Being Well 1001: Women and Heart Disease

Being Well 1001: Women and Heart Disease


[music playing]
Speaker 1: Production of Being Well is made possible
in part by Sarah Bush Lincoln Health System. Supporting healthy lifestyles, eating a heart
healthy diet, staying active, managing stress and regular check-ups are ways of reducing
your health risks. Proper health is important to all at Sarah
Bush Lincoln Health System. Information available at SarahBush.Org. Rediscover Paris. Our patient care and investments in medical
technology show our ongoing commitment to the communities of East Central Illinois. Paris Community Hospital Family Medical Center. HSHS St. Anthony’s Memorial Hospital, delivering
compassionate care close to home. From advanced surgical techniques and testing,
to convenient care for your family, we promise to make a healthy difference each and every
day. St. Anthony’s, together we are better. Ke’an:
Hi, thank you for joining us today for this episode of Being Well. I’m your host Ke’an Armstrong and I’m joined
today with our special guest, Dr. Jessica Prange. She is a cardiologist with Prairie Cardiovascular
Consultants. Jessica:
Hey. Ke’an:
Thank you so much for joining us today. Jessica:
Thank you for having me. Ke’an:
We’re going to be talking today about cardiovascular disease in women and why that’s so important. Why is it so important? Jessica:
Cardiovascular disease is actually the number one killer of women in the United States. That’s a statistic that a lot of people don’t
know and actually a women is 10 times more likely of cardiovascular disease than they
are of breast cancer. Actually more women die of cardiovascular
disease than all forms of cancer combined. I think most people are shocked by that. Obviously we worry about cancer and that’s
a big bad thing, but you are more likely to die of a heart of cardiovascular related issue. I think part of that is we just haven’t done
as good a job as the breast cancer folks as getting that awareness out there. We’re working on it, which is why we’re doing
things like this taping today and our discussion. The biggest question I get from patients is
why? Why is that the case? We don’t really know, but a lot of it stems
from … Well, first and foremost, most cardiologists don’t look like me. Only about 20% of doctors training to be cardiologists
are women. Maybe that plays into it a little bit. Also, women we know don’t always present the
same way with the same signs and symptoms as a man would when they’re presenting with
cardiovascular issues. Ke’an:
What are some of those differences? Jessica:
Women tend to present with more subtle symptoms. It could be that they’re having more fatigue,
and not normal, “Oh, I didn’t sleep well last night,” fatigue doing activities that wouldn’t
normally cause you to be tired, more shortness of breath. There’s a lot of women that never have a chest
pain, so that makes it really tough to pinpoint. What we know is women tend to present later. They don’t seek care right away. I think women have, sometimes, almost a caregiver
syndrome, which isn’t a real thing, but what I hear patients say is, “I didn’t have time
to be sick.” A lot of times they’re taking care of an ill
spouse, an elderly parent, a sick child. They put whatever is hurting them or not feeling
right on the back burner and so they tend to come in later. Because of that, if they do have cardiovascular
disease, we tend to not do as well. We’re more likely to die. We’re more likely to have complications related
to our heart related issues. All of that together makes it more dangerous
for women to have heart disease. Ke’an:
It does. I’m glad we’re talking about it today to help
folks understand, especially women, not that we’re discounting it with men, but … Jessica:
No, of course not. Ke’an:
Today we want to talk about that sort of exhaustion. I think to myself, and a lot of women that
I know, we have a lot of things that we do during the day. Jessica:
Absolutely, yeah. Ke’an:
We’re thinking, “Oh, I’m just exhausted.” That may be more than what meets the eye. Jessica:
Most patients, they know their body better than we do. When a women comes in to say, “This isn’t
right. I’m just not feeling like myself,” that is
usually … It sets off bells and whistles in my mind. It takes a lot for most people who are busy
and taking care of other people to really stop and say, “You know what, this isn’t right.” We have to, as doctors, take that very seriously. Ke’an:
Since we’re talking about this subject and we’re talking about these are a few of the
symptoms, what exactly is cardiovascular disease? Jessica:
That’s a very good question. Cardiovascular disease is a term that we throw
out there a lot, but it’s really a blanket term, or an umbrella term. If you break it down, cardio means heart. As a cardiologist, we deal with obviously
the entire structure of the heart. The heart is kind of like a house. You have your foundation. That’s the heart muscle. Inside that, you have valves that direct the
flow of blood. You could have problems with those. If you have a weak heart muscle, or a stiff
heart muscle, you could have things like congestive heart failure, which I’m sure you’ve heard
of. You could have a tight valve or a leaky valve. That’s the foundation. Then we also have the plumbing. The plumbing is like the arteries of the heart. When we talk about heart attacks and coronary
artery disease, it’s really a problem with the blood vessels. There is the electrical system of the heart,
so that’s where we talk about palpitations and heart rhythm problems. Then there’s the structures around the heart. The heart sits in a sack, called the pericardium,
which also can have problems. That’s the cardio part of cardiovascular. The vascular part means blood vessels. We also specialize in diseases of blood vessels
throughout our body. That could be the aorta, which is your main
artery supplying blood to your whole body, that goes to your legs. A lot of times people will have pain and cramping
in their legs that they think is either a muscle problem, a joint problem, and sometimes
it’s actually because they have blockages in the leg arteries. Also the arteries of the neck, your carotid
arteries. We deal with a lot of different disease processes
that go with cardiovascular disease. Ke’an:
It’s very detailed. It’s probably kind of hard for a person to
say, “Hey, this is what I’m feeling and I just don’t know that this might be a problem. Maybe I just walk too much or …” Jessica:
Sure, absolutely. Ke’an:
Exercise and different things like that. What about stroke? That falls into play when you’re talking about
blood clots and the flow of blood and different things like that. Am I correct? Jessica:
Absolutely. Stroke is part of a cardiovascular specialist’s
area of expertise. We work alongside our neurology colleagues
to first and foremost treat you to make sure that you have the best outcomes, and also
how do we prevent it and how do we know what caused it in the first place? It’s really hard to prevent another stroke,
or mini-stoke, if you don’t know what caused it. We help the neurologists figure that out. A stroke is divided into two different categories. The first category is the most common, which
is called ischemic, which means that a blood clot essentially has traveled somewhere from
the body to the brain and you’re not getting as much blood flow as you should. The second cause is a bleed in a brain. That’s much less common, and the treatment
of which is different. Common causes of stroke that we deal with,
so one we had already mentioned, which is the carotid arteries. If you have plaque, and that means cholesterol
plaque build up, if that becomes severe or that plaque goes somewhere it’s not supposed
to go, that can obviously cause a stroke. We look for subtle things, like holes inside
the heart that can increase your risk of a blood clot traveling to the brain. Sometimes if there’s a hole in the heart,
we actually have to close that hole. One of the most common causes of a stroke
that people do the whole work up and we can’t find anything is actually a rhythm problem
called atrial fibrillation. It’s extremely common and sometimes it’s hard
to catch because it comes and goes. That’s an irregular heart rhythm and it actually
allows blood to sit inside the heart and that makes a blood clot form. If that blood clot would move and go to your
brain, obviously that can cause a stroke. We typically have folks wear a heart monitor
at home. We actually have now a heart monitor that
goes underneath the skin, right on your chest, and it can monitor your heart rhythm for three
years continuously. If you have A-Fib, we are going to catch it
because it is important. If you have A-Fib, we are going to treat you
very differently. People would have to be on blood thinners
and that can prevent people from having another stroke. It’s a big deal. Ke’an:
It is a big deal. I have a family member who’s struggling with
that right now. It’s scary because it’s exhausting when your
heart goes out of rhythm and you just don’t feel good. Jessica:
Amazingly enough, there are some people that are zero symptoms when they’re in atrial fibrillation. A lot of times it’s picked up incidentally,
like they get an EKG for a pre-op surgery, or their doctor hears an irregular heart rhythm. Then there’s some people that know the second
they go into A-Fib. They know the second they go in and the second
they go out, and there’s everybody in between. It’s not a one size fits all diagnosis. Ke’an:
No, it’s all very different. Going back to the stroke, what are the warning
signs of a stroke? What should people really pay attention to? Jessica:
This is very important. This is probably the most important thing
when it comes to stroke. With cardiology, we have a saying, “Time is
myocardium,” meaning the sooner we can get your blood vessel open, we can save that heart
muscle. With stroke, time is brain. What you would notice would be a sudden change
in a neurologic symptom. That could be something as simple as slurred
speech. Some people will say that they know what they
want to say but they can’t get the words out. More obvious things are a drooping of a side
of the face, or an eyelid, or weakness, or abnormal sensation, particularly on one side
of the body. Those would be the warning signs. It’s very important to not wait. Nobody will ever fault someone for coming
into the emergency department or calling 911 because they’re having a change in a neurologic
symptom. Our treatment actually depends on the timing
of the symptoms. That’s changing a lot. It’s a moving target as far as how soon after
the symptoms started that we can give those clot busting medications. Those can actually be life saving and prevent
people from having severe debilitating issues after the stroke, so don’t wait. Ke’an:
Don’t wait. Jessica:
That’s the bottom line. Ke’an:
Should they go straight to the ER? What is the route they should take to get
help? Jessica:
Don’t mess around. Don’t call your doctor’s office. Call 911 or get to the emergency department. That’s going to be the place that’s going
to be able to tell you, “Yes, you’re having a stroke,” or, “You’re not.” Ke’an:
Now let’s go back and talk about folks who may be experiencing symptoms of a heart attack. We’ve talked about stroke, what about a heart
attack? What are the warning signs there and what
do people do? Jessica:
The classic warning signs, or symptoms, are easy to pick up. Those are the straightforward ones that we
all, as cardiologists, wish that people came in the door with. When I give talks to the public on this, I
say, “Now, if I told you that someone in this room was having a heart attack, could you
look around and pick them out?” Most people in their mind think of a middle
aged guy who’s pale and sweaty and clutching his chest and short of breath. You could go, “Yeah, that guy. That guy’s having the heart attack.” That’s easy for doctors when they walk into
the emergency department. That doctor’s going to say, “Okay, I think
you’re having a heart issue. We’re going to do XYZ.” That’s not always the case, especially for
women, especially for diabetics. Some of those things that we talked about
earlier about more subtle symptoms. I give an example of my grandmother. It was my wedding day and the … Ke’an:
Oh my goodness. Jessica:
The grandmothers were supposed to walk down the aisle and do their whole formal thing. Someone had come to me and said, “Grandma
Mary doesn’t really feel like walking down the aisle. Is that okay?” I said, “Absolutely. Just have her sit in the pew. Not a big deal.” She, God bless her, she drove to the church,
she sat through the ceremony, she did all the pictures, pre and post. Come to find out that whole day she really
wasn’t feeling well. She was a tough farm girl, raised six kids,
so pretty tough lady. Didn’t exactly care for doctors too much. She was a smoker and a diabetic and overweight,
high blood pressure, high cholesterol, all the risk factors. She just wasn’t feeling well. She was tired and she felt sick to her stomach. She thought she was coming down with a flu
type illness. Went to the reception and apparently spent
the whole time in the restroom, throwing up. My uncle took her home. Of course they didn’t tell me. I was a medical student at the time and I
definitely would have been alarmed. God bless them, they didn’t want to ruin my
day. They tried to get her to go to the emergency
room then and she wouldn’t. She went home. The next day, still not feeling right. Eventually agreed to go to the ER. The doctor did the work up, the blood work,
the EKG, and she was having a heart attack. She actually went up to Springfield St. John’s
Hospital and a Prairie heart doctor put a stent in her. My journey to become a Prairie cardiologist
has come full circle and I’m very proud to be part of this organization. It just goes to show you, in a million years
she wouldn’t have guessed that she was having a heart attack. She never had a single chest pain. Ke’an:
It can be a lengthy process. Jessica:
It can be. She’s in a way very lucky that she was able
to stretch that out. Some people are not so lucky. A decent amount of people, their first presentation
of a heart attack is actually sudden cardiac death. She was lucky in that she had time to wait
it out and seek treatment, but not everybody is that lucky. Ke’an:
There’s a friend of mine, actually a coworker, has struggled with some of this cardiovascular
disease as well. It’s scary after you go through something
that you didn’t know was part of your make up or your work up of your system. It’s the anxiety, I think, that gets to people
afterwards. Like, “What am I missing? What do I need to pay attention to because
I can’t see inside my body?” What do you tell people that are struggling
with that? Jessica:
That’s a huge issue, actually. First of all, follow your doctor’s instructions,
obviously. Take those medicines that are prescribed to
you. If you have a chance to go through the cardiac
rehab process, so most people if they’ve had a stent or bypass or heart attack get referred
to cardiac rehab. Sometimes that can ease a lot of the stress
and anxiety about getting back into the world. You know, what can I do? Can I exercise? Can I be intimate? Can I do those things that I used to do? Cardiac rehab is a supervised exercise program. They start you off slow and they build up
your confidence and they monitor your heart rate, blood pressure, EKG, so that people
can feel like they’re confident in what they can do to get back in the world. Some other things to watch out for. We get very alarmed about symptoms that come
on when you’re exerting yourself. I tell people, “Life is a stress test.” If you’re going up a flight of stairs or you’re
walking in the grocery store and you start noticing similar symptoms to maybe what you
had before, whether that’s chest pain or pressure, or if it’s more of a shortness of breath,
or getting sweaty during something that shouldn’t cause you to be sweaty, those are those warning
signs that we need to know about it so we can catch it before it gets bad again. What I tell people too is that usually the
same warning signs that someone had before, it’s going to be similar within the same person. Now your symptoms might be different than
your neighbors, but within the same person they’re usually going to be very similar. Ke’an:
What about if a person wants to feel the same that they did before they had something like
this, or had a stent, and they feel like they’re slowed down, and they’re like, “How come I
just don’t feel like I did before”? What do you tell people? Jessica:
There can be a lot of different reasons. First and foremost, if the heart muscle actually
had a lot of damage done, that can take time for that to recover. Also, after a heart attack we put people on
a lot of medicines. Unfortunately we don’t have one magic pill
that combines all the good things of all of our medicine. People are generally on a lot more medicines
than they were on going in. Those medicines have side effects and tend
to lower blood pressure, lower heart rate, and that can really change the way someone
feels. Ke’an:
And slow them down on purpose. Jessica:
Absolutely, absolutely. Getting back on track with exercise, like
the cardiac rehab … A lot of the medicine’s, their side effects will go away over time,
you just have to push through it. Like you said, with anxiety and depression
we actually see a lot after heart attacks, especially after things like bypass surgery. Depression is under recognized a lot of times. It’s actually part of our screening process
when we see somebody after a big heart surgery. That can make you feel sluggish and tired,
obviously. There’s a lot of different things that go
into it. Ke’an:
What can women do to prevent heart disease or cardiovascular disease, however you want
to say it? Jessica:
That’s the million dollar question, right? None of us want to go through those bad things. I divide it into things we have control over
and things we don’t have control over. As much as we all feel 18 years old inside,
we’re not. You can’t control your age. You can’t pick your family. If you have a family history of heart problems,
you just have to deal with it and realize that your risk is higher. Then there are the things that you do have
control over. Probably the number one thing is smoking. People feel like they don’t have control over
it, and I think that goes into why it’s so hard to quit, but that is probably the number
one thing that you can do as a person, if you are a smoker, to cut back and stop smoking. It is very hard to do and talk to your doctor
about it because we’ve got some tools in our tool chest, like medications, nicotine replacement,
other helpful resources. There’s that piece. Obviously there’s the diet and exercise part. That is obviously easier said than done, as
we all know. Ke’an:
Right, for everybody. Jessica:
I tell people, “If fat was so easy, there would be no fat cardiologists, and unfortunately
that’s not the case.” It doesn’t mean that it’s not important. Most of the time we say you should do some
type of activity that gets your heart rate up for maybe 30 minutes to 60 minutes most
days of the week. That’s going to be different for every patient
because some people, they’re starting off at a much lower activity level, and you got
to build up to that. It’s not that you got to go 30 minutes straight
on a treadmill. Little changes make big rewards. As simple as instead of circling the Walmart
parking lot for 10 minutes to find that close spot, park in the back. Force yourself to do a little bit of extra
walking. Instead of taking the elevator, go up that
flight of stairs. Those little things can make a big difference. Ke’an:
Make a big difference. Jessica:
Absolutely. Ke’an:
Get up during your work day and walk around or don’t try to carry all the bags from the
grocery store in one trip. Jessica:
Yeah, yeah. Although, I do think that’s a badge of honor
if you can carry all your bags in from the grocery store with one trip, but it doesn’t
often happen. Ke’an:
What resources should people seek out? What’s out there for people to educate themselves,
besides what we’re doing today? Jessica:
Obviously if you have a primary care doctor, they’re a great resource. They can help navigate as well. Is this something that needs further testing? Do I need to send Mrs. Jones to the cardiologist? If you want to just look on the web, there’s
a lot of great resources out there. One that I love is the Go Red For Women campaign. That is our attempt to try and get that message
out there about women’s cardiovascular disease. Ke’an:
That’s why I wore red today. Jessica:
Absolutely. I’ve got my little pin here, if you can see
it. That is our logo, the red dress. If you ever see that, that means that we’re
trying to get that message out about women’s heart disease. They have a website. I believe it’s GoRedForWomen.Org. They’ve got a lot of great resources, things
on diet, exercise, specific cardiac diagnoses and also information about tests. People have a lot of anxiety about heart tests. This runs them through what to expect. Obviously, we have our Prairie Heart website. If you Google Prairie Heart Institute, we’ve
got a great website up for patients. It’s got information on doctor, our locations,
also those things like diet and exercise and tests. We actually put out a publication called The
Well Fed Heart. It’s a little pamphlet that you can get, or
it’s on the web, about healthy exercise, recipes, that sort of stuff. We also have an app that you can download
from there to help. Ke’an:
We have just a couple more minutes left. Speaking of diet and exercise, one thing that
I hear a lot about is high cholesterol. How does that play into all of this as well? Jessica:
Absolutely. This is a daily struggle for me, as far as
educating patients on cholesterol. When we talk about blockages in the arteries,
we’re talking primarily about cholesterol plaque. When someone has a heart attack, when they
need a stent, when they’ve got plaque build up in the neck arteries, that is cholesterol. We’ve really changed the way we treat high
cholesterol now. We really used to focus on the numbers. You say, “If you hit this number, you get
a cholesterol medicine.” We’ve really shifted the way we treat people
because now what we understand is there’s actually a group of people that have completely
normal cholesterol numbers and they come in with a heart attack. We look at their arteries and they’ve got
tons of cholesterol plaque. That doesn’t make intuitive sense for most
people or doctors. We have decided that the best way to treat
cholesterol is actually on your risk. If we know you have blockages in the arteries,
especially diabetics, and other groups of people, we know that your risk is high. Therefore, you should get a cholesterol medicine. It’s a lot different than it used to be. People are really scared of cholesterol medicines. They’ve gotten a bad rap, probably unfairly. They really help reduce your risk of heart
attack and stroke. That is why your doctors, in particular cardiologists,
push so hard because we don’t want those bad things to happen to you. Ke’an:
Okay. Well, thank you so much for joining us today. Jessica:
Absolutely. Ke’an:
I believe this has been very educational. I hope that if you are watching today’s episode
of Cardiovascular Disease in Women, that you are paying attention to your body, you’re
eating right, you’re taking care of your health and you’re listening to your doctor. Thank you Dr. Jessica Prange, once again from
the Prairie Cardiovascular Consultants, for joining us today and thank you so much for
watching. Speaker 1:
Production of Being Well is made possible in part by HSHS St. Anthony’s Memorial Hospital,
delivering compassionate care close to home. From advanced surgical techniques and testing,
to convenient care for your family. We promise to make a healthy difference each
and every day. St. Anthony’s, together we are better. Sarah Bush Lincoln Health System. Supporting healthy lifestyles, eating a heart
healthy diet, staying active, managing stress and regular check-ups are ways of reducing
your health risks. Proper health is important to all at Sarah
Bush Lincoln Health System. Information available at SarahBush.Org. Rediscover Paris. Our patient care and investments in medical
technology show our ongoing commitment to the communities of East Central Illinois. Paris Community Hospital Family Medical Center. [music playing]

Leave a Reply

Your email address will not be published. Required fields are marked *