Cardiologist Answers Heart Questions From Twitter | Tech Support | WIRED

- I'm Sunil Rao, a cardiologist at NYU Langone Health.

Let's answer some questions from the internet.

This is "Heart Support."

[upbeat rhythmic music]

@ThiggyMan asks: "Ay...

What heart rate is considered too high?"

There's no one number

that's considered too high for everyone.

If you have a fever, if you have the flu,

your heart rate may go up to 120, 130,

and that's probably, quote, too high for you.

Let's say you're on the treadmill and you're wondering,

"Gosh, how high should my heart rate get?"

Well, there's a rule of thumb that you can remember.

220 minus your age.

So let's say you're 40 years old.

That would equal 180 beats per minute,

which would be really the maximum heart rate

that you're aiming for.

Really what you wanna do is try to get

to about 70 to 85% of that heart rate,

which would be somewhere between 145

and 155 beats per minute while you're exercising.

If you notice that your heart rate's going above 180,

you probably oughta cut back a little bit.

tehRisa asks: "I need a doctor to tell me medically

what is happening in my chest when my heart skips a beat

while reading a cute romance manga."

Occasionally what will happen is that the heart

will have a beat that occurs prematurely.

Well, the heart has a way to compensate for that.

It has a pause,

and then it gets back on rhythm.

It's that pause that you're feeling

when you say your heart is skipping a beat.

Many of us have occasional skipped beats that happen.

Maybe we had a little too much caffeine that day.

Maybe we're nervous about a job interview,

nervous about a first date.

That's very, very common.

But if you notice that your heart is skipping beats a lot,

you may have what's called an arrhythmia.

Arrhythmia's just a general term

that says there's something wrong

with the electrical system:

atrial fibrillation, atrial flutter,

ventricular tachycardia, there are a whole bunch

of other things that can be diagnosed very, very easily

by getting an EKG.

Okay, so next question.

"EKGs, how do they work?"

EKG is an electrocardiogram.

Here's a normal EKG.

And you can see that these lines are occurring

at a very regular interval.

And the baseline has a few curves on it,

but those curves are pretty much the same

with every single beat that's happening.

That's a normal EKG.

And what does an abnormal EKG look like?

First of all, these deflections that are going up and down

are occurring very, very irregularly.

Look at the spaces between these deflections.

You see how there's so many different waveforms here?

There are lots of lumps and bumps.

This is an EKG of a person who has something

called atrial fibrillation.

And that's when the top chambers

of the heart beat irregularly.

So let's go to our heart model.

So there are the upper chambers of the heart,

and there are the lower chambers of the heart.

When someone has atrial fibrillation,

the top chambers of the heart stop beating.

And that's that irregular waveform

that you pick up on the EKG.

The problem with that is that the blood can pool

in parts of the heart.

And if it forms a blood clot,

no matter how tiny it might be inside the heart,

and that blood clot travels to your brain,

it can put you at risk for having a stroke.

@ChicagoSeavey asks: "Guys I can hear my heartbeat...

Without a stethoscope????

Is that normal???"

It's very, very common to hear your heartbeat in your ear.

So a lotta people can hear it when they're laying down

and when they're going to sleep.

You may be even be hearing the blood going

through the blood vessels in your neck.

Some people hear it, some people don't.

That's a very, very common finding

and really nothing to worry about.

@BaseballMurse7 asks: "True or false:

you can restart the heart with a defibrillator?"

Well, that's true, you can.

Now, there are a couple things that are important

to keep in mind here.

Oftentimes, on television,

they show, for example, a patient's heart who's stopped

and the monitor shows a flat line.

You actually can't use a defibrillator to restart

a patient's heart if they're flatlined.

What you do use it for is when the bottom part of the heart,

these chambers of the heart, go into something

called ventricular fibrillation.

In other words, they're not beating.

They're just quivering.

And because these chambers are responsible

for pumping blood to the rest of the body,

if they're not pumping,

the rest of the body ain't getting any blood.

And so the external defibrillator that we use

when someone has a cardiac arrest can basically restart

the heart and get it pumping again.

But you can't do it if the person's flatlined.

@derapops asks: "Is broken heart syndrome a real thing?"

Absolutely, it's a real thing.

In fact, I just treated a patient

with broken heart syndrome this morning.

It's a situation where the heart all of a sudden

stops working normally

because of some kind of psychological stress.

Even on the EKG,

it can look like someone's having a heart attack.

And when we look for blockages,

we find they don't have any blockages.

But the good news is that that recovers over time.

These patients often go on to have normal lifespans.

But absolutely, yes, broken heart syndrome is a thing

and we're seeing more and more of it,

just because of life stresses

that people are having these days.

@kjewels71 asks: "Will we ever learn what happened

to Damar Hamlin...exactly what caused his cardiac arrest?"

So Damar Hamlin, a professional football player,

he unfortunately had cardiac arrest during a game.

And what happened to him is that he was hit in the chest

at exactly the right time during the electrical activity

of the heart so that his heart stopped.

It has to happen in such a specific time

of what we call the cardiac cycle

or during the normal heartbeat

that it is a very, very rare phenomenon.

And thankfully, he's really become an advocate

for community education around CPR,

so that if someone does have a cardiac arrest,

they can be resuscitated very, very quickly.

It's really important for all of us really

to get educated about basic life support and CPR.

So rolls asks, "i train and work out a [beep] ton

why is my resting heart rate still fast asf?"

First of all, it may be that even though you're hitting

the gym a lot, maybe you're not doing enough cardio.

Your heart rate when you're just resting

should be somewhere between 60 and 100.

Anything below 60 is probably a little too slow,

but keeping in mind, marathon runners, for example,

they'll have very, very slow heartbeats.

And that's normal for them.

So to find your own resting heart rate,

what you wanna do is sit in a quiet room,

feel your pulse in your wrist or in your neck,

and count the beats for six seconds.

Multiply what number you get by 10,

and that'll give you what your resting heart rate is

in beats per minute.

If you're in pretty good shape,

you're exercising regularly,

and your resting heart rate still is high,

it's probably a good idea to see your doctor

and just get checked out.

itzkayshoe asks: "Hey guys what are the signs

of a heart attack?

I can't feel my arms."

Well, I'm not that if you can't feel your arms,

that's really the sign of a heart attack.

The classic symptoms of a heart attack are chest pressure

or chest tightness.

You may feel shoulder pain

either in your left shoulder or both shoulders.

It may radiate to your jaw.

You may feel jaw pain.

Women may have symptoms

that are a little bit different from men.

They may feel shortness of breath.

They may feel profound fatigue

that's really abnormal for them.

A heart attack is when part of the heart muscle dies

because the blood supply to that heart muscle

has been choked off.

I have a picture for you here that shows

the blood vessels that supply the heart muscle.

What you see here is there's a narrowing

in that blood vessel,

and that blood is not able to get past that blockage.

That's what causes the pain that people are feeling

in their chest, and our job as cardiologists

is to diagnosis this as quickly as we can,

go in there and actually open that blockage,

which is exactly what we do

with balloon angioplasty and stents.

@chicafromthechi asks, "So does a low dose aspirin

help prevent heart attacks or not?"

If you don't have manifests of cardiovascular disease,

it's really not recommended that you take an aspirin,

specifically if you're trying to prevent heart disease.

It doesn't prevent heart attacks

and does put you at risk for bleeding complications,

because aspirin can be directly irritating

to the lining of the stomach.

Aspirin is a blood thinner.

And because a heart attack involves blood clots

that are occurring inside the blood vessels of the heart,

aspirin can actually address those blood clots

by actually breaking them up and reestablishing flow

to the heart muscle.

If you have cardiovascular disease already,

aspirin can prevent future heart attacks

by gently thinning your blood.

Or if you're actively having a heart attack,

it can treat a heart attack by breaking up the blood clot

that's causing it.

But if you don't have either one of those things,

low-dose aspirin really is not gonna prevent you

from having a heart attack.

@DoGsMoveSilent says: "You get served this for breakfast.

What's your reaction?"

My reaction is, I probably didn't order this.

But let's take a look at what's on this plate.

Processed meats can be very, very high in saturated fat,

but they also might be high in salt.

So for example, the beans, which are a great source

of protein and fiber, you know,

these beans might be from a can.

And canned vegetables and canned beans do have

a lot of salt in them. For most of us, salt is fine.

But some of us do have what's called

salt-sensitive hypertension.

And minimizing the amount of salt or sodium in our diet

can certainly protect you

from developing high blood pressure.

Eggs are perfectly fine for you.

They're a great source of protein.

You should eat the yolk.

You know, one of the reasons that people said

that eggs were bad for you,

'cause they said it was high in cholesterol.

It turns out that dietary cholesterol contributes

very, very little to your blood cholesterol.

What does contribute to your blood cholesterol

is saturated fat.

And prepared appropriately,

eggs can be very low in saturated fat.

I'll confess, I love French fries.

But anything that gets fried can increase saturated fat.

Saturated fat in and of itself can increase

your blood cholesterol,

and blood cholesterol is directly linked

with the development of heart disease like heart attacks.

@BettyPhuck9 asks: How does covid affect your heart?"

Well, COVID has a lot of effects on the heart.

The viruses can infect the lining of the blood vessels,

leading to blood clots forming and an increased risk

of heart attack.

COVID-19 can also affect the heart muscle itself

and weaken the heart muscle.

During the pandemic, we saw an increased risk

of heart attacks, so it's really, really important

to try and avoid COVID-19 and prevent it if at all possible.

@Batla_G asks: "A 45 years old close relative has found 100

and 95% blockage in two arteries

and they're exploring options between Stents and Bye Pass.

Can someone suggest what's less risky?"

Well, I'm sorry to hear that your relative's having issues.

I certainly can't comment on their specific case,

but let's talk a little bit about stents and bypass surgery

and what they do.

So a stent is just a wire mesh tube

that's made out of a specific type of metal

that goes inside the arteries of the heart muscle

and props open blockages.

It may be a blockage

that's filled with cholesterol, for example.

So the stent is this metal part,

and it comes crimped on this balloon.

And this red tip is the end of the balloon catheter itself.

Once we position this on the X-ray in the right spot,

we can use this device

and push saline, which is salt water,

and expand that balloon.

What I'll do is I'll turn this device

and push that saline into this balloon.

There is goes.

And it pops open that stent.

I can then deflate the balloon

and remove the balloon catheter

and then leave the stent behind.

So that's how stents work.

But how does bypass surgery work?

A surgeon will take blood vessels oftentimes

from your legs or maybe from your arm

and attach them to the aorta here

and put it into an area that's past the blockage.

Think of it as a blocked highway.

So if the highway is blocked,

oftentimes there's a bypass that goes around it.

Around 12% of the patients with atherosclerosis

affecting the heart get bypass surgery.

About 65% or so get stents.

@catgirlgale says: "wtf is a cholesterol?"

Well, cholesterol is just a substance in your body

that's all over your body.

It's an integral part of the cell membranes

that make up your body.

But cholesterol also can float around in your body

and cause blockages in the blood supply to the heart muscle,

the blood supply to your brain,

the blood supply to your legs.

There are different types of cholesterol.

There's good cholesterol and there's bad cholesterol.

Bad cholesterol's the one

you really oughta pay attention to.

It's also called LDL cholesterol.

That's the cholesterol that if it's too high

can cause heart attacks and strokes.

It's important to minimize the amount of LDL cholesterol

that's measured in your blood.

Exercise, minimizing the amount of saturated fat.

There are some very, very good and very, very safe medicines

that will allow you to lower your blood cholesterol.

One of the more common medications for cholesterol

is something called LIPITOR.

The generic name is atorvastatin.

It's a very cheap drug.

It's incredibly effective and has been shown

not only to lower cholesterol safely

but also prevent heart attacks.

lazzypoo asks: "how does the human heart just do that?"

The human heart is really pretty amazing.

It does a lotta things.

It pumps 100,000 times a day.

It pumps 2,000 gallons of blood

through nearly 60,000 miles of blood vessels.

It's got these blood vessels that are going into it

and coming out of it.

Now, they're not really this color inside the body,

but these blue blood vessels are carrying blood

that needs oxygen.

The organs in your body have already used the oxygen.

They're sending it back to the heart.

It comes in through this right side of the heart,

and these white structures here are valves

that open and close and allow the blood to flow through.

And then it pumps through the right side

and goes to the lungs where it can pick up the oxygen

that we're breathing.

And that blood then comes back

to the left side of the heart.

And the left side of the heart pumps it

through this giant blood vessel that you can see here

called the aorta.

From the aorta, there are all kinds of branches

that go to all the organs throughout the body.

And they can then get the oxygen that they need

for normal functioning.

@SarahBarleyMc asks: "Can anyone tell me

how Heart Rate Variability impacts on your health?"

Heart rate variability is just the normal variation

in our heart rate during the day.

A lot of consumer goods are measuring things

like heart rate variability.

The reason that heart rate variability is important is

that it's an indicator of a healthy heart.

Because if you're getting excited, for example,

your heart rate should go up.

If you're relaxed, your heart rate should come down.

If your heart rate is unable to maintain

that kind of variability,

it's a sign that something may be abnormal

with your cardiovascular health.

Probably the thing that matters a little bit more

than heart rate variability is what's called

heart rate recovery.

So for example, if you're exercising,

how fast does your heart rate return back to normal?

Your heart rate probably should come back

to 90% of your resting heart rate

after you stop exercising within two to three minutes.

If it's taking longer than that,

you can actually improve your heart rate recovery

by continuing to exercise.

@rosamarei asks: "wtf is a heart murmur

and why do I have it?"

Well, a heart murmur is just a sound

that your cardiologist or your doctor hears

when they listen to your heart with a stethoscope.

Here's what a normal heartbeat should sound like.

[heart beating]

And if you have a heart murmur, that's an extra sound.

So if you have aortic stenosis or a narrowing

of the aortic valve, for example,

that sounds a little bit like this.

[heart beating]

Some murmurs do develop when you're a child,

and they go away.

Some murmurs, you may not have until you get older.

As we get older, our heart valves,

they're just a little bit stiffer than when we were younger.

And that can cause a heart murmur.

But again, it's completely normal

in that particular setting.

@EvieeMcLovin asks: "how do pacemakers worq?"

So your heart itself has pacemakers.

The muscle of the heart has in it electrical fibers.

So it can continue to beat regularly

to pump the blood to the organs

so that they can get the blood that they need.

Sometimes, as we get older, for example,

those pacemakers stop working,

and we have to put in what's called an external pacemaker.

This is a pacemaker, and as you can see,

it's very, very small.

These wires will plug into this pacemaker battery,

and it goes just under your skin on the left side

of your heart.

And then, those wires will actually go inside the heart.

The pacemaker itself will take over the pacing function

of the heart.

It will actually send out a regular electrical signal

through these wires.

And those wires will deliver that electrical signal

to the heart muscle itself and allow the heart

to beat normally.

@CarperG64 asks: "How do fit athletes

have heart attacks at 23 yet people drink,

eat badly and live to 90+ and never have a heart problem?"

The reality is, some of heart disease

is determined through genetics.

And we can't choose who our parents are,

and heart disease does run in families.

Some of the reasons why a young person

could have a heart attack could be

because they have some genetic issue with their cholesterol,

something called familial hypercholesterolemia.

That just means that there's a genetic abnormality

that makes their cholesterol really, really, really high.

There are some other very rare conditions,

something called spontaneous coronary artery dissection,

where the linings of the blood vessels

that supply the heart muscle themselves tear.

And that can cause a blockage in the blood flow.

Those are really unusual circumstances,

and really, for all of us,

we should be following a healthy lifestyle.

@user_1_1 asks: "Is it true that there's a correlation

between gum health and heart health?"

Yes, there is a correlation between gum health

and heart health.

We know that patients who have terrible gum disease

are at a higher risk for having cardiovascular disease.

It might just be coincidence, but you know,

it's probably a good idea to maintain both

good cardiovascular health and good gum health.

@IreneChosen asks: "What diet is best

for reversing heart disease?"

There are some studies that suggest

a plant-based diet can reverse heart disease.

The downside with a plant-based diet

is it can be very, very difficult to follow and adhere to.

But there are some principles that are important to follow.

Increasing the amount of fiber in your diet

is really, really important.

Try to make sure that you have four grams of fiber

for every 100 calories that you're eating.

Minimizing the amount of saturated fats

so that it makes up less than 20%

of the overall caloric intake.

@ThatCapeVerdean says: "Show me how alcohol

and cigarettes affect the heart."

Well, I can't really show you,

because alcohol and cigarettes affect the heart really

over a lifetime of use.

If you're someone who's really drinking a lot,

that can affect the heart abnormally

because it can weaken the heart muscle itself

and predispose you to having something

called congestive heart failure.

Alcohol itself in large doses is toxic to the heart muscle.

Cigarettes work a little bit differently.

At least seven years of smoking is really what it takes

to really affect the heart.

And what cigarettes do is,

the nicotine itself can directly damage the lining

of the blood vessels.

Then cholesterol starts getting attracted to that area,

and it starts building up.

And it can predispose you to having a heart attack.

Cigarettes also can increase your blood pressure.

And increased blood pressure makes it harder

for your heart to pump its blood to the organs

that need the oxygen.

@ElidhGant says: "High blood pressure means

your heart pumps harder to circulate blood.

Exercise means your heart pumps harder to circulate blood.

I'm confused, why is one bad and the other good?"

When your blood pressure goes up during exercise,

after you stop exercising, it comes back down to normal.

In fact, if you exercise regularly,

long-term, your blood pressure's actually lower

because it's good for your heart.

The other term for high blood pressure is the silent killer.

Because you feel fine,

but your blood pressure is high.

And it sets you up for all kinds of bad things.

A stroke, it can lead to heart failure

because your heart is pumping so hard

and eventually just sort of tires out and weakens.

High blood pressure as a disease is very, very different

from blood pressure transiently going up

and coming back down during exercise.

So those are all the questions for today.

Thanks for watching "Heart Support."