Getting to the Heart of the Matter

February is American Heart Month, and cardiovascular disease continues to be the No. 1 killer of people in Hawaii and across the United States.

Dr. Carol Lai, a Hawaii Pacific Health Medical Group cardiologist who specializes in advanced heart failure at Straub Benioff Medical Center, was drawn to the field of cardiology because of its ability to make a significant impact on patients' lives – especially during critical and life-altering moments, such as after being diagnosed with heart failure or having a heart attack.

"My favorite part is helping a patient regain their ability to do activities they once enjoyed," Lai says.

Here, she shares facts about cardiovascular disease, as well as prevention tips and new treatments.

What does a specialty in advanced heart failure entail?

Heart failure is a common chronic condition in which the heart is not able to pump blood effectively to meet the body's needs. This leads to a buildup of fluid in the lungs and other parts of the body, causing symptoms such as fatigue, shortness of breath and swelling.

The condition is considered advanced when patients develop severe symptoms, even while resting, that reduce their quality of life.

Heart failure and multiple hospitalizations also take a big toll on the body and can often lead to other organ symptoms getting worse.

What kind of patients do you usually treat?

As a heart failure specialist, I focus on treating patients with severe and near-end stage and/or end-stage heart failure. I do a thorough evaluation of patients and, if needed, adjust any medication to improve their health as much as possible.

When medications are no longer sufficient, I help guide patients to be evaluated for other cardiac devices, such as implantable sensors to monitor fluid status, pacemakers or defibrillators, valve interventions, and, in extreme cases, a heart transplant or a surgically placed heart pump.

What are the common symptoms of cardiovascular disease?

The most common symptoms of cardiovascular disease are chest pain and shortness of breath, particularly during physical activity. Other symptoms include fatigue or weakness, swelling in the legs and/or abdomen, and palpitations.

The symptoms can be similar in men and women, though women may also experience atypical symptoms, especially in the case of a heart attack. These can include nausea, vomiting, fatigue and indigestion.

What are the dangers?

The main risk factors for cardiovascular disease are high blood pressure, high cholesterol, diabetes, smoking, obesity and physical inactivity. Genetics may also play a significant role.

If a close relative, like a parent or sibling, had heart disease at an early age, your risk of developing heart disease is also higher. Genetics may affect cholesterol, blood pressure and tendency to develop conditions like diabetes. There are also certain inherited cardiomyopathy conditions that may lead to heart failure.

Are there any new treatments?

Cardiology is an evolving field with new treatments and innovation. I am excited about new devices for patients with severe heart failure.

One device is surgically placed on top of the blood vessel in the neck where specialized pressure sensors are located. During heart failure, these sensors are activated and cause an increased stress response for the heart. It sends electrical impulses to these sensors to block this response, which reduces the workload for the heart.

What can people do to prevent heart disease?

Managing risk factors for heart disease can drastically reduce your risk. There are no symptoms for high blood pressure and cholesterol, but both cause damage to the heart and blood vessels over time and can lead to cardiovascular disease. These conditions infrequently occur in isolation. High blood pressure and high cholesterol usually are in addition to other risk factors, such as diabetes, obesity, a sedentary lifestyle and smoking.

A healthy lifestyle can also significantly reduce your risk of cardiovascular disease:

• Eat a heart-healthy diet, which includes lots of fruits and vegetables, lean meats and fish, and whole grains.
• Limit salt, sugar, sweetened beverages and highly processed foods.
• Get moving; aim for 30-60 minutes of regular physical activity daily.
• Don't smoke or use tobacco.
• Try to get enough quality sleep and manage stress in healthy ways.

This article was first featured in the Feb. 26, 2025, issue of MidWeek as a part of the “Dr. in the House” series. See the full publication.

Published on: February 28, 2025