Heart Disease – How to prevent it, catch it early and treat it with cardiologist Dr. Samuel Congello

Speaker 1:

Welcome to Mason City: Docs on Call, a podcast series with North Iowa specialists who educate us about how to stay healthy. I’m your host, Carol Gifford.

Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 33 seconds in the US from heart disease. With us today is board certified interventional cardiologist, Samuel Congello, who will help us understand how heart disease develops in people, who is most at risk, how to lower your risk, as well as the medical and surgical options for treating patients. So welcome to the program Dr. Congello.

Speaker 2:

Thank you for having me.

Speaker 1:

So heart disease does seem to be an epidemic in this country. Do you agree?

Speaker 2:

It’s definitely epidemic and it’s growing. As obesity grows and diabetes grows, of course cardiac disease grows. It’s the number one cause of death in the United States as heart-related issues, myocardial infarctions, heart failure, peripheral vascular disease. In fact, in women it’s the number one cause of death. More women die of heart disease than all the cancers women have combined. So as people don’t realize that, they stress their breast cancer and all these cancers. But heart disease is a number one killer of women. Number one killer of everybody.

Speaker 1:

And I’m wondering, do women not have the understanding of how their symptoms or risk factors are different than men?

Speaker 2:

Yeah, women’s often present in different ways. Less typical, less chest pain, more fatigue, more tiredness, more atypical symptoms, more nausea. So they have to have a high threshold of suspicion and people don’t think about it. Traditionally, it’s always been a male disease. Although that’s changing, they get more and more recognition because we’re doing better as doctors tell them. But women have to be cognizant. And it usually reaches them at an older age than men. But because it happens when they’re older, they also get sicker and have a higher mortality. So it has to be recognized early and treated early.

But I think it’s not as much stressed in the press as the breast cancers and things like that and it really should be. Because it is the number one cause of death for women.

Speaker 1:

And how do genetics or family history factor into risk factor for all populations?

Speaker 2:

I mean, the biggest risk factors for heart disease of course are family history, and that’s genetics. And then the next would be diabetes and then smoking, and then high cholesterol and then hypertension. But the two big ones are family history and of course male sex, but you can’t help that. It was all genetics. Genetics is a very important, one of the most important issues of heart disease. That’s something you can’t control though, that’s the problem.

Speaker 1:

So let’s say you don’t have hypertension and you don’t have diabetes and you’re in pretty good shape, but you know that someone in your family has had, or more than one member of your family has had some sort of heart disease, what do you do? Do you just talk to your primary care physician about it? Do you see a cardiologist?

Speaker 2:

You talk to your primary care physician. There’s screen tests they can do. There’s risk scores they can do, there’s tests you can get, calcium scores, cholesterol levels checked. There’s all kinds of things you can do. A lot of people, 10% of people, the first sign of a blocked artery is a heart attack. And 10% of a heart attacks, the first sign is you die. So I think people have to be aware and cognizant and talk to their family doctor and say there’s things you can do.

An easy test you can do is a CT calcium score, and that’ll show you your risk of heart disease. I think the thing is, if you have a family history, you have to be aware. Especially early histories. Atherosclerosis starts at a young age. During the Vietnam War, the autopsies of soldiers showed there was plaques and arteries in people in their twenties and thirties. So it’s an early disease. You got to catch it early and treat it early.

And as obesity gets more prevalent, as diabetes gets more prevalent in younger age people, it’s going to be more prevalent.

Speaker 1:

So when patients come to you and they have hypertension, they have diabetes, they’re overweight, they’re smoking, are you trying to… So what as a cardiologist are you talking to patients about? Are you trying to help them quit smoking, look at their diet, get more active? What happens?

Speaker 2:

We always try to do risk factor modifications. First find the disease, then treat the disease, and of course, better to prevent the disease. And that’s more in the primary care milieu than me. When it gets to me, it’s already been diagnosed, they have it.

Speaker 1:

I see.

Speaker 2:

But I think we surely have to aggressively treat their risk factors. And we can actually, if you get their cholesterol very low and treat their diabetes and treat their obesity and get an exercise program and get them on a reasonable diet, often shown you can regress plaque, you can make the blockages be less. And there’s all kinds of new and more aggressive anti-cholesterol medicines that are very effective and lots more options than we had even the last, even from five years ago that we have now.

Speaker 1:

Wow.

Speaker 2:

So it’s an up and growing field. And I think the recognition of the importance of these things is much more relevant than it was before. And also with the diabetic epidemic and obesity epidemic, it’s become much more important to stress these issues.

Speaker 1:

Why has it become an epidemic in the United States? Why is there so much obesity? Why is there so much diabetes? Why is there so much hypertension?

Speaker 2:

I mean, I’m an epidemiologist. I don’t know for sure, but my suspicion would be Americans are much less active than they used to be. They’re not out running around, their kids are playing video games. More fast food, more processed foods. People are busier so they do less home cooking, they do more processed foods. The portions are large. With obesity comes all these other issues. So I think the main problem is the obesity epidemic because of just poor lifestyle choices people are making. They’re less active and they’re eating less home-cooked meals, more processed food, McDonald’s, huge portions. So I think that’s a lot of it.

Speaker 1:

That’s the problem. Yeah. So let’s say a patient comes and there needs to be an intervention, a surgical intervention. So can you walk me through a variety of different interventions that you provide at the heart center here for patients?

Speaker 2:

So we have many options, and that’s the exciting part about cardiology, how many options we have. So you can have, suppose you have blocked arteries in your heart, we can balloon those open, we can put stents in, we can drill them out. We can put drug-eluting stents in drug-eluting balloons in. If you have a slow heart rate, we can put pacemakers in. If you have a weak heart, we can do devices to help your heart be stronger. We can replace your valves, we can repair your valves. We can put devices in that make you have less chance of having stroke. There’s all kinds of options we can do. We have bypass surgery, of course. Which has been around for years, but it’s gotten much more sophisticated and better outcomes. And the options are growing and growing and growing. There’s more and more stuff available every day. There’s more research, more things become available. There’s more and more non-invasive ways or less invasive ways to treat heart disease than we had before. And these are new aggressive cholesterol medicines. Shots can get once a week, or shots you can get twice a year that drive your cholesterol down, actually regress plaque at a pretty fast rate are just very exciting.

And there’s way down the road, there’s things where they are making antigenic-neutral pig hearts. You have heart transplants and there’s all kinds of exciting things. They’re putting cells and 3D printing artificial organs. The technology is just the next 20, 30 years, it’s just going to be amazing options we’re going to have.

Speaker 1:

Wow. Right. So do sometimes people think if they’re going to have some sort of heart intervention that they’ve got to go north or south and they can’t do it in Mason City? What would you say…

Speaker 2:

I think less, when I came here three years ago, we had a cath lab and a trailer and that’s what we were. And now we have four cath labs. We have a training program for cardiologists. So we’ve trained cardiologists here. We have three spots to train cardiologists, we have 490 applications. People want to come here and train for our three spots.

Speaker 3:

Wow.

Speaker 2:

So I think most people now recognize our reputation. And people don’t usually go elsewhere unless we send them for some really strange thing we don’t have. There’s very few services that we don’t offer that they offer someplace else. Some of my patients refer to us as a small garage. You go to the big garage, you can go to the small garage, you get the same thing taken care of and people know who you are. And that’s what I like about being here personally, is that you can practice tertiary referral center care in a small town hospital. I know my patients, they know me. I see them at the grocery store, I see them at the restaurant. They send me Christmas cards, they bring me cookies. It’s more personal than just where you go to a big thousand bed institution. You do your procedure from somebody you don’t know and you’ll never see again. And then see a different doctor the next day, and then the third doctor when you see him in the office was a different guy every time you go back. That would not suit me personally. Some doctors like that, but it’s not for me. I like to see my patients. At the grocery store I always, my joke is on a Sunday at Hy-Vee is good for three office visits because-

Speaker 1:

I love that. And so some of the cardiologists in the department do outreach, right? They go out into communities. Why do you think that’s important for the patient population?

Speaker 2:

We all take turns. I was in Britt yesterday. I think it’s nice to go out and see the patients in their communities. It’s good for the community hospital too. It keeps them in business, which is important. ‘Cause you have to have easy access to healthcare. You don’t want to have to drive two hours if you’re in an emergency situation.

I think it saves these older patients from driving. Why should 30 patients drive and see me when I can drive half an hour and see 30 patients? It’s much easier for me to go. And personally, I don’t mind doing it. Nice drive. The nurse drives, you go out. Eat at a restaurant locally, you get to meet people, the referring docs, and it’s more convenient. ‘Cause we go two hours in every direction. I think we do 56 outreach clinics a month, our practice.

Speaker 1:

Yeah. That’s incredible. So what do you love, I mean you sort of said it already, but what do you love the most about being a cardiologist here in Mason City?

Speaker 2:

Oh, I mean, I think I like cardiology in general because there’s so many different things you can do. You can have procedures, you can have x-ray procedures, you have radiology procedures, you have imaging. You have surgical procedures, and you have primary care procedures. I have patients I’ve taken care of for 25, 30 years. I have patients I’ve taken care of them, their fathers, and I take care of their kids now. ‘Cause they’ve had this family history, they have heart disease. And I like that ability to have that type of connection with patients and their families that I wouldn’t get at a big tertiary referral center. So I get to practice the big city medicine in a small town situation. That’s a very rare thing.

And as we bring physicians in, recruit physicians, they all say the same thing. They all want to stay because they like that kind of atmosphere of not being just a cog in a wheel, having commitment to the patients and the community and not just be doing procedures. It’s a personal connection. And I think that makes the care better too. I think that makes the care better. If you know this is Mr. Smith and you’ve taken care of Mr. Smith’s grandfather and father, and it’s not just the female in room 552.

Speaker 1:

Right. There’s one thing that has come up in recent years is sleep apnea. Sleep apnea, I think, has been sort of misunderstood, but now I think a lot more people understand what it is. How is that connected to a risk of any sort of heart disease or…

Speaker 2:

Oh, sleep apnea markedly increase your risk for heart disease. Increase for heart attack, increase your risk of stroke, increases your risk of heart failure. So I think it’s very important. And we are very aggressive in treating it here and screening for it. In fact, we just recruit another sleep physician. And of course as [inaudible 00:12:38] grows, sleep apnea grows. And the treatment options grow also. But I think what’s recognized is we thought it just sort of an annoyance, but now it’s definitely a health issue. It needs to be treated. It can’t be ignored.

Speaker 1:

Right. Interesting.

Speaker 2:

And [inaudible 00:12:52], you can have a weak heart and treat your sleep apnea and over the next six months it’ll improve. So it’s something you can see benefits from quickly.

Speaker 1:

So is there one patient that sticks with you that you’ve taken care of over the last… How long have you been here? 35 years you said?

Speaker 2:

33.

Speaker 1:

33. So you’ve treated thousands of patients.

Speaker 2:

Tens of thousands of patients.

Speaker 1:

Tens of thousands of patients. Is there one patient story that sticks with you that you think about from time to time?

Speaker 2:

Oh, I have lots of patients. My most recent one was this 89 year old lady who I took care of, who was very ill, who had a super high-risk procedure, who was turned down for multiple surgeries, who had renal failure. And people giving up on her. And we took care of her here and got her better. And I just called on the phone ’cause I hadn’t heard from her, and she’s not going to be on dialysis. Doing great. And she sent a donation to the Humane Society in my name ’cause I have eight dogs at home, so she thought of that.

I have another patient, I take care of the husband and the wife. And last year, maybe 23 dozen cookies. And he was just in the hospital and brought… It’s not good for my diet or my diabetes, but it’s good. It’s good. I have tons of patients like this. They’re actually more part of my family than patients, Christmas cards and…

Speaker 1:

Wow.

Speaker 2:

And they come, drop things off at the house. And I’ve taken care of their kids, and I can just go on and on. And that comes to the advantage of being here 33 years.

Speaker 1:

Well, thank you for talking to us today Dr. Congello. It’s really eye-opening. I think we have to get in and see our primary care doctor or cardiologist early, right?

Speaker 2:

That’s correct.

Speaker 1:

Okay.

Speaker 2:

Don’t be one of the 10% that your first sign is die suddenly. Then it’s too late.

Speaker 1:

Exactly.

Speaker 2:

It’s not good for me and it’s not good for you.

Speaker 1:

Well, thanks for being on the program.

Speaker 2:

Thank you.

Speaker 1:

Thank you for listening to Mason City Docs On Call. For more episodes, go to mcclinic.com/radio-podcast.