Dr. Hassan Alhosaini calls himself a "heart mechanic."
It's an unusual but apt job description for a highly skilled cardiologist who treats advanced heart failure.
"The cardiovascular system is a hydraulic system," said Dr. Alhosaini, the new medical director of the Center for Advanced Heart Disease and Pulmonary Hypertension at Novant Health Forsyth Medical Center. "You have the heart muscle as the main pump and the blood vessels, or pipes, completing the circuit. My field is mechanical — we deal with a pump backward and forward failure."
He and his team have a variety of tools to help the heart pump as it's meant to — from medications to state-of-the-art mechanical devices called left ventricular assist devices, better known as LVADs, that support the native heart’s function.
Because he personally treats advanced heart disease, Alhosaini hopes patients will never need his help. And the advanced heart failure program he is building in Winston-Salem aims to head off problems before they get that serious.
Compassionate care for your whole heart.
At the foundation: layers of care. From preventive measures to disease management, teams of professionals from different disciplines and fields work together to deliver the best possible care to patients. In health care, this is known as multidisciplinary care.
Some cardiologists deal with the consequences of problems like blocked arteries. Others, like Alhosaini, care for hearts that are too weak to pump enough blood to a patient's lungs and distant parts of the body.
For patients with concerns about their hearts, knowing whom to call — and when — can be puzzling. Alhosaini offered a look at the different roles various specialists play.
Q: If I have questions about my heart or suspect I have a problem, what doctor should I call?
Talking to your primary care doctor is the first step. Ideally, conversations related to heart health should happen before you have any symptoms. At your yearly physical, your primary care doctor will review your numbers — blood pressure, blood sugar and cholesterol levels, as well as factors affecting your personal risk of heart disease, including diabetes, obesity and family history.
It's important to follow your doctor's advice to reduce your risk, and to take prescribed medications and lifestyle modifications as directed.
Remember: Heart disease is the No. 1 cause of death for men and women in the U.S., claiming one life every 33 seconds, according to the Centers for Disease Control and Prevention (CDC).
If your primary care doctor suspects you have a heart-related condition, you may be referred to a general cardiologist for evaluation.
Q: What kind of tests might a general cardiologist do?
The first will be an electrocardiogram (EKG), which measures electrical activity as your heart beats.
You may also take a stress test. You'll walk on a treadmill or ride a stationary bike at increasing levels of difficulty while hooked up to monitors that show how well your heart responds to exercise.
Your cardiologist might order an echocardiogram, an ultrasound of the heart. This noninvasive test will show the size and shape of your heart, how it moves as it beats and how strong it is, and whether its valves are working correctly. These tests will inform the next steps in your care.
Q: Does a general cardiologist test for blockages that can cause a heart attack?
One of the most common heart procedures performed in the U.S., cardiac catheterization, is typically done by another specialist called an interventional cardiologist.
During the procedure, doctors insert a long, thin tube called a catheter to look for blocked coronary arteries. They may open them up with a balloon (angioplasty) or a metal sleeve called a stent. Catheterization also lets doctors check pressure in all four chambers of the heart, look for defects and obtain tissue for a biopsy if necessary.
Coronary stents can reduce chest pain (angina) that occurs when parts of your heart don't get enough blood.
Your need for any procedure will be based on symptoms, physical exam, other tests, and your personal risk factors.
Q: What if I need open heart surgery or a pacemaker?
For most procedures requiring an incision, your cardiologist will call in a cardiothoracic surgeon. These are specially trained surgeons who operate on the heart, lungs and other chest (thoracic) organs.
A specialist called an electrophysiologist places a pacemaker, an implant that sends electrical pulses to help your heart beat at a normal rate and rhythm, or an implantable cardiac defibrillator, a battery-powered tracker that delivers an electric shock as needed to restore a normal heartbeat.
Q: What is an advanced heart failure cardiologist?
These specialists manage complicated cases of heart failure that go beyond the scope of care provided by general cardiologists.
Patients who haven't responded to treatment and those with cardiomyopathies (heart muscle diseases) may be referred to my team. We also treat patients with pulmonary hypertension, a condition in which the pressure in blood vessels from the heart to the lungs is too high.
My field is the mechanical field, because we deal with the heart pump failure and its consequences. Heart failure can affect one side of the heart — or both.
With left-sided heart failure, which is more common, the heart is too weak to pump enough blood to the body. Shortness of breath, fatigue and a fluid build-up result. When the right side fails, the heart is unable to supply enough blood for the lungs to get oxygen.
Q: How do all the layers of heart care come into play?
A primary care doctor can often manage heart-related issues by prescribing medication and lifestyle changes. When more focused heart care is needed, the specialists step in as needed.
Because our patients are seriously ill, my team monitors them closely (multiple visits in a given month). That's far more often than with a primary care doctor or general cardiologist. We want to be aggressively involved in patients' care.
Q: Before joining Novant Health in February, you grew the heart failure program at ECU Health in Greenville, North Carolina, into one serving more than 20 counties. What's the plan for Novant Health?
We are assembling a multidisciplinary team of doctors, nurse practitioners, physician assistants, pharmacists, social workers, nurse coordinators, cardiac psychologist, heart failure nurses, LVAD providers and heart failure surgeons.
It takes a village to manage these patients with their complex conditions. The cardiomyopathy, pulmonary hypertension and heart failure clinics are up and running. The next phase is laying the foundations for the mechanical circulatory support and LVAD team.
For patients in the Triad with heart problems, the ready availability of advanced care should be reassuring. “We have the full spectrum of cardiovascular support at Novant Health, and that ranges from the most common diseases and interventions to the more complex and advanced and rare conditions as well," said Alhosaini.
5 ways to be good to your heart
1. Get a physical every year and know your numbers — blood pressure, blood sugar, cholesterol levels and weight all affect your risk for heart disease.
2. If you are prescribed medications such as statin drugs to prevent buildup of plaque in your blood vessels or antihypertensives to regulate your blood pressure, take them as prescribed. Let your doctor know about any unwanted reactions.
3. Heart experts recommend a Mediterranean diet, one that includes plenty of fruit, veggies, whole grains and olive oil while limiting red meat and processed foods.
4. Be more active, watch your weight, aim for seven to nine hours of sleep a night and don't use tobacco, the American Heart Association's Life Essential 8 recommends.
5. Heart problems often develop over many years and may present in ways patients don't expect. Women having a heart attack may have vague symptoms like dizziness and squeezing rather than crushing chest pain, for example. Tell your doctor if you experience subtle symptoms.