When Hearts Attack

Sometimes ignoring a problem doesn’t make it go away. Mitral valve prolapse is often a benign condition, but without proper monitoring, it could lead to something worse, explains Marc Miller, MD. In this podcast, Dr. Miller talks about the importance of treating mitral valve prolapse – and the path to recovery from a heart attack.


[00:00:00] Stephen Calabria: From the Mount Sinai Health From the Mount Sinai Health System in New York City, this is Road to Resilience, a podcast about facing adversity. I'm Stephen Calabria. In today's episode, we're delving into matters of the heart.

[00:00:13] We're joined by Marc Miller, MD, a pioneering cardiologist and electrophysiologist, as well as an associate professor of cardiology at the Icahn School of Medicine in Mount Sinai. Dr. Miller shares his experiences in treating heart attack and cardiac arrest victims, as well as his and his Mount Sinai colleagues' research into a heart disease that affects millions worldwide.

[00:00:34] Arrhythmic mitral valve prolapse is a disease in which the valve between the heart's left atrium and left ventricle functions abnormally and can lead to cardiac arrest, even in asymptomatic patients.

[00:00:44] The condition has received a lot of attention recently and has been the focus of national news programs in part because of a tragic, high profile case that spurred the nation's policymakers and scientists to action.

[00:00:57] Dr. Miller and his colleagues are at the forefront of clinical research, helping to identify the condition's most at-risk patients. We're happy to welcome Dr. Miller to the show.

[00:01:08] Dr. Marc Miller, welcome to Road to Resilience.

[00:01:12] Marc Miller: Thank you for the invitation.

[00:01:13] Stephen Calabria: Now, you are both a cardiologist and an electrophysiologist. What is the difference between a cardiologist an electrophysiologist?

[00:01:22] Marc Miller: So a general cardiologist generally pays attention and treats cardiovascular disease such as cholesterol, high blood pressure, sometimes heart failure.

[00:01:33] A lot of preventative measures to prevent heart attacks in the future. A cardiac electrophysiologist is specifically focused on heart rhythm disorders. So, for example, we do our training in general cardiology, then we do an additional few years on heart rhythm disorders.

[00:01:51] And that basically encompasses therapies such as catheter oblation, as well as pacemaker implants and defibrillator implants.

[00:02:00] Stephen Calabria: What drew you to the work?

[00:02:02] Marc Miller: It was a new language for me. So after you finish general cardiology, some people further specialize, but to me it was a, a world I didn't understand and it was literally learning a complete new language and that was enticing for me.

[00:02:16] Stephen Calabria: What percentage of the population would you say suffers from cardiac rhythm disorders?

[00:02:22] Marc Miller: Actually quite a large percentage of the population. So The most common arrhythmia that we treat, which is something called atrial fibrillation, is present probably in 20 to 30 million Americans that know about it and probably another 10 to 20 million Americans who don't even know they have it yet.

[00:02:39] So it's a very common condition. So the patient population we assess is actually quite large.

[00:02:46] Stephen Calabria: Now, sir, as a cardiologist, you've had to contend a great deal, I imagine, with cardiac arrests, which are often conflated with heart attacks. Is there a difference between cardiac arrest and heart attack?

[00:03:00] Marc Miller: Yes, they're actually unrelated. A heart attack usually implies that there's been a blockage in the artery of a heart that causes damage to a portion of muscle of the heart. That is a heart attack.

[00:03:13] Cardiac arrest is an electrical phenomenon whereby the heart either stops in something called heart block, or more often, they go into something called ventricular tachycardia or ventricular fibrillation, which is the heart is beating so fast that it doesn't perfuse blood to the rest of the body.

[00:03:31] So, a heart attack is what you often think about when someone grabs their chest and says, I'm having chest pain, whereas cardiac arrest is, if you often, you've ever seen in videos or EMS, when someone suddenly collapses, and for example, they need to be defibrillated or shocked by one of those AEDs.

[00:03:50] Now, a heart attack can cause cardiac arrest, but cardiac arrest generally doesn't cause a heart attack.

[00:03:57] Stephen Calabria: From a bird's eye view. What are the causes and symptoms, most likely, of a heart attack?

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