Preventing Heart Disease
Dr. Paul Ho
Chief of cardiology at Kaiser Permanente
Where did you receive your schooling and training?
I grew up in Philadelphia and went to the University of Pennsylvania. After earning my bachelor’s and master’s degrees in biomedical engineering, I attended Temple Medical School. I completed my internship and residency in internal medicine at Dartmouth, and then went to Beth Israel Deaconess Medical Center in Boston for cardiology and interventional cardiology fellowships.
How long have you been in practice?
What demographic is most at risk for heart problems, like sudden cardiac arrest?
In the younger population, risk of sudden cardiac death is normally genetically related or congenital. An arrhythmia can be because of congenital heart abnormalities or congenital problems with the electrical conduction system. This is why we screen young people, especially athletes – to ensure they’re going to be safe when they play sports and exert themselves at a high level.
As we age, the same problem is usually an acquired condition. Substance abuse with alcohol or drugs can damage your heart tissue, which can set you up for arrhythmia and the potential for sudden cardiac death. Other health conditions, such as high blood pressure, high cholesterol, diabetes, cigarette smoking and obesity, can lead to blockages in the arteries nourishing the heart muscle. Blockages can lead to heart attacks, which damage the heart muscle, which can further lead to arrhythmia, heart failure and sudden death.
What is arrhythmia?
The timing of the heartbeat is controlled by a network of nerve tissue inside the heart muscle. You can envision the nerve network as electrical wiring for the heart muscle, which works like a pump for blood circulation. The electrical system tells the heart muscle how fast to beat based on the physical demands on the body – sleep versus running. When there’s damage to this electric network, abnormal heartbeat situations can occur, which we designate as arrhythmia.
When should a person get screened for heart problems?
Typically we wait for symptoms to occur. Appropriate tests are then ordered to find out whether these symptoms are associated with a cardiac condition. Symptoms of heart disease usually are exertional. The severity of a heart condition can be correlated to the degree of physical impairment. For example, chest tightness with minimal walking may be associated with a higher degree of coronary artery blockage.
There’s a good analogy between the human body and an automobile. The heart is like an engine for a car. You’re not going to know what’s wrong with the engine if the car is parked. You have to drive it. The faster you drive the car, the more you’re going to know if there’s a problem, say, a clogged fuel line. The heart is very similar in that it’s the engine for the body. There is wisdom in your doctors telling you to stay active. Aside from being healthier, you’re able to identify health problems a lot sooner than if you were sedentary, like with a parked car. If you’re very sedentary and have heart disease, it’s usually more advanced by the time you notice symptoms than if you’re an athlete noticing symptoms. If an active person gets diagnosed with a heart condition, oftentimes we catch it in the beginning stages and it’s therefore easier to treat.
When offering aid to someone suffering cardiac arrest, do CPR and a defibrillator serve the same purpose?
They’re different. CPR helps with the mechanical pumping of the heart and circulation, while the defibrillator works on the electrical failure of the heart. When the electrical system is restored, it can intrinsically help the heart muscle to pump normally. CPR is very temporary in that when somebody is down, you can sustain them for a few minutes before defibrillation is available. Either the ambulance will have to come, or if you’re in a public place with an AED (automatic external defibrillator), put it on the patient and start to defibrillate them. Early defibrillation is key to saving someone’s life. The patient then would need to be hospitalized so we can find out what caused the collapse. They may leave the hospital with a permanently implanted defibrillator if they continue to be at risk for sudden cardiac death.
Once someone is diagnosed with heart disease, is there a way to reverse the problem?
That depends on the type of heart disease. With arterial blockages, you can prevent further buildup or even reverse them by healthy lifestyle changes, such as eating healthier, losing weight, stopping substance abuse, having a positive outlook and managing your stress. Stress is significant in harming the heart. You have to make these changes intensively and faithfully, so you must have a big reason for your behavioral and lifestyle changes, otherwise you will stop doing them after a while.
Anything else you’d like to mention about heart health?
The best way to live is to keep yourself healthy and prevent heart disease. Because the majority of health disease is acquired, it is in people’s control to prevent it. It’s far better not to get heart disease than to try to fix it. It’s far better not to “break it” than to have to repair it later because of poor care of our body.
If you do develop a heart condition, don’t be discouraged, because it’s never too late to improve your lifestyle. Few people are unlucky enough that, by the time we see them, they’re too far gone. Most of the time when we see patients who come in with heart attacks, cardiac arrest, heart failure, arrhythmia, etc., they are very treatable and they get better. These folks can live a normal and happy life. Patients have to be good partners with us in terms of adopting a healthier lifestyle and following our medical game plan.
I had a heart attack myself. I had open-heart bypass surgery about 12 years ago and began living the life that I teach people today. I understand how hard it is, but if you have a big enough reason, it can become a rewarding journey. I was sick for a long time, but I changed my ways, took my medicine and completely turned my life around. Now I’m healthy and strong, and I can tell you that living healthily is by far a much better way to live.