Skip to playerSkip to main contentSkip to footer
Beasley Digital
  • 2 days ago
Electrophysiology With Dr. Darius P. Sholevar, MD, Virtua Health

Category

😹
Fun
Transcript
00:00Welcome, everybody. I'm Andrew Salchunas. You can hear me on 97.5 The Fanatic, the midday show from 10 to 2, Monday through Friday.
00:07I love doing these. I was telling Dr. Sholivar before we even got on, I love doing these things.
00:12You know, I have family that is in the medical field, so this stuff excites me.
00:15I learn a lot, even more than I thought I already knew, which, let's face it, I don't have a medical degree, so I don't know as much as Dr. Sholivar today.
00:21So I am joined by Dr. Darish Sholivar, electrophysiology lab director and lead physician as a part of the Virtua Health team.
00:29Doc, your resume is incredible. You know, we all know the MD part, but you're also FACC, FHRS, a bunch of letters that mean a lot.
00:38That means that you did a lot of great stuff in schooling and getting to where you're at today.
00:42Electrophysiologist with Virtua Health System, Dr. Sholivar obtained his medical degree from Jefferson Medical College, which is awesome.
00:49Postgraduate fellowships in cardiovascular disease from Albert Einstein Medical Center and cardiac electrophysiology from the University of Medicine and Dentistry.
00:59Of New Jersey. So a local guy. I appreciate that. Dr. Sholivar is board certified in both electrophysiology and cardiovascular diseases and is deeply involved in research and clinical trials related to heart rhythm.
01:11Doc, what's going on, man? Thanks for coming in today.
01:14Good morning, Andrew. Thank you so much for having me.
01:16I appreciate when the bio is longer and longer because it just tells me how incredible you are, how much I could trust you when it comes to all the information that you're going to give us today.
01:24So let's start by talking about electrophysiology. What exactly does an electrophysiologist do?
01:30So that is probably the most common question I get from people because a lot of times most of the people I see already have a general cardiologist.
01:38When they come to see me, they say, doctor, my cardiologist sent me to see you and you are a clinical cardiac electrophysiologist, which is what my board certification is.
01:46People have no idea what that means. So what I am is a heart rhythm specialist.
01:51So what I do is I diagnose people with heart rhythm disorders.
01:55I treat them if they have the condition. And in addition to that, I also will try to prevent heart rhythm disorders in certain situations.
02:02So the most common thing that people are familiar with is a pacemaker.
02:06If people have a slow heartbeat, they get a pacemaker installed.
02:09But there are a variety of other things we do in terms of defibrillators and in terms of something called a cardiac ablation,
02:16where we find abnormal heart rhythms that are occurring, go into the heart and try to modify the heart's electrical system so that people no longer have a problem.
02:25Now, what was your inspiration to becoming a heart rhythm doctor?
02:27I mean, for me, I like sports. So I talk sports. I didn't really go on a ledge here.
02:32Obviously, you doing everything that you had to do to get to where you're at right now.
02:35What was your inspiration?
02:36So that's an interesting story. And I think a lot of doctors and a lot of people look at people and they see the MD after your name.
02:43When you get done with medical school, you're an MD.
02:45But in the United States, most people have to train for a minimum of three more years to practice medicine.
02:50So when I went through medical school, I think my entire coverage of cardiac electrophysiology was probably about two hours during four years of medical school.
02:58So when I got out, I started my internship. I'm a brand new doctor being supervised by other people.
03:02And the first experience I had was with a doctor named Mark Preminger at University of Medicine and Dentistry.
03:09And I had a patient who was in the midst of having a cardiac arrest.
03:12Blood pressure was in the 60s. We treated him.
03:15We were shocking him with defibrillators, doing all types of things.
03:17We couldn't get this guy out of the abnormal rhythm.
03:20I've been a doctor for about a month.
03:22So basically what happened is we consulted the electrophysiologist.
03:26He came in, looked at the patient, very, very relaxed.
03:29Everyone is going crazy in the emergency room, very relaxed.
03:32He's like, let me go to my car.
03:33So I'm like, what do you mean you're going to your car?
03:35So he goes to his car and the patient had a defibrillator.
03:38And he goes and gets the defibrillator programmer and uses that to connect to the wires inside the patient's heart.
03:44Basically turns the patient's heart rate up a little bit above their cardiac arrest rhythm and completely stops the abnormal rhythm when everything else we were doing in the emergency room didn't work.
03:54And, you know, with the experience I'd had in medical school, I had no idea what was going on.
03:59I thought it was the coolest thing I'd ever seen.
04:01So a couple of weeks later, I followed him for a whole day.
04:04And he had a 22-year-old woman, had been completely healthy, no problems whatsoever, no past medical history.
04:10But this poor woman was having heart rates of over 200 beats a minute.
04:14Whenever she got it, she would pass out.
04:15She would be lightheaded.
04:16She'd feel awful.
04:17She was going into the emergency room every month or two.
04:20So when I followed with Dr. Kreminger and we went into the EP lab, he did a one-hour-long procedure where he was able to induce and find this abnormal heart rhythm problem and treat it by doing four or five individual ablation lesions.
04:33So basically finding an electrical short circuit in her heart and eliminating it.
04:37So about two hours later, she was up walking around and left the hospital, and she never had the problem again after this being something that was debilitating, not life-threatening her for years and years.
04:47So once I had those two experiences, I was like, this is what I want to do.
04:50And I was an intern, so I had to make it through three years of internal medicine training and then three more years of cardiovascular training.
04:57And then after that, most people train for two more years of electrophysiology.
05:01That's a big chunk of your life gone, but that's where all those extra letters after your name come from.
05:06Yeah, well, you absolutely paid your dues, and I respect it.
05:09It's incredible.
05:10So what's the difference between what you do and, let's say, the work a cardiologist would do when it comes to keeping hearts healthy?
05:17So the most common metaphor we use for this is when you are a general cardiologist or a general contractor, the cardiologist's job is to make sure all the different parts of the heart are working well, from, again, diagnosis to prevention to treatment.
05:32And if you're building a house, you're going to have your general contractor who's kind of going to be the quarterback.
05:36He's going to do everything.
05:37But you're generally not going to have your general contractor go in and do the specialty work in the house.
05:42So you're going to bring a plumber in to check your pipes, make sure they're okay.
05:45That would be an interventional cardiologist who usually puts in stents in.
05:49And if there is a problem with the electrical system, the general cardiologist will call in the electrophysiologist who will go in and try to check the health of the electrical system and then identify any problems and treat them as new.
06:02Okay, good to know.
06:03Now, we all know keeping your heart healthy is a good thing, right?
06:06You want a healthy heart.
06:07Well, why is it so important to keep your heart rhythm in check?
06:11Well, actually, a lot of the problems that people associate with the heart are not necessarily due to issues with plumbing or general cardiac issues.
06:20A lot of the reasons that people have problems with their hearts that are severe are related to electrical problems with the heart.
06:26So I think anyone who's a fan of the NFL saw what happened with DeMar Hamlin, a defensive back for the Bills, and he had a very unusual condition where he just had a very poorly timed hit to his chest.
06:39We see this more commonly with young boys who are playing softball, where if you get hit in the chest at just the right time, it can induce a cardiac arrest.
06:47But the most common reason that people have cardiac arrest and die in the United States is actually not related to heart attacks or other problems with the heart.
06:55It is due to electrical short circuits of the lower chamber of the heart.
06:59And these types of problems causing cardiac arrest are the number one cause of death in the United States.
07:04And it actually outstrips people from dying from all types of cancer when you add them up, this one type of lower chamber electrical problem.
07:12So at the very basic level and the origin of the field is really based on preventing people from dying from cardiac arrest.
07:19That that is probably the most important reason to do this.
07:22But as we kind of go down the the acute what we call the acuity chain, a lot of heart rhythm problems are related to strokes, which can leave people alive, but can be disabling and life altering in a major way to people.
07:35And then beyond that, when we catch heart rhythm problems earlier and earlier, what we are really focusing on right now is trying to identify these heart rhythm problems early enough that we can prevent the cardiac arrest.
07:47We can prevent people from having heart failure and weakening the heart muscle.
07:50We can prevent people from having strokes.
07:53And some of the new data that we have suggests that treating these heart rhythm problems early may have a role on preventing dementia.
08:00So there are many different reasons to kind of keep an eye on your heart rhythm.
08:03That being said, the majority of people live their whole lives without any problems.
08:07Though one of the things we find that with many of the heart rhythm disorders, as people get older, the risk of having heart rhythm problems goes up.
08:14And as the U.S. population is aging and aging in a more healthy fashion, it's increasingly important to keep your brain healthy, to keep your heart healthy so you can have a good quality of life for what now is a life expectancy for most people in their late 80s.
08:28So everybody that's listening to this and hearing you talk about that, I think we've all seen our heart rhythm increase at some point.
08:35Walk up the steps, right?
08:36Maybe eating something that's too salty at night.
08:38Maybe having too much tequila one night, right?
08:40Like we've all seen our heart rate go up.
08:42But what is it at the end of the day?
08:44Like when should I know exactly if my heart rhythm is out of check?
08:48So there's some big ticket items we look for, and then there are some relatively basic things.
08:55So some of the clues that we look for are people having severe symptoms.
08:58So if you're going to the gym and exercising and you can go, you know, two miles on your treadmill.
09:03I was doing a Tabata workout yesterday doing interval training.
09:06And if I can do my four minutes of Tabata and then two weeks later, I can only do 30 seconds before I get severely short of breath or a lot of chest discomfort, that can be a sign that you're having a problem.
09:17If you're having a feeling where you're near passing out all the time or start to pass out, that is a serious issue that we look at.
09:25And then beyond that, there are a whole lot of other heart rhythm problems that can be relatively asymptomatic and that sometimes it can be difficult to diagnose.
09:33So I often get questions from people.
09:35I go to the gym.
09:35I exercise.
09:36My heart goes way up.
09:38And I feel it.
09:39I can feel my heart really pounding when I'm working out.
09:41That is often a normal finding.
09:43What is not a normal finding is that if you go and you work out and your heart rate stays up for a long period of time, for two minutes, five minutes, 20 minutes after you stop working out, that can be something that's a problem.
09:54And the other thing that we're dealing with a lot is on-demand heart monitoring has really become a giant part of the U.S. on-demand healthcare consumer marketplace.
10:04So we are seeing more and more people right now who have a smartwatch, whether it's an Apple Watch or another product.
10:11And, you know, right now, around this time of year, we see a lot of this.
10:14So, you know, my kids got me an Apple Watch for Christmas.
10:17I put the Apple Watch on.
10:18And my Apple Watch says that there's a problem.
10:21So those types of on-demand heart monitors are really something that is both an opportunity and a challenge that we're seeing as a screening tool.
10:29And some of the nice things about some of these products is not only will they tell you there's something irregular with your heart rate, but a lot of these products can really actually record an on-demand EKG that then the patient can show me on their cell phone and I can take a look to see if there's an issue or not.
10:43And in many cases, when we see those problems with the Apple Watch, those problems are often benign.
10:49But we often, we actually fairly frequently do diagnose serious heart rhythm conditions based on those on-demand heart monitors.
10:55Now, one of the terms I always hear when it comes to heart rhythm is AFib.
10:59Can you explain more about AFib and what makes it so unique?
11:04Absolutely.
11:05And atrial fibrillation is a different type of condition than people having a cardiac arrest.
11:12So a cardiac arrest is often but not always going to be something that occurs in people with some type of a significant genetic problem or people who have had prior damage to their heart from heart attack or another issue.
11:24Atrial fibrillation is a different problem in that it is an electrical irritability of the upper chamber of the heart that usually starts in the left upper chamber.
11:35And one of the things that's interesting about atrial fibrillation is that it is a strongly age-related condition.
11:41So we think there is a group of people that the upper chamber of muscle tissue becomes irritated.
11:47And there's another group of people that is probably more common that as they get older, as they get to be 60, 70, 80, and 90 years old, that there is scarring of the aligning of the heart.
11:57So the muscle cells get areas of healthy tissue mixed with scar tissue.
12:00I often describe it as getting wrinkles on the inside of your heart.
12:04And that complex electrical, the complexity of the electrical system there can lead to short circuits, which is where we get atrial fibrillation.
12:12So as the U.S. population is aging and getting older and older, and so baby boomers are getting older, we are seeing that the incidence of atrial fibrillation is tremendously increasing.
12:23And atrial fibrillation is associated with an increased risk of dying sooner, an increased risk of dementia, an increased risk of congestive heart failure.
12:31And in many cases, it causes symptoms that can be very subtle.
12:34But by treating them, we can often get people to live longer and healthier lives with a better quality of life.
12:41Well, I hope everybody that's watching this doesn't need treatment yet, right?
12:44I hope everybody's healthy and everybody's thriving.
12:46Everybody's doing great with their lives and their health.
12:48So let me ask you, when it comes to prevention, what are some of the things that we can do to make sure that we have a healthy and balanced heart rate?
12:56So we think that in the United States, about 85% to 90% of cardiovascular disease is preventable.
13:04So there is a major focus, especially with conditions like atrial fibrillation that are associated with elevated weight, that is associated with people having sleep apnea, that living a healthy lifestyle is really the best way to prevent this.
13:19And this does not just go for electrical problems of the heart.
13:22This goes for heart failure and pretty much your overall health, including your risk of cancer.
13:26So living a healthy and active lifestyle, most people are recommended to do, ideally, at least 30 minutes of exercise every other day.
13:37Mixing some resistance training with aerobic training is helpful.
13:40And portion control and eating a healthy diet is important.
13:44Many heart rhythm disorders are triggered by alcohol.
13:47And many heart rhythm disorders can be triggered by really big, heavy meals.
13:50So you're actually as likely to have a heart attack or a major electrical problem with your heart from exercising or having a drink or coffee as you are from just eating a big meal with, you know, lots of pasta.
14:01So it is something that it's important to do.
14:03And some of the things we're finding when we're looking at the centenarian population, the people that are living healthy lives into the 100 plus range, which is a small fraction of the population,
14:14is portion control, keeping your weight under control, and maybe increasing your level of low-level activity to maybe as much as one to two hours a day.
14:22So this is not going to the gym for two hours, but being up, walking around, social engagement, and keeping your brain healthy, these are all really critical to keeping your entire body healthy.
14:33Now, not to put you on the spot, but I trust you.
14:35Like, you and I were talking sports before we even started recording this.
14:38You brought up sports in the middle of this interview.
14:39I trust you.
14:40I feel like you're a well-rounded man.
14:42So if I were to ask you, what does a healthy heartbeat sound like?
14:46Like, can you compare it to any sort of song that people know about?
14:49What does that healthy heartbeat sound like?
14:52Well, we've got one favorite song when we talk about electrophysiology.
14:56And anyone who's taking a basic life support class has probably heard this song.
15:01And are you an Office fan?
15:03Do you like Steve Carell?
15:03I know exactly where you're going.
15:06So the big one that we always look at, and then the Office episode is fantastic, is Stan Lott.
15:12So Stan Lott has a very regular beat when you get into the chorus portion of it.
15:17Or just the chorus.
15:18Not the beginning.
15:20Like in the episode of The Office.
15:22Yeah, you don't want the intro, because the intro's all over the place.
15:24And I think the intro's kind of like any Eagles fan that's been watching, you know, the Eagles play over the last eight weeks of the season.
15:30It's up, it's down, it's all over the place.
15:32But when you get into the main chorus of staying alive, you know, it's a very regular rhythm.
15:37And that's kind of what you want to see.
15:39And it's important for electrophysiologists, because one of the things that is really important to keep people alive when they have cardiac arrests is knowing how to do CPR.
15:47So teaching people to do CPR is important.
15:51And the rhythm and the rate that they play in staying alive is often what is taught when people are doing basic life support.
15:58So when you get going on your chest compressions, that's kind of the rhythm that they want everyone to be at.
16:03And the most important part of that is that it's regular.
16:06So that's kind of what you want to look at.
16:08And again, irregular rhythms, if your heart rate is erratic, it does not always indicate a serious or life-threatening problem.
16:15But it can indicate that there's an abnormality.
16:17Now, how often was that song in your head when you were going through school?
16:21Going through school, it was not in my head that much.
16:24I'm a little older, so if I was at the roller skating rink, it would be in my head all the time.
16:28But going through school, not so much.
16:30Doc, listen, I appreciate it.
16:31You were tremendous.
16:32That was very informative.
16:34I always appreciate speaking to every doctor from the Virtua team.
16:37This was great, and I think it's very important.
16:39People need to take care of their heart.
16:40And if you need any more information on everything that we talked about today, you can always check it out at Virtua.org.
16:45So thank you so much.
16:46We appreciate you taking the time today.
16:49Can't wait to talk to you again soon.
16:50All right.
16:51Thank you very much, Andrew.