Q&A with Dr. Sameer Mehta: Vascular Disease Treatment
What is the most common cause of vascular disease?
The vast majority of vascular disease has to do with plaque formation, which can happen in any arterial bed in our body. That can be the carotid arteries, which can lead to strokes; the kidney arteries, which can lead to high blood pressure; the heart, which can lead to heart attacks; and lastly the legs, which can lead to either pain or non-healing wounds. Most of that is cholesterol deposition and not simply related to cholesterol. Risk factors of age, smoking, unhealthy lifestyle, diabetes, poor diet are things that contribute. There's a smaller percentage of rarer vascular diseases-- inflammation of the artery or other rare diagnosis— but in general, when we talk about vascular disease, we're talking about cholesterol deposition in the arteries. Video
How can I prevent heart disease?
We kind of break those down into couple aspects: one is diet. It's very hard to counsel patients about their diet in the office so I refer most patients to the American Heart Association website. That's where all our dietary experts have said ‘this is what we feel is the most heart healthy’. Secondly, the question comes up: should I exercise and how much exercise is beneficial for my heart. The exercise data shows that three hours of moderate exercise a week is what decreases the incidence of heart disease, stroke and death. Moderate exercise is truly that— walking, walking in a pool, water aerobics. It doesn't require joining a gym, it doesn't require going to CrossFit. It really is things you enjoy doing, for a relatively minimal amount: three hours a week decreases the incidence of heart disease. Video
Should patients with high cholesterol get a carotid scan?
There are times that we'll either look at a carotid scan, or what's called an EBCT score, which is a coronary calcium score taken by CT scanning. This gives us a relatively non-invasive assessment for having plaque in the arteries. Usually we will reserve ordering those tests for patients who do not have symptoms. For those patients that we’re not sure how aggressive we need to be with their cholesterol. For instance, if your cholesterol is mildly elevated and you have a family history of heart disease, those tests give us an idea that yes, you are forming plaque in your arteries and we will likely be more aggressive with your cholesterol management than we would if you were not. Video
How do your surgeries differ from traditional procedures?
Field couples with traditional surgery but is by no means traditional surgery. We're doing everything through small, quarter to half inch incisions where small tubes are put in the body. Through those tubes, we have access to the blood vessels in the heart valves where we can do things. We don't have traditional cutting and sewing, it's done through needle sticks and tubes so much less invasive. Video
Who gets peripheral vascular disease?
Major patient populations we see afflicted with bad peripheral vascular disease are patients who smoked, diabetic patients, and then lastly, elderly patients. As we age, our incidence of building plaque goes up. In that realm, those are the three patient populations we see. In the younger patient population, it's smokers and diabetics and then as we get older, it's a myriad of whomever. Video
What are vascular disease risk factors?
Vascular disease is very complicated. When we think of traditional risk factors for vascular disease, as we all get older the incidence of vascular disease goes up. Genetics play a big role in this. We're not super knowledgeable of what genetics mean but family history of heart disease, smoking, diabetes, high blood pressure and lastly high cholesterol. One of the more modifiable risk factors we have is cholesterol. And that can lead to blockages not just in the heart but in the legs and the kidneys and the carotid arteries that can lead to strokes. Video
What is interventional cardiology?
Interventional cardiology essentially encompasses procedures where we open arteries. That can entail opening arteries in the heart, opening arteries in the legs, the kidneys, the carotid arteries and more recently, adopting the ability to treat traditionally surgical conditions, specifically heart valves, with less invasive procedures where we can put heart valves in via catheters. Video
What is preventative cardiology?
The cardiologists in our group don't just specialize in their subspecialty, meaning I don't just practice interventional cardiology, I practice general cardiology also. One of the most important parts of my practice is what we would call preventive cardiology. One of the more rewarding things we can do for society is to delay or prevent heart disease. That goes with healthy living, healthy diet, controlling cholesterol, high blood pressure, diabetes etc. A large part of our practice focused on preventative cardiology. Video
What are common cardiac pain symptoms?
The most common symptom of cardiac pain is chest pain, but patients will often experience less typical symptoms. It is more common in women to have non-typical symptoms that's not chest pain. Other things that we think of are shortness of breath, exercise intolerance, exercise fatigue, fatigue. Some patients will experience jaw pain, some patients will experience shoulder or scapular pain or back pain. Lastly pain in the epigastrium, or "stomach pain" would be another thing to look for. That may be a sign of cardiac pain. Video
What is Rose Advanced Wound Care?
We've been very lucky as Rose has taken a very advanced step in the management of patients with critical limb ischemia, specifically patients who are at risk of amputation. Here at Rose, we have what's called Rose Advanced Wound Care, which is a center designed to help patients preventing amputations. I'm the co-director of Rose Advanced Wound Care, specifically the Vascular Director, so my role simply is for patients who are at risk of amputation to try my best to get blood flow to the wound so that it has the best chance of healing. We do that in a variety of methods. These all fit kind of in the realm of less invasive procedures. The general gist of this is to find the arteries that are blocked to the wound and in some manner of cutting out the plaque, ballooning open the plaque or putting stents in to try to restore flow to the wound so it can heal.
What are options for non-life-threatening blockages?
If patients have blockages that are amenable to putting stents in. That is, they benefit from a stent and do not need bypass surgery because the blockages aren't bad enough. Patients most commonly go home the same day barring complications or will go home the next morning. The things that comfort patients are almost immediate quality of life improvement, a not-quite non-invasive procedure but a less invasive procedure than traditional surgery and recovery time is quick. Usually within a week we let patients go back to their full activity including exercise. Video