Cardiology (THE HEART) with Herman Taylor

Summary

Ologies with Alie Ward: Cardiology (The Heart) with Dr. Herman Taylor

Release Date: February 26, 2025

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1. Introduction to Dr. Herman Taylor

In this episode of Ologies with Alie Ward, host Alie Ward welcomes Dr. Herman Taylor, a distinguished cardiologist with an illustrious career spanning over three decades. Dr. Taylor is not only recognized as one of the top cardiologists in the United States but also serves as the Director of Player Engagement and Education for the Football Players Health Study at Harvard University. His academic credentials include an undergraduate degree from Princeton and a doctorate from Harvard Medical School. Dr. Taylor's dedication to cardiovascular research and his contributions to the Jackson Heart Study, which focuses on the cardiac health of African Americans, underscore his commitment to addressing heart disease disparities.

Dr. Herman Taylor [05:54]: "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."

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2. Understanding the Heart: Structure and Function

Dr. Taylor begins by elucidating the heart's anatomy, describing it as a four-chambered muscle composed of two atria and two ventricles. He explains the flow of blood through the heart, emphasizing the roles of the right and left sides in circulating deoxygenated and oxygenated blood, respectively. The discussion highlights the heart's electrical properties, detailing how it can beat independently outside the body when provided with oxygen and nutrients.

Dr. Herman Taylor [17:24]: "You have four chambers: two atria and two ventricles. The right side handles deoxygenated blood, sending it to the lungs, while the left side pumps oxygenated blood to the entire body."

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3. Blood Pressure and Heart Health

A significant portion of the conversation delves into the critical relationship between blood pressure and heart health. Dr. Taylor explains how high blood pressure (hypertension) exerts undue stress on arterial walls, leading to endothelial damage and the buildup of cholesterol plaques—a condition known as atherosclerosis. He outlines the cascade of events that can result from uncontrolled blood pressure, including the rupture of plaques, which may trigger heart attacks.

Dr. Herman Taylor [23:50]: "The pressure you need to keep blood flowing to the heart itself is crucial. If it's too much, it damages the arteries, leading to cholesterol accumulation and plaque formation."

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4. Stress and Cardiovascular Impact

The episode explores how various forms of stress—be it emotional, environmental, or societal—affect cardiovascular health. Dr. Taylor discusses the physiological responses to stress, such as increased adrenaline levels, elevated heart rate, and heightened blood pressure. He underscores the importance of managing stress to prevent long-term damage to the heart.

Dr. Herman Taylor [33:22]: "Stress and the hormones related to stress, like adrenaline, can cause blood pressure to go up and arteries to constrict, increasing the strain on the heart."

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5. Gender Differences in Heart Disease

Dr. Taylor highlights the often-overlooked fact that heart disease is the leading cause of death among women, surpassing breast cancer. He notes that women frequently experience atypical symptoms during cardiac events, such as fatigue, indigestion, and pain in less typical areas like the back or jaw. This disparity in symptom presentation can lead to underdiagnosis and delayed treatment in women.

Dr. Herman Taylor [43:29]: "The leading cause of death for women is heart disease. Women are more aware of the threat in 2009 than in 2019, especially younger women who seem less informed about this threat."

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6. Diet and Lifestyle Recommendations

Addressing preventive measures, Dr. Taylor advocates for diets rich in vegetables, fruits, whole grains, and healthy fats, such as the Mediterranean and DASH (Dietary Approaches to Stop Hypertension) diets. He emphasizes the importance of maintaining a healthy weight, regular exercise, adequate sleep, and avoiding smoking and excessive alcohol consumption to mitigate heart disease risk.

Dr. Herman Taylor [73:25]: "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."

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7. Understanding Heart Failure vs. Heart Attack

The distinction between heart failure and heart attacks is thoroughly examined. Dr. Taylor explains that heart failure refers to the heart's inability to pump blood effectively, which can result from various factors, including prolonged high blood pressure and heart muscle damage. In contrast, a heart attack, or myocardial infarction, occurs when blood flow to a part of the heart is blocked, leading to tissue death.

Dr. Herman Taylor [70:16]: "Heart failure can be thought of as the heart wearing out—the ejection fraction can drop to 20% or less, severely compromising its pumping ability."

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8. Listener Questions: EKGs, Diet, Exercise

The episode features listener-submitted questions addressed by Dr. Taylor, covering topics such as the accuracy of EKG tattoos, the impact of various diets on heart health, and the benefits of exercise. Dr. Taylor provides insightful answers, debunking myths and reinforcing the importance of regular health monitoring and lifestyle modifications.

Alie Ward [77:05]: "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?"

Dr. Herman Taylor [77:15]: "I don't really dig the carnivore diet. Saturated fats are much more cholesterol genic than eating cholesterol."

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9. Conclusion and Final Thoughts

Wrapping up the episode, Alie Ward and Dr. Taylor emphasize the importance of heart health awareness, regular check-ups, and embracing diverse perspectives in medical research to tackle heart disease effectively. Dr. Taylor shares his admiration for the resilience within marginalized communities and expresses hope for ongoing advancements in cardiology.

Dr. Herman Taylor [79:13]: "Never too early, never too late."

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Key Takeaways

• Heart Anatomy & Function: Understanding the four chambers and their roles in blood circulation is fundamental to comprehending heart health.

• Blood Pressure Management: Maintaining optimal blood pressure is crucial to prevent arterial damage and subsequent heart diseases.

• Stress Reduction: Effective stress management can significantly reduce the risk of cardiovascular issues.

• Gender-Specific Symptoms: Recognizing that women may exhibit atypical heart attack symptoms is vital for timely diagnosis and treatment.

• Healthy Lifestyle Choices: Adopting diets like the Mediterranean or DASH, exercising regularly, and avoiding harmful habits are essential for heart health.

• Distinguishing Heart Conditions: Knowing the differences between heart failure and heart attacks can aid in better understanding and responding to heart-related emergencies.

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Notable Quotes with Timestamps

• Dr. Taylor [05:54]: "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."

• Dr. Taylor [17:24]: "You have four chambers: two atria and two ventricles. The right side handles deoxygenated blood, sending it to the lungs, while the left side pumps oxygenated blood to the entire body."

• Dr. Taylor [23:50]: "The pressure you need to keep blood flowing to the heart itself is crucial. If it's too much, it damages the arteries, leading to cholesterol accumulation and plaque formation."

• Dr. Taylor [33:22]: "Stress and the hormones related to stress, like adrenaline, can cause blood pressure to go up and arteries to constrict, increasing the strain on the heart."

• Dr. Taylor [43:29]: "The leading cause of death for women is heart disease. Women are more aware of the threat in 2009 than in 2019, especially younger women who seem less informed about this threat."

• Dr. Taylor [73:25]: "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."

• Dr. Taylor [70:16]: "Heart failure can be thought of as the heart wearing out—the ejection fraction can drop to 20% or less, severely compromising its pumping ability."

• Dr. Taylor [77:15]: "I don't really dig the carnivore diet. Saturated fats are much more cholesterol genic than eating cholesterol."

• Dr. Taylor [79:13]: "Never too early, never too late."

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Final Remarks

Dr. Herman Taylor's comprehensive insights into cardiology serve as an invaluable resource for listeners seeking to understand heart health better. From the intricacies of heart anatomy to the profound impact of lifestyle choices, this episode underscores the multifaceted nature of cardiovascular well-being. By addressing common misconceptions and highlighting the importance of preventive measures, Ologies with Alie Ward equips its audience with the knowledge to make informed decisions about their heart health.

For more information and resources discussed in this episode, visit Ologies Merch and support the show through Patreon.

Transcript

[Alie Ward]

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[Alie Ward]

Virtual prepaid card allow 15 days qualifying unlock device, credit service port in 90 plus days with device and eligible carrier and timely redemption required. Card has no cash access and expires in six months. Oh hey, it's the woman on the Swamp tour who won't stop screaming. Yee haw Alie Ward. And we are here with your heart in your ears. Cardiology. Let's consider this episode a101. 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. He had a conference to go to in November and then he was going 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. 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 helped the show so much, such as this recent review from Amy in Arlington who wrote learn new stuff each time you come away amazed by all the smart and good people in the world. Something we all need nowadays. Thank you Amy and 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 a101, a primer. Get pumped for valves, tubes, beats, electrical shocks, Grey'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. The worst heart art out there and why a wedding ring goes on that finger Would with researcher professor, physician, heart hero, and your new favorite cardiologist, Dr. Herman Taylor. This one is going to come up on Tuesday, so this is going to be a quick turnaround. Yeah.

[Dr. Herman Taylor]

Okay. All right, well, let's get to it.

[Alie Ward]

Okay. He. Him.

[Dr. Herman Taylor]

Yes.

[Alie Ward]

Okay. Herman Taylor, now you are a cardiologist. How long have you been a cardiologist?

[Dr. Herman Taylor]

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

[Alie Ward]

Yeah.

[Dr. Herman Taylor]

Yes. Quite a long time.

[Alie 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?

[Dr. Herman Taylor]

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 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. 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. 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. And that's sort of where things, every. 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 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, etc. And really having a wonderful experience being in my hometown, treating people who were maybe colleagues and friends and co workers 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 a almost entirely white. In fact, even more specifically, mostly it was either Italian Irish or Irish Italian in terms of its heritage.

[Alie 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.

[Dr. Herman Taylor]

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.

[Alie 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?

[Dr. Herman Taylor]

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

[Alie 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 and your culture. And actually, if you want a great Black History Month episode on cuisine. Dr. Psyche Williams Forson is a food historian who we interviewed for a Black American magerology episode. But yeah, some heart conditions are just wired into your cells.

[Dr. Herman Taylor]

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 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.

[Alie Ward]

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

[Dr. Herman Taylor]

Sequela.

[Alie Ward]

Yes, sequela. Okay, got it.

[Dr. Herman Taylor]

Maybe I should pick another word.

[Alie Ward]

I just don't have that.

[Dr. Herman Taylor]

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

[Alie 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 has was this viral video that went around of this heart. So it is a one piece.

[Dr. Herman Taylor]

Can you do a piece?

[Alie 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?

[Dr. Herman Taylor]

Wow. Well, I haven't seen the video. 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, it left to its totally through its own devices, as long as it had oxygen and nutrients.

[Alie 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 is arrhythmic. So it's out of sync heartbeats. So if a person has a cardiac arrest, 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. I'm a podcast host and I'm just search engining 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 Volk, 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 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, Dr. Joseph Wu and his team at Stanford were able to restart a donor heart, keep it warm with blood and beading 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?

[Dr. Herman Taylor]

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 is the heart.

[Alie 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?

[Dr. Herman Taylor]

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 year in a building. And that atrium is the first chamber and it receives blood and then loads the sort of more business end, 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, that'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 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 a tricuspid valve for those who want detail. But coming through that valve, leaving the atrium, it goes into the right ventricle.

[Alie Ward]

Which is downstairs from the right entry or atrium.

[Dr. Herman Taylor]

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, alveoli 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.

[Alie 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 got fresh blood back to the heart for distribution.

[Dr. Herman Taylor]

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 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 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 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.

[Alie Ward]

Several thousand.

[Dr. Herman Taylor]

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.

[Alie Ward]

Okay, so the atrium is on top, the ventricles are on the bottom, and the left side is tasked with shooting blood and 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. Digitized, friends, it's flim flam. All the veins in the arteries go back and forth to the heart. And wedding rings, over time they've been worn on either hand. 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 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, etc. That's the whole title. I find that etc. 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 in 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 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.

[Dr. Herman Taylor]

Yes.

[Alie 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?

[Dr. Herman Taylor]

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.

[Alie Ward]

Okay, so a quick terminology breakdown here. Myocardial muscle, card heart, em 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.

[Dr. Herman Taylor]

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 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.

[Alie 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, but.

[Dr. Herman Taylor]

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

[Alie Ward]

And remember that plaque is like spackle.

[Dr. Herman Taylor]

Over a moldy wall, 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 platelets, 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.

[Alie 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 cause. Again, that's the higher pressure it's when it contracts and pumps out blood. And numbers above 13080 will kind of raise your cardiologist's eyebrows because something over 130, over 80 could cause some plaque in your arteries to break off. Okay, then what would happen?

[Dr. Herman Taylor]

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. Oh, that's not good. 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, 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, 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. 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. 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. Oh, 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 HIP pef. That's an acronym for heart failure with preserved ejection fraction and heart failure with a reduced ejection fraction. And ejection fraction is simply a measure of how Much blood the pump pumps out with each beat.

[Alie 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?

[Dr. Herman Taylor]

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 and that's.

[Alie Ward]

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.

[Dr. Herman Taylor]

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.

[Alie 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.

[Dr. Herman Taylor]

Life, this is the year 2025.

[Alie Ward]

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

[Dr. Herman Taylor]

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.

[Alie 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.

[Dr. Herman Taylor]

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.

[Alie 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 Cardiovasc 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.

[Dr. Herman Taylor]

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. 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.

[Alie Ward]

Wow.

[Dr. Herman Taylor]

If you listen to a lot of agitated type music, 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. 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, 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, you know, we've tried Everything else, I would. Yeah, I would invite that. 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. The first thing you saw was the calm that came over her face. The next thing you saw was a monitor showing us that her heart rate was steadily coming down to where it should be.

[Alie Ward]

Wow.

[Dr. Herman Taylor]

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.

[Alie 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 but possibly dangerous and can lead to stress and or life threatening arrhythmias. But I needed to know what medal 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. Let's take a quick listen. 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?

[Dr. Herman Taylor]

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

[Alie 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.

[Dr. Herman Taylor]

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.

[Alie 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. 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 an 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 supply 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. So if, 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. Cause you never know when a stranger's life could just depend on a course that you took at the community center.

[Dr. Herman Taylor]

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. The leading cause, perhaps of medical angst in a lot of women is cancer, Specifically breast cancer.

[Alie Ward]

Yeah.

[Dr. Herman Taylor]

And that is a very important, very important disease on the sort of. On the landscape of things that threaten women's health. But if I were to tell you that 1 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.

[Alie Ward]

Wow. Oh, my gosh.

[Dr. Herman Taylor]

So it's important to know that. And 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.

[Alie Ward]

Why is that?

[Dr. Herman Taylor]

I'm not entirely sure, but it was particularly true among younger women who seemed somehow to have become either less worried or less informed about that particular threat.

[Alie 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 US and also in Canada, the UK 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. Especially for people assigned female at birth.

[Dr. Herman Taylor]

They largely viewed cancer, in particular breast cancer, as the leading threat to their lives. So it's important. And for men, the rates of death from heart disease are even higher. So should every woman run out and get a calcium coronary CT to look for coronary calcium today? No, 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.

[Alie 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 Sheeran 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. Dr. Sheeran, that fucking rocks. Other dentists, think about it.

[Dr. Herman Taylor]

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.

[Alie 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 going to 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.

[Dr. Herman Taylor]

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 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 viscera and that which is the more toxic form of weight distribution. Those are the first things. Oh, and I should add to that quickly. Those are the sort of numbers, the measured numbers. There are certain set of behaviors also that are concerning that with these numbers together can pose a real, real threat for early onset coronary disease and other types of heart disease. Those behaviors are ready exercise or the lack thereof and your eating habits, what types of foods you like and what quantities I see. Exercise, eating, sleep. Let me say it again. Sleep.

[Alie Ward]

You don't get enough of it.

[Dr. Herman Taylor]

Right, right. You know, I mean, when I was coming up through medicine in particular, you know, 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 in the door. I'm going to be the best doctor ever was, you know, I'll sleep when I'm dead kind of attitude.

[Alie Ward]

Right?

[Dr. Herman Taylor]

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.

[Alie Ward]

We chat about vaping risks to your arteries. In the recent surgical angiology episode, we also discussed 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.

[Dr. Herman Taylor]

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, 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. 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. Certainly if you're having symptoms, then you know, that sort of raises the ante if you're having some of the classic heart related symptoms. Let's go again with heart attack or angina, which comes from angina being pain pectoris is the whole name. Angina pectoris being chest pain. That of course is a significant red flag.

[Alie 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.

[Dr. Herman Taylor]

And if you're having discomfort in your chest, particularly on exertion or instances of high motion. 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 91 1- because 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. 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. 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 15, 20 minutes, those things also have been shown to be manifestations of significant blockages that lead to heart attacks in women. Now, you will also get indigestion sometimes, right? That's going to happen. You will also maybe have fleeting, you know, symptoms that concern you that won't be your heart. However, if you are, you know, a Saturday morning, you know, and you're at the soccer match and you're having this unmistakable, undeniable deep again, as some of my patients used to say, this misery in the chest or, you know, even in the stomach, it is just. It's not. It's not going away. It's insistent. You may need to dial 91 1. 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. How dramatic is that? 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, right?

[Alie 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 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.

[Dr. Herman Taylor]

Be real 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. 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.

[Alie Ward]

Can I ask you just a couple of questions from listeners?

[Dr. Herman Taylor]

Sure, go ahead.

[Alie Ward]

Okay, great. And each week we send money from our heart to an organization chosen by the ologist. And this week, Dr. Herman Taylor suggested the center for black agency and resilience, cbar, 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. Are you ready to optimize your nutrition this year? Meet factor America's number one ready to eat meal service. Factor's fresh, never frozen meals are dietitian approved and ready to eat in just two minutes. Their chefs handle the shopping and shopping, delivering fresh, fully cooked meals to your door. All you have to do is heat and Enjoy. Choose from 40 weekly options across eight dietary preferences like calorie, smart, protein plus, and keto. And if you're looking to lose weight, factor's Keto meals can help you lose up to 88 pounds in eight weeks. Savor nutritious premium meals no matter how busy life gets. Eat smart with Factor get started at factor meals.com factor meals50off and use code factor meals50off to get 50% off plus free shipping on your first box. Weight loss with Factor Keto based on a randomized control clinical trial. Results will vary depending on diet and exercise. This podcast is sponsored Brought to you by Squarespace I am a happy Squarespace customer and I have been since the start of Ologies. Right before I launched Ologies, I was like, I have to do a website. I gotta make my personal website. How am I gonna do this? I procrastinated for three years and then I heard about Squarespace on another podcast and I was like, I'm gonna try it. Turns out I'm in love with them. Squarespace is an all in one website platform. Squarespace makes it really easy to just make a beautiful website. They have great templates, they have drag and drop tools. It's really easy to edit and change. You can engage with your audience. You can sell anything from products to content to time all in one place. And you can get 10% off your first purchase of a website or domain at squarespace.com ologies Squarespace really makes it easy for people and I talking about myself to make the website of your dreams. So check out squarespace.com for a free trial and then when you're ready to launch squarespace.comologies to save 10% off your first purchase of a website or domain. You can do it. I did it. You can do it. I know I usually save my secrets for the end of the episode, but I'm going to tell you my secret favorite candy. It's Reese's Peanut Butter Cups. It's really Reese's. Anyway, anything but Reese's Peanut Butter Cups are the thing that I'm like, have I had a bad day? I get these. Have I had a good day? I get these chocolate, salty peanut butter. The textures. I love everything about them. Also that there's two. So I'm like, oh, I get this one for later. Which is one second later. Anyway, Reese's Peanut Butter Cups. I love you. That's all. If you're me, you can shop Reese's Peanut Butter Cups now at a store near you found wherever candy is sold. And I am. If you've been listening to this podcast for a while, you know that I love sleep. So important. It's one of the Best things you can do for your brain. Also your podmother Jared. This man has been on a quest to find the perfect pillow. And now we have several Coop Sleep Goods pillows. They're adjustable so they come with some extra fill so you can stuff it a little bit more if you need a little bit more support. They also have a sleep quiz to help you find your perfect pillow. They have an Edencool plus adjustable pillow crescent. It has a cool touch cover. You know how it's like. May your pillow be cold on both sides. Coop Sleep Goods delivers. They have a heat wicking inner liner. It has cooling gel memory foam. They also have this original body adjustable pillow which for Jarrett who is a black belt jiu jitsu and has busted knees and shoulders because of it. He loves this. It's longer, it's wider than average. Also I'll sleep on airplanes. I'll sleep wherever. They have an adjustable travel neck pillow that has memory foam fill. You can inflate it quickly and then it squishes down for storage. I was so deeply excited to upgrade the pillows. Treat yourself to a better pillow. You're going to use it eight hours a day. Have it be good. You can visit coopsleepgoods.com ologies to get 20 off your first order. That's Coop C O O P sleepgoods.com ologies good night.

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[Alie Ward]

Allow 15 days qualifying unlock device, credit service port in 90 plus days with device into eligible carrier and timely redemption. Required card has no cash access and expires in six months. 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. Jenna Congdon wanted to know.

[Listener Questioner]

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 played this game too.

[Dr. Herman Taylor]

Oh, all the time. Yeah. I mean, you know, it's in logos. It's where, you know, 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 in terms of not getting too upset about that. Actually. We kind of like the attention that people are thinking about their hearts in that way.

[Alie 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 Alie 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, and it's keeping things on beat. 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. 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 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 Azzam's partner Ollie Andy Pepper. Zack, ever eight first time question askers Melanie Abbott and Jacqueline Costa Rye of the Tiger Earl of Gramogen Anne Tiger Yuri Sagawayoung wanted to know are there really similar cells to brains and guts in the heart?

[Dr. Herman Taylor]

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'll beat after the shot. There are cells that we say they spontaneously depolarize and that is there's a flux of ions across the membranes of the cells. You know, potassium and sodium 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 to through the rest of the 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.

[Alie 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 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 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?

[Dr. Herman Taylor]

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.

[Alie 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.

[Dr. Herman Taylor]

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 certainty. Viral infections. Alcohol excess can poison the muscle and lead to congestive heart failure. And there are other causes, even uncontrolled thyroid disease. Can lead to heart failure.

[Alie Ward]

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

[Dr. Herman Taylor]

It tends to be a fairly gradual onset process, taking years, 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.

[Alie Ward]

Wow.

[Dr. Herman Taylor]

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 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.

[Alie Ward]

And when it comes to what you eat yourself, a lot of people. Rayha 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 in the minds of patrons. Mims Isabella Bartleson Raya Anastasia Press. Ronnie Rob Morgan, Ali is tired, Karen H. Ron, Wendy Fore 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 eat or like, what do you recommend?

[Dr. Herman Taylor]

Let me tell you what I recommend, okay? 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 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. It doesn't totally restrict other types of meat, but 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, 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.

[Alie 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 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 are bad at cooking? The American Heart association says that good convenience 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, 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 sleigh. Gotta have em.

[Dr. Herman Taylor]

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.

[Alie 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?

[Dr. Herman Taylor]

That's a very good question. They are not my favorite. 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 as 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 genic than eating cholesterol. You know, eating a piece of steak will produce a lot more issues in terms of cholesterol than eating an egg. Right? So I would say that, yeah, I don't really dig the carnivore diet.

[Alie 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 Takato, Anthony Richards, Beth and Greer. Kyla C. Marathoner, Curtis Takahashi, Samwise Addy, Cappello, Ghoul next door and Hayley Bolanzo, first time question asker. They all asked about the effects of exercise on the heart. And Hayley, 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, Brendan and Ashley. First time question asker Ask, 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?

[Dr. Herman Taylor]

Never too early, never too late.

[Alie Ward]

Okay.

[Dr. Herman Taylor]

I am so proud of her. That is fantastic. That's cause for celebration. Your heart is celebrating. Let me tell 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.

[Alie Ward]

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

[Dr. Herman Taylor]

Well, in recent years, I migrated much to 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 was, yes, 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 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. 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 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.

[Alie Ward]

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

[Dr. Herman Taylor]

Yeah, I'll deal with him later.

[Alie Ward]

We're now friends online.

[Dr. Herman Taylor]

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 with Matthew Evan Taylor.

[Alie Ward]

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

[Dr. Herman Taylor]

You gotta do that. You gotta do that.

[Alie Ward]

Multi generational Taylor's well, thank you so, so much. I'll let you get back to your Saturday. I really appreciate it.

[Dr. Herman Taylor]

Oh, it's been, it's been great.

[Alie 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. 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 matthewevantaylor. Now we are logies on Instagram and bluesky. I'm Le 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 Portland artist Boni Dutch. Also, Ologies Merch is [e-mail] and if you would like to be a patron of the show and submit questions before we record, you can find [e-mail] Ologies it costs $1 a month to join. That is the entrance fee. Into Our Heart now. Erin Talbert, Admins The Ologies podcast Facebook group. Avileen Malik makes our pro transcripts. Kelly Ardwyer does the website. Noelle 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 Pacemade 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, 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. 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. Pachydermatology, Homeology, Cryptozoology, Lithology, Nanotechnology, Meteorology, Olfactology, Maplity, Serology Cell.

[Dr. Herman Taylor]

Phone. Honey, you have such a big heart.

[Alie Ward]

Our state has changed a lot in the last 140 years. We know because Multicare has been here guided by a single making our communities healthier. That comes from making courageous decisions, partnering with local communities to grow programs and services and expanding healthcare access to those who need it most. Together, we're building a healthier future. Learn [e-mail].