jean hamill you're welcome you're watching as the doctor tonight's guest is dr george so because george is a specialist in heart and a cardiologist specializing in congestive heart transplant direct direct board certified i well you know basically just to give a brief over what congestive heart failure is it's basically when the heart is not pumping appropriately so hard to please squeeze out blood to the body and when it gets injured either by a heart attack or for other reasons the heart doesn't  at that point they usually get sent to a cardiologist and i see i'm a cardiologist believe especially in heart failure and at that point we start some medications and do some further testing to really find out why why that happened so it's far as what is the most common cause of congestive heart failure most common cause is coronary artery disease or heart or heart attack so that's that's really the number one number one thing that we see and also really closely left side of the heart goes and gets sent out to the body to the brain and to all the old organs so when the one thing about the heart it never gets a chance to rest correct it's different than any other organ so you know it's constantly beating and it's really it has we call sicilian diastole so it does have some sort of rest period it's what squeezing is called sisterly and that's really that that's that's what that's really what affected most but with heart failure but also the second part of that is it's called diastole or the resting phase so that's that's people have problems with that as well but me when you think of heart failure most you think of impaired squeezing so the heart gets its blood fills the blood vessels perfect if you're just tuning in tonight starker george so because he's a specialist cardiac specialist and congestive heart failure and also in transplant which we're going to get into in just a little bit when you see somebody that has congestive failure there are a significant number of medicines correct correct typically most of our heart failure patients have about five medications that we that we standardize used to  be and for the most part they're all generic medications so we're able to treat our patients really for less than twenty twenty dollars twenty dollars a month with respect to the medication so we there's a core set of medications one basically the beta blocker the other is an ace i the length of life is not there with the jocks and so there while there are several payson still on joe jackson and it does keep people out of the hospital it really really isn't a mainstay as much of a mainstay how should say as it was in the past and it's such a high risk disease associate with clear disease that when someone has the diagnose of diabetes we assume that they have coronary artery disease so but smoking is probably the number one modifiable risk factor for coronary artery disease so  we really really push smoking cessation with all of our patients how many heart attacks does your average patient have to have before you decide you want to start stops you know it's kind of hard to say i'd say at least one thoughts about that but there's a lot to it you know people really have to want to quit because you know we can stress that we'd like them to quit all you know all the time but if you really don't have the energy zire to quit it's just not going to your inability to get people to quit smoking unless they actually want to i mean you know i tell people you know it's just as much a desire you know you want to do anything else in your life you've got to really want to do it and so i agree with you you know i wish to me it's just like any other drug it's just as bad as narcotics it's just as difficult to quit well my understanding is that the nicotine is actually more dictaphone even cocaine not having tried either drug i don't know that for a fact i'm with you there i haven't tried either as well so i feel comfortable i believe it because you know i do have patients that are have an easier time quitting drugs and they do was safer that that tonight's guest dr george said this if you'd like to get a hold of him force so basically when you have high blood pressure the hardest to squeeze against a higher pressure so the left side the heart becomes thicker and then as time goes by is that the kiss as it progresses the heart becomes very stiff and a cause is just the same symptoms as if the heart weren't squeezing correctly so that's a major problem that we see and something that i stress to our all our patients and really to their family because by the time someone gets to see me it's almost it's not too late but they've twenty over seventy one twenty over eighty well still you know if you have no other risk factors we're still looking at one forty over you know we saw to be less than one forty were pushing for let you know i think as a group we'd like to see our our numbers be one twenty over eighty would love to see that but you know starting treatment surely still isn't indicated unless it's above one forty or unless you have other risk factors like diabetes for example ok so if you're tuning in tonight and you're eaten at twelve inches get a go at the local eatery you want to ask yourself a couple questions what's your cholesterol absolutely and why the last time your blood pressure checked by a physician and or nurse practitioner absolute absolute blood pressure control cholesterol growth and quitting smoking those are transplant in the west bank allegheny system yes allegheny general began heart transplants and we've been doing transplants for over twenty years and really over twenty years and last year was our most transplants we've ever done we did thirty one transplants and got  thousand and ten already done seven so far this year and very active program we also have the ability to place left in trickle or system ices or l that's maybe familiar with dick cheney his has a heart pump that was placed so those are those are steps that when your heart gets sick enough and you can't treat it just with medications we have the ability to what we call bridge people to transplant is that as dick cheney's as his running petroleum from probably from you know that there are some sort of and i know that for a fact and i believe everything i read the paper and so the important thing is what you believe on t v which is you've got to get that blood pressure number and you've got to really get it you got to get a handle on that you do you do and i think you know we turn on the a silent killer that's what they it's what we call it it is a silent killer and so we really really want our faces to be aware that especially our younger patients because you know don't take this wrong way we don't really want them to see i don't want anybody to see that you know and that y c cardiac absolutely that's when what are some of the symptoms to people that aren't paying attention and haven't paid attention for twenty thirty or forty years what are some of the serious symptoms that put them you can no longer take these five medicines we'll put you on a list for transplant trast well basically repeat hospitalization so you've been in the hospital multiple times for heart failure despite us trying to put you on the right medications if you can't  state symptom i mean it is really what people think about when i think of heart failure but i like to have people recognize some of the other symptoms so if you had abdominal bloating of telstra bell you're you know adamant swelling you could hide some fluid there as well so that's not eating as much those kind of things anything to do a sweating really profuse sweating not not not a big not a big thing that we look at ok is this when you get this  shortness of breath going to be at rest this is the after certain number of steps so i think i tell my patients if you notice that ok yesterday you were able to two weeks ago you were able to walk up a flight of stairs and  without difficulty now you're able to do that but you're huffing and puffing by the time you get to the top those are some the some things we think about those early symptoms but time you get to the point where you're short of breath at rest that's more advanced you know you're more you know you've waited too long essentially if  you mention people that have hypertension can actually be in a category can just a failure without it you know i would assume the deep person is the one that's on the transplant list exactly so if they had at that point they've had either on an something that's done at the hospital or home or some combination thereof it's not home you know we used to think they used to have clinics where they thought giving these up you to be therapy if you could do it intermittently but that we found it that does not work that doesn't help at all so we it's a continuous infusion where you go on with a with a pump basically you know you have home nursing care that helps you do that and you learn it yourself and you carry around with you all the time so it's usually always initiated in the hospital but it's something that you can go home with i'm  won't get on a path you said engine a bit aren't these things done a clinic survey done at home where they had clinics so you can't do that at home cannot do that or how do you get to the clinic if you have angina what's it like yeah well it's called it's  not stable what we call stable and i'll let you know that so if you don't have chest pain and rest but if you're able if you know that you get it every time you walk up a flight of stairs that's what we call stable enough so that someone may be a candidate for that kind of therapy that's really not my area of expertise but it's good to say that it's out there we don't want to criticize it want to see if it's out there but it's useful for certain things but it's not useful for us as agreed ok because you know i think as my dad taught me a long time ago if know i can live with that though i understand telling you that you have no idea ok back we have george so we have a little interlude there george is a cardiac specialist cardiologist specializing in heart failure prevention of heart failure is mainstays of our program is that we have no close contact with our local primary care physicians and we don't want to be seen as the doctors in the ivory tower so to speak and so we do what we do want to maintain close contact with everybody what's the typical let's say somebody has to get a cardiac transplant is there a typical age group typically you know we as allegheny we don't do pediatric so we do that we stick from eighteen and above but typically the cutoff for transplants eight seventy and five years ago i was eighty five over eighty five percent and i'm ten years survival at this point we're looking at over sixty percent so that's go pretty good given it's a pretty good so when you as you when you look at the people that are getting transplant their one year life expectancy is you know less than ads and things like that so well that is left in trickle or system ice so basically at the heart pump again that's what we talked about that dick cheney had and but typically there's been the mainstay that we use is something called the heart mate t change change the whole outcomes of transplant so we really stop the amount of rejection that we have and allow the people to live a normal life for an extended period of time there's no one meant multiple trials with respect to failure that's been recently shown to be more effective in patients who are less sick so we're trying to use that more and more is new and improved necessarily improved now you know i'll be honest with you like i said the most the medications that we use when it's hard to say are have been to give the oxygen a chance to get back to the heart muscle rather isn't that that's that's kind of a side to side bar of it but really the number one reason we use a beta blockers to block the what we call the neuro more are more and cause a cascade or basically when the heart starts to fail a new patient facility specializing in heart failure congestive heart failure hopefully he won't have to see him put you in a transplant list but it certainly can help you along with your family physician to control your blood pressure control your cholesterol it's really important to know watch your salt intake and that's really important hypertension as well so sodium restriction is important so there's a lot of hidden salt out there and i would love love you to please take a take a look at the label and give the numbers i mean there are certain foods that are they see me they see a dietician they see a pharmacist they see a nurse they get a fool a fool routine and so i think it's very important tonight's guest was dr george said this will run his byline one more time at the bottom george has a phenomenal physician specializing again congestive heart failure hopefully we won't have to see in the realm of cardiac transplant but wow by the statistics and i and i think i'm a little taken aback because that should be the sharp tip of the spear we should that should be out there for people to understand that because i mean ninety percent when you're sure i waited five percent two years five years ago five or survivor those are phenomenal numbers you know looking at national averages so we were here to get the word  two minutes to wrap this up you want to hit your highlights one more time for the folks at salie so anybody had a diagnosis of heart failure they might have been told is your heart's not squeezing right or congested say it is many older terms even dropsy for that matter people to be aware of is that we do not treat poverty hypertension as well or high blood pressure in the lungs i'm one of the few specialized centers really within the state and then to be able to do that so myself and my partners that's that's one of our areas of expertise  love to have it back we'll talk about that next time ok george thanks for coming along folks out there remember what he said if you haven't got your blood pressure check this week within the last month especially if you're hypertensive get it checked absolute number two you've got to know what your cholesterol numbers that's really important i know everybody is looking at their portfolio numbers but in the long run the cholesterol is going to keep you allowed you to take advantage of that portfolio number so pay attention slow down don't pass and double lines like some