SpaceCoast Living sat down with Dr. James Ronaldson recently in his office at Health First’s Viera Medical Plaza.
As we start 2017, many of us begin new exercise regimens and alter our diets to improve our heart health. We thought getting some general information on heart disease could help us all understand the issues regarding our heart health. Dr. Ronaldson was very happy to oblige, saying, “It is truly an honor to participate in the health care of my patients. I believe that if you are lucky enough to find a job you truly love, then you will end your life with a tombstone that reads, ‘He never worked a day in his life.’ I believe that medicine is a vocation, not a job, and truly look forward to work every day.”
Dr. Ronaldson’s residency was at St. Vincent Medical Center in New York. His cardiology fellowship was at the University of South Florida, and he came to Brevard County in 1988.
Q: Could you explain exactly what heart disease is?
A: I believe when discussing heart disease, you should break it down into five components:
- Congenital heart disease: Diseases of the heart that an infant is born with, which often requires urgent and successive, intricate surgeries. Over the last 30 years, major improvements in surgical technique have stabilized and prolonged the lives of infants with congenital issues that were once fatal.
- Congestive heart failure: The heart is a pump that must push oxygenated blood to the body, commensurate with the needs and demands of all the organs. When the heart cannot do this effectively, it is said to fail. Congestive heart failure has many causes. Myocardial infarctions can damage heart muscle and make the heart muscle weak. The heart muscle can also be damaged by chemotherapy drugs, excessive alcohol use, severe diabetes and, many times, by a viral infection of the heart muscle. Heart failure can sometimes be helped with medication, but other times require referral to tertiary centers for consideration of a heart transplant or left ventricular assist device (LVAD) to support the heart pump.
- Valvular heart disease: The heart has four valves and over time, there can be gradual deterioration of the cells of the valves or they can become infected. When this occurs, the valve either leaks, causing regurgitation, or becomes heavily calcified and very narrow. The development of a valvulopathy occurs slowly over decades but eventually requires surgery. Recent advances have allowed for certain valve replacements to be completed with minimally invasive approach through the ribs, as opposed to cutting open the sternum or, most recently, transcatheter aortic valve replacement (TAVR). TAVR is a procedure in which the aortic valve is replaced via an endovascular approach.
- Coronary artery disease: This is the gradual atherosclerosis or narrowing of the coronary arteries that can lead to progressive chest pain or angina and, ultimately, a heart attack or sudden cardiac death. This arena has been greatly improved with the advent of cardiac stents, and our appreciation that certain blood thinners – specifically aspirin and Plavix – help keep stents open for longer periods of time. Our appreciation in the role of cholesterol and the invention of drugs that drive down the bad cholesterol (LDL) has greatly improved cardiac outcomes in the last 20 years.
- Electrical system of the heart: The heart is made of muscle but is coordinated and stimulated by its own electrical or nervous system. This brilliant series of nerve fibers stimulate the heart 100,000 times a day or over 2 trillion times in the course of one’s lifetime. Disorders of the electrical system can occur that cause the heart to beat too fast – tachycardia or supraventricular tachycardia (SVT), atrial fibrillation or atrial flutter – and require medication to slow the heart down; sometimes, an invasive procedure called ablation is required. The heart can also sometimes beat too slowly, and these patients will require a pacemaker. There is a subspecialty of cardiology dedicated to the treatment of these electrical disorders, and the physicians who take care of the disorders are called electrophysiologists.
Q: What are some of the major myths about heart disease?
A: I believe the major myth regarding heart disease is it is predetermined one will get a heart disease, much like one would get cancer. This is not true at all. The majority of heart disease is preventable through appropriate diet, exercise and treatment of underlying risk factors, such as high cholesterol, diabetes, hypertension and smoking.
Q: What can people do to protect themselves from heart disease?
A: Knowledge is power in the fight against heart disease. Knowing what your blood pressure is, knowing your blood sugar and cholesterol levels, not smoking, adopting a consistent exercise regimen and eating appropriately, are excellent ways to prevent heart disease. Understanding the role of genetics in certain types of heart disease and seeking out a cardiac specialist to further investigate your risk is very important. If there is a strong family history of premature coronary artery disease or death, specifically when close family members have had heart disease in their 30s to 50s, this should trigger an alarm for the the patient to seek medical attention.
Q: Exactly what is atrial fibrillation (A-fib)? What causes it? How should patients be treated?
A: Atrial fibrillation is a disorder of the electrical system that causes the two top chambers of the heart (the atria) to beat in a rapid and chaotic fashion. Atrial fibrillation affects 3 million Americans. It is caused by hypertension, valve disease and thyroid disorders, but mostly by a gradual aging of the electrical system. It is much more prevalent in our elder population.
There are three main problems with atrial fibrillation. First, it causes the heart to beat very fast. Second, it causes the heart to beat in an unsynchronized fashion, causing the heart pump to be 20 percent weaker than normal and, third, the rapid chaotic movement of the atrium creates an environment for clots to form, which can mobilize or embolize to the brain and cause a stroke.
Treatment of atrial fibrillation can involve heart rate control with medication, anticoagulation to prevent stroke and the initiation of antiarrhythmic drugs to potentially convert the patient back to a normal sinus rhythm. Sometimes, an invasive procedure called an ablation, where the problematic area in the heart is burned or frozen to stop the arrhythmia, is performed.
Q: How does the Heart Center at Health First’s Holmes Regional Medical Center rank as a destination for patients seeking cardiac care?
A: I started my cardiology career in Brevard in 1988, and I am proud to have witnessed the impact that the Heart Center has had on the community. I commend Health First for realizing the need for optimal cardiac care, which led to the creation of the Heart Center. The dedication of the nurses and physicians toward this critical need for our county is demonstrated daily through their magnificent efforts.
The level of cardiac surgery, interventional cardiology and electrophysiology now being done at the Heart Center is unprecedented in my career.
Q: Why do athletes get heart disease?
A: The majority of athletes who succumb to heart disease usually have an undiagnosed congenital structural abnormality of the heart. Many of our physicians have dedicated themselves to assisting with high school physicals that enable our athletes to get the appropriate medical attention they deserve.
Another cause of athletes getting sick has to do with inappropriate use of supplements, stimulants or steroids that have potentially deleterious effects. As parents, we should be mindful of our children, who are very driven and competitive and might fall prey to bad advice. Appropriate screening with your primary care physician and, when needed, a cardiologist, certainly could prevent many of the sad but rare casualties that athletes sometimes succumb to.
Q: What is your message to the public to help them maintain healthy hearts?
A: Take responsibility for your health. You must take an active role in staying healthy. You must take an active role in knowing your medical condition and knowing how each and every medication that you take works. In my practice, I try to spend a lot of time educating my patients and making them “informed consumers.” Through an intelligent partnership, we can better communicate, maintain and enhance their health.