How healthy is your heart?

Signs it’s time to see a cardiologist

Cardiologists specialize in the prevention and treatment of heart disease, treat coronary artery disease, high blood pressure, valve disease, heart failure, heart rhythm disorders, problems with blood vessels, and elevated cholesterol.

Your primary care doctor takes care of your overall well-being, but if he or she finds a potential heart condition, you will be referred to a cardiologist, who works as an extension to the primary care team and focuses on cardiovascular issues. Cardiologists spend an extra three to six years of training focused specifically on cardiovascular disease and, therefore, can offer more experience when treating heart and vascular disorders.

BJC Medical Group cardiologist Michael Missler, MD, says the patients he sees with high blood pressure are generally in their 40s and 50s, while those who suffer heart attacks are typically in their 60s. “The important thing to remember,” he adds, “is that heart disease can happen at any age.”

Primary care doctors often refer patients to a cardiologist if they have heightened risk factors for heart disease, heart failure or if their heart condition requires more specialized evaluation and treatment. “The relationship between a PCP and a cardiologist is a partnership for managing the most effective treatment for a patient.”

Although there is not a certain age to consider seeing a cardiologist, conditions that increase your risk of heart disease include:

• high blood pressure
• elevated cholesterol
• diabetes
• smoking
• lack of physical activity
• unhealthy weight
• diet high in fat and salt
• excessive alcohol
• family history of heart disease

Risk factors or symptoms that indicate it may be time to see a cardiologist include:

• chest discomfort
• shortness of breath
• swelling in your legs
• light-headedness
• passing out
• fatigue easily with activity
• abnormally fast or slow heart rate

Complete our heart health assessment to understand your risk of heart disease.

What to expect during your first visit to a cardiologist

Visiting a cardiologist for the first time might seem intimidating and you may be nervous but detecting a problem and taking early steps to treat your heart issues increases your chances of living a longer, healthier life. It’s important to make the most of the time with your cardiologist by planning ahead for your visit.

You will be asked both general health questions and some more specific questions related to the reason for your visit. A physical examination follows, and if necessary, your cardiologist might order further testing.

Addressing the concerns that many first-time patients have, Metro Heart Group cardiologist Aaron Tang, MD, says, “Many patients are nervous and that is normal. We take time to put patients at ease by answering their questions when assessing their heart health and disease risk. Knowing what a cardiologist will do during your first visit and preparing in advance can help you relax and get the most out of your upcoming appointment.”

Initial visits with a cardiologist include learning about the patient, and appointments are tailored to a patient’s specific symptoms or condition. When meeting with a cardiologist for the first time, patients should be prepared to:

• Bring a list of current medications. It is important to include any vitamins and supplements.
• Bring a list of heart-related issues, identifying what symptom(s) you have been experiencing and what you were doing when the symptoms occurred.
• Share your family medical history. Your family history is filled with important clues, so be thorough, especially if your relatives, including your parents, siblings and grandparents, have high cholesterol, diabetes, heart disease and high blood pressure.
• Discuss your medical history. List your surgeries, along with any medical procedures, including previous cardiac results.
• Schedule additional testing like a stress test or echocardiogram.

Questions to ask your cardiologist

• What lifestyle changes do I need to make?
• Will this medication have certain side effects I should watch for?
• Why did you order that specific test? What does it do or look for?
• Can you explain my test results to me?
• Should I make any changes to my daily activities?
• What warning signs should I watch for that indicate my condition is worsening?
• How will my condition progress?

Your cardiologist is an important member of your care team — a team that centers around you and your health. Take full advantage of the time, develop a good personal connection, and remember that no matter how small the detail, there's nothing too minor to bring up at your appointment. “It is important to be completely honest with your cardiologist,” Dr. Tang says, “so that we are aware of what is happening at home and what you are putting in your body. You never know what information could lead to the right diagnosis and treatment.”

From routine office visits to more complex care, our team of heart experts in St. Charles County bring together their expertise to treat all types of cardiovascular disease. Call 314-273-2315 or request an appointment with one of our heart specialists today.

Know the Warning Signs of a Heart Attack

Tanya English was physically fit and led an active lifestyle. Having a heart attack seemed an unlikely event for her. But when the warning signs were there, she knew to seek help.

Knowing the warning signs of a heart attack can make a big difference. The faster someone having a heart attack can get care, the better the outcomes, according to Dr. Linda Stronach, a BJC Medical Group cardiologist practicing at Missouri Baptist.

Only 40% of women who were having a heart attack actually thought they were, as many women have symptoms other than pain in their chest.

Time is muscle, and the faster we can improve blood flow to the impaired heart muscle, the better the outcome for the patient,” Dr. Stronach said.

Men and women experience similar warning signs of a heart attack, Dr. Stronach said. “The most common symptoms are chest discomfort or pain; but women are more likely to have other symptoms like shortness of breath, nausea/vomiting and back or jaw pain.”

Subtle Warning Signs

Heart Attack Warning Signs in Women

• Pain or pressure in the chest, upper back, jaw or neck
• Shortness of breath
• Indigestion
• Flu-like symptoms such as nausea, vomiting or cold sweats
• Unexplained weakness or fatigue
• Feelings of anxiety, loss of appetite or malaise
• Sense of impending doom or a feeling that “something isn’t right”

Even though heart disease, including heart attack, remains the leading cause of death in women, women often overlook warning signs and symptoms, thinking they are less life-threatening conditions. Unfortunately, even if the signs are subtle, the consequences of a heart attack can be fatal.

Tanya almost overlooked the signs. While exercising, she felt discomfort in her upper chest but felt better after resting. That evening, she experienced a similar sensation after eating pizza with peppers but dismissed it as heartburn.

“I didn’t think anything was wrong with my heart because I’m healthy and don’t have a family history of heart disease,” Tanya said. “Plus, I was able to walk and talk without difficulty during the episodes.”

The next day, however, Tanya’s chest discomfort returned and became more intense with arm and shoulder pain.

“I knew that I had to go to the emergency room,” she said.

Call 9-1-1

Dr. Stronach stresses the importance of calling 9-1-1 if a heart attack is suspected. “Paramedics can provide lifesaving measures on the way to the hospital and alert the emergency room so that the teams are ready to act.”

When a heart attack is identified, the staff in the Emergency Department and cardiologists on the cardiac catheterization team at Missouri Baptist Medical Center work closely together to make sure patients are treated as quickly as possible.

In the case of a severe heart attack, patients may receive emergency treatment in the catheterization lab to open the blocked artery. The Cardiac Cath lab at MoBap uses the latest diagnostic imaging equipment to provide detailed imagery of the heart to determine the need for further treatment.

“If a patient is experiencing a smaller heart attack, we can often stabilize them with medication first before scheduling a cardiac catheterization,” Dr. Stronach said.

An Unexpected Diagnosis

In Tanya’s case, the emergency room team performed an electrocardiogram (EKG) and blood work that confirmed she had a small heart attack. She was admitted to the advanced cardiac care unit for further testing, observation and treatment.

Tanya met with Dr. Stronach, who explained that she suspected Tanya suffered a spontaneous coronary artery dissection (SCAD), an uncommon condition that occurs when a tear forms in one of the heart’s blood vessels.

To check Tanya’s heart and to help plan her treatment, structural heart cardiologist Dr. Gus Theodos performed a cardiac catheterization the next day.

During this procedure, he gently advanced a catheter to Tanya’s heart through a vessel in her arm. The catheterization found adequate blood flow to her heart with no blockages, and stenting wasn’t needed.

Getting Back to Normal Life

A day after the procedure, Tanya was placed on a medication regimen and discharged home. She participated in cardiac rehabilitation and continues to follow up with Dr. Stronach.

Looking back on her experience, Tanya feels fortunate. “Don’t ignore symptoms,” she advised. “I never thought I’d have a heart attack.”

Dr. Stronach echoes Tanya’s advice. “If something doesn’t feel right, contact your medical provider and seek help. Discounting or ignoring warning signs and symptoms is a risk that is too great to take.”

Coordinated Heart Care Between Hospitals

When Robert Malon, 74, of O’Fallon, Mo., was experiencing drainage and congestion in his chest, he went to see his BJC primary care physician. Though Robert was not experiencing any chest pain, she ordered a stress test and echocardiogram be completed. His results came back normal, but Robert’s symptoms persisted. His doctor referred him to Mark Lewen, DO, a BJC Medical Group cardiologist at Barnes-Jewish St. Peters Hospital, who performed an EKG.

“The results showed I had a previous heart attack, probably a long time ago,” says Robert. “I had no idea.”

A follow-up cardiac catheterization revealed a 90% blockage in three major arteries — coronary artery disease. Robert had been experiencing angina, which is a condition where reduced blood flow to the heart causes chest pressure.

The cardiologists at Barnes-Jewish St. Peters and Progress West Hospitals have the capabilities to diagnose and treat a range of heart conditions. “By offering a full array of cardiac services in St. Charles County, patients enjoy greater convenience,” says Michael Missler, DO, a BJC Medical Group interventional cardiologist. “And if patients need more advanced intervention, we can easily coordinate that care within the BJC network. We also work collaboratively with primary care physicians to ensure our patients receive the best care possible.”

Advanced Heart Therapies at Missouri Baptist Medical Center

Robert needed to be immediately transported via ambulance to Missouri Baptist Medical Center, whose surgeons routinely partner with BJC Medical Group cardiologists to perform advanced heart surgery. Joshua Baker, MD, a cardiothoracic surgeon at Missouri Baptist, was informed of Robert’s case and ready to meet with him and his family when they arrived.

The St. Charles County Ambulance District (SCCAD) plays an important role in these interfacility transfers in addition to providing life-saving emergency response. “Interfacility transfer is a specialty of ours,” says Josh McGaughey, lieutenant for the interfacility transfer division at SCCAD. “During transit, we consider ourselves an extension of the hospital. Great care is initiated there, and we pride ourselves on continuing that level of care.”

“As a family member of a critically ill patient, the BJC system has it all,” says Jodi Malon, Robert’s wife. “I can’t imagine being outside of this system. The care was seamless from the primary care doctor through the end.”

Follow-up Care Close to Home

Heart care patients receive complete care, including care after surgery. Convenient cardiac rehabilitation — a specialized gym where nurses help design workouts and monitor progress — is available at Barnes-Jewish St. Peters Hospital.

After recovering from open heart surgery, Robert received his follow-up care in St. Charles County. Always active before, Robert had to relearn how to exercise and eat for his newly healthy heart. Many patients continue coming to the rehab center after their ordered care ends because they find comfort with being monitored by the nurses.

Now, Robert is enjoying time with his wife, Jodi, and his children and grandchildren. He’s also able to do the activities he wasn’t able to do before, like restoring vintage cars. “I’m back,” says Robert. “Because of the good results I had, from the initial diagnosis to the surgery and follow-up care, I’m able to do what I enjoy, and that’s stay active.”

The BJC HealthCare family of hospitals allows patients, like Robert, to access a higher level of comprehensive, coordinated heart care without relying on him or his family to do all of the logistic work. Whether in an emergency situation or through a referral, our heart care team works together to provide seamless care so you can focus on getting well.

Courtney

Courtney Ewert knew something in her body felt odd, but she gave it little thought until she began losing weight. “I noticed over a few weeks that my size was smaller and when I weighed myself, the change was not normal.” Originally from Chicago, both she and her sister were diagnosed with dilated cardiomyopathy as children. The inherited condition causes the heart to become enlarged and not pump blood effectively.

Even with heart disease, Courtney continued to lead a normal life “I was very active—regularly running, biking, swimming and lifting weights.” She married, moved to St. Louis and had two children. As a 31-year-old, full-time mom of a toddler and a newborn, it was difficult to make time for her own health. In addition to the weight loss, Courtney had a nagging sinus infection that sent her to a neighborhood Walgreens clinic. It was there a doctor noticed her heart rate was elevated to 170, and suggested she see her local cardiologist for a check-up.

Her cardiologist confirmed the abnormally high heart rate and, upon further testing, referred Courtney to Barnes-Jewish Hospital for advanced heart therapy. Within 24 hours of her initial visit, Gregory Ewald, MD, Washington University cardiologist and director of the advanced heart failure and cardiac transplantation program at Barnes-Jewish Hospital, diagnosed her with advanced heart failure.

Heart failure is a serious health condition that occurs when the heart cannot pump enough blood to the rest of the body. Heart failure commonly develops because of underlying conditions, like the dilated cardiomyopathy Courtney was diagnosed with as a child.

A few years ago, Courtney’s sister passed away from complications related to cardiomyopathy. “It was a crazy whirlwind,” she says. “I was scared the same thing would happen to me.”

Courtney was admitted to Barnes-Jewish Hospital in September 2016. Along with the heart failure diagnosis, Dr. Ewald and Joel Schilling, MD, Washington University cardiologist at Barnes-Jewish Hospital performed additional testing. They found her to be in critical cardiogenic shock, which takes place when the heart has been damaged so much that it is not supplying enough blood to other organs of the body.

As a result, an assistive device was implanted inside Courtney’s heart to temporarily support a failing left ventricle, and help it pump blood to the rest of her body. Due to the worsening of the cardiogenic shock, she developed failure in both ventricles. So Courtney was placed on extracorporeal membrane oxygenation, which is a temporary support device that supports both the left and right ventricle as they work to pump blood. Known as ECMO, this assistive technology also functions as a lung, providing oxygenation throughout the body. Barnes-Jewish is one of the few medical centers in the St. Louis region to offer this therapy to patients for various periods of time.

“She was resilient,” says M. Faraz Masood, MD, Washington University cardiothoracic surgeon at Barnes-Jewish Hospital, who performed all of Courtney’s procedures. “And her husband and parents supported her every step of the way.”

A week later, because of the lack of cardiac recovery, she had a left ventricular assist device (LVAD) implanted by Dr. Masood. LVADs are mechanical pumps serve as a bridge to heart transplantation, providing long-term support. These are implanted when a patient is a candidate for a heart transplant, but their condition is not yet strong enough for such a major surgery. With the LVAD, Courtney was able to be discharged from the hospital, recover and become a patient eligible for transplantation.

Finally in March 2017, Courtney was able to receive a heart transplant at Barnes-Jewish. “The doctors and nurses were phenomenal,” she says, “very caring and nurturing, particularly the one-on-one care. I never felt like I was alone. Every day a doctor was at my bedside, always checking on me and keeping my family informed.”

The procedure and recovery went smoothly. Says Courtney, “Post-op recovery came naturally for me. I was in pretty good shape prior to the surgery so I just had to regain muscle mass and rebuild my body.”

However as someone who is physically active, she is getting accustomed to having a denervated heart, which is typical with any heart transplant. Unlike her old heart, the new organ is not connected to her brain like before. It relies on internal electrical impulses in the right atrium, generated by circulating hormones. This causes a slower response than if the nerve connections to the brain were still intact and makes it critical for Courtney to warm up and cool down with any vigorous activity.

“With a new heart, the hardest thing has been getting it ready to move. I can’t just get up and jump around anymore. I can go for a run, but I am getting used to warming up first.”

An added bonus of the transplant is that the cardiomyopathy Courtney had earlier in life was removed with the old heart.

Says Courtney, “I am free from heart disease for the first time in my life.” Next month, Courtney and her family will celebrate the two-year anniversary of her transplant. In addition to enjoying her role as a full-time mom, she has run a 5k race with one big goal in mind. “I have a long way to go with training, but my dream is to compete in the Chicago Triathlon next year.”

When asked to offer advice for heart disease prevention, Courtney says, “Be smart and get checked out. Don’t risk your life—listen to your body. People tell me ‘You’re so young to go through all of this’, but I say it can happen to anyone.”