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Improving How We Care For Heart Valve Disease · UK HealthCast

• 0:05
  Nolan Alexander (Host): Welcome to UK HealthCast, a podcast
• 0:08
  presented by UK healthcare.
• 0:10
  I'm Nolan Alexander, and joining me today is Dr.
• 0:13
  Peter Hegg.
• 0:15
  A non-invasive cardiologist from the UK Gill Heart and Vascular Institute.
• 0:21
  We are here to dive into an important conversation about heart valve disease
• 0:25
  and explore the newly structured heart valve program at UK Healthcare.
• 0:30
  Well, Dr.
• 0:30
  Hag, how are you today?
• 0:32
  Peter Haigh, MD: I'm doing great, Nolan, thanks so much for having me on the show.
• 0:36
  Nolan Alexander (Host): It's our pleasure, and let's establish the basics here.
• 0:39
  What exactly is heart valve disease?
• 0:42
  Peter Haigh, MD: Yeah, it's a good question Nolan.
• 0:44
  I think to understand what is heart valve disease, it's first helpful to talk about
• 0:48
  what are the heart valves themselves.
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  And so if you imagine rooms in a house, you have doorways
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  that connect room to room.
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  And Those are basically the valves.
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  And just like rooms in a house, we have chambers of the heart.
• 1:00
  And so these doorways or valves sort of open and close to help blood flow
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  through the heart in an organized fashion.
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  valve disease boils down into two main problems.
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  Those little doorways either have a hard time opening, we call that stenosis,
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  And that restricts blood flow forward.
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  Or the valves or little doorways don't close properly, which allows
• 1:24
  blood to leak back the wrong way.
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  We call that regurgitation, and if either of these problems occur, it can cause
• 1:31
  a patient to feel unwell with symptoms like shortness of breath or fatigue or
• 1:36
  exercise intolerance and left untreated.
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  These problems can progress and become quite serious leading to things
• 1:43
  like heart failure or even death.
• 1:45
  So it's important that if someone does have a valve problem, it's
• 1:50
  followed appropriately and it's intervened upon when the time is right.
• 1:55
  Nolan Alexander (Host): What happens when someone's diagnosed
• 1:56
  with heart valve disease?
• 1:58
  Peter Haigh, MD: Sure.
• 1:59
  So typically the diagnosis is made when your doctor hears a murmur, when they
• 2:04
  listen to your chest with a stethoscope.
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  That murmur is usually followed up by a test called an echocardiogram, which
• 2:12
  is just an ultrasound of the heart.
• 2:13
  And on that test, we can figure out what's causing that abnormal heart
• 2:18
  sound, what's causing that murmur.
• 2:20
  We can figure out what valve is leaking or not opening.
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  Well, we can figure out how bad it is And then determine
• 2:27
  the appropriate, next steps.
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  For many patient's, this will mean additional monitoring, but sometimes
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  we catch something that it's advanced enough that the time is right to go ahead
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  and do an intervention on that valve, be it a valve replacement or a repair.
• 2:44
  Nolan Alexander (Host): So how common is valve disease and are cases increasing?
• 2:48
  Peter Haigh, MD: Yeah, valve disease is, quite common and cases are increasing.
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  one of the main risk factors for valve disease is increased age.
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  And as our population continues to get older and older, So, it does the
• 3:01
  prevalence And the number of people walking around with valve problems.
• 3:05
  So the devil's in the detail here, Nolan.
• 3:07
  So if you.
• 3:09
  Ask me how common is a leaky valve?
• 3:11
  Well, that's extremely common, and many times that's actually a normal finding.
• 3:16
  But if you take valve problems that are moderate or severe, meaning it's
• 3:21
  bad enough that it might cause symptoms or certainly need follow-up, the
• 3:24
  prevalence of that increases with age.
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  So if you look at people over the age of 60, having a significant
• 3:30
  valve problem is about two to 3%, which is a whole lot of people.
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  There are also valve problems that people are born with, so about one
• 3:39
  to 2% of the population are born with something called mitral valve
• 3:43
  prolapse or an abnormally formed aortic valve, and those often are not caught
• 3:49
  until somebody is much older in life.
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  When an astute physician hears a murmur on exam.
• 3:55
  Nolan Alexander (Host): Building off what you said about age, who would you
• 3:57
  say is most at-risk for valve disease?
• 4:00
  Peter Haigh, MD: Well, the people most at-risk for valve
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  disease are elderly individuals.
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  People that either have had, a lot of time for wear and tear damage to occur.
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  The human heartbeats about a hundred thousand times a day.
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  And so if you do the math there, that's a lot of heartbeats over the
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  course of years and decades of life.
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  So it's not surprising that somewhere and tear occurs.
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  otherwise certain medical problems that one develops or acquires over the
• 4:26
  course of their lifetime can then go on to make valve disease more likely.
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  For example, people that develop heart failure for other reasons or
• 4:34
  have had heart attacks, all those problems can leave valve problems,
• 4:39
  autoimmune conditions, radiation therapy, and even certain medications.
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  So the list is quite long in terms of what can cause valve disease.
• 4:47
  Nolan Alexander (Host): Doctors, people go about their day-to-day lives.
• 4:50
  What symptoms should people be watching for that might signal a valve problem?
• 4:56
  Peter Haigh, MD: Sure.
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  So most valve problems are identified by symptoms such as shortness of breath,
• 5:02
  exercise, intolerance, and fatigue.
• 5:05
  Sometimes they'll also have things like chest pain, dizziness, and passing out.
• 5:11
  Now all those symptoms can be due to a huge number of causes.
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  The list of things that can cause fatigue is just about endless.
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  So really, if you're having symptoms like that, the next step is go see your
• 5:22
  doctor and have them do a good physical exam and take a close, listen to your
• 5:27
  heart with a stethoscope if they find evidence of heart failure or heart murmur.
• 5:32
  The next step should be an echo or a heart ultrasound.
• 5:35
  And from there if there's a problem there, going to see a cardiologist.
• 5:40
  Nolan Alexander (Host): Well, let's talk about that.
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  If someone's coming to UK Healthcare, what can a patient expect when coming
• 5:45
  into the Valve program at UK healthcare?
• 5:48
  Peter Haigh, MD: So patient's who are referred to our valve program
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  can expect streamline expert care for their cardiology needs,
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  especially their valve disease.
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  After being referred, one of our nurse coordinators will reach out to
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  the patient and make sure that they understand where to go, why they're
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  coming to the appointment, and make sure that we on our end, have all the
• 6:08
  relevant tests and imaging results.
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  This way when the patient shows up to the clinic, we can have a meaningful
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  conversation about what's going on with their heart and their valve.
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  And there's not any wasted trips to the doctor while we're waiting on tests.
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  On some occasions, we may also arrange for a test on the same-day.
• 6:25
  One of those echocardiograms I keep bringing up so that we get a look
• 6:28
  at the valve then and there From there, we can then refer patient's
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  on, to an interventionalist or a surgeon if the time is right.
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  But the idea with our valve clinic is it's comprehensive, that we have everything we
• 6:40
  need under one roof And we can minimize the number of trips patient's are making.
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  'cause we realize that patient's are coming from sometimes, hours
• 6:49
  away across the state of Kentucky.
• 6:52
  Nolan Alexander (Host): That shows a real care for the patient.
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  And with that, what inspired UK to restructure its approach to
• 6:58
  treating those with valve disease?
• 7:00
  Peter Haigh, MD: Sure.
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  Nolan, I like to use the word restructure because it is true that
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  for valve disease we already have all the pieces necessary to take care
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  of patient's with valve problems.
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  in fact, for just about any valve problem, we now have options.
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  So if you go back 10, 20 years ago, if you had a valve problem that pretty much meant
• 7:20
  you're going to need to have surgery.
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  I always tell patient's a valve problem is a mechanical problem
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  and medications just doesn't work.
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  in this day and age, we now have minimally invasive approaches where
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  valve disease can be, corrected or fixed.
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  By going through the artery or vein, so through a catheter rather than
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  having an incision and going to the operating room for open heart surgery.
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  There's a lot of factors that influence which decision or which
• 7:47
  treatment is best for each patient.
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  But the point is valve disease has become much more, complicated to treat just
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  because we have so many different options of management various valve problems.
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  So having the surgeons, the interventional cardiologists.
• 8:02
  And cardiac imagers like myself, all under one roof.
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  All, seeing the patient together, is what makes this so special
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  for taking care of patient's.
• 8:12
  Nolan Alexander (Host): So how do you feel that that restructure, that holistic
• 8:15
  approach has improved patient outcomes?
• 8:17
  Peter Haigh, MD: we, wanna make sure that we have the experts from all the different
• 8:21
  areas weighing in on the patient.
• 8:23
  We have a conversation about the patient and get everybody's perspective
• 8:27
  on what's going to be best for that patient's anatomy and their valve lesion.
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  in addition, when patient's are referred to our valve clinic, they'll be enrolled
• 8:35
  into our valve tracking program, which will be, a system for us to make sure
• 8:41
  no patient's fall through the cracks.
• 8:43
  So if a patient has a valve problem, but it's not quite ready to be
• 8:47
  fixed, we wanna make sure that that patient doesn't get lost.
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  So they're going to need regular appointments, physical exams
• 8:55
  and imaging tests so that we can monitor the valve and catch it.
• 8:58
  when the time is right to intervene, And then after a patient does get a new
• 9:02
  valve, we wanna make sure that we're keeping an eye on that new valve because
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  as hard as we try, nothing is good of the valves that we're born with, although
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  technology's starting to creep up on that.
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  So all these different, procedures need to have appropriate follow-up care.
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  And for many patient's that'll mean not coming back to Lexington, but
• 9:21
  following with a cardiologist locally.
• 9:23
  But for those that wanna make the trip to Lexington or live close enough.
• 9:27
  we wanna make sure that we're doing everything on our end to
• 9:30
  make sure that, nothing progresses without us knowing about it.
• 9:34
  Nolan Alexander (Host): You've already demonstrated a great ability to try
• 9:37
  to put yourself in the patient's shoes as they go through this.
• 9:40
  Journey, but heart treatments and procedures, they can be
• 9:43
  very nerve wracking for so many.
• 9:45
  How do you support your patient's, both medically and emotionally?
• 9:49
  Peter Haigh, MD: Nolan, a great point that valve disease and all
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  cardiology test and procedures can be anxiety-provoking and nerve wracking.
• 9:58
  I think some of That is normal and human to have a little bit of anxiety
• 10:01
  before you have a procedure or surgery.
• 10:04
  And I find that it's the unknowns about these things that drive a lot of fear.
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  So I do my best when I'm sitting with a patient to explain.
• 10:12
  Hey, This is what your valve problem is.
• 10:15
  These are the treatment options.
• 10:16
  This is what you can expect for each of these approaches, and just removing some
• 10:20
  of those unknowns and uncertainties.
• 10:22
  But for those patient's that are still really having trouble coping
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  with the emotional mental health component, we actually have a
• 10:29
  dedicated cardiac, psychiatrist that we, can refer patient's to.
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  And I've heard nothing but glowing reviews from patient's that I've sent for this.
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  So we like to think that we have a really comprehensive approach for treating
• 10:41
  not just the heart, but also the mind.
• 10:44
  Nolan Alexander (Host): It seems like y'all have thought of everything.
• 10:46
  Peter Haigh, MD: we're certainly doing our best and we have a lot of help.
• 10:48
  We have a big team And we wanna make sure that This is gonna be good for
• 10:52
  patient's at the end of the day.
• 10:54
  Nolan Alexander (Host): So you mentioned some symptoms earlier, Signals to
• 10:56
  look for at the end of this podcast.
• 10:59
  If listeners are experiencing symptoms or if they have some concerns, what's
• 11:02
  the best next step for them to take?
• 11:05
  Peter Haigh, MD: great question.
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  So if patient's are having symptoms that, raise concern, like trouble
• 11:10
  breathing or exercise intolerance and fatigue, the next step is to get in with
• 11:15
  your family doctor who knows you well.
• 11:17
  from there, I'd recommend a really careful physical exam, taking a
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  good listen to the heart and seeing if, they hear anything abnormal.
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  From there, the next step is an echocardiogram to get
• 11:28
  a good look at the heart.
• 11:30
  Nolan Alexander (Host): And lastly is.
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  Anything else you'd like to add on this topic today?
• 11:33
  Peter Haigh, MD: I'd just like to restate that, this valve clinic is a huge
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  multidisciplinary approach from multiple different cardiologists coming from
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  different expertise from interventional cardiologists who specialize in those
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  minimally invasive procedures to our cardiac surgeons that can offer
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  state-of-the-art care and all the advanced surgical techniques for bowel disease.
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  To our imagers nurse coordinators, nurses, social workers, cardiac
• 11:59
  psychiatrists, cardiac pharmacists.
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  it's a huge undertaking, but I think it's gonna be great for patient's.
• 12:05
  Nolan Alexander (Host): It's a large team that works together And
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  we were so thankful to have Dr.
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  Peter Heg with us today.
• 12:10
  Dr.
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  Heg, thank you so much for your time.
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  Peter Haigh, MD: Thank you, Nolan.
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  It's been a pleasure.
• 12:15
  Nolan Alexander (Host): That was Dr.
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  Peter Hegg.
• 12:16
  If you enjoyed this podcast, please share it on your social channels
• 12:20
  and explore our entire podcast library for topics of your interest.
• 12:24
  and thanks for listening to UK HealthCast, a podcast from UK Healthcare.