September 27, 2024 • 47 mins
Heart disease is the biggest killer of people in New Zealand, including women, yet it is still often seen as a male issue. This episode, Francesca and Louise discuss their own heart and cholesterol journeys and get advice and insight from leading cardiologist, Dr Cara Wasywich.
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Speaker 1 (00:08):
Hello, I'm Francesca Rudkin and I'm Louise Aria, and this
is season three of our New Zealand Here'll podcast The
Little Things. It's good to have you with us.
Speaker 2 (00:16):
In this podcast, we talk to experts and find out
all the little things you need to know to improve
all areas of your life.
Speaker 1 (00:21):
And today we're talking about something really important and often overlooked,
women's heart health. The stats are crazy.
Speaker 2 (00:29):
Heart disease is the leading cause of death in New
Zealand women. I didn't know that. I don't know what
I thought the cause of death would be, Louise. Maybe
I thought it was cancer or something. But I was
a bit surprised by this. I mean, it's the leading
cause of death for men too.
Speaker 1 (00:43):
Yeah. And maybe we've also thought that perhaps even if
we knew that it was a high rate, we might
have thought it was just much much much older people
than we are, right, And actually that's not true either.
Speaker 2 (00:54):
Every week and nearly fifty women die of heart disease.
I'm just really trying to hammer this home. It's not
a man's disease.
Speaker 1 (01:01):
Yeah, And it's not always obvious.
Speaker 2 (01:03):
No, it isn't. And I suppose I can share a
little bit about my little heart journey. I have a
segment of partially calcified plaque of twenty five to forty
nine percent, approaching fifty percent in my proximal LED. There
is some further calcified plaque of less than twenty five
(01:25):
percent in my mid LAED. This means that I am
at risk of heart disease, so I manage that with
some statins. Now I am I would like to think
a pretty healthy middle aged woman. I exercise a lot,
I eat pretty well, I take care of myself. I
(01:45):
keep an eye out for any symptoms or anything. Had
absolutely none. And this is purely off the back of
this is just a very generous present that my parents
gifted me with my genetics. So it's not always about
your heart health is a noise about a symptom that
you may be aware of or that you that comes
(02:06):
to your knowledge. You also have to, unfortunately keep a
really close eye on your family history because you never
know how that can impact your risk. And I think too,
we do we do this with you know, we talk
about this later, but we you know, we we do
this with cancer. We deal with other risk factors, but
there's something about our heart we just keep thinking it's
just going to keep ticking.
Speaker 1 (02:27):
All your ticker is it right?
Speaker 2 (02:29):
Well?
Speaker 1 (02:29):
Who knows? I mean, Michelestero is not good. It's not good.
And I did go on Stantons and then I didn't.
I just so you know, I can't go. I can't
go to the GP because I know it's the first
thing I'm going to talk about. But yeah, no, I
need to. I need to address that today is as
good a day as anything. I have a funny feeling
(02:49):
that approach might be suedested that that's not the best
approach throughout this podcast. I mean, we don't have a
family history of I've certainly got some the ugly branches
and some of the DNA in my family, but heart
isn't one of them. But that is not a reason.
So just as you did because your DNA, you know,
your family history is not great, I don't think it's
(03:10):
not a reason to go get your heart checked just
because you know, generally speaking, your family is okay.
Speaker 2 (03:15):
So we need to be aware of the risks, especially
if there are particular risks for women. We need to
know what we can do to prevent heart disease, and
we need to know what we should be doing and
when to get things checked out.
Speaker 1 (03:27):
So joining us today talk about all this is doctor
Karazi Witch, a leading cardiologist at Auckland City Hospital and
at the Heart Group who interests include heart failure, cardiac transplantation,
general cardiology including acute coronary symptoms and echo cardography, and
the management of cardiovascular diseases in women.
Speaker 2 (03:47):
Doctor Kara was Hewitch, thank you so much for being
with us.
Speaker 3 (03:50):
Thanks for having me.
Speaker 2 (03:52):
Heart disease is the leading cause of death in New
Zealand women, but many people are unaware. I think of
the statistic because they believe it's a man's disease.
Speaker 1 (04:01):
Would that be fair to say?
Speaker 3 (04:05):
I think yes is the answer. Although because I am
a cardiologist and I work in cardiology, I see a
lot of women with cativascular disease, so you know it's
where I live. Cativascular disease is actually the leading cause
of death for all people, including women, so just as
important as cancer and other things that people sort of
(04:28):
think about more.
Speaker 2 (04:29):
I guess so do women pay enough attention to it?
Are they surprised when they come to you to discover
what might be going on with their heart?
Speaker 3 (04:37):
I think women often don't put themselves first, and so
the nature of females, I guess is to be caregivers
and to kind of look after everyone else, and so
probably women don't pay enough attention to their cativascular health,
although that's a huge generalization obviously it's everyone's different. But yes,
(05:00):
frequently we see people who are surprised that they've got
a heart problem.
Speaker 1 (05:04):
So I think where I'd want to start as some
kind of understanding of what heart disease actually is, or
cardiovascular disease specifically.
Speaker 3 (05:14):
Sure, so look that is a massive question. But the
common causes of catervascular disease, including in women, are heart attacks.
There are people who have valvular heart disease and that's
a particular issue in New Zealand, so problems with their
heart valves either being too narrow or too leaky, problems
(05:37):
where there is impairment of the heart pumping function or
heart failure, and lots of other types of heart disease
as well, including congenital heart disease, so people who are
born with abnormal hearts. There are types of inherited heart
problems that people are at risk of, including women. And
then there are some conditions that are a little more
frequent in women than men, including something called spontaneous chroniatery dissection,
(06:01):
which generally is a it's not only seen in woman,
but it is much more common in women.
Speaker 2 (06:06):
Yeah, and we'll talk about that a little bit later
as well. So is there a general course all this
if we say what causes it? Is it different for
all those different things that you've just mentioned.
Speaker 3 (06:16):
So there are sort of a few basic causes. So
one of them is getting older. You know, we live
a lot longer than we used to. But actually a
lot of cadvescular disease is age related. A lot of
it's genetic, and so people carry various genes from the appearance,
and some of those are associated with increases in coroniattery disease,
heart attacks, angina, but also other types of heart problems.
(06:39):
There is a definitely an increase in the risk of
cadi escular disease for females at the age of menopause,
So when you kind of get to that menopausal age,
the risks increase significantly. And then there are other things.
High blood pressure more common in woman, a strong driver
of heart disease. High cholesterol definitely a problem for women
(07:00):
for men.
Speaker 1 (07:01):
I'm swear that my heart rate has just got up.
It's your spread. My heart's slightly racing. And so if
you talk about that specific to women, because we do
talk about menopause a lot on this podcast, what about
menopause is not great for our hearts? Yeah? Or peri menopause. Yeah.
Speaker 3 (07:22):
I'm not a menopause expert, and doctors like me don't
like to say things that they're not totally sure of,
but I think there is clearly some relationship to it,
to the withdrawal of estrogen and the increase in the
risks of cartivascular disease. And you are probably aware, particularly
if you talk a lot about menopause in this podcast,
(07:44):
that there's been sort of varying recommendations about medical hormone
replacement therapy and the cadi vescular safety of MHRT, and
women initially thinking it would be protective, then a big
study showing that actually it seemed to be associated with
an increase in risk, but more modder and data actually
suggesting that it is when prescribed appropriately safe and probably
(08:05):
does with the reduced cadi vascular risk over time.
Speaker 2 (08:08):
So it's pregnancy another time where maybe women should be
more attentive to their heart as.
Speaker 3 (08:12):
Well, So there are a few things that happen a
bit more commonly in pregnancy. So it is pretty common
to be breathless and have palpitations during pregnancy, and a
lot of that's just normal pregnancy, but some of those
patients do actually have their first presentation of CADI vascular
disease when they're pregnant, because there's a big increase in
the cadiv essculatives when you're pregnant, you need to increase
(08:32):
your carde output a lot, So there are a few
people with occult heart disease who will present in pregnancy
with new symptoms. If you have known cardiac disease, it's
obviously a big stress and so people who have a
cardiac problem are often closely monitored during pregnancy. And then
there's a few things that are more likely to occur
in pregnancy, like preclamsier pregnancy associated hypertension, diabetes, a big
(08:56):
risk for catect disease, and then these other rareer things
like chinary dissection or actually a order dissection for people
with big, big gay orders.
Speaker 2 (09:05):
It's good you get a baby out of it at
the end of day. Yeah, thank goodness.
Speaker 1 (09:09):
I'm just going back to sorry, that heart rate thing.
I see you're wearing a smart watch, are you?
Speaker 3 (09:13):
Yeah?
Speaker 1 (09:13):
Yeah, I have one? You have one? We you know
I'm interested in my resting heart rate? Is your heart
rate any indication of heart health?
Speaker 3 (09:21):
It depends if your a normal rhythm, so there's a
huge range of normal. And for most people, if they're
a normal rhythm sinnus rhythm, it kind of doesn't matter
what their heart rate is because your heart will respond
to the circumstances around you. So if your hat rates
has gone up now you might be a bit nervous.
You don't want me to tell you something that might
be directly related to you. If you're running up a hill,
(09:43):
your heart rate will be high. If you're I don't know,
doing something that's stressful, your heart rate will be high.
And if you're a normal rythm, that's totally fine. But
smart watchers do sometimes pick up a rhythmics and they
you know, a high heart rate could be a marker
of that.
Speaker 1 (10:00):
High resting heart rate do you mean or any high
will it?
Speaker 3 (10:03):
So if you're in an a rhythm, often your heart
rate will be higher, whether it be at rest or
with exertion, and some of the watchers will tell you
what's going on. You'll get a notification you had atrial fibrillation,
your heart rate was too high when you were asleep.
A lot of the time it's packing up normal, and
so quite a lot of what we do when we
see patients. We do see people who come where they're smart.
(10:27):
Watch has told them that something's going on, and sometimes
something is going on, but quite a lot of the
time they're being warned about normal, and that leads to
quite a lot of anxiety about Kadie vascular.
Speaker 2 (10:38):
It's one of those things. It has its pros and cons. Right,
you might be able to help pick up someone with
a problem, but at the same time it can create
anxiety when there's absolutely nothing wrong. So it's really good
to remember if if you had that watch and you're
following it very closely, you can see I'm really good
at very really weird of mine unless I'm exercising. Is
it sorry, I'm going completely off track now, But since
(10:58):
Louise is brought up the whole watch, is it a
sign of fitness how quickly your heart rate goes after
you've exerted yourself back to a resting heart race rate?
Speaker 3 (11:07):
An athletically trained person will will start with a slower
heart rate, mount a high heart rate response, and slow
down more quickly. So yes, that is a marker of
ethnic training. But for an individual like to be focused
on what their heart rate is and become worried because
it's not coming down quite as quickly as they might want,
(11:27):
that probably is taking the kind of the ability of
the watch to tell you stuff a little bit too fast.
Speaker 2 (11:32):
Okay, so Cara, as I age that would probably be
a normal thing. It might take a little longer for
it to come back to yeah, okay, all right. Then,
just going back to what puts women at risk of
heart disease, and we spoke about those two times of
the hormones kind of kick into play. Are there any
other different factors to men?
Speaker 3 (11:52):
I think the one thing to remember is that the
standard CANDI vascular risk factors apply to women just as
much as they lighter men. And so just because you're
a woman, I mean, it's still relevant. If you're a smoker,
it's still relevant. If you've got diabetes, it's still relevant.
If your cholesterol's abnormal, highly relevant, and so your blood
pressure is still relevant. So being less concerned about the
(12:14):
standard cat escular risk factor is just because you're a woman,
is not inherently logical sign is not a protectar. Yeah, yeah, exactly.
The same rules still apply to women as much as
they do to men. And I guess the other thing
is understanding what is happening when a CADI vescular risk
assessment is being made, because what we're doing is trying
(12:36):
to predict the risk of a heart attack or a
stroke in the next five to ten years. We know
that there are some risk factors that we've got control
over that can be managed that will definitely bring down risk,
and some things that we can't change, like your genetics.
And then when we're recommending treatment, it's because the patient
is at increased vascular risk, and so what you're trying
(12:58):
to do is use medicaid to reduce the risk in
the long term and reduce the likelihood of bad things
happening over time.
Speaker 1 (13:07):
I don't know that people. Yeah, when you said stroke,
that is a cardiovascular Yeah, right, I mean I probably
didn't know that because obviously a clot or in the
absence of one is all to do with what's happening
from you.
Speaker 3 (13:20):
A significant amount of strokes are cardiovascular in nature related
to athosclerosis, little plaques of hardening, rupturing and blocking a
brain blood vessel, just like a block a heart blood vessel.
But there's another problem called atrial fibrillation, which is common
as you get older, common if you've got high blood pressure,
and a significant number of strokes are related to atrial fibrillation.
Speaker 2 (13:43):
I am more worried about the stroke with my calcified
artery than I am about blocking and having a heart attack.
Speaker 3 (13:49):
Is that rational, Cara, Be honest, common, it's common to
be more concerned about stroke because people don't want to
be disabled day. I guess a proportion of heart attacks
present with sudden death, so that's quite a good thing
to avoid.
Speaker 1 (14:04):
Yeah, possible.
Speaker 3 (14:06):
But the good thing about cadevscular is the reason that
people like me really quite enjoy what we do is
that quite a lot of that we do is treatable.
We're not in the business of making people sick. We're
in the business of making people better. So even if
you have a heart attack, usually we get you back
to full functional capacity by hook or by crook.
Speaker 1 (14:23):
And so do you see people in the normal BMI range,
And I know that's kind of a BMI is a
little bit crude.
Speaker 3 (14:30):
It's a reasonably it's a simple measure of yeh off weight.
Speaker 1 (14:35):
You know people that would present like like us just
walking in and completely yeah.
Speaker 3 (14:39):
So it's not all the time.
Speaker 1 (14:40):
So it's not just like you're overweight people.
Speaker 3 (14:43):
And definitely not. And actually, lifestyle modification is really important,
so patient, it's really important to be as fit as
possible and to be and to have a weight that's
as normal as possible. But that's very challenging for lots
of people. And actually, if you come to me and
you are at increase risk and I think your cholesterol
needs to be treated, particularly if you've got on a
(15:04):
test evidence of ethyroosclerosis or calcification in your chriniaies, I'm
not going to not treat you just because you get
your weight down to a certain level.
Speaker 1 (15:13):
I mean, just look at me, Luise.
Speaker 2 (15:14):
I'm a fine example of a healthy, middle aged woman
doing all the right things, and thanks to the wonderful
gift my parents gave me, I have to deal with that.
And that's really Let's talk about the sort of symptoms
that might indicate heart disease, because a lot of people
do just focus on their cholesterol and they go my
cholesterol is great, fantastic, I don't have to worry about it.
Is cholesterol the first indication that you might have outside
(15:37):
of having a heart attack or something no an emergent.
Speaker 3 (15:41):
So cholesterol is a risk factor for ethosclerosis or cadivesque
or cariniati disease or three bra vascular disease or peripheral
vascular disease, like smoking as a risk factor, like high
blood pressure as a risk factor, like diabetes is a
risk vector, and all of those things come into your risk.
So being at risk of heart disease is not the
same as having heart disease, okay, And so when we're
(16:04):
treating for it's called primary prevention. We're trying to avoid
a problem in the long term, and most patients want
to do all that they can to reduce their risk,
usually not always or at least be able to make
an informed decision one way or the other. So that's
where the primary prevention comes in. Actually having heart disease
is when something's happened or you have symptoms, and so
(16:25):
having chlinary calcification without angina, without having had in the
past a heart attack, without having impairment of the heart
pumping function, you don't have heart disease.
Speaker 1 (16:34):
I'm just at risk.
Speaker 3 (16:35):
You're at risk of heart disease, and you've got a
big opportunity to reduce your risk.
Speaker 1 (16:41):
What does angina feel like?
Speaker 3 (16:43):
So it's different for everyone, right, And so angina is
the is the symptom that comes when your heart's not
getting enough blood where you're getting a skeinia. And usually
patients with angina present with exertion because at rest you
need your heart needs less blood to function than it
does with exertion. So anyone who comes to me with
(17:04):
exertional symptoms I get concerned about. And that can be breathlessness,
it can be chest pain that the sort of classical
angina is crushing central chest pain. But it can be
jaw pain. It can feel like tooth pain. I've had
people that have had headaches with exertion that have been
Angina can be like a funny feeling in your arm.
And so the history and the pattern of pain is
(17:26):
really important, or the pattern of symptoms. And people don't
often describe it as pain either, they talk about discomfort
or pressure. But anything that's there with exertion and going
away with rest that makes me want to go looking
for trouble. A heart attack is when you have a
blockage of one of those blood vessels, not just a narrowing,
and you present with the same type of symptoms, but
at rest because a blood vessel's blocked off, your heart's
(17:48):
not getting enough blood, and you'll have that same character
of discomfort, but it'll come at rest.
Speaker 1 (17:54):
I was asking about the angina just in case you
and I are out and a run and you have
any of those symptoms.
Speaker 2 (17:59):
Francesca Arstley the other day she'd done CPR recently.
Speaker 1 (18:02):
We'll get onto that later.
Speaker 2 (18:05):
Any other symptoms that people should think about that it
might make them want to get their heart checked.
Speaker 3 (18:12):
So, I mean, there are so many different types of
heart disease, isn't it. I mean, palpitations are important, and
many people get ectopic beats or their will skip a
beat from time to time. Most of that stuff is
actually normal, but it does cause a lot of anxiety
about something going on. Some palpitations are a sign of
a heart rhythm problem, and so palpitations that make you
(18:34):
feel unwell are really important. If you feel breathless or dizzy,
or like you might faint, if you've got exercise and
tolerance associated with palpitations that that should make you go
to your doctor, and often you'll be referred on to
a cardiologist. Breathlessness when you lie down is often a
sign of heart disease. Ank or swelling, position or chest
(18:55):
pain can be relevant, and so there are lots.
Speaker 2 (18:57):
Of So the key thing here is if you've got
but if you've got an interesting collection of things, just
make sure you tell your GP all of the symptoms.
You might have decided what you've got in your head,
you might have jumped on Google, but actually it's a
matter of just being ticking off all the yeah, all
the little things which you might have noticed.
Speaker 3 (19:13):
The other thing I guess is if someone comes to
me and tells me about chest pain that's like sharp
and very localized and kind of comes. It's very bad,
but comes and goes very quickly, I'm not at all
worried about that attack. That's well, it could be all
sorts of things off and it's musculo skilletal chest pain.
People talk about costo chondritis or inflammation of the joints
between the ribs and the sternum. Muscle pain. Often when
(19:36):
people are anxious, they get chest pain, and that you
know is usually not cardiat chest pain.
Speaker 1 (19:44):
But I wouldn't want any woman to dismiss thinking they're
having an anxiety attack or something and when it really.
Speaker 3 (19:49):
Isn't exactly And I definitely have patients who have come
with heart attacks or angina where they've thought they were
had to get anxiety attack, but they weren't really anxious
at the time. So why would you be having an
anxiety attack?
Speaker 1 (20:01):
I know, but that's just one of the lovely things
that menopause brings us as well, a little bit of
increased anxiety and a whole lot of other little symptoms
that we didn't have before. So you know that I
was interested too and what a health what a heart
health check looks like, and how often we should even
be having them if we're not symptomatic.
Speaker 3 (20:20):
So I think I've got two different places that are work,
the public system and the private system. And certainly in
the public system we don't have the capacity to see
asymptomatic people. We just would drown. And so for most people,
the first place you go for a heart help check
as your GP, who will take a history, will measure
(20:42):
things like your blood pressure and your cholesterol, and then
decide a further evaluation is appropriate. In the private system,
we've obviously got a bit more capacity to see people
who are wanting to make sure that things are okay.
For most people who actually don't have any symptoms, it's
pretty rare for us to find trouble. But we can
do things like a calcium score, which is a way
(21:04):
of so risk assessment is a population based tool. We
know that a percentage of people with high blood pressure
or high cholesterol or smokers will end up with cardiac disease,
which is kind of helpful but doesn't actually help an
individual because you don't know if you're the person that
it really matters that your risk factors are being true.
And so a calcium score will allows us to look
(21:26):
at the heart blood vessels, look for atherosclerosis, and if
we see it, we know that for you, your high cholesterol,
for instance, is associated with increased risk, and you definitely
are going to benefit by bringing that down with medication,
damping down the inflammation that that causes in your arteries,
and that definitely will reduce your risk over time.
Speaker 1 (21:47):
You've had one, haven't you, Yes, I have. I'm quite intrigued.
Speaker 2 (21:51):
I also had a CT chudinary angiogram report done recently
as well. I'm quite intrigued with health care hate you
get ranked scorer is I've got one hundred and thirty seven,
which places me in the ninetieth percentile rank. I'd love
to be in the ninetieh percentile for most things life.
But that means that there's only ten percent of female
at the age of fifty one to fifty five who
(22:13):
have a higher calcium school than me, and the ranking
it kind of doesn't make me feel good, you know
what I mean, It's kind of like, oh, okay, that's
that's not ideal. That's doing is putting your risk in
in perspective. So what it really is saying is that
you've got evidence of atherosclerosis, and you and your heart atteries,
(22:34):
the process that can cause a heart attack has started
at the age of fifty one. That's more than most
people your age, so you are at increased risk. So
what it's doing is telling us that your risk is
higher than the average fifty five year old female And
so we know.
Speaker 1 (22:50):
This though, You're right, so these other people walking around
who haven't.
Speaker 3 (22:54):
Well, no, because those Eggerston schools were based on scans
of normal popa and so it is of a normal population,
and so that's how they can work out with You're
the nineteenth center. So in your case, we know that
by addressing your risk collectors and really managing them tightly,
you're doing all that you can to reuse your risk.
(23:14):
In the long term, you still might have a problem,
because that's what happens sometimes, but you will have reduced
your risk in a meaningful way by doing things like
treating high blood pressure and high cholesterol and exercising and
looking after yourself.
Speaker 2 (23:31):
I think I'm the example of somebody who would go, well,
I've got no symptoms, nothing that you've mentioned. I have
a family history of heart disease, which I was determined
to be the one that I was going to outrun,
and you know, it did take me a long time before,
you know, finally everybody else in the family said, can
you just go and get this checked out? And I'm
really pleased I have, because now I have an understanding
(23:53):
of the risk and I can take the appropriate measures
to try and do everything I can to kind of
keep it in place. So I suppose the question, you know, is,
how seriously do you take your genetics, how seriously do
you take your family history?
Speaker 1 (24:05):
When it comes to something like heart health.
Speaker 3 (24:07):
So pretty it's significant, significant, particularly if it's first degree relative,
so your parents or your siblings and of the age
that they have developed a problem. So if your grammar
had a heart attack when they're eighty, that's not going
to meaningfully increase your own risk. But if actually your
dad had a heart attack at forty and you've got
a brother who's forty five who had angina and needed
(24:29):
a stent, and they both have high cholesterol, and you
have high cholesterol, then there's probably some kind of familial
high cholesterol problem in your particular family, and we know
that that significantly increases the risk of cadevascular disease.
Speaker 2 (24:43):
Can I do any things my kids proved to help
them out at this point?
Speaker 1 (24:48):
Yeah?
Speaker 3 (24:48):
Yeah, So I mean, if that is that story, your
kids should get their cholesterol checked, okay. And in people
with familiar hyperlipidemia, we do treat kids at a or
young play teenagers at a much younger age then you
would for standard people. We risk assessed from about the
age of forty or fifty, depending on the gender and things.
(25:12):
But if you come from a family where there's a
high chance of familiar hyperlipidemia. It's completely fine to check
cholesterol and blood pressure at an earlier age because this
is a lifetime risk. You know, you're exposed to the
risk for your whole lifetime, and what you're trying to
do is to reduce that risk over time.
Speaker 1 (25:30):
Isn't that interesting because I think I've been having colin
oscarp since I was gosh, what was I thirty two,
thirty three, because my mother had colon cancer. She died
when she was forty four, and my whole family has.
So we do it with the cancer checks, right, So
why wouldn't we do it with any cardiovascular.
Speaker 3 (25:50):
That's a question for you rather than me.
Speaker 1 (25:54):
Well, yeah, then went and got breast cancer.
Speaker 3 (25:56):
But I mean the other thing that's really interesting to me,
And it's just an observation, as most people are totally
fine taking blood pressure medication. Like most people think, oh
my blood pressure is high. My doctor said I should
take medicine, so I will. There is a much there
is a completely different approach to cholesterol medication, which is
not inherently logical. But many people are very anxious about
the idea of taking cholesterol medicine, whereas they're both reducing
(26:20):
your risk in the same way.
Speaker 2 (26:21):
Why is that?
Speaker 1 (26:22):
Do you think?
Speaker 2 (26:22):
What is it about the statin that has that reputation that.
Speaker 3 (26:26):
You're clearly asking someone who believes that that statins are, Oh,
I'm really effective, and I'm.
Speaker 2 (26:31):
Trying them back because I've seen the risk.
Speaker 3 (26:35):
No question that reducing your cholesterol with a statin reduces
your risk of heart attacks, strokes, dementia. I mean, many
people say that it should just be There are studies
saying should everyone have a stat in their respective of
what their cholesterol is, and that would probably or it
would significantly reduce the population risk of cativascular disease. There
is a lot of misinformation in the lay press. People
(26:57):
are obviously concerned about side effect, which is completely sensible.
What I talk to patients about as I let them
know about the side effects, I reassure them that most
people on medication don't have significant side effects. I tell
them to not plan for side effects, but to complain
about them because we've always got options. And that's the
same for blood pressure medicine as well. There are, if
(27:19):
I can think of, maybe two or three patients who
definitely not tolerate any statin, But that is out of
thousands and thousands of patients over the last kind of
twenty years of being a cardiologist more than twenty years.
Speaker 1 (27:30):
Actually, yeah, I so the other thing too is my
bad cholesterol is high, but my traditionally my good cholesterol
was high too, and I always kind of just sent
sweet as I would be fine, no, but no, my
ratio is not good. Yeah, so it was like five
point six.
Speaker 3 (27:49):
Yeah, so the ratio was what's used in the risk
assessment equations to help the side of cholesterol needs to
be treated. Good cholesterol HDL is protective and older is athrogenic.
So that's the good and the bad cholesterol. But there
are definitely people who've got a normal ratio who have
evidence of coronary calcification. But most people with cholesterol like yours,
(28:13):
with their ratio of five, you know that risk has increased,
and your risk will be lowered if that ratio can
be improved and.
Speaker 1 (28:21):
You can't exercise that away.
Speaker 3 (28:22):
Most people who are fit and slim and don't eat
a terrible diet will not be able to bring improve
their cholesterol to the point that they don't need medication.
If you're fat and you eat takeaways every day and
you don't do anything and you change those, then often
you can improve things. People get very frustrated though they
try really hard with exercise and with diet and often
(28:44):
don't get anywhere and get kind of demoralized. But that's
just understanding that it's actually those riskrectors are important, but
they're not the determinive of your high cholesterol.
Speaker 2 (28:54):
Yeah.
Speaker 1 (28:54):
No, I'm going to go to understand. So you're listening
to the little thing in.
Speaker 2 (29:00):
Our guest on the podcast today is leading cardiologist doctor
Kara was He, which will be back shortly after this break.
Speaker 1 (29:11):
I'm sure have you sorry. We've seen the ads recently
where there's a person in the street or a woman
or a man walking along and they say, this woman's
having this symptom and that symptom, she went and had
a shower, you know, instead of calling the ambulance. I've
seen them recently.
Speaker 3 (29:27):
I haven't seen them watch many heads.
Speaker 1 (29:30):
I'm pretty sure they must have been online when I
was streaming something and there was another one where it
was like can you pick the person in the crowd
who's heading and so you can't write.
Speaker 3 (29:38):
Ah, I mean you can. I think there is there
is data that shows that that females who have heart
attacks present a hospital later that they have symptoms which
are not typical, or may have symptoms that are not typical,
And so those campaigns really are trying to raise awareness
that things may present in a different manner in females.
(29:59):
But actually, if you take a good history at the
time the patient's in front of me, if you explore
the exertional component, the indigestion you feeling, which is often
oft an angina, And that's another thing that's quite commonly confused.
Is this indigestion or is this a heart attack? And
sometimes you can't tell until you actually evaluate those patients.
And so I think just it's not always a sort
(30:23):
of slightly overweight fifty five year old male who collapses
on the golf courses that's having a heart attack.
Speaker 2 (30:27):
So how do we know if we're having a heart attack.
Speaker 3 (30:30):
So to me, the things that I would be concerned
about a new chest discomfort somewhere between there and there
where you feel unwell, where you feel that was.
Speaker 1 (30:41):
Quite a large area you signaled there from the from
your nose down to your belly button.
Speaker 3 (30:48):
Yeah, okay, So in general, patients who are having a
heart attack have some type of chest discomfort. They feel
breathless and nauseated and sweaty, and they feel like something
bad's going on. But not always so. There are plenty
of people who who present with relatively minor discomfort in
(31:08):
primary care or in the emergency department. We use a
test called troponin, which is a really sensitive way of
identifying cardiac damage, and so people with chest discomfort will
often have blood tests taken to evaluate whether their traponin
is up or not. And you know that's how we
diagnose a heart attack.
Speaker 1 (31:25):
What should you do if you suddenly go okay, I
think I'm okay, but I'm I'm not quite right. Do
you sit and wait? Do you call one one one?
Speaker 2 (31:35):
Do you take yourself to an emergency to plants how.
Speaker 1 (31:37):
Bad you feel?
Speaker 3 (31:38):
Because people will present with relatively minor symptoms, they're not
too sure about that. Often they'll seek primary care, but
if you have they'll often ring healthline. Health fine is
really useful, actually, But if you have anything that makes
you feel really unwell, I think you probably need to
go to hospital. And if you feel really unwell, you're
probably need to call the ambulance.
Speaker 1 (31:58):
And will it if you don't call the amirans? If
you rock up to ed yeh, and you are presenting
with chest pain. Will you be triarched quite quickly? Yeah?
Speaker 3 (32:04):
Yeah, So they have a checklist that they look at.
You'll have ECG taken, blood test taken, and often that
that's been reviewed while you're waiting to see adopted.
Speaker 2 (32:14):
I'm sure I've sat in the emergency apartment with a
kid with a broken wrist or something like that.
Speaker 1 (32:18):
You're sitting there.
Speaker 2 (32:19):
Watching all the watching people sort of head through. You
mentioned earlier, spontaneous coronary artery dissection. I believe that this
makes up thirty percent of heart attacks and women. Is
that about the right statistic?
Speaker 3 (32:33):
I think probably a little less than that, okay, But
it is a cause of heart attack and women, which
is much more common in women than men, And it
does present often in patients who you wouldn't normally expect
to be at risk of cardiac disease. So younger women,
for instance, can have currenty Ateraye dissection and present with cardia,
chest pain and a heart attack. And so it is
(32:55):
something that we see causing heart attacks in young women.
Speaker 1 (32:58):
And what is it? It sounds like because it's some
sort of spontaneous explosion of a vessel or.
Speaker 3 (33:03):
So it's it's a little tear in the inside wall
of a colonyaartery, which then leads to blocking of that artery.
And so it's a heart attack because there's damage to
the heart muscle and there's pain that that and often
easy do changes. But it's not caused by etherosclerosis or
the sort of hardening of the arteries which causes most
(33:25):
heart attacks.
Speaker 1 (33:27):
Gosh, our hearts are incredible. They We really should be
more grateful for them. They're doing an awful lot. Keep
things every like the homeostasis. Yeah, yeah, it's crazy. Should
we all know how to do CPR? Yes, okay, put
that on the list. Still, que is it staying alive?
Staying alive?
Speaker 2 (33:44):
Is it?
Speaker 1 (33:44):
Yeah? So what?
Speaker 3 (33:46):
Yeah, so you have to do CPR fast enough and
so the est yeah, the precious and so one of
the one of the songs that has the right tempo
one hundred beats permittent is staying alive.
Speaker 1 (34:00):
Okay.
Speaker 2 (34:01):
That is good to know because I think if I
saw someone doing that, I've been like, seriously, Yeah, and
you've got begs right now?
Speaker 3 (34:06):
Yeah, totally, and you've got to press pretty hard as well.
Speaker 1 (34:10):
It is interesting.
Speaker 2 (34:10):
My son's about two eighteen, he's going to head off
to university and we've got you know, we're very fortunate
to have two sets of grandparents still around us, which
we who we spend time with. And I'm just really
conscious to the fact that I'd hate something to happen
if he was with them and things. He's got no
idea how to do CPR, And then I thought to
myself the other.
Speaker 1 (34:27):
Day, neither do I.
Speaker 2 (34:28):
I mean, it's been decades since I lasted a course
and could remember what to do.
Speaker 1 (34:34):
And it has changed. Yeah, but hasn't it over the years.
Speaker 3 (34:37):
The basics basic are the same. So there's this this
mnemonic doctor's ABC, airways, way breathing circulation, CPR, call for help,
and the other thing that the things that are really
important are calling for help because someone will bring you
a defibrillator. And those automatic defibrillators are idiot proof it
(34:58):
lay people use them, and so that's important. And there
are lots of workplaces. There probably is an ad in here,
I would imagine, and then getting on the job and
doing something.
Speaker 2 (35:10):
I'll add that to the list of things to do.
Speaker 3 (35:12):
The Red Cross does lots of red Yeah, yeah, no.
Speaker 1 (35:15):
Heaps of it. I think it's timely.
Speaker 2 (35:17):
How do we prevent heart disease? So we've spoken about
some of the medical assistance that we can get, but
what should we just be thinking about in general when
it comes to heart health.
Speaker 3 (35:28):
Oh, so it's simple stuff, adding as well as you
can doing some exercise every day, which doesn't have to
be joining a gym and doing expensive things going out
for a walk, but going out for what you feel
yourself getting a bit puffed, trying to maintain a normal
body weight, and then proactively being screened. Good primary care
(35:51):
really is fundamental, So having things like your blood pressure
checked and your cholesterol checked. Stopping smoking. It's actually very
unusual now for patient to be a smoker, Like that's
changed a lot in the last ten years.
Speaker 1 (36:03):
What about vaping are you seeing any I mean, do
you just put that in the same category.
Speaker 3 (36:07):
So the vaping is exposure to nicotine, and actually there
aren't there isn't a lot of data suggesting that vaping
nicotine is associated with an increase in CADI vascular risk.
And in fact, we use nicotine patches all the time
in hospital for people that come in who are smokers.
And it's fine from a cadic point of view, There
is some data and it's not my area of expertise
(36:28):
that vading associate is associate with some lung injury.
Speaker 2 (36:33):
Yeah.
Speaker 3 (36:33):
The other thing that we see and it's not really
a sort of for the wider community, but metham fedipine
is a big problem and there is a lot of
cativascular disease caused by methamphetamine. It's quite extraordinary.
Speaker 2 (36:45):
That the long list of reasons why you should just as.
Speaker 1 (36:48):
Worts thing to avoids for the myth I have heard,
I have and I'm probably many of our listeners have
had to have to have came therapy and radio therapy,
radiation therapy after breast cancer or any other kind of cancer.
Does that put you at increased risk?
Speaker 3 (37:07):
So it depends on the drugs and the treatment. And
so first of all, being alive is quite important, and
so the cancer treatments really quite important. Some of the
cancer drugs are associated with impediment and the heart pumping function,
for instance her septin, and then some of the chemotherapy drugs,
the admisin type drugs which are often in breast cancer regimens.
(37:32):
And so many people who are having cancer treatment have
regular screening of their heart pumping function. With a test
card eco cardiography and then more specifically left sided radiotherapy.
So if you've got had a left sided breast cancer
and you need left sided radiotherapy, particularly with the older
radiotherapy regimens, we do sometimes see an increase in chloniatery
(37:52):
disease with that because the hearts in the in the
radio they've shortened that they've shortened the regimen now, haven't. Yeah,
but the cardiotoxicity of cancer treats is recognized now and
carefully managed. The newer cancer drugs too, the immunotherapy drugs
k truder and some of those other new drugs that
have MAD at the end of them. Some of those
(38:14):
are associated with a risk of something called myacaditis or
inflammation of the heart, and so that's looked for obviously,
and people who are having those treatments, but you've got
to kind of remember that being alive is oh no,
quite important, and so the cad toxicity as something that
is managed rather than would stop you being treated.
Speaker 1 (38:32):
I'm just thinking it might just encourage the woman to go, well,
perhaps I will just go for that.
Speaker 3 (38:36):
Yeah. Yeah, escular checkup is important. Just because you've had
one thing doesn't mean you can ignore it.
Speaker 1 (38:45):
Don't we know it? Carol.
Speaker 2 (38:46):
We hear a lot about how much we're learning about
the brain these days. Is there still things we don't
know about the heart? Are we still learning a lot
about the heart and now it works allow it?
Speaker 1 (38:57):
Yeah?
Speaker 3 (38:58):
Yeah, I mean researchers where cadi vascular research is a
huge field. I mean we, like I talked about with
the HRT, we learn over time and change recommendations and
views over time. And there's a lot of research actually
that's done in Auckland and in New Zealand and cardiac.
Speaker 2 (39:16):
What's exciting you the most that's been locked at.
Speaker 3 (39:20):
So the thing that I think is going to change
cutio vascular risk over time are the weight loss drugs,
the sex senders, and the a zepics, because they definitely
reduce the metabolic syndrome, they reduce risks, rates of cativascular disease,
they change people's lives. So I think that's in five
(39:41):
or ten years time, the way we're treating obesity is
to be enormously different.
Speaker 2 (39:46):
It's really interesting you mentioned that, because we've been discussing
that and hoping to do a podcast on it and
doing quite a lot of research and I'm a bit
torn because I can see how it can change our
medical system so drastically and could just be this incredible tool.
But I also worry we're going to sell our souls
to you know, that there's going to be sort of
(40:07):
a lot of people who shouldn't be on it that
are on us, and a lot of other consequences that
we haven't thought through.
Speaker 3 (40:12):
I kind of I'm not too worried about the people
that are a little bit overweight, ye who kind of
want want to look better. I mean, there is clearly
a risk that and it's I think being observed internationally.
Not so much a museum becausey're quite hard to get
hold of and very expensive and very very expensive. But
you know, celebrities taking drugs and making themselves feel better.
But people with significant obesity there are options at the
(40:35):
moment are bariatric surgery, pretty drastic undertaking, often irreversible, or
staying very overweight, and it's an almost impossible problem to treat.
Speaker 2 (40:46):
Is it publicly funded at the moment? What is a
valuable envirnment?
Speaker 3 (40:49):
Yeah, there is. There are publicly funded barriertric programs for
people who have significant obesity who have other risk factors.
Speaker 1 (40:56):
Right, but the drugs significantly.
Speaker 3 (40:58):
It's the rugs are funded for people with diabetes only yep.
And actually no because of supply chain issues because the
companies are ramping up supply, no new patients with diabetes
are able to access those drugs in a funded way
at the moment. So people who are on them already
and have special authority can continue to have those communications,
(41:22):
but not new patients.
Speaker 2 (41:24):
I was going to end with a question for you,
if you could waive a magic wand tomorrow to help
improve health in New Zealand, what would you wish for
I'm wondering if we've just if.
Speaker 3 (41:31):
That's it, Well, well, I maybe I also work at
the very kind of severe end of CADS. Was exom
a transplant doctor, and so I think that, you know,
having less patients come to that end of my practice
would be quite nice. And that's all about prevention and
kind of management of the sort of simple stuff.
Speaker 2 (41:51):
That would be one aspect of your job that you
would be happy to no longer to become redundant in.
Speaker 3 (41:57):
I think that's pretty unlikely. Yeah, yeah, but you know,
it's only a small number of patients every year who
we're able to treat with.
Speaker 1 (42:04):
And it's a good reminder to think about being a donor.
I suppose to. Oh, look, there's just that it's a
huge topic and we've covered all sorts of aspects of it,
some of the usual, some of the exceptionals, and we're
incredibly grateful for your for your depth of knowledge.
Speaker 2 (42:22):
So you're going to go and sort of cholesterol. I'm
going to do a first aid course again, just to
get up to speed.
Speaker 1 (42:28):
I don't know there has been through it significant or
traumatic health event and become quite reluctant to ever have
another blood test or even see their GP. But I
am one of them, and it's become increasingly obviously I'm
probably you know, being a bit of an idiot because.
Speaker 3 (42:45):
I guess what you want to do as you as
you want to be able to make an informed decision, yes,
And you can't make an informed decision by avoiding the topic.
And actually being scared about accessing healthcare is a really
really common and you know sometimes so for some people,
the more health interventions you have, the worse it is.
(43:08):
And maybe that's something to be addressed as well. But
not not avoiding something because it's scary or frightening that's right.
Speaker 1 (43:14):
You wouldn't have avoid the lump in your breast. You
would have to go and get it seen, right, And
if I hadn't, I wouldn't be here. So so just
because you can't feel it will see it, doesn't mean
you shouldn't go get it.
Speaker 3 (43:26):
And I guess many people want to do the best
they can and stuff happens sometimes. But if you if
you've known about something and you haven't addressed it, and
then in two years time you have a heart attack,
you're going to be pretty sad about yourself.
Speaker 1 (43:38):
Yeah, yeah, for sure, just an honest conversation with my GP.
It was pretty be a good start. And remember those
lab tests or the alnu labs. Now, those flabotobus are
usually really good as not the drawing of the blood,
it's the waiting for yeah, results and stuff. But they
are amazing. And also you don't even need a little
piece of paper anymore, just goes straight to here all electronics. Good,
(43:59):
doctor Carr.
Speaker 2 (44:00):
Was We were to thank you so much for your
time this morning.
Speaker 1 (44:02):
We really appreciate it. You're welcome, Louise.
Speaker 2 (44:10):
I feel like you were really hoping that Kara would
change her answer to your cholesterol questions.
Speaker 1 (44:18):
Yeah, I don't know what I was. You're saying to me, Oh, no,
that's that's fine. No, you don't need to do anything.
Just carry on as you ask.
Speaker 2 (44:26):
But it's always as we always know what the answer
is going to be, because it's that little thing that
just sits in the back of your mind, going I
probably should really do something about that. And as Kara
said at the very beginning, you know, women, we're spending
our time looking after other people, putting other people first,
and sometimes it's really hard to get to that list
of things that we go should have, should have, really
could you know.
Speaker 1 (44:46):
It's a pretty big inventory in the back of my
mind for Friendshisca, and but that one has been sitting
there going, oh, just just get to the lab, do
the bloody test, and probably go on the statins because
I think I have been going, oh, but I'll go
back once I've been running more. I'll go back once
really nailed my diet. Just go and do it now.
(45:06):
And that goes for anybody listening who's got a bit
of a news that their blood PreCure is high, or
the cle strolls high, you're worried about family history, It's
not going to make a difference if you lose two
kgs the next few months or something and then go
and do it.
Speaker 2 (45:20):
That's what we're saying. It's not going to make any
difference whatsoever. So that's knowledge is power. I have really
struggled to get my head around my diagnosis and the
calcification in my artery, even though cadiologists keep saying to me,
you're at risk. You don't necessarily have heart disease, you're
at risk of this happening or at risk of that happening.
(45:43):
And I think today Kara finally got that in my head.
Just stop worrying about it, do all the things.
Speaker 1 (45:48):
That I can do, manage the risks that I can exactly,
and get on with life. Yeah, and I can stop
worrying that if you're just being a bit quite on
a run, you're about to just PLoP down behind me
and I'm going to have to do staying alive.
Speaker 2 (46:00):
It's just some a bit tired. Although I think we should.
I think we should go and do a first aid course.
I just don't think it would hurt at this point.
It's been so long since I've done it, and I
would feel a bit better if we were in the
middle of the bush and we didn't have a defibrillator
on hand, noise that in you what you were.
Speaker 1 (46:17):
Doing well, Our dear friend, our dear doctor friends listening
who we do go running with once a year. At
least we've kind of relied on them, haven't we, just
to know what to do in an emergency psyches Just
of course when we're next with them, it does bring
up the little memory about a broken foot, but we
won't go there. They'll be laughing when they hear that. Look,
(46:38):
a heart is a complicated thing, but looking after it
might be simpler than we realize.
Speaker 2 (46:43):
So thanks for joining us on our New Zealand Herald
podcast series, The Little Things. We hope you share this
podcast with the women in your life so we all
know how to look after our hearts, live long and prosper.
Speaker 1 (46:52):
You can follow this podcast on iHeartRadio or wherever you
get your podcasts, and for more on this and other topics,
here to nzed Harold dot co dot m Z and
we'll catch you next time on The Little Things m HM.
Hello, I'm Francesca Rudkin and I'm Louise Aria, and this
is season three of our New Zealand Here'll podcast The
Little Things. It's good to have you with us.
Speaker 2 (00:16):
In this podcast, we talk to experts and find out
all the little things you need to know to improve
all areas of your life.
Speaker 1 (00:21):
And today we're talking about something really important and often overlooked,
women's heart health. The stats are crazy.
Speaker 2 (00:29):
Heart disease is the leading cause of death in New
Zealand women. I didn't know that. I don't know what
I thought the cause of death would be, Louise. Maybe
I thought it was cancer or something. But I was
a bit surprised by this. I mean, it's the leading
cause of death for men too.
Speaker 1 (00:43):
Yeah. And maybe we've also thought that perhaps even if
we knew that it was a high rate, we might
have thought it was just much much much older people
than we are, right, And actually that's not true either.
Speaker 2 (00:54):
Every week and nearly fifty women die of heart disease.
I'm just really trying to hammer this home. It's not
a man's disease.
Speaker 1 (01:01):
Yeah, And it's not always obvious.
Speaker 2 (01:03):
No, it isn't. And I suppose I can share a
little bit about my little heart journey. I have a
segment of partially calcified plaque of twenty five to forty
nine percent, approaching fifty percent in my proximal LED. There
is some further calcified plaque of less than twenty five
(01:25):
percent in my mid LAED. This means that I am
at risk of heart disease, so I manage that with
some statins. Now I am I would like to think
a pretty healthy middle aged woman. I exercise a lot,
I eat pretty well, I take care of myself. I
(01:45):
keep an eye out for any symptoms or anything. Had
absolutely none. And this is purely off the back of
this is just a very generous present that my parents
gifted me with my genetics. So it's not always about
your heart health is a noise about a symptom that
you may be aware of or that you that comes
(02:06):
to your knowledge. You also have to, unfortunately keep a
really close eye on your family history because you never
know how that can impact your risk. And I think too,
we do we do this with you know, we talk
about this later, but we you know, we we do
this with cancer. We deal with other risk factors, but
there's something about our heart we just keep thinking it's
just going to keep ticking.
Speaker 1 (02:27):
All your ticker is it right?
Speaker 2 (02:29):
Well?
Speaker 1 (02:29):
Who knows? I mean, Michelestero is not good. It's not good.
And I did go on Stantons and then I didn't.
I just so you know, I can't go. I can't
go to the GP because I know it's the first
thing I'm going to talk about. But yeah, no, I
need to. I need to address that today is as
good a day as anything. I have a funny feeling
(02:49):
that approach might be suedested that that's not the best
approach throughout this podcast. I mean, we don't have a
family history of I've certainly got some the ugly branches
and some of the DNA in my family, but heart
isn't one of them. But that is not a reason.
So just as you did because your DNA, you know,
your family history is not great, I don't think it's
(03:10):
not a reason to go get your heart checked just
because you know, generally speaking, your family is okay.
Speaker 2 (03:15):
So we need to be aware of the risks, especially
if there are particular risks for women. We need to
know what we can do to prevent heart disease, and
we need to know what we should be doing and
when to get things checked out.
Speaker 1 (03:27):
So joining us today talk about all this is doctor
Karazi Witch, a leading cardiologist at Auckland City Hospital and
at the Heart Group who interests include heart failure, cardiac transplantation,
general cardiology including acute coronary symptoms and echo cardography, and
the management of cardiovascular diseases in women.
Speaker 2 (03:47):
Doctor Kara was Hewitch, thank you so much for being
with us.
Speaker 3 (03:50):
Thanks for having me.
Speaker 2 (03:52):
Heart disease is the leading cause of death in New
Zealand women, but many people are unaware. I think of
the statistic because they believe it's a man's disease.
Speaker 1 (04:01):
Would that be fair to say?
Speaker 3 (04:05):
I think yes is the answer. Although because I am
a cardiologist and I work in cardiology, I see a
lot of women with cativascular disease, so you know it's
where I live. Cativascular disease is actually the leading cause
of death for all people, including women, so just as
important as cancer and other things that people sort of
(04:28):
think about more.
Speaker 2 (04:29):
I guess so do women pay enough attention to it?
Are they surprised when they come to you to discover
what might be going on with their heart?
Speaker 3 (04:37):
I think women often don't put themselves first, and so
the nature of females, I guess is to be caregivers
and to kind of look after everyone else, and so
probably women don't pay enough attention to their cativascular health,
although that's a huge generalization obviously it's everyone's different. But yes,
(05:00):
frequently we see people who are surprised that they've got
a heart problem.
Speaker 1 (05:04):
So I think where I'd want to start as some
kind of understanding of what heart disease actually is, or
cardiovascular disease specifically.
Speaker 3 (05:14):
Sure, so look that is a massive question. But the
common causes of catervascular disease, including in women, are heart attacks.
There are people who have valvular heart disease and that's
a particular issue in New Zealand, so problems with their
heart valves either being too narrow or too leaky, problems
(05:37):
where there is impairment of the heart pumping function or
heart failure, and lots of other types of heart disease
as well, including congenital heart disease, so people who are
born with abnormal hearts. There are types of inherited heart
problems that people are at risk of, including women. And
then there are some conditions that are a little more
frequent in women than men, including something called spontaneous chroniatery dissection,
(06:01):
which generally is a it's not only seen in woman,
but it is much more common in women.
Speaker 2 (06:06):
Yeah, and we'll talk about that a little bit later
as well. So is there a general course all this
if we say what causes it? Is it different for
all those different things that you've just mentioned.
Speaker 3 (06:16):
So there are sort of a few basic causes. So
one of them is getting older. You know, we live
a lot longer than we used to. But actually a
lot of cadvescular disease is age related. A lot of
it's genetic, and so people carry various genes from the appearance,
and some of those are associated with increases in coroniattery disease,
heart attacks, angina, but also other types of heart problems.
(06:39):
There is a definitely an increase in the risk of
cadi escular disease for females at the age of menopause,
So when you kind of get to that menopausal age,
the risks increase significantly. And then there are other things.
High blood pressure more common in woman, a strong driver
of heart disease. High cholesterol definitely a problem for women
(07:00):
for men.
Speaker 1 (07:01):
I'm swear that my heart rate has just got up.
It's your spread. My heart's slightly racing. And so if
you talk about that specific to women, because we do
talk about menopause a lot on this podcast, what about
menopause is not great for our hearts? Yeah? Or peri menopause. Yeah.
Speaker 3 (07:22):
I'm not a menopause expert, and doctors like me don't
like to say things that they're not totally sure of,
but I think there is clearly some relationship to it,
to the withdrawal of estrogen and the increase in the
risks of cartivascular disease. And you are probably aware, particularly
if you talk a lot about menopause in this podcast,
(07:44):
that there's been sort of varying recommendations about medical hormone
replacement therapy and the cadi vescular safety of MHRT, and
women initially thinking it would be protective, then a big
study showing that actually it seemed to be associated with
an increase in risk, but more modder and data actually
suggesting that it is when prescribed appropriately safe and probably
(08:05):
does with the reduced cadi vascular risk over time.
Speaker 2 (08:08):
So it's pregnancy another time where maybe women should be
more attentive to their heart as.
Speaker 3 (08:12):
Well, So there are a few things that happen a
bit more commonly in pregnancy. So it is pretty common
to be breathless and have palpitations during pregnancy, and a
lot of that's just normal pregnancy, but some of those
patients do actually have their first presentation of CADI vascular
disease when they're pregnant, because there's a big increase in
the cadiv essculatives when you're pregnant, you need to increase
(08:32):
your carde output a lot, So there are a few
people with occult heart disease who will present in pregnancy
with new symptoms. If you have known cardiac disease, it's
obviously a big stress and so people who have a
cardiac problem are often closely monitored during pregnancy. And then
there's a few things that are more likely to occur
in pregnancy, like preclamsier pregnancy associated hypertension, diabetes, a big
(08:56):
risk for catect disease, and then these other rareer things
like chinary dissection or actually a order dissection for people
with big, big gay orders.
Speaker 2 (09:05):
It's good you get a baby out of it at
the end of day. Yeah, thank goodness.
Speaker 1 (09:09):
I'm just going back to sorry, that heart rate thing.
I see you're wearing a smart watch, are you?
Speaker 3 (09:13):
Yeah?
Speaker 1 (09:13):
Yeah, I have one? You have one? We you know
I'm interested in my resting heart rate? Is your heart
rate any indication of heart health?
Speaker 3 (09:21):
It depends if your a normal rhythm, so there's a
huge range of normal. And for most people, if they're
a normal rhythm sinnus rhythm, it kind of doesn't matter
what their heart rate is because your heart will respond
to the circumstances around you. So if your hat rates
has gone up now you might be a bit nervous.
You don't want me to tell you something that might
be directly related to you. If you're running up a hill,
(09:43):
your heart rate will be high. If you're I don't know,
doing something that's stressful, your heart rate will be high.
And if you're a normal rythm, that's totally fine. But
smart watchers do sometimes pick up a rhythmics and they
you know, a high heart rate could be a marker
of that.
Speaker 1 (10:00):
High resting heart rate do you mean or any high
will it?
Speaker 3 (10:03):
So if you're in an a rhythm, often your heart
rate will be higher, whether it be at rest or
with exertion, and some of the watchers will tell you
what's going on. You'll get a notification you had atrial fibrillation,
your heart rate was too high when you were asleep.
A lot of the time it's packing up normal, and
so quite a lot of what we do when we
see patients. We do see people who come where they're smart.
(10:27):
Watch has told them that something's going on, and sometimes
something is going on, but quite a lot of the
time they're being warned about normal, and that leads to
quite a lot of anxiety about Kadie vascular.
Speaker 2 (10:38):
It's one of those things. It has its pros and cons. Right,
you might be able to help pick up someone with
a problem, but at the same time it can create
anxiety when there's absolutely nothing wrong. So it's really good
to remember if if you had that watch and you're
following it very closely, you can see I'm really good
at very really weird of mine unless I'm exercising. Is
it sorry, I'm going completely off track now, But since
(10:58):
Louise is brought up the whole watch, is it a
sign of fitness how quickly your heart rate goes after
you've exerted yourself back to a resting heart race rate?
Speaker 3 (11:07):
An athletically trained person will will start with a slower
heart rate, mount a high heart rate response, and slow
down more quickly. So yes, that is a marker of
ethnic training. But for an individual like to be focused
on what their heart rate is and become worried because
it's not coming down quite as quickly as they might want,
(11:27):
that probably is taking the kind of the ability of
the watch to tell you stuff a little bit too fast.
Speaker 2 (11:32):
Okay, so Cara, as I age that would probably be
a normal thing. It might take a little longer for
it to come back to yeah, okay, all right. Then,
just going back to what puts women at risk of
heart disease, and we spoke about those two times of
the hormones kind of kick into play. Are there any
other different factors to men?
Speaker 3 (11:52):
I think the one thing to remember is that the
standard CANDI vascular risk factors apply to women just as
much as they lighter men. And so just because you're
a woman, I mean, it's still relevant. If you're a smoker,
it's still relevant. If you've got diabetes, it's still relevant.
If your cholesterol's abnormal, highly relevant, and so your blood
pressure is still relevant. So being less concerned about the
(12:14):
standard cat escular risk factor is just because you're a woman,
is not inherently logical sign is not a protectar. Yeah, yeah, exactly.
The same rules still apply to women as much as
they do to men. And I guess the other thing
is understanding what is happening when a CADI vescular risk
assessment is being made, because what we're doing is trying
(12:36):
to predict the risk of a heart attack or a
stroke in the next five to ten years. We know
that there are some risk factors that we've got control
over that can be managed that will definitely bring down risk,
and some things that we can't change, like your genetics.
And then when we're recommending treatment, it's because the patient
is at increased vascular risk, and so what you're trying
(12:58):
to do is use medicaid to reduce the risk in
the long term and reduce the likelihood of bad things
happening over time.
Speaker 1 (13:07):
I don't know that people. Yeah, when you said stroke,
that is a cardiovascular Yeah, right, I mean I probably
didn't know that because obviously a clot or in the
absence of one is all to do with what's happening
from you.
Speaker 3 (13:20):
A significant amount of strokes are cardiovascular in nature related
to athosclerosis, little plaques of hardening, rupturing and blocking a
brain blood vessel, just like a block a heart blood vessel.
But there's another problem called atrial fibrillation, which is common
as you get older, common if you've got high blood pressure,
and a significant number of strokes are related to atrial fibrillation.
Speaker 2 (13:43):
I am more worried about the stroke with my calcified
artery than I am about blocking and having a heart attack.
Speaker 3 (13:49):
Is that rational, Cara, Be honest, common, it's common to
be more concerned about stroke because people don't want to
be disabled day. I guess a proportion of heart attacks
present with sudden death, so that's quite a good thing
to avoid.
Speaker 1 (14:04):
Yeah, possible.
Speaker 3 (14:06):
But the good thing about cadevscular is the reason that
people like me really quite enjoy what we do is
that quite a lot of that we do is treatable.
We're not in the business of making people sick. We're
in the business of making people better. So even if
you have a heart attack, usually we get you back
to full functional capacity by hook or by crook.
Speaker 1 (14:23):
And so do you see people in the normal BMI range,
And I know that's kind of a BMI is a
little bit crude.
Speaker 3 (14:30):
It's a reasonably it's a simple measure of yeh off weight.
Speaker 1 (14:35):
You know people that would present like like us just
walking in and completely yeah.
Speaker 3 (14:39):
So it's not all the time.
Speaker 1 (14:40):
So it's not just like you're overweight people.
Speaker 3 (14:43):
And definitely not. And actually, lifestyle modification is really important,
so patient, it's really important to be as fit as
possible and to be and to have a weight that's
as normal as possible. But that's very challenging for lots
of people. And actually, if you come to me and
you are at increase risk and I think your cholesterol
needs to be treated, particularly if you've got on a
(15:04):
test evidence of ethyroosclerosis or calcification in your chriniaies, I'm
not going to not treat you just because you get
your weight down to a certain level.
Speaker 1 (15:13):
I mean, just look at me, Luise.
Speaker 2 (15:14):
I'm a fine example of a healthy, middle aged woman
doing all the right things, and thanks to the wonderful
gift my parents gave me, I have to deal with that.
And that's really Let's talk about the sort of symptoms
that might indicate heart disease, because a lot of people
do just focus on their cholesterol and they go my
cholesterol is great, fantastic, I don't have to worry about it.
Is cholesterol the first indication that you might have outside
(15:37):
of having a heart attack or something no an emergent.
Speaker 3 (15:41):
So cholesterol is a risk factor for ethosclerosis or cadivesque
or cariniati disease or three bra vascular disease or peripheral
vascular disease, like smoking as a risk factor, like high
blood pressure as a risk factor, like diabetes is a
risk vector, and all of those things come into your risk.
So being at risk of heart disease is not the
same as having heart disease, okay, And so when we're
(16:04):
treating for it's called primary prevention. We're trying to avoid
a problem in the long term, and most patients want
to do all that they can to reduce their risk,
usually not always or at least be able to make
an informed decision one way or the other. So that's
where the primary prevention comes in. Actually having heart disease
is when something's happened or you have symptoms, and so
(16:25):
having chlinary calcification without angina, without having had in the
past a heart attack, without having impairment of the heart
pumping function, you don't have heart disease.
Speaker 1 (16:34):
I'm just at risk.
Speaker 3 (16:35):
You're at risk of heart disease, and you've got a
big opportunity to reduce your risk.
Speaker 1 (16:41):
What does angina feel like?
Speaker 3 (16:43):
So it's different for everyone, right, And so angina is
the is the symptom that comes when your heart's not
getting enough blood where you're getting a skeinia. And usually
patients with angina present with exertion because at rest you
need your heart needs less blood to function than it
does with exertion. So anyone who comes to me with
(17:04):
exertional symptoms I get concerned about. And that can be breathlessness,
it can be chest pain that the sort of classical
angina is crushing central chest pain. But it can be
jaw pain. It can feel like tooth pain. I've had
people that have had headaches with exertion that have been
Angina can be like a funny feeling in your arm.
And so the history and the pattern of pain is
(17:26):
really important, or the pattern of symptoms. And people don't
often describe it as pain either, they talk about discomfort
or pressure. But anything that's there with exertion and going
away with rest that makes me want to go looking
for trouble. A heart attack is when you have a
blockage of one of those blood vessels, not just a narrowing,
and you present with the same type of symptoms, but
at rest because a blood vessel's blocked off, your heart's
(17:48):
not getting enough blood, and you'll have that same character
of discomfort, but it'll come at rest.
Speaker 1 (17:54):
I was asking about the angina just in case you
and I are out and a run and you have
any of those symptoms.
Speaker 2 (17:59):
Francesca Arstley the other day she'd done CPR recently.
Speaker 1 (18:02):
We'll get onto that later.
Speaker 2 (18:05):
Any other symptoms that people should think about that it
might make them want to get their heart checked.
Speaker 3 (18:12):
So, I mean, there are so many different types of
heart disease, isn't it. I mean, palpitations are important, and
many people get ectopic beats or their will skip a
beat from time to time. Most of that stuff is
actually normal, but it does cause a lot of anxiety
about something going on. Some palpitations are a sign of
a heart rhythm problem, and so palpitations that make you
(18:34):
feel unwell are really important. If you feel breathless or dizzy,
or like you might faint, if you've got exercise and
tolerance associated with palpitations that that should make you go
to your doctor, and often you'll be referred on to
a cardiologist. Breathlessness when you lie down is often a
sign of heart disease. Ank or swelling, position or chest
(18:55):
pain can be relevant, and so there are lots.
Speaker 2 (18:57):
Of So the key thing here is if you've got
but if you've got an interesting collection of things, just
make sure you tell your GP all of the symptoms.
You might have decided what you've got in your head,
you might have jumped on Google, but actually it's a
matter of just being ticking off all the yeah, all
the little things which you might have noticed.
Speaker 3 (19:13):
The other thing I guess is if someone comes to
me and tells me about chest pain that's like sharp
and very localized and kind of comes. It's very bad,
but comes and goes very quickly, I'm not at all
worried about that attack. That's well, it could be all
sorts of things off and it's musculo skilletal chest pain.
People talk about costo chondritis or inflammation of the joints
between the ribs and the sternum. Muscle pain. Often when
(19:36):
people are anxious, they get chest pain, and that you
know is usually not cardiat chest pain.
Speaker 1 (19:44):
But I wouldn't want any woman to dismiss thinking they're
having an anxiety attack or something and when it really.
Speaker 3 (19:49):
Isn't exactly And I definitely have patients who have come
with heart attacks or angina where they've thought they were
had to get anxiety attack, but they weren't really anxious
at the time. So why would you be having an
anxiety attack?
Speaker 1 (20:01):
I know, but that's just one of the lovely things
that menopause brings us as well, a little bit of
increased anxiety and a whole lot of other little symptoms
that we didn't have before. So you know that I
was interested too and what a health what a heart
health check looks like, and how often we should even
be having them if we're not symptomatic.
Speaker 3 (20:20):
So I think I've got two different places that are work,
the public system and the private system. And certainly in
the public system we don't have the capacity to see
asymptomatic people. We just would drown. And so for most people,
the first place you go for a heart help check
as your GP, who will take a history, will measure
(20:42):
things like your blood pressure and your cholesterol, and then
decide a further evaluation is appropriate. In the private system,
we've obviously got a bit more capacity to see people
who are wanting to make sure that things are okay.
For most people who actually don't have any symptoms, it's
pretty rare for us to find trouble. But we can
do things like a calcium score, which is a way
(21:04):
of so risk assessment is a population based tool. We
know that a percentage of people with high blood pressure
or high cholesterol or smokers will end up with cardiac disease,
which is kind of helpful but doesn't actually help an
individual because you don't know if you're the person that
it really matters that your risk factors are being true.
And so a calcium score will allows us to look
(21:26):
at the heart blood vessels, look for atherosclerosis, and if
we see it, we know that for you, your high cholesterol,
for instance, is associated with increased risk, and you definitely
are going to benefit by bringing that down with medication,
damping down the inflammation that that causes in your arteries,
and that definitely will reduce your risk over time.
Speaker 1 (21:47):
You've had one, haven't you, Yes, I have. I'm quite intrigued.
Speaker 2 (21:51):
I also had a CT chudinary angiogram report done recently
as well. I'm quite intrigued with health care hate you
get ranked scorer is I've got one hundred and thirty seven,
which places me in the ninetieth percentile rank. I'd love
to be in the ninetieh percentile for most things life.
But that means that there's only ten percent of female
at the age of fifty one to fifty five who
(22:13):
have a higher calcium school than me, and the ranking
it kind of doesn't make me feel good, you know
what I mean, It's kind of like, oh, okay, that's
that's not ideal. That's doing is putting your risk in
in perspective. So what it really is saying is that
you've got evidence of atherosclerosis, and you and your heart atteries,
(22:34):
the process that can cause a heart attack has started
at the age of fifty one. That's more than most
people your age, so you are at increased risk. So
what it's doing is telling us that your risk is
higher than the average fifty five year old female And
so we know.
Speaker 1 (22:50):
This though, You're right, so these other people walking around
who haven't.
Speaker 3 (22:54):
Well, no, because those Eggerston schools were based on scans
of normal popa and so it is of a normal population,
and so that's how they can work out with You're
the nineteenth center. So in your case, we know that
by addressing your risk collectors and really managing them tightly,
you're doing all that you can to reuse your risk.
(23:14):
In the long term, you still might have a problem,
because that's what happens sometimes, but you will have reduced
your risk in a meaningful way by doing things like
treating high blood pressure and high cholesterol and exercising and
looking after yourself.
Speaker 2 (23:31):
I think I'm the example of somebody who would go, well,
I've got no symptoms, nothing that you've mentioned. I have
a family history of heart disease, which I was determined
to be the one that I was going to outrun,
and you know, it did take me a long time before,
you know, finally everybody else in the family said, can
you just go and get this checked out? And I'm
really pleased I have, because now I have an understanding
(23:53):
of the risk and I can take the appropriate measures
to try and do everything I can to kind of
keep it in place. So I suppose the question, you know, is,
how seriously do you take your genetics, how seriously do
you take your family history?
Speaker 1 (24:05):
When it comes to something like heart health.
Speaker 3 (24:07):
So pretty it's significant, significant, particularly if it's first degree relative,
so your parents or your siblings and of the age
that they have developed a problem. So if your grammar
had a heart attack when they're eighty, that's not going
to meaningfully increase your own risk. But if actually your
dad had a heart attack at forty and you've got
a brother who's forty five who had angina and needed
(24:29):
a stent, and they both have high cholesterol, and you
have high cholesterol, then there's probably some kind of familial
high cholesterol problem in your particular family, and we know
that that significantly increases the risk of cadevascular disease.
Speaker 2 (24:43):
Can I do any things my kids proved to help
them out at this point?
Speaker 1 (24:48):
Yeah?
Speaker 3 (24:48):
Yeah, So I mean, if that is that story, your
kids should get their cholesterol checked, okay. And in people
with familiar hyperlipidemia, we do treat kids at a or
young play teenagers at a much younger age then you
would for standard people. We risk assessed from about the
age of forty or fifty, depending on the gender and things.
(25:12):
But if you come from a family where there's a
high chance of familiar hyperlipidemia. It's completely fine to check
cholesterol and blood pressure at an earlier age because this
is a lifetime risk. You know, you're exposed to the
risk for your whole lifetime, and what you're trying to
do is to reduce that risk over time.
Speaker 1 (25:30):
Isn't that interesting because I think I've been having colin
oscarp since I was gosh, what was I thirty two,
thirty three, because my mother had colon cancer. She died
when she was forty four, and my whole family has.
So we do it with the cancer checks, right, So
why wouldn't we do it with any cardiovascular.
Speaker 3 (25:50):
That's a question for you rather than me.
Speaker 1 (25:54):
Well, yeah, then went and got breast cancer.
Speaker 3 (25:56):
But I mean the other thing that's really interesting to me,
And it's just an observation, as most people are totally
fine taking blood pressure medication. Like most people think, oh
my blood pressure is high. My doctor said I should
take medicine, so I will. There is a much there
is a completely different approach to cholesterol medication, which is
not inherently logical. But many people are very anxious about
the idea of taking cholesterol medicine, whereas they're both reducing
(26:20):
your risk in the same way.
Speaker 2 (26:21):
Why is that?
Speaker 1 (26:22):
Do you think?
Speaker 2 (26:22):
What is it about the statin that has that reputation that.
Speaker 3 (26:26):
You're clearly asking someone who believes that that statins are, Oh,
I'm really effective, and I'm.
Speaker 2 (26:31):
Trying them back because I've seen the risk.
Speaker 3 (26:35):
No question that reducing your cholesterol with a statin reduces
your risk of heart attacks, strokes, dementia. I mean, many
people say that it should just be There are studies
saying should everyone have a stat in their respective of
what their cholesterol is, and that would probably or it
would significantly reduce the population risk of cativascular disease. There
is a lot of misinformation in the lay press. People
(26:57):
are obviously concerned about side effect, which is completely sensible.
What I talk to patients about as I let them
know about the side effects, I reassure them that most
people on medication don't have significant side effects. I tell
them to not plan for side effects, but to complain
about them because we've always got options. And that's the
same for blood pressure medicine as well. There are, if
(27:19):
I can think of, maybe two or three patients who
definitely not tolerate any statin, But that is out of
thousands and thousands of patients over the last kind of
twenty years of being a cardiologist more than twenty years.
Speaker 1 (27:30):
Actually, yeah, I so the other thing too is my
bad cholesterol is high, but my traditionally my good cholesterol
was high too, and I always kind of just sent
sweet as I would be fine, no, but no, my
ratio is not good. Yeah, so it was like five
point six.
Speaker 3 (27:49):
Yeah, so the ratio was what's used in the risk
assessment equations to help the side of cholesterol needs to
be treated. Good cholesterol HDL is protective and older is athrogenic.
So that's the good and the bad cholesterol. But there
are definitely people who've got a normal ratio who have
evidence of coronary calcification. But most people with cholesterol like yours,
(28:13):
with their ratio of five, you know that risk has increased,
and your risk will be lowered if that ratio can
be improved and.
Speaker 1 (28:21):
You can't exercise that away.
Speaker 3 (28:22):
Most people who are fit and slim and don't eat
a terrible diet will not be able to bring improve
their cholesterol to the point that they don't need medication.
If you're fat and you eat takeaways every day and
you don't do anything and you change those, then often
you can improve things. People get very frustrated though they
try really hard with exercise and with diet and often
(28:44):
don't get anywhere and get kind of demoralized. But that's
just understanding that it's actually those riskrectors are important, but
they're not the determinive of your high cholesterol.
Speaker 2 (28:54):
Yeah.
Speaker 1 (28:54):
No, I'm going to go to understand. So you're listening
to the little thing in.
Speaker 2 (29:00):
Our guest on the podcast today is leading cardiologist doctor
Kara was He, which will be back shortly after this break.
Speaker 1 (29:11):
I'm sure have you sorry. We've seen the ads recently
where there's a person in the street or a woman
or a man walking along and they say, this woman's
having this symptom and that symptom, she went and had
a shower, you know, instead of calling the ambulance. I've
seen them recently.
Speaker 3 (29:27):
I haven't seen them watch many heads.
Speaker 1 (29:30):
I'm pretty sure they must have been online when I
was streaming something and there was another one where it
was like can you pick the person in the crowd
who's heading and so you can't write.
Speaker 3 (29:38):
Ah, I mean you can. I think there is there
is data that shows that that females who have heart
attacks present a hospital later that they have symptoms which
are not typical, or may have symptoms that are not typical,
And so those campaigns really are trying to raise awareness
that things may present in a different manner in females.
(29:59):
But actually, if you take a good history at the
time the patient's in front of me, if you explore
the exertional component, the indigestion you feeling, which is often
oft an angina, And that's another thing that's quite commonly confused.
Is this indigestion or is this a heart attack? And
sometimes you can't tell until you actually evaluate those patients.
And so I think just it's not always a sort
(30:23):
of slightly overweight fifty five year old male who collapses
on the golf courses that's having a heart attack.
Speaker 2 (30:27):
So how do we know if we're having a heart attack.
Speaker 3 (30:30):
So to me, the things that I would be concerned
about a new chest discomfort somewhere between there and there
where you feel unwell, where you feel that was.
Speaker 1 (30:41):
Quite a large area you signaled there from the from
your nose down to your belly button.
Speaker 3 (30:48):
Yeah, okay, So in general, patients who are having a
heart attack have some type of chest discomfort. They feel
breathless and nauseated and sweaty, and they feel like something
bad's going on. But not always so. There are plenty
of people who who present with relatively minor discomfort in
(31:08):
primary care or in the emergency department. We use a
test called troponin, which is a really sensitive way of
identifying cardiac damage, and so people with chest discomfort will
often have blood tests taken to evaluate whether their traponin
is up or not. And you know that's how we
diagnose a heart attack.
Speaker 1 (31:25):
What should you do if you suddenly go okay, I
think I'm okay, but I'm I'm not quite right. Do
you sit and wait? Do you call one one one?
Speaker 2 (31:35):
Do you take yourself to an emergency to plants how.
Speaker 1 (31:37):
Bad you feel?
Speaker 3 (31:38):
Because people will present with relatively minor symptoms, they're not
too sure about that. Often they'll seek primary care, but
if you have they'll often ring healthline. Health fine is
really useful, actually, But if you have anything that makes
you feel really unwell, I think you probably need to
go to hospital. And if you feel really unwell, you're
probably need to call the ambulance.
Speaker 1 (31:58):
And will it if you don't call the amirans? If
you rock up to ed yeh, and you are presenting
with chest pain. Will you be triarched quite quickly? Yeah?
Speaker 3 (32:04):
Yeah, So they have a checklist that they look at.
You'll have ECG taken, blood test taken, and often that
that's been reviewed while you're waiting to see adopted.
Speaker 2 (32:14):
I'm sure I've sat in the emergency apartment with a
kid with a broken wrist or something like that.
Speaker 1 (32:18):
You're sitting there.
Speaker 2 (32:19):
Watching all the watching people sort of head through. You
mentioned earlier, spontaneous coronary artery dissection. I believe that this
makes up thirty percent of heart attacks and women. Is
that about the right statistic?
Speaker 3 (32:33):
I think probably a little less than that, okay, But
it is a cause of heart attack and women, which
is much more common in women than men, And it
does present often in patients who you wouldn't normally expect
to be at risk of cardiac disease. So younger women,
for instance, can have currenty Ateraye dissection and present with cardia,
chest pain and a heart attack. And so it is
(32:55):
something that we see causing heart attacks in young women.
Speaker 1 (32:58):
And what is it? It sounds like because it's some
sort of spontaneous explosion of a vessel or.
Speaker 3 (33:03):
So it's it's a little tear in the inside wall
of a colonyaartery, which then leads to blocking of that artery.
And so it's a heart attack because there's damage to
the heart muscle and there's pain that that and often
easy do changes. But it's not caused by etherosclerosis or
the sort of hardening of the arteries which causes most
(33:25):
heart attacks.
Speaker 1 (33:27):
Gosh, our hearts are incredible. They We really should be
more grateful for them. They're doing an awful lot. Keep
things every like the homeostasis. Yeah, yeah, it's crazy. Should
we all know how to do CPR? Yes, okay, put
that on the list. Still, que is it staying alive?
Staying alive?
Speaker 2 (33:44):
Is it?
Speaker 1 (33:44):
Yeah? So what?
Speaker 3 (33:46):
Yeah, so you have to do CPR fast enough and
so the est yeah, the precious and so one of
the one of the songs that has the right tempo
one hundred beats permittent is staying alive.
Speaker 1 (34:00):
Okay.
Speaker 2 (34:01):
That is good to know because I think if I
saw someone doing that, I've been like, seriously, Yeah, and
you've got begs right now?
Speaker 3 (34:06):
Yeah, totally, and you've got to press pretty hard as well.
Speaker 1 (34:10):
It is interesting.
Speaker 2 (34:10):
My son's about two eighteen, he's going to head off
to university and we've got you know, we're very fortunate
to have two sets of grandparents still around us, which
we who we spend time with. And I'm just really
conscious to the fact that I'd hate something to happen
if he was with them and things. He's got no
idea how to do CPR, And then I thought to
myself the other.
Speaker 1 (34:27):
Day, neither do I.
Speaker 2 (34:28):
I mean, it's been decades since I lasted a course
and could remember what to do.
Speaker 1 (34:34):
And it has changed. Yeah, but hasn't it over the years.
Speaker 3 (34:37):
The basics basic are the same. So there's this this
mnemonic doctor's ABC, airways, way breathing circulation, CPR, call for help,
and the other thing that the things that are really
important are calling for help because someone will bring you
a defibrillator. And those automatic defibrillators are idiot proof it
(34:58):
lay people use them, and so that's important. And there
are lots of workplaces. There probably is an ad in here,
I would imagine, and then getting on the job and
doing something.
Speaker 2 (35:10):
I'll add that to the list of things to do.
Speaker 3 (35:12):
The Red Cross does lots of red Yeah, yeah, no.
Speaker 1 (35:15):
Heaps of it. I think it's timely.
Speaker 2 (35:17):
How do we prevent heart disease? So we've spoken about
some of the medical assistance that we can get, but
what should we just be thinking about in general when
it comes to heart health.
Speaker 3 (35:28):
Oh, so it's simple stuff, adding as well as you
can doing some exercise every day, which doesn't have to
be joining a gym and doing expensive things going out
for a walk, but going out for what you feel
yourself getting a bit puffed, trying to maintain a normal
body weight, and then proactively being screened. Good primary care
(35:51):
really is fundamental, So having things like your blood pressure
checked and your cholesterol checked. Stopping smoking. It's actually very
unusual now for patient to be a smoker, Like that's
changed a lot in the last ten years.
Speaker 1 (36:03):
What about vaping are you seeing any I mean, do
you just put that in the same category.
Speaker 3 (36:07):
So the vaping is exposure to nicotine, and actually there
aren't there isn't a lot of data suggesting that vaping
nicotine is associated with an increase in CADI vascular risk.
And in fact, we use nicotine patches all the time
in hospital for people that come in who are smokers.
And it's fine from a cadic point of view, There
is some data and it's not my area of expertise
(36:28):
that vading associate is associate with some lung injury.
Speaker 2 (36:33):
Yeah.
Speaker 3 (36:33):
The other thing that we see and it's not really
a sort of for the wider community, but metham fedipine
is a big problem and there is a lot of
cativascular disease caused by methamphetamine. It's quite extraordinary.
Speaker 2 (36:45):
That the long list of reasons why you should just as.
Speaker 1 (36:48):
Worts thing to avoids for the myth I have heard,
I have and I'm probably many of our listeners have
had to have to have came therapy and radio therapy,
radiation therapy after breast cancer or any other kind of cancer.
Does that put you at increased risk?
Speaker 3 (37:07):
So it depends on the drugs and the treatment. And
so first of all, being alive is quite important, and
so the cancer treatments really quite important. Some of the
cancer drugs are associated with impediment and the heart pumping function,
for instance her septin, and then some of the chemotherapy drugs,
the admisin type drugs which are often in breast cancer regimens.
(37:32):
And so many people who are having cancer treatment have
regular screening of their heart pumping function. With a test
card eco cardiography and then more specifically left sided radiotherapy.
So if you've got had a left sided breast cancer
and you need left sided radiotherapy, particularly with the older
radiotherapy regimens, we do sometimes see an increase in chloniatery
(37:52):
disease with that because the hearts in the in the
radio they've shortened that they've shortened the regimen now, haven't. Yeah,
but the cardiotoxicity of cancer treats is recognized now and
carefully managed. The newer cancer drugs too, the immunotherapy drugs
k truder and some of those other new drugs that
have MAD at the end of them. Some of those
(38:14):
are associated with a risk of something called myacaditis or
inflammation of the heart, and so that's looked for obviously,
and people who are having those treatments, but you've got
to kind of remember that being alive is oh no,
quite important, and so the cad toxicity as something that
is managed rather than would stop you being treated.
Speaker 1 (38:32):
I'm just thinking it might just encourage the woman to go, well,
perhaps I will just go for that.
Speaker 3 (38:36):
Yeah. Yeah, escular checkup is important. Just because you've had
one thing doesn't mean you can ignore it.
Speaker 1 (38:45):
Don't we know it? Carol.
Speaker 2 (38:46):
We hear a lot about how much we're learning about
the brain these days. Is there still things we don't
know about the heart? Are we still learning a lot
about the heart and now it works allow it?
Speaker 1 (38:57):
Yeah?
Speaker 3 (38:58):
Yeah, I mean researchers where cadi vascular research is a
huge field. I mean we, like I talked about with
the HRT, we learn over time and change recommendations and
views over time. And there's a lot of research actually
that's done in Auckland and in New Zealand and cardiac.
Speaker 2 (39:16):
What's exciting you the most that's been locked at.
Speaker 3 (39:20):
So the thing that I think is going to change
cutio vascular risk over time are the weight loss drugs,
the sex senders, and the a zepics, because they definitely
reduce the metabolic syndrome, they reduce risks, rates of cativascular disease,
they change people's lives. So I think that's in five
(39:41):
or ten years time, the way we're treating obesity is
to be enormously different.
Speaker 2 (39:46):
It's really interesting you mentioned that, because we've been discussing
that and hoping to do a podcast on it and
doing quite a lot of research and I'm a bit
torn because I can see how it can change our
medical system so drastically and could just be this incredible tool.
But I also worry we're going to sell our souls
to you know, that there's going to be sort of
(40:07):
a lot of people who shouldn't be on it that
are on us, and a lot of other consequences that
we haven't thought through.
Speaker 3 (40:12):
I kind of I'm not too worried about the people
that are a little bit overweight, ye who kind of
want want to look better. I mean, there is clearly
a risk that and it's I think being observed internationally.
Not so much a museum becausey're quite hard to get
hold of and very expensive and very very expensive. But
you know, celebrities taking drugs and making themselves feel better.
But people with significant obesity there are options at the
(40:35):
moment are bariatric surgery, pretty drastic undertaking, often irreversible, or
staying very overweight, and it's an almost impossible problem to treat.
Speaker 2 (40:46):
Is it publicly funded at the moment? What is a
valuable envirnment?
Speaker 3 (40:49):
Yeah, there is. There are publicly funded barriertric programs for
people who have significant obesity who have other risk factors.
Speaker 1 (40:56):
Right, but the drugs significantly.
Speaker 3 (40:58):
It's the rugs are funded for people with diabetes only yep.
And actually no because of supply chain issues because the
companies are ramping up supply, no new patients with diabetes
are able to access those drugs in a funded way
at the moment. So people who are on them already
and have special authority can continue to have those communications,
(41:22):
but not new patients.
Speaker 2 (41:24):
I was going to end with a question for you,
if you could waive a magic wand tomorrow to help
improve health in New Zealand, what would you wish for
I'm wondering if we've just if.
Speaker 3 (41:31):
That's it, Well, well, I maybe I also work at
the very kind of severe end of CADS. Was exom
a transplant doctor, and so I think that, you know,
having less patients come to that end of my practice
would be quite nice. And that's all about prevention and
kind of management of the sort of simple stuff.
Speaker 2 (41:51):
That would be one aspect of your job that you
would be happy to no longer to become redundant in.
Speaker 3 (41:57):
I think that's pretty unlikely. Yeah, yeah, but you know,
it's only a small number of patients every year who
we're able to treat with.
Speaker 1 (42:04):
And it's a good reminder to think about being a donor.
I suppose to. Oh, look, there's just that it's a
huge topic and we've covered all sorts of aspects of it,
some of the usual, some of the exceptionals, and we're
incredibly grateful for your for your depth of knowledge.
Speaker 2 (42:22):
So you're going to go and sort of cholesterol. I'm
going to do a first aid course again, just to
get up to speed.
Speaker 1 (42:28):
I don't know there has been through it significant or
traumatic health event and become quite reluctant to ever have
another blood test or even see their GP. But I
am one of them, and it's become increasingly obviously I'm
probably you know, being a bit of an idiot because.
Speaker 3 (42:45):
I guess what you want to do as you as
you want to be able to make an informed decision, yes,
And you can't make an informed decision by avoiding the topic.
And actually being scared about accessing healthcare is a really
really common and you know sometimes so for some people,
the more health interventions you have, the worse it is.
(43:08):
And maybe that's something to be addressed as well. But
not not avoiding something because it's scary or frightening that's right.
Speaker 1 (43:14):
You wouldn't have avoid the lump in your breast. You
would have to go and get it seen, right, And
if I hadn't, I wouldn't be here. So so just
because you can't feel it will see it, doesn't mean
you shouldn't go get it.
Speaker 3 (43:26):
And I guess many people want to do the best
they can and stuff happens sometimes. But if you if
you've known about something and you haven't addressed it, and
then in two years time you have a heart attack,
you're going to be pretty sad about yourself.
Speaker 1 (43:38):
Yeah, yeah, for sure, just an honest conversation with my GP.
It was pretty be a good start. And remember those
lab tests or the alnu labs. Now, those flabotobus are
usually really good as not the drawing of the blood,
it's the waiting for yeah, results and stuff. But they
are amazing. And also you don't even need a little
piece of paper anymore, just goes straight to here all electronics. Good,
(43:59):
doctor Carr.
Speaker 2 (44:00):
Was We were to thank you so much for your
time this morning.
Speaker 1 (44:02):
We really appreciate it. You're welcome, Louise.
Speaker 2 (44:10):
I feel like you were really hoping that Kara would
change her answer to your cholesterol questions.
Speaker 1 (44:18):
Yeah, I don't know what I was. You're saying to me, Oh, no,
that's that's fine. No, you don't need to do anything.
Just carry on as you ask.
Speaker 2 (44:26):
But it's always as we always know what the answer
is going to be, because it's that little thing that
just sits in the back of your mind, going I
probably should really do something about that. And as Kara
said at the very beginning, you know, women, we're spending
our time looking after other people, putting other people first,
and sometimes it's really hard to get to that list
of things that we go should have, should have, really
could you know.
Speaker 1 (44:46):
It's a pretty big inventory in the back of my
mind for Friendshisca, and but that one has been sitting
there going, oh, just just get to the lab, do
the bloody test, and probably go on the statins because
I think I have been going, oh, but I'll go
back once I've been running more. I'll go back once
really nailed my diet. Just go and do it now.
(45:06):
And that goes for anybody listening who's got a bit
of a news that their blood PreCure is high, or
the cle strolls high, you're worried about family history, It's
not going to make a difference if you lose two
kgs the next few months or something and then go
and do it.
Speaker 2 (45:20):
That's what we're saying. It's not going to make any
difference whatsoever. So that's knowledge is power. I have really
struggled to get my head around my diagnosis and the
calcification in my artery, even though cadiologists keep saying to me,
you're at risk. You don't necessarily have heart disease, you're
at risk of this happening or at risk of that happening.
(45:43):
And I think today Kara finally got that in my head.
Just stop worrying about it, do all the things.
Speaker 1 (45:48):
That I can do, manage the risks that I can exactly,
and get on with life. Yeah, and I can stop
worrying that if you're just being a bit quite on
a run, you're about to just PLoP down behind me
and I'm going to have to do staying alive.
Speaker 2 (46:00):
It's just some a bit tired. Although I think we should.
I think we should go and do a first aid course.
I just don't think it would hurt at this point.
It's been so long since I've done it, and I
would feel a bit better if we were in the
middle of the bush and we didn't have a defibrillator
on hand, noise that in you what you were.
Speaker 1 (46:17):
Doing well, Our dear friend, our dear doctor friends listening
who we do go running with once a year. At
least we've kind of relied on them, haven't we, just
to know what to do in an emergency psyches Just
of course when we're next with them, it does bring
up the little memory about a broken foot, but we
won't go there. They'll be laughing when they hear that. Look,
(46:38):
a heart is a complicated thing, but looking after it
might be simpler than we realize.
Speaker 2 (46:43):
So thanks for joining us on our New Zealand Herald
podcast series, The Little Things. We hope you share this
podcast with the women in your life so we all
know how to look after our hearts, live long and prosper.
Speaker 1 (46:52):
You can follow this podcast on iHeartRadio or wherever you
get your podcasts, and for more on this and other topics,
here to nzed Harold dot co dot m Z and
we'll catch you next time on The Little Things m HM.
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