Mukherjee Q&A Taking It To Heart

Taking It to Heart

Protecting your heart health is his priority: a question and answer session with Dr. Sunit Mukherjee, an interventional cardiologist at Holy Family Hospital.

In spring of 1996, Sunit Mukherjee, MD, arrived at Holy Family Hospital after extensive training in general cardiology and interventional cardiology at Boston Medical Center. Dr. Mukherjee specializes in the care of patients with coronary artery disease and congestive heart failure. However, his goal is to prevent heart disease by helping patients control their risk factors – especially hypertension.

Q. What does an interventional cardiologist do?
A. If you are having a heart attack or have a blocked coronary artery, an interventional cardiologist can find the blockage and open it to restore blood flow to the heart. We perform angioplasty (threading a tiny balloon through your blood vessels to a blocked area) to open blockages and place tiny stents in arteries to keep them open. These procedures are less invasive than open-heart bypass surgery.

Q. Your specialties are congestive heart failure (CHF) and coronary artery disease (CAD). What’s the difference?
A. CHF and CAD are both types of cardiovascular (heart) disease. CAD refers to blockages to the coronary arteries, which supply blood to the heart. There is a significant amount of CAD when at least one coronary artery has at least a 50 percent narrowing due to fatty plaque buildup.

CHF refers to the heart being unable to pump blood effectively to the rest of the body. This can happen when the heart muscle has been damaged by some type of disease, such as a heart attack or uncontrolled high blood pressure. Fluid builds up in the lungs and blood can’t pump effectively. CHF patients sometimes feel tired and out of breath. There is another type of heart failure where the heart muscle is too stiff and cannot fill with blood properly. The same thing happens: Not enough blood is pumped out to the rest of the body.

Q. You also focus on hypertension. What exactly is hypertension?
A. Hypertension is high blood pressure, which is a risk factor for all types of heart disease. If you have significantly high blood pressure, it can affect your heart, brain and kidneys. Hypertension is also called the “Silent Killer” because many patients have already suffered a major complication – a heart attack, stroke or damaged kidney function  - by the time they are diagnosed. Hypertension can be treated effectively with diet, weight loss and/or medical therapy.

Q. What are other risk factors for heart disease?
A. There are two types of risk factors – those we can change and those we cannot. By managing the risk factors in our control, we can effectively reduce our risk:

• Diabetes: Control your blood sugar with medication and healthy lifestyle habits. The better your blood sugar is controlled, the lower your risk of heart disease.
• Smoking: You have to stop smoking!
• Elevated cholesterol: A high “bad” LDL level can be treated with medications. A low “good” HDL level is more difficult to treat than , but things such as diet, exercise, weight loss, moderate alcohol usage and some medications can raise HDL levels.

We can’t change some heart disease risk factors, such as family history, but we should be aware of them. A “strong family history” for heart disease for men is having a first-degree relative (such as your father) with heart disease before age 45; for women, it’s a first-degree relative younger than 55.

Q. Do men and women have the same chance of dying from heart disease?
A. Heart disease is the No. 1 killer for both men and women in the U.S. However, women don’t complain of the traditional symptom of crushing chest pain that men complain about, so they may not be sent in for diagnostic testing. Women’s symptoms may include fatigue, or maybe they just have shortness of breath with exertion. These women need a stress test or echocardiogram to check their heart muscles and valves. If symptoms are not recognized, they end up with heart attacks or even worse, sudden death.
Women are at greater risk of dying from heart disease because their diagnoses usually come later than men’s. By the time the diagnosis is made, the disease is at a more advanced stage than it would be in a comparable man.

Q. What’s being done to diagnose patients with heart disease as soon as possible?
A. Getting preventive treatment depends on the patient calling us and coming in to see us. When you see your doctor, ask him or her questions and honestly express how you are feeling. If you are not feeling well, tell your doctor you want to know why.

Q. At what age should people begin thinking about cardiovascular disease?
A. We do not have set guidelines for heart disease screenings. Instead, heart health starts with teaching kids about nutrition, exercise and risk factors. All children and teenagers should understand the importance of healthful eating, adequate exercise and staying away from smoking and secondhand smoke. We can’t start early enough.

Q. Changing habits can be very hard. How do you encourage your patients to adopt heart-healthy lifestyles?
A. Unfortunately, it’s easier to convince someone to make heart-healthy lifestyle choices if they have already needed a heart intervention – such as a stent put in an artery or open-heart bypass surgery. But we hope it doesn’t come to that. Oftentimes it comes down to motivation: You don’t want to end up on an operating table when you can control so many of your risk factors.