[music playing] Lacey: Over 800,000 people have heart attacks in the United States each year.

Well, what if we told you there are steps to take to prevent being part of that statistic?

Sarah Bush cardiologist, Dr. Lakshmi, joins us in studio to explain how the average person can work toward preventing a heart attack.

Lori: They're the ones who raise the bar, the ones dedicated to providing care in the most demanding of circumstances, the ones that understand the healing benefits of kindness and compassion.

They're the people of Sarah Bush Lincoln, and they set the bar high.

Sarah Bush Lincoln, trusted compassionate care right here, close to home.

Speaker 2: For over 50 years, Horizon Health has been keeping you and your family healthy, and although some things have changed, Horizon Health's commitment to meet the ever-changing needs of our community has remained the same.

Horizon Health, 50 years strong.

Speaker 3: Carle is redefining healthcare around you, innovating new solutions and offering all levels of care when and where you need it.

Investing in technology and research to optimize health care, Carle, with Health Alliance, is always at the forefront to help you thrive.

[music playing] Lacey: Thank you for joining us for this episode of Being Well, I'm your host, Lacey Spence, and today we are talking about preventing heart attacks with Dr. Lakshmi, coming all the way from Mattoon.

Thank you for being here today.

Batlagundu: Thank you very much, Lacey.

It's a pleasure.

Lacey: Of course.

So, you are being a new guest to the show.

We like to get a little bit of a background, just so our viewers at home can get to know a cardiologist that they might get to see.

If you could, give us a little bit of background on who Dr. Lakshmi is?

Batlagundu: Fantastic.

I'm originally from India, I did medical school in India.

At the age of 24, I went to United Kingdom, and I did three years of residency in United Kingdom.

In 1992, I came to United States, to Chicago.

I did residency, I repeated it, residency and fellowship in Chicago.

And I finished the fellowship and came in '99 to Mattoon.

That was my first job, love at the first sight.

And then five years I worked here and went to Champaign for about 15 years, I'm back in 2020.

They called me and said, "We're going to restart the program here.

Why don't you come and join us?"

My wife used to be a physician here too, she worked with Dr. Colemans in the 2000s, and she's working in OSF in Champaign.

I have one daughter who just finished masters in Georgetown, in foreign affairs in Georgetown and looking for a job in New York.

She tells me that I don't understand what her degree, whatever it is.

I'm here, and I'm having a great time in Mattoon.

As you know, I know this place for a long time and I have a lot of patients seeing me, even when I went to Champaign.

It's like I have communication with this place.

A lot of nurses are good friends of mine and many of the nurses working here now still my old friends.

It worked out really great.

Lacey: And I hear Sarah Bush Lincoln is very happy to have you back.

Batlagundu: Fantastic, for both of us.

Lacey: We're talking today about preventing heart attacks.

Now, I'd ask you prior to the show if you're able to prevent heart attacks, and you said 100%.

Batlagundu: No, this is the most important thing.

Actually, we have been struggling with this question, why do people have heart attacks?

As a resident, as a physician, after I finished medical school, I didn't understand it.

Most of the public and lot of physicians think heart attacks are caused because of progressive narrowing of the coronary arteries.

There are patients or even doctors will come and say, "I wish they had a cardiac cath in my dad three months back, because they would've found out that he had significant disease and saved him."

It's wrong.

It took me a long time to understand the answer to the question, why do people have heart attacks?

You guys are lucky to know the answer, now you're going to get.

It's the plaque rupture, which means if you have done a cath on this guy about a month back, you would've had 50% or 60% disease and you wouldn't done anything about it.

It's not constantly progressive narrowing, as you would imagine, I would ask this as a quiz question, whenever I go, what do you think this guy's, I will show artery 100% occluded, about a month back, if I have done an angiogram, what do you think I would've seen?

Most of them say 90%.

It will be less than 60% blockage.

I want you to understand that.

So the vast majority of the heart attacks are caused by people who don't have significant blockage, but they ruptured a plaque, and 100% occluded, you get this massive heart attack we call stemmy where you have to go to the hospital soon.

And within 90 minutes you have to do balloon or stent in those patients.

So heart attacks are cause by plaque rupture, and you could prevent it because it happens in particular types of patients who have big plaques, people who are smokers.

People have high blood pressure.

People have genetic predisposition.

People are overweight and not able to exercise.

So there are various factors, but I want you doing the crux of the matter is not a 90% blockage, which will occlude it's that 50% to 60% blockage.

And on Monday morning, when you pick up a fight with your spouse, or you are arguing about politics after an election, you're rupture a plaque, boom, you get a heart attack.

Does it make sense what I'm saying?

Lacey: It might be a little more familiar for folks who have actually gone through it.

But to me I'm a little bit struggling with what is a plaque.

Batlagundu: So plaque is a combination of inflammation and fat deposition in the coronary arteries.

We have coronary arteries with supply the heart muscle everywhere.

There is blood supply to every part of the body.

So when you have the heart muscle has got the blood supply from the coronary arteries, there are one artery in the right side and a big artery in the left.

We divides it to two branches.

Normally they're clean, squeaky clean when you're born.

As we get older, we get deposits of fat and some inflammation, like dental plaque, they get the plaque, but you can't floss it out.

So these plaques became unstable because they get more cholesterol in it.

And once at some point they decide to rupture.

And we still, as I said, we know why they're rupture because of the high blood pressure, heart rate, arguments, genetics, and so on, so forth.

So these plaques will grow.

The issue is you won't know that.

Even if you do an angiogram, you will not see the plaque.

So a lot of the patients would say at the age of sixty, a had no symptoms, how did they get a heart attack?

Because the first symptom is a heart attack.

So you have to prevent it and we'll go over it during this talk about it.

Does it make sense what I'm saying?

Lacey: Yeah.

So then, I mean, let's start there.

Batlagundu: So the two things happen, when the plaque rupture, if it's 100% occludes the artery, they get this massive heart attack.

Those are the patients you see in the ER, sweaty and short of breath.

A lot of these patients don't make it to the hospital.

50% of them who die in the heart attack, they die because the heart is erratic and irregular.

So their heart will fibrillate.

And then you have about three to five minutes to save them.

So if you hear stories, many of them will say we died in the sleep, or they have a bowel moment and the strain or constipator, whatever it is, the strain ruptured the plaque, and they went to ventricular fibrillation.

So they don't die because of the heart attack.

It's secondary to heart attack, but that's because of an arrhythmia.

So the only thing which will save is if you get in resuscitate them within three to five minutes, sometimes the family members can do a CPR until the ambulance arrives.

So again, it's really hard to prevent it, once they get the erratic heart rate, unless you have support within a few minutes, that's why they die.

Once they survive that they come to the hospital and you put a balloon in, then people who die because of congestive heart failure and weakness.

But the initial death is caused by the ventricular arrhythmias, the erratic heart rate.

And the only way that would be saved is if you have see somebody who knows how to do CPR if they within five minutes, the ambulance arrives and they start the resuscitation.

So I want two things to clear, people get heart attack because of the plaque rupture.

And we'll talk about prevention.

They die because they develop an arrhythmia.

Sometimes patients have a defibrillator, which is like a small refrigerator inside the chest, which is the defibrillator is inside your heart.

That will defibrillate them from A-FIB.

But we only put those for people who had previous heart attacks and they have weak heart muscles.

Lacey: So the folks who, I mean, they haven't had any issues before.

If they don't have that defibrillator in there, there's nothing to restart the car.

Batlagundu: Correct.

Correct.

That's why, so the 50% of them they're going to die in the heart attack dies in first five to 10 minutes.

And so that's all the more reason to prevent heart attacks in the first place.

And that way we're going to talk about it.

Lacey: Yeah.

So, I mean, you're talking about kind of all-around it that we can prevent heart attacks.

So let's dive right in.

What is the best first thing someone can do?

Batlagundu: So the most important thing is information to know about it.

Many folks were extremely smart, would not know anything about heart or the health because they're scared.

It's like my dad is in India, he's very smart, he's 87, world read, traveled around the world.

He doesn't want to know, is there anything to do with the medicine?

He says, "I'll check with my son.

I don't want to deal with that."

So I think it's important to know information.

So it starts with, what is your BMI?

Basic metabolic?

What is your Basic Metabolic Index?

Normally it's less than 25 is normal.

I don't want to go into the details of it to know, "Okay, what's my BMI.

What's my blood pressure."

Everybody should have an idea.

I'm not talking about 20-year-old girl, like Maggie, but once you're more than 40, you should know.

What is your blood pressure?

What is your cholesterol?

And what is your blood sugar?

These are some basic information you're supposed to know.

I see many of them.

They're like, "I don't know.

What's my cholesterol.

My doctor will know it."

You have to know the information.

Diet and exercise, we hear so much about it.

I'm not an expert, but I'm just going to give some basic stuff.

I tell diet, anything which you can chew is generally good.

So what do we do whenever you're stressed?

We have a doughnut or an ice cream, which tastes good and immediately raises the blood sugar.

You want to eat an apple or vegetables, a healthy diet, a salad.

It takes time.

You have to chew.

That takes more time.

So vegetables, salad, fruits, white meats.

Those are the type of food you want.

There are a lot of details of it, but stuff is to say lot more vegetables and fruits and salads and cut down the red meat.

I'm not a lot of patients get really upset.

That's all I eat.

I tell people if you're eating red meat every day, make it every week.

If you're making every week, every two weeks, if you're doing every two weeks, once a month.

So kind of cutting it down.

Exercise is simply moving.

If you are smart, if you're going to the gym, forget that.

But most of them asked me.

I said, "If you're a walker, just walk for 30 to 45 minutes.

If you're a swimmer, the same thing."

Moving is good.

But the most important thing I tell about exercise, this is another secret today, the weight loss has nothing to do with exercise.

90% of the weight loss is related to the diet, but exercise will stabilize the weight, but make you feel good, which is important.

Everybody.

When you go to the gym, you look at the middle five times, even though nothing has changed.

If you notice it, particularly guys.

So diet, exercise, knowing the numbers.

Now, the real importantly, which we can do recently is something called coronary artery calcium scope.

Now I told you, plaques will develop from the age of 20 or 30.

So patients who were having extensive disease at the age of 60, probably started when you're 20 or 30.

And you want to know if I do a stress test, a lot of patients will say, "I had a stress test, which was normal doctor."

The stress test is only abnormal if you have more than 80% blockage, that's why we put balloon or stent.

But suppose you have a 30% or 40% disease.

The exercise stress test will be normal.

Does it mean you don't have coronary disease?

No, it means there's no critical blockage, but I told you, plaque rupture happens in less than 60% disease.

So the coronary artery produces calcium as a repair mechanism.

I almost describe as microscopic heart attacks are happening all the time in this patients.

So small that you can't see it.

The body produces calcium as the adaptive response, as a repair mechanism, this has nothing to do with the calcium you take.

Patients has this, "Can I take calcium doctor?"

This has nothing to do with the calcium.

So the body produces calcium.

Suppose you are 40 or 50 years old and we can do a CT scan.

It takes about two minutes to do the CT.

If your calcium score is zero, that means you have minimal atherosclerosis.

It doesn't mean you'll never have a heart attack, but you can smile.

Okay?

It's not bad.

Between zero to 100 is kind mild to moderate, 100 to 400 calcium score is moderate.

And if the calcium score is more than 400 or 1,000, that means you have extensive atherosclerosis.

Now we know that when you have extensive calcium, the risk of heart attack is increased.

The risk of dying with heart attack is increased.

Doesn't mean you panic, but at least you understand the information.

Lacey: That infer that knowledge.

Batlagundu: Knowledge.

So let's say you have a family stay of coronary disease.

Two, three members of the family of died of a heart attack.

They will come to me at 40 or 45.

I'll tell, "Okay, let's do a coronary artery calcium score.

If it's zero, I said, "Okay, we don't need to be too aggressive, but at least you still need to diet and exercise.

Lacey: It's not a free pass.

Batlagundu: It's not a free pass.

But if the calcium score is 500 or 1,000, I would aggressively treat them.

We know that if the LDL cholesterol, which is the bad cholesterol, is really low, less than 70, the risk of heart attack substantially goes down.

But all drugs come with some side effects.

You're going to put them on drugs to get them down.

There are lots of new drugs.

We have fantastic drugs to keep the cholesterol down.

We can eliminate coronary artery disease entirely from the world.

There is enough drugs to do that.

If you have the right patients and the right medical care and the right system.

So calcium score is the best way in addition to this, because if it is zero, it's really, really low.

If it's 1,000, it's really high risk.

So you know where you stand.

So that is what I would recommend for patients with intermediate risk.

Of course, if somebody's 25 years old, they're running marathon.

They have no, everybody in their family lived up to 1,000 years.

I'm exaggerating, but they don't need to undergo any test.

But lot of these patients between the age of 40 and 60 have risk factors and they're walking around in the community.

And I said, every heart attack, you miss the boat.

It's a failure on the part of all of us.

Every man's death diminishes me.

One of the famous poems is, because I'm involved in mankind.

So we are going to lose every time we have a heart attack, in the hospital, we take good care of them, but we missed an opportunity to stop it.

Because if I know his calcium score is high, if I know his blood pressure is high, if I know his blood sugar is high, would've aggressively treated him.

And I told you a 100%, it's 99.99% there's nothing is 100%, but do you get that point?

Lacey: Well, and it's important to realize that getting that annual wellness check with your doctor is so important to catch something early.

What age would you maybe recommend if I got heart disease in the family?

Batlagundu: So in general, I used to say men after 40, women after 50, assuming there's no significant risk factors, but there are exceptions.

Imagine about four or five members of the family died of a heart attack in young, there is a strong genetic predisposition because we are still learning about the genes.

So, I think if you have multiple, for example, cancers, I tell them, you can do mammogram, it's typically started 40, right?

But if you have three members of the family had breast cancer, I'll start at 30, but generally 40 in men are 15, women is what, because women are partially protected by the hormones and they start about 10 years later, I'm talking about average.

But more importantly, we do that test at Sarah Bush Hospital now as calcium score and they are doing extremely well.

What they do is at the moment, the insurance are not paying for this calcium score test, but they do for, I think a hundred bucks, correct me if I'm wrong.

For not only that, they look at the carotids and they do like fasting lipids and bunch of other tests, and they will give you the printed out result and tell you what to do.

So I think it is a very nice, many hospitals are charging a lot, and are they not doing it?

I mean, I have every week, a phone call from somewhere in United States or in the world because I have all these friends.

How to prevent it?

This is a question they're calling me and nobody has done a calcium score.

And four friends are family members have died in the last year of the heart attack in my family.

And two of them are doctors, from United States.

One is trained by me in Chicago, and is a body builder.

Another was in Florida is an internist.

My point is we somehow assume that it's not going to come to us.

I bet if you go to Sarah Bush and ask about 90% of the doctors or nurses, they would say, "Oh, I haven't checked it because I'm feeling good."

Because that doesn't tell you whether you have plaque or not.

And you don't know what's your calcium score.

Lacey: It's that rupture.

And it'll just sneak up on you.

Batlagundu: Exactly.

Exactly.

And that's why you were surprised.

The lot of famous personalities, there are one of supreme court judge just died a few years back.

He went to sleep, never woke up.

The famous NBC, Tim Russert, apparently had a stress test.

Tim Russert, I know he's very famous, and he just dropped dead about 10, 15 years back.

And these are not poor people.

That's the point I'm saying, I mean, there is information out there.

If you can only get those information.

Lacey: And so I believe it's called a heart-to-heart test.

Batlagundu: Correct.

Lacey: I've actually had one.

And I found it very interesting just to get that inside look, I've got heart disease in my family.

I do carry some extra weight, things of that nature.

So it was very eye opening.

Batlagundu: You look fantastic.

Lacey: Well, thank you so much.

Knocked out 40 pounds, prior to recording.

Batlagundu: Nice.

Lacey: Not that I'm worried.

So anyways, as we are talking about possibly wanting to get one of these, is this a conversation I have with my primary care physician?

If I'm concerned or will the doctor bring it up to me?

Maybe.

Batlagundu: I think we are trying to educate more primary care physicians.

I think many of the Sarah Bush guys knows about it, but you should discuss with the primary care physician, particularly as I said, if you have risk factors, I mean, you could do everything perfect and still things can go wrong.

And that's the reason why if you have risk factors, you should bring it up to the primary care physician, say heart-to-heart.

I try to do that conversation with many of my patients who refer to me, they have normal stress test.

And I say, and I'll be surprised sometimes, one of the physician who comes from Champaign to see me and my old friend, is a tennis player, extremely agile and looks really good.

He was 70, I said, "Let's do a calcium score."

It was 2,500.

I thought it's going to be normal.

Anyway, he had no symptoms.

I put him on statins.

We get the cholesterol as low as possible, right medications.

And the point is outward look can be deceiving, and particularly if you have risk factors, please discuss with your physician.

And as I said, once you go on the right medicine, it prevents the heart attack substantially close to 100%.

And even if they do have heart problem, it's not severe.

Doesn't make sense, if the patients were on appropriate medications, even if they get one or two problems, the heart attacks they'd be milder and they'd get better soon.

It also prevents a lot of this medicine, strokes and arrhythmia as well.

So they're all connected to each other.

Lacey: Definitely.

And so as we're talking about preventing heart attacks, how important is it also to pay attention to, like you said, the blood pressure and cholesterol, and making sure you're checking these things often.

Batlagundu: Absolutely true.

The blood pressure is in, we can talk for hours, but I want to do this.

The normal blood pressure is 120 over 80.

So those days we used to say, oh the age plus 80 it's okay, if they're 90 years, old blood pressure at 160 is okay, no, your blood pressure is normal, you rarely get strokes.

In my experience in more than 30 years, I'm getting old, that I have rarely seen patients who have normal blood pressure on stroke.

And also normal blood pressure prevents dementia.

A lot of this dementia happens because they get small strokes called Lacunar strokes.

These strokes happen in the front of the brain.

That's where your imagination and behavioral patterns.

So a lot of these elderly guys, they're all acting weird.

People say, "Oh, the old man is crazy."

No, they were having multiple strokes.

Because they had high blood pressure over the years and not treated.

So, normal blood pressure also proves biological aging because the arteries get stiff as we get older.

And if you can keep the pliable, the blood pressure is the pressure of the walls, the blood on the walls.

And if you keep your blood pressure normal, you don't age.

I'm talking about vascular aging, not the outward look, but again, so normal blood pressure means almost no stroke, prevents aging, prevents dementia.

So you got to check your blood pressure and get it right.

Now blood sugar, there are lots of good medicines have come recently to keep the blood sugar down without major side effects.

They're actually beneficial, preventing heart attacks and preventing congestive heart failure.

So talk to the doctor and the normal A1C should be, A1C is the average of blood sugar, or three much less than 6.5.

If you've never checked it, check A1C.

Particularly if you think you're lot of full blood sugars and fasting blood sugar more than 125 is diabetes, between 100 and 125, we call prediabetes.

So you could check the A1C, and if it's more than 6.5 you're diabetic.

Doesn't mean you need to need medicine.

You could do exercise and stuff like that.

So I will check.

And then cholesterol, you should at least check it.

Every adult after they have 20 or 25, every five years, I'll check the cholesterol.

This is for patients who have no problem with that, every five years as an adult, check your blood cholesterol to see where you stand.

So it'll give an idea.

We talked about body mass index, there a lot of people argue if a muscular, it can be high, but if it's less than 30, that 24 is what the definition between 26 and 29 is obese and more than 30 to 40 is obese, and more than 40 is morbidly obese.

But my suggestion is you want to know where you are, and be honest about yourself.

I think most of us are scared and we just somehow think that it's going to disappear either it's blood sugar or overweight.

They don't want to talk about it.

I think if it come you're honest about it, discuss with your doctor about it, and anxiety, which has actually gotten worse over the last few years in this pandemic, people are anxious to discuss about a lot of things to the doctors.

So I think if you establish a good communication with the doctor and talk about it, it's been much more beneficial to doctors and we have so many things to offer.

Lacey: Well, and it's funny that you bring up anxiety, because I was going to ask about in our last couple of minutes here.

Managing stress, externally, internally, how important is that?

Like you said, I mean, it could just be the fight with the spouse heading out the door, but that could be the nail in the coffin.

Batlagundu: Absolutely.

And that we looked at this data, patients who are depressed more likely to get heart attack.

And when they have heart attack, they're depressed, and nobody talked to them about it.

There are so many psychosocial issues with that, relationship with the wife or husband after heart attack, romance.

So many people are scared after bypass surgery about relationships.

I think it's become a taboo to discuss this thing with doctors.

I think we need to change the culture where you feel comfortable discussing with the doctor or patients who have erectile dysfunction.

They need to talk about medications with it because it's important to have good relationship with your spouse.

Particularly with heart disease.

Anxiety and stress are the most important thing, particularly in the last few years, as I said in America, doctors, probably nurses and doctors who are probably the worst effective, because they're under so much stress.

They don't want to talk about it.

Because it's a taboo to discuss anxiety with anybody.

We grew up in a culture where you have to be manly or womanly, which means you don't discuss your personal problems.

Stress and anxiety are the main reason.

A lot of us are talking about now yoga, meditation, it's become meditation has really become so famous.

I started doing meditation the last two years.

I do 12 minutes in the afternoon and 12 minutes at night, where you sit down quietly, and I do it in the office between 12:45 and 1:00.

I think these are the... You don't need to be particular type of meditation.

For you, the meditation is watching TikTok.

I mean, that's what my nurse say, or maybe relaxing or maybe going for a walk or listening to Simon and Garfunkel or whatever new music you have.

So I think, and these are things we should promote.

Even at work, we should give them 10 or 15 minutes where people have this kind of relaxation classes and every year to discuss with their physician about it, about the issues, various issues.

So I think all of them will make a tremendous change.

We have the technology.

The question is, are we using it?

Lacey: That's a very good question, Dr. Lakshmi.

Well, we are out of time for this episode, but a lot of great information.

Thank you for coming on today.

Batlagundu: Thank you very much.

It was a pleasure, Lacey.

Lacey: You're so welcome.

And we can't wait to see our viewers for our next episode of Being Well.

So we'll see you next time.

Speaker 3: Carle is redefining healthcare around you, innovating new solutions and offering all levels of care when and where you need it.

Investing in technology and research to optimize health care, Carle, with Health Alliance, is always at the forefront to help you thrive.

Speaker 2: For over 50 years, Horizon Health has been keeping you and your family healthy, and although some things have changed, Horizon Health's commitment to meet the ever-changing needs of our community has remained the same.

Horizon Health, 50 years strong.

Lori: They're the ones who raise the bar, the ones dedicated to providing care in the most demanding of circumstances, the ones that understand the healing benefits of kindness and compassion.

They're the people of Sarah Bush Lincoln, and they set the bar high.

Sarah Bush Lincoln, trusted compassionate care right here, close to home.

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