Chief of cardiology for Highland Hospital: People need to manage their stress on a healthy and meaningful level to decrease the negative effect on their heart
Q: Tell us a bit about your specialty.
A: I would be considered a non invasive cardiologist. In the field of cardiology, there are lots of different aspects to the care of the cardiovascular system, the heart, the blood vessels. Invasive cardiologists would do angiograms and stents. I don’t do that. I do more management of chronic conditions, coronary conditions, hypertension, hyperlipidemia, arrhythmias, as well as evaluation of the heart with non invasive methods like nuclear stress tests or ultrasounds of the heart and monitoring heart rhythm over time.
Q: What does your patient base look like?
A: I see patients between the ages of 18, and I believe it’s currently 104. So it’s quite a diverse group of patients with a number of different issues. As you can imagine, the vast majority of my patients are older. As we age, it’s more common to see more cardiovascular issues to emerge. But, of course, we do see people who develop issues much earlier in life. And we look after them as well.
Q: There’s been a lot of talk in the media lately about myocarditis in the context of COVID-19 and the COVID-19 vaccines. Would treating issues like that fall under your umbrella?
A: Yes. Myocarditis is a term that means inflammation of the heart, which is something we’ve been dealing with for a long time. It’s not an uncommon finding. It’s something that we dealt with before COVID-19, but is more prominent in the media after COVID-19. Historically, most cases of myocarditis are caused by viruses, so it’s not all that surprising that COVID-19, which is a virus, affects organs like the heart. Often with myocarditis a virus will attack the heart and cause inflammation of the heart. That can manifest in a number of different ways: chest pain, shortness of breath or symptoms of heart failure. So patients will present with those symptoms and then through blood tests and other imaging, we can determine if patients do have myocarditis. While it’s more prominent recently, it’s still a fairly rare condition.
Q: What other viruses commonly cause it?
A: It can be caused by a number of reasons, including viruses. Historically it’s been caused by the flu virus. It’s also caused by a number of viruses that are more difficult to detect.
Q: When it comes to stress on the heart, what differentiates healthy and unhealthy stress?
A: I think stress of any level can affect that heart. Physical stress, such as exercise, is typically a good thing for the heart and improves your cardiovascular activity when it’s done at the appropriate level for the appropriate amount of time. That kind of stress on your heart can improve your conditioning. We can also see that physical stress on the heart can be a bad thing when it’s a level of activity that people do fairly intensely but is out of proportion to what their body is used to. Other types of stress that can cause issue are emotional and psychological issues, which certainly do have an impact. The mind-body connection is a real thing. We know that people who are prone to high stress levels for any number of reasons over time are more at risk of cardiovascular complications over time. So decreasing those stressors and improving mindfulness can be very beneficial to the well-being of the heart.
Q: What does the mechanism for that look like? Is it detectable in tests as a chemical? A type of inflammation?
A: I think it’s a bit of all of the above. Certainly, whenever there’s an emotional stressor there’s a cortisol release, which affects all of the hormones of the body and leads to physiological responses in the body like an increase in heart rate, blood pressure. Typically those things you’d see in a flight or fight response, which is an evolutionary adaptation we’ve had since the beginning of mankind. And often that response does cause stress on heart. So being under constant stressful situations it can put undo stress on the heart over time.
Q: What should the average person be looking for when it comes to monitoring the type of stress their heart is under?
A: I’m not sure there’s a black or white answer to that. I see a lot of people from all walks of life, from CEOs of large companies to people who work as cashiers or manual laborers and who are under stresses of all kinds, most of the time. I think we all have stress. There’s not any magic pill we have to relieve stress, so people need to find ways to manage their stress on a healthy and meaningful level in such a way to decrease the effect on their health and heart health. That’s different for everyone, and there are a lot of ways in which it can be done from mindfulness and meditation to religion, to medical or talk therapy. All of those things or combinations of those things can be helpful.
Q: Are patients generally referred to you or do they come see you directly.
A: The vast majority of my patients are referrals from primary care physician who has determined there’s a problem with their heart health, their blood pressure, their cholesterol. There are a smaller number of patients we see who had been admitted to the hospital who have identified issues with their cardiovascular health, who we see in those settings.
Q: What kinds of non-invasive interventions can you do?
A: I’m a part of the larger cardiovascular team. My role is different than, say, a cardiac surgeon who typically operates on patients after we’ve identified a need for urgent surgical intervention. I typically would be involved in their care both before and after, and be involved in medical therapy, rehabilitation and diagnostic testing for surgeries or stenting if those were indicated.
Name: Jason Pacos
Position: Chief of cardiology at Highland Hospital; associate professor of clinical medicine
Education: State University of New York-Buffalo School of Medicine & Biomedical Sciences; fellowship in cardiology at University of Rochester Medical Center; residency in Internal Medicine at University of Rochester Medical Center
Affiliations: Highland Hospital; Strong Memorial Hospital, Strong West Hospital
Organizations: American College of Cardiology; American Heart Association
Family: Wife, three children
Hobbies: Golf, skiing