Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast bringing you access to leading doctors who answer your questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. I'm your host, Maggie McKay. Today, we're speaking with Dr.

Courtney Foxwell, a cardiologist who has an interest in women's health and specifically cardiac care for pregnant patients. Dr. Foxwell, welcome. It's so good to have you here.

Courtnay Foxwell, DO: Thank you. Appreciate it

Maggie McKay (Host): This is such an interesting topic. To start with, I imagine it could be scary to navigate a pregnancy while managing other health conditions. So how do you reassure a patient who is pregnant and has a heart condition?

Courtnay Foxwell, DO: Yeah. So one of the things that, and honestly why we created this niche in cardiology, is that we are having, you know, patients get pregnant later in life. So essentially, they're going to have more, acquired heart disease at that point. And probably we just are doing a much better job of taking care of, you know, children who are born with congenital heart disease so that they're living into reproductive age.

So obviously, we have a need to take care of people who have heart disease and when they're pregnant. Biggest thing I always tell my patients is, you know, following closely with a cardiologist, you know, a high-risk OB and then your regular OB is really gonna be the best, most comprehensive care that you can get while you're pregnant We know that just keeping a closer eye, more frequent appointments between all of our specialties will certainly lead to more successful pregnancy and obviously, you know, a healthy baby that, you know, as best as we possibly can, and healthy mom.

So that's typically what I try to start off with when I talk to them.

Maggie McKay (Host): So for women who want to become pregnant and they know they have a heart condition, what's your advice to them?

Courtnay Foxwell, DO: So biggest thing is preconception counseling. We wanna make sure that you're getting in with your OB and letting them know this is something that you're interested in doing and, and then getting in with cardiology itself because, you know, there are a subset of patients who are quite a bit of risk.

They're very high risk, that sometimes it actually isn't recommended to get pregnant. And obviously we, you know, value and respect patients' decisions on, on how they want to live their life. But at least for them to know, you know, if they do end up pregnant and they have a significant cardiac condition, what does that look like for them, you know, outcomes-wise and how, you know, do they need to be diligent or not?

Is that something that they're willing to risk themselves for? So, and, and I think everybody should have that decision if they wanna do that or not. But all those conversations are so much more important to have before you're pregnant than if you, you know, come in while you are pregnant. And, you know, certainly we still care for you either way, but at least then it makes you have the most informed decision

Maggie McKay (Host): And do you also see women who become pregnant and then later learn they have a heart condition?

Courtnay Foxwell, DO: Yeah, absolutely. So we kind of see pretty much everybody at all stages There are many times when patients don't necessarily know they have a cardiac condition until they're pregnant because there's so many changes to your cardiovascular system while you're pregnant that sometimes these, cardiac conditions don't show themselves until you are pregnant because it's a lot of stress on your body. So we certainly see that. And then, you know, preeclampsia itself, you know, hypertension in pregnancy, those kinds of things obviously don't present until you're pregnant, so we see them as well

Maggie McKay (Host): And what are some common heart conditions that you treat that pregnant women may face?

Courtnay Foxwell, DO: Again, preeclampsia, hypertension, probably my most common conditions. And then on top of it, there's also patients who have valve disorders, so, you know, maybe a leaky valve, like a aortic valve or mitral valve, or maybe stiff heart valves. We'd have some patients with that Some people have heart disease or actually have heart blockages.

They've had stents in the past. It's not common certainly in, in patients that are younger, but it does happen. So we manage those patients as well, or patients who have had heart conditions when they were born and they're now, like maybe they had a valve replacement or some sort of congenital surgery and now they're pregnant and we're, we, you know, care for them Most common would be hypertension. And then on top of it, anybody who has, something called SVT, supraventricular tachycardia. So that's just a, a tachycardia coming from the top chambers of the heart. It's fairly common of an arrhythmia to see in patients who are younger

Maggie McKay (Host): And how do you collaborate with other specialists, such as OB-GYNs, on caring for women who are pregnant?

Courtnay Foxwell, DO: So ACC, the American College of Cardiology, that's kind of the, one of the big governing bodies for cardiology, created a really great document about, you know, cardio obstetrics and, and care of a pregnant patient. And so one of the things that they really try to hone in on is, you know, team-based care And the biggest thing is obviously very good collaboration with your, maternal fetal medicine, your high-risk OBs, your general OBs. Cardiac anesthesia should be involved as well because certainly the patients that have cardiac conditions and maybe need an epidural, is that safe for them? You know, or do they need something more? So it's, it's a really good comprehensive on top of obviously the regular OB. So coordinating between all of them can be tough of course.

but typically, and I know high risk, OB already does this, is they will have sort of a powwow or a conference, and they talk about every patient and, and kind of, you know, how they're doing and what's our, our plan for delivery and, you know, what kinds of things could we, you know, potentially deal with or, or, you know, what are some of the things that we want to anticipate in, in order to be prepared.

So I guess at this point, really, I just, I have all of their numbers and I call them if I have any questions or need to talk to them about a patient.

Maggie McKay (Host): That's great. When it comes to deliveries, how do you work together to ensure safety for mom and baby?

Courtnay Foxwell, DO: Biggest thing is coming up with a really solid care plan Obviously, I'm cardiology, so majority of the plan is gonna be coming from the obstetrical side and coming from, you know, obviously the, the, the general OB and then the high-risk OB I always like to come up with, if this happens, we need to do this, or we need this specific type of monitoring based on each patient's cardiac condition.

so I think really the biggest thing is just making sure we have everything spelled out so that no matter when, because we know that, and, I know every female knows this who's been pregnant, you can't really anticipate when you're gonna go into labor. So having a really good solid plan in place that's well-documented, so whoever, because we know it can happen whenever, so whoever comes in contact with that patient when they come into the hospital or, you know, I guess certainly if you're doing an induction, but, you know, say they have spontaneous labor, that there is a good plan in place that everybody can follow and be on the same page.

So I think that's really important. Also gives providers who are seeing the patient a, a good peace of mind as well that they have already-- the patient's already been established and gotten testing done, and we know where they're at from their cardiac condition and what is safe and, and how do we wanna, you know, monitor them while they're in labor.

Maggie McKay (Host): I know that men and women don't always experience heart issues the same ways. So what are some general signs that women should not ignore that should prompt a visit to their care provider?

Courtnay Foxwell, DO: Yeah, absolutely One of the things that I always tell my pregnant patients specifically too, because this is something that I think we really struggle with in, in pregnancy, is symptoms that typically gets told to you that this is just preg- you're just because you're pregnant. You know, you, you have swollen legs because you're pregnant, or you're short of breath because you're pregnant. I always worry that we're going to miss things because we're just chalking every symptom up to pregnancy. And I'm, I'm sure OB probably has the same worry that I do, you know, for pregnant patients as well. so I always try to tell them, you know, if there's anything out of the abnormal, even if it's overly cautious, I would rather look into it, especially if we already know that you baseline have a cardiac condition.

I would rather do extra testing, because typically, you know, obviously we're always gonna be doing testing that's safe for baby. I would much rather do extra testing and be safe than certainly miss something and, and, you know, have a really poor outcome. And then in general, of course, just I always tell my female patients who, you know, my non-pregnant female patients, females typically don't present like males when it comes to, for example, like heart disease, like heart attacks.

So things that I always tell them to look out for is I want you to be notifying us if there's any pain, does not necessarily have to be chest pain, that you notice that's a- associated with exerting yourself and gets better with rest. That's always concerning for a potential heart blockage. Symptoms like acid reflux that just won't go away despite you've taken, you know, everything over the counter. I have some females where they just get pain down their arm, and they never actually got chest pain or just jaw pain. So typically, the symptoms are not gonna be what you would think of and a lot of times can get ignored. Or even I've-- I have some patients that have had, you know, nausea and vomiting, which these are all really tough things to kind of tease out because they can be quite vague and mean something else certainly.

but, you know, always to have kind of this in the back of your mind. And at the end of the day, I always tell them, "You know yourself, you know your body. If this is something that is abnormal for you and you're worried about it, let us know." I would rather us be safe than sorry.

Maggie McKay (Host): Absolutely. As we wrap up our conversation, I would just love to know what drew you to this specialty

Courtnay Foxwell, DO: So kind of funny, I actually, in undergrad, I-- my major was cardiac rehab, so I- I, you know, I studied to be an exercise physiologist, so that's somebody who just, puts the patients on the treadmill and, and gets them through the stress test portion of their, you know, cardiac care. So th- I kind of started out with that, and then when I went to medical school, I actually tried really hard to keep an open mind to other specialties, but, certainly I still ended up in cardiology.

So here we are.

Maggie McKay (Host): That's awesome. Well, thank you so much for sharing your expertise and experience today. This has been so informative, and we really appreciate your time

Courtnay Foxwell, DO: Thank you. I appreciate it

Maggie McKay (Host): Again, that's Dr. Courtney Foxwell. To find a physician, visit novanthealth.org. For more health and wellness information from our experts, visit healthyheadlines.org