Dr. Jonathan Fialkow

Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, explains population health is a growing and important aspect of health care.

The population’s health strategy is being responsible, in some way, for the total health of the patient and the patient’s population, he says. Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, says there are some studies that say you are 45 times more likely to have some cardiac event when you have sleep apnea and twice likely to have a heart attack or stroke.

He also explains sleep apnea is a long-term problem and it cannot be solved in just one night, so he recommends dedicating some time to treat it patiently. Triglycerides are basically energy, food. It’s a main component of nutrition, says Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.

He also affirms cholesterol and triglycerides have nothing to do with each other. “They’re both passengers in the particle,” he explains. Eating more natural foods, trying a good night sleep, exercising and not having a high stress lifestyle are the recommendations of Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, to have a better quality of life.

He also advises doing things as naturally as possible. Lisa Klein-Davis, Physician Assistant with Miami Cardiac & Vascular Institute, affirms there are some people who have certain genetic abnormalities, that they have really high levels of cholesterol.

She also describes in that case, diet and exercise can help the patient lower their cholesterol levels. In some cases, medication is required.

Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, agrees with her and adds the condition is individualized. Family history, genetics and other components are important. Home medical visits are a good way to help any patient and reduce their hospital visits, according to Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.

The specialist also explains the spectrum of care of a patient is called care management and adds that’s a program based on patients’ needs and has a coordinating team, or even a coordinator, who’s responsible for that person. Eating in the most natural form is the best way to prevent any heart disease, says Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.

The doctor also notes It’s important to consider fat intakes. There are different kinds of fats. Saturated fats can increase your risk for disease.
It is important to diagnose if you have a heart problem. In order to do that, you can have some of these cardiac diagnostic tests: ECG, Stress test, echocardiogram, cardiac catheterization, MRI, Tilt Table Test and Holter monitoring.

Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, says most arrhythmias are not all the time; people can have episodes of tachycardia and with the monitor the physician can see if you are having any episode. Obstructive sleep apnea and central sleep apnea are the two types of this condition. Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, says the most common form is the obstructive one, which is when the body is trying to inhale against a closed airway.

The central sleep apnea happens when the brain does not stimulate the lungs to breathe. “It’s usually seen in people with significant neurological disorders, like stroke or Parkinson,” he points out. Atrial fibrillation is a heart condition associated with sleep apnea. According to Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, it is a very common arrhythmia where the least cells of the upper chamber do not beat in a synchronized fashion and the lower chamber starts being very fast and irregular.

He also says atrial fibrillation is related to age and it could lead to having strokes and it is important to have a diagnose to prevent further complications. Lipids are basically fats. Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, explains fatty acids oils are absorbed by people’s body; it uses and packages them in certain ways.

Lipids are fatty compounds and they’re not soluble in water. The two main lipids are cholesterol and triglycerides, he describes.
Cholesterol is not consumed, because it is made by the body and It’s not an essential nutrient, the specialist says. The cells make cholesterol and the majority of it is made in the liver. That’s why It’s possible to have a cholesterol-free diet and be healthy. It’s a bit of misconception the idea about HDL is being the good cholesterol and LDL being the bad cholesterol, says Lisa Klein-Davis, Physician Assistant with Miami Cardiac & Vascular Institute.
She explains some people can have the same amount of what is bad or good cholesterol, but some people might be more prone to particles being atherogenic or plaque forming type particles where somebody else with the same number.

Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, agrees with her and affirms he tells people there’s no such thing as good and bad cholesterol. “There’s cholesterol,” he affirms.

He also says cholesterol doesn’t travel freely in the body, It’s encased in lipoprotein particles and there is not a cholesterol disease. The disease is atherosclerosis. Irregular heartbeat, high blood pressure, heart attack, stroke, daytime sleepiness and increased risk of motor vehicle accidents are some of the factors sleep apnea is associated with.

Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, says sleep apnea increases stress, hormonal changes and the way mind thinks. He also says sleeping pills could make the sleep apnea worse because the muscles are more relaxed. Cholesterol has three main functions: helps produce hormones, a building block for cells and assists in bile production in the liver.
Lisa Klein-Davis, Physician Assistant with Miami Cardiac & Vascular Institute, affirms people’s body produces enough cholesterol that it needs, to be able to do all of these functions that are essential.
Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, explains cholesterol is mostly made in the body. Excess cholesterol can cause inflammation if it is built up in the arteries.
Excess of it is removed by the body. If it efficiently clears the excess, people have a low cholesterol level, he affirms. With a 3D imaging of atherosclerotic plaque, Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, explains what atherosclerosis is.
The specialist affirms It’s important to be alert about the cardiac risk factors such as elevated cholesterol and blood pressure, diabetes and smoking, because those things increase the risk of atherosclerosis.
He describes atherosclerosis occurs in the walls of the arteries. Atherosclerosis is inflammation caused by cholesterol containing particles narrows of the artery. Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, explains there are many sleep disturbances that can affect the body and the heart, but sleep apnea is the most serious one. “It’s very prevalent but also most people don’t even know they have it and a lot of doctors aren’t screening for it,” he says.

He points out when you are not having proper sleep it can have consequences and sleep apnea is a condition where when we breathe into sleep, the muscles relax and close-off, so the body is trying to inhale against a closed airway causing metabolic and physiological abnormalities. There are some tips to have good sleep habits, such as following a regular sleep schedule, avoiding napping late in day and eating large meals close to bedtime, developing a bedtime routine and limiting screen time in bedroom.

Dr. Jonathan Fialkow, Deputy Chief of Cardiology at Miami Cardiac and Vascular Institute, recommends not using the bed for watching TV, if you spend 15 minutes in bed and you don´t fall asleep, get out of the bed and sit in a chair until you are tired again and go back to bed. Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, talks about what is the best information that patients should know in order to identify what to do in case of chest pain or heart attack.

The specialist says physicians always try to do the best for their patients’ health. The best recommendations of physicians is trying to eat things in the most natural form, says Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute.
The expert explains triglyceride is a three carbon sugar, with a fat attached to each one. The step determines how much triglycerides the body makes.
He recommends a diet low in sugar to improve triglyceride levels. Lipids are the medical term for basically fats, explains Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute.
He says relevance of fats (cholesterol and triglycerides) have to do with how they travel in the body, which is not freely in the blood.
The doctor explains lipid profile is a series of blood tests that look at different components of the lipids of fat in people’s body. EKG (Electrocardiogram), stress test, cardiac catheterization, cardiac MRT and coronary CT scan are the main tests to diagnose a heart attack.
The real art of the chest pain center, or E.R evaluation, is if the patient has signs of something that will lead to a heart attack, physicians need it to know that fast, says Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.
The specialist also explains angina is the term physicians use of the symptom when the heart’s not getting blood. Angina doesn’t necessarily mean it’s the heart but when they use that term they’re talking about cardiac pain. People with low cholesterol who have elevated triglycerides may be at risk of heart disease, affirms Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute.
He also explains LDL cholesterol is the particle taking the cholesterol into the arteries.
The ideal numbers are: LDL cholesterol, under 130 and must be below 190 and triglycerides ideally below 150, the doctor says. The particles travel through the blood and they’re meant to be going to the liver, where they can be eliminated. However, when something, such as tobacco, processed foods, stress or not getting enough sleep, erodes of inflames the endothelium and plaque appears, explains Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute.
The expert affirms triglyceride levels are markers of an inflammation in the body which affects the arteries.
When the artery wall rips, all the plaque gets exposed to the bloodstream and this causes blood clots. When this happens, the patient could have a blocked artery and a heart attack, the specialist describes. Chest pain can be an early warning sign of heart attack, which can lead to death. Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, affirms people may feel uncertain about what to do if it happens.
The doctor explains the causes of chest pain: Heart-related, digestive, muscle and bone, lung-related and panic attack.
He also affirms over 99% of the time, it’s not a heart attack. Sometimes it could be inflammation of the esophagus and 50% of the times it could be anxiety. There are some recommendations when calling 9-1-1 in case of chest pain: pain lasts over a few minutes, avoid driving to hospital, making sure door of the home is unlocked, making sure patient has a phone with him and patient may be directed to chew and swallow an aspirin.
Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, advises always asking for help in case of severe chest pain, whatever it is calling 9-1-1, a relative or a friend. The concept of a silent heart attack is when someone has a heart attack and doesn’t know it, affirms Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.
People can have heart attacks without having chest discomfort, sweating, indigestion and back pain among others, he explains.
The person who’s most likely to have a heart attack is someone who has already had a heart attack. If someone had a silent heart attack, the important thing is what it may indicate as a risk for future problems. Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute, explains people don’t have any alcohol storage in their bodies.
He affirms when people try to lose weight it is almost impossible if they drinking alcohol, because the alcohol is burning first, before carbs, proteins or sugars. He advises stopping drinking when patients have to reduce their triglycerides levels.
The specialist doesn’t recommend cereal with milk at breakfast. A silent heart attack is when someone has a heart attack and doesn’t know about it, explains Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.

Patients can have heart attacks without having the classic symptoms of chest discomfort, sweating, indigestion and back pain among others, he explains.

A person is more likely to have a heart attack when he or she has already had one. That is why detecting silent heart attacks can be critical to protect a patient’s wellbeing. There are several risk factors for high triglycerides: being overweight or obesity, physical inactivity, cigarette smoking, excess alcohol consumption, diet very high in carbohydrates and genetics.
Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute, affirms the triglycerides themselves are not necessarily the problem. It’s what causes patient’s triglycerides to go up becomes the problem.
The most prevalent reason for elevated triglycerides is being overweight, the specialist says. Mr. Steven Blumberg, Corporate Vice President of Value Based Care Medicine with Baptist Health South Florida, says there are assumptions about access to health care with varying levels of income and folks who are insured vs. uninsured.

“It’s easy to build resources around patients who have coverage but because we are a community asset and a nonprofit system; we try to build out ecosystems around delivery of care at all levels of health coverage in the community. It’s a uniquely American problem, because we have different kinds of coverage available to folks and depending on the conditions people show up with, we are dependent,” he says. Physicians recommend children to undergo tests to determine if they have a genetic disorder, says Dr. Jonathan Fialkow, Deputy Chief of Cardiology with Miami Cardiac & Vascular Institute.
He considers lipid profile could be done every three years if people are healthy. But if someone has any disease, the medical checkup should be more frequently.
The National Lipid Association has a great education material to deal with cardiovascular health as well as the American College Cardiology. Time is very important in cases of chest pain and heart attacks. The quicker the physician can treat them, the better the patient will feel, affirms Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida.
When a patient is in the E.R, physicians check vital signs, blood pressure, pulse and they will do an EKG quickly, because it’s the best initial screening test that says if the patient is having a heart attack, the doctor says.
The heart team are doing all the tests and then take the patient into the catheterization lab to do a procedure and open up that artery. With a digital imaging of a heart muscle, Dr. Jonathan Fialkow, Chief Population Health Officer with Baptist Health South Florida, explains how a heart attack happens.
He describes the coronary arteries are the arteries that supply muscle with blood. The heart muscle is a pump. It pumps all the blood with oxygen to the body.
The congestive heart failure is when the heart is so weak and it cannot push blood forward. He also explains electrical activity can set up by the dying cells. That’s arrhythmia. Companies that invest in their workers have more satisfied workers and have better productivity and lower absenteeism, says Mr. Steven Blumberg, Corporate Vice President of Value Based Care Medicine with Baptist Health South Florida.

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Care coaches and care managers are developed and deployed at Baptist Care to help patients who need them.

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