Tolulope Agunbiade, MD - Medical Director - Virtua Health Advanced Heart Failure
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00:00Doctor, how are you doing today? Good to see you again.
00:04Good to be here. Thanks for having me.
00:06Now, I know I did this before, but I'm going to read your resume again because it is spectacular.
00:10And I always love reading the resumes because it makes me feel like I'm smarter because I get to speak to you today.
00:15Like, I always feel a little bit smarter doing these.
00:18Doc, MD, highly respected cardiologist, medical director of advanced heart failure at Virtua.
00:23So that sounds great in itself. A graduate of Harvard Medical School.
00:28Doc uses the latest therapies in the treatment of heart failure, including left ventricular assist devices.
00:34Doc is also board certified in internal medicine, cardiovascular disease, advanced heart failure and transplant cardiology and echocardiography.
00:43Like, I just do sports talk radio. So, again, thanks for making me sound a little bit smarter today.
00:48She has participated in many research studies, has published articles in numerous publications.
00:53Doc, you are incredible. You also play video games, which I really appreciate.
00:56So while you're also, you know, solving people's lives and helping everybody's health, you're also playing Super Smash Bros on the weekend.
01:02So I respect that a lot. But not only am I talking to you today, I'm also for the first time talking to one of your patients.
01:10I want to welcome in Ms. Bernadine Jones, who came to you after being referred by her cardiologist.
01:16You had a procedure and then was referred to the heart failure clinic in Cherry Hill.
01:20So, Ms. Jones, welcome. Thank you for joining us today.
01:22Thank you. Thank you for having me.
01:23So let's start off with you, Doc. What does it mean when a doctor tells me I have heart failure?
01:30Let's start right there. That's your specialty. What does it mean when somebody says, hey, you have heart failure?
01:36For a lot of patients, it's a scary term to hear, right? Because they think my heart is failing.
01:41When we say heart failure, what we're talking about, the fact is that the heart is not able to pump blood to the rest of the body the way it needs to.
01:49So either because the heart muscle is too weak for whatever reason and it's not able to squeeze as hard as it needs to to get the blood to the body.
01:57Or sometimes people have a stiff heart and it's not able to work as well because the muscles in the heart are too stiff.
02:03So that's what it means. It basically means that the heart's not able to pump blood as effectively where it needs to go.
02:08And so people can end up having symptoms of heart failure.
02:10Now, is there one specific definition of heart failure? Like, are there various stages of heart failure?
02:17I can imagine some are worse than others. So what are the different stages of heart failure?
02:22It's a great question. So there are four stages of heart failure that go from A to D, with A being those who are at risk of developing heart failure.
02:30And then those with stage D disease are really the sickest of the sick.
02:34Those are the patients for whom we're thinking that medical medications and medical therapies are no longer enough.
02:40And those are the patients that we're thinking about more advanced therapies, whether they need a heart transplant or an LVAD or mechanical heart pump.
02:48So, Ms. Jones, I want to ask you, when did you first notice that you were having symptoms of heart failure?
02:54Did you know that it was heart failure? And then when you went and seek treatment, what did they tell you?
02:59Well, I have been seeing another doctor for quite a while.
03:05I believe it was a couple of years. I just happened to have an episode at work and I was taken to.
03:15I believe it was Virtua in Willingboro.
03:19And then I ended up having a.
03:23A stress test.
03:26Well, what happened was I was.
03:29Aggressive real bad.
03:31I couldn't barely make it to my car without running out of air.
03:37I was extremely tired.
03:40My breathing was terrible.
03:44I couldn't get enough air.
03:47I couldn't sleep because I couldn't get enough air.
03:50I had to sit up.
03:50And the doctor mainly referred me to a Gumbiati.
03:58And this is how we came in contact with each other.
04:02And I love that you're in the same room together.
04:04Right.
04:04Like I was.
04:06I was going to not just be talking to Dr.
04:08Aggambiati.
04:09I was also going to be talking to you.
04:10I was like, all right, so there'll be two different spots.
04:12Now you guys are in the room together, which I think is truly special.
04:15So, Doc, I'll ask you when Miss Jones or when anybody is potentially dealing with heart failure, what kind of tests and what kind of imaging do you do to check whether or not they actually have heart failure?
04:26How do you diagnose it?
04:27So, first, well, when we see them in the office, there are some signs that we can see on exam.
04:33So, if people have come, first of all, in the history, they'll tell me they're short of breath.
04:37Basically, a lot of the symptoms that Miss Jones is describing.
04:39Short of breath.
04:40It's difficult for them to walk as far as they need to.
04:44They can't sleep at night because they feel like they're drowning or short of breath when they lay back.
04:48All of that is, those are signs that someone has extra fluid in their body and their legs being swollen is often another big symptom.
04:54So, if I see them and they have any of those signs, it already clues me into, okay, I'm thinking something is up and they maybe have heart failure.
05:01We usually start off with an echocardiogram, which is just the ultrasound of the heart.
05:05And that tells us, gives us a sense of how well the heart is squeezing, how well the valves are working, and if something is awry there.
05:12So, the echocardiogram is usually the first step.
05:15Then afterwards, you might end up needing to do a catheterization if we want to get a better sense of what the blood vessels that are supplying the heart look like.
05:22And that also is what will tell us how much blood is getting to the rest of the body, what the pressures in the heart and the lungs are, among other tests, blood tests that we would probably do also.
05:32So, what kind of treatments?
05:34Let's say it's diagnosed, you're having heart failure.
05:37What kind of treatments are there for heart failure?
05:39Because heart failure doesn't mean end of life, right?
05:42Like, it means that you can bounce back from this.
05:44So, what are kind of treatments for heart failure?
05:47It's a great question.
05:48So, there are different types.
05:49So, I'll focus on the type where the heart muscle is weak and not pumping blood well.
05:53And that's the type that Ms. Jones had.
05:55And so, first thing that we always do is we try to figure out the why.
05:58And then if there are reversible causes with regards to what caused the heart muscle to be weak, whether it's because they have a blockage in the blood vessel, we'd fix that.
06:06If it's because there was a medication or a toxin they were exposed to, the cause that we would kind of address that.
06:11But for everybody, if their heart muscle is weaker than it should be, there are four classes of medications called guideline-directed medical therapy that patients should be on.
06:20And that's because these medications have been shown to help people live longer and they can help the heart muscle get stronger with time.
06:27And so, I can just beta blockers.
06:29Some people have seen the advertisements on TB for Entresto, Parsega or Jardians, Spironolactone.
06:36So, different medications have been shown to be beneficial.
06:39So, we try to get patients on those medications.
06:41And then, in addition to medications, some patients also are eligible for a special type of pacemaker, which Ms. Jones actually got as part of her treatment course that also helps the heart muscle to get stronger in a lot of cases.
06:54And if people are failing those therapies, that's when we talk about more advanced options, such as heart failure or transplant.
07:00But the goal, at the end of the day, is to try to give you medications and treatments that will help prolong survival with a good quality of life, right?
07:09Because the goal is to get people to be living their best lives.
07:12Absolutely. That's beautiful.
07:13Now, Ms. Jones, you had the medication that wasn't necessarily going your way.
07:18I know you got on some other medication.
07:20You got the pacemaker put in.
07:22But obviously, that doesn't just solve everything.
07:25You have to make some lifestyle changes, I imagine.
07:27And I would like to hear from both of you what lifestyle changes you can make.
07:30But, Ms. Jones, specifically for you, what kind of lifestyle changes did you have to make once you were diagnosed with heart failure, once you got everything taken care of?
07:38What are you doing to help better your life moving forward after everything that you've been through?
07:43Well, I try to eat better.
07:47I try to watch my sodium intake.
07:52And watch my weight.
07:54But I haven't had to do a lot of changes.
08:01The medicine is working well for me.
08:04So I'm able to do everything that I was doing before the pacemaker.
08:10Well, that's awesome.
08:11I can walk to my car with no problems.
08:14You know, I'm breathing well.
08:17I'm doing everything that I usually do.
08:20I walk now, I can walk around the building instead of across the street to my car, I can walk around the building.
08:27So I am doing excellent right now.
08:31That's amazing.
08:31I love that.
08:32Now, Doc, if you can, it's great that you're doing great.
08:36That's fantastic.
08:37Sometimes I imagine there might be not complications, but it might be more difficult of a road for some other people.
08:42So, Doc, if you can talk about it, what other kind of lifestyle changes might some of us have to make to try to make sure we keep going?
08:49So when someone has heart failure, we often talk to them about some of what Ms. Jones alluded to.
08:53We say that you should watch the amount of sodium that you're taking in.
08:56Also, we often will tell them to limit how much they're drinking, because when someone has heart failure, their body is in a state where it wants to hold on to all the extra salt and fluid.
09:06And that's what makes people end up short of breath and to have the swelling in the legs, not able to lay down flat without feeling like it's hard to breathe.
09:13So we tell them to watch your sodium, their water intake.
09:17If there were certain, tell people to exercise more, weight loss for those in whom are overweight.
09:23And then big lifestyle changes is just also taking your medications the way that you need to if it's someone that's not used to taking medications before and showing up to your visits.
09:33Those are the big things that I would say are keys for success.
09:36And then also patients have to weigh themselves often, because one of the early ways to see that you're holding on to extra fluid is your weight starts to go up.
09:44So we often ask them to do that and keep track of their blood pressures and heart rates as we're adjusting their medical therapy.
09:52Now, I want to ask a question for you, Doc, because this is something that I need to kick myself in the rear end every once in a while.
09:59Once you start realizing something's wrong, right, can symptoms get worse?
10:03I know I'm one of those people that goes, ah, let's see, let me wait a couple of days before I check down.
10:08So let's start. You can start feeling sick. You realize there's something not right.
10:12Like, can symptoms get worse? How bad can those symptoms can get?
10:16When should I go to the hospital? When should I go to a doctor?
10:19Like, if I've noticed that something's up, how quickly should I get checked out?
10:23I think if that something is off and you know you're not feeling yourself, I always tell patients it's always good to get yourself checked out.
10:30And that checking out varies from calling your primary care doctor to make an appointment.
10:34If it's not really bad, to going to an urgent care to get checked out, to going to the emergency room if you're really sick.
10:41But I think if you notice something is different about your body, I always tell people, don't wait till it's really bad.
10:46Because some people come to us in extremis and then everything becomes an emergency.
10:50The things we could have fixed easier a couple of days before when they weren't as sick.
10:55So I do think, especially if you know you have a history of heart problems and something is not right, you should get yourself checked out quickly.
11:02And Ms. Jones, you've gone through it.
11:05So what advice would you give to other heart failure patients?
11:09Somebody that's currently dealing with the symptoms or somebody that is in your position.
11:13You've gotten everything taken care of, but they still just need to work a little bit harder to get back to feeling comfortable.
11:18What kind of advice would you give to somebody that's gone through your situation?
11:22I don't know. I think it would have to do with finding the right doctor.
11:30If you want to live a little longer, you've got to do the research.
11:35Find the best doctor. And I believe I did that.
11:38By finding this lady right here, she saved my life.
11:43And she's an excellent doctor.
11:46And she has a great bedside manner.
11:48I experienced being in the hospital, having a pacemaker put in.
11:56And she was there every day.
11:59She made sure everybody was on top of what they're supposed to do for me.
12:03And I really appreciate that.
12:06Yep. That's why the team at Virtual Health is incredible.
12:08Dr. Agambiati, I really appreciate your time again today.
12:11Ms. Jones, thank you so much for telling your story.
12:14That can't be easy for you, but you're here. You're doing great.
12:17You're walking around that building. You're living your best life again.
12:20That's fantastic. I love hearing that.
12:23I hope everybody enjoyed this and learned a little bit something about your heart.
12:27You can check out all of our Virtua Stay Well Health chats that we have on 97.5thefanatic.com.
12:32But if you want to learn more specifically about heart failure, why don't you check out the Virtua website,
12:37Virtua.org slash heart failure program.
12:41You'll be able to get a lot from that website right there about whether or not you have the symptoms,
12:45once you get checked out.
12:46And if you need to schedule something, schedule an appointment, you can check it all out there.
12:50Again, Virtua.org slash heart failure program.
12:53Thank you so much.
12:54I appreciate you guys joining me today.