MedEvidence Monday Minute: Discussing Heart Health & Music Trivia with Dr. Michael Koren

Narrator: 0:00

Welcome to the MedEvidence Monday Minute radio show hosted by Kevin Gettings of WSOS St. Augustine Radio and powered by ENCORE Research Group. Each Monday morning, Dr. Michael Koren calls in to bring you the latest medical updates with insightful discussions. MedEvidence is where we help you navigate the real truth behind medical research, with both a clinical and research perspective. So sit back, relax and get ready to learn about the truth behind the data in medicine and health care. This is MedEvidence.

Kevin Geddings: 0:30

Dr. Michael Koren joins us every Monday morning and he's a pretty good rock and roll affectionato knows this music pretty much inside and out. I've always found that people are either lovers of The Monkeys or they really are not big fans at all. There's like no middle ground. Where do you land, doctor?

Dr. Michael Koren: 0:48

I like The Monkeys. They have a fun sound. Actually, one of the more interesting things I read about The Monkeys came out in the St. Augustine paper recently, talking about how The Monkeys were touring with Jimi Hendrix in the 1960s. Did you read that piece, by chance?

Kevin Geddings: 1:04

No.

Dr. Michael Koren: 1:05

And you can talk about strange bedfellows. You can imagine it didn't go particularly well, since the demographics of the people who followed The Monkeys and followed Jimi Hendrix were quite different. But they actually toured together and actually played together in St. Augustine. So that was an interesting piece of medical trivia, I mean musical trivia, excuse me, before we get to medical trivia. Yeah, no, kidding.

Kevin Geddings: 1:28

Yeah, no kidding. Dr. Michael Koren is with us with ENCORE Docs. He joins us every Monday morning and, of course, he's very much involved in leading medical research that you can be a part of. You can be a part of clinical trials, get compensated but, more importantly, get access to some leading edge medical care and be a part of the future, which is pretty darn cool. We're going to talk this morning a little bit about heart health issues. Speaking of The Monkeys, of course, Davey Jones passed away from a heart attack. He was only 66 years old and died in Stuart Florida when he suffered that heart attack. Now, I don't think that was from congestive heart failure, which is what we wanted to talk about this morning, but it was still a heart health issue right.

Dr. Michael Koren: 2:06

Well, rock and roll is tough on the heart, Kevin.

Kevin Geddings: 2:09

Yeah, no, kidding, although that pig heart for Mick Jagger seems to be doing pretty well.

Dr. Michael Koren: 2:15

Yeah, well, he got, as I understand it, a taver valve, which is a valve that now can be put in without open chest surgery. So a great example of medical innovation and how things are advancing. Years ago, of course, you had to have your chest cracked open to replace a valve and that would take you off the stage for many, many, many months, but Jagger had a pretty quick turnaround.

Kevin Geddings: 2:37

So we've heard this term for decades. Maybe some of us have had family members that passed away from congestive heart failure. Help us understand as layman. Exactly when somebody gets that diagnosis, what's going on inside our bodies?

Dr. Michael Koren: 2:52

Yeah, that's a great question. So just let's break down the term congestive heart failure. So congestive means that your body, particularly your lungs, is filling up with fluid and you become congestive and typically you'll have crackles in your lungs and it's difficult to breathe. Those are the hallmarks. That's what we mean by congestive, and heart failure sounds really, really ominous and of course it's not a good situation, but it basically means that your heart muscle is not doing what it needs to do to meet the needs of your body. So you put those together and you get congestive heart failure. And what we learned over the years is that there are different reasons for congestive heart failure and we actually break it down into two major categories as physicians. One is called congestive heart failure with reduced ejection fraction, or CHF - REF and there's a congestive heart failure with preserved ejection fraction, and the ejection fraction is a measurement of how well the heart is contracting. So we have some situations in congestive heart failure where the heart muscle is weak, it's just not contracting well, and that's what we call HEF-REF, or heart failure with reduced ejection fraction. But there are circumstances where the heart muscle is actually contracting very well, just not efficiently, and we call that HEF-PEF, for preserved ejection fraction. So your doctor may refer to your congestive heart failure situation with either term either congestive heart failure with reduced ejection fraction, meaning reduced muscle function of the heart, or heart failure with preserved ejection fraction. So those are one of the important considerations that we think about medically. And then, of course, what it means for a patient is that you can't do as much as you'd like to do because you get short of breath, or if you wake up in the middle of the night having difficulty breathing, or you have struggles with things that you used to be able to do fairly easily. So all these things should lead to evaluation with a physician and a look at the heart muscle function to make a further diagnosis.

Kevin Geddings: 5:01

When you get these diagnoses today versus, say, 20 years ago, is the potential outcome better.

Dr. Michael Koren: 5:08

Oh, tremendously, tremendously better. So congestive heart failure was equivalent to being diagnosed with cancer 20 or 30 years ago and now it's quite manageable and in fact some people with congestive heart failure can experience a complete reversal of their symptoms and their underlying disease. So the whole biology of congestive heart failure gets pretty complicated. But one of the ways of thinking about it is it can be triggered by a number of different conditions. It could be hypertension we call it a hypertensive cardiomyopathy where over time the heart muscle gets very thick and inefficient because of the effects of blood pressure. It could be related to coronary artery disease, which are blocked, just the arteries that can damage the heart or make the heart operate less well officially than it should. It can be related to the heart valves, like Mick J agger, where the valves are either blocked or leaking and that leads to problems with the heart muscle over time. There's many, many other things that are called laundry lists of things that can affect the heart muscle function. So good physician will help a patient identify the underlying issues and correct them.

Kevin Geddings: 6:15

Once again, that's Dr. Michael Koren, with ENCORE Docs. Learn more by going to ENCOREDocs. com. Speaking of clinical research, if people have a heart condition, including AFib and the like, there are opportunities for them to participate in clinical research with ENCORE Docs, correct?

Dr. Michael Koren: 6:31

Absolutely, absolutely, in fact. So, getting back to the diagnostics of congestive heart failure, one of the issues is to identify problems when they're very early on in their genesis. And this is not only for humanitarian reasons, but quite frankly, it's also for financial reasons, because hospitals right now get penalized if they have a patient with congestive heart failure that was in the hospital that needs to be readmitted to the hospital. The hospitals now have a lot of incentives to identify people with congestive heart failure, treat them and then keep them out of the hospital. So, for example, right now we're working with monitoring devices that people can use. One of the neat monitoring devices that we're using is fabulous. You basically just talk into your phone and the phone uses an AI algorithm to determine whether or not things are getting better or worse for you with congestive heart failure. The other thing about research is that you don't need any insurance, medical insurance or any resources again involved in our programs, because they're provided free of charge. So in a lot of our studies we'll do an echocardiogram for you to see what the muscle function of your heart is. That can be extremely helpful. We're also studying some new drugs that we think to be particularly useful, and just a quick note on the drugs. Currently, there are three classes of drugs that are considered the cornerstone of treatment for congestive heart failure. And they all block different enzyme systems or hormone systems. One of them blocks something called angiotensin 2. One of them blocks something called aldosterone, and the third blocks adrenaline, which is a beta blocker. So that is considered the standard of care, but there are many other approaches that we're using right now to help people that have just a heart failure either with preserved ejection fraction or reduced ejection fraction.

Kevin Geddings: 8:19

Okay, well, learn more by once again going to ENCOREdoc. com. ENCOREdoc. com and, of course, on heart health related issues and all sorts of other health related issues. There's another great website. We want to make you familiar with Medevidence. com and I know Dr. Koren we will lose you here in a minute, but explain to our listeners what they'll find on that site.

Dr. Michael Koren: 8:42

MedEvidence is our platform to share medical information with the world. It's geared towards lay people, but physicians are telling me more and more that they enjoy the podcast, and really what it does is it helps you understand a medical situation through dialogue between physicians. So instead of just having a physician or somebody lecture to you, you actually learn a lot more when you see the give and take between two experts and we discuss whatever the issue is and you can see that issue from all sides and get an objective view of how to deal with that issue. So we like to call the truth behind the data. So, instead of going to Google and just getting some information that's trying to sell you something, you'll actually learn about the particular issue and then hopefully be able to make a decision that will benefit you and or your family.

Kevin Geddings: 9:30

Yeah, it's a great website. Highly recommend it. In addition to all sorts of content from Dr. Koren podcasts and the like, it's great information that you can trust as opposed to just trusting whatever you find on the internet. So go once again to MedEvidence. com. That's MedEvidence. com, and if you think you might want to participate in some leading edge medical research, you can do that right here in St. John's County with offices for ENCORE Docs at UF Flagler Hospital. Go to ENCOREDocs. com, actually right next door to UF, Flager Hospital. ENCOREDocs. com. Well, Dr. Koren, thank you very much for your time. We appreciate it and we'll talk with you again soon.

Narrator: 10:08

So it's a pleasure, Kevin. Have a great week. Thanks for joining the MedEvidence podcast. To learn more, head over to MedEvidence. com or subscribe to our podcast on your favorite podcast platform.