Maggie McKay (Host): When it comes to women's health, many of us put ourselves last, but when it deals with heart disease, we need to pay attention. Today, we'll find out what you need to know with Family Medicine Physician, Dr. Crystal Hines-Mays at Silver Cross Medical Group in Homer Glen. Welcome to Silver Cross Hospital's IMatter Health Podcast, where medical experts bring you the latest information on health topics that matter most to you and your family.

I'm your host, Maggie McKay. Welcome, Dr. Hines-Mays.

Crystal Hines-Mays, MD: Thank you. Thank you. Thank you.

Host: Yes, well, let's dive right in and start with, what are some common misconceptions about heart disease in women?

Crystal Hines-Mays, MD: Yes. A prevalent misconception is that heart disease primarily affects men. But in reality, over 60 million women, that's 44 percent of the United States living women are having some form of heart disease. This consists of coronary artery disease, which are the arteries around the heart, arrhythmias to the heart, which are abnormal heartbeats or congestive heart failure.

This misunderstanding can lead to this underestimation of personal risk, delayed preventative care, and overlooking their symptoms, ultimately increasing their likelihood of adverse outcomes.  

Host: So, how can we help women better understand their unique risk factors?

Crystal Hines-Mays, MD: The way that we can assist women with understanding their unique risk factors is through our conversations and education. Common risk factors, some common risk factors for heart disease are hypertension, which is high blood pressure, high cholesterol, obesity and a sedentary lifestyle. There are some unique concerns additionally for women such as preeclampsia during pregnancy. This is when women have very high blood pressures during pregnancy and then also menopause. As women, as they age, they lose their amount of estrogen, which then increases their chances for heart disease. Some autoimmune disorders that women can learn about, such as lupus and rheumatoid arthritis, also increase their chances of heart disease.

So, our goal is to educate women through our conversations in the office and then also locally.

Host: Isn't it enough that we have to go through menopause, let alone add a heart risk factor to it? That just does not seem fair. And childbirth to boot. What about hereditary issues? Like, if both your parents had heart attacks?

Crystal Hines-Mays, MD: Absolutely. So during our conversation in the office, when patients come in to meet their primary care physician, it's very important to be very candid with the primary care doctor and let them know as much as possible about one, their past medical history in addition to their family history. Because a lot of times we learn through our family that we are at increased risk for heart disease. However, we're going to discuss some things about that that can modify our risk.

Host: Let's talk about that. What are some key lifestyle changes that women can make to lower their risk of heart disease?

Crystal Hines-Mays, MD: Education is very important. So understanding what heart disease is, understanding what cardiovascular disease, understanding about arrhythmias are very important. So some things that women can do to change the outcome and prevent heart disease or decrease the chances of the negative outcomes are try and maintain a healthy lifestyle.

If you're overweight, our goal is to help you to reduce weight through healthy diet and exercise. If your blood pressures are high, learning how to check your blood pressures at home, learning some foods that will decrease your blood pressures or your chances of having hypertension, which is high blood pressure, will help as well. And also foods that will help to lower the risk of having high cholesterol. In addition to that, we like to encourage patients to do about 150 minutes of exercise a week. That's about 30 minutes. And truly, just getting out to have a nice walk either before work or after work to help reduce your stress also helps your heart.

Eating healthy, we mentioned fruits, cruciferous vegetables. I love saying that word cruciferous vegetables. So we're talking about green leafy vegetables, cauliflower, broccoli, things of that nature and lean pieces of meat, pulling away from that red meat, but pushing in on chicken and turkey and also our oily fishes such as salmon. If women smoke cigarettes, we encourage them to stop smoking cigarettes, because the nicotine in the product will actually induce heart disease. And most importantly, things that are not discussed quite frequently in the office, but affect us all, is stress.

So we encourage patients again to be very candid, to have that partnership with their physician, to talk about things that matter to their mind,which can matter to their heart. So we want them to be very mindful, practice meditation, yoga, journaling, and also if they need to visit a therapist to tap in their resources to use a therapist in order to help manage stress.

Host: Dr. Hines-Mays, all those are great suggestions. What if somebody is overwhelmed and they don't know where to start? What is a good starting point for making these changes? Like if you had to start with one or two, what would you recommend?

Crystal Hines-Mays, MD: Small steps lead to great changes. So first things first. Again, talking to their primary care doctor, going into the doctor and getting an assessment, looking at your blood pressure, looking at some of your risk factors, being very aware and candid about your personal and your family history. So biggest things that we can do is to change our mind. Change our mind about how we see ourself and where we'd like to advance for our future in terms of our mental and physical health. So number one, visit the doctor. Number two, it's the lifestyle change that we have to go after. If you're used to eating processed foods or fast foods, it's time to push in with again, those cruciferous vegetables, lean pieces of meat, drinking plenty of water. Exercise. Exercise. Reducing the salt in your diet and the fried fatty foods if you consume them. And most importantly, getting some sleep, seven to eight hours a night, as well as reducing your stress.

Host: You mentioned salt. My mom had a heart attack many decades ago, and I remember she was in pretty good health. She exercised, she didn't smoke. Anyway, so we had to take all the salt out of all the food, and honestly, I didn't miss it. And now, when I have salty food, I go like, no, no, no, I don't like salt. So, it sounds hard to get rid of salt in your diet, but I don't know. I didn't miss it at all.

Crystal Hines-Mays, MD: Absolutely. And a lot of times, what I encourage patients to do is to utilize different herbs and spices. A lot of times when we take the salt out and we push in what new changes such as different herbs, different spices, and even try different foods; we will find out that it is more enjoyable that we're giving to ourselves because we're preparing healthier food choices and we're reducing our chances of high blood pressure, high cholesterol, and again, heart disease.

Host: I don't know how much sodium is in this. I should look, but have you heard of Everything But the Bagel? That seasoning from Trader Joe's? Is that a good thing or no?

Crystal Hines-Mays, MD: What I typically encourage my patients to do is if they're interested in any supplements, please bring them to the office. Let's evaluate it, see exactly what's in it, see how it can benefit them or not. And before they choose to try it out, even if it's a preserved food, any food choices or supplements, bring them in.

I encourage them to give me a call or send me a message through the portal and we can discuss it before they try it. Because our goal is, yes, we want you to try new things, but we don't want you to do anything harmful.

Host: Exactly. You mentioned stress. Let's just talk a little bit more about it. What strategies or practices do you recommend for women to manage stress effectively? I know you said taking walks and meditation. Anything else?

Crystal Hines-Mays, MD: Yes, since our pandemic and moving forward, we've noticed an increased amount of stress. This stress in isolation has led people more into high blood pressure, depression, anxiety, heart disease. So we're encouraging patients again, to bring this to your physician, to discuss these, your feelings, your thoughts, your moods, and your isolation, and to become more mindful.

So a couple of ways to become more mindful, are journaling, early morning walks. Quiet meditation. I call it, just unplugging for a short period of time. You can have an unplugging afternoon where there are no devices, the phone, the computers, and just relaxing your mind. Physical activity is the best way to increase those endorphins, which then help your heart and your stress levels to come down.

So, for instance, patients will say, well, I don't want to do a membership. Memberships at, gyms are very expensive. And they can be. So one of the best forms of exercise and stress reduction is to walk. Again, our goal is 150 minutes a week. So if we just push in what about 30 minutes a day, that helps tremendously.

Time management is a key to helping to reduce your stress as well. Knowing when to say when. Knowing when to say work's done, it's now time for me. So prioritizing yourself first helps to tremendously reduce stress.

Host: That's such a good point, especially for women, because like we said in the beginning, you know, women are juggling so many balls and taking care of everybody else. And sometimes your health gets put on the back burner. You mentioned, ways to cut down on stress. What are some of the symptoms that it's taking a toll on heart health? And how should women address them? Because you know, if you have like, a little weird pain out of the ordinary, you think, ah, am I having a heart attack? What are the signs that you should be aware of?

Crystal Hines-Mays, MD: Well, this can be tricky because for women, unlike men, where men may have chest pressure, they may have pain to radiate to their neck, they may have back pain or feel nauseous. Women, when it comes to heart disease, it can be very subtle. So yes, they can experience chest discomfort or shortness of breath.

Their heart can flutter, which are called palpitations. They may have frequent headaches or vision changes. However, for women, it just may be fatigue, I'm more tired, I can't complete my activities at home, I may have jaw pain, I may have difficulty swallowing, I may have aching muscles, or again, just feeling fatigued, dizzy, or lightheaded. 

Women can also experience irritability or some mood changes. They may become more frustrated or anxious or feeling more sad, which a lot of times we may think that this is anxiety or depression. However, this could be early symptoms of heart disease. Difficulty with our concentration, feeling panic attacks, feeling worried or feeling sudden fear. Again, can be subtle symptoms of heart disease.

Host: How are those linked?

Crystal Hines-Mays, MD: So how are these symptoms linked? Again, this goes back to stress levels. This goes back to hormones increasing in our body. Our cortisol level, for instance, will increase and it gives us that fight or flight response. And so when our bodies have higher levels of cortisol, it can also increase our blood pressures. And these arteries, which are called coronary arteries around our heart, can go into small spasms, and this in itself can lead to some of those symptoms that women express, such as, anxiety, or jaw pain, or just fatigue. So when they're trying to do their natural or normal activities, these vessels become dysfunctional.

And so it can lead to a decreased amount of blood coming to the heart where during the time of stress or activity, we need more movement and blood in our heart. But unfortunately, women that have heart disease may not be able to have that capacity. So this is how they start to experience these subtle symptoms.

Host: Wow. That's such useful information. I've never heard that. And like you were saying before, time balance, management, just such a basic thing, but something a lot of people don't think about. We all multitask so much these days, it's hard to be mindful of just, like you said, unplugging for an hour or whatever.

What role does regular medical care, like say, checkups and screenings play in preventing heart disease?

Crystal Hines-Mays, MD: Right up my alley. I'm a family practice physician, and so I practice preventative medicine. I encourage patients to, yes, come for your annual examination. However, if you find that you're having some of these subtle symptoms, or any questions or concerns, this may be the prompt, or this may be the push in to say, visit the doctor.

Checking your blood pressure at the doctor and even with a slight elevation, a normal blood pressure is 120 over 70, a slight elevation of 130 over 80 may be an indication that there may be some changes that they need to do on their end with their diet and with their exercise and lifestyle changes to decrease their risk of heart disease.

So regular check ins with yourself will then prompt you to go check in with the doctor. So we have our yearly screening. However, there are other times again, where women need to go into the doctor for their annual wellness, women wellness exams for their mammograms and their pap smears. Women that are a little bit advanced in age, they have their osteoporosis screening.

And these are other ways and moments where we can check in with our physician and just see if we're on track. Again, if you're feeling some of these subtle symptoms, especially women that are perimenopausal or menopausal, where they have difficulty sleeping or they have changes in their mood, this is the opportunity again to visit the doctor. Just share their thoughts and their feelings. So then again, they can have this evaluation to see if they're at risk for heart disease.

Host: Just very quickly, I always wonder about those little electrodes they put all over your chest during your annual physical. How does that work? What are they checking for?

Crystal Hines-Mays, MD: So that is an EKG. This is a test where yes, they put different electrodes onto your chest, onto your arms and legs in order to get a one snapshot picture of the conduction through your heart. So it is a very useful tool, especially when you're having chest discomfort. However, there may be a normal test.

And a lot of times we may be kind of fooled and say, oh, I'm feeling okay at this time. And we can brush off our symptoms. However, it is very important still, if you're having a normal EKG, but persistent symptoms, continue to pursue going to the physician or even a cardiologist, which is a doctor that specializes in heart care to have that evaluated.

Host: Well, Dr. Hines-Mays, thank you so much for making the time, number one, to be here and sharing your expertise. I learned so much, things I've never heard before, which are just so useful. So thank you again for joining us.

Crystal Hines-Mays, MD: Thank you for having me. Thank you.

Host: Absolutely. If you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics of interest to you.

Thank you for listening to this edition of Silver Cross Hospital's IMatter Health podcast. To learn more, visit silvercross.org.