Cardiology (THE HEART) with Herman Taylor

It beats. It throws blood. It breaks – but not if Dr. Herman Taylor can help it. He is a physician, professor and director of the Cardiovascular Research Institute at the Morehouse School of Medicine in Atlanta, and an absolute legend. Cardiology is a vast field but Dr. Taylor joined for a 101 on how the heart works, and how to take care of it. Get pumped for valves, tubes, electrical shocks, Grey’s Anatomy glossaries, heavy metal hearts, the effects of long term stress and systemic oppression on the heart, what those blood pressure numbers mean, what to do in an emergency, cardiac disease symptoms, what your heart wants you to eat, how to decipher your cholesterol numbers and why you would want to. Also: the worst heart tattoos out there.

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:00Alie Ward?

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• 0:45Alie Ward?

  Unlike other services, there's no subscription required, so you can order whenever you want without a huge commitment. Plus, you get free shipping and returns. Get started today at StitchFix.com. That's StitchFix.com.

• 1:01Alie Ward?

  This podcast is brought to you by Aura. Your body has a lot going on. Sleep, stress, recovery. You would be surprised how connected it all is. Aura Ring tracks more than 50 metrics from your finger, and the Aura app brings that information together to help you see patterns across your sleep and stress, activity, and more, so you can start connecting the dots and figure out what works for you. Learn more at AuraRing.com. Wear your best life with Aura. Oh, hey, it's the woman on the Swamp Tour who won't stop screaming yee-haw, Ally Ward, and we are here with your heart in your ears cardiology. Let's consider this episode a 101.

• 1:43Alie Ward?

  It's a very basic intro to a really huge discipline, and this is a guest I have waited months and months and months to interview. It all started, I got a note from a listener named Matthew Evan Taylor, who said, not only was this person a top cardiologist in the country, but he also has a great radio voice and also was his dad. I did a little research and quickly realized no other cardiologist would do. Me and this guest. We chatted months back over the phone and he wanted to time the episode so that it hit in February to encompass both American Heart Month and Black History Month. But he's super busy. He had a conference to go to in November and then he was going

• 2:25Alie Ward?

  to the Super Bowl in February. Turns out, he didn't just have a conference to go to. He was being awarded the Clinical Research Prize at the American Heart Association's Scientific Sessions in 2024. Oh, and the Super Bowl tickets? You know, he was there as the Director of Player Engagement and Education and a co-investigator into the Football Players' Health Study at Harvard University. He was there working. He is a professor and a director at the Cardiovascular Research Institute at the Morehouse School of Medicine in Atlanta. He did his undergrad at Princeton, his doctorate from Harvard Medical School, and has been named the American Heart Association's Physician of the Year.

• 3:06Alie Ward?

  This man's schedule, like some of our arteries, is packed wall-to-wall with huge responsibilities. But he is gracious and generous, and we were able to nab him for about an hour this past Saturday morning. I was terrified to take up too much of his time because I already loved him so much. And we turned this episode around in just a few days. He showed up on video in a shirt and tie, all smiles. He let me ask him so many questions. But first, before we get into it, thank you to all the patrons who submitted their questions before we recorded. Thanks to all the folks in Ologies Merch from ologiesmerch.com. Thank you to all the listeners leaving reviews, which help the show so much, such as this recent review from Amy in Arlington who wrote, "You learn new stuff each time. You come away

• 3:51Alie Ward?

  amazed by all the smart and good people in the world," something we all need nowadays. Thank you, Amy in Arlington, and everyone who has ever left a review. I have read them all. Okay, let's get to the heart of the matter. Cardiology comes from the Greek for heart. Easy. And we covered as much as we could in the time that we had. So yeah, consider this a 101, a primer. Get pumped for valves, tubes, beats, electrical shocks, gray's anatomy glossaries, heavy metal hearts, the effects of long-term Stress on the heart, what those blood pressure numbers mean, how to read an EKG, what to do in an emergency, cardiac disease symptoms, what your heart wants you to eat, how to decipher your cholesterol numbers and why you would want to. Trust me, it's fun.

• 4:36Alie Ward?

  The worst heart art out there and why a wedding ring goes on that finger with researcher, professor, physician, heart hero, and your new favorite cardiologist, Dr. Herman Taylor.

• 5:08Alie Ward?

  This one is going to come up on Tuesday. So this is going to be a quick turnaround. Yeah.

• 5:12Speaker 01

  Okay, all right. Well, let's get to it.

• 5:14Alie Ward?

  Okay, he/him?

• 5:16Speaker 01

  Yes.

• 5:16Alie Ward?

  Okay.

• 5:17Speaker 01

  Herman Taylor.

• 5:19Alie Ward?

  Now, you're a cardiologist. How long have you been a cardiologist?

• 5:24Speaker 01

  I've been a cardiologist really since 1990, which now I guess is what, 35 years? Is that right?

• 5:31Alie Ward?

  Yeah.

• 5:32Speaker 01

  Yes, quite a long time.

• 5:34Alie Ward?

  Now, what was it that drove you into cardiology? When you were in med school, when you were on this path to becoming a doctor, when did that passion start for you?

• 5:44Speaker 01

  Well, let's see. Originally, I was, I guess, just very interested in science. The thing that got me going actually was, believe it or not, and this dates me a bit, the space program.

• 5:56Alie Ward?

  Really?

• 5:56Speaker 01

  That got me first interested in science in general. And I gravitated through a period where I wanted to be an oceanographer. You may not be familiar with the undersea world of Jacques Cousteau.

• 6:07Alie Ward?

  Oh.

• 6:08Speaker 02

  We would like to know more about this serpent who ages ago returned from land to the ocean of his origin to prey on the tiny bottom dwellers.

• 6:18Speaker 01

  But if you go back in the archives, I'm sure you could find that. I found that really inspirational. But as time went by, I got more interested in physics, as it turns out. Which led me actually to cardiovascular physiology. The way it was taught back then, there was a heavy emphasis on hemodynamics and flows and fluids as sort of one of the primary things you had to master if you wanted to understand what was going on with the circulation with the heart. In college, while I was still vacillating a little bit about what I was going to do after college, I had the opportunity to go to Cornell University's School of Medicine for a research fellowship. And part of that experience was teaching cardiovascular physiology.

• 7:00Speaker 01

  And that's sort of where things, everything came together for me in terms of my interest in the heart and circulation. And that combined with sort of seeing through the opportunity of this summer research fellowship, seeing clinical scenarios that showed that marginalized populations had a particularly bad time with cardiovascular disease. All of that sort of piqued my interest, got my passions going, and pointed in the direction of cardiology. After spending some time on a faculty in Birmingham, my hometown, teaching cardiology, seeing patients, et cetera, and really having a wonderful experience being in my hometown,

• 7:41Speaker 01

  treating people who were maybe colleagues and friends and coworkers of my parents and friends. And I got inspired by the idea of studying a large population of African Americans, looking specifically at cardiovascular risk. There had been a study, and still, actually still is a study, called the Framingham Heart Study, which looked at a long-term, took a long-term view of cardiovascular health in a population in the Northeast that happened to be almost entirely white.

• 8:16Alie Ward?

  Yeah.

• 8:17Speaker 01

  In fact, even more specifically, mostly it was either Italian, Irish, or Irish-Italian in terms of its heritage.

• 8:24Alie Ward?

  So this study, founded just after World War II, focused on the long-term heart health of over 5,000 residents of Framington, Massachusetts. And it's ongoing, it's in its third generation of volunteer subjects. And among many discoveries, chronicled in thousands of published papers, were findings about cigarette smoke and heart disease, psychosocial factors, and genetic or inherited risk factors.

• 8:48Speaker 01

  That study has been tremendous in its contributions, but there was a major omission. You know, that's a very small slice of the human family. When you talk about people whose heritage is traced principally to Western Europe. Mankind, womankind is much broader than that. And there were some special challenges in the black population that weren't adequately being met. So the world of research was really looking for a way to fill that gap. And we came together with the idea of the Jackson Heart Study to do that. So it was a particularly fun time of my career.

• 9:27Alie Ward?

  And the Jackson Heart Study, started 25 years ago, looked at the cardiac health of, again, over 5,000 participants, but this time in Jackson, Mississippi. And another reason why we waited until February for this episode at Dr. Taylor's suggestion for Black History Month is that black history factors into what care patients receive. And one 2020 study laying out a lot of info was published in the Journal of Hypertension titled, "Discrimination and Hypertension Risk Among African Americans in the Jackson Heart Study." You mentioned that there are certain circumstances that put heart health at risk more. What is genetic versus what is lifestyle? What is access to medical care? What factors are really affecting any person?

• 10:11Speaker 01

  Well, there's so many. And it's a combination, a convergence of a lot of different dimensions, let's say. So the genetic, certainly, you know, family history and things that run in families are important. There are some very specific things like abnormalities in cholesterol metabolism, tendencies towards high blood pressure. Those things can run in families. But so can things like eating habits, which are not genetic in any serious way. If there, there's a family tradition of eating a quote, "southern diet", or what people might consider a soul food diet, or some other diet that has a preponderance of certain types of foods, seasoning,

• 10:56Speaker 01

  that carries certain electrolytes that might not be good, taken in overabundance, the tendency to fry foods, which causes chemical changes in foods that may not be ideal, et cetera.

• 11:09Alie Ward?

  So cardiac disease may involve a straight up DNA predisposition, like familial hypercholesterolemia, which is caused by this genetic link on how your body recycles LDL or bad cholesterol. And it might require meds, no matter how you change your habits. And of course, heart health is affected by geographic and lifestyle factors, like how walkable your neighborhood is or diet in your culture. And actually, if you want a great Black History Month episode on cuisine, Dr. Psyche Williams Forsen is a food historian who we interviewed for a Black American Magorology episode. But yeah, some heart conditions are just wired into yourselves.

• 11:46Speaker 01

  Those types of things can run in families. Then you have cultural and societal exposures that may be quite material in terms of whether a person develops high blood pressure, diabetes, et cetera, or heart disease itself. And these can relate to things that induce stress in the population, whether it's the stress of city life or the stress of, you know, let's call it discriminatory practices or limited access to care or limited access to good food. Those things too can all come together to create an ecosystem

• 12:29Speaker 01

  that's very unfavorable for your heart. And some people face those things day in and day out, and they accumulate over time and can lead to some fairly serious sequelae.

• 12:40Alie Ward?

  Yeah, I didn't know what that word meant.

• 12:42Speaker 01

  Sequela, yes.

• 12:43Alie Ward?

  Sequela, okay, got it.

• 12:45Speaker 01

  Maybe I should pick another word.

• 12:48Alie Ward?

  I just don't have that.

• 12:49Speaker 01

  Things that happen in consequence or, you know, in sequence, I guess.

• 12:54Alie Ward?

  But, you know, I'm not sure. I don't take you as someone who spends a lot of time scrolling on social media because you've got a lot of important things to do. But there was this viral video that went around of this heart.

• 13:06Speaker 03

  So it is a one piece.

• 13:13Alie Ward?

  So it was a model of a heart that they were teaching in anatomy. And it it almost was spiral. The muscle, they almost stretched it out like unrolling a map or something. Is that how a heart is constructed?

• 13:28Speaker 01

  Wow, well, I haven't seen the video.

• 13:31Alie Ward?

  Okay.

• 13:31Speaker 01

  But what is true is that the heart, in the embryo, the heart starts out as a straight tube, right, of cells. And as gestation goes forward, that tube begins to fold up, twist on itself and fuse. And what you wind up having is this four chambered marvel of a muscle. Muscle is maybe too simple a description of what it is because it has electrical properties. It has contractile properties and even sort of a mind of its own. I mean, it can beat on outside of your body powered by its own spontaneous electrical impulses.

• 14:15Speaker 01

  It left totally to its own devices as long as it had oxygen and nutrients.

• 14:21Alie Ward?

  So when you see people in medical dramas, hopefully not in real life, unless you're a healthcare worker, in which case, thank you so much, they may be using what's called an AED, and this is an automated external defibrillator. And it's called automatic because it detects and then it analyzes a patient's heart rhythm and then it delivers an electrical shock to reset the cardiac arrhythmia, which arrhythmic, so it's out of sync heartbeats. So if a person has a cardiac arrest and they have no pulse, no heartbeat, they're not breathing, the protocol is typically to administer CPR if you know how to do it. And then if there's an AED nearby, use that next. And I cannot stress enough that first aid training is going to do a better job than me.

• 15:03Alie Ward?

  I'm a podcast host and I'm just search engineering how to save a life. And then I'm trying to tell you in like 17 seconds. Now, if a heart can beat with electrical charge and oxygen, is that what happens in heart transplants? I don't know, I've never had one, but our guest, Dr. Tom Bulk, in the Mycology episode, did have a heart transplant. And we discussed it in his episode, which we'll link for you. During which he pointed me toward this felted box on his desk. It looked like a Kleenex box, but it contained a fluid-filled plastic bag with the heart he was born with. It was sliced up like thick roast beef. Now, how do those transplants work? Well, in brief, a donor heart is removed, usually from a patient who has experienced brain death,

• 15:48Alie Ward?

  but is alive via intubation. And once that support is withdrawn and the patient passes, the heart is removed and it's taken on ice to wherever the recipient is. Hopefully close by, they only have a couple hours on ice. Now, the recipient is prepped and while the surgeons replace their heart, a cardiopulmonary bypass machine circulates and oxygenates their blood while the recipient's heart is getting taken out. Now typically, the donor heart would be transplanted, not beating, and then restarted. But thrillingly, weirdly, and surreally, as described in this 2023 paper, first in human beating heart transplant.

• 16:30Alie Ward?

  Dr. Joseph Wu and his team at Stanford were able to restart a donor heart, keep it warm with blood and beating as it was being implanted into its new recipient. Trust me, we could do a 13-episode series just on this topic, but those are some basics. Back to even basicker basics. How did you build your heart in the first place? How did you do it?

• 16:54Speaker 01

  So, yeah, it starts out as a tube. It twists and folds and fuses in just the right way. And you get, again, this four-chambered structure that we know as the heart.

• 17:05Alie Ward?

  What are those four chambers doing? If you had to break it down to someone who is obviously not a cardiologist, the ventricles, the chambers, what's doing what?

• 17:18Speaker 01

  Okay, so there are four chambers. There's a left heart, if you will, and a right heart. Each side of the heart, let's go with that terminology, has sort of an atrium, just like the atrium to a building, the four you end up building. And that atrium. Is the first chamber and it receives blood and then loads the sort of more business in the stronger, more thickly muscled chamber called the ventricle. The right atrium takes all of the venous blood, all the blood that's been, say, used, let's call it, uh, it's been out to the body, has dropped off its nutrients and its oxygen, has participated in cholesterol transport, has taken immune cells to where they need

• 18:01Speaker 01

  to go and all the various functions of blood. That comes back with a lot of the oxygen and nutrients depleted for another round to pick up essentially more oxygen by being pumped through the lungs. So there's a special part of the heart that's devoted entirely to making sure that fresh blood with a fresh supply of oxygen is supplied to the body. The first stop after first coming into that right atrium, going through a valve, which is a one-way door. Now, that valve is called the tricuspid valve for those who want detail. But coming through that valve, leaving the atrium, it goes into the right ventricle.

• 18:45Alie Ward?

  Which is downstairs from the right entry or atrium.

• 18:49Speaker 01

  That strong ventricle then pumps it up to the lungs where it goes through this amazing network of blood vessels and down to where the blood vessels are so thin, they come right up next to the little sacs that have air, oxygen.

• 19:07Alie Ward?

  Alveoli.

• 19:09Speaker 01

  And they're so close that the oxygen can just diffuse across into the blood. And then after the blood gets refreshed from, people like to talk about blue blood and bright red blood, it turns much more closely to this bright red type of blood.

• 19:25Alie Ward?

  So once again, the spent blood enters the right atrium via the vena cava as venous blood, heads to the ventricle and then to the lungs via the pulmonary arteries where it fills up on oxygen and then it heads back to the heart's left atrium via the pulmonary veins. Okay, so you've got fresh blood back to the heart for distribution.

• 19:45Speaker 01

  All of that then drains from the lungs into now the left atrium, okay, which is the first chamber after the blood has been refreshed. Once there, that atrium.

• 20:00Speaker 01

  Squeezes and pushes, loads the true business end of the heart, the left ventricle. This is the most powerful part of the heart. This is the thickest muscle in the heart. Why? Because it has to then generate enough pressure

• 20:17Speaker 01

  to push blood through the body to every cubic millimeter or even smaller portion of tissue throughout the heart and every organ to, again, supply oxygen and nutrients. And then allow, after it all is used, for the whole thing to circle back again to the heart. The heart does this through, it's estimated, thousands of miles. If you could, if you could stretch all of these vessels out end to end, they'd be several thousand miles for an individual person, which is kind of hard to conceive.

• 20:55Alie Ward?

  Several thousand.

• 20:56Speaker 01

  But when you consider that the blood vessels go from the big, obvious vessels down to tiny microscopic capillaries that allow, again, the diffusion of nutrients and oxygen into every part of tissues and organs throughout the body, you can imagine that, yeah, if it was possible, that it would make for a very, very long highway of blood vessels.

• 21:24Alie Ward?

  Okay, so the atrium is on top. The ventricles are on the bottom. And the left side is tasked with shooting blood out to your whole body, like an Olympic shot putter, but just throwing buckets of blood as far as it can. And that beefy left side is why our heart is kind of left leaning in our chest. Now, as for a wedding ring on the left ring finger, what's the deal with that so-called vena amoris, which is the blood plumbing that leads from the heart straight to that one wedding ring finger digit? Friends, it's flim flam. All the veins and the arteries go back and forth to the heart. And wedding rings, over time, they've been worn on either hand.

• 22:08Alie Ward?

  Some were even worn on the thumb when the fashion was like blingier and bulkier hundreds of years ago. So, no, you do not have a vein or an artery that goes straight from your heart to your wedding ring. It's cute, though. Now, if you're like, I must know more about this history. You can see the 1917 book. Hold on, I'm going to take a breath here. It's titled Rings for the Finger From the Earliest Known Times to the Present, With Full Descriptions of the Origin, Early-Making Materials, the Archaeology, History, For Affection, For Love, For Engagement, For Wedding, Commemorative, Mourning, Et Cetera.

• 22:45Alie Ward?

  That's the whole title. I find that et cetera at the end to be like the funniest thing I've ever read because it's the longest title of a book, maybe in the universe. Anyway, onward. I need you to know also that atrium, you know how it means entry hall for the heart? Ventricle derives from the Latin for little belly. So that's the little belly of your heart. More on guts and your hearts later in the episode. Now, remember how in the recent surgical angiology episode with Dr. Sheila Blumberg about veins and arteries? We learned that venous blood is on its return trip to the heart. It's darker in color. It's low in oxygen from delivering it all over your body. While arterial blood, it's fresh from the lungs, it's brighter, and it's fueled up

• 23:29Alie Ward?

  with O2 on the way to your body. If you don't remember that, that's okay because I just told you. So obviously, the speed and pressure that that fluid is pumping through your body is important. When it comes to blood pressure.

• 23:43Speaker 01

  Yes.

• 23:43Alie Ward?

  When it comes to heart health, too, we always hear like, my blood pressure, it's good or bad. What does blood pressure have to do with your heart health?

• 23:50Speaker 01

  Well, it has so much to do with it. One, the pressure you need to keep blood actually flowing to the heart itself. Just like every other tissue in the body, the blood has arteries that feed itself, that pump blood through to the heart muscle or what's called the myocardium.

• 24:12Alie Ward?

  Okay, so a quick terminology breakdown here. Myo, muscle. Card, heart. Eum means the tissue and itis means inflammation. So myocardium is the muscle tissue of the heart and myocarditis is inflammation of the muscle tissue of the heart. But yeah, the myocardium, the heart muscle, is the pump. And in fluid dynamics or hemodynamics, you need to keep things moving, baby.

• 24:41Speaker 01

  In order to do that, there's a certain head of pressure that's needed in the heart, but it can't be too much. If it's too much, then what can happen is those arteries that are so vital to the heart survival become damaged. The lining inside of them called the endothelium, that thin lining that allows for the exchange of oxygen and nutrients and so forth, is so very important. If it becomes damaged and starts to dysfunction, that allows all sorts of badness like cholesterol accumulation, the formation of what we call fatty streaks, which are just, it's like a giant oil slick on a road where you have cholesterol gathering, breaking through

• 25:26Speaker 01

  the barrier that should be intact, that cholesterol then is being consumed by cells from the body that are designed to protect the body against invaders.

• 25:37Alie Ward?

  They're called leukocytes, AKA white blood cells. Those macrophages that gobble up the LDL or the bad cholesterol, they help convert it to foam cells. Don't worry, don't worry about that. So these macrophages, Dr. Taylor explains.

• 25:51Speaker 01

  But they come in, they engorge themselves on the cholesterol, they break down and form debris, it causes inflammation, and there's this cascade of events that then leads to the body trying to contain it by forming a plaque over the top, a very fragile covering over this whole mess, right? And that contains the damage for a while, and it could be years. This whole process can take years in development. In fact, we see some of these changes I'm describing in the autopsies of, you know, soldiers who are 18, 19 years old. You can see the very beginnings of this process. Anyway, that type of damage can be initiated by pressures that are too high.

• 26:36Speaker 01

  That then sets up a situation where that plaque could erode or rupture.

• 26:45Alie Ward?

  And remember, that plaque is like spackle over a moldy wall.

• 26:50Speaker 01

  Exposing all of that garbage to the blood passing by, which sort of sees it as this disruption in the artery. And then sends all sorts of things to fix this break in the artery. Platelets, which you remember from high school biology, are mainly intended to stop you from bleeding, right? They form a clot to close a cut you may have or bruise. But in this case, the platelets, which are like, think of these tiny pieces of Velcro. They come to the site where all of this has happened, and they stick to each other as well as sticking to the site.

• 27:31Alie Ward?

  So we covered this a little in the surgical angiology episode, but atherosclerosis or hardening of the arteries is kind of under the umbrella of coronary artery disease. And high blood pressure can stress out the arteries, and it damages cells and it invites more plaque to build up. So what is high blood pressure exactly? Well, the top number of your blood pressure is your systolic blood pressure, and that is how much force is pushing against your artery walls when the heart contracts, like how stiff is the garden hose? Now, the bottom number of your blood pressure is the diastolic blood pressure, and that's how much pressure is in the arteries or the hose between the beats. So the top number is usually what's under scrutiny for your heart health.

• 28:16Alie Ward?

  Because again, that's the higher pressure. It's when it contracts and pumps out blood. And numbers above 130 over 80 will kind of raise your cardiologist eyebrows because something over 130 over 80 could cause some plaque in your arteries to break off. Okay, then what would happen?

• 28:35Speaker 01

  And this process can go on as a cascade out of control and ultimately cause a blockage in that artery, which could lead to a heart attack. Thank you. Now, I've abbreviated a whole lot of processes just to somewhat dramatize the idea that blood pressure is one of those things that damages the artery that leads to a cascade of events that could be quite, quite bad for you. And that's a mechanical injury to the wall. Now, you can also have a chemical injury to the wall from things like cigarette smoke and all of the toxins that are in the cigarette smoke. Other inflammatory processes that might be tied to obesity, diabetes,

• 29:20Speaker 01

  even things like stress can be injurious and set up this cascade of problems that can lead to damage to the vital insides of the arteries. It's important to know that having blood pressure out of control can damage the heart itself. It can damage it another way, by the way. If you imagine this heart and your heart beats about, what, 100,000 times a day? 100,000 times a day silently, it's carrying out its function over and over. This repetitive and steady activity. That's a lot of weightlifting. If you have pressure inside the system higher than it should be,

• 30:03Speaker 01

  then your muscle is working harder than it should. And that strain causes the muscle to grow. Just like if you did a whole lot of curls with a weight, you'd expect your biceps to grow. Then that muscle grows bigger than it was originally intended to grow.

• 30:24Speaker 01

  And that can lead to other problems in terms of the function of that ventricle. To put it simply, to overwork the heart for any long period of time under the strain of high blood pressure can lead to failure of the pump.

• 30:42Speaker 01

  Actually, two types of failure. One failure being that the heart can begin to sag and be weak and ineffective, and the pump is sort of worn out. Another type of failure is that the heart gets so thick that it doesn't relax in between beats.

• 31:01Alie Ward?

  Oh.

• 31:02Speaker 01

  That non-relaxation then produces symptoms that are very much like the heart failure when the heart is baggy and weak. And so, one we call hep-ref, one we call hep-heph. That's an acronym for heart failure with preserved ejection fraction and heart failure with a reduced ejection fraction. And the ejection fraction is simply a measure of how much blood the pump pumps out with each beat.

• 31:34Alie Ward?

  So when that left ventricle is either too big or too baggy, and it goes to squeeze out blood, it may only squirt like a dribble, you know, like below 50% of what's in there, instead of the normal 70%. Does the heart ever take in more than it's pumping? Does it ever get behind, like, taking in too much and not able to pump it out fast enough, or vice versa?

• 31:57Speaker 01

  Yes, and that happens in a number of ways. I just talked about the heart failure of the really thick heart, where it's not relaxing like it should. And what happens is that the pressures go up inside the heart, and that pressure backs into the lungs. It manifests as shortness of breath, fatigue, other things. That can happen with a heart that's gotten too big.

• 32:22Alie Ward?

  And that's congestive heart failure, which, again, can occur if the heart muscle is too weak to pump a lot of blood when it contracts, which would be a systolic issue, or if it's too thick and therefore that left ventricle, or the left little belly, is too small to fill up properly between beats, which would be diastolic.

• 32:43Speaker 01

  And the classic picture of that can look like swollen legs, swollen liver, and sort of the engorgement of all of the organs that otherwise normally let blood flow right back up to the heart.

• 32:57Alie Ward?

  And where does stress factor into all of this? If you're freaking out over any various amount of things, let's say your job or your home life, or you just have a lot of stress in your life.

• 33:08Speaker 01

  This is the year 2025.

• 33:10Alie Ward?

  What is that doing to your heart, like beat by beat, day by day?

• 33:15Speaker 01

  Well, stress and the hormones related to stress, like adrenaline, just as one that everybody is somewhat familiar with. Those things can cause blood pressure to go up, can cause arteries to constrict, and cause the heart rate to increase. Those things increase the stress on the system.

• 33:37Alie Ward?

  And adrenaline has a very good reason for doing this. It's raising your blood pressure so blood can rush where it needs to be to run away or to stay and kick someone's ass.

• 33:48Speaker 01

  Inflammation that can be tied to all of those processes not only help raise the blood pressure directly, but they can be, again, injurious to the blood vessels and weaken them in important ways. So, for instance, take the stress of perceived discrimination as just one example. And this applies to discrimination based on race, on appearance, and other things.

• 34:14Alie Ward?

  And this is true across many marginalized populations, such as Native communities, women, LGBTQ folks, people of lower socioeconomic status, trauma survivors, and more. And you can see the 2010 paper, "The Impact of Social Determinants on Cardiovascular Disease", for a start, or the 2024 study, "LGBTQ+ Cardiovascular Health Equity", the 2020 study, "Cardiovascular Health in American Indians and Alaska Natives", or Dr. Taylor's recent paper, "Cardiovascular Risk and Resilience Among Black Adults: Rationale and Design of the Morehouse Emory Center for Health Equity Study", or his 2016 paper, "Perceived Discrimination Is Associated With Health Behaviors Among African Americans in the Jackson Heart Study".

• 34:57Speaker 01

  It's clear that, from the Jackson Heart Study and other studies, that having the perception that you're being discriminated against can actually raise your blood pressure and lead to a chronic, sustained elevation in your blood pressure, which can lead to some of the things we've already talked about. Stress can come in many ways. So there's the emotional stress. There's a stress sometimes of environmental. Toxins, if you will, you know, inhaled exhaust from living near highways, other aspects of the environment that can add to systemic inflammation, add to a stressful day emotionally.

• 35:40Speaker 01

  All of these things can, again, converge and really cause the cardiovascular system, cause it difficulties. I mean, the system is so sensitive to the environment. And sometimes that's a positive thing. So it's very curious to note that if you listen to a certain type of music, if you listen to slow soothing music, your heart tends to slow towards the beat of the music.

• 36:07Alie Ward?

  Wow.

• 36:07Speaker 01

  If you listen to a lot of agitated type music, then you know, it's stimulating. I have one example of this from early in my practice, where this came into play in a very dramatic way. I was doing a residency and rotating through western North Carolina, through Appalachia. And a woman came in, in the middle of the night, with a massive heart attack. And part of the things that we do in those situations is not only all of the fancy drugs, but it's very important to keep the heart rate down. The faster the heart beats, the more oxygen it requires.

• 36:47Speaker 01

  And you don't want a heart that's undergoing a fresh event to be overworking like that. And this woman, we could not get her heart rate down. We were even using medications, the standard medications, to help bring it down. And it was resistant to that. Her husband was watching us as we were paying a lot of attention to the monitor in terms of how fast the heart was going. And he said, Doc, um, do you mind if I sing to her? And of course, we looked at each other and it was the middle of the night. We're in the ICU. And I said, uh, you know, we've tried everything else. I would, yeah, I would invite that.

• 37:32Alie Ward?

  No.

• 37:32Speaker 01

  So the guy goes to his car, gets a dulcimer, this beautiful mountain stringed instrument, comes back to the ICU and starts singing this beautiful bluegrass melody to her.

• 37:47Speaker 01

  The first thing you saw was the calm that came over her face.

• 37:51Alie Ward?

  Oh.

• 37:52Speaker 01

  The next thing you saw was a monitor showing us that her heart rate was steadily coming down to where it should be.

• 38:01Alie Ward?

  Wow.

• 38:02Speaker 01

  It was one of the most impressive and beautiful moments early in my career. But the heart is that type of organ. It is very responsive to things in the environment that could be used for good, although sometimes the environment can be hostile and be hard on the heart.

• 38:20Alie Ward?

  The proof is in the studies, such as the effects of music on the cardiovascular system and cardiovascular health. And the abstract of that study states that the greatest benefit on health is visible with classical music and meditation music, whereas heavy metal music or techno are not only ineffective, but possibly dangerous and can lead to stress and/or life-threatening arrhythmias. But I needed to know what metal was chosen for these studies. And according to the 2014 German paper, acute auditory stimulation with different styles of music influences cardiac autonomic regulation in men. The researchers chose "Heavy Metal Universe" by German power metal band Gamma Ray.

• 39:05Alie Ward?

  Let's take a quick listen.

• 39:09Alie Ward?

  Okay, that's probably good. Can you explain what signs to look for for having cardiac issues? I feel like there's a lot of maybe misinformation or fragmented information about how to spot heart issues, what symptoms you might be having. What should people look for?

• 39:29Speaker 01

  Okay, well, there are many forms of heart disease, of course. But the one that kills most people, and we'll go straight to things that kill you. I'm ready. The one that kills most people is, of course, heart attack. And unfortunately, a huge segment of heart disease deaths manifest as the very first symptom of heart disease. It was often said when I was in training that when it comes to death from heart disease, often the first symptom is the last.

• 39:59Alie Ward?

  Hmm.

• 40:00Speaker 01

  And what was meant by that, of course, is that a lot of people have no suspicion that they have heart disease, even though, you know, in often in retrospect, they say, well, I should have known. So this question of how do you know or what should trigger you to thinking about heart disease?

• 40:19Alie Ward?

  Mm hmm.

• 40:20Speaker 01

  It's a big question. Heart disease kills more Americans than any other cause.

• 40:25Alie Ward?

  Really? What about globally? I mean, America, we're not known for our walkable cities or our bike-friendly roads or a commitment to conservative portions. We love hot dogs and pie. Surely globally, there must be bigger threats across the whole world. Wait, okay. According to World Life Expectancy Statistics, the number one cause of death globally in 2019, with 18.6 million deaths worldwide, was cardiovascular disease.

• 40:54Speaker 01

  The leading diagnosis within the heart disease category is heart attack or myocardial infarction. That just means myocardial means cardiac muscle and infarction means death. So a death of a portion of the beating heart muscle is what a heart attack is. And it's caused by that series of events where you get a usually an acute blockage in an artery that is supposed to supply the heart muscle with an ever-fresh supply of blood full of oxygen and nutrients. And when that gets interrupted by thrombus, that shuts down and things south of the blockage then are exposed to death.

• 41:36Alie Ward?

  So a clot or thrombosis is really sadly common and about 25% of deaths worldwide are due to this because they can get into the lungs as an embolism, or a clot can cause a stroke, or of course, a heart attack. How does it lead to a heart attack? So, a big enough clot in a blood tube means that the heart gets starved of oxygen. That's known as hypoxia, and other nutrients it needs. And that starved heart muscle is in coagulative necrosis, which is a great name for a fashion line sold at Hot Topic. But what becomes of that dead heart tissue is a scar that functionally doesn't contribute much.

• 42:19Alie Ward?

  It's just like a hot mess of a house guest who is a drain on your home and your vibe. And this dead muscle, or infarction, can look kind of drained and pale yellowish. Imagine like a steak is your heart with a rubbery pale spot. That would be the infarction. Now, in the event of a heart attack, CPR keeps the blood circulating because you're manually pumping the heart. And this is done to keep oxygen supplying your body's tissues, including the heart, to prevent cell death. A defibrillator, however, can give the electrical stimulus to restart the heart so that it beats again on its own. And remember that AED, the Automated External Defibrillator that we talked about.

• 43:04Alie Ward?

  So if, huh, if you're ever feeling like you don't know how to help in this topsy-turvy world, you don't know where to start, consider maybe a first aid glass because you never know when a stranger's life could just depend on a course that you took at the community center.

• 43:22Speaker 01

  And while I'm on this, I should also say that it's particularly important that we stress that the leading cause of death for women Is heart disease.

• 43:33Alie Ward?

  Hmm.

• 43:34Speaker 01

  Uh, the leading cause perhaps of medical angst, uh, in a lot of women is cancer, specifically breast cancer.

• 43:41Alie Ward?

  Yeah.

• 43:42Speaker 01

  And that is a very important, very important disease that, uh, on the, sort of on the landscape of things that threaten women's health. But if I were to tell you that, uh, one in 39 women will succumb to breast cancer, I would counter, I would, I would further tell you to be aware that one in three women will succumb to heart disease.

• 44:08Alie Ward?

  Wow. Oh, my gosh.

• 44:10Speaker 01

  So it's important to know that. And, uh, one of the distressing things in a recent publication from American Heart Association is that women were more aware of the threat of heart disease in 2009 than they were in 2019.

• 44:27Alie Ward?

  Why is that?

• 44:28Speaker 01

  I'm not entirely sure.

• 44:30Alie Ward?

  Yeah.

• 44:30Speaker 01

  But it was particularly true among younger women who seemed somehow to have become either less worried or less informed about that particular threat.

• 44:42Alie Ward?

  Now, breast cancer advocacy and visibility has done so much for awareness and promoting screenings. And if you're in any of the countries that have designated October as Breast Cancer Awareness Month, you've likely been exposed to pink ribbons and balloons and campaigns. We released a Surgical Oncology episode in October 2018, and we talked about those campaigns. But did you even know that February is Heart Month in the U.S. and also in Canada, the U.K., and the Philippines, Australia, New Zealand? Now, globally, World Heart Day is September 29th, but as the leading cause of death in the world, it flies under the radar more than I would expect. We're not as scared and thus preventative about it as many cardiologists would like,

• 45:26Alie Ward?

  especially for people assigned female at birth.

• 45:29Speaker 01

  They largely viewed cancer, in particular breast cancer, as the leading threat to their lives. So it's important. And, and for men, uh, the rates of death from heart disease are even higher.

• 45:41Alie Ward?

  Wow.

• 45:41Speaker 01

  So should every woman run out and get a calcium coronary, uh, CT to look for uh, coronary calcium today? No, I, I don't think that's where I want to go with this. I think, first of all, It's important that people know their numbers, we like to say. That is, know some basic things about your physiology right now. You need to know what your blood pressure is from a fairly recent reading. If you have no idea, then you should go and get it checked. And there's some specifics about how to get it checked.

• 46:13Alie Ward?

  So ask your doctor or nurse or healthcare provider to check it and note those numbers. Get your cholesterol checked. Even hit that blood pressure machine at the back of the pharmacy, which is not just for bored kids stuck waiting for their parents to get a prescription. Are you a dentist? Save a life and take blood pressure readings when people come in for their six-month cleanings and checkups. If you're like, why would a dentist do that? I thought the same thing. My dentist, Dr. Peter Sharon in LA, takes my blood pressure every time I come in. And at first I was like, why are we doing this, doc? We're here for my chompers. And he explained, many people don't see medical doctors until there's a problem. And he was like, people are in here regularly? Let's do it. And he's helped catch cardiovascular disease in earlier stages for his patients.

• 46:58Alie Ward?

  Dr. Sharon, that fucking rocks. Other dentists, think about it.

• 47:02Speaker 01

  You should know what your cholesterol profile looks like, what your LDL and HDL numbers in particular look like. There are some other categories of cholesterol that might even be more important to know, but at least knowing your LDL and HDL is important.

• 47:22Alie Ward?

  Just some crib notes. LDL, it stands for low-density lipoprotein, and it's the bad cholesterol. It's the main source of blockages in the arteries. Now, HDL, high-density lipoprotein, is the good cholesterol, which helps get rid of bad LDL cholesterol. In general, if you're over 20 years old, you're gonna want total cholesterol under 200. With that LDL, the bad stuff, under 100, and HDL, the good stuff, over 40, 60 or above is best. Mine, last time I checked it, my total is 198. So I'm really riding the line here. And later, Dr. Taylor will tell me and you what to do about it.

• 48:04Speaker 01

  You need to know what your blood sugar or something called your hemoglobin A1C is. Critically important for all of us, particularly those of us in families that have high rates of diabetes or heart disease. And you need to have an idea about your, your weight or BMI or waist circumference. Having some idea about those numbers gives you an idea about how much of the dangerous type of fat you may be carrying around your waist, around your, your viscera and that, which is the more toxic form of weight distribution. Those are the first things. And I should add to that quickly.

• 48:49Speaker 01

  Those are the sort of numbers, the measured numbers. And a certain set of behaviors also that are concerning that with these numbers together can pose a real, a real threat for early onset coronary disease and other types of heart disease. Those behaviors are. Ready? Exercise or the lack thereof. And you're eating habits, what types of foods you like and what quantities. I see exercise, eating, sleep. Let me say it again. Sleep.

• 49:18Alie Ward?

  You don't get enough of it.

• 49:21Speaker 01

  Right, right. You know, I mean, when I was coming up through medicine in particular, you know, you people thought it was really cool to say, you know, I'll stay up all night and I'll, I'll do this and I'll do that. And I'll learn from every patient that comes at the door. I'm going to be the best doctor ever was. You know, I'll sleep when I'm dead kind of attitude. Right? Not a good philosophy. Not a good philosophy at all. And of course, smoking or vaping. Those things are, again, as I've said a couple of times, one of those chemical insults to the endothelium that can start a whole cascade of problems.

• 49:59Alie Ward?

  We chat about vaping risks to your arteries in the recent surgical angiology episode. We also discuss gardening or smoking the ganja and how that can affect your heart. And we also have episodes on sleeping and dreaming and circadian rhythms, which is going to scare your ass into pajamas pretty quick.

• 50:17Speaker 01

  So, okay, so there's the cluster of things that if there are any aberrations, if you are, let's call it non-compliant with what we like to say is a healthy lifestyle.

• 50:33Speaker 01

  Then you begin to put yourself at an increased need to surveil yourself in terms of whether or not there are issues related to your health. Now, I didn't talk about genetics. Genetics can be very, very important.

• 50:48Alie Ward?

  Mm-hmm.

• 50:49Speaker 01

  You know, if you have a history of someone in your family, particularly first-order relative, you know, father, mother, sister, brother, that died early, say, a woman who died before age 65, or a man who died before age 55 of heart-related problems, then you yourself will probably be at enhanced risk and need to be a little more vigilant than the next person about your heart. And certainly, if you're having symptoms, then, you know, that sort of raises the ante. If you're having, you know, some of the classic heart-related symptoms, let's go again with heart attack or angina, which comes from, angina being pain, pectorus is the whole

• 51:33Speaker 01

  name, angina pectoris being chest pain. That, of course, is a significant red flag.

• 51:39Alie Ward?

  So, angina means pain. I didn't know that. I also thought it was pronounced angina this whole time. Alas. Now we know why Grey's Anatomy is always shouting these medical words like myocardial infarction and pectoral angina, because this is the stuff we actually die from.

• 51:55Speaker 01

  And if you're having discomfort in your chest, particularly on exertion or instances of high emotion, those things need to be paid attention to and may require specific evaluation. If you are in the throes of an actual heart attack, okay, we're getting really sort of deep into the disease process now, but if you're having, classically, an elephant sitting on your chest, shortness of breath, cold sweats, pain radiating down your arm, obviously something is quite wrong, and you need to dial 911. Don't drive, don't have someone drive you, don't get on the subway, call 911, because

• 52:38Speaker 01

  the care is coming to you to be initiated right away, not when you arrive at a hospital, even if it's three blocks away. Okay. That description I gave you is classic and derived almost entirely from the male population.

• 52:56Alie Ward?

  Ah.

• 52:57Speaker 01

  So it needs to be amended and amended in everyone's mind to be inclusive of other manifestations that are perhaps a little more frequent among women. Now, women can have any of those classic symptoms, but they have a higher preponderance of what we have historically called atypical presentations. They may be typical for women, but they were atypical according to the old textbooks.

• 53:27Alie Ward?

  Mm hmm.

• 53:28Speaker 01

  That can be more of a deep fatigue, a deep sense of indigestion, other symptoms above the waist that are just distinctly unusual and lasting fifteen, twenty minutes.

• 53:48Alie Ward?

  Hmm.

• 53:49Speaker 01

  Those things also have been shown to be manifestations of significant blockages that lead to heart attacks in women.

• 53:59Alie Ward?

  Ah.

• 54:00Speaker 01

  Now, you will also get indigestion sometimes, right? That's gonna happen. You will also maybe have fleeting, you know, symptoms that concern you. That won't be your heart. However, if you are, um, you know, it's Saturday morning, you know, and you're at the soccer match.

• 54:22Alie Ward?

  Mm hmm.

• 54:23Speaker 01

  And you're having this unmistakable, undeniable, deep, again, as some of our patients used to say, this misery in the chest or, you know, even in the stomach, it's just, it's not, it's not going away. It's insistent. You may need to dial 911. Run the risk of being embarrassed, quote unquote, that it was just indigestion. I say run that risk because some people will delay or deny or say, I don't want to cause people a lot of trouble. I certainly don't want the embarrassment of an ambulance coming up here to my son's soccer match. Right? How dramatic is that?

• 55:08Speaker 01

  Right? But unfortunately, you know, I've had patients die of what they thought was indigestion when in fact it was a heart attack in the making. So I'm not trying to scare people. What I want to do is sort of elevate alertness to the manifestations of a significant health problem that might not fit the Hollywood description of what you saw, you know, in the movie.

• 55:33Alie Ward?

  So you don't have to clutch your chest and scream, I'm having a heart attack to be having a heart attack. And it doesn't just involve pain down your left arm. Some real world, non Hollywood symptoms of a cardiac emergency can be chest pain or discomfort, pain or discomfort in the jaw, neck or back, pain or discomfort in the arms, either arms, or shoulders, shortness of breath, feeling very tired, lightheaded or faint, even nausea or vomiting. And ladies and those assigned female at birth, you may have additional or different red flags, including anxiety, pain in the back or arm, upset stomach.

• 56:14Alie Ward?

  And brushing off these cardiac symptoms could lead to your family donating all your clothes to Goodwill and starting a GoFundMe to buy your casket. Not to freak you out, let's just be real.

• 56:25Speaker 01

  So that alertness may save lives. And I myself always had respect for the person who came in and we found, you know, the EKG is normal, the blood work is normal, everything's beautiful, and you can go home.

• 56:42Speaker 01

  I don't mind seeing, you know, a whole bunch of people like that over the course of the day, if that means that people are paying attention and it might mean that we may save someone who otherwise may have dismissed their symptoms.

• 56:56Alie Ward?

  Hmm, mhm. Can I ask you just a couple of questions from listeners?

• 57:01Speaker 01

  Sure, go ahead.

• 57:03Alie Ward?

  Okay, great. And each week, we send money from our heart to an organization chosen by the ologists. And this week, Dr. Herman Taylor suggested the Center for Black Agency and Resilience, C-BAR, which was recently founded to trumpet the indisputable tradition of Black resilience and agency, challenging the narrative that emphasizes vulnerability. And as the founder and president, Dr. Taylor aims to increase knowledge about the Black community's interpersonal relationships, which provide joy and resilience via a multidisciplinary research project. So a donation will go to cbar.org, which is linked in the show notes. And thanks to sponsors of the show for helping us do that. This podcast is brought to you by Squarespace. If you haven't heard me gushing about Squarespace for years, it's an all-in-one website platform.

• 57:45Alie Ward?

  Whether you're trying to grow a business you have, or if you're just a baby business getting started, it has everything you need. That's where I secured my domain name. It helped me build a professional site. I can update it so easily. I've been using Squarespace since before ologies existed. After procrastinating for years, I literally built my website in one evening. They have templates, they have flexible editing tools. Squarespace also makes it easy to share your work. You can book clients, you can get paid. They have built-in tools for scheduling and invoicing and email all in one place. Whenever someone I know needs a website, whether they're a scientist that needs to put their work up, or someone who's just starting a business, I'm like, dude, Squarespace. So head to squarespace.com/ologies for a free trial.

• 58:30Alie Ward?

  And when you're ready to launch, use offer code OLOGIES to save 10% off your first purchase of a website or domain. You can do it. Supplement this, supplement that. Maybe you want to supplement your time by simplifying your supplement, once and for all. IM8 has got that on lock. IM8 has daily ultimate essentials. It has 16 19 supplements. It replaces 90 different ingredients across nine major organ systems in one bevy. Does this work for people? 95% of people who tried it for 12 weeks felt more energy. And that is from a clinical trial conducted by the San Francisco Research Institute, which you know me, I love a clinical trial. So many athletes and high performers rely on IM8.

• 59:14Alie Ward?

  And I don't know if I'm a high performer or an athlete, but I do too. I'm actually drinking one right now. So if you're like, cool, let's give it a try. Go to IMhealth.com/ologies right now. Use our code OLOGIES for a free welcome kit, five free travel sachets, plus 10% off your order. So that's code OLOGIES at IMhealth.com/ologies. It's code OLOGIES at IMhealth.com/ologies. These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. We have to say that. Peppa Pig is your preschooler's best friend. Give the gift of bike riding confidence this year and help Peppa learn to ride her bike. Kids can imagine learning to ride a bike

• 59:59Alie Ward?

  with the Ready Pedal Go Peppa Bicycle Playset. Put Peppa's helmet on, attach the push stick to her bike, and push to make her pedal. Ready Pedal Go Peppa and more from Peppa Pig are now available at all major retailers this holiday season.

• 1:00:18Alie Ward?

  Ologies with Ally Ward is sponsored by Sylvania. It's time to upgrade your nighttime drive with Sylvania LED Ultra Fog and Powersport Lights. These powerful lights deliver cool white clarity and crisp visibility that's built to last. And thanks to their compact design, Sylvania LED Ultra Fog and Powersport Lights are engineered for a DIY install. No mechanic required. They're also backed by a limited lifetime warranty and 125 years of lighting expertise, bringing you LED Ultra Night Vision to help you see better at night. Switch today and see better tonight with Sylvania LED Ultra Fog and Powersport Lights. Oh, trips are full of unexpected discoveries. Maybe you see a sea slug or you find out that you're

• 1:01:01Alie Ward?

  Friend still sleeps with a stuffed animal. But when it comes to your vacation rental, there should not be any surprises. When you book a Verbo vacation rental, if what you expect isn't what you get, Verbo Care has you covered. If something's broken or just not right, Verbo will work to make it right. Plus, you get 24/7 live human support with every booking. Grab your stuffy, we're going on vacay. So book today on the Verbo app. If you know, you're Verbo. Terms apply. See verbo.com/Trust for details. Okay, your questions. Dr. Taylor is a very, very busy man. So we didn't even get to scratch the surface because cardiology is a huge field, and this is just one episode. But we got to ask a few great ones from patrons via patreon.com/ologies. Onward, let's hear them. We had so many great questions.

• 1:01:45Alie Ward?

  Jenna Congdon wanted to know.

• 1:01:47Speaker 04

  Hey, so my question is regarding EKG tracings in the wild. You see them on logos, on people's tattoos, kind of everywhere. And very often, they're really inaccurate and pretty funny, if you know what you're looking at. My husband and I both work in healthcare and we play a little game of pointing out these really wrong EKG tracings and trying to diagnose them. Do you notice when you see really wacky EKG lines and try to make up in your head what they could be if they were in real life? I have seen one that just didn't make any sense and was so inaccurate on the side of an ambulance. So let me know if you play this game, too.

• 1:02:26Speaker 01

  Oh, all the time, yeah. I mean, you know, it's in logos. It's where, you know, the critical parts of the waveforms are missing that would either not exist in nature or be totally alarming. You know, they tend to be a little bit idealized. So yeah, but we're okay. We're in terms of not getting too upset about that. Actually, we kind of like the attention

• 1:02:57Speaker 01

  that people are thinking about their hearts in that way.

• 1:03:00Alie Ward?

  And if you're like, "Heh, heh, heh, yes." But you have no idea what Jenna or Dr. Taylor are talking about. Congratulations, you are Ali Ward. Come along as I figure out what those waves mean. Okay, so a normal EKG or ECG, an electrocardiogram, is when they adorn you with all those wired stickers that look like they have little denim rivets or small robot nipples on them. And they pick up electrical activity that looks like a line with some wiggles and a spike, and it repeats over and over if you are not dead. And this is called a sinus wave because the sinus node is a part of the heart that works as a pacemaker. It's keeping things on beat.

• 1:03:44Alie Ward?

  So on an EKG, there's a little bump above the baseline, followed by that big spike, which then comes down, dips a little below the baseline, and then another bump, like the first one, but a little bigger. Very, very simply, that first small bump is a P wave, and that represents the electrical activity in the atria, the two atriums. And the big spike, or QRS complex is what that big spike is called, is the ventricle electrical activity. And then the third bump, a little bigger than that P wave, is called a T wave, and that's when the heart is at rest. And if these rhythms are off, then that could indicate an issue under the hood. Buddy, you got something going on. And an irregular beat is called an arrhythmia.

• 1:04:29Alie Ward?

  An AFib, or atrial fibrillation, is an irregular, and some say chaotic, heart rhythm that needs to be monitored to make sure that it doesn't cause blood clots or stroke down the line. Now, how many beats a minute should you have? What's the good tempo you want to shoot for? So 60 to 100 is in the healthy range, but consistently over 100 is what's known as tachycardia, which means fast heart. And if you're in good cardiovascular shape, you might have a lower resting heart rate because your myocardium is strong enough where a heartbeat blasts enough blood out so it can kind of slow down the pace. It's breezing along. Conversely, a weaker heart has to kind of frantically beat faster to get

• 1:05:14Alie Ward?

  blood to where it needs to go. Now, back to the tissues and the issues of the heart. How is the heart electrified? What is happening here? Asked Azam's partner Ali, Andy Pepper, Zach Ever8, first time question askers Melanie Abbott and Jeklin Costa, Rye of the Tiger, Earl of Grimalken, and Tiger Yuri Sagawa-Yang wanted to know, are there really similar cells to brains and guts in the heart?

• 1:05:39Speaker 01

  Well, yeah, in a manner of speaking, in particular, one, let's start with the brain. You know, the heart has a nervous system of sorts in that I mentioned that if it was removed from the body of a human or another species, if you will, it would continue beating. And it beats because of that electrical system. It has its own pacemaker. It generates its own electricity that the muscle responds to. The muscle is what we call an excitable tissue. If you shock it, it jumps. If it had stopped for whatever reason, it will beat after the shock. There are cells that we say they spontaneously depolarize, and that is, there's a flux of

• 1:06:24Speaker 01

  ions across the membranes of the cells. You know, potassium and sodium are flowing, and calcium are flowing in a certain way that the change in the electrical potential across the membrane causes a discharge to occur from this pacemaker. I'm trying not to go too deep into the technicalities that I hope, I hope I haven't lost people. But because of that property, the heart has its own pacemaker and the rest of the heart responds. The pacemaker is way up in that right atrium we talked about earlier. But there's a network of fibers that carry each impulse through the rest of the

• 1:07:06Speaker 01

  heart, as well as the heart muscle itself can carry the impulse even without those fibers. But it does have a sort of nervous system. Cardiac muscle is different from skeletal muscle is perhaps in some ways, it has some similarities to smooth muscle and other parts of the body. But the myocardium is special. It has a ton of mitochondria, those energy-producing cells. It has that spontaneous depolarization property, and it is woven in a special way that allows the type of contraction with each beat that propels the blood forward.

• 1:07:46Alie Ward?

  And that depolarization, which creates the humps and the spike of a sinus wave on the EKG, that's this wave of electrical depolarization, and it triggers the cardiac muscle to contract. And as for the heart and the gut alliance, a study just came out a month or so ago titled, "Unlocking the Gut Cardiac Axis: A Paradigm Shift in Cardiovascular Health." And it notes that an imbalance in your gut microbiome can trigger an immune response, and that inflammation can affect the lining of your arteries, and it can lead to plaque buildup. And we all know now that plaque buildup can cause all kinds of problems for the heart. Also, you have a vagus nerve that runs from your brain to your gut, and it can regulate

• 1:08:29Alie Ward?

  heart rate and arrhythmias, which is another reason to just respect your wonderful bod. Eat your vegetables, go for a walk if you can. Now, congestive heart failure, is that one of the bigger risks for people? And how is congestive heart failure, how is that different than a heart attack? Is that more insidious?

• 1:08:51Speaker 01

  Yeah, great question. Heart failure can be thought of as sort of a final, common pathway for a lot of different problems, okay? Let's start with a quick description of heart failure. Let's go with the classic heart failure, the congestive heart failure, as you referred to it. The heart wears out, right? It gets big and baggy and it's not a very good pump. That ejection fraction should normally, each time the heart beats, it should pump out about 60% of what's in it, right? The ejection fraction can go down to 20% or less.

• 1:09:29Alie Ward?

  So, operating at about a third of what it should be, congesting the heart like a traffic congestion, which is frustrating. Also, in this case, low-key lethal.

• 1:09:39Speaker 01

  That's heart failure of a sort. Now, how does that happen? A big heart attack, in the wake of that, you could develop heart failure. A valve breaks down and leaks severely because valves are normally supposed to be a one-way door that keeps blood flowing through the heart in one direction. That breaks down, congestion can happen. The heart gets big and weak. Uncontrolled high blood pressure, as we talked about earlier, that can lead to heart failure. Viral infections can lead to heart, certain viral infections. Alcohol excess can poison the muscle and lead to congestive heart failure. And there are other causes.

• 1:10:21Speaker 01

  Even uncontrolled thyroid disease can lead to heart failure.

• 1:10:27Alie Ward?

  Just a side note, we got a recent thyroid episode. You know who wants to hear it? Your thyroid, so cue it up.

• 1:10:33Speaker 01

  It tends to be a fairly gradual onset process, taking years and multiple insults to finally get to that stage. It is a deeply, it's a challenging problem. If today, someone was diagnosed with congestive heart failure, their five-year survival would probably be roughly equivalent to the five-year survival of receiving a diagnosis of colorectal cancer the same day, right?

• 1:11:06Alie Ward?

  Wow.

• 1:11:07Speaker 01

  However... We have developed multiple approaches to the treatment of heart failure that are promising. And the specific type of heart failure matters in terms of how we approach it. The specifics of those therapeutic approaches are best discussed with your physician. And I want to just, I want to leave a note of hope. Because of these therapeutic advances, things are getting better all the time. And even today, I was reviewing a paper that looked at engineered heart muscle that was grown from stem cells that actually was proven to improve

• 1:11:50Speaker 01

  the contractile function of the left ventricle to a significant degree. And there are all sorts of other new advancements that are being made. So there's a lot of hope in the area.

• 1:12:02Alie Ward?

  And when it comes to what you eat yourself, a lot of people, right? Anastasia Press, Dawn Smallcheck, Raya asked, the relationship between high sugar intake and heart health, assuming one eats otherwise well, asking for a quote, friend. Anastasia wanted to know what you think of plant-based diets. And Dawn asked, are Cheerios actually good for your heart? Diet was also on the minds of patrons Mims, Isabella Bartelson, Raya, Anastasia Press, Ronnie Rob Morgan, Elliot's Tired, Karen H, Ron, Wendy Forman, and Stacy Pinkowitz, who asked, am I going to live to be 500 because I eat oatmeal with flaxseed meal every day? When it comes to what you eat, your diet, what does Dr. Herman Taylor? Or like, what do you recommend?

• 1:12:47Speaker 01

  Let me tell you what I recommend. No, I have to say, and this is kudos to my wife. We are really beginning to move as much as we can, as deliberately as we can, to more and more of a plant-based diet, which doesn't eliminate, you know, consumption of certain meats, especially fish. Our ideal is a Mediterranean-style diet, right? Where there's plenty of fiber, plenty of vegetables and fruits, olive oil.

• 1:13:18Speaker 01

  It doesn't totally restrict other types of meat, but it, I mean, it doesn't eliminate it, but it does restrict it. And we try not to overdo the sodium. We stay away from processed meats as much as possible because there's all sorts of badness there. But I strongly recommend leaning towards plant-based types of food. There's also something called the DASH diet, which was designed specifically to help lower blood pressure. And it too is characterized by high number of feedings of vegetables and fruits, as well as high amounts of fiber, potassium, low-fat, high-calcium foods like yogurt,

• 1:13:57Speaker 01

  and an assortment of sort of dietary alterations that actually have been shown to lower blood pressure by some 11 points in certain populations, which is as much as some drugs.

• 1:14:10Alie Ward?

  And the DASH diet, side note, stands for Dietary Approaches to Stop Hypertension, and it recommends eating vegetables, fruits, and whole grains, including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils, and limiting foods that are high in saturated fat, like fatty meats, full-fat dairy products, tropical oils like coconut, palm kernel, palm oil, and limiting sugar-sweetened beverages and sweets. And the DASH diet eating plan says it's important to choose foods that are low in saturated and trans fats and rich in potassium, calcium, magnesium, fiber, and protein, and also lower in sodium, since excess sodium, usually from processed foods, makes your body retain water

• 1:14:54Alie Ward?

  to dilute that sodium, which raises your blood volume and it leads to higher-than-healthy blood pressure. Now, for folks with low blood pressure or low blood volume, say if you have POTS, if your doctor says to go hog wild on the sodium for other reasons, obviously listen to them. But in general, we eat way more sodium than we evolved to do. Now, what if you're on a road trip or you were bad at cooking? The American Heart Association says that good, convenient store DASH diet snacks include part-skim string cheese, boiled eggs, Unsalted nuts, Greek yogurt, and Whole Foods, which are not Cheetos, but they will keep you alive. Now, when it comes to hydration and eating produce,

• 1:15:38Alie Ward?

  sometimes you're like, the world sucks, I need a treat. So what I like to do is pretend that I'm in a post-apocalyptic world, like Mad Max style, and that water is something that people start wars over. So if anyone gives me like free water, like at a restaurant, I like to pretend it's the score of a lifetime. My fridge dispenses clean, filtered water. I would be a fool to pass up 64 ounces or more of that a day. Fruits and vegetables? What if I mouthed off of the government and I got shipped to Mars, but I escaped the prison pod and I found a stash of salads and oranges until I could build a ship to go home? That's elaborate, but you can just like pretend you're lost at sea or something. And then you see water and vegetables and you're like, what a slay. Got to have them.

• 1:16:19Speaker 01

  There's help out there. Dash diet, Mediterranean diet, those are sort of two at the top of my list. And eat plants every chance you get.

• 1:16:28Alie Ward?

  Do you ever experience any eye pain when you see headlines about carnivore diets? Like, do you roll your eyes so hard that they hurt?

• 1:16:38Speaker 01

  That's a very good question. They are not my favorite. And now this is a controversial area for some. But yeah, we're omnivores, right? So some meat's okay. But I think historically, meat was more of a condiment than it was a central part of the meal. And I think that is sort of a model of where we need to go in terms of inching more and more towards vegetable sources of protein and all the other great things that vegetables do. I think we should keep pushing towards that. You know, saturated fats are much more cholesterol genetic than eating cholesterol. You know, eating a piece of steak will produce a lot more issues

• 1:17:23Speaker 01

  in terms of cholesterol than eating an egg, right? So I would say that, yeah, I don't really dig the carnivore diet.

• 1:17:33Alie Ward?

  I figured it was something along those lines. So that's helpful in terms of what to put in your mouth. But how about lacing up your sneakers or dipping into some water aerobics? Maybe rollerblading without a shirt. Patrons Matt Tocato, Anthony Richards, Beth and Greer, Kyla C, Marathoner Curtis Takahashi, Samwise, Addie Capello, Ghul Next Door, and Haley Balanzo, first time question asker. They all asked about the effects of exercise on the heart. And Haley, I'm happy to accompany you in your ears on any walks you take. I know a lot of ologites. You're here to learn about weird stuff while you're out on strolls. I salute you. Way to go. But is it ever too late to start that? And very, very last question from listeners.

• 1:18:15Alie Ward?

  Brendan and Ashley, first time question asker, asked, can getting into shape through regular cardio later in life undo some of the potential heart damage of being obese or sedentary previously? They say, I was overweight my whole life until last year when I started running and eating better and lost 85 pounds. Is it ever too late to get to help out your heart?

• 1:18:33Speaker 01

  Never too early, never too late.

• 1:18:36Alie Ward?

  Okay.

• 1:18:37Speaker 01

  I'm so proud of her. That is fantastic. That's cause for celebration. Your heart is celebrating, let me tell you. When you, when you take off, even a loss of 5% of total body fat is felt by the heart in terms of that strain of pumping through those thousands of miles of arteries, capillaries, and so forth. That's critically important to your heart health. You have done yourself a tremendous favor. I would say to you, congratulations, and I wish I had more patients like you.

• 1:19:13Alie Ward?

  Oh, that's such great news. So it's, that's inspiring. It's never too late to do something good for your heart. Now, what about, what about you? What's the hardest part of your job and the part you love the most?

• 1:19:26Speaker 01

  Well, in recent years, I migrated much more heavily towards research. But I will tell you that the hardest part of my job, if I look over the span of my career, was seeing people when it was too late, was the heart attack or the cardiac arrest we could not reverse. You know, walking from that bedside and telling the family.

• 1:19:48Speaker 01

  Was yes, that those were the hardest moments. What I have loved the most clinically is, I guess, kind of the opposite of coming out of the cath lab and telling a family who was worried about chest pain in their loved ones that the arteries were clear. While we may not have the answer to the chest pain today, what we know is that the most dangerous thing that it could be appears not to be on the table. And we can now move methodically through the other less lethal possibilities. Those were good moments. I think finally, I think realizing that for some populations where we hear a lot

• 1:20:31Speaker 01

  of important work, which I've been proud to contribute to, on the disparities that those populations, like African Americans, like other marginalized populations historically, that there's a lot of bad news, there's a lot of news about foreshortened lives, or higher rates of heart disease, hypertension, and so forth. Important to document, important to heighten our awareness that we need to have public health and other approaches that target some of these really troubling statistics, that simultaneous with the sort of bad news, that there's a lot of reason to be excited about the resilience of these populations.

• 1:21:16Speaker 01

  You know, there was a time in American history about 100 years ago where the extinction of African Americans was predicted based on statistics at that time and the circumstances of the fallback on reconstruction and other things that were aimed at helping the black population that was newly freed. Despite all that travail, there are incredible stories of health and longevity, and call it joy, among a population that has had to confront such important obstacles. And that resilience, I think, really points to another aspect of human existence, if you will, that points to how

• 1:22:03Speaker 01

  It is so humanly possible to overcome so many of these challenges. And I'm, I'm very, very proud of those resilient African Americans and others who are living life long and well and thriving and flourishing, despite some of the challenges that they face historically and present day. So I think that resilience that I see evidence of all the time is something that gives me a lot of happiness and joy.

• 1:22:33Alie Ward?

  Well, your work is amazing and I thank Matthew for suggesting.

• 1:22:40Speaker 01

  Yeah, I'll deal with him later.

• 1:22:43Alie Ward?

  We're now, we're now friends online.

• 1:22:45Speaker 01

  I do have to just say, Matthew's my oldest son. I'm so proud of him out at UC Berkeley. And the frontier that he's opening up in music, I think is exciting. And everybody should pay attention to what happens next for Matthew Evan Taylor.

• 1:23:01Alie Ward?

  You know, I need to have him on for a music episode now.

• 1:23:03Speaker 01

  You gotta do that. You gotta do that.

• 1:23:06Alie Ward?

  Multigenerational Taylors. Well, thank you so, so much. I'll let you get back to your Saturday. I really appreciate it.

• 1:23:12Speaker 01

  It's been, it's been great.

• 1:23:15Alie Ward?

  So ask caring people your cardiac curiosities because you only live once and you will live better and longer if you listen to them. I cannot thank Dr. Herman Taylor enough for his time to do this episode and for highlighting February as Heart Month and as Black History Month. And it's just another among millions of examples of how much diversity matters in science because discovery is all about what questions we're asking. And you need a variety of experience and perspectives to identify and tackle problems and find solutions. Thank you again, Dr. Taylor, for all of your work. Thank you to his son, Dr. Matthew Evan Taylor, who's an associate professor of composition at UC Berkeley's Department of Music. Dr. Taylor, Dr. Matthew Evan Taylor, that is, will release his first LP soon.

• 1:24:00Alie Ward?

  It's called Life Returns and it was recorded live at the Metropolitan Museum of Art in 2022. You can find out more about that and follow Matthew on Instagram at Matthew Evan Taylor. Now we are at Ologies on Instagram and Blue. Sky, I'm at Ali Ward on both. We have shorter, kid-safe, and classroom-friendly versions of Ologies wherever you get podcasts. Just look for them in their own feed. We have new green artwork by a Portland artist, Bunny Dutch. Also, Ologies merch is available at ologiesmerch.com. And if you would like to be a patron of the show and submit questions before we record, you can find us at patreon.com/ologies. It costs $1 a month to join. That is the entrance fee into our heart. Now, Erin Talbert admins the Ologies Podcast Facebook

• 1:24:43Alie Ward?

  group. Avilene Malik makes our pro transcripts. Kelly Ardwire does the website. Noel Dilworth is keeping us on beat as scheduling producer. Susan Hale is managing director and the blood supplying all of our organs and also did additional research and producing for this episode. Thank you, Susan. Our assistant editor and atria for raw audio is Jake Chaffee. And left ventricle helping us pump these out every Tuesday is Mercedes Maitland, our lead editor of Maitland Audio. Nick Thorburn paced made the theme music. And if you stick around until the end, I burden you with a secret about my life and some behind the scenes on this episode. Okay, so, we were recording with Dr. Taylor. It was going great. He was amazing. The mic that we sent him was working wonderfully. For some reason,

• 1:25:28Alie Ward?

  the interface that I use to record kept popping up with a notice saying that his end wasn't recording. No fault of his own. I have no idea what was going on with the website that was supposed to be recording us. And in fact, I went to go look at the files. The files were not there. They did not record. Thankfully, Mercedes found a backup copy somewhere in a folder that had to be downloaded and pieced together, so all of the audio survived. But I was like, if this is just not recording, I don't even know. I'm going to disappear. I'm going to go into witness protection or something. I'm going to change my name. I'm going to wear a wig the rest of my life. This is too embarrassing. I honestly started crying when she told me that she was able to get a backup of the files. I shed tears.

• 1:26:11Alie Ward?

  I was so thrilled. Anyway, think of your heart like a shelter pet who deserves nothing but the best in life and take care of it as you would a stray guinea pig or a surrendered collie. You deserve it. Okay, bye-bye.

• 1:26:43Alie Ward?

  Honey, you have such a big heart. How's your ponytail looking? Maybe like a little thinner than it used to? We've talked about this in our menopause episode. At some point, it's bound to happen to all of us. So if you're ready for thicker, fuller hair, start your free online visit today at forhers.com/ologies for personalized care. So that's F-O-R-H-E-R-S dot com slash ologies. Individual results may vary. Featured products include compounded drug products, which the FDA does not approve or verify for safety, effectiveness, or quality. Prescription required. Price varies based on product and subscription plan. See website for full details, restrictions, and important safety information.