Dr. Michael S. Megaly Discusses Advancements in Complex Coronary Artery Disease on KTBS Healthline 3
Dr. Michael S. Megaly Discusses Advancements in Complex Coronary Artery Disease on KTBS Healthline 3
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Content
1.36 -> Hello and welcome to HealthLine3. I'm
Terri Simmons . We're talking with Dr
5.6 -> Michael Megaly of Willis-Knighton Cardiology.
We're going to be talking about the advances in
10.56 -> treating complex coronary artery disease.
Thank you so much for being here doctor.
31.44 -> Thank you, Terri, it's a pleasure.
It's our pleasure. This is fascinating to me and
35.84 -> I'm sure to a lot of our viewers because it's all
about complex coronary disease and artery disease
42.24 -> and we were talking about earlier you and I off
camera and on camera early this morning about how
48.16 -> coronary disease heart attack is a big umbrella
for a lot of specific terms that we can talk about
53.2 -> today and redefine what's going on with all the
things that you may hear about. generally when
58.56 -> you go to the doctor or you wonder about. let's
talk about what this complex disease means first
66 -> It's a great question and I'd start by
saying that coronary disease is very,
71.92 -> very common. It's the most common cause of death
and we have gone a long way in treating those
81.04 -> and that coronary disease it's exactly as you said
it's an umbrella for a lot of terms. It includes
87.12 -> the disease that is acute that comes acutely like
heart attacks. You go to the hospital and it's a
94.8 -> lot of times life-threatening and also encompasses
the other spectrum which is chest pain when you
104.32 -> walk, shortness of breath all that and in this
disease both spectrums can range from being just
113.28 -> easier to treat to difficult to treat
to what they at some point called
119.6 -> impossible to treat or there is no option.
It's a new field in interventional cardiology
127.52 -> to be able to treat what was supposedly not
treatable or very, very, very hard to treat
133.52 -> and that is what encompasses the
term complex coronary artery disease.
141.04 -> It hasn't been too long ago this has really
been in the forefront. We're hearing a lot
144.24 -> about this and it's alarming. At first you might
think there's more people are getting coronary
149.52 -> artery disease or having these problems but that's
not true. The reason we're hearing about it and
154 -> I really want to stress that again is because
there's so much advancement in the treatment.
159.04 -> That is very true. This started years
and years and years back with coronary
164.32 -> disease. I started by treating it with just a
balloon and mainly surgery for a long time and
171.52 -> with time stenting had come out and a lot
of techniques had come out to treat it
176.24 -> but still it was very limited in treating a lot
of these diseases. As an example when they are
182.8 -> very calcified, they have a lot of calcium. This
is very tough to treat. When they have multiple
188.96 -> vessels, this is very tough to treat. We're going
to talk about arteries that are 100% occluded.
196 -> We call it chronic total occlusion. This has
been like a place of no go for a long time,
201.92 -> As you said in the last two decades, there's
been a lot of advancements in treating those.
208.08 -> That's why they are being brought into attention.
That's why we talk to patients and tell them well
213.76 -> you still have other options other than surgery
and even if surgery is not an option we still
220.24 -> have a final option to offer right now these days.
It's hard to believe that it wasn't that long ago
226.16 -> where people were told I'm sorry there's not any
more we can do and they were sent home right. T
232.72 -> The sad thing is that still some people
are told that they have no option but
243.04 -> because because the knowledge and
advancement has happened and it's there
249.52 -> yet. It's an important thing to
you know bring attention that
256.32 -> having no option is probably a term of the past
we hope. Still there will be a very very small
264.16 -> percentage of people that really have no option,
but now we can offer options to a lot of people.
269.52 -> That's amazing I'm sure and so gratifying to you
in your field to help people to know that you can
275.2 -> offer even just having the conversation to tell
someone there are so many options we can try.
280.72 -> It's got to be very gratifying that's
why I went right straight to that
288 -> to that field. I went to Detroit and the
Henry Ford Hospital to train specifically for
296.24 -> treating complex disease and chronic total
occlusions. It is actually one of only five
301.76 -> programs in the country. Let's talk a little
bit about the program because you have been to
306.96 -> Chicago, Arizona, Detroit. You've trained in this
specifically all over. Tell us about the programs.
314.72 -> As physicians we train a lot, interventional
cardiology is a specific one-year training and
322.24 -> I did that in Arizona but having another extra
year of specific training to do a lot of these
328.56 -> complex cases and chronic total occlusions
was it was a privilege. I went to detroit
334.64 -> and we throughout the year we only did these cases
that were referred to us from everywhere, Ohio,
342.88 -> Michigan.
I think we have a caller for you.
346.56 -> Jerry thank you for calling.
What's your question?
356.24 -> I have a question a person who is a diabetic
and they have low sugar and they sit there and
369.76 -> have a seizure. Does this if you have a bad
heart does that affect your heart or not?
382.08 -> That's a great question so if I'm understanding
correctly you're saying that having a seizure
388.4 -> from low sugar does that affect your heart
or not. Having a bad heart gives you a very
401.2 -> low threshold of tolerating a lot of things and
seizures are a very stressful event on the heart
407.36 -> and the whole body. I would say it would not be
the best thing. It can induce a lot of bad things
416.16 -> like heart attack or something although this
might not be very common. The best thing is to
421.76 -> not get sugar get too low and not to have a
seizure of course, but it can affect it for sure.
432.88 -> I had a bad heart attack in 2014. I was
in ICU for 18 days and I am a diabetic
446.08 -> and I did have a seizure. I did have a low sugar
and I finally laid there for about an hour and
453.6 -> a half going through the seizures and before
anybody realized that I was having a problem
459.44 -> and then I got sent to the emergency room and I
was about six hours there getting my sugar back.
468.4 -> I was trying to explain to him that I
was at the emergency room and I said
474.16 -> I have a heart problem. He said that
doesn't have anything to do with your heart.
485.76 -> As I said most of the times it does
not but it can and you're very lucky.
493.6 -> I understand that. I
appreciate talking to you, doc.
535.92 -> We're happy that everything turned out okay. That
really is a concern. I guess when you already have
540.64 -> a what's called a bad heart, anything can affect.
It would have affected in the moment
553.2 -> but having long-term effects from that is
probably not something that we see very often.
558.88 -> If someone is walking around with
what they're told is a bad heart.
562.32 -> That term is that a broad term for what could be
going on? Does anyone really have a bad heart?
571.36 -> I would say it's not a very scientific term but
it encompasses a lot of things it can include
576.88 -> like heart failure. It can include coronary
disease. It can include a lot of things and
583.2 -> That's when we investigate more when we hear
the word "bad heart". You know hopefully
589.68 -> bad heart can turn into good.
Can turn into good.
593.84 -> Once a heart is damaged like if you have a heart
attack or something and it damages the heart,
597.6 -> does it stay damaged or does it like any
kind of muscle where it can get better
601.92 -> and stronger and and heal itself?
It depends on the extent of damage.
608.72 -> If what we were speaking about heart attacks.
If you go to the hospital right time,
616.56 -> you don't ignore your chest pain and you get it
fixed right away, the amount of damage is very,
622.4 -> very minimal. It might not affect it at all. If
you delay, you know think it's just dyspepsia.
629.84 -> It's just nothing and then turns out to be a
heart attack and time passes it's a muscle and
635.84 -> and there's a saying time is muscle so every
time it's like you got some muscle fibers die.
642.8 -> That's not the end of it because a lot of times if
we intervene in a reasonable time and we get blood
649.76 -> flow to the heart, the amount of damage that is
done can be compensated and with medications and
656.4 -> everything I mean the heart can do pretty well.
You said specifically you were really drawn to
662.56 -> this when we lit up when we were talking
about ways to help people and what what
666.88 -> brought you to this specialty? What is it that
youfound so interesting about coronary disease?
674.64 -> I have a surgical background and I used to be
a surgeon and honestly it's a lot of invasive
685.92 -> things to do open people up and cut people
up and I mean sometimes absolutely needed but
693.52 -> with the advancements of this that I have
heard about since I came to US I was really
698.08 -> drawn to be able to help people through less
invasive approaches. Instead of cutting you up,
705.12 -> you just go through arm or the leg and you know
fix it do the same thing. You can say a passion
715.04 -> for helping people that are you know told well
you cannot be helped. It's very gratifying.
724.24 -> We're very grateful too that you're here with
us, especially this program like you said is
728.48 -> one in five in the country.
That training program is like that
733.44 -> the organized training program is just one and
five in the country. We hope to grow it. We
739.84 -> hope to make this more available to everybody.
That's our role. I'm very involved in writing
753.84 -> on the topic and writing the books on the topic
and a lot of research as well and the teaching
762.64 -> physicians on the techniques on how to do that.
What are the terms. What are the tools. How to
767.92 -> use it . It's our goal as a community is
to make this available to a lot of people
775.68 -> Because like you said physicians
and surgeons are always training,
778.88 -> always learning and luckily there's so much
information out there and then what you do
783.2 -> is with every patient you treat that's research
right there and you're able to teach and and write
788.32 -> and document everything that you're learning. It
just all works together in this huge network of
792.4 -> healing between physicians and surgeons. Always
learning. Always teaching what you've learned.
797.04 -> Exactly.
And we get to benefit from all of that.
800.88 -> So tell us what these these treatments in this
program actually does offer so our viewers here
804.88 -> in Shreveport and Bossier, all over the Arklatex,
all of our viewing area are hearing about these
808.64 -> advanced treatments. Let's start how
it's diagnosed or or how this comes
814.88 -> about before the treatment actually happens.
It is diagnosed the regular way. Chest pain,
821.84 -> shortness of breath. Most people undergo some
stress test and they undergo an angiogram and
826.8 -> they found very bad disease or you know then
they are either offered surgery for that
836.4 -> and they are told you know yours is too extensive
you need surgery. Most of the time surgery has a
842.4 -> lot of great benefits but sometimes people are not
candidates. They cannot undergo surgery. They are
848.24 -> older. They already had surgery before so doing a
redo surgery is very very risky. They have other
855.04 -> diseases like kidney disease, liver disease,
lung disease so they cannot undergo surgery.
860.8 -> At this moment when you don't have the surgical
option and you have very , very complex disease
867.6 -> the option is the world is there someone able
to do this or will we just give you medicine and
874 -> that's it. That's how it's diagnosed,
how it comes comes about and then
881.28 -> according to the community where it's available,
what are the tools available, this determines
886.88 -> the fate of the patients. The tools and techniques
that we use are so extensive but most of these can
898.56 -> be treated with a percutaneous approach without
surgery, What are some of the advanced treatments?
907.12 -> the regular treatments for coronary artery disease
are balloon angioplasty which is going in crossing
914.56 -> that lesion, ballooning it with a balloon opening
flow and putting in a stent. That's the regular
920.96 -> treatment. The problem with complex disease is
that it is either very difficult to cross it
928.96 -> or get around it. It is very difficult to balloon
it because it's very tight and tough and calcified
935.36 -> or it is like a hundred percent occluded which
is not the way a normal wire can go. What we do
943.28 -> in these situations is that we can attack this
occlusion from both sides. We use two catheters
953.36 -> and we go around through the small channels in the
heart and try to make a connection and then when
959.44 -> we make connection we can place in a stent and
the vessel should be open. This technique has been
968.32 -> developed in last two decades, three decades
and it's been amazing how we got so far. We
974.08 -> can do it with lesser catheters. We can do it
with smaller catheters. We can go around things
980 -> that were impossible to do years back.
That's incredible Say you are going in
988.08 -> so it's like one vein or artery and it's
the catheters coming from each so how does
992.4 -> that happen? Is there an incision? What are the
tests first to find out where the occlusion is?
1002.48 -> We find it by an angiogram. Just the regular
angiogram you have when you have like a
1008.64 -> phosphorous test or chest pain and that that
shows us like everything in the heart and where
1013.76 -> the arteries are and where the occlusion and
blockages are and then at this point we spend a
1020.88 -> lot of time on developing this strategy. It's like
a code. You should spend like 20 minutes looking,
1029.12 -> just looking and then we
decide on which ways to go.
1034.24 -> We decide which channels are supplying
this vessel and then we try to go with
1038.56 -> two catheters and use special wires, special
micro catheters to go around these small small
1045.44 -> channels in the heart trying to get it from the
back and then try to connect. It can be lengthy.
1054.64 -> That's incredible and if people
don't know or they're not familiar
1059.68 -> with what an angiogram is describe one
An angiogram is basically a test where
1065.52 -> we get a small tube in the either the groin or the
arm. We go to the heart with a tube and then we
1074.96 -> selectively go into the heart arteries and
shoot a dye and under x-ray the dye shows us the
1082.56 -> coronary arteries or the heart arteries and
it's the best test for seeing the arteries
1089.28 -> and seeing what is going on with them. It has
been there for so long and it's still the best.
1097.52 -> And this is with dye. Has the dye itself been
improved? What is what is special about this dye?
1107.36 -> This dye is what we call radio opaque meaning if
you put it under x-ray it gives you a very, very
1113.68 -> distinct view. It's black and it has been advanced
so much. In the past there is dye that can give
1124.08 -> you a lot of allergies. It was very thick. It
can hurt the kidneys. In the last 12 years or
1131.04 -> something, the advance has been great. Now the
risk of allergy is very low and the amount of
1140.24 -> contrast is higher. It still affects the kidneys
but not as before. Everything is advancing.
1151.36 -> That's really good to know. I never thought
about the dye causing anything or not being
1156.24 -> very healthy to even have that done. I'm sure
that's always a choice for the patient. You know
1161.6 -> to understand all of that. If they say I don't
really want dye injected is there another way do
1167.12 -> you find out. Are there alternatives or another
way to find out if they don't want that?It's
1172.56 -> a science in itself. If we are like more than 90%
sure that this is coronary disease, the best thing
1180.48 -> is to go for an angiogram because that's what
chooses what's going on. If the possibility is
1189.52 -> the middle or lower, we can do a stress test
and if the stresses is normal you're fine. Then
1195.28 -> most of the times you're fine and there's no
issues with that but if it shows something,
1204 -> the end result is getting an angiogram still.
You might weigh the odds too because
1210.24 -> you're really trying to save your heart and
there hasn't been you know that much that
1214.88 -> we say that the dye is going to cause.
Not in these days at all especially we
1221.84 -> pay close attention to the amount of die we give
close attention and we never give an amount that
1228.88 -> hopefully most of the time whenever given amount
that is higher than what the kidney can tolerate.
1233.44 -> Very much lower doses and it's much better too.
It's improved too. That is not to worry if you're
1238.64 -> someone who googles the internet and tries to
find all that kind of stuff out and very safe
1243.76 -> procedures, another advancement. What else can
you tell us about the advances in this program?
1250.32 -> I can tell you we are trying to
bring that to Shreveport-Bossier.
1255.36 -> We have actually done two patients already
with chronic occlusions in the past three
1260.08 -> weeks and they are doing great. There
are a lot of people here that need.
1269.04 -> We're glad you're here a lot of people. Is
there anything we can do to prevent this?
1276.56 -> Is there a lifestyle that we can live? Do
we need to pay attention to if we have it
1282.08 -> in our family. What are the kind of things that
you see that this comes up in certain patients?
1289.52 -> I'll tell you the the short answer is that there
is no one single thing. It is a lot of genetics
1297.36 -> and and family history that can cause this. And
age we cannot control but what we can control
1307.36 -> is what we eat and our activities. The most
important thing what we eat salt and fried food
1318.16 -> less, veggies and fruits more. This specific
diet is associated with with bad coronary disease
1327.36 -> and, of course, inactivity and not exercising. I
think these two factors can summarize it all. yeah
1334.48 -> and would you say that's and that's just the
answer to get out ahead of anything like get as
1339.28 -> healthy as you can first um just make that and it
doesn't mean it means in moderation we talk about
1345.92 -> this a lot here especially living in the South
because we got this great fried food and sometimes
1350.64 -> like now the weather is it's too hot. I mean it
is dangerous to get out and try to exercise. You
1355.76 -> might overdo it. I mean there are all kinds of
things that fall into the conditions and the
1360.08 -> cultures and where you are so what's the mindset.
What do you tell someone to just when they say
1365.36 -> that all of these things that are coming up.
Great question and it depends
1370.32 -> on who I'm talking to. I was recently talking
a very nice gentleman and he says he just loves
1377.44 -> potato chips and I cannot stop eating for their
chips. I told him listen. I won't tell you to stop
1383.44 -> it but if you're eating two bags, I'll ask you to
eat one and let's see in three months. I mean it
1390.32 -> all starts with small steps. You can turn into you
know a vegetarian athlete overnight. It cannot.
1405.6 -> It's all starts with small things. You
eat a lot of salt, reduce a little bit.
1410.8 -> If you don't eat veggies at all just
start with one thing. It starts like that.
1416.8 -> Do you feel like that's come a long way too
because it seems like back in the day it would be
1422.16 -> like don't do that. You know cut out all your salt
and because that was really all we really knew. It
1427.92 -> was the terminology a long time ago and this is
like you know 30, 40 years ago and and doctors,
1433.12 -> physicians everybody was doing the best they
could and just saying you know what just
1437.68 -> eat salt, don't eat fried foods. Now it's so
much better. It's like we understand we're human
1444.16 -> and if you do cut something all the way out do
you find if a patient does try to cut something
1448.16 -> out they're just going to replace it with
something else that might be equally as dangerous
1453.2 -> It depends. It depends on the individual.
We discovered that if you tell someone you
1468 -> just don't do that they will not listen to you
which is very understandable. I mean it took us
1472.48 -> a lot of time, a lot of psychology research
to find out but it's very intuitive, right?
1479.44 -> When you tell someone to cut out something
or turn down you know some what they're doing
1486.56 -> yeah you gotta be careful you're not
introducing any another harmful thing.
1495.12 -> That's part of the overall discussion
and I think people now understand
1499.2 -> what they need to do. You just need a little push.
A little push. And support yes and it's nice to
1507.36 -> hear too. I'm sure the patient especially if a
patient comes in worried about heart disease or
1512.48 -> any kind of blockage or anything with their
circulation anything like that that's such
1516.08 -> a mystery to a patient to hear moderation.
Do you see that it takes a lot of the shame
1540.64 -> too out of it too?
Llike people come and
1542.32 -> they're embarrassed because maybe they've lived
this lifestyle or they feel like they don't
1545.68 -> walk enough when there's so much pressure out
there to be athletic not just fit but athletic?
1552.24 -> We have another call. Vera, what
is your question for the doctor?
1584.88 -> I've been complaining about my chest for the last
week. Feels like I'm being smothered. I've been
1589.6 -> complaining about my chest and hurting.
I do have a big blood clot in my lung
1594.4 -> and I was in a bad wreck last year.
The term that you're using is
1604.4 -> smothering you in your chest that is a little
concerning and most the typical pain that comes
1611.12 -> from the heart is described as this pressure
smothering. An elephant sitting on my chest.
1618.4 -> It is kind of typical. recommend that
you get checked as soon as possible.
1629.68 -> Okay.
And
1647.36 -> that is another thing. Talking about feeling
smothered on the chest. We've heard before
1650.96 -> it's like an elephant and standing on her
chest. It's hard for us to describe too do
1656.08 -> you suggest that we just come in and just tell
you not try to sound too knowledgeable really.
1661.84 -> Just tell you exactly how it feels? And
another important point this typical pain,
1668 -> it happens in a certain percentage of
people but otherwise people might not
1675.04 -> think it's the heart. Sometimes
it comes to just shoulder pain.
1678.48 -> Sometimes it comes, with some especially
in women , it just comes with a feeling of
1683.12 -> dyspepsia or something and I'm not feeling
right. People usually ask how do I know
1689.6 -> if this is just dyspepsia or something
and I mean the easier way is you know
1697.12 -> take a dyspepsia medication if it doesn't go away
in half an hour an hour, you should be a little
1702.56 -> concerned that it might not be just dyspepsia.
Being alert. Having people understand that
1709.12 -> this can be a symptom it's very important. right
And don't be afraid to ask. Don't be embarrassed.
1713.84 -> I mean it'd be great if i came in think i'm
having a heart attack and you said you're
1717.76 -> okay it's indigestion. I would love to hear that
and so we need to not be embarrassed if we come
1722.64 -> in and we think we're being overly dramatic.
Right. One hundred percent. If you're a little
1728.24 -> concerned you should get checked.
Definitely get checked.
1732.72 -> Thank you soo much.
What else would you like
1734.8 -> to leave our viewers with today about this
condition and what do patients need to know.
1741.6 -> As you said it's very important
to prevent it in the first place
1746 -> and take steps while you're healthy not take steps
when you are diagnosed. That's very important and
1756.56 -> it can be very, very scary but
as I said we're come a long way
1762 -> and advances in everything not just
techniques, in medications and everything. It's
1770.08 -> should not make you scared. You should get checked
and hopefully you know these days we can make
1777.36 -> people live better and healthier.
Definitely better and healthier. well
1781.76 -> thank you so much this has been a very helpful
and hopeful discussion. Thank you for coming
1786.4 -> here today. It's been such a pleasure meeting
you and and discussing this. It's so pleasant
1790.88 -> and thank you for watching everyone.
We'll see you next time on HealthLine3.
Source: https://www.youtube.com/watch?v=ZbDKilfTjfo