Ep. 29: Heart Disease and Symptoms in Women

Good morning. I'm Cathy Murtaugh Schaefer. And I'm your host for this episode of heartbeats. This podcast is brought to you by Shipley Cardiothoracic Center, and educational series dedicated to providing our patients and the community with information and education about our cardiothoracic surgery program, lead, health and matters affecting your health. This is the fourth in a series of podcasts dedicated to our female listeners and celebrating the woman's care. It's a Surgery Center here at HealthPark in Fort Myers. Also celebrates our continued collaboration with our Cardiology colleagues without moving. A lot of this would not be possible. Our Guest today is dr. Joann Journigan. One of the health cardiologist. Who is board certified in adult comprehensive echocardiography, nuclear cardiology and cardiovascular computed tomography. She has a special interest in preventive cardiology, heart disease and women valvular heart disease and cardiac imaging. Dr. Journigan attended, Vanderbilt University in Nashville and did her General, Cardiology fellowship at Emory University in Atlanta. She brings to her practice a wealth of knowledge and experience from prestigious train. She has received. Dr. Journigan, welcome. And thank you so much for being here today. Perhaps, you'd like to begin by telling us how you came to be here and how your interest in women's heart health developed. Good morning. Thank you for inviting me today to discuss this important topic. I made the decision to join Lee health because I sought a great cardiology opportunity that offered an impressive work culture, growth potential, and a good work-life balance. Moreover Fort Myers is a wonderful place to raise a family. I became interested in women's heart health because it is a leading cause of death for women in the US but awareness and education. We have historically been little one in three women, die of heart disease each year, but only 44 percent of women recognize that cardiovascular disease is their greatest health threat. In fact, two-thirds of woman who died suddenly have no previously recognized symptoms as a cardiologist. I realized that I have an important role to play in. Increasing the awareness of heart disease in women and educating women about their heart disease risk factors. I know that when I've done talks with women and I asked, what's the number one killer of women in the United States. Every one of them raised their hand say, breast cancer every single one and you're so right. I think the education as far as the ladies are concerned is just not out there. They don't realize that heart disease is their biggest Nemesis the topic for this month. Has been about women's heart health, Dr. Cosway spoke about Knowing your numbers. Dr. Arnold spoke about cancer treatment in your heart. Dr. Sarah DiGorgi from OBGYN spoke about how cardiovascular care really often starts with the first pregnancy today? I'd like to top off those topics by talking to you about some of the gender differences in cardiovascular disease. What was one of the first indicators to you, that we should be treating women's heart health differently. It was the realization that almost half of women who have heart attacks do not present with chest pain, women tend to present with atypical symptoms, which means that they seek emergency care later, causing a delay and their cardiac here and moreover, their symptoms may not be recognized by a health care. Provider as heart-related. Also, the statistics show that women tend to be treated less aggressively compared to men upon presentation to the hospital. In fact, women are less likely to undergo cardiac testing such as receiving EKG. These blood tests and even are less likely to receive a Cardiology consult and cardiac medications. Women also tend to be referred and less for life-saving procedures, such as heart, catheterizations, and even heart surgery, compared to men. Dr. Journigan that sounds like a provider education problem when we're in school. We don't talk about the gender differences in in heart health. Where did that design come from? Do you know? You're right Cathy? We don't discuss this in medical school at the gender differences. I think we still have a lot of work to do with should start at a medical school level and into residency and Cardiology Fellowship training. We have a lot of Going to do. And I think we have to take before front and leaving that cause. I'm not sure if you heard the story that was presented at the last LPG dinner, but apparently, a female patient went to Urgent Care and complained of a funny sensation in her throat. When she rode her bike, the very astute PA who saw her convinced her to go to the ED because she was concerned about her heart. And sure enough, the patient had had a heart attack and required a stent to her right coronary artery. It was a great save but I'm wondering how typical the PA's response was to a woman with those types of complaints. But PA did an excellent job recognizing the atypical symptoms of heart disease and women. Most providers would tend to place a gastrointestinal problem at the top of the list and consider treatment for acid reflux. What are the different types of symptoms that a woman has? If she's having a heart attack? Well, men tend to experience more atypical symptoms compared to men. Some of those symptoms include shortness of breath, nausea, or vomiting, and some woman, as in the prior story, have acid reflux symptoms. Women can also have arm pain, neck pain, jaw or back discomfort. Some women experience, dizziness and some only present with cold sweats. I hear a lot of our valves patients come in expressing significant fatigue and that is always not only seems to be the number one complaint for our latest. I can't get my housework done. I'm really so tired. I have to take a nap in the middle of the afternoon and so many will say it's just because I'm getting old but there's other issues that they need to be looking at. Would you agree? Certainly agree. And one fact that we always tell patients. If you feel that, there's something different, in fact, some patients present. And see that just don't feel right. If you feel there's a difference in your activity level, your level of functioning. You don't feel good. I would recommend at least presenting at telling your primary care provider or come in to the cardiologist for heart health, screening. One of the things I like to talk about when I talk to women is the need to take care of their general health. I recently read a journal article, saying that even young women entering the health system with their first pregnancies are in poor heart health. Dude, comorbidities such as poorly controlled, diabetes, obesity high blood pressure and renal disease. And this has contributed greatly to maternal mortality in the United States. We know that these diseases are directly linked to heart disease, but are there other disease states that affect women more often than men that also contribute to heart disease? Yes, you mentioned some of the traditional risk factors which include high cholesterol and smoking. There are also non traditional risk factors, which contribute to the development of heart disease in women, which include pregnancy related factors. Such as preeclampsia, Priya. Calcia, actually doubles a woman's risk of heart disease. Later in life. There are also on immune disorders which can contribute to heart disease development, such as lupus or rheumatoid arthritis, a history of chest wall, radiation for women who have had breast cancer. Premature menopause, is a risk factor and also one that's often overlooked is the fact that someone may be suffering from depression or just unable to deal with big stressors in their life. I think that going to a doctor can be a bit intimidating for some women in, maybe that's a factor in seeking. Care. Would you talk to our listeners through what an exam with you looks like and what women should expect when they see you for the first time women should expect a far review of their medical history, which will include medications. Pertinent family history about any cardiac conditions or Members with strokes and their lifestyle habits including diet and exercise. They will then receive a cardiac physical examination. And finally, any suggestions regarding Lifestyle Changes will be offered and recommendations will be made concerning any appropriate. Cardiac testing that the patient may need to help her, determine her cardiac risk. What does a cardiac exam consists of? So we do focus on basically the cardiac physical exam which includes checking the carotid arteries. Making sure there's no significant carotid artery disease. Obviously listening to the heart for any types of murmurs or any abnormal heart, sounds that we met here. We also listen to the lungs to make sure there's no fluid in the lungs or any type of lung abnormality. And then we're checking pulses. Make sure that the vascular flow is good and for our listeners carotid arteries are the large arteries that feed your brain, they run up alongside both sides of your neck and blockages in those arteries can cause Strokes. It would seem that getting a very targeted history from a female patient would be advantageous to identifying risk factors. I often think women feel a need to hide information. In about themselves or they don't feel it's important. How important is it for a woman to be knowledgeable and forthcoming about her medical history. It is very important to be forthcoming with your medical history because certain facts that a woman might not think are significant. May be pertinent to a woman's risk of a future cardiac event. Basically, we need every piece of information to piece together, a person's cardiac risk factors and then be able to help them overcome. Any of those risk factors. There's you mentioned earlier issues, about anxiety and depression and one of the areas that I had some particular interest in his PTSD. We know that PTSD is associated with a risk for cardiac disease and that women suffer PTSD at a greater rate than men. Ten percent versus 5%. Talk a little bit about what you've seen as far as your patients are concerned. Concerned and they're coping with PTSD or that depression or anxiety and how that affects their heart health. One important factor that comes up is after bypass surgery and is very commonly known that approximately 50% of patients after bypass surgery or even a heart attack may suffer from depression. So it's certainly something to bring up in your follow-up and examination. After you've had a cardiac event or major surgery so that it can be addressed. If necessary, some patients need to be started on medications, others may need to seek counseling or help from a psychologist to overcome. The depression. Most patients will eventually do fine. But most of the time it is a shock for a lot of patients that they actually had a cardiac event. Cardiac rehab is also an excellent recent great. We refer patients after a cardiac event. A lot of help is offered to patients and most patients, find cardiac rehab to be a very rewarding and fulfilling experience. I think the camaraderie that cardiac rehab offers is probably one of the biggest draws to rehab besides all of the programs and nutrition issues. But I think people need to know they're not alone. I'm an older female and one of the more disturbing issues around sex based differences is the delay in care. That women often face. Why does this phenomena exist and how can women advocate for themselves in are very complex, medical world. One reason for the delay and cardiac here is secondary to the atypical symptoms that women experience causing them to see Cardiac Care leader than men. However, some of these sects bees did. This is in cardiac here are secondary to do, physiologic differences between women and men. Men tend to develop blockages of the major heart arteries. Whereas woman may develop plaque and a smaller heart vessels with sometimes are not ideal for interventional treatments such as cardiac stunting or heart bypass surgery. Other differences are present because women are underrepresented in clinical trials. In fact, when we 38 percent of participants in clinical trials are woman, which tends to come. For some of these differences, the best way, women can advocate for themselves is to educate themselves about the signs and symptoms of heart disease, and know, their individual risk factors. I think it's important to provide information to women, so that they know how to advocate for themselves. And one of the things I've recently learned about is a calcium, screening score. What is the utility of this score and who should be asking for it? A coronary calcium score is a screening test. Used to determine whether an asymptomatic individual has plaque or atherosclerosis and their coronary arteries and is at risk for heart disease. The test uses computed tomography or CT to check for calcium buildup. In the coronary arteries. The test is not required ID, or any contrast dye, and is associated with very low radiation exposure. You only spent about 5 to 10 minutes of your time. In the CT scanner. The test is recommended for women between the ages of 45. 55 or older with one or more risk factors for heart disease. A score of 100 or greater is associated with a moderately increased risk for future cardiac events and should be viewed as an indicator. For the need for more intensive risk factor modification. Is that something that a primary care physician can order? Yes, certainly your primary care physician can order to test. So again, the goal is to educate women about available resources. You can certainly ask for the test from your primary care provider. And if the test is abnormal, they will then refer you to a Cardiologist for help. Wow, dr. Journigan this has certainly been informative and I think our listeners are going to gain a lot from this conversation. Is there anything you want to add before we sign off? Yes, I would strongly encourage every woman to know the symptoms of heart disease. Know your individual risk factors and take control of your heart, health through risk factor modification, which includes a heart health, screening and lifestyle modification. I agree. And that's the purpose of these conversations is to make sure that we Our patients better informed so that they can make good decisions about their health. Thank you. Dr. Joanne Journigan for being here today until next time I'm Cathy Murtaugh Schaefer and this has been heartbeats Shipley. Cardiothoracic centers podcast, dedicated to Bringing research, Innovation, and education to our patients and the community.