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Women's Heart Disease

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SARA LOMAX-REESE: Today we are going to continue to delve into heart health, this time focused on women and heart disease. It is February, and in addition to being black history month, February is also American Heart Month. We will be joined in studio by Dr. Donee Patterson, who is a family medicine physician with Einstein Healthcare Network and Dr. Niku Thomas, who is an attending cardiologist with Einstein. She is a board-certified cardiologist and she specializes in non-invasive cardiology. Later in the hour we will talk with Gwen Foster, Philadelphia's former health czar and we are going to talk about the 40-Day Health Journey. Let me introduce again, Dr. Niku Thomas. Welcome.

NIKU THOMAS, MD: Thank you very much. It's great to be here. 

LOMAX-REESE: It's great to have you, and Dr. Donee Patterson, welcome. 

DONEE PATTERSON, MD: Thank you so much. Good afternoon.

LOMAX-REESE: Good afternoon. Good afternoon. It is February, American Heart Month, and a couple of weeks ago we talked generally about heart disease, but today we are going to focus in on women and heart disease. Why don’t we just start at the beginning with what are some of the differences between the ways that heart disease manifests in women versus men? I will start with you Dr. Donee. 

PATTERSON: Right, so we definitely wanted to talk today because February is Heart Health Month and March is Women's Health Month, so we thought we would combine them today, but women, there's some recent studies that were done and they polled women across the U.S. and they asked them what is the major cause of death in women. These women, 60 percent, picked breast cancer and so even though we are happy that we are getting the word out about breast cancer, in fact the number one killer of men and women in the U.S. is heart disease. We wanted to emphasize today how important heart disease and heart health is for our women and encourage them to know that there are some risk factors involved and to try to change those risk factors as much as they can. Thirdly, we wanted them to know the symptoms. So that's your question. What are some of the things how heart disease is different for women, but it is very common, because women, we are our own people and when we go through menopause heart disease tends to go up. Dr. Niku Thomas, let's talk about some of the things we had mentioned before about women and heart disease and just knowing how to decrease your risk factors and knowing what those risk factors are. 

THOMAS: Sure. It's a very important question because a lot of us in the community, and also in medicine, have been taught to associate chest pain with something going on with your heart and that is true, particularly among men, you get what we call typical anginal symptoms with chest tightness with exertion, but for women it is also possible for women to present with symptoms that are not chest pain at all, shortness of breath, even dizziness, fatigue, things like that can actually be signs of a problem with your heart. 

PATTERSON: Breaking out in a cold sweat.

THOMAS: Breaking out into a cold sweat, numbness or tingling in your arm, so these so-called atypical symptoms, don't always signal to us something going on with our heart and so we ignore it or we attribute it to something different. In fact, the latest statistic that I read says that only about 20 percent of heart attacks among women are preceded by typical chest pain symptoms. 

LOMAX-REESE: Are you suggesting that if say you break out into a cold sweat or you have tingling in your arm or you have some of these atypical symptoms, are you suggesting that you should go to the ER or should you, if you are a certain age, if it is a certain time of your life, what are some of the things, because some of those things are easy to overlook, are easy to ignore and slough off, and not pay attention to.

THOMAS: That's absolutely right because we do get symptoms like that for other reasons when we are young throughout our lives and most of the time they are caused by things other then the heart. How do you know? Are you expected to know the difference between tingling or fatigue or dizziness that's coming from your heart or from some other cause and the answer is absolutely not, but you should have it in the back of your mind that it's a possibility because if it is associated with your exerting yourself in some way, that should be your red flag for you. If it is a new symptom associated with exerting yourself, that needs to be a red flag and you should go directly to your doctor if that's the case. If it is tingling that you have had in your arm since you were 13 years old for instance, it is obviously less likely to be your heart. There's a spectrum of how these things can present and you are not expected to make that determination. Is this something that's benign or is it your heart? I would suggest that if it feels new, worrisome to you, severe, go and see your doctor about it because you need to keep in mind that women do present in ways that you are not used to thinking about when it comes to your heart and so let your doctor help you out in making that distinction. 

PATTERSON: Definitely. So again, if it is something that has been going on for a while or can be explained by something that's already going on, for example, if you know that you have a pinched nerve in your neck and your arm is getting numb, then, yes, discuss that with your doctor, but if it is something out of the blue and something new, you must seek medical attention right away. If nothing else, have a talk with someone who knows more, your physician, and say to them is this something that I need to go to the emergency room about. 

LOMAX-REESE: We are talking with Dr. Donee Patterson and Dr. Niku Thomas, who is an attending cardiologist at Einstein. Dr. Patterson is a family medicine physician at Einstein Healthcare Network. We are talking about women and heart disease today. One of the things that you are talking about is a level of awareness, of self awareness, to be able to determine and differentiate between what is regular and ongoing and what is something new, and way too often, we as women, we are taking care of everyone else, our children, our partners, our jobs, everything else around us is getting that attention and it is easy to kind of lose connection with what's going on with ourselves. Are there any things that you can say to kind of remind women how important it is for us to kind of prioritize our own wellbeing? Dr. Thomas?

THOMAS: Yes, I think there are. I agree with you that women tend to see ourselves as caretakers and everybody minimizes symptoms to some degree, but in women in particular, we tend to put our own health on the back burner. Some of us have just learned that, for some of us it is second nature to do that, but I think when I talk to my patients, I try to remind them that in order for them to care for their families and for their loved ones at their best, they need to be physically healthy and able and if they ignore their symptoms, or if they don’t take care of these conditions and end up with a chronic, debilitating condition, they're not going to be able to do that very well and they actually may end up being dependent on other people and other family members. Women tend to recoil from that notion of having to, to have one of their family members take care of them. I think we like to see ourselves the opposite way. I think I don’t want to frighten people into taking care of their health, but I think that to some degree, it does make sense for you to consider the fact that you are going to be best able to care for the people that you love and put their minds at ease if they know you are taking of their mother or their sister or whoever you are to them. They are going to be happier and they are going to be able to thrive better then that. 

PATTERSON: I think so often we think about exercise, but we all say we are tired, we don’t want to do it, or we put it on the back burner for another day, but there are some really very simple things that we hear all the time that we can actually do to decrease our risk factor for heart disease. If you exercise 20 to 30 minutes a day, even if you just do it several days a week, I know that everyone is busy, but there's 24 hours in a day, and if you just exercise for 20 or 30 minutes a day. It doesn’t have to be a gym membership. You can just walk or you can join Zumba classes or Tae Bo classes or even hula hoop in your house, but if you just do some physical activity every day. If you smoke, smoking has carbon monoxide in it and it really does change your blood vessels and it makes your blood vessels smaller. It makes a big difference in heart disease and if you smoke it is the number one thing that you can do for yourself to help decrease some of your risk factors for heart disease. 

LOMAX-REESE: I want to invite callers. If you have a question for Dr. Donee Patterson or Dr. Niku Thomas, we are talking about women and heart disease today. The number is 215-634-8065. Toll free 866-361-0900. Now you all are MDs so I am going to ask you to step out of your comfort zone for a minute because we know that the diabetes and hypertension and obesity all lead to increased risk of heart disease. We know the physiological ramifications of these things, but I want you to talk about the heart kind of more metaphorically around emotional wellbeing. I want to know if in your work, looking at the body, if you see a connection between maybe a broken heart or someone who is living with a lot of emotional pain and suffering if that does have a physiological impact on the heart. You are nodding your head, Dr. Donee, so I will start with you.

PATTERSON: Absolutely. Stress can be related to heart disease. It doesn’t clog your arteries, but there's studies that show that there's chemicals that are released that make your blood vessels smaller and make your heart have to pump harder, make your blood pressure higher and that stress really does release chemicals throughout your body and if it consistently released over time that it can definitely affect health and also if people are getting depression from that then it can affect if they take their medicine and if they are taking care of themselves at all, but definitely stress can affect the heart. 

LOMAX-REESE: Dr. Thomas, do you want to add anything?

THOMAS: Yeah, I agree, and there actually is a condition that used to be called broken heart syndrome where when you go through a very traumatic, stressful event, you end up with a weakened heart, that actually has the appearance of having had a major heart attack, but which can recover over time. There's a known, well-described condition. Like I know that you asked me to speak in a way that's not medical or doesn't refer to specific medical diagnoses, but I did want to point that out. In terms of what I see in my practice among my patients, I would say, absolutely, anxiety, stress, depression really appear to, and this is again a non-medical association, but what I have seen is that when you have these conditions and they are not controlled and they're not being addressed, you are not in a condition where you are going to be taking good care of yourself, either you don’t care or you care too much, you are worrying about the wrong things or you just can't cope and you are not going to be taking your medications or adhering to the kinds of behaviors that you need to be focusing on in terms of your diet or exercise. They're just not going to be priorities for you. Whether or not I think they cause heart attacks in and of themselves, I can't say for sure, but I can say that they certainly worsen just about everything that is associated with causing heart attacks like the blood pressure and adherence to medications and healthy lifestyle. 

LOMAX-REESE: If you have a question for Dr. Niku Thomas, who was just speaking, or Dr. Donee Patterson, both from Einstein, you can give us a call, 215-634-8065. Toll free 866-361-0900. Of course you can always listen on the web at 900amwurd.com. We've got Heather on the line. Welcome to the show, Heather. 

HEATHER: Hi, thank you. Good afternoon. 

LOMAX-REESE: Good afternoon.

HEATHER: A question for Dr. Thomas or Dr. Patterson, you just answered some of my questions about stress. Anxiety and stress manifest with tightness in chest, you know, as symptoms? 

PATTERSON: Yes, so a lot of times when people are having panic attacks or anxiety attacks, this is Donee Patterson, they often say that they feel anxious or they feel dizzy or they feel chest tightness or they feel like they are breaking out in a cold sweat or they feel confused. Those are all very common symptoms of heart disease or having an acute heart attack or having a stroke. They can very commonly mask a lot of those symptoms. Again, we don’t want to be alarmists and say if you have those symptoms you are definitely having a heart attack, but we want you to be thoughtful and think these things through because heart disease is so very common and if you are having any of those symptoms, again, consult your healthcare provider. 

HEATHER: I have a question about EKGs. If you have EKGs, heart disease, is that picked up on an EKG?

PATTERSON: I think that's important because people should know that an EKG is a snapshot in time. It's what's going on with your heart right now. It is almost as if I can take a picture of your right now, but you can go out today and totally change, dye your hair, change your makeup, you can totally have a totally different look. So it doesn't predict what's going to happen in the future, but it tells us what is going on right now and it can be very, very informative to know if you have had something going on or even stress from high blood pressure, we can often pick up on an EKG, but it doesn't predict future risk. People get this false sense that their EKG was fine so their heart is totally fine, but you still have to do those things that are protecting your heart. Do you have something else to say about that?

THOMAS: I agree. This is Dr. Thomas speaking. An EKG sometimes can show us if there has been a heart attack. Sometimes your EKG can stay normal even though we know you've had a heart attack. An EKG, as Dr. Patterson was mentioning, can show us whether there has been longstanding high blood pressure, if it has been severe and poorly controlled, we see certain things on the EKG. Sometimes you may have had high blood pressure for years and we don’t. An EKG can sometimes show us if there are abnormalities in the size of various chambers of the heart. It can show us if there are problems with the electrical wiring, so to speak, or the conduction system of the heart, but it is true that it does not always show us those things. Just because your electrocardiogram is normal, that does not mean that we are going to then minimize the symptoms that you are describing to us. We will frequently, if we are concerned about them, go ahead and order additional assessments. To address your first question, when you were asking about anxiety and chest tightness, I wanted to mention one more thing, which is that if you are somebody who has a lot of anxiety or stress or has an issue with gastritis or something going on with your stomach, an ulcer for instance, sometimes that can be experienced as chest pain as well. That's another possibility for why you may be experiencing chest pain even though you end up with an evaluation of your heart that shows no problems with your heart. 

LOMAX-REESE: We are going to take a quick break. We are talking with Dr. Niku Thomas and Dr. Donee Patterson, both from Einstein Healthcare Network. When we come back I want to talk about menopause and heart disease because you mentioned at the outset that there is a connection between the two and we need to know what hormones and the shift in our hormones as we age, what that does in terms of contributing to heart disease or heart health. We are going to take a quick break. Don't go away. We will be right back. And we are back. You are listening to HealthQuest Live on 900AM WURD and we are talking about heart health, particularly as it relates to women today. It is February and it is American Heart month and we have got two outstanding physicians in studio, Dr. Donee Patterson, a family medicine physician and Dr. Niku Thomas, who is a board-certified cardiologist, both of them at Albert Einstein. Before we went to break I was asking about menopause and heart health and heart disease. Menopause, I guess men, they say men have some version of menopause, but it really is a uniquely feminine/female phenomenon, and I am curious, and maybe I'll throw this to you, Dr. Thomas, what are the things that we as women, as we age, as our estrogen starts to, our hormones start to shift around and we move into this next phase called menopause, what are some of the things we need to be aware of in terms of heart health? 

THOMAS: Well, that's a very good question. Issues with women and hormones and heart disease have gotten a lot of press over the past 10 or 15 years, mainly because there have been a lot of changes in the recommendations about how to manage women around menopause and post menopausally, but the fact is that the first thing that has been noticed is that initially women's estrogen seems to protect them from heart attacks and then after menopause, we catch up with men in terms of how often we have these events and the development of coronary artery disease, such that after age 75 the incidence of coronary artery disease is equivalent, it's equal, between men and women, meaning how often it occurs, how often someone is diagnosed with it. We know that estrogen seems to provide us with higher levels of the "good cholesterol" the HDL cholesterol and after menopause we lose that benefit of estrogen and so that has led investigators to look to see whether or not replacing that estrogen could give us back that benefit and reduce the number of events that we experience. Unfortunately, that has not panned out and there have been problems with hormone replacement therapy so it is no longer recommended that that be prescribed for the purposes of reducing heart attacks and strokes. It actually could be dangerous. 

PATTERSON: Just a recap of that is just that estrogen is protective for women and heart disease. We can still have heart attacks before menopause, but it is protective effect and after menopause we catch up to men and for years we were taught to give women estrogen after they went through menopause to help get that protective effect back, but then it would cause problems elsewhere. It might increase the risk of cancer elsewhere. We no longer, as a rule, give women estrogen. It is very important, especially if you are menopausal, meaning you no longer menstruate, it is so important for you to watch your risk factors. Dr. Thomas and I were talking before and I love something that she said about how it is almost impossible to have absolutely zero risk factors for heart disease. So to have zero risk factors for heart disease you have to be your perfect ideal body weight. You have to have no family history of heart disease. You have to make sure your cholesterol is perfect and that your blood pressure is ideal without medication. If you have any risk factors for heart disease, we are encouraging you to take all of this seriously and to do something now so that we are not doing medication and loss of your job or loss of time at work or loss of time with your children on the back end. 

LOMAX-REESE: Contraceptives have been in the media a lot lately and there is always this question about the birth control pill and its impact on heart health. Given the media hype around contraception right now, I am curious if you could speak to, Dr. Thomas, if there is a heart health risk factor associated with the birth control pill.

THOMAS: Well, unfortunately, as we get older, there is more of a risk of cardiovascular events happening if you are on oral contraceptive pills and I think that's one of the problems with it being prescribed for older women. So we have to be careful about that.

LOMAX-REESE: What is older?

THOMAS: Over age 35, particularly when you are in your 40s. In fact, when we are categorizing our patients into high-risk or just being plain at risk or optimal risk, having been on oral contraceptives puts you into that middle category, in addition to having any complications during pregnancy, preeclampsia, pregnancy-induced hypertension, gestational diabetes, any of those things puts you into that middle category of somebody who is at risk for coronary disease. Yes, that's part of what we were talking about earlier, that a lot of women, even if they don’t have a personal history of hypertension when they are not pregnant just having had that experience when they were pregnant puts them into that middle category of somebody who really needs to control their blood pressure and their cholesterol as if they are at risk for that condition. It affects the way that we approach these patients when we see them in the office and it should affect the way you see yourself and your own health and your risk for having some kind of event that has to do with your heart later on.

LOMAX-REESE:  Is there any impact of pregnancy? You mentioned preeclampsia and things like that, but I am talking about sometimes in terms of your risk factor for breast cancer, whether you have been pregnant or not it relates to, is there anything like that since when we look at menopause and the lack of estrogen and things like that and when you are pregnant you are not menstruating and things like that. Is there any connection between whether you've ever been pregnant or how many pregnancies and your risk for heart disease?

THOMAS: The risk seems to be more associated with whether you have had certain types of complications with your pregnancy, like the ones I mentioned, and pre-term birth, etcetera, because it seems to be more an indication that you are vulnerable to the types of changes in your blood vessels that will lead you to develop hypertension later on or strokes later on or heart attacks later on.

PATTERSON: There's definitely a condition called lupus that does increase your risk of heart disease, especially during pregnancy. It makes the blood vessels more irritated and they can rupture. That's a possibility.

LOMAX-REESE: As we begin to wrap this up, I want to get some final thoughts, some take aways, some inspiring to-dos that our listening audience can do so that we are being proactive around our heart health. We will start with you, Dr. Thomas?

THOMAS: Sure. I would say that always keep in mind that women don’t always follow the same rules that we've learned to follow when it comes to looking at men with heart disease. Take your symptoms seriously, especially if they are associated with you're exerting yourself, and having said that, keep in mind that we are pretty sedentary as a culture. We don’t exercise as much as we should so you might not be able to challenge yourself to the point where you would notice these symptoms with exertion so that's another reason to take them seriously. It is not easy to schedule in exercise into your life. It is not easy to make eating healthfully a priority, but it is absolutely essential if you are going to reduce your risk. You are more likely to develop high blood pressure with time, which will put you at risk for developing heart attacks and strokes later on, but if you really try to get these under control, your behaviors under control and a low-salt diet, low-fat diet, you can do a lot to reduce your risk, especially quit smoking. Don't bother doing it. There really is nothing that it is doing for you.  Maintain a healthy diet. Maintain a healthy weight. Make it a priority. Keep in mind that the difference between the way we eat now and the way we ate 30 years ago is basically, these days we eat about 300 calories per day more then we did 30 years ago, which is not a lot, right, and so if you reduce the amount that you are eating each day by 300 calories, think of it that way, it doesn't really seem like a big difference, but it could make a big difference. It is doable and it is worth it in terms of decreasing your risk of having a heart attack and a stroke, dying from a heart attack or a stroke, or just becoming debilitated from those conditions. 

LOMAX-REESE: Dr. Donee? Final thoughts?

PATTERSON: Real quick, just very inexpensive, know your family history, your mother, your father, your grandparents are still alive, ask them today. Did anyone in my family die of heart disease, because your family history makes a big difference and then lastly, don’t forget your children. Childhood obesity is huge in the U.S. Don’t forget your children because they're developing heart disease now. Get your children active. Make sure they are eating fruits and vegetables during the day and we just want to leave you with one thought just to be encouraged by this. Don’t be overwhelmed and just know that you have the power to take over for yourself and to make yourself healthier and we wish you well and if you need any more information you can always contact us at www.einstein.edu.

LOMAX-REESE: Well, thank you very much, Dr. Donee and Dr. Niku Thomas. Thank you very much for being with us today, giving us excellent information about women and heart disease and we are looking forward to seeing you in another two weeks, Dr, Donee.  We are going to take a quick break.


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