scaffold to hold
the artery open and that all has advanced over the
801.06 -> last 30 years substantially to a point that we now
know that we can get good angiographic results in
810.48 -> other words a pretty picture and have it remain
that way about 95 to 97 percent of the time.
818.52 -> That's the rough way we treat that.
I had a friend that had a CT her heart
833.76 -> to show if there was any plaque buildup
in her heart muscle and her arteries
845.94 -> Cardiac catheterization is is the gold standard to
look at heart arteries now what you're referring
850.92 -> to I think is a cardiac CAT scan which is a
technique that's evolved over about the last 20
857.88 -> years. CAT scanning has been available since the
mid 70s. It allows the X-ray camera to move in a
866.16 -> very fast fashion around the patient in a tube
so to speak right and for the first 30 years or
875.46 -> so of CAT scanning that we were somewhat limited
by the ability to get as much x-ray information
882.12 -> as we can now. That's just technology but the
bottom line is we can put an IV in the hand,
890.82 -> inject some contrast material and then
do a CAT scan in a very fast fashion
896.04 -> that allows us to see in images that are
about a half a millimeter in in thickness
904.44 -> in the the artery
supplying in the heart.
907.56 -> There's some limitations which include the motion
of the patient and size and some other technical
916.38 -> factors but cardiac CAT scan can be a very
useful tool to look for heart artery disease.
928.8 -> Thank you very much, Dr Winterton. I'll have to
you that your dad was my pediatrician for my two
938.04 -> sons. I have a great fondness and respect for
him as a doctor and I know you as a cardiologist
944.34 -> moving back to the area is a wonderful thing.
That's wonderful.
971.94 -> You talked about as early as 32 years old
this can start. Do people have symptoms
976.2 -> that young? And what are they?
That's the unfortunate fact is
980.58 -> that obviously most people at 32 years of age
do not have symptoms. The problem being that
987.3 -> the development of cholesterol plaque itself poses
substantial risk in some people more than others.
994.68 -> It's incredibly important to recognize those
risk factors that that I mentioned because that
1000.44 -> paints the picture of the future for you. If you
have those risk factors then I think you have to
1007.88 -> assume it's possible you've developed cholesterol
plaque . Another unfortunate fact is that on any
1014.9 -> given day a cholesterol plaque that we would
call 20 or 30 percent narrowing the artery is
1022.1 -> insignificant in terms of blood flow can become
instantly a problem if the plaque breaks open
1028.7 -> which leads to what is a heart attack. how does
that happen? A heart attack implies heart muscle
1035.72 -> damage which can be temporary or permanent.
If it's not treated quickly it's permanent
1043.76 -> because their heart has no no
way of regenerating itself.
1047.6 -> What can happen is a cholesterol plaque of any
severity become unstable. It breaks open and
1055.82 -> exposes the cholesterol esters, the cholesterol
debris in the form of little crystals to the
1062.24 -> bloodstream and once that happens it stirs up the
inflammatory response of the body typically has
1071.36 -> at its disposal to treat wounds and infections
and etc. That's wonderful with the exception
1078.68 -> of the fact that you were talking about an
artery that's three millimeters in diameter
1083.96 -> so if you cut your finger and you bleed
you make a blood clot. You stop bleeding.
1088.04 -> That's great if it's your finger, It's not
so good if it's a three millimeter artery
1092.18 -> that cannot accommodate much in the way of
clot. Blocks the artery off. Causes damage.
1099.2 -> We have Charles on the line for
you. Charles, what's your question?
1107.78 -> I was wondering is there any kind of medication
that can clear plaque out of your arteries? I've
1114.5 -> had cholesterol for probably 35 years and I've
tried statins and they affect my muscles where I
1123.5 -> can't take them and I had a Lifeline screening and
it showed that I had a mild carotid artery plaque.
1135.26 -> I was just wondering if is there any kind
of medication that clears plaque out?
1144.74 -> That's a question that a lot
of people need answered for the
1148.52 -> very reasons that you highlighted. The
medications are out there to treat high
1152.3 -> cholesterol. There are some side effects.
They are rare fortunately but some people
1158.84 -> don't tolerate them and there are other options
besides statins. Do they cause the regression
1165.02 -> of existing cholesterol plaque is a controversy.
The general answer to that question is we cannot
1173.9 -> tell you that but as I was alluding to a
minute ago talking about heart attacks.
1180.5 -> Cholesterol plaque is made up of cholesterol
esters in the form of crystals. They're very
1186.14 -> irritating to the tissue and the artery itself
and they induce an inflammatory response you
1195.02 -> get scar tissue formation, calcification just
like if you if you had problems with your knee.
1204.86 -> The ultimate mechanism for the medications we use
is to reduce the cholesterol ester content of the
1214.22 -> plaque, stabilize the plaque so that it doesn't
rupture. You'd like to think and hear that we
1221.06 -> could tell you with certainty that we're going to
make it go away, sort of the Drano idea but while
1228.68 -> that's not true what we can tell you with good
certainty is that if you take cholesterol medicine
1234.98 -> and reduce your LDL cholesterol which ultimately
reduces those inflammatory cholesterol crystals
1243.2 -> in the in the arteries that we can help you
live longer and that's very clear. In fact the
1250.1 -> the reduction in mortality is substantial up to
around 50 percent if we achieve a goal. They're
1259.22 -> guidelines for each group of patients relative
to the number of risk factors that they have.
1266.48 -> We can't tell you with great certainty that
we're going to make it all go away but we can
1270.8 -> tell you with a high level of certainty that by
taking medication and stabilizing what's there
1276.98 -> that we can help you live longer and stay out
of trouble. It's also then very important to not
1283.34 -> smoke and pour gasoline on a fire so to speak.
We have David on the line. David, what is your
1314.78 -> question?
Exercise,
1324.62 -> I can''t do too much of it. I run out of
breath. I'd be walking or doing something,
1331.82 -> and run out of brreath. I sit down about three
or four minutes. It's like it never happened.
1342.32 -> What you're describing highlights the importance
of paying attention to how you feel and not
1350.12 -> necessarily that you're having chest pain although
in your case you described being short of breath
1356.42 -> paying attention to the fact that
you can't do what you want to do
1360.14 -> and that means that you need to see
your doctor with those symptoms and
1365.72 -> you need to see your doctor
before you start exercising.
1384.98 -> You're highlighting symptoms and and that means
that you need immediate attention from your doctor
1392.78 -> either your family doctor or your
cardiologist. I would do that immediately.
1407.9 -> You take care of yourself. We have
James on the line. What's your quesion?
1426.26 -> My question this morning is I'm feeling
always fatigued and shortness of breath.
1434.84 -> I'd like to know what I need to do. They took
me off my Pravastatin because of my liver. For
1443.48 -> my medicine to work with my liver and now that
I've finished the medicine do I go right back
1450.62 -> on the Pravatatins and what do I need to do
about exercise with with shortness of breath?
1459.38 -> Let me answer the question relative to what you
need to do and it applies to the gentleman who
1466.22 -> called earlier which is to say that if you're
having symptoms such as pain or pressure or
1472.16 -> tightness in your chest. If you're short of
breath. If you notice that you can't exercise
1477.44 -> without having symptoms or simply don't have the
energy. You need to contact your family doctor
1484.04 -> or your cardiologist immediately. Certainly
a person who's having continued chest pain
1489.8 -> should go to the emergency room. If that's not
something that's not already been addressed.
1498.32 -> To exercise before being evaluated if
you're having symptoms is dangerous.
1505.28 -> Again getting immediate attention from your doctor
or your cardiologist or the emergency room is is
1515.06 -> very important. Relative to the cholesterol
medication, that's again something you need
1523.4 -> to address with your doctor We have a lot
of choices to treat high cholesterol. The
1528.62 -> statin medications refers to medications that
alter cholesterol metabolism in the liver.
1537.2 -> One of the potential side effects is alteration
of liver function which is what you alluded to.
1545.9 -> Today the number of number of folks that are
limited by liver function taking either Statin
1552.92 -> medicine is not real high, but we have other
options that can get us around that problem.
1560.72 -> You need to talk to your doctor about
that to try to get a solution all.
1570.38 -> We have Sharon on the line.
Sharon what is your question?
1574.82 -> I want to know what is the best
treatment for social anxiety?
1581.3 -> Social anxiety is a common problem but certainly
not necessarily a cardiovascular problem.
1587.36 -> I'll tell you that it does affect the heart. We
often see patients who present with the feeling
1596.84 -> that their hearts beating fast, etc. Social
anxiety has lots of different manifestations
1603.2 -> and so again the simple answer to it
is to talk with your family doctor.
1631.4 -> We've got Margaret back on the line.
Hi Margaret, what is your question.
1635 -> My question is how long do stents last?
Historically stents were first developed in about
1647.54 -> 1993 and there were issues with stents. The early
stents that had scar tissue formed within the
1657.32 -> struts of the stent, the metal pieces their open
gaps as I described it kind of like window screen.
1664.46 -> In about 1997, the first stents with medication
were developed. Medication in the form of
1672.98 -> chemotherapy agents and those chemotherapy agents
were designed to prevent the end growth of scar
1679.46 -> tissue. Those have developed progressively over
the next five or so years so that around 2003
1687.08 -> we were using lots of those medicated stents.
The chance of the stents and failing or having
1694.04 -> cholesterol plaque and scar tissue grow through
them is around five percent. It's very low.
1707.84 -> I have spent some years ago. It might have been
20 years ago but since that time I don't smoke.
1714.74 -> I see my cardiologist and my medical doctor
during the time that I'm supposed to. I take
1726.32 -> care of my cholesterol. I put my cholesterol
medicine and everything that I'm supposed to
1731.66 -> do I do it. I j just want to know is this enough.
Well, it sounds like you're doing the things that
1739.52 -> we ask our patients to do to do their part
to prevent the problem from getting worse.
1745.46 -> You take care of diabetes. There's a lot of
new medication out there to treat diabetes
1751.46 -> aggressively. We aggressively treat high
blood pressure and we apply this the standard
1756.68 -> measurements to everyone in general. Normal being
130 over 80. and then we drive LDL cholesterol
1765.92 -> down for patients with heart artery disease
below 70. And then lastly don't smoke. I think
1773.18 -> it sounds like you're doing all those things.
All right that sounds really good. Thank
1784.04 -> you for talking to us, Dr. Winterton.
We'll see you next time on HealthLine3.
Source: https://www.youtube.com/watch?v=JOTfV5WJOqk