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Has cardiovascular treatment changed over the past decade or so, and what do you expect to see in the near future?

Not many years ago, it was common for a heart attack to be a catastrophic event in someone’s life. But with prompt diagnosis, that’s often no longer the case. Our tools for diagnosis and treatment continue to get better, be less or more minimally invasive, with more advanced treatment options. For example, when my grandfather had a heart attack 30 years ago, he was in the hospital for six weeks. Today, we take someone to the catheterization lab, identify the blocked artery, open it up, and the patient frequently can go home the next day. We also have the ability to replace heart valves without open-heart surgery and pacemakers, and defibrillator and ablation technology is continually evolving. 

In my specialty, cardiac electrophysiology, I treat electrical problems of the heart—heart rhythm disorders. For example, a patient’s heart may beat erratically. In this case, we might use medication or a catheter ablation procedure. With this type of procedure, we are able to create three-dimensional and electrical maps of her heart. This allows me to study and understand the abnormal rhythm and then use ablation or heat energy to modify the heart’s electrical system with the goal of eliminating or reducing the abnormal rhythm. For slow heart rates, we can use traditional pacemakers and in some patients we have the next generation pacemakers that may be inserted into the heart through a vein in the leg, leaving no external sign.   


Are women’s cardiac concerns different than men’s?

Traditionally, women were believed to be at lower risk of cardiovascular disease. Therefore, physicians often treated women less aggressively. However, research shows that women have substantial risk of cardiovascular disease, but their symptoms may be different. Women having a heart attack may not experience the typical pain in their chest: They may instead present with nausea, indigestion or fatigue. Treatments and therapies studied largely in men may have different levels of success and safety in women. Women often have smaller blood vessels, making intervention more difficult, or they can have different responses to medications. And choice of medication may change in childbearing years. 


What are steps we can take to prevent cardiovascular disease?

Know your 10-year cardiovascular risk score. It just requires a few answers to questions, and there are free risk calculators at websites and apps. If you’re at a higher risk, become even more aggressive in managing risk factors including avoiding tobacco, treating cholesterol, maintaining healthy weight and blood pressure and identifying and treating diabetes if present.

Everyone should exercise. Anything that gets people moving is a good idea.

And nutrition is an under-appreciated aspect of health. Someone once taught me that “People make the most important decision for their health 3 times a day when they choose what they eat.” For almost every patient I meet, it’s a struggle. But better nutrition does pay off, and luckily we live in the Hudson Valley, where there is great local agriculture. For most of us, options for better health are just around the corner. 


When should someone see a cardiologist versus a general internist?

Cardiovascular care isn’t limited to heart attacks. We treat all issues of the cardiovascular system, from high blood pressure to any issue of the heart, structural or vascular to electrical and more. But, at the same time, we always recommend people maintain a close relationship with their internists. For many common cardiovascular concerns—such as elevated cholesterol and hypertension—a good internist is perfectly equipped to assess and manage treatment. Our aim is to work as a team–patient, primary MD and cardiologist. 

If you’re at risk for cardiac disease, or if you’re having symptoms that are concerning, it is important that you talk to your primary doctor or a cardiologist. Fifty percent of us will have some cardiac issue in our lifetimes. As the primary caretaker in most families, women may put their health lower on the priority list and delay seeing a doctor. But early diagnosis and treatment are critical to good outcomes. Taking better care of yourself will ultimately help you (and your family, too). 

Sarah Levin, MD, FACC
Vassar Brothers Medical Center
The Heart Center, a division of Hudson Valley Cardiovascular Practice, P.C.
1 Columbia Street 
Poughkeepsie, NY 12601
TTY /Accessibility: (800) 421-1220

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Hudson Valley Magazine editorial staff.

 Sarah Levin, MD, FACC
More about Dr. Levin