When to See a Cardiologist with Greg May, M.D.

In this episode of Advance with MUSC Health, Greg May, M.D., an interventional cardiologist at the MUSC Health Florence Medical Pavilion, talks about symptoms that warrant a trip to the cardiologist, what to expect at a cardiology appointment, and tips to keep your heart healthy.

“It's nothing to fear. I mean, I think it's a sigh of relief to see somebody that's on your side to help you with your health issues and to try to keep you healthy. So I really feel like that's my job every day is just to try to keep people going as long as we can.”
— Greg May, M.D.

Topics Covered in This Show

• Common risk factors for cardiovascular disease include smoking, having high blood pressure, high cholesterol, or a history of family disease.
• If you experience chest discomfort with exertion, this symptom warrants a trip to the cardiologist, May says. This sort of chest discomfort may also radiate out to your arms, neck, jaw, and upper back. Even if it goes away with rest, this symptom is a reason to see a cardiologist.
• He says exertional chest pain, worsening shortness of breath, dizziness, or a racing heart beat is reason to be seen by a cardiologist immediately.
• If you have a family history of premature coronary disease you should also see a cardiologist. This family history is defined as a male under the age of 55 or a woman under the age of 65 in your immediate family who had a cardiac event, May says.
• An appointment with a cardiologist typically includes an electrocardiogram, notes on family history, a physical examination, and planning the diagnostic tests that are appropriate for the patient.
• May offers diet recommendations for a healthy heart, such as eating lean proteins and staying away from fried foods, egg yolks, red meat, and fatty pork.
• May’s exercise recommendation is to walk three to four times a week at a brisk pace for a minimum of 30 minutes.
• An interventional cardiologist’s job consists of checking the arteries through cardiac catheterization and then deciding what the best treatment is according to the amount of blockage in the arteries.
• Noninvasive techniques can include an echocardiogram and a stress test done on a treadmill with nuclear imaging.
• Intravascular lithotripsy is the biggest advancement in cardiology over the past decade, according to May. Many patients are now able to receive stents that wouldn’t have been able to before intravascular lithotripsy.

Read the Show Transcript Below

Erin Spain, M.S.: Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Seeing a cardiologist for the first time can be a little intimidating, but necessary if you have certain risk factors or symptoms of heart disease. Here with details on when you should see a cardiologist is Dr. Greg May, an interventional cardiologist with MUSC Health at the Florence Medical Pavilion. Welcome to the show, Dr. May.

Greg May, M.D.: Hi. So nice to be with you today.

Erin Spain, M.S.: Tell me about the symptoms people may experience that warrant a trip to the cardiologist.

Greg May, M.D.: There's a lot of symptoms that could warrant a visit. I think if people have risk factors for heart disease, if they smoke, if they have high blood pressure, diabetes, particularly high cholesterol or a family history of heart disease, they need to pay close attention to certain symptoms.

The symptoms would include discomfort in the chest. We don't have to call that chest pain. It can be simply pressure, tightness, and fullness in the chest. The pain may stay in the middle of the chest, usually would spread across the chest, not be localized to a little pin point, and it would go on for at least a few minutes.

The chest discomfort may not necessarily be in the middle of the chest. It can radiate to your arms, your neck, your jaw, your upper back, not down a leg and not associated with a headache. Frequently, this type of discomfort would be brought out by exertion.

So if someone was cleaning their house or working in their yard or walking in the department store, they may experience it with exertion. And typically the chest discomfort would go away with rest. So usually it lasts for a few minutes and it would follow this pattern of coming on with exertion and being really by rest, of course.

In the later stages, people can have these same kinds of symptoms happen at rest and even wake them from sleep. So if those kinds of things happen, that would be a good reason to come to see the cardiologist. I think the most important part of deciding to go to the cardiologist would be to be concerned about your health. The kind of chest pain that I'm describing, I think is really where we should focus on chest pain that lasts for a few seconds, no matter how severe, is never the heart.

So these are things that keep in mind when analyzing the type of chest pain that someone has. Other symptoms that might bring you to the cardiologist would be just an extreme fatigue, just sudden onset of fatigue, and you can't do the things that you normally would be expected to do or would expect you could do. Shortness of breath, doing minimal activities, things like this. You know, we like to get to patients early. So when I hear somebody tell me that they've been having chest pain for several months, I would encourage that patient not to wait because sometimes it really is too late. I'd much rather see someone in the office and take care of things before there's an emergency. Of course we're here for emergencies. We get up in the middle of the night frequently, for those kinds of things, having an exertional chest pain, worsening shortness of breath. Your heart's racing, you're getting dizzy, you feel like you're going to pass out, these are things that you need to come right away. You know, you can call the number in MUSC Florence or Charleston or wherever you live, and it should be fairly simple to get an appointment right away. There is no referral necessary. All you have to do is pick up the phone and make that call. Old cardiac records are an advantage, but not necessary.

Erin Spain, M.S.: So you mentioned these things could happen while doing mundane tasks around the house, but they also tend to happen during a really stressful event. Someone having a heart attack at a wedding or another important moment in life. Tell me about that and the role stress can play.

Greg May, M.D.: Yeah, absolutely. You know, stress is usually associated with elevated blood pressure and or elevated heart rate. So I think that's the connection that stress plays in bringing out heart symptoms. We've talked about Monday morning heart attacks. We see more heart attacks on Monday morning than any other time. And that's probably because the stress of your weekend is over and you're getting up Monday morning and your blood pressure shoots up and you don't want to go to work. So that's not an uncommon scenario. But yes, stress, mental stress can bring it out, but again, would result in the similar symptoms that I just described.

Erin Spain, M.S.: You mentioned family history. That can mean different things to different patients. What do you mean when you talk about family history?

Greg May, M.D.: That's a good question. A lot of people think that if anybody at all in their families had a heart condition, that means something. But, you know, an 80 year old grandfather had a heart attack, that's not a family history. You know what we're really asking, is there a family history of premature coronary disease? And we define that as male, 55 or younger, having a cardiac event like a heart attack or needing a bypass or a stent. And for women under the age of 65. So that constitutes a history of premature CAD or coronary artery disease. And, you know, the grandmothers and grandfathers and distant relatives don't really help us use that in particular as deciding if we're really suspicious or not.

Erin Spain, M.S.: So when someone does come to see you for the very first time, what can they expect? What's going to happen? What sort of tests are you going to do?

Greg May, M.D.: Well, we're always going to look at an EKG and we're going to talk about their risk factors. And we're going to spend a lot of time talking about their history and why they came. And the majority of the time is that, just the history. That's really important to get that history and make sure that we're communicating and understanding why the patient was concerned and why they came in. And of course, there's a physical examination. And then the final thing, we're going to make some plans on what kind of diagnostic tests we feel are appropriate for that particular patient to see what's going on. Not all tests are for everyone, but basically directed at the symptoms they came with and what we're seeing and hearing.

Erin Spain, M.S.: You also will recommend lifestyle changes. Let's talk about that. What do you recommend to your patients?

Greg May, M.D.: Well, it's almost a joke, but I tell my patients if it tastes good, just don't eat it. And we laugh and they laugh, and I laugh too, because I'm not able to follow that rule all the time. It's a hard rule to follow. But basically, we're talking low fat, low cholesterol. When we're talking about heart disease, in particular, blocked arteries, we're not talking about salt. You know, we talk about diabetes management and the importance of that, but we're not involved with that. That's their primary care physician. But fat and cholesterol are the mainstays of what we talk about. So I tell people to eat lean proteins, chicken, fish, turkey to make it, broil it, grill it, stay away from fried foods, stay away from egg yolks, bacon, sausage, red meat and fatty pork are not on the healthy cardiac diet. So for the most part, you know, everyone's human. We're all going to eat some bad stuff every now and then. So we try to follow that rule of if it tastes good, try not to eat it too often. But I think that's the main thing that we're trying to get across is just lifestyle modification. Most people have not even thought about what they eat, so just to get them to think about it and analyze it is a big first step.

Erin Spain, M.S.: And then exercise.

Greg May, M.D.: Yeah, exercise. I mean, we promote aerobic exercise, something that gets your heart rate up and so we promote a walking program. You know, the American Heart Association says daily, it's hard to do that. I tell my patients that have arthritis and everything else to try to do at least 3 to 4 times a week of walking. And we're talking a brisk walk, as brisk as they can stand, and something that, you know, for 30 minutes in duration. So we advocate aerobic exercise. If people want to lift weights and whatnot and do resistance training, that's fine too but the heart healthy exercise is felt to be aerobic. And the reason for that is, you know, that has favorable effects on your blood lipids, your cholesterol and your fat. It helps with weight loss, it helps with blood pressure control. So all of us link together. Everything is connected.

Erin Spain, M.S.: Tell me about some of the success stories for folks who are able to make some of those bigger lifestyle changes. With diet and exercise.

Greg May, M.D.: We see a lot of patients that are able to stabilize their disease. We're mainly talking about coronary artery disease, you know, buildup of plaque in your arteries. So if we can get people's cholesterol low and it frequently takes medication, but certainly diet and exercise are part of it. If we can get that cholesterol low and keep it low, that gives us the best chance of not developing progressive coronary disease or by that I'm saying to keep the plaques from getting any bigger in their arteries. So that's our goal.

Erin Spain, M.S.: You're an interventional cardiologist. Just explain to the audience what exactly that means and then what else is available in U.S. health and cardiac care, the different specialists within your specialty?

Greg May, M.D.: Well, we have a non interventional cardiologist. We have interventional cardiologist and we have an electrophysiologist. So I tell people as an interventional cardiologist that I'm kind of the plumber. By that I mean that we're checking the arteries. You know, we get to the point where we think cardiac catheterization is necessary.

We're usually going to go from the wrist and we put a small catheter into the wrist and we run that up into the heart. And using x-ray dye, we take pictures of the coronary arteries and that allows us to assess, you know, how many arteries are blocked and how severe the blockage is. And based on that information, we can come up with the best treatment. It may be as simple as medication. If there's a major vessel tightly blocked and it correlates with symptoms or a stress test, we may feel like the best thing is a stent.

So that's something we do in the cath lab. We can put a stent in from these sites from doing the cath in the wrist. We put the stent in and open it up and they usually go home the same day. So that's mainly what we do. Obviously, we do other things and we do cardio versions and people's hearts that are out of rhythm. We convert their hearts into rhythm. Our electrophysiologist, she studies people that need pacemakers and people that need defibrillators and people that need a-fib ablations, you know where there's a catheter technique to get rid of atrial fibrillation or atrial flutter, which is a cousin of atrial fibrillation.

And then on the noninvasive side, we do echocardiograms as an ultrasound of the heart to look at heart function, the valves in the heart. And that's important an part of the puzzle is just looking at heart function. A Stress test, you know, we do regular treadmill tests and frequently we do that with nuclear imaging. Nuclear imaging allows us to get an estimate of blood flow to the heart muscle. So that test is sometimes a starting point to decide if we need to go to the heart cath. Some people we decide on cardiac can give us a rough idea of how the arteries in the heart look. So we use that in some cases. So we have interventional things we do and we have non interventional techniques.

Erin Spain, M.S.: What would you say have been some of the biggest advances in the past 10 to 20 years that have benefited your patients?

Greg May, M.D.: Well, the most recent events that I think are huge. We now have intravascular lithotripsy. The brand name of that is Shock Wave and that's pretty new over the last year or so. That allows us to deal with calcium that builds up in the artery, the coronary artery walls. Not everybody that develops plaque gives calcium, but in the older patients and even some of the younger patients, there's a tremendous amount of calcium buildup.

The calcium makes it very difficult to work on the vessels with our standard techniques. So with the intravascular lithotripsy, we're able to put that catheter down and by using ultrasound energy fracture that calcium in the wall, the artery, then it allows us to advance things down the artery, the stance and the balloons that we need to use to open up the vessel.

So that's been huge. A lot of patients that wouldn't be able to be treated with angioplasty are now able to get stents and so that's been a huge advance. We have other techniques to remove calcium. They're a little bit more invasive compared to that. Stents are always being advanced. I think we're on our second or third generation drug eluting stents now. Drug eluting stents were developed many years ago to combat the problem of the blockage coming back within the vessel after a regular stent. So these are things that have advanced in the last 20 years. Of course, catheters and wires and all the stuff that we use, the X-ray equipment, all that's been advanced. So things are a lot easier now than they used to be.

Erin Spain, M.S.: What would you say to someone who's listening if they or a loved one have an appointment with a cardiologist, they've never been before and maybe they're feeling a little nervous? Any bits of advice?

Greg May, M.D.: It's nothing to fear. I mean, I think it's a sigh of relief to see somebody that's on your side to help you with your health issues and to try to keep you healthy. So I really feel like that's my job every day is just to try to keep people going as long as we can.

Erin Spain, M.S.: What do you do to optimize your health and live well?

Greg May, M.D.: I don't eat red meat very often. I try to follow the chicken, fish and turkey rule, but I do cheat. And I tell my patients, you know, we're all human. We all cheat sometimes. I try to exercise. I get a lot of walking done in my work. Most of it is brisk. So I try to exercise as much as I can, but I love to fish, and fishing is my passion, so I like to fish and that's my real relaxation is going to Florida and seeing my grandson and fishing.

Erin Spain, M.S.: Thank you so much, Greg May, M.D., for all of this information today and some good tips to help us all think about when we might need to see a cardiologist. Thank you for your time.

Greg May, M.D.: Oh, you're welcome. Nice talking with you.

Erin Spain, M.S.: For more information on this podcast, check out Advance with MUSC Health.