Heart Health: Why it’s Different for Women
February 11, 2025 | Episode 32
Producer’s Note: The following is an AI-generated transcript of The Wellness Conversation, an OhioHealth Podcast
SPEAKERS: Marcus Thorpe, Dr. Castle, Lindsey Gordon, Dr. Flannery
Lindsey Gordon 00:14
Your heart deserves better. No, I'm not talking about the love in your life. I'm talking about your heart health and for women, especially how a potentially life-threatening disease can go undetected to no fault of your own. Welcome to the Wellness Conversation an OhioHealth Podcast. I'm Lindsay Gordon.
Marcus Thorpe 00:31
And I'm Marcus Thorpe. From recognizing unique symptoms of heart disease to demanding better care, this is a conversation we all need to have, and we're about to dive deep into all things heart health for women joining us today, Dr. Lindsay Castle and Dr. Laura Flannery. Dr. Castle specializes in advanced heart failure, transplant cardiology and cardiovascular disease. Dr. Flannery specializes in structural heart disease and interventional cardiology. Thank you both for joining us for this podcast. We're really excited about having this conversation with you both.
Lindsey Gordon 01:05
Dr. Castle, let's start with you. Tell us about the work that you do in this space and how you landed at OhioHealth.
Dr. Castle 01:12
I work in our advanced heart failure department as a heart failure cardiologist. I actually did my training here with OhioHealth. I practiced out of state for a couple years, but got the opportunity to come back and work for OhioHealth again in 2020 so very happy to be back. I love working in our heart failure clinic. Here at OhioHealth, we have an amazing multidisciplinary team that provides care for our complex heart failure patients. And I love getting to spend time with heart failure patients. That's the one thing that drew me into that specialty, is the long term relationship that I get to have with my patients as I kind of guide them through the course of diagnosis and treatment of their heart failure.
Lindsey Gordon 01:59
That's an interesting way to look at it. I never really thought about that before. Dr. Flannery, same for you. I mean, tell us about the work that you do and why OhioHealth?
Dr. Flannery 02:09
So I'm a structural interventional cardiologist, so that's a procedural based specialty, so I spend most of my time doing procedures if a patient has an abnormal stress test or comes into the hospital having a heart attack, I do the procedure to diagnose coronary artery blockages, and if appropriate, to treat it by opening up the blockage with a stent. I also take care of patients, specifically with structural or valvular heart disease, such as aortic stenosis, and offer them transcatheter based procedures to address that disease, such as the transcatheter aortic valve replacement or TAVR. I actually was born at Riverside, grew up around here, left for about 20 years for my education and training, and specifically sought out returning to OhioHealth because of the opportunities and structural cardiology and the desire to raise my family in Columbus.
Marcus Thorpe 03:05
Yeah, lots of growth in the heart space at OhioHealth, and obviously a tremendous need. I mean, we're all getting older. Unfortunately, not all of us are following the things we should be doing when it comes to taking care of our heart health, families and women and men altogether, it's one of those things that I'm glad we're having this conversation, because we don't talk about this enough.
Lindsey Gordon 03:24
No, we don't, and even myself, like I think about heart disease, I hear it, about it. I hear about it every year, around February, this time of year, right? It's Heart Month. But what? What is heart disease, and what are the symptoms? And what do I really need to know about it, especially as a woman.
Dr. Castle 03:42
Well, I can go ahead and get started. So heart disease, you know, the heart is a very complex organ. I remember being in medical school, it was probably my least favorite organ to learn about at first, I know, but then as I got to learn more about it and truly understand the physiology and the way it worked. It was very intriguing, and I wanted to help other people understand, too, how their hearts work. So heart disease really can involve any part of the heart or any part of the cardiovascular system. So anything from high blood pressure, as Dr. Flannery mentioned, the heart has arteries, and if there's blockage or narrowing of those arteries that can cause symptoms and lead to heart problems, there's valves inside the heart that help the blood flow in one direction through the heart, and if those valves are not opening or closing correctly, that can lead to symptoms of fluid retention or build up, I specialize in heart failure, which is weakness of the heart muscle and its pumping or high pressure that's higher in the heart chambers than it should be.
Dr. Flannery 04:56
And with regards to symptoms we always typically think about. Out the symptom of chest pain or chest pressure, elephant on the chest, radiating to the jaws, sweating, trouble, breathing. But there are different symptoms, and women often experience more subtle symptoms. So when I talk to my patients, especially those who end up with an abnormal stress test or being diagnosed, the number one thing I hear from them is fatigue, just feeling like they can't keep up with the same things that they used to and exercise intolerance, and they'll blame it on anything else, not getting enough sleep, feeling like they're getting out of shape. But there's something going on that's different, that's typically fatigue that they notice.
Lindsey Gordon 05:39
With that fatigue, is there an age you see with that? Or can it? Does it? Is there no limit to that age? I mean, could it be young? It could be middle age, older? I mean...
Dr. Castle 05:49
No, there really, yeah. So unfortunately, cardiovascular disease really does not affect people of a specific age. It certainly is more common as people get older, but unfortunately, I even see patients sometimes in their, you know, early 20s, that are that are diagnosed with heart failure or other problems, things that tend to become more common as people get older, would be like high blood pressure, problems With the heart valves, blockage or narrowing up the heart arteries, and all of those are really related to aging of our cardiovascular system. The other thing too is sometimes people are born with abnormalities of the heart that might not be diagnosed until early adulthood.
Marcus Thorpe 06:38
Yeah. So we know that there's plenty of myths when it comes to heart disease and heart issues. Can we talk about misconceptions that you might encounter, especially when it comes to women's heart health?
Dr. Flannery 06:51
Yeah, I think there are many misconceptions. I think one thing is that women just don't think it affects them in the same degree, or that they get as much heart disease. And we have to remember, it really is the number one disease process of women, and the number one killer of women, over cancers, over other things,
Marcus Thorpe 07:11
Is the age. Part of that kind of the misconception too, I'm young, you know, I'm in my 20s, or I'm in my 30s. I don't have to worry about that yet. Is that something you hear, especially if you have somebody come in and they're saying, I'm really having some problems. I didn't think I had to worry about that. Is that something you guys hear, as you know, talk to patients on a regular basis.
Dr. Castle 07:31
It certainly is. I think cardiovascular disease can affect women at different stages. You know, I said that a lot of these are disease processes that happen to women or happen to people as they age. But we have to remember that women are unique, and that many women will decide to have a pregnancy. Women go through menopause, and so we know we now know things like blood high blood pressure that develops during pregnancy, diabetes that develops during pregnancy, preeclampsia, which is a problem with the vascular system that can that can also affect pregnancy. All of those things will eventually increase a woman's risk of having cardiovascular disease. So if, if they had a pregnancy that was complicated by those things, we might be seeing coronary artery disease or high blood pressure earlier in those women.
Marcus Thorpe 08:30
Doctor Flannery, let's talk about risks of heart disease. We talked about it a little bit there, but what should we really be paying attention to when it comes to those risk factors for women and heart disease.
Dr. Flannery 08:41
So there's the usual suspects that we know about a strong family history of coronary disease, smoking, diabetes, high blood pressure, high cholesterol. But for women, just as Dr. Castle mentioned, there's a few specific things. One is the pregnancy related risk factors that Dr. Castle just went through. Another thing is PCOS, polycystic ovarian syndrome, increases your risk of heart disease, the choice to use certain hormonal therapies for contraception or hormonal replacement therapy fertility treatments that can increase your risk. By no means is that all off limit, but it's just important to consider and think about. And another specific one is a is breast cancer, and not so much having breast cancer, but the treatments for breast cancer, both the chemotherapy and radiation, can have specific effects on the heart, and it's important for women who've been treated with breast cancer to be aware of those.
Marcus Thorpe 09:38
Can you talk about some of the preventative measures that go along with some of those risk factors, medication has taken some leap forward, I'm assuming, as well as the work that you all do when it comes to interventions and those kind of things, where are we when it comes to taking care of some of these issues with preventative measures, or if you're experiencing something that is we got to take care of this right now. How have we advanced beyond where we were, maybe even five or 10 years ago. So
Dr. Castle 10:04
I certainly think that prevention is becoming more of like a buzz word so to speak. I think that, you know, we have medications now to treat high blood pressure, high cholesterol, the research that is going into caring for women with some of those pregnancy related disorders has expanded drastically to the point where we're now using aspirin sometimes during pregnancy to help prevent the preeclampsia syndrome that I had talked about. That's a relatively new development in the last couple of years. And also, I think, just being just being aware some of the things that Dr. Flannery mentioned, you know, monitoring women who are undergoing therapy for breast cancer. So we're doing serial ultrasounds of the heart, or echocardiograms to ensure that as they receive therapy for their breast cancer that is not affecting the overall pumping function of their heart. And I think as those guidelines were created and developed, we now know how to follow those women much, much more closely, and so we're helping to prevent some of those chemotherapy induced effects before they ever occur.
Lindsey Gordon 11:24
So interesting about the research. I know when I was doing the research for this podcast, I discovered that a lot of the research around heart health is based around men's physiology men's health. Are you still concerned about that, and is there need for more research for women?
Dr. Flannery 11:40
Absolutely. I mean, I think this is something that we've come a long way with, but we still have a long way to go. And there's an increasing focus on not just being able to ensure that we increase more women into clinical trials and have more representation of women throughout the field, to help with women being seen, but also to focus on sex specific differences and outcomes.
Lindsey Gordon 12:05
Absolutely, I know for me personally, I'm a mom, I have the job, I have life, right? Things are going on. I'm not necessarily thinking about my heart and my heart health every single day. And I could totally see how I would be one of those people to kind of brush off the symptoms of a heart attack, right? Like, oh, I'm always stressed, or, Oh, I'm always short of breath. It's like an Olympic sport getting my kids out the door in the morning, right? So, you know, it's funny to think about, but then at the same time, it's like, well, it's kind of terrifying in a way, to think about. I might be one of those statistics of someone who ignores the symptoms of a heart attack. How concerned are you about how common that happens?
Dr. Castle 12:43
I, you know, I'm very concerned about that. I make rounds in the hospital, and I talk with people routinely who, you know, felt poorly for six months, you know, ignoring their you know, clear symptoms of heart failure before they ever decide to come into the hospital. So I am very concerned about that. I think one of the best things that anybody can do is to develop a really good relationship with a primary care physician, somebody that you feel comfortable calling or going in and talking with, hey, you know, these are the symptoms I'm having. What do you think about it? Should we do some additional testing so, you know, just realize, realizing that, you know, if, especially if you do have young children, you know, to do those Olympics with your young children, like you've got to stay healthy for them totally. So just kind of remembering to pause, you know, listen to how you're feeling, and definitely discuss any concerns with a primary care physician right away.
Dr. Flannery 13:37
I think a lot of women will say I knew something was off, but I couldn't quite pinpoint it, and just listening to that when you feel like something's off, yeah, I think
Marcus Thorpe 13:47
one of my favorite parts about this podcast is having experts come on and having the access that we have to ask you questions like this, so you both are in the heart field. As somebody who is always curious, I want to know what you two do for your own heart health, right? I know sometimes physicians aren't always the best people at taking their own advice, but how do you all take care of your heart health? How closely do you monitor what you're doing and what you're eating and the exercise that you get? You both have demanding careers, busy lives, lots of different ventures. What do you two do?
Dr. Castle 14:22
So that's an excellent question, and very good time of year to ask that question too, right? As we all make our New Year's resolutions, but I feel very fortunate. I grew up in a family where we ate tons of fruits and vegetables. You know, my dad had a huge garden, so I feel like early in my life, my parents instilled some very good eating habits, so I try to eat healthy. I love to walk and run so I'm on the treadmill or when the weather permits. I love walking in my neighborhood outside. But I think one thing. I've had to focus on a little bit as I get older, and I have that busy career is also just creating time for myself. Like it is okay to sit down and read a book for an hour, or it is okay to work on a craft project. I don't it's okay to say, you know, this weekend, I'm not going to run and do eight different activities with friends. It's okay to take time for yourself and do something that you enjoy. And I also have an excellent relationship with my primary care physician, who I check in with at least yearly.
Marcus Thorpe 15:32
Nice. All right, Dr. Flannery.
Dr. Flannery 15:34
I think I could take a page from Dr Castro's book. As my children are very young, it's been a challenging it was a challenging 2024 to focus on myself, but I do try to find time for exercise. I do try to make sure that I eat healthy, and I do try to make sure I get adequate sleep when I'm not on call. That's a big one.
Marcus Thorpe 15:58
It's interesting that you say, you know, you do a lot of the physical, but sometimes those things, and even having some time for yourself, there's a mental aspect to your heart health too, right, being in the right mental space and maybe relieving some of that stress in your brain really impacts your heart. Talk about that a little bit too if you could.
Dr. Castle 16:17
Yeah. So there is, there is, without, without any doubt, a strong connection between our mental health and our, you know, cardiovascular health. So we know, without a with, you know, without any doubt, that high stress levels can lead to premature cardiovascular disease. So, you know, I it's very, very important to think about not just how we're feeling physically, but also how we're doing emotionally.
Dr. Flannery 16:48
Yeah, and I think there you know that comes through in a few different ways. There's the fact that stress just leads to behaviors that are often not good for cardiovascular help, such as poor sleep or hygiene or not having a good diet, or other things like that. But there's very specific biological factors that we are researching and finding out are involved, such as increased inflammatory markers, increased cortisol response, increased blood pressure, and some of these things affect women in a disproportionate way.
Lindsey Gordon 17:19
So there's truth to the saying that makes my heart happy, right? Like, if you have a heavy heart, your heart truly might be impacted in some way. And if you have a happy heart, you're in good shape.
Dr. Flannery 17:28
I mean, women who have had a heart attack, if they report higher rates of marital stress, they are three times more likely to have a recurrent heart attack a happy relationship. It's really important.
Lindsey Gordon 17:42
Wow, wow. Well, this was a wonderful conversation. I think we love to leave the listeners with one, you know, takeaway, if there's one thing you could tell a listener today to take charge of their heart health and to advocate for themselves, what would that be? Dr. Flannery, not to put you on the spot, but you could go first.
Dr. Flannery 18:02
I think if you haven't seen your primary care doctor in a while, just make an appointment. Check in, get that cholesterol checked and that blood pressure checked.
Dr. Castle 18:10
Yeah, I would obviously that is very important. But just we've talked a lot today about just listening to your body. If you really feel like something is not right. Speak up. Say something, get some help.
Marcus Thorpe 18:24
I feel like this is one of those podcasts that I could actually do a couple of hours on, and there's just so much. So I hope that in the future, when we do a couple more of these podcasts, we'd love to have you two back, because I do think there's a lot to get to. But as they both said, start with primary care, if there's a need for specialties and getting to the right kind of doctors, I think that's the beauty of our health system and having these connectors, because sometimes you do need that extra layer of care and that extra layer of expertise beyond your primary care doc. Have you seen specialties like yours really grow in the needs as we've all grown a little bit older. Are you seeing more specialty? I don't know, expansions here at OhioHealth?
Dr. Castle 19:12
So certainly, without a doubt, we you know in in medicine, you need a very strong foundation of primary care pediatrics, you know, internal medicine, and then you kind of move up, you know, through the sub specialties. But take, for instance, you know, Dr Flannery and I both trained to do heart casts, but you know, she's doing these amazing, you know, heart valve replacements that that took her an additional, like, two years of training, and I did an additional year of training to learn, you know, who's a good candidate for a heart transplant if heart failure ever becomes that severe. So as you see, the transitions kind of apart within the same specialty. We refer to that as siloing. You know, in medicine, that's kind of the technical term for that. And we do see a lot of that, not just in cardiology, but in other areas like kidney disease, where some kidney doctors are only focusing on dialysis patients and yeah, so we're really seeing that across the board.
Marcus Thorpe 20:28
Are you surprised, Dr. Flannery, how much it's grown? I mean, I know you've been at this for a while, but to see where the advancements have come to this point, but then the future state of what it could look like for heart health. I mean, it's probably hard to even imagine what we look like 5, 10, 15 years down the road. It's amazing,
Dr. Flannery 20:45
It's so exciting to think about what we will be able to do when what we're working on, we've come so far, but there are so many things to still figure out.
Marcus Thorpe 20:54
yeah, my father had a heart attack, you know, in the 80s, and they had to do the full like chest crack open, and you know all of that to think about. I know they still do some of that, if they have to, but to think of the advancements that he could have had back in the 80s when he had that first heart attack, it's come such a long way. It's really impressive.
Lindsey Gordon 21:15
Well, this has been a wonderful conversation. We thank you both so much for being with us to talk about women's heart health, especially since the symptoms can be different, the risk factors can be different, and the bottom line is, advocate for yourself, right? Take your heart health seriously, because your heart deserves better.
Marcus Thorpe 21:33
And we'd like to thank you for joining us for this episode of the Wellness Conversation an OhioHealth podcast. Before we wrap up, we do invite you to follow us on all major social channels so you can stay up to date on new episodes and other health and wellness topics. If you're looking for more information on OhioHealth services and locations, just go to ohiohealth.com.
Lindsey Gordon 21:52
The information in this episode will also be available on the podcast page. Also be sure to subscribe to join the conversation. And one final note before we say goodbye On this episode, we are just getting started. Reviews and ratings help us keep the conversation going with you and allow others to find us and join the conversation too. As always, thanks for joining us.