In this heart-stirring episode of MedStar Health DocTalk, we delve into the alarming trend of heart attack fatalities among the young. With heart disease steadfastly holding its ground as the leading cause of death in the U.S., our host Debra Schindler sits down with cardiologists Dr. Barbara Srichai and Dr. Estelle Jean from the MedStar Heart and Vascular Institute to dissect the why's and how's of this disturbing rise.
The episode takes an unexpected turn with the inspiring story of Jude Mabone, Miss District of Columbia 2023, who shares her jaw-dropping experience of surviving six heart attacks before turning 18. Her advocacy for heart health education, CPR, and AED awareness is a beacon of hope and action.
Together, our experts and special guest unravel the symptoms that young people should not ignore, the impact of lifestyle choices, and the silent threat of conditions like hypertension and diabetes. They stress the importance of early intervention, knowing your body, and never dismissing potential warning signs of heart distress.
As we navigate through the nuances of heart health in the young, including the role of substance abuse and vaping, we're reminded that heart disease does not discriminate by age. This episode is a must-listen for anyone seeking to understand the critical importance of heart health vigilance, from adolescence through adulthood.
For a pulse on the latest in heart health, tune in to MedStar Health DocTalk, where real conversations with physician experts pave the way for a healthier tomorrow. For more episodes, visit medstarhealth.org/doctalk.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
In this heart-stirring episode of MedStar Health DocTalk, we delve into the alarming trend of heart attack fatalities among the young. With heart disease steadfastly holding its ground as the leading cause of death in the U.S., our host Debra Schindler sits down with cardiologists Dr. Barbara Srichai and Dr. Estelle Jean from the MedStar Heart and Vascular Institute to dissect the why's and how's of this disturbing rise.
The episode takes an unexpected turn with the inspiring story of Jude Mabone, Miss District of Columbia 2023, who shares her jaw-dropping experience of surviving six heart attacks before turning 18. Her advocacy for heart health education, CPR, and AED awareness is a beacon of hope and action.
Together, our experts and special guest unravel the symptoms that young people should not ignore, the impact of lifestyle choices, and the silent threat of conditions like hypertension and diabetes. They stress the importance of early intervention, knowing your body, and never dismissing potential warning signs of heart distress.
As we navigate through the nuances of heart health in the young, including the role of substance abuse and vaping, we're reminded that heart disease does not discriminate by age. This episode is a must-listen for anyone seeking to understand the critical importance of heart health vigilance, from adolescence through adulthood.
For a pulse on the latest in heart health, tune in to MedStar Health DocTalk, where real conversations with physician experts pave the way for a healthier tomorrow. For more episodes, visit medstarhealth.org/doctalk.
For more episodes of MedStar Health DocTalk, go to medstarhealth.org/doctalk.
Comprehensive, relevant, and insightful conversations about health and medicine happen here when Medstar Health doc talk. You're listening to Medstar Health doc talk, real conversations with physician experts from around the largest healthcare system in the Maryland DC region. I'm your host, Debra Schindler. Heart disease has for decades been identified as the leading cause of death in the United States, bar none. The statistics are not surprising. They do, after all, include a wide range of cardiac conditions like coronary artery disease, heart failure, and heart attacks. What is surprising is the rise in the number of heart attack deaths among young people. Since 2000, statistics have shown an increase in the number of people under the age of 40 dying from a heart attack. That number is increasing by 2% every year. Why? How do we know who could be at risk, and what can be done about it? Today on Medstar Health doc talk, we are joined by two cardiologists from the Medstar Heart and Vascular Institute to get answers to those questions and more. Dr. Barbara Srichai is here with me at Medstar Georgetown University Hospital. And calling us from Medstar Montgomery Medical center is cardiologist Dr. Estelle Jean. Thank you both for sharing your expertise with us on MedstarHealth doc talk.
>> Speaker B:I'm happy to be here. Thank you for inviting me. I have such an important issue to discuss today.
>> Speaker A:Absolutely. But wait, we have another very special guest today. Welcome. As District of Columbia 2023, Jude Mabane, whose amazing story of surviving six heart attacks before the age of 18 has propelled her to use her title and platform to advocate for heart health. Jude has worked closely with the American Heart association and other organizations, including Medstar Health, to promote the use of automated external defibrillators, or aeds, and to teach CPR. Jude, tell us about your goal, and have you seen any impact since taking on this heart health platform as MiSTC.
>> Speaker C:My goal is to educate as many people as possible on the importance of taking your heart health seriously, the earlier, the better. It's also important to me to teach people CPR and AED education to make it more accessible. working with Medstar Health and Gallaudet to try to teach it at NASL was a really big highlight for me. And so, since taking on the Miss DC title, I'm just really excited to see the tangible change that's happening here in the district to, help promote those two initiatives and to really help keep us heart healthy and heart safe. Right.
>> Speaker A:Can you elaborate on the Gallaudet project for those who may not know what you were referring to?
>> Speaker C:So Menstar Health and I teamed up with Gallaudet University back in August to teach a CPR and AED training completely in American Sign Language. It was the first of its kind in a very long time, and it's been really inspiring to see how Menstar health is committed to helping make this information accessible to the over 20,000 Washingtonians who utilize ASL as their primary form of communication.
>> Speaker A:Thank you for partnering with us on those. I should mention here that listeners can see the CPR training videos that Jude did, including the one in American Sign Language online. By going to medstarhealth.org backslash CPR, you can learn what's new in CPR training or just refresh your skills. Jude, have you ever had to administer CPR?
>> Speaker C:I haven't had to use CPR, but I do know that the likelihood of using CPR is pretty high in that most people have to do it to someone that they know. And so it's really important to me personally to make sure that I'm informed and to also help other people be informed.
>> Speaker A:Really important, because CPR actually has changed through the years.
>> Speaker C:We don't do the rescue breaths anymore. So hands only CPR is the preferred form of CPR, which is nice, I think, in a post Covid world where people don't necessarily feel comfortable breathing into somebody else's mouth.
>> Speaker A:you were 16 when you first experienced a cardiac event. Did you have an underlying condition at the time?
>> Speaker C:so I was 16 when I had my first episode, and before I turned 18, I had my six. And it wasn't something that was running in my family. It wasn't something that I'd had an issue with before. with a lot of studying and with a lot of testing, we realized that this is something that I did have. And then it was a condition that was already extant in my body. But it wasn't until I had, an issue that we really determined that was a problem for me. And so that's why I think that being really on top of your heart health is so important, because a lot of the time, we don't realize that these issues are existing until it's already become a problem.
>> Speaker A:So when we talk about someone who is 16 having a heart attack, Dr. Sreeche, is that still in the category of young people having heart disease, or is that more of a pediatric case? What's the age range of those you would consider to be a young patient having heart disease?
>> Speaker B:So you're right. Usually patients who are under the age of 20, we think of pediatric, cardiologists taking care of those patients, as opposed to adult cardiologists, pediatric cardiologists, more focused on congenital heart disease. So things that affect your heart that you were born with and cause symptoms, usually throughout the development period. When we think of adult heart disease, we think more of things like coronary artery disease, heart failure that affects the blood vessels, that usually takes a bit of time to develop and manifest. And so a 16 year old, you're right, we don't think of, having an adult type of heart disease in that sense. When we think of young adults with heart disease, and again, the main one being coronary artery disease or plaque build up in the heart arteries, we think of somebody that's less than 40 years of age, but generally not less than 20. That's pretty young.
>> Speaker A:That's highly unusual. Would it be for the same reason then?
>> Speaker B:It could be, but it'd be very rare. For the type of disease that we see in adults, that is mainly the buildup of plaque due to, lipids in the body that then deposit and cause narrowing in the heart arteries. That's the more typical type of coronary artery disease, heart disease that causes heart attacks that we see in adult patients, and again, patients that are under 20, that would be very, very rare to see. Jude did not have that kind of heart disease. She had, an underlying condition that was not related to plaque buildup at all. So a little bit different flavor, but the result is that it did cause narrowing in her art arteries, but a different pathophysiology, mainly because of her younger age doctors.
>> Speaker A:Is myocardial infarction the same as a cardiac arrest, and is that the same as a heart attack? Is it just a matter of interchanging the names? What's actually happening in the body when these events occur?
>> Speaker B:So I like to think of it as what's the underlying pathophysiology that's causing the process? When we say cardiac arrest, we say that there is decreased blood flow to the heart, for whatever reason, that's causing the heart to not work well to get enough blood to the rest of the body. That can be due to a number of different factors. Heart attacks are one of the things that can cause it. Another condition could be your heart just goes out of rhythm. That's a little complicated, because that can be from a heart attack, but it can be from something different. It can be a primary rhythm abnormality. So they are distinct in that sense. When we say heart attack, we usually are referring to a myocardial infarction. So those two terms, can be used semi interchangeably. I think heart attack is the more, colloquial term and myocardial infarction is the more scientific term. But either way, it means that there is decreased blood flow to the heart muscle that's causing, the muscle to suffer and can die off.
>> Speaker A:So what are the symptoms? What might raise a flag as a cardiac arrest?
>> Speaker B:A cardiac arrest is when there's suddenly loss of blood flow to the rest of the body. That then causes, usually a person to pass out because there's no blood going to the brain or to the rest of the body, or to the heart muscle. And it can be due from a myocardial infarction. But we can have myocardial infarctions that don't cause cardiac arrests, but that cause symptoms ahead of time that are different and usually related to, again, that poor blood flow to the heart muscle. That can lead to symptoms that we normally hear about. Chest discomfort, shortness of breath, feeling dizzy, diaphragm. Sorry, dizzy, sweating, or just feeling like your heart's racing. Those are kind of some of the symptoms that we talk about. That could be a sign that you're having poor blood flow to the heart muscle. And then the sequelae of that, if you don't act on it, is you could end up then having a cardiac arrest.
>> Speaker A:Jude, did you have those symptoms?
>> Speaker D:Yeah.
>> Speaker C:So when I was having my first heart attack, I was on a six mile run in, around mile three, I started having chest pains. I felt like I was breathing through a straw, I was profviously sweating, I had pain in my left shoulder, I was dizzy, and I was nauseous. And so I know that the symptoms, that way that they manifest in women is different than the way that they manifest in men, but those are the ones that I had, and those are pretty common for women.
>> Speaker A:Did you pass out?
>> Speaker C:No, I stayed conscious. I actually ended up running back to my school for help, which was a mistake. Definitely don't do that. Definitely stop and call 911 immediately if you're experiencing symptoms. But I was 16 and a little bit less informed than I am now.
>> Speaker A:How did you find out that you were having a heart attack?
>> Speaker C:I went to the hospital. They didn't have pediatrics. They did a full cardiac workup on me as they would for an adult, and they realized that my enzyme levels were really high. And just with all the testing, they determined that it was a heart attack.
>> Speaker A:So I had a weird experience when I was in high school, too. I'm 17, same symptoms, chest pain, actually, it started in my upper back. The sweating, nausea, passed out, couldn't speak, couldn't get, my breath. When I came to tingling down my right side. And they told my parents that I had a heart attack. I followed up with an internist who found that I had a mitral valve prolapse. Okay, fast forward 30 some years. And I wanted to get, a membership at the fitness center. And they had me do a physical, probably the first time since then that I had a full cardiac workup. And they said, you didn't have a heart attack. Now, they made that diagnosis based on some imaging. Can they tell? How can you tell with imaging if someone has had a heart attack or not?
>> Speaker B:So, as Jude was mentioning, we diagnosed a heart attack, or I'd say, injury to the heart muscle by looking at lab tests, looking at the enzymes she mentioned. The troponin value is the most common one used, and it's gotten more sensitive over the years. So back 30 years ago, it was not as sensitive as it is now for determining that there's been some damage to the heart muscle imaging tests. EKG is the more common one that we do when you present, and it can show signs that there is some, injury going on to the heart muscle. And if we manage to treat it right away, we can abort a heart attack. So prevent the development of these enzymes from showing up in your bloodstream. If we don't abort it, though, imaging tests that then can show whether there's been a heart attack or not would be the gold standard is a cardiac MRI to look for fibrosis in the heart muscle. Back 30 years ago, we looked for things like wall motion abnormalities on the echocardiogram. So areas of the heart muscle that don't work as well or don't contract as well as the other areas, or that might be, we say, stunned. So, in other words, all of your heart muscle should be contracting at the same level, and there might be an area that's not getting enough blood flow that isn't contracting as well as the other areas. And that could be a sign of a heart attack, or it could be a sign of. The other term we use is like ischemia or stunning, meaning something's happened where it's not working well, but it has the potential that it could recover. My guess is that in your case, because you were told you had a heart attack back then and then later told that you did not have a heart attack, was that you may have had something we call myocardial stunning. So something happened that caused some portion of your heart muscle to not work as well, but that with time, it recovered function. I don't know if you've ever had any definitive imaging to look to see if you have any fibrosis in the heart muscle. but an cardiac MRI, as I mentioned, is a test that can look for actual scar tissue in the heart muscle and tell for sure how much was affected, if there was any damage to the heart muscle itself.
>> Speaker A:By the way, sometimes I forget how old I am. It was actually more than 40. It was more like 40 years ago. I just forget how old I am. Did you have, the similar experience when you had your subsequent heart attacks? And is she at risk now? Yeah.
>> Speaker C:So I had the very similar symptoms. All of my episodes were while I was running, so it was all tied to exercise. I went through a lot of stress testing, and I had the MRI and a lot of blood tests and ekgs and all of that good stuff. And so all of my symptoms presented the same way, though, every time.
>> Speaker B:So she had signs that the heart muscle was probably not getting enough blood flow, but not to the extent that it was causing, actual scar tissue formation in the heart muscle. And so because of the underlying process, pathophysiology in her disease process, again, she doesn't have blockages, but she has what's something we call coronary vasospasm, where the vessels can clamp down suddenly, but then they open up, and so you don't see anything kind of long lasting in terms of narrowings, but during the time when it's clamping down, the blood flow to that area of the heart muscle is diminished. And that probably reflects the types of symptoms that she was having. But lucky for her, it wasn't long lasting in terms of staying closed, long enough to where it was causing actual damage that you can see on an imaging study. So her heart function is normal, she's able to exercise to the same extent that she was, except counting for getting older. and we didn't see any long lasting kind of damage in her heart muscle.
>> Speaker A:Good for you.
>> Speaker D:Yeah.
>> Speaker C:I'm glad that I have good doctors here to, make sure that I can still do this if I love.
>> Speaker A:But someone in their twenty s, thirty s, or even their 40s would find it very easy to dismiss the symptoms if they were having a heart attack or having some kind of cardiac event. Right. Dr. Jean, what is your recommendation for someone who's relatively young having symptoms? When is it a, 911? When do we dismiss the possibility of it just being indigestion.
>> Speaker D:Thanks so much for having me on today. The key is, if you feel something is know, let us be the providers and decide what it know. I do find many times my patients kind of go through in their head. Should I go? Should I not? Is it panic attack? And that can, unfortunately, lead to bad outcomes if, there is a significant delay. as stated by Dr. Sri Chai, thankfully, the rates overall of a heart attack is lower in younger individuals. But more recent studies are showing higher rates of heart attacks and death, particularly in young women. And this seems to be driven by risk factors, because we're seeing higher rates of obesity, high blood pressure, diabetes, as well as smoking. And, of course, for some patients, family history may play a critical role, and other habits, such as substance uses, including cocaine, unfortunately, can also increase the risk. And so if you're having any of the, typical signs of the chest pain, neck pain, jaw pain, discomfort, or associated shortness of breath and you just aren't sure, it's always best to call 911, go to the emergency room, and let the healthcare team come up with the correct diagnosis.
>> Speaker A:Yeah, I'm glad that you raised that, because statistics do show that there's a greater increase in the prevalence of heart disease in young women than in young men, but also that women are more often, african american or of color.
>> Speaker D:Yeah. Unfortunately, current studies do show ages of 20 and above 45% of women have some form of cardiovascular disease. And unfortunately, in black women, that number is at 59%. So there are important health care disparities, and a big part of it is driven by social determinants of health. Things that we talk about, where you live, where you work, where you play, where you learn, has tremendous impact on our health outcome, and in particular, for black women, that's driven by socioeconomic, environmental, and structural racism, that can significantly increase the risk for premature heart disease. And so I'm glad that Judith has been doing her awareness and letting us know that these are real issues and to not be dismissive of your symptoms, because it can be you. And the data is showing that the rates are increasing.
>> Speaker A:I also read, too, that being young does not necessarily serve as an advantage in the recovery once someone has had a heart attack. Patients in their 20s or 30s face the same risks as older patients once they've survived one.
>> Speaker B:The number of heart cells we have doesn't really change throughout life. So I think once you're born, everyone's born with a certain number of heart cells. And through puberty, the male hearts get larger than the female hearts, but that's only because the cells get bigger, not that you have more cells. And so there's no increased, like, turnover. And so those are your cells for life. And regardless of whether you damage them at 30 versus damage them at 60, you're not getting more cells. And so that, probably, my guess, reflects why the outcomes are similar in terms of after you've had a heart attack and then the events that you may experience. Now, older patients tend to have more risk factors, but we're seeing an increase, as, Dr. Jean had mentioned, in risk factors in the younger population, too. And so that also plays a role in terms of the outcomes as well. I don't know if you wanted to add to that, Dr. Jean.
>> Speaker D:Yes. time is muscle, and so that's why we tell patients if you're having any symptoms, that you please seek medical evaluation. And unfortunately, we do know in the literature that women are more likely to wait. so there is a delay in presentation, and there are inherent implicit bias in sort of the assessment, which can lead to further delay in both the diagnosis and referral for more advanced testing.
>> Speaker A:Okay, let's talk about the risks. True or false, if you have diabetes, you're two to four times more likely to die from heart disease compared to adults who don't have diabetes.
>> Speaker B:Well, diabetes is, an inflammatory condition that affects all the blood vessels, and it is a pretty significant risk factor for underlying heart disease, much to the extent that if you have diabetes, our prevention guidelines already recommend that you actively treat, patients for heart disease with the use of statins.
>> Speaker A:It is true, according to the American Heart association, two to four times more likely to die from heart disease if you have diabetes.
>> Speaker C:Exactly.
>> Speaker D:And unfortunately, with diabetes, it is one of the conditions that actually has a greater impact on women compared to men. And there's multiple reasons for it, but probably because our arteries were smaller compared to men and are a little bit more prone to the impact of diabetes and both clogging up the big arteries and the smaller artery. And so if you know someone or personally have diabetes, it's so important to know your numbers and to get the regular follow up, and treatment of your diabetes to make sure that all of your numbers are within appropriate range.
>> Speaker A:In the same way, heart attacks among young people are trending, statistically, so, too, is the incidence of hypertension or high blood pressure. It's rising faster in younger adults than in older adults. Why is that?
>> Speaker D:Again, a big part of it is just being, driven by risk factors, especially during a pandemic, for example, a lot of individuals have had flexibility to work from home, but then that can translate into just not being as physically active during the day or just the excess stress that many of my patients have been under over the past several years, that they're seeing higher rates of blood pressure. And so it really is important that as we're sort of getting older, that you one, get your regular checkup and assessment of your blood pressure to know what your numbers are, but to continue to engage in healthy lifestyle, eating a healthy diet, that's particularly low in sodium, as well as managing your stress and sleeping that seven to 9 hours.
>> Speaker B:I think one other point that we could bring up is substance abuse and vaping in particular in the younger population. that tends to constrict the blood vessels and lead to increase in blood pressure. in addition, I think younger patients probably are just not as treated as aggressively as older patients for their hypertension. in fact, I think the new guidelines suggest you should be keeping the blood pressure less than 130 over 80 for younger patients, compared to our usual standard of 140 over 90 for the older patients. Mainly because it's a lifetime, you're being affected by this on a lifetime. And I think we're just not as aggressive with younger patients in terms of, starting them on medications and, getting their blood pressure down, getting their numbers under controlled. And I think one of the studies have shown, like, even though, diabetes, I think in this age group may have flattened or not significantly increased, the number of patients that are actually at their goal or where they should be is only like 50%. So we're just not being aggressive. We think we'll tell them to exercise more and adopt a heart healthy diet, decrease salt. I think it's harder for younger patients to do that. And, hypertension isn't something that most patients have symptoms related to. a lot of the younger patients don't even seek medical attention to get their blood pressure even checked.
>> Speaker A:What will it take for the industry to change those guidelines? Experts are calling that what you just described, silent atherosclerosis, as a means to drive the change to address hypertension, high cholesterol earlier in life. What will it take for that to happen?
>> Speaker B:Let me go to Jude as being part of that population. What do you think? Because, you're closer to other people that other young adults, I should say, and what do you think will take it? I mean, I understand you've had personally been affected by heart disease. So how do you make your other colleagues aware you don't have hypertension, right?
>> Speaker A:You don't have, well, high cholesterol.
>> Speaker C:High cholesterol and high blood pressure does run in my family. On my dad's side, those are two things that he has. And so I think, I didn't really think about that. Even being someone who had a preexisting condition, I didn't think about necessarily maybe the diet piece as much because I was a division one athlete, I was eating pretty well. I was moving my body regularly. But the reality is, I've found that, especially now that I'm not a competitive athlete. In conversations that I've had with Dr. Srishai, the reality is that we view this. I think younger people view this as an older person's disease, but it becomes an older person's disease because you don't take it seriously when you're young. And so my message has been to my peers and to people who are in that age range of just, like, not necessarily considering our cardiovascular health as, seriously or not making it a priority, is that the reality is this becomes an older person's problem because we don't take it seriously in our youth. And so I think that having conversations about it, trying to break the stigma of what heart disease looks like, when people think about heart disease, it's often not people who are young that come to mind. It's not people who are healthy or doing all the right things. We think. We think of it as something that is a product of poor decision making over time. But the reality is, if we don't make those good choices now, it's going to be our issue later. And so, for me, I've been really open about my history with heart disease, the choices that I make now to try to make it not an issue for me later. And I think that the more we talk about it, hopefully the more young people will catch on. I do think that my generation is one that really cares about holistic wellness. I think when you go on social media, it's pretty normal to see people talking about what they eat or how they move their body during the day or stress management piece. And so I hope that it becomes something that's not just a trend online, but it's something that's really lived out in people's daily lives. And so, for know, I just talk about it, and I hope that me sharing my story and raising that awareness that this is a younger person's problem will make it something that people really act on.
>> Speaker A:When you go out as Miss DC and you share your story, what's the feedback that you get from young people?
>> Speaker C:Oftentimes times I've heard a lot of people say, oh, you know, I had chest pains, but I thought it was just stress, or I thought it was just a panic attack or whatever. And so I think it's been really positive for me to see people reaching out and saying, hey, I heard your story on the news, and something really similar happened to me a couple of years ago. what do you think I should do? And I'm like, you should definitely go see someone. Go to Medstar Health, go see one of the great cardiologists there, because I found that making this a really large part of my life is making me just healthier long term. And I hope that other people get that out of this, too.
>> Speaker A:Should they go see a cardiologist if they have chest pains, or is the primary care physician enough, or should they go to an emergency department?
>> Speaker B:So I think we're talking about two kind of, distinct but related issues. So one is the acute setting. So in patients who are having symptoms that could be relatable to heart disease, could start with your primary care doctor. But a cardiologist has more experience in, teasing out whether your symptoms might be related to the heart or not. And then the other key aspect, I think, is the prevention aspect. So a lot of times I see patients coming to me, and they're coming to me at 40 because their father had a heart attack at 40, or their mother had something at 40. And I think what Jude said is very important, because the reason they had it when they're 40 is because of all the things they did when they were in their twenty s and thirty s. And so you have a fresh, clean heart. let's prevent it from getting that way at 40. But when you come to me at 40 and you haven't been seeing, your doctor regularly before that, to get your blood pressure checked, to get you to know your numbers, the preventive aspect is very important. And I think I'll give you an example. My sister, who's had always borderline elevated cholesterol, and my mom's getting followed up for a dilated aorta. I happened to do a scan on my mom, and I was like, oh, my gosh, mom, you have so much plaque all over your arteries. And my sister, for whatever reason, was undergoing a cardiac evaluation, but she decided this was a changer. She's like, I don't want to have the arteries that my mom has, and my arteries right now are nice and clean and fresh. I'm going to do whatever I can, adjust my diet, exercise regularly, do whatever I can to get my cholesterol down so that I don't end up with my mom's arteries. and I think we relate to our family. We relate to, our parents. And knowing, though, that things you're doing now as a young adult definitely have an impact to change how your outcome is going to be. So you don't have to be 40 and worry that you're going to have a heart attack like your father because you did different things to prevent that.
>> Speaker D:Did her pain also go ahead, Dr. Jean? No, I was going to say, I would also add, part of this conversation being so important is because we are also seeing higher rates on young women as it relates to their reproductive years. Going into your pregnancy with high blood pressure, with diabetes or BCA, high cholesterol can actually impact your pregnancy outcomes, because we are, unfortunately, seeing higher rates of either development of high blood pressure or worsening high blood pressure during pregnancy, which can lead to a serious condition called preclampsia that can increase the risk for seizures and other negative outcomes for both the baby and mom, and as well as higher rates of diabetes. And why it's really important to have these checks done before getting pregnant is because we're finding that pregnancy can be sort of the window into your future brain and heart health, and that women who've experienced any of these adverse pregnancy outcomes, again, preeclampsia, high blood pressure, or diabetes, are at double the risk for having heart disease and stroke and at a much earlier age. And that when we've done scanning in these women in their 40s, we're seeing evidence of hardening of the arteries that are much more compared to if they did not have these conditions. So I'm really thankful to Jude for continuing to raise the awareness in this important topic, because the more that we can get women in sooner to get their blood pressure checked, get their cholesterol checked, get their blood sugar checked, they can hopefully go into pregnancy healthier, and we can start to make a better dent and to lower some of the rising rates that we're seeing in pregnancy and the adverse, outcomes.
>> Speaker A:what are your top tips, then, for keeping your blood pressure down?
>> Speaker D:Yeah, I mean, the good news is that 80%, right, 80% of, cardiovascular disease, including hypertension, can be reduced with a healthy lifestyle. So that does include maintaining healthy weight, limiting your alcohol intake, and definitely not smoking any sort of nicotine products. But you want to stay active. The goal would be at least, 30 minutes a day of some sort of physical activity where you're getting your heart rate up and hopefully breaking some sweat, and as well as at least two days a week of, strength training, healthy diet, avoiding the processed foods and a red meat. And I can't emphasize enough managing your stress and getting your sleep seven to 9 hours to help lower your blood pressure as well.
>> Speaker B:I would totally agree with what Dr. Jean said, though, and particularly for younger patients adhering to that, so that we can reduce the risk that you're going to have, heart disease early and late in life. And then I think the other thing is that there are some patients that lifestyle is not going to be the only thing to get you there. And especially if you have a strong family history of heart disease, then we start moving towards medications and to not necessarily be scared of medications, because I know a lot of patients don't want to take medications. But if you're not able to reach your numbers with the lifestyle changes, then I think we move on to medications.
>> Speaker A:What about low blood pressure? Are there any heart health risks related to low blood pressure?
>> Speaker B:If your blood pressure is too low, then it can decrease blood flow to all of your organs, including the heart, and you can become symptomatic.
>> Speaker A:But someone who routinely has low blood pressure when they get it checked, if.
>> Speaker B:They'Re not having symptoms related to the low blood pressure, it's fine.
>> Speaker A:Okay, switching gears for a minute, let's talk real quickly about, ineffective endocarditis, which develops after bacteria enters the bloodstream and settles in the heart lining. Just because I read that endocarditis has declined in most adults across the United States, but it has risen among those 25 to 44. What is going on? That sounds very scary.
>> Speaker B:you're right that overall, the numbers have been going down for endocarditis. infective endocarditis, meaning an infection within your bloodstream that's attacking the. Usually we say, usually it's on the heart valves, but it can be anywhere in the heart tissue. And although the numbers have been going down overall, when you break it down by age group, we actually see an increase in the younger population. It's a little bit unclear. What's the driving force there. A lot of it's thought to be related to substance abuse in the younger population. We're still trying to understand the risk factors that are associated with it, and particularly in that younger group. And there's an association with substance abuse and increased risks. So if that is a driving force, then decreasing, particularly intravenous drug use. But oftentimes they go a little bit hand in hand with other substance abuse use.
>> Speaker A:Okay, vaping, cigarettes, the legalization of marijuana, could these have a factor on the rising numbers of cardiac deaths in young people?
>> Speaker B:Absolutely. I think we talked about a little bit about the risk factors in young patients and how there's an increase in the, different risk factors. And we know that vaping, even though it's not as bad as tobacco use, as cigarette smoking itself, does increase the heart rate, causes the blood vessels to constrict more. So it can be associated with increased blood pressure changes. And that, in itself could be related to why we're seeing the increased number of cardiac deaths in this young population, where we know vaping is occurring more frequently.
>> Speaker A:Okay, so what's the most important thing that you hope people take away from this podcast today?
>> Speaker B:I think just an awareness that, heart disease is one the leading cause of, morbidity and mortality, and that it affects not just older patients, but younger patients, and that there's a lot you can do to prevent developing heart disease, either as a young patient or as your parents did as an older adult, with things that you do to control your numbers, preventing diabetes, preventing obesity, not vaping, not smoking. And I think, as we just mentioned, the healthy lifestyle changes and exercise.
>> Speaker A:Anything to add, Dr. Jean?
>> Speaker D:I mean, I agree with Dr. Shu chai as, know, just remembering one in three. One in three women will die from cardiovascular disease, and that's either stroke or a heart attack. And that could be our mom, your sister, your loved ones. And so please continue to share this information with others, because knowledge is power, and hopefully this will help women be better advocates for themselves.
>> Speaker A:Jude, any thoughts?
>> Speaker C:Yeah. And finally, I would say, know the symptoms and know the signs and take them very seriously. Too often, women especially, and young people kind of brush it off and think that we're invincible or that it can't be us. But the reality is, it was me at 16, so it can really be anybody.
>> Speaker A:Dr. Srichai, how many patients have you treated who have had heart attacks and later said that they'd let it go? They had symptoms that they ignored because they didn't want to be a hypochondriac or they didn't want to go to the ED just to be sent home with.
>> Speaker B:I've had patients come in and apologize for their appointment because they think they're wasting my time. And I said, no, you're not wasting my time. You know, your body the best you know, when something's not right and feels off. And, it's up to me to kind of decide, could this be related to your heart or not? And to work with you on figuring out what's going on. I can't put a number on it.
>> Speaker A:But countless times, important message, let that be our closing thought that you know your body, have it checked out. Thank you.
>> Speaker C:I was impressed. I don't know, I've eat a lot of doctors and they're just like, big words, big words. And I'm like, that's cool, but what does that mean for real people?
>> Speaker A:Well, thank you for giving a voice to that. Yes, you've played an important role in that. And thank you for choosing heart health as your platform.
>> Speaker C:Ah, chose me, man.
>> Speaker B:I would have chosen, like, animals or something.
>> Speaker A:Believe me, something a little more sexy. Thank you all. We've been talking with Dr. Barbara Srijai and Dr. Estelle Jean of the Medstar Heart and Vascular Institute and M miss district of Kulum TH 2023 Jude Mabene for more information on heart health and heart disease, go to medstarhealth.org mhvi. Close.