Let’s Talk about Women’s Heart Health

Sarah Gosnell, NP

Kate Kolb (00:10):
All right. Welcome back to another episode of center scripts. We are super excited to have Sarah guys now with us here today. She’s one of our providers here at Centra and we’re going to talk a little bit more about heart month and specifically women’s heart health and I’m very excited to talk about that with you today, Sarah. So thanks so much for being here. And Sarah, if you don’t mind just giving us a little bit of your background, kind of what brought you here, how long you’ve been at Centra and I kind of a little bit more about yourself.

Sarah Gosnell, NP(00:38):
Yeah, well thanks for having me. I have been with Centra for 13 years. I actually moved into this area my senior year of high school and then ended up going to Liberty for my undergraduate nursing degree and stuck around after that. So I worked on the progressive cardiac unit, which is now called the cardiac intermediate unit at Lynchburg general, which is a like heart step-down floor. And I worked there as a bedside nurse from 2007 to 2013 and in 2013, I had graduated as a nurse practitioner through the old dominion program. And since then I’ve been with cardiology as a nurse practitioner. Okay. Both in the inpatient and outpatient setting at Stroobants. So yeah, that’s kind of a little bit of my educational background and

Sarah Gosnell, NP (01:28):
As to why cardiology? Well, and even why medicine in general. Yeah. You know, when I was younger I always thought I was going to go into business and be a mutual fund manager is my goal and my dream. When I, was in college, my first year my mom got really sick and she had a little cancer scare and ended up not being cancer, but that was my first real brush with health care in a hospital. And I thought it was really interesting what the nurses were doing and how they helped her. And I met a friend who was in nursing and I just kind of [inaudible] I don’t know, it just something switched and all of a sudden business went away. And I think it’s probably for the best. I don’t think I would have been good in the business world though.

Kate Kolb (02:03):
Well that’s awesome. I love that. That was sort of your, your why and your impetus to get to get into this. And everybody says wonderful things about you at cardiology and I know that your patients definitely appreciate you as well. So I think it’s important in the field of medicine to have that, that sort of heart behind what you do and it’s clearly evident that you do so. That’s awesome. I want to talk a little bit today. We had an episode last week with Dr. Meyer and we talked a little bit about heart month and just the generalities of how that affects our society and kind of different, different things with that. But I want to talk specifically about women’s heart health with you today. And I know a couple of years ago I went to an event where you were speaking at a luncheon. You talked a little bit about

Sarah Gosnell, NP(03:00):
This then too. And just the idea of, you know, there’s a, there’s a lot about women’s heart health that we don’t talk about. There aren’t conversations had about it and people sort of gloss over it I think. So let’s start with what heart month is a little bit. Why, why do you think that that’s important to have a whole month dedicated? Yeah, well I think that’s great. You know, I think part of the reason I feel like Heart Month is so important is it’s one of those things, you know, we just get so busy in our daily lives and especially as women, a lot of times we’re caregivers both for people older and younger than us in our lives. And a lot of women are working at least one job if not more than that outside of the home. And if not, are very busy inside of the home.

Sarah Gosnell, NP(03:44):
And I think we just get busy and it’s easy to put yourself and especially your health on the back burner. It’s something you don’t think about. And I think Heart Month is very important because it kind of brings all that to the forefront. And it’s a chance to almost like the beginning, you know, January, new year, new year, it’s a moment to stop and say, Oh, how has my hurt, you know is there anything that I can be doing differently to change my risks for heart disease and how much at risk am I? You know, I think even for myself, you know, people, we just tend to have this sort of hubris of like, well that’s for later or that’s not for me. And then you know, to take that time to say, maybe it is and it’s something I can think about and consider. So I think awareness is the biggest thing in my mind.

Sarah Gosnell, NP(04:29):
Yeah. That’s awesome. I love that. I think that concept of Oh, I’ll just wait, I’ll check it out later. Right? Like it’s not something I have to be concerned with that’s, that’s actually a, a big epidemic type of a problem I think among, among most people in our society. But women in particular. And that actually brings me to the next topic. I want to talk about this myths idea around heart health with women. I think it speak, speak a little bit about that. Like is there a myth that there doesn’t need to be as much concern for women in heart, heart disease? Yeah. Well, I mean I guess it’s hard to say, but what I would say my opinion is about it is I find a lot of times people that I speak to, even in my personal life like anecdotal experience are more concerned about things like cancer.

Sarah Gosnell, NP(05:16):
And that comes from me as a cancer survivor myself. But a lot of times women specifically are worried about breast cancer. And it’s funny because what’s not funny, but it’s so boring to look at the statistics. Actually heart disease is the number one killer of women and it kills more women than all types of cancer combined. So it’s a big deal. And I think a lot of women, when they think about a heart attack, if you just picture it in your mind right now, a lot of times it’s going to be maybe a man in his fifties or 60s clutching his chest in his left arm, something down on the ground. But just from my experience as a provider, that’s not what it looks like a good majority of the time. And so I think if, if that is a myth out there, if people believe what I think they do and, and some studies have shown that women grossly underestimate their risks for heart disease, that that would be a myth of, of a lack of awareness of how at risk you are as a woman.

Sarah Gosnell, NP(06:16):
Yeah. Are there any other myths or any maybe misinterpretations of what heart disease looks like in women that you’ve run into? Yeah, so I mean, I think when we’re talking about heart disease in women, you can think of the heart as sort of three systems. And I hear our cardiologists talk about this all the time. You know, there’s the heart as a, an electrical system. So there’s like rhythm issues and the nerve side of it. And then you have the heart as a pump, how strong the heart muscle is itself and the valves and things like that. And then you have the plumbing of the heart, which is really the area that we’re kind of talking about and focusing on where the blood vessels can get clogged up with fat and calcium and things like that. And I think when we’re talking about that issue, the, the plumbing of the heart and we’re talking about myths and misunderstandings, I think it’s that people are not aware as much as we should be swimming and specific about the things that we can do that affect that.

Sarah Gosnell, NP(07:16):
And I think, especially when we’re younger the things that we’re doing matters so much every day, but I think we always think like later seventies, 80s, and, but what we’re doing right now is what will build what happens tomorrow, kind of a thing. Right. So I think maybe just a lack of understanding of that kind of thing. Yeah, that makes sense. You spoke a minute ago about the differences in what a heart attack looks like. A woman versus a man. Let’s talk about that for a minute. Cause I think there’s a huge misconception about, well you know, if is this type of pain something that this is associated with heart disease or what does that look like in a woman? Yeah, so the, the tricky part is women can present a little differently than men and there have been some studies in the past that have shown in the emergency room.

Sarah Gosnell, NP(08:04):
Sometimes we can miss identify and sometimes women tend to downplay their symptoms to really anything that goes from the jaw line down to the upper abdomen, including your trunk, including your extremities, can signify heart pain. You know, things in the arm, things in the chest, things in the back between the shoulder blades things in the neck, those sorts of things. And symptoms can be anything from pressure, tightness, squeezing pain. It can be a fullness or a heaviness. People will will say that it feels like someone’s sitting on them or impressing on them. A lot of times women too can present with just indigestion. They’ll feel like they have bad heartburn. I’ve heard that many times from women, and that’s something that shows up in the literature. Also, women can describe symptoms such as feeling more fatigued than usual. That’s a tough one because who doesn’t feel tired?

Sarah Gosnell, NP(08:56):
We’re tired, we’re all tired. Shortness of breath and then that upper back pain between the shoulder blades. Some of those things can be common in women, but one of the main things that I always tell people to look out for is a change in symptoms. And so if you’ve not been having this, and this is coming up, I think sometimes women, like we talked about earlier, are very busy, right? And they just put it off and they say, well, if it’s still here a few months from now, then I’ll address it. But if you’re a little bit older and you have some of the risk factors that we’re going to talk about in a little bit and this symptoms persist, it’s always a good idea to get them checked out. And especially if they’re happening with exertion when you’re up and moving around, you’re climbing stairs and you’re getting unusual symptoms, it’s always good to get it checked out.

Sarah Gosnell, NP(09:40):
Very cool. Well let’s talk age for a minute cause I think that there is an idea, and I know this has been prevalent in my own life even too, and we talked about it just a second ago with the, Oh, you know, I’ll get to that at some point in my life. But is there a misconception that heart disease really does only affect a certain age population and is it something that that is further reaching than 50 and above? Yeah, well I think one of the biggest things in terms of age is what are the other risk factors too, but it definitely can affect people younger. I just, myself as a provider see patients even in their mid to late thirties having heart disease that have other risk factors. And so it’s definitely not something that’s just for retired aged people or even just middle aged people anymore.

Sarah Gosnell, NP(10:28):
You know, I think it’s one of those things that you really have to be aware of at all stages of the lifespan. Kind of thing. Okay. So let’s talk risk factors then that a few times. So what does that look like? What are the things that you need to be looking out for? What are you more going to be more predisposed to in certain risk populations? That sort of thing. Risk factors are like, my favorite things to talk about. Knowledge is power. And I feel like, so what I want is anybody who’s listening to this right now, I want you to take a personal inventory and start checking your mental checkboxes when I list these things off to see where you fall on this spectrum. And I think one of the most important things that you can do as a woman or even a man to help prevent heart disease is to have a good relationship with a primary care physician to help work on all of these risk factors.

Sarah Gosnell, NP(11:17):
And to know that this, this, this idea of heart disease, the number one killer of women is something that you can have a hand in effecting your statistical chance of developing it. You do have power. It’s not just something that will happen to you in most cases. I think the statistics say something like 75% of women with heart disease can have an effect or a change based off of modifying their risk factors. So there’s two categories of risk factors. One’s that you can’t modify and those are things like age. As you get older, your risk goes up and things like a family history. And when I say family history, we’re talking about a first degree relative like a parent or a sibling who’s also had heart problems and has developed it at a younger age. So for like a male family member that would be below 55 for a female that would be below 65.

Sarah Gosnell, NP(12:13):
And then, but there is a whole category of things that you can affect the modifiable risk factors. Some of those are other disease processes. So things like high blood pressure, high cholesterol, and diabetes. Now, if you have all of those, it doesn’t mean you’re definitely going to have heart problems. But the important thing to do is to control them as best possible. So if you have high cholesterol and your doctor recommends that you take a Statin, take a Statin, I know Statins get a bad rap, but they have done so much to help people stabilize plaques in what I’m talking about plaques, I’m talking about the gunk that sits inside your heart arteries, fat and calcium that clogs things up, keeps blood from flowing, keeps oxygen from getting to heart muscle. If you have high blood pressure and your doctor recommends that you take medication for that or try a new program to lose weight, you know, losing weight is such a difficult and daunting thing and is so discouraging sometimes to people.

Sarah Gosnell, NP(13:12):
But to try to make the efforts to move towards that or to take the medicine, at least take the medicine, you know and then the diabetes to do everything you can to control that. Diabetes is one of those tricky things. You know, they’ve done some studies that have shown that women with diabetes will be more likely to develop heart disease than men in some of these risk factors are just worse for women. And it’s just tough and sometimes there’s not a lot you can do about it other than manage what you have. Another big one is smoking. And I think a lot of people think about smoking and they think lung cancer or respiratory problems, but it is a huge risk factor for heart disease. And quitting smoking is one of the best things that you can do for yourself to help prevent heart disease.

Sarah Gosnell, NP(13:58):
And for people who’ve been smoking for a long time, it doesn’t mean that it’s hopeless. There’s always a chance that when you stop, you know, damage will be undone and your risk starts to go down. And there’s lots of AIDS to help you with quitting. Smoking. Welbutrin which is an antidepressant, helps a lot of people. Chantix sometimes helps people. The nicotine patches and the gums and things like that are also other options. Hypnotherapy classes. There was a tobacco free class at center that’s offered. There’s a lot of options other than just trying to go cold Turkey or willpower through it, you know. Another risk factor is stress and anxiety and depression and stress all fall under that umbrella, all that psychological stress. And you know, I think that’s another thing that especially as women, sometimes we can just sort of grit our teeth and bear it.

Sarah Gosnell, NP(14:53):
But besides the fact of it’s just not an ideal way to live. It does have an effect on your body. Stress has a very real effect, causes inflammation in the body. And so I do encourage patients, and I take this advice myself. A combination of medication and therapy can be so helpful if you have any of these problems that you find are affecting your day to day life, even lifestyle changes. You know, if you have a job that is just so stressful that every day you’re getting tension headaches and you just feel like you’re going to explode when you come home, maybe it’s time to think of a new work opportunity. You know, something to do to change your day to day life that can reduce your risk. Because at the end of the day when you have that heart attack, it’s not going to be worth it, you know?

Sarah Gosnell, NP(15:39):
And then other risk factors include exercise. Now that’s one of those things I think we can have an all or nothing mentality. I’m either going to go to the gym and exercise for 30 minutes a day, five days a week, or I’m going to do nothing because I can’t do it. And if I try, I don’t do it and it, nothing works. But there is a middle ground and I’m a big proponent of the middle ground. You know, there’ve been studies that have been done that have showed if you exercise even 30 minutes a day, a couple days a week, something that gets your heart rate at walking. It doesn’t have to be in a gym. It doesn’t have to be a formal program. If you never lose weight, you still add years to your life expectancy. It has a real measurable effect on your insides.

Sarah Gosnell, NP(16:22):
And I think anybody who’s getting out, getting their heart rate up and moving, whether it’s parking further in the parking lot, one of the doctors I work with, Dr. Warner is always a proponent of that. Taking the stairs, even doing little things. Even if you feel like, I know I’m not doing what I’m supposed to be doing, those little steps add up and you can feel good about what you’re doing on your insights, even if your outsides don’t change. And it’s not all about how we look on the outside. Anyway. another thing is nutrition. And I know it seems like the guidelines for what’s right to eat seem to change every couple. Yeah. And your head’s kind of going back the fourth, like a yo-yo. Like which one do I do? But the main thing that we recommend is just part what they describe as her healthy foods.
Sarah Gosnell, NP(17:03):
So lean proteins, whole grains. Avoiding trans fats and keeping your saturated fats low, but your good fats, you can have, you know, those and which is such a weird comment. I know it’s a thing. It’s a title thing. Yeah. I’m trying to avoid a lot of refined carbohydrates and processed foods that kind of thing. But lots of fruits and vegetables that kind of thing. And then obesity can be a risk factor as well. So again, trying to work on getting that weight down, which can be a difficult thing, but you know, I think you have to sort of look at it as a whole in general. It’s not going to be just one risk factor. The only one I would say, if you have a very strong family history, you really need to have this on your radar, even if rest of your life is perfect.

Sarah Gosnell, NP(17:51):
Right. You know, in terms of risk factors, sometimes the genes are enough to do it, but the rest of the risk factors, if you kind of just look at them as a whole instead of just saying, well I feel on this one. So there’s no point trying, you know, to try to do what you can to modify anything you can, it makes a difference. It really does. In general when we see patients coming into the hospital with a heart attack, they have a combination of risk factors that were not optimally controlled. That makes sense. So talking about heart disease in general, this just kind of came up while you were talking through some of that stuff. When we talk heart disease and the end culmination of that, we often think it’s just a heart attack, but is there other things that people need to be concerned about that maybe, maybe you don’t have a heart attack, but what other things in that heart disease realm do people need to keep an eye on?

Sarah Gosnell, NP(18:41):
Yeah. So you know, a lot of times when we’re talking about like the damage, because when you have a heart attack, the, the, the concern is that you’ve lost heart muscle and then when you’ve lost heart muscle, you’re at risk for lots of other problems happening. Like a weak heart muscle that can cause congestive heart failure, fluid building up, you’re more at risk for abnormal heart rhythms, arrhythmias that can sometimes even be fetal, things like that. So before that process happens where you start having the pain where you end up having the heart attack you’re, I would say you’re just sort of in like a warning zone. Sure. whereas the, the damage hasn’t happened yet, but the risk is there and I think you can end up sort of just being sort of like that ticking time bomb. Like something’s just waiting to happen.

Sarah Gosnell, NP(19:37):
I don’t know if there’s nobody else. Okay. And so that’s where that conversation with like your primary care provider is super, super important yearly exams and things like that. Because I think people think of and it’s true cardiology as a specialty care piece to their health and wellness, but how does that integrate into the overall health conversation with, with these appointments and things that you need to be having? Well, I think again, like we said, heart month, it’s so important because now that you have this understanding of your risk factors and an awareness of where you fall on the spectrum of risk. So you know, say you’re a woman who is 45, but you know, your dad had a heart attack at 50, and you have diabetes and you have a very stressful lifestyle. You can take those things and come to your primary doctor and you may not be having any symptoms right now, but to come to them and say, listen, I know this was in my family and I know that I have these issues.

Sarah Gosnell, NP(20:34):
What else can I be doing? And you know, sometimes they might want to even do some more diagnostic testing. They might want to get an EKG to see how things look. They might even want to do theirs. There’s some screening tests that are kind of controversial and aren’t always covered by insurance, but things like a coronary CTA, which is kind of like a cat scan that looks at calcium buildup in the arc heart arteries. And it kind of really just helps to determine presence or absence of any kind of lay down of a process in the her arteries. And sometimes that can be helpful to know where you’re at on the spectrum, but some people end up paying for that out of pocket. But really the most important thing is making sure that you’re on the right medications and doing the right things with your lifestyle. So I think going to that primary physician, sometimes they’ll bring it up. Sometimes you may need to bring it up. It may not be on the forefront of their mind when they see you, but making sure at each visit that you’re doing everything you can. You know, and, and really with a lot of those other disease processes, having them control doesn’t just benefit the heart. It benefits other organ systems, the kidneys and different things like that that can be affected by some of those things. So yeah,

Kate Kolb (21:42):
And ultimately that’s kind of the conversation that we want to keep having with people and kind of the point of what we’re doing here with center scripts is that keeping the conversation open, we want to make sure that, you know, we are being an advocate for our own health and that sort of thing so that you can be a partnership with the providers that you’re seeing and help increase that healthy lifestyle in general. So you talked a lot about the, the risks and things and that kind of works its way into the prevention piece that we’ve talked a little bit about. Is there anything else prevention wise for women specifically that you may not have touched on that you feel like might be an important factor?

Sarah Gosnell, NP(22:22):
I think, I think that’s mostly everything. I think the main thing that I would just emphasize again is just remembering that as a woman you are very much at risk just as much so, and sometimes even more so than a man. And even there’s hormonal factors and reproductive factors that weigh into a woman’s risk of heart disease that doesn’t even play in for a man. Sometimes that perimenopausal time miscarriages up the risk of heart disease, things like that early men are, can sometimes increase the risk. And so adding all of that and just being aware that this is something for you as well. Right.

Kate Kolb (22:59):
And we actually offer a heart risk assessment through you can go to our website actually, it’s central health.com/heart hero and you can take one of those assessments right there and it actually goes over a lot of the things that Sarah you were just talking about with those risk factors and things. I love that you were like, this is a checklist while I’m talking like see what things you check off. And we would love, we would love for people to be able to check that out too. So if you get to a point in your life as a woman and you have been diagnosed with heart disease, what does the treatment process look like for that going forward? And quality of life and and all of that. How does that play in to the long run?

Sarah Gosnell, NP(23:40):
So the ideal would be if you have a of enough clogging gunk in your arteries that you would require treatment for that, such as like a stent or medication. A stent is a piece of metal that opens up, kind of pushes all that to the, to the side so that blood flow can be opened back up again. The ideal would be that we have enough morning based on symptoms that you seek medical attention. Sometimes you end up having a stress test and that might alert us and lead to a heart catheterization where they go in with a flexible tube and put that stent in if they need to. Or even potentially a bypass surgery if you have enough blockages that are bad enough. But the ideal would be that you would have that identified before you have a heart attack because the heart attack is where blood flow gets cut off enough.

Sarah Gosnell, NP(24:31):
That tissue starts to die and time is muscle. It’s so critically important when to identify a heart attack as quickly as possible. So it’s possible to find those blockages and treat them before a heart attack happens. If you’re aware of your symptoms, if you have enough warning, you know, some folks don’t have any morning and the first, the first thing is it, you know, and it can be fatal and that happens out of hospital and we don’t even have to ever end up seeing that. Right. And that’s where that whole identification of risk factors comes into play. But on the other side, if you, so if you have that done you can end up on good medical therapy, which often consists of aspirin, another blood thinner that goes with it. If you end up having a stent if you don’t, it would be usually just aspirin and then a medicine called a beta blocker, which can help to prevent scar in the heart.

Sarah Gosnell, NP(25:21):
Kind of relaxes things, lowers the heart and blood pressure a little bit. And that Staten medication that can help to stabilize and even regress plaques a little bit. If you do have a heart attack. Again, like I said, the main thing is we try to identify it as quickly as possible and get you into the cath lab as quickly as they can and get that opened back up again. And then we kind of take a step back. One split flu is restored to figure out if there was any change in the strength of the heart muscle itself and the pump and how effective it’s going to be at pushing blood through the body. From now on. We use medicines if there’s any weakness in the heart muscle to try to strengthen it back up again. And cardiac rehab is a big part of this process too.

Sarah Gosnell, NP(26:04):
It’s a program of exercise with monitoring and nursing staff available, a physician available upstairs as well at our office to help get the heart healthy again. Using a program of exercise and nutrition and even psychological assessments afterwards. Depression is a very common thing after heart issues that we like to assess for. So much so that we even have a licensed clinical social worker who works with Piedmont psychiatric but also works in our office a day or two a week to help with our patients because it’s such a big thing even before and after. Right. You know but those are sort of the main

Sarah Gosnell, NP (26:44):
Stays of therapy, restoring blood flow, good medical therapy and a monitored program of exercise, nutrition and psycho psychological assessment afterward. Yeah. And it’s super important I think for people to understand that just because you’ve had issues with heart disease or you’ve been diagnosed with different pieces of that, that your life isn’t over. There’s definitely still a lot of good life to be lived and and good ways to work your way through that with, with partnership with your providers and that sort of thing. So, yeah, it’s, I, you know, we don’t want people to feel like, well, it’s over. That’s, that’s all I’ve got left. You know. So that’s, that’s huge. That’s super important for sure. I just lost my train of [inaudible]. Hold on one second. What was I going to go? There was something you said.

Sarah Gosnell, NP (27:33):
Oh man. And I was like, Oh, I need to ask her that. Too long winded.

Kate Kolb (27:38):

No, it’s all so very good. This is really, really good. Oh, I don’t remember what it was. It was just a play off of something else that you had said. So it wasn’t a big deal.

Kate Kolb (27:50):
Prevention, treatment, yada, yada, yada. Let’s see.

Kate Kolb (28:03):
Oh, I was just going to wrap it up. Let’s see.

Kate Kolb (28:08):
I think a theme that we have heard through all of the stuff that you’ve been saying today has been that holistic approach to everything. And so what kind of final words of encouragement would you have for women as they’re taking a look at their risks and, and you know, is this me? Is this something that I need to be concerned about? Kind of final word with you.

Sarah Gosnell, NP
Okay. So my final word would be keep your eyes open, but don’t be afraid because I think sometimes fear can be a thing that keeps us from moving towards these things. Keeps us away from a doctor’s office, a fear of change, a fear of what we may discover. But again, like I said earlier, knowledge is power and this is something that you can have a positive effect on your own life. You can have a positive effect on your own life expectancy.

Kate Kolb (28:55):
And so to look at it more as an empowering thing and less as a scary fearful thing and look at your own risk factors and think of them as things that you can have a positive change on. So to think of yourself as strong, you are strong. You know, you can identify these things and move towards that. Yeah, I love that. I’m empowered and not fearful, so that’s excellent. Sarah, thanks again so much for being here. It’s been a pleasure to talk with you and we’re just super excited about all the heart month things that have been going on this month and hope that it’s been a help to you as our listeners and we look forward to continuing this conversation with you guys. Next time.

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