Heart disease remains a significant health concern, particularly among Black Americans, who face higher rates of high blood pressure and other risk factors. In this Q&A, with Carl Horton, M.D., F.A.C.C. at Texas Health Cleburne and Texas Health Physicians Group, we delve into the key risk factors for heart disease affecting the Black community and discuss strategies for managing these risks effectively. As a cardiologist, Dr. Horton also explores the importance of recognizing and responding to cardiac arrest, addressing disparities in CPR administration, and promoting recovery and support for individuals who have experienced cardiac events.
Statistics have shown that the frequency of high blood pressure among Black people in the U.S. is among the highest in the world. What are the key risk factors for heart disease that affect the Black community, and how can individuals manage these risks effectively?
That's a good question. Hypertension is a big risk factor for congestive heart failure in our community. So, a lot of the congestive heart failure in our community is due to hypertension that's been uncontrolled and high blood pressure. African Americans tend to be more relevant and more severe and usually have more end-organ damage, and particularly, it's a big cause for kidney disease or end-stage kidney disease in the African American community. So, usually in our community, the main thing is to make sure if we do have high blood pressure that it is treated and treated aggressively to try to get it within normal range. Also, more than likely, we should be getting regular physician appointments, especially at an early age because a lot of us will develop hypertension at an earlier age than other ethnicities. And if it's untreated for several years, it can lead to significant damage. That's the first point that I want to make. We also have higher rates of diabetes in our community, and diabetes is also a big risk factor for coronary artery disease or ischemic heart disease. So, those of us who have family members with type 2 diabetes running in our families, we need to be getting screened. And if you have diabetes, you want to also have that treated.
Recognizing the signs of cardiac arrest is crucial for timely intervention. Could you explain what happens during a cardiac arrest and what symptoms individuals should look out for?
Yes, and usually, it's when somebody has a cardiac arrest that you want to do aggressive CPR as early as possible because that's their best chance for survival. So, the main thing is, of course, to recognize that they're not being responsive and then you want to activate EMS or 911 right away and then start CPR right away, and it should be aggressive CPR.
The New England Journal of Medicine reported that just under 46 percent of Black and Hispanic victims received CPR, compared to 60 percent of their white counterparts. Why do you think there’s a disparity in CPR administration, and how can we improve these numbers?
Yes, that's a good point. I think the disparity may exist because there's a lack of education, and people may be hesitant to perform CPR. So, we also need to focus on making sure that people are adequately trained or try to explain their training as much as possible.
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As we talk about this lack of education and people being hesitant to perform CPR, can you talk about some of the misconceptions about CPR and if there are any ways to encourage people, especially in the Black community, to learn or take a class so that they have those skills in a moment where it may be needed?
I think maybe one misconception is that it's hard to do, hard to perform. So, I think that once you go through the training, you see, for the most part, it's relatively basic. The only thing you really have to adjust is based on the patient's size, but it's fairly easy to do once you learn the technique of doing CPR. I think the other thing that I want to mention is that besides just how easy it is, there's also the concern that people may feel like they're going to hurt the person further when the patient has a cardiac arrest. Even if you were to cause a rib fracture, that patient still may live and can survive.
After a cardiac arrest, what is the recommended treatment plan for recovery? How can family members and communities support individuals who have experienced cardiac arrest?
I think that's kind of a multi-faceted answer. So, when somebody actually survives a cardiac arrest, family members kind of have to keep in mind that when you have a cardiac arrest and the heart completely stops working, there's a transient time where the brain may not receive oxygen. And so, some patients who have actually survived cardiac arrest, sometimes they may have some cognitive difficulties that they didn't have before, and that's usually related to having what's called hypoxic brain injury. So, family members who may be helping to take care of these patients, have to keep in mind that cognitively, some of these patients may not necessarily be the same person that they were in terms of their abilities, and to be very patient. Also, in the acute setting, usually, if a patient survives a cardiac arrest, we're able to get them back. Sometimes in the hospital, there are specific treatments that they may do if the patient is suspected of having an acute heart attack, which caused the cardiac arrest. They would usually be referred for coronary angiography or a cardiac catheterization. Other patients may be referred for what's called TTM, which is targeted temperature management, where they bring the body temperature down for approximately 36 to 40 hours to try to help with their neurologic outcomes long-term.
What advice would you give to individuals who want to take proactive steps in maintaining heart health and reducing their risk of heart disease, especially considering the higher prevalence of high blood pressure in the Black community?
I think the main thing in the Black community, of course, is making sure that we see the doctor on a regular basis, getting appropriate screening tests that are indicated. If you see your favorite physician on a regular basis, they may notice an abnormal EKG and then refer you for further testing. So, you want to be more on the preventative side and try to get away from being on the reactive side. I think that's a big issue in our community. Also, you want to know your numbers with regards to your cholesterol, your blood sugar, your blood pressure, and you also want to focus on maintaining a healthy weight and exercising. We know that obesity is a big problem in our community, and so we want to try to keep our body weight at a more recommended level. Also, there's been an underemphasis on diet and exercise in our community, so we really need to focus on getting a healthier diet and then exercising on a regular basis. Even though we are busy and stressed and have families, you cannot take care of anybody else until you take care of yourself first.
Anything else you’d like to share?
I think also, particularly in our communities, we need more education. It would be nice if we could expand basic CPR training to places, particularly in African American communities like beauty shops, barber shops, community centers, churches, where this is offered on a regular basis. And then, in addition to educating patients on proper CPR techniques, it would also be good if we also had training on AEDs, which are automated external defibrillators, which you'll find in public places like airports or malls. Because some patients have a rhythm that's called ventricular tachycardia or ventricular fibrillation, those rhythms require defibrillation. And so, if you're able to defibrillate a patient very early, that also can be key in them surviving that cardiac arrest. So, in addition to proper CPR education, we also need education on AEDs for more of the public. That would be very beneficial.
I know the importance of AEDs has been brought into the light a lot, especially with the cardiac arrest that Damar Hamlin suffered. Can you talk a bit more about the importance of AEDs in connection to cardiac arrest and CPR?
Usually, if a patient has a shockable rhythm, such as ventricular tachycardia or ventricular fibrillation, that rhythm needs to be defibrillated as soon as possible, meaning that their highest chance of survival is with defibrillation. So, it's important to have AEDs available in the public arena so that while you're waiting for EMS personnel to arrive, the public can defibrillate a patient. They're very easy to use. Essentially, you attach the AEDs to the patient, turn the device on, and just simply follow the directions. The AED device itself will tell you whether the patient has a shockable rhythm, and if it's instructed you to deliver that shock, you just hit a button. So, it's very easy to use and can be lifesaving. Particularly with the amount of athletics that we see for teenagers, young adults, even children, it's very important to have those AEDs available if possible. It also stresses the importance of younger athletes, and teenagers, getting physicals prior to participating in sports with strenuous activity. That way, something can be detected early and can be lifesaving.
I think this is definitely an important conversation to have, especially regarding sports, and what happened with Damar Hamlin and LeBron James' son. Can you talk a bit more about the importance of understanding the potential causes of cardiac arrest in both younger and older individuals?
Yes, understanding the potential causes of cardiac arrest is crucial, especially when considering the differences between younger and older individuals. In younger adults, we often think about more anatomical or genetic causes that could potentially lead to cardiac arrest. For example, Damar Hamlin likely had commotio cordis, where he was hit at a specific point in the cardiac cycle, which probably led to his cardiac arrest. In older patients, we would think about other things that could potentially cause it, such as myocardial infarction, pulmonary embolism, or some other cause of respiratory failure. It's important for people to know that heart disease can affect individuals at young ages, especially in the Black community, and to be aware of the signs and symptoms, regardless of age.