Michelle Rupp: Hello, and welcome into this week’s edition of AFMC TV.  We’re so glad you’re joining us today. It’s all about the ladies. We are talking about women and heart disease on today’s episode. And who better to have join us on the show today, but Dr. Monica Lo from Arkansas Heart hospital. Hi Dr. Lo, thanks for joining us today.

Dr. Monica Lo: Hi Michelle. Thanks for having me.

MR: So, I want to start by just asking you know what are contributing factors for women to develop heart disease.

ML: So, just to start out with, women- One in three women die of heart disease. So, more than cancer combined. So, it is important. I’m glad you’re bringing awareness to this. And the risk factors that we often think of for heart disease, there are some that similar to men. For example, age, high blood pressure, diabetes, high cholesterol and smoking. Those are the same risk factors that we see in women and heart disease, that we can see in men. But there are certain things such as smoking and diabetes that may affect women more as compared to men. Also, of course there are some women specific factors. So, hormone plays a big role in this in terms of polycystic ovarian syndrome. Or if they’ve had pregnancy induced hypertension or pregnancy induced diabetes. Those women are more at risk for developing heart disease.

MR: If a woman did experience for example hypertension or diabetes during pregnancy, either one, but delivered the child fine, haven’t had any problems since that delivery. Is this something, though that could just show up at any time? I mean, they could just go from not having any heart problems to all of a sudden, something not feeling quite right.

ML: Yes. So, we work closely with our OB Colleagues, because it is important in terms of, you know, why did this woman develop hypertension, diabetes during pregnancy? Do they have baseline, increased insulin resistance that would have triggered that? Do they have some sort of cardiovascular risk factors or metabolic syndrome that kind of led to this? So, those women need to be followed more closely. Perhaps they could develop heart disease earlier than their counterparts. And in terms of one thing that is specific, of course with women is Peripartum Cardiomyopathy. And that’s a whole different topic. But, basically developing heart failure during pregnancy or even after delivery. So, if there are issues during pregnancy it’s very important to be followed up.

MR: Absolutely. Would those pregnant women who maybe had one or more of those conditions during their pregnancy, would they already have a cardiologist? Or, is this something that they will want to talk with their primary care, assuming that the child has grown now and maybe they aren’t as in tune with their OB physician?

ML: Yeah, so I I agree they should see a cardiologist because most of the time, even women of, you know, pregnancy age don’t really have a primary care physicians. So they use their OB-GYN as their primary care physicians. So, a lot of times I think the referral to see a cardiologist would be necessary. Especially if they’ve developed hypertension. It is important to get an echo or a sonogram of the heart just to see how thickened the heart muscle is if the heart muscle relaxes or whatnot to prevent progression of heart failure.

MR: So, let’s transition from this to women who might experience a heart attack. And what are some of those signs and symptoms? And are they different than what men might experience?

ML: Yes. So the typical signs of heart attack or angina, chest pain, is basically substantial. So, in the middle of the chest, under sternum exacerbated by exertion and then relieved with rest. So, pressure- elephant sitting on the chest. So, women of course can experience that. But a lot of times, women can also have the more atypical symptoms, So nausea, shortness of breath and maybe shoulder pain. So I generally say, you know, anything above the waist is fair game for a woman at risk.

MR: And some women might say, oh, it’s just indigestion or maybe it’s a panic attack. But that’s not really the right way to approach it.

ML: Yes. And you bring that point up and I think that’s in terms of why, you know. So, the incidence of men getting heart disease is higher than women. But again, we talked about that one in three women can have heart disease or die of heart disease. So, strokes or heart attacks. And a lot of times it’s because they present late. They can often be more dismissed even though we don’t want to, you know, really classify people. This is how our brain works and how we can categorize data or whatnot. So, of course a lot of times people are perceived as more anxious or you know, sometimes they can just have nonspecific fatigue and perhaps if you were a man they would be referred to a cardiologist or when they see a cardiologist more testing done. But in a woman, not necessarily. Because people try to justify, “oh, it’s just heartburn, it’s just anxiety.” And oftentimes if you do have the risk factors, of course, positive family history as one of them as well. That needs to be looked into.

MR: You mentioned family history as a possible risk factor. What are some of the others, such as maybe diet or stress?

ML: So, in women, you bring up stress and that a lot of times actually triggers for heart disease. So, stress could be for different reasons, but we carry a lot of stress. You know, women most of the time are the caretakers of the family. They have to coordinate multiple children, husband, cook and a lot of them work as well in addition to that. And so there is a lot of stress and internalizing that stress can cause inflammation. And that can of course lead to kind of stress to the vessels, the blood vessels, and hence lead to heart disease. Sometimes stress can actually cause heart failure, stress induced cardiomyopathy. So, it’s just stress is a big contributor um in terms of um women and heart disease too.

MR: So, along those lines with stress obviously being a huge contributor. What are ways, or maybe talk about how important it is to reduce that stress as well as self-care. You know, we hear that all the time about women need to have self-care days, maybe not just on their birthdays. And maybe talk about how those two kind of go hand in hand.

ML: Yeah, I think that a lot of times we ask a lot of ourselves, women do. And we don’t give- We’re hard on ourselves. So we’re go, go, go. We always take care of other people and we’re not really taking care of ourselves. It’s okay for their husband to go to the gym to run because that’s just what men do. And women, “Oh I, you know work around the house already as I have to chase my,” I hear this all the time, “I have to chase my kids around. So, I am always, you know, I’m active.” But that is not activity for yourself, so you know, you have to basically take time for yourself. 150 is kind of the number- 150 minutes of moderate exercise a week. Just take that time for yourself and relaxation. So you know, yoga, meditation. That would be helpful and then eating a balanced diet. So, instead of grabbing some fast food on the way to somewhere, just actually take some time. And there are tools nowadays I’ve seen little candles that’s like 20 minutes, you burn it, that’s your time. Even that little bit can help with our health.

MR: You mentioned some of the tools and that just brought a thought to mind. What about some of the smart watches, some of the smart devices? We hear occasionally in the news that a smartwatch triggered or alerted, I should say, to the wearer that maybe they were experiencing some heart problems or maybe teetering on heart attack. Maybe they had an elevated blood pressure or something. Are, are those, if you can just generally speaking- The accuracy of some of those wearables?

ML: So, the wearables have been very good at helping us diagnose, especially arrhythmias. So, we mentioned that women actually have more incidents of stroke actually than the men, and a lot of it is atrial fibrillation. Undiagnosed atrial fibrillation. So, people don’t actually feel the irregularity of it. So, the wearables nowadays have the EKG function. So, even if- and it doesn’t necessarily say okay, you have Afib. It says possible Afib. So, we could definitely review those strips. Even if they are quote-unquote, not as accurate as what, you know, an EKG may be. But at least it brings to our attention that something is going on. The most devastating thing is if somebody presents with the stroke and that’s their first symptoms and it could have been prevented.

MR: With Afib, is that something that can show up anytime or are you born with it or how does that work?

ML: So, most of the time it is related to age. So, one in 10 people over the age of 70 have it. So, it is very common as you age. But now we’ve seen because of our diet and habits we’ve seen younger and younger people with Afib as a result of, you know, hypertension early on or family history. Sometimes in a young person when we see Afib, it could be related to an abnormal electrical circuit that they’re born with. So, if we get rid of that circuit, we can actually cure the Afib in younger people. So, of course we put Afib all in the same category and there are different reasons for it. It is very common. And the stroke risk is real And it also depends on the risk factors of each individual. So it’s important that once you have a wearable that alerts you of that to then talk more with a physician on what the next step is.

MR: And real quick, is there a special type of cardiologist that a person needs to see if they are experiencing arrhythmia discomfort?

ML: So, I’m an electrophysiologist. So basically, electrician of the heart. So, I look at rhythm. So of course, you can see your primary care and then they will refer you to a cardiologist and then sometimes they’ll refer you to EP. But nowadays I think we’re all, kind of, since it’s so prevalent a lot of patients are knocking our doors saying, “Hey, I have Afib, I need to see an electrician.”

MR: Okay. Dr Lo, thank you very much for joining us today. And if anyone has any questions or may think that they are experiencing some arrhythmia issues, of course, they can always go to arheart.com to check it out. So, thanks Dr. Lo. Good to see you today and thank you so much for joining us. We’ll see you back here next week for more AFMC TV.