August 27, 2025 • 25 mins
Host Jenn Seay along with her Valley Girls Jess and Melanie discuss women's cardiovascular health with the self-described Nancy Drew of nurse practicioners, Laura Mayer. Find out what you may not be looking for when it comes to your heart!
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Speaker 1 (00:00):
The content shared on this podcast is for informational and
educational purposes only and should not be gets strewed as
medical advice. While we strive to provide accurate and up
to date information, the host and producers make no representations
or warranties regarding the accuracy, reliability, or completeness of the
information presented. Medical information this constantly evolving, and what is
discussed may not reflect the most current research or guidelines.
This podcast is not a substitute for professional medical advice, diagnosis,
(00:21):
or treatment. Always seek the advice of your physician or
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Speaker 2 (00:40):
This is TMI Talking Medical Information with Value Health. Hello
and welcome back to TMI Talking Medical Information with Value Health.
I am your host, gen C and I am with
my val girls again. Jess Staple, Hey, how are you?
Speaker 1 (00:57):
Hello?
Speaker 3 (00:58):
And Melanie Atkins Hey, everybody gat he good to be
here nice.
Speaker 2 (01:02):
So today we are focusing on cardiology and specifically women's
health in cardiology. And we're actually with nurse practitioner Laura
Mayer today, so she is going to be answering all
of our questions.
Speaker 3 (01:17):
But Laura, tell us a little bit about you.
Speaker 4 (01:19):
So I have been in the Hunton area now, this
is my twenty fifth year. I came from Cincinnati, went
to school at the University of Cincinnati, worked as a
nurse for ten years, and then I wanted to go further.
I was really interested in being more involved in the care.
So I went back, got my nurse practitioner, and actually
(01:40):
I started working at University Hospital in Cincinnati. And at
that time, doctor Snapeley was actually in his fellowship, oh
his last year of his fellowship. He signed on as
an attending So I've been working with him since two thousand.
Speaker 5 (01:54):
So awesome that you guys came together. So great.
Speaker 3 (01:56):
Yes, you all stayed together. I love that.
Speaker 2 (01:59):
And now we have your expertise here at Valley Health,
which is so incredibly important, especially for our community. And
so I say we just kick it off right into
these questions for you.
Speaker 6 (02:09):
We've always heard that heart disease is sort of you know,
for years and years, it was always kind of a
man's thing, you know, it was men died earlier, the
classic clutch your chest heart symptoms. But we now we
know that women are just as susceptible to heart disease.
But it looks different, you know, man to women. So
let's kind of jump into that. What are some of
the things that women should be watching for versus a guy.
Speaker 4 (02:33):
So it is true there are definite differences. There is
a lot of overlap, but there are differences. And pretty
much what we know today comes from the Framingham study,
which is it's ongoing. They're in their third generation of
participants now, so they enrolled, which is unusual sometimes for
medical research. They enrolled equal amounts of men and women.
(02:55):
A lot of times in medical research men are overrepresented
and when women are under presented. That sampling was excellent
to get good data. But apparently from what I read
was they defined symptoms as chest pain. A lot of
times women don't necessarily have chest pain with their heart symptoms.
(03:17):
So it did I think initially maybe skew it a
bit because they left them in the study thinking maybe
those were heart symptoms when it wasn't. But I think
as it went along they started teasing out that, hey,
wait a minute, this isn't making sense. So I think
we have definitely pulled more information from that and continue
(03:40):
to It's an ongoing study to differentiate male female symptoms
for me thinking about this, and maybe to make sense
to people so it doesn't become confusing. I think you
have to think of two different scenarios with heart disease.
In the acute situation, like somebody having a heart attack,
the number one symptom in eighty percent of people presenting
(04:00):
to an emergency room is chest pain. Women will women,
man or woman. Eighty percent of people presenting are going
to have chest discomfort. And I'll say I've learned that
over my years. I try not to say chest pain
to patience because almost every single one of them will say, well,
it wasn't really pain.
Speaker 3 (04:15):
Really pain, maybe, oh sure, no pressure.
Speaker 4 (04:19):
Heaviness, tight and is squeezing, throbbing. I try to give
them some words to describe it themselves. But that is
the number one symptom, and then down from there it
kind of starts varying between men and women. But the
most common symptoms then are shortness of breath, nauseas wedding. Okay,
those symptoms are pretty common with heart attack. It's really
I think where the difference comes in is the day
(04:39):
to day the woman that is fatigued, short of breath
for no good reason. A lot of times women have
more palpitations with their heart disease, more subtle symptoms that
it's a little harder to pick up in women than
it is in men, because men will typically have more
traditional Yeah, when I walk up the stairs, I'm getting
heavy in the chest, whereas a woman might say, man,
(04:59):
just short of breath, or my heart's really pounding or
things like that. But I will say I always use
this example. Any person, anytime can have an atypical presentation.
And this is my favorite story to tell.
Speaker 3 (05:12):
And I can.
Speaker 4 (05:12):
Remember the exact exam room I was in with this
patient seeing him. It was a man for the first time.
He was probably in his forties at the time, and
he said, yeah, every time I do whatever it was,
I can't remember if it was walking upstairs whatever. He said,
my watch feels too tight. I think my watch band
is too tight. And the more I kind of talked
to him, I said, I think this is your heart.
And we did a Hartcat and yes, he had disease.
(05:34):
And we did a stint and miraculously his watch band
was no longer too tight. Now he had a very
atypical presentation.
Speaker 2 (05:43):
And it was just that little something that was off
to him like, oh, yes, watch just gets too tight.
Speaker 6 (05:49):
Ass.
Speaker 4 (05:49):
No, And that's what I tell people. If you see
a change in your symptoms or a new symptom that
isn't fitting with your life in general, that should raise
a flag to you. Those are the things I've tried
to I think of myself like Nancy Drew, I'm trying
to search for the clues. Yeah, And I think that's
the thing nurse practitioners do. Well, we talk, we sit,
(06:10):
we listen to me. Taking history is them telling me
their story. Yeah, and that's how I want to hear it. Well,
what'd you do next? What happened? Did that help it
make it worse? You know? I try to get it
as a story because I want them to see it
and I want to see it.
Speaker 2 (06:25):
Yes, And I think to a lot of patients when
they do come in, they might have certain issues or whatever,
you know, maybe last week they had them or whatever,
and they don't remember everything. That kind of brush it
off in the moment they don't remember to tell you.
Speaker 3 (06:39):
Then you don't have the full picture.
Speaker 5 (06:41):
So we all work in somewhat stressful environments. Have kids,
have families, have life, The dog's running around, the laundry
is not done, and that creates some stress both emotionally
and physically. How does that kind of stress affect the
women's heart?
Speaker 4 (06:56):
So it's true that women are physiologically different on many
levels than men. Our vessels are smaller, our hearts are smaller,
chest cavity smaller, our body fat is higher, just based
on our body makeup versus a man. So there are
differences which then translates to how our bodies respond differently
(07:17):
to external and internal factors. Stress tends to cause adrenaline release,
which then causes sugar release to cause that flight or
fight response, and those things contribute to a environment of inflammation,
which has been determined to be a large factor in
heart disease, vascular disease, and then stress. Typically a lot
(07:41):
of people will have high blood pressure, raises your heart rate.
All of those things kind of contribute to that whole picture.
Speaker 2 (07:48):
Oh man, So the inflammation is really what's going to kill.
Speaker 3 (07:51):
You, right, So that's what we need. Now.
Speaker 6 (07:52):
Everybody says reduce stress, but that is really it's just
really hard because life doesn't stop. It just keeps coming
at you. So besides stress, what do you think some
of the other risk factors are specifically for women?
Speaker 4 (08:07):
Well, number one, smoking, Smoking affects women far more than
non smokers, and it affects women more so than a
smoking male.
Speaker 3 (08:17):
Oh wow, says the vessels.
Speaker 4 (08:18):
Well, it's partly because of the smaller vessels that smoking
causes that inflammatory process. It makes your blood more likely
to clump things like that. And I read something last
night that I did not know that nicotine is an
anti estrogen. It is true that estrogen does give us
some protective effect while we still have it. Once it's gone,
(08:39):
that's when we start catching up to the men with
our heart disease. That's why we lag. Typically our symptoms
are disease comes on later in life versus it being
earlier for men. This is a crazy statistic. A smoking
woman versus a non smoking woman is six to nine
times higher risk for heart disease, but after stopping in
(09:00):
a year, your risk goes down to half that and
over time you get back to normal.
Speaker 2 (09:05):
Oh wow.
Speaker 4 (09:06):
So to me, I tell people, I don't care if
you eat a steak every night. Put the cigarettes down.
That's the biggest thing, and it is better. You know,
smoking rates are much better than they used to be,
but smoking is huge.
Speaker 2 (09:18):
So along those same lines, what about alcohol and your heart?
Is there a correlation there that could cause issues?
Speaker 4 (09:26):
You don't have to stop alcohol, it's not bann I
don't tell my patients to stop alcohol. Certainly, overindulging in alcohol,
like anything in life, is not good. Alcohol translates into
sugar in the body, it breaks down into sugar. Higher
sugar levels drive up the inflammation, and it's all kind
(09:47):
of goes back to that moderation.
Speaker 3 (09:49):
Is key to race.
Speaker 2 (09:49):
Yes, exercise and diet. We keep hearing that, and I
think it's true.
Speaker 4 (09:54):
If only there was a special button, we.
Speaker 6 (09:57):
Would be hitting that button all those long. You'd mentioned
that estrogen is a protective factor. But there may be
some people who are on the perimenopause or possibly menopausal side.
Speaker 3 (10:09):
I don't know who that would be, but I'm not
pointing any fingers. Okay, right, it's me. Whatever, I don't care.
Speaker 6 (10:15):
What can you do if you're in that zone to
be more protective of your heart.
Speaker 4 (10:20):
Well, initially in the studies they thought hormone replacement was
going to be beneficial from the heart, and that has
not borne out. It is beneficial for bone help obviously.
If you see older women still on estrogen, they have
the most beautiful skin and hair, but it is not
beneficial for the heart. So that's you really just need
to look at your risk I mean, I would say
(10:41):
to it before perimenopause and menopause, look at what your
risk factors are and be addressing those.
Speaker 6 (10:47):
If you're in menopause and you're not on estrogen and
hormone therapy, I mean, are your two tools diet and
exercise and continue to get your heart check because all
of a sudden that protective factor is gone.
Speaker 4 (10:59):
So the next factors after smoking, our blood pressure and
cholesterol levels. Those are the next two big risk factors
that raise your risk for heart disease. So those are
the things to be looking at. Is you know regular checkups,
and there's there's a frame what's called a Framingham Score,
and that you plug in your information, your gender, age,
(11:21):
your cholesterol, your total and your good cholesterol level, and
it will give you a ten year risk factor and
that helps us determine depending on that risk, are we
going to say, yeah, start this drug because you have
high cholesterol, or let's just work with your diet and
try to get this better aligned because I don't want
to put a twenty year old on drugs sure for
(11:43):
the rest of their life if we don't have to sure.
Speaker 5 (11:46):
The lifestyle changes for stess.
Speaker 6 (11:47):
Okay, let's talk about We've talked about diet, exercise. What
about sleep. That's something that's hard to come by. Does
that affect your heart health?
Speaker 3 (11:55):
Well?
Speaker 4 (11:55):
Yes, and you you know you hear a lot about
shift workers have a lot of issues and can tend
to have a lot of heart disease. Yes, definitely, because
you tend to you interrupt the body's natural circadian rhythms,
and that's never good. You are more prone to health
issues when you're not getting enough sleep. You're not resting,
(12:18):
your body's not resting. Sleep apnea. We see a lot
of sleep apnea with heart disease. It's very closely tied.
So when people say, well I sleep, fine, You're asleep,
but your body's not sleeping, you have to get down
into that rim sleep. Your body is restoring itself. Basically,
if you have sleep apnea, you're on this constant roller
(12:40):
coaster through the night. You stop breathing, your heart rate
and blood pressure shoot up again, the epinephyrins things like
that are released, which is the inflammation and just vascular stress.
So those effects. Definitely, sleep has an effect on.
Speaker 6 (12:54):
Goodn So get your eight people, well, see and I
don't even seven or six, but try to get something.
Speaker 4 (13:00):
Quality sleep because some people say they sleep four hours
and they feel great, so they probably hit that rim fast.
Speaker 2 (13:07):
And quality is really what matters when it comes to sleep.
Maybe not as long, but obviously five is probably not.
Speaker 4 (13:13):
Yeah, I think it's probably different for each person.
Speaker 5 (13:16):
Okay, okay, I had a couple questions about pregnancy and
how your heart. Does your heart change during pregnancy.
Speaker 4 (13:24):
Well, your blood volume significantly increases, which probably I do
not know o B I take care of obie patients,
But definitely your blood volume goes up, which probably creates
a bit of a more high output what's called a
high output state with the heart. Women who do suffer
(13:45):
pre aclampsia, clampsia diabetes during their pregnancies, unfortunately, are likely
going to have it down the road. So just because
it goes away after they've had their baby doesn't mean
it's never going to happen again. They likely will have
it down on the road.
Speaker 6 (14:00):
Oh, let's talk about screenings like what should be on
your to do list as a woman, like.
Speaker 4 (14:06):
I say, blood pressure, cholesterol, or the two big ones.
Speaker 3 (14:09):
Weight.
Speaker 4 (14:10):
You know, I'm not my.
Speaker 3 (14:11):
Perfect weight, but who is.
Speaker 4 (14:14):
It's being aware and doing the things that you feel
like you can work into your life to take care
of that. And again the smoking is the big thing.
Those are really the top factors. Diabetes, which if you're
getting just kind of routine yearly labs, you'll start to
(14:34):
pick up if the sugar's trending a little high, and
then maybe looking at that a little more.
Speaker 6 (14:39):
So, you should be pretty aggressive if your blood pressure's
riding high, like don't drag your feet and weight.
Speaker 2 (14:44):
Yes, yes, it's usually about timing, it seems with symptoms.
When you're starting to see some symptoms, don't just brush
them off.
Speaker 4 (14:51):
You really shouldn't.
Speaker 2 (14:52):
At least bring it, at least get checked out to
your family doc, you know, and then they can refer you.
Speaker 4 (14:57):
Depression is actually another factor that has been tied to
heart disease. You have a fifty percent higher risk of
heart disease if you have depression in women, and depression
is more common in women, Oh so it really has
another huge impact. And I think some of that I
believe is chemically in the body, the effects, but also
(15:19):
just if you're depressed, you're not taking care of yourself.
Speaker 3 (15:21):
Sure, sure, something else to watch for it. That's interesting.
Speaker 6 (15:24):
I've never heard that about depression of stress I get,
but depression, I would feel like your body might actually
slow down, which is kind of a misnomer, you know
there that you would that you wouldn't be up and
moving around, you would kind of be at rest and
not really into anything.
Speaker 3 (15:39):
But maybe that could.
Speaker 4 (15:40):
Be right heart right, that's yeah, exactly, you're typically not exercising,
taking care of yourself. But depression was a long misunderstood thing,
and they are finding there are chemical imbalances, and those
imbalances you have cardiovascular effects.
Speaker 6 (15:57):
It's interesting. That's very interesting. What do you find encouraging
for the future of women's heart health.
Speaker 4 (16:03):
Well, I think this we talk about it more. I
see that more as a topic in other podcasts, you know,
just conferences presenting things about things specific to women, and
just that ongoing Framingham study continuing on and you're right.
Coming out of that, they are pulling out blood work factors,
(16:25):
enzymes that we can check that are more targeted toward
showing risk in women versus men. And if that study
weren't still ongoing, and you know, I don't think we
would have found those things. And it's just amazing. And
I went to a talk recently a specialist in Cincinnati.
Women are more likely. So if they're having classic heart symptoms,
(16:50):
we say, okay, let's do a hartcat. Thirty percent of
the time, they're going to not have anything in there.
It's going to look normal. And what we're seeing now
is they likely have microvascular disease, which is disease you
can't see with the human eye when you do a
heart cap. But the symptoms are pretty much the same
as if you had had one large vessel block. And
(17:12):
this specialist is coming up with ways of measuring flow
in those microvascular vessels and how to target treatment, and
he's hit the majority of his patients are female. Got
to be.
Speaker 5 (17:25):
Extra all the time, don't We always always but that
we need more.
Speaker 2 (17:29):
You're right, though, just I think more information to everybody.
You know, you can sit and doom scroll on TikTok
all day long, learn about stuff you don't even need
to know about, but you need to know about your
heart health and you need to know that. It's very
important to start looking at these risk factors early so
that you can just manage them the rest of your life.
You don't have to worry about, hopefully that you don't
(17:51):
have a big cardiac activity or an event.
Speaker 4 (17:54):
I should say, you know, we said at the beginning
that heart disease has always been thought of as a
man disease, and typically it was you know, women worry
more about breast cancer, and you know, I've kind of
been in that mindset myself. This is the statistic women
one and thirty one will dive from breast cancer. One
in three will die of heart disease. That's a ten
(18:15):
times wow factor. Yeah, it's out there. Unfortunately, a lot
of people don't want to know. They're afraid. Medicine now
is so phenomenal in the imagings we can do and
pick things up and just you know, I just would say,
don't be afraid to say something.
Speaker 5 (18:33):
Well, let's talk about it.
Speaker 2 (18:35):
Yeah, And I will say that everybody that I've talked
to a valley providers or nurses or even just the
staff here. Everybody's been very very welcoming and open and sweet,
and it doesn't feel like you can't open up about things.
I mean, everybody that we've interviewed on the podcast too,
we've just opened up and told every little thing about us,
you know.
Speaker 3 (18:53):
So I feel like that's that's wonderful.
Speaker 2 (18:55):
That's great to know that you have providers here at
Valley that you don't have to be worried about your
sin or maybe oh gosh, are they going to judge
me if I say yes I do smoke or yes
I drink every night.
Speaker 3 (19:05):
No, it doesn't matter.
Speaker 2 (19:06):
They're just trying to give you that information to help
you help yourself.
Speaker 3 (19:10):
Yeah.
Speaker 4 (19:11):
I think our team is very just. They're approachable. Yes,
we have our bad days like anybody else, and we
may seem in a hurry, but we will stop and
slow down and say okay, tell me nice.
Speaker 3 (19:24):
Wonderful.
Speaker 6 (19:25):
There are a lot of different tests that you can
run now that people may not be familiar with, Laura,
So can you walk us through some of the different
imaging things that they can do right here at Valley Health.
Speaker 4 (19:34):
So what we will be able to do here is
screen for disease in the neck arteries, disease in the
leg arteries. We will be able to do various types
of stress tests, whether you can walk on the treadmill
to do it, or if we need to do a
medication style stress test. We'll do ultrasounds. For heart, We're
(19:55):
going to do X rays of various types. We will
also be doing heart monitors people that have palpitations, passing out, dizzy,
things like that. As far as testing available in the community,
so a lot of people hear about the calcium heart scans.
Those are very popular now. That is a good screening
test for younger people who have a strong family history
(20:18):
or maybe even themselves have some of the risk factors
already of heart disease. That is a good use for
younger people.
Speaker 5 (20:26):
Like how old, what's your age range? There?
Speaker 4 (20:28):
Typically we would recommend those forty and younger got it
forty and after. We want to be a little more targeted.
I don't that's maybe not the best word, but we
would probably be you would be someone we would do
more profusion imaging with the stress test. Maybe even there
are specialized cat scans of the heart that give us
(20:48):
images as if you had just had a heart cat
without having a heart cat, So based on potential symptoms
things like that, that might be an option also, but
the calcium scans are better used for a younger population
to screen risks, stratify.
Speaker 5 (21:06):
It was a really cool nuclear something back there. It's awesome,
like lights up purple and blue and what neat?
Speaker 3 (21:13):
What is it? Now? What does that test show you?
And what what? What would that test be called?
Speaker 4 (21:17):
These are smaller cameras, so you're not under a camera.
You're basically almost hugging it like a pillow to your
chest to get the pictures. And I had a man
who would not do a stress test because he's terribly claustrophobic.
I said, you can do this because the camera is smaller.
You can. It's not over your face, it's not you're
not going to feel enclosed. It will just be around
(21:39):
the chest. So that takes the images for a stress test.
Speaker 3 (21:42):
Oh that's better.
Speaker 5 (21:44):
Literally, like he was just hugging it when he was
over there demonstrating in a.
Speaker 6 (21:47):
Chair like a lounger. Almost a relief for a lot
of people. Yes, a lot of people do not like
that tube No, right, aery right, well, kind of the
cool stuff over there. You'll have to come check it out.
Speaker 3 (21:56):
I'm excited. I want to check it out now. Want
to get my heart scanned, just to just to be sure.
Speaker 2 (22:00):
I feel like I want to make sure that everything's okay.
Speaker 3 (22:03):
I know.
Speaker 6 (22:04):
I do think it's interesting though, because we all talk
ourselves into I mean, maybe we don't feel good and
my blood pressure has not been the best at times,
and I've kind of brushed it off and it's not
that bad. But I think the message I get today
is that we just all need to be much more
in tune and maybe even a little bit more aggressive
to ask the right questions and not blow it off
as just I'm tired again, it could be something more so,
(22:28):
and with yourself, talk with your provider and see if
you need to take it to the next step.
Speaker 2 (22:32):
And I think it's a lot about just you know,
especially as women, we tend to help others beforehand, like
kind of like on the airplane, they say, put your
oxygen mask on first, and then you can help whoever's
around you. It's because you have to take care of
yourself first, because you take care of so many other people,
so you really need to focus on your own health
and get the testing and the screenings done and just
(22:53):
a yearly check up too.
Speaker 3 (22:55):
Is I know so.
Speaker 2 (22:57):
Many girls that just say, well I don't have time,
or the insurance isn't the greatest, so I'm not gonna
deal with it or something.
Speaker 3 (23:03):
I'm like, no, you need to take care of yourself.
Speaker 4 (23:06):
Women are good about typically getting their mammograms and pap
smears every year, but not having their blood pressure or
labs checked. You know, the hospitals both do those screening
panels once a year for like twenty five dollars. You
get your blood count, kidney, liver, and a cholesterol panel
for I think twenty five dollars.
Speaker 3 (23:25):
Yeah.
Speaker 6 (23:26):
Well, it's been very enlightening. I'm more encouraged to get
up and take care of myself.
Speaker 3 (23:31):
Yeah, because I better.
Speaker 4 (23:32):
Right.
Speaker 6 (23:33):
Yeah, one in three go for it. One in three.
That's the number that's gonna haunt me. One in three
is gonna have a hard issue of women. So heads up, everybody, Yeah,
that is one of us.
Speaker 3 (23:44):
Oh my gosh, there's four of us here.
Speaker 2 (23:46):
Oh no, oh, no, oh no, but no, you have
given us some great information today, Laura, and we appreciate
you sitting down to talk with us, and we are
so excited for everything happening at Valley right now, and
listen if you are looking for a provider, and if
you have any questions that you might want to ask
as well. We are taking questions for later podcasts and
(24:08):
anything you want to know that maybe you're a little.
Speaker 6 (24:10):
Afraid to ask your doctor about. Yeah, and don't forget.
The Valley Health Heart and Vascular Center opens up September
the second. It's open to Valley Health patients and to
people in the community. We have three cardiologists and three
nurse practitioners coming to take care of you, So we
can't wait to see you and help provide everything you need.
They know it all one hundred and sixty eight years
(24:30):
of experience that we're packing into the Heart and Vascular Center.
So we're here to help and we can't wait to
see you.
Speaker 3 (24:37):
Yeah, I can't wait. Incredible.
Speaker 2 (24:39):
Well, thank you so much again, Laura Mayor for answering
all of our TMI questions, and Jess, Melanie and I
will be back next month with another round of TMI,
so submit those questions too.
Speaker 5 (24:50):
You can go to Valleyhealth dot org. We actually have
a new submission form. There is a link underneath the
top banner that talks about TMI, and in that you
can find the podcast, all of our previous episodes, and
then afford to submit new questions.
Speaker 2 (25:05):
Perfect, all right, that's vallelyhealth dot org and we will
see you next time on tm I
The content shared on this podcast is for informational and
educational purposes only and should not be gets strewed as
medical advice. While we strive to provide accurate and up
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(00:21):
or treatment. Always seek the advice of your physician or
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Speaker 2 (00:40):
This is TMI Talking Medical Information with Value Health. Hello
and welcome back to TMI Talking Medical Information with Value Health.
I am your host, gen C and I am with
my val girls again. Jess Staple, Hey, how are you?
Speaker 1 (00:57):
Hello?
Speaker 3 (00:58):
And Melanie Atkins Hey, everybody gat he good to be
here nice.
Speaker 2 (01:02):
So today we are focusing on cardiology and specifically women's
health in cardiology. And we're actually with nurse practitioner Laura
Mayer today, so she is going to be answering all
of our questions.
Speaker 3 (01:17):
But Laura, tell us a little bit about you.
Speaker 4 (01:19):
So I have been in the Hunton area now, this
is my twenty fifth year. I came from Cincinnati, went
to school at the University of Cincinnati, worked as a
nurse for ten years, and then I wanted to go further.
I was really interested in being more involved in the care.
So I went back, got my nurse practitioner, and actually
(01:40):
I started working at University Hospital in Cincinnati. And at
that time, doctor Snapeley was actually in his fellowship, oh
his last year of his fellowship. He signed on as
an attending So I've been working with him since two thousand.
Speaker 5 (01:54):
So awesome that you guys came together. So great.
Speaker 3 (01:56):
Yes, you all stayed together. I love that.
Speaker 2 (01:59):
And now we have your expertise here at Valley Health,
which is so incredibly important, especially for our community. And
so I say we just kick it off right into
these questions for you.
Speaker 6 (02:09):
We've always heard that heart disease is sort of you know,
for years and years, it was always kind of a
man's thing, you know, it was men died earlier, the
classic clutch your chest heart symptoms. But we now we
know that women are just as susceptible to heart disease.
But it looks different, you know, man to women. So
let's kind of jump into that. What are some of
the things that women should be watching for versus a guy.
Speaker 4 (02:33):
So it is true there are definite differences. There is
a lot of overlap, but there are differences. And pretty
much what we know today comes from the Framingham study,
which is it's ongoing. They're in their third generation of
participants now, so they enrolled, which is unusual sometimes for
medical research. They enrolled equal amounts of men and women.
(02:55):
A lot of times in medical research men are overrepresented
and when women are under presented. That sampling was excellent
to get good data. But apparently from what I read
was they defined symptoms as chest pain. A lot of
times women don't necessarily have chest pain with their heart symptoms.
(03:17):
So it did I think initially maybe skew it a
bit because they left them in the study thinking maybe
those were heart symptoms when it wasn't. But I think
as it went along they started teasing out that, hey,
wait a minute, this isn't making sense. So I think
we have definitely pulled more information from that and continue
(03:40):
to It's an ongoing study to differentiate male female symptoms
for me thinking about this, and maybe to make sense
to people so it doesn't become confusing. I think you
have to think of two different scenarios with heart disease.
In the acute situation, like somebody having a heart attack,
the number one symptom in eighty percent of people presenting
(04:00):
to an emergency room is chest pain. Women will women,
man or woman. Eighty percent of people presenting are going
to have chest discomfort. And I'll say I've learned that
over my years. I try not to say chest pain
to patience because almost every single one of them will say, well,
it wasn't really pain.
Speaker 3 (04:15):
Really pain, maybe, oh sure, no pressure.
Speaker 4 (04:19):
Heaviness, tight and is squeezing, throbbing. I try to give
them some words to describe it themselves. But that is
the number one symptom, and then down from there it
kind of starts varying between men and women. But the
most common symptoms then are shortness of breath, nauseas wedding. Okay,
those symptoms are pretty common with heart attack. It's really
I think where the difference comes in is the day
(04:39):
to day the woman that is fatigued, short of breath
for no good reason. A lot of times women have
more palpitations with their heart disease, more subtle symptoms that
it's a little harder to pick up in women than
it is in men, because men will typically have more
traditional Yeah, when I walk up the stairs, I'm getting
heavy in the chest, whereas a woman might say, man,
(04:59):
just short of breath, or my heart's really pounding or
things like that. But I will say I always use
this example. Any person, anytime can have an atypical presentation.
And this is my favorite story to tell.
Speaker 3 (05:12):
And I can.
Speaker 4 (05:12):
Remember the exact exam room I was in with this
patient seeing him. It was a man for the first time.
He was probably in his forties at the time, and
he said, yeah, every time I do whatever it was,
I can't remember if it was walking upstairs whatever. He said,
my watch feels too tight. I think my watch band
is too tight. And the more I kind of talked
to him, I said, I think this is your heart.
And we did a Hartcat and yes, he had disease.
(05:34):
And we did a stint and miraculously his watch band
was no longer too tight. Now he had a very
atypical presentation.
Speaker 2 (05:43):
And it was just that little something that was off
to him like, oh, yes, watch just gets too tight.
Speaker 6 (05:49):
Ass.
Speaker 4 (05:49):
No, And that's what I tell people. If you see
a change in your symptoms or a new symptom that
isn't fitting with your life in general, that should raise
a flag to you. Those are the things I've tried
to I think of myself like Nancy Drew, I'm trying
to search for the clues. Yeah, And I think that's
the thing nurse practitioners do. Well, we talk, we sit,
(06:10):
we listen to me. Taking history is them telling me
their story. Yeah, and that's how I want to hear it. Well,
what'd you do next? What happened? Did that help it
make it worse? You know? I try to get it
as a story because I want them to see it
and I want to see it.
Speaker 2 (06:25):
Yes, And I think to a lot of patients when
they do come in, they might have certain issues or whatever,
you know, maybe last week they had them or whatever,
and they don't remember everything. That kind of brush it
off in the moment they don't remember to tell you.
Speaker 3 (06:39):
Then you don't have the full picture.
Speaker 5 (06:41):
So we all work in somewhat stressful environments. Have kids,
have families, have life, The dog's running around, the laundry
is not done, and that creates some stress both emotionally
and physically. How does that kind of stress affect the
women's heart?
Speaker 4 (06:56):
So it's true that women are physiologically different on many
levels than men. Our vessels are smaller, our hearts are smaller,
chest cavity smaller, our body fat is higher, just based
on our body makeup versus a man. So there are
differences which then translates to how our bodies respond differently
(07:17):
to external and internal factors. Stress tends to cause adrenaline release,
which then causes sugar release to cause that flight or
fight response, and those things contribute to a environment of inflammation,
which has been determined to be a large factor in
heart disease, vascular disease, and then stress. Typically a lot
(07:41):
of people will have high blood pressure, raises your heart rate.
All of those things kind of contribute to that whole picture.
Speaker 2 (07:48):
Oh man, So the inflammation is really what's going to kill.
Speaker 3 (07:51):
You, right, So that's what we need. Now.
Speaker 6 (07:52):
Everybody says reduce stress, but that is really it's just
really hard because life doesn't stop. It just keeps coming
at you. So besides stress, what do you think some
of the other risk factors are specifically for women?
Speaker 4 (08:07):
Well, number one, smoking, Smoking affects women far more than
non smokers, and it affects women more so than a
smoking male.
Speaker 3 (08:17):
Oh wow, says the vessels.
Speaker 4 (08:18):
Well, it's partly because of the smaller vessels that smoking
causes that inflammatory process. It makes your blood more likely
to clump things like that. And I read something last
night that I did not know that nicotine is an
anti estrogen. It is true that estrogen does give us
some protective effect while we still have it. Once it's gone,
(08:39):
that's when we start catching up to the men with
our heart disease. That's why we lag. Typically our symptoms
are disease comes on later in life versus it being
earlier for men. This is a crazy statistic. A smoking
woman versus a non smoking woman is six to nine
times higher risk for heart disease, but after stopping in
(09:00):
a year, your risk goes down to half that and
over time you get back to normal.
Speaker 2 (09:05):
Oh wow.
Speaker 4 (09:06):
So to me, I tell people, I don't care if
you eat a steak every night. Put the cigarettes down.
That's the biggest thing, and it is better. You know,
smoking rates are much better than they used to be,
but smoking is huge.
Speaker 2 (09:18):
So along those same lines, what about alcohol and your heart?
Is there a correlation there that could cause issues?
Speaker 4 (09:26):
You don't have to stop alcohol, it's not bann I
don't tell my patients to stop alcohol. Certainly, overindulging in alcohol,
like anything in life, is not good. Alcohol translates into
sugar in the body, it breaks down into sugar. Higher
sugar levels drive up the inflammation, and it's all kind
(09:47):
of goes back to that moderation.
Speaker 3 (09:49):
Is key to race.
Speaker 2 (09:49):
Yes, exercise and diet. We keep hearing that, and I
think it's true.
Speaker 4 (09:54):
If only there was a special button, we.
Speaker 6 (09:57):
Would be hitting that button all those long. You'd mentioned
that estrogen is a protective factor. But there may be
some people who are on the perimenopause or possibly menopausal side.
Speaker 3 (10:09):
I don't know who that would be, but I'm not
pointing any fingers. Okay, right, it's me. Whatever, I don't care.
Speaker 6 (10:15):
What can you do if you're in that zone to
be more protective of your heart.
Speaker 4 (10:20):
Well, initially in the studies they thought hormone replacement was
going to be beneficial from the heart, and that has
not borne out. It is beneficial for bone help obviously.
If you see older women still on estrogen, they have
the most beautiful skin and hair, but it is not
beneficial for the heart. So that's you really just need
to look at your risk I mean, I would say
(10:41):
to it before perimenopause and menopause, look at what your
risk factors are and be addressing those.
Speaker 6 (10:47):
If you're in menopause and you're not on estrogen and
hormone therapy, I mean, are your two tools diet and
exercise and continue to get your heart check because all
of a sudden that protective factor is gone.
Speaker 4 (10:59):
So the next factors after smoking, our blood pressure and
cholesterol levels. Those are the next two big risk factors
that raise your risk for heart disease. So those are
the things to be looking at. Is you know regular checkups,
and there's there's a frame what's called a Framingham Score,
and that you plug in your information, your gender, age,
(11:21):
your cholesterol, your total and your good cholesterol level, and
it will give you a ten year risk factor and
that helps us determine depending on that risk, are we
going to say, yeah, start this drug because you have
high cholesterol, or let's just work with your diet and
try to get this better aligned because I don't want
to put a twenty year old on drugs sure for
(11:43):
the rest of their life if we don't have to sure.
Speaker 5 (11:46):
The lifestyle changes for stess.
Speaker 6 (11:47):
Okay, let's talk about We've talked about diet, exercise. What
about sleep. That's something that's hard to come by. Does
that affect your heart health?
Speaker 3 (11:55):
Well?
Speaker 4 (11:55):
Yes, and you you know you hear a lot about
shift workers have a lot of issues and can tend
to have a lot of heart disease. Yes, definitely, because
you tend to you interrupt the body's natural circadian rhythms,
and that's never good. You are more prone to health
issues when you're not getting enough sleep. You're not resting,
(12:18):
your body's not resting. Sleep apnea. We see a lot
of sleep apnea with heart disease. It's very closely tied.
So when people say, well I sleep, fine, You're asleep,
but your body's not sleeping, you have to get down
into that rim sleep. Your body is restoring itself. Basically,
if you have sleep apnea, you're on this constant roller
(12:40):
coaster through the night. You stop breathing, your heart rate
and blood pressure shoot up again, the epinephyrins things like
that are released, which is the inflammation and just vascular stress.
So those effects. Definitely, sleep has an effect on.
Speaker 6 (12:54):
Goodn So get your eight people, well, see and I
don't even seven or six, but try to get something.
Speaker 4 (13:00):
Quality sleep because some people say they sleep four hours
and they feel great, so they probably hit that rim fast.
Speaker 2 (13:07):
And quality is really what matters when it comes to sleep.
Maybe not as long, but obviously five is probably not.
Speaker 4 (13:13):
Yeah, I think it's probably different for each person.
Speaker 5 (13:16):
Okay, okay, I had a couple questions about pregnancy and
how your heart. Does your heart change during pregnancy.
Speaker 4 (13:24):
Well, your blood volume significantly increases, which probably I do
not know o B I take care of obie patients,
But definitely your blood volume goes up, which probably creates
a bit of a more high output what's called a
high output state with the heart. Women who do suffer
(13:45):
pre aclampsia, clampsia diabetes during their pregnancies, unfortunately, are likely
going to have it down the road. So just because
it goes away after they've had their baby doesn't mean
it's never going to happen again. They likely will have
it down on the road.
Speaker 6 (14:00):
Oh, let's talk about screenings like what should be on
your to do list as a woman, like.
Speaker 4 (14:06):
I say, blood pressure, cholesterol, or the two big ones.
Speaker 3 (14:09):
Weight.
Speaker 4 (14:10):
You know, I'm not my.
Speaker 3 (14:11):
Perfect weight, but who is.
Speaker 4 (14:14):
It's being aware and doing the things that you feel
like you can work into your life to take care
of that. And again the smoking is the big thing.
Those are really the top factors. Diabetes, which if you're
getting just kind of routine yearly labs, you'll start to
(14:34):
pick up if the sugar's trending a little high, and
then maybe looking at that a little more.
Speaker 6 (14:39):
So, you should be pretty aggressive if your blood pressure's
riding high, like don't drag your feet and weight.
Speaker 2 (14:44):
Yes, yes, it's usually about timing, it seems with symptoms.
When you're starting to see some symptoms, don't just brush
them off.
Speaker 4 (14:51):
You really shouldn't.
Speaker 2 (14:52):
At least bring it, at least get checked out to
your family doc, you know, and then they can refer you.
Speaker 4 (14:57):
Depression is actually another factor that has been tied to
heart disease. You have a fifty percent higher risk of
heart disease if you have depression in women, and depression
is more common in women, Oh so it really has
another huge impact. And I think some of that I
believe is chemically in the body, the effects, but also
(15:19):
just if you're depressed, you're not taking care of yourself.
Speaker 3 (15:21):
Sure, sure, something else to watch for it. That's interesting.
Speaker 6 (15:24):
I've never heard that about depression of stress I get,
but depression, I would feel like your body might actually
slow down, which is kind of a misnomer, you know
there that you would that you wouldn't be up and
moving around, you would kind of be at rest and
not really into anything.
Speaker 3 (15:39):
But maybe that could.
Speaker 4 (15:40):
Be right heart right, that's yeah, exactly, you're typically not exercising,
taking care of yourself. But depression was a long misunderstood thing,
and they are finding there are chemical imbalances, and those
imbalances you have cardiovascular effects.
Speaker 6 (15:57):
It's interesting. That's very interesting. What do you find encouraging
for the future of women's heart health.
Speaker 4 (16:03):
Well, I think this we talk about it more. I
see that more as a topic in other podcasts, you know,
just conferences presenting things about things specific to women, and
just that ongoing Framingham study continuing on and you're right.
Coming out of that, they are pulling out blood work factors,
(16:25):
enzymes that we can check that are more targeted toward
showing risk in women versus men. And if that study
weren't still ongoing, and you know, I don't think we
would have found those things. And it's just amazing. And
I went to a talk recently a specialist in Cincinnati.
Women are more likely. So if they're having classic heart symptoms,
(16:50):
we say, okay, let's do a hartcat. Thirty percent of
the time, they're going to not have anything in there.
It's going to look normal. And what we're seeing now
is they likely have microvascular disease, which is disease you
can't see with the human eye when you do a
heart cap. But the symptoms are pretty much the same
as if you had had one large vessel block. And
(17:12):
this specialist is coming up with ways of measuring flow
in those microvascular vessels and how to target treatment, and
he's hit the majority of his patients are female. Got
to be.
Speaker 5 (17:25):
Extra all the time, don't We always always but that
we need more.
Speaker 2 (17:29):
You're right, though, just I think more information to everybody.
You know, you can sit and doom scroll on TikTok
all day long, learn about stuff you don't even need
to know about, but you need to know about your
heart health and you need to know that. It's very
important to start looking at these risk factors early so
that you can just manage them the rest of your life.
You don't have to worry about, hopefully that you don't
(17:51):
have a big cardiac activity or an event.
Speaker 4 (17:54):
I should say, you know, we said at the beginning
that heart disease has always been thought of as a
man disease, and typically it was you know, women worry
more about breast cancer, and you know, I've kind of
been in that mindset myself. This is the statistic women
one and thirty one will dive from breast cancer. One
in three will die of heart disease. That's a ten
(18:15):
times wow factor. Yeah, it's out there. Unfortunately, a lot
of people don't want to know. They're afraid. Medicine now
is so phenomenal in the imagings we can do and
pick things up and just you know, I just would say,
don't be afraid to say something.
Speaker 5 (18:33):
Well, let's talk about it.
Speaker 2 (18:35):
Yeah, And I will say that everybody that I've talked
to a valley providers or nurses or even just the
staff here. Everybody's been very very welcoming and open and sweet,
and it doesn't feel like you can't open up about things.
I mean, everybody that we've interviewed on the podcast too,
we've just opened up and told every little thing about us,
you know.
Speaker 3 (18:53):
So I feel like that's that's wonderful.
Speaker 2 (18:55):
That's great to know that you have providers here at
Valley that you don't have to be worried about your
sin or maybe oh gosh, are they going to judge
me if I say yes I do smoke or yes
I drink every night.
Speaker 3 (19:05):
No, it doesn't matter.
Speaker 2 (19:06):
They're just trying to give you that information to help
you help yourself.
Speaker 3 (19:10):
Yeah.
Speaker 4 (19:11):
I think our team is very just. They're approachable. Yes,
we have our bad days like anybody else, and we
may seem in a hurry, but we will stop and
slow down and say okay, tell me nice.
Speaker 3 (19:24):
Wonderful.
Speaker 6 (19:25):
There are a lot of different tests that you can
run now that people may not be familiar with, Laura,
So can you walk us through some of the different
imaging things that they can do right here at Valley Health.
Speaker 4 (19:34):
So what we will be able to do here is
screen for disease in the neck arteries, disease in the
leg arteries. We will be able to do various types
of stress tests, whether you can walk on the treadmill
to do it, or if we need to do a
medication style stress test. We'll do ultrasounds. For heart, We're
(19:55):
going to do X rays of various types. We will
also be doing heart monitors people that have palpitations, passing out, dizzy,
things like that. As far as testing available in the community,
so a lot of people hear about the calcium heart scans.
Those are very popular now. That is a good screening
test for younger people who have a strong family history
(20:18):
or maybe even themselves have some of the risk factors
already of heart disease. That is a good use for
younger people.
Speaker 5 (20:26):
Like how old, what's your age range? There?
Speaker 4 (20:28):
Typically we would recommend those forty and younger got it
forty and after. We want to be a little more targeted.
I don't that's maybe not the best word, but we
would probably be you would be someone we would do
more profusion imaging with the stress test. Maybe even there
are specialized cat scans of the heart that give us
(20:48):
images as if you had just had a heart cat
without having a heart cat, So based on potential symptoms
things like that, that might be an option also, but
the calcium scans are better used for a younger population
to screen risks, stratify.
Speaker 5 (21:06):
It was a really cool nuclear something back there. It's awesome,
like lights up purple and blue and what neat?
Speaker 3 (21:13):
What is it? Now? What does that test show you?
And what what? What would that test be called?
Speaker 4 (21:17):
These are smaller cameras, so you're not under a camera.
You're basically almost hugging it like a pillow to your
chest to get the pictures. And I had a man
who would not do a stress test because he's terribly claustrophobic.
I said, you can do this because the camera is smaller.
You can. It's not over your face, it's not you're
not going to feel enclosed. It will just be around
(21:39):
the chest. So that takes the images for a stress test.
Speaker 3 (21:42):
Oh that's better.
Speaker 5 (21:44):
Literally, like he was just hugging it when he was
over there demonstrating in a.
Speaker 6 (21:47):
Chair like a lounger. Almost a relief for a lot
of people. Yes, a lot of people do not like
that tube No, right, aery right, well, kind of the
cool stuff over there. You'll have to come check it out.
Speaker 3 (21:56):
I'm excited. I want to check it out now. Want
to get my heart scanned, just to just to be sure.
Speaker 2 (22:00):
I feel like I want to make sure that everything's okay.
Speaker 3 (22:03):
I know.
Speaker 6 (22:04):
I do think it's interesting though, because we all talk
ourselves into I mean, maybe we don't feel good and
my blood pressure has not been the best at times,
and I've kind of brushed it off and it's not
that bad. But I think the message I get today
is that we just all need to be much more
in tune and maybe even a little bit more aggressive
to ask the right questions and not blow it off
as just I'm tired again, it could be something more so,
(22:28):
and with yourself, talk with your provider and see if
you need to take it to the next step.
Speaker 2 (22:32):
And I think it's a lot about just you know,
especially as women, we tend to help others beforehand, like
kind of like on the airplane, they say, put your
oxygen mask on first, and then you can help whoever's
around you. It's because you have to take care of
yourself first, because you take care of so many other people,
so you really need to focus on your own health
and get the testing and the screenings done and just
(22:53):
a yearly check up too.
Speaker 3 (22:55):
Is I know so.
Speaker 2 (22:57):
Many girls that just say, well I don't have time,
or the insurance isn't the greatest, so I'm not gonna
deal with it or something.
Speaker 3 (23:03):
I'm like, no, you need to take care of yourself.
Speaker 4 (23:06):
Women are good about typically getting their mammograms and pap
smears every year, but not having their blood pressure or
labs checked. You know, the hospitals both do those screening
panels once a year for like twenty five dollars. You
get your blood count, kidney, liver, and a cholesterol panel
for I think twenty five dollars.
Speaker 3 (23:25):
Yeah.
Speaker 6 (23:26):
Well, it's been very enlightening. I'm more encouraged to get
up and take care of myself.
Speaker 3 (23:31):
Yeah, because I better.
Speaker 4 (23:32):
Right.
Speaker 6 (23:33):
Yeah, one in three go for it. One in three.
That's the number that's gonna haunt me. One in three
is gonna have a hard issue of women. So heads up, everybody, Yeah,
that is one of us.
Speaker 3 (23:44):
Oh my gosh, there's four of us here.
Speaker 2 (23:46):
Oh no, oh, no, oh no, but no, you have
given us some great information today, Laura, and we appreciate
you sitting down to talk with us, and we are
so excited for everything happening at Valley right now, and
listen if you are looking for a provider, and if
you have any questions that you might want to ask
as well. We are taking questions for later podcasts and
(24:08):
anything you want to know that maybe you're a little.
Speaker 6 (24:10):
Afraid to ask your doctor about. Yeah, and don't forget.
The Valley Health Heart and Vascular Center opens up September
the second. It's open to Valley Health patients and to
people in the community. We have three cardiologists and three
nurse practitioners coming to take care of you, So we
can't wait to see you and help provide everything you need.
They know it all one hundred and sixty eight years
(24:30):
of experience that we're packing into the Heart and Vascular Center.
So we're here to help and we can't wait to
see you.
Speaker 3 (24:37):
Yeah, I can't wait. Incredible.
Speaker 2 (24:39):
Well, thank you so much again, Laura Mayor for answering
all of our TMI questions, and Jess, Melanie and I
will be back next month with another round of TMI,
so submit those questions too.
Speaker 5 (24:50):
You can go to Valleyhealth dot org. We actually have
a new submission form. There is a link underneath the
top banner that talks about TMI, and in that you
can find the podcast, all of our previous episodes, and
then afford to submit new questions.
Speaker 2 (25:05):
Perfect, all right, that's vallelyhealth dot org and we will
see you next time on tm I
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I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com