Latest / 20-Minute Health Talk / Heart disease and pregnancy: Prevention, treatments and a new approach

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Heart disease and pregnancy: Prevention, treatments and a new approach · 20-Minute Health Talk

• 0:08
  Sandra Lindsay (Host): Hello,
• 0:08
  and welcome to 20 Minutes Health
• 0:11
  Talk. I'm sandra lindsay.
• 0:13
  Pregnancy is like a stress
• 0:16
  test on the body.
• 0:18
  Most women adapt just fine.
• 0:21
  But for some,
• 0:22
  the strain can dramatically
• 0:24
  raise the risk of heart disease,
• 0:26
  which continues to be the No. 1
• 0:29
  cause of maternal
• 0:31
  mortality in the US.
• 0:33
  Addressing the risk factors
• 0:36
  based on gender has become an
• 0:38
  important strategy to
• 0:40
  reduce this toll,
• 0:42
  which is why our guest today,
• 0:44
  Dr. Evelina Grayver,
• 0:47
  has turned her attention to a
• 0:49
  new field of medicine called
• 0:51
  cardio-obstetrics,
• 0:54
  which brings together a team of
• 0:56
  specialists in cardiology
• 0:59
  obstetrics and maternal fetal
• 1:01
  medicine to care for expecting
• 1:04
  mothers. Dr.
• 1:06
  Grayver is Director of Northwell
• 1:09
  Health Woman's Heart program for
• 1:11
  the central region and helped
• 1:14
  launch Northwell's Cardio
• 1:16
  obstetrics program in 2020.
• 1:20
  She joins us today to explain
• 1:22
  how this program came to be and
• 1:25
  how it is helping detect and
• 1:27
  prevent heart issues before,
• 1:30
  during, and after pregnancy.
• 1:33
  Here is my conversation with Dr.
• 1:35
  Evelina Grayver.
• 1:40
  All right, well,
• 1:41
  such a pleasure again
• 1:43
  to meet you,
• 1:44
  and thanks for joining us today
• 1:46
  on 20 Minutes Health Talk.
• 1:47
  Dr. Grayver: Thank you.
• 1:48
  Sandra: Earlier this year, I had Dr.
• 1:51
  Stacey Rosen on the podcast
• 1:53
  during Heart Month.
• 1:55
  And as you know, Dr.
• 1:56
  Grayver,
• 1:57
  she is the president of the Katz
• 1:59
  Institute for Women's Health
• 2:01
  here at Northwell.
• 2:02
  And one of the things that
• 2:05
  fascinated me that she mentioned
• 2:07
  and I wanted to delve
• 2:09
  deeper into it,
• 2:10
  is heart disease and pregnancy,
• 2:13
  right?
• 2:14
  How one affects the other,
• 2:16
  vice versa.
• 2:17
  Dr. Grayver: I know, it's very interesting, right?
• 2:21
  So we're not used to recognizing
• 2:24
  the fact that heart disease
• 2:25
  can be in women.
• 2:26
  We are not used to the fact that
• 2:29
  heart disease can affect
• 2:30
  the young.
• 2:31
  And now you're taking a
• 2:32
  combination of a young woman
• 2:34
  who's not even thinking of
• 2:35
  having any cardiac
• 2:36
  issues at all,
• 2:37
  who is either thinking of
• 2:40
  getting pregnant or is pregnant
• 2:41
  and develops cardiac
• 2:42
  complications.
• 2:44
  Pregnancy really is like a
• 2:45
  stress test on the body,
• 2:47
  on a woman's body,
• 2:48
  based upon all of the
• 2:48
  hemodynamics that take place,
• 2:51
  your heart rate significantly
• 2:52
  increases because of the
• 2:54
  fact that your heart,
• 2:55
  it goes from pumping usually
• 2:57
  four to five liters of
• 2:58
  blood per minute.
• 3:00
  To about eight to ten liters
• 3:02
  of blood per minute.
• 3:03
  So that's a significant strain
• 3:05
  on the heart, right?
• 3:06
  So in med school we were taught
• 3:09
  a lot of really sort of clear
• 3:11
  cut evaluation in reference to a
• 3:14
  woman that does have congenital
• 3:16
  heart disease and gets to the
• 3:17
  point where she's in her
• 3:18
  reproductive years and wants
• 3:19
  to become a mom.
• 3:20
  And subsequently we know the
• 3:23
  fact that there is a potential
• 3:24
  risk of maintaining a pregnancy
• 3:27
  with certain of that congenital
• 3:28
  component. However,
• 3:30
  the one thing so we kind of knew
• 3:31
  it as a sort of a one way
• 3:33
  street relationship,
• 3:34
  but we never understood the fact
• 3:35
  that that it's actually a
• 3:36
  two way relationship.
• 3:38
  Meaning because of that
• 3:39
  component of a stress on the
• 3:41
  body and on the heart during the
• 3:42
  time of the pregnancy a lot of
• 3:44
  women develop what's called
• 3:45
  adverse pregnancy outcomes.
• 3:47
  And adverse pregnancy outcomes
• 3:49
  are known as sort
• 3:51
  of preclampsia,
• 3:53
  which is high blood pressure
• 3:54
  during the time of the actual
• 3:56
  delivery and other complications
• 3:58
  of it,
• 4:00
  or spontaneous preterm delivery
• 4:02
  before the week of 32 or
• 4:04
  intrauterine growth restriction
• 4:06
  where the baby's a little is
• 4:07
  definitely smaller than
• 4:08
  its expected size.
• 4:09
  The old school mentality
• 4:11
  was that it happens,
• 4:13
  the woman delivers,
• 4:14
  the baby's good,
• 4:15
  the mom is good.
• 4:16
  We maintain the blood pressure
• 4:17
  well controlled within
• 4:18
  the first week or so,
• 4:19
  and then it's forgotten.
• 4:21
  We now know that that's
• 4:22
  not the case.
• 4:23
  We now know the fact that those
• 4:24
  women that have those adverse
• 4:26
  pregnancy outcomes
• 4:27
  the preclampset,
• 4:28
  the spontaneous preterm
• 4:29
  delivery,
• 4:29
  the intrauterine growth
• 4:31
  restriction,
• 4:32
  they are at significant risk for
• 4:34
  lifelong cardiovascular disease.
• 4:37
  So,
• 4:37
  whereas we know the fact that
• 4:39
  there are certain classical
• 4:40
  risk factors right,
• 4:41
  there's the diabetes,
• 4:42
  there's the hypertension,
• 4:43
  which is the high blood
• 4:44
  pressure, high cholesterol,
• 4:46
  smoking,
• 4:46
  obesity we know those are sort
• 4:48
  of the classic risk factors
• 4:50
  for the heart.
• 4:51
  But now these adverse pregnancy
• 4:53
  outcomes have finally made it
• 4:55
  into what's called novel gender
• 4:57
  specific cardiovascular risk
• 4:59
  factors where we know the fact
• 5:01
  that these women have to be
• 5:03
  clearly monitored very closely
• 5:05
  during the first six to twelve
• 5:07
  months after delivery because
• 5:08
  that's when we see the
• 5:10
  most complications.
• 5:11
  That's when we see certain
• 5:12
  heart attacks,
• 5:12
  that's when we see strokes for
• 5:14
  those a lot of those
• 5:14
  young women.
• 5:16
  Sandra: So really, who is at risk?
• 5:20
  Dr. Grayver: Everyone.
• 5:22
  There are certain women that
• 5:24
  are at higher risk.
• 5:26
  Certain races,
• 5:27
  such as African American women,
• 5:29
  such as women of Hispanic
• 5:31
  descent,
• 5:31
  they are at higher risk.
• 5:33
  Women that have predisposing
• 5:35
  conditions such as baseline
• 5:37
  hypertension, baseline diabetes,
• 5:40
  those that have other risk
• 5:41
  factors that I mentioned that
• 5:42
  are considered classic
• 5:43
  risk factors.
• 5:44
  So obviously those women that
• 5:45
  are going into the pregnancy
• 5:48
  with those risk factors are at
• 5:49
  higher risk of developing the
• 5:51
  adverse pregnancy outcomes.
• 5:53
  And we see a lot more of them
• 5:55
  now because a lot of women tend
• 5:57
  to get pregnant a little
• 5:58
  bit later in life.
• 6:00
  Women prioritize career at
• 6:02
  a certain period of time.
• 6:03
  But even those that do not,
• 6:05
  even the younger ones that are
• 6:06
  in their early 20s, mid 20s,
• 6:09
  are still at risk,
• 6:10
  and we don't know why.
• 6:12
  And this is where the research
• 6:13
  in the field is so,
• 6:14
  so important at this
• 6:15
  period of time,
• 6:16
  because we don't know
• 6:17
  what happens.
• 6:17
  Is it the fact that what comes
• 6:20
  first is the chicken or the egg,
• 6:21
  as they say? Right.
• 6:22
  So is it the fact that
• 6:23
  the pregnancy,
• 6:24
  because of it being sort of like
• 6:26
  a stress test on the body,
• 6:27
  unveils certain things?
• 6:29
  Or is it that the... placenta
• 6:34
  releases something and there's
• 6:36
  issues with the actual
• 6:37
  vasculature of the placenta that
• 6:39
  increases the woman's risk?
• 6:40
  This is where the research is.
• 6:42
  This is why this is such a
• 6:44
  highly rapidly developing
• 6:46
  field right now,
• 6:47
  because we don't know enough
• 6:49
  and we need the research.
• 6:51
  Sandra: And Dr. Rosen shared that as well,
• 6:54
  just in women and heart
• 6:56
  disease in general,
• 6:57
  she kept stressing the
• 6:59
  importance of research.
• 7:02
  And it's kind of scary because
• 7:05
  up to six months after delivery,
• 7:07
  you mentioned and oftentimes
• 7:10
  women believe that you deliver
• 7:13
  and you're good.
• 7:14
  And a lot of the symptoms that
• 7:16
  you mentioned could be justified
• 7:20
  by other things, right? Yes.
• 7:21
  Dr. Grayver: 100%. Yes.
• 7:22
  Sandra: Shortness of breath or
• 7:23
  feeling fatigued.
• 7:24
  You just have a new baby and
• 7:26
  you're not sleeping.
• 7:27
  So I would say perhaps women
• 7:30
  would delay coming into the
• 7:32
  hospital because they think
• 7:33
  these symptoms are related to other things.
• 7:36
  Dr. Grayver: Very much so.
• 7:36
  And to be honest with you,
• 7:37
  a lot of it is very cultural,
• 7:39
  and there's a little bit
• 7:39
  of a bias right.
• 7:41
  Even before delivering during
• 7:43
  the time of the pregnancy,
• 7:45
  for some reason,
• 7:46
  it appears that when
• 7:48
  a woman is pregnant,
• 7:50
  being short of breath
• 7:51
  has become a normal.
• 7:53
  Having significantly swollen
• 7:55
  feet is a norm.
• 7:57
  And when they come to me with
• 8:00
  those swollen feet and the
• 8:02
  swollen hands and the
• 8:03
  significant shortness of breath,
• 8:05
  I always tell them we have
• 8:06
  to rule out all other
• 8:08
  possibilities,
• 8:09
  including cardiomyopathies,
• 8:11
  including gestational
• 8:12
  hypertension,
• 8:13
  including everything else that
• 8:14
  can actually fall into before
• 8:16
  we actually say that this is
• 8:18
  pregnancy related. Right.
• 8:19
  And unfortunately,
• 8:21
  I do end up catching anywhere
• 8:22
  between five to 10% of those
• 8:25
  women that do come in with
• 8:27
  pregnancy normal short of breath
• 8:29
  that's actually just not
• 8:30
  pregnancy induced.
• 8:31
  Sandra: So I just want to clarify
• 8:33
  for our listeners yes.
• 8:34
  Swollen hands,
• 8:35
  swollen feet, shortness of
• 8:37
  breath, when you're pregnant,
• 8:39
  it's not a pregnancy symptom that you should be comfortable with.
• 8:46
  Dr. Grayver: Correct. Correct. Again,
• 8:49
  there are certain normals that
• 8:50
  come across. However,
• 8:52
  those symptoms have
• 8:54
  to be evaluated,
• 8:55
  and it's not even to be stricken
• 8:58
  panic of any kind.
• 9:00
  But to be able to see
• 9:01
  a cardiologist,
• 9:02
  to get a baseline EKG,
• 9:04
  to get a baseline echocardiogram
• 9:06
  and an ultrasound of your heart
• 9:08
  to assess to make sure the fact
• 9:09
  that you don't have any
• 9:10
  significant cardiomyopathy or
• 9:12
  weakening in the heart muscle
• 9:13
  or vavillar disease.
• 9:15
  Because unfortunately,
• 9:16
  one of the things that pregnancy
• 9:18
  does unveil as well is
• 9:20
  vavillar disease.
• 9:21
  Disease of the valves that
• 9:24
  potentially young woman would
• 9:25
  never really know about because
• 9:27
  they may not have seen a
• 9:28
  physician besides maybe their
• 9:31
  pediatrician or something
• 9:32
  of that nature.
• 9:32
  And maybe someone sometime
• 9:34
  mentioned that they might have
• 9:35
  had a murmur but they didn't
• 9:37
  pay attention much to it.
• 9:38
  So once again,
• 9:40
  exactly like you said,
• 9:41
  delaying care and thinking the
• 9:43
  fact that certain symptoms such
• 9:45
  as the shortness of breath,
• 9:46
  such as the swollen hands and
• 9:48
  feet and face is considered
• 9:50
  to be normal pregnancy.
• 9:52
  It's not normal pregnancy until
• 9:54
  you've ruled out all the other
• 9:56
  possibilities. Yes,
• 9:57
  Sandra: I served as the Director of
• 9:59
  Critical Care at Long Island
• 10:01
  Jewish Medical Center recently
• 10:03
  and I remember seeing women
• 10:05
  postpartum coming in with
• 10:08
  cardiomyopathy just
• 10:10
  out of nowhere.
• 10:12
  Dr. Grayver: So peripartum cardiomyopathy
• 10:14
  it's actually very interesting
• 10:15
  that you say that.
• 10:16
  I actually am rounding this week
• 10:19
  in the CCU at North Shore and I
• 10:21
  actually have a postpartum woman
• 10:23
  there with a significant
• 10:25
  complication with peripartum
• 10:27
  cardiomyopathy.
• 10:28
  So peripartum cardiomyopathy or
• 10:30
  the weakening of the heart
• 10:31
  muscle can take place anywhere
• 10:33
  between two to four weeks before
• 10:36
  the delivery and even up to six
• 10:38
  months after the delivery.
• 10:39
  It's one of those things
• 10:41
  that is kind of 30 30,
• 10:43
  30% stay the same,
• 10:44
  30% actually unfortunately get
• 10:46
  weaker and 30% do get better.
• 10:50
  We need to monitor those women
• 10:51
  incredibly closely like you
• 10:53
  mentioned in the cardiac
• 10:54
  intensive care unit to make sure
• 10:56
  the fact that they don't
• 10:56
  decompensate to get them on the
• 10:58
  appropriate medical therapy.
• 10:59
  But it's sometimes very hard,
• 11:01
  right?
• 11:01
  Because you have a young mom who
• 11:05
  just gave birth or is about to
• 11:07
  give birth and she's in the
• 11:10
  height of her happiness
• 11:11
  as they say.
• 11:12
  She's about to become a mom and
• 11:13
  she's going to have a lot of
• 11:14
  responsibility on her hands.
• 11:16
  And this is where a lot of women
• 11:17
  get into trouble because of they
• 11:20
  will prioritize that baby.
• 11:22
  Right.
• 11:23
  And unfortunately they will not
• 11:25
  prioritize themselves and all of their ailments.
• 11:30
  Sandra: So we know, Dr. Grayver,
• 11:30
  that about 80% of cardiac
• 11:33
  disease is preventable.
• 11:35
  How can we prevent heart related
• 11:38
  problems during pregnancy?
• 11:40
  Dr. Grayver: So the first thing is to make
• 11:42
  sure that you are in the best
• 11:44
  cardiovascular shape before
• 11:46
  getting pregnant.
• 11:47
  Sandra: And how do we do that?
• 11:48
  Dr. Grayver: That is with constant
• 11:52
  I don't like to say diet because
• 11:54
  people think when people die
• 11:56
  it's like a two to four
• 11:57
  week sentence.
• 12:00
  I'm talking about more of a
• 12:01
  lifestyle modification and being
• 12:03
  able to maintain a healthy diet,
• 12:06
  which you and I can discuss for
• 12:07
  hours as to what that
• 12:08
  actually means.
• 12:09
  And continuous exercise where
• 12:11
  you're exercising at least
• 12:13
  30 minutes a day,
• 12:14
  at least five days out
• 12:15
  of the week, okay.
• 12:16
  And maintaining your ideal
• 12:18
  weight. That's number one.
• 12:19
  I think the other component is
• 12:21
  never be concerned about getting
• 12:25
  what's called preconception
• 12:26
  counseling. Okay?
• 12:27
  Meaning if someone ever told you
• 12:29
  the fact that there is a genetic
• 12:32
  predisposition for heart
• 12:33
  disease in your family,
• 12:34
  if somebody has ever told you
• 12:36
  the fact that maybe you did have
• 12:37
  an abnormal EKG or an abnormal
• 12:40
  physical exam consistent with a
• 12:41
  murmur before getting pregnant,
• 12:43
  go see a cardiologist.
• 12:45
  I think that's also quite
• 12:46
  important to do.
• 12:47
  We want to make sure the fact
• 12:48
  that all of those classic risk
• 12:50
  factors that we spoke about
• 12:51
  for heart disease,
• 12:52
  such as the diabetes,
• 12:53
  the cholesterol,
• 12:54
  the hypertension, the smoking,
• 12:55
  the obesity,
• 12:56
  all of it is controlled,
• 12:57
  that you don't smoke or vape
• 12:59
  because vaping right now is even
• 13:01
  more prevalent within the
• 13:02
  young than smoking.
• 13:04
  And then if you do have genetic
• 13:06
  predisposition,
• 13:07
  because that's the other 20%,
• 13:09
  right? So 80% is preventable.
• 13:10
  20% is genetic.
• 13:12
  And we cannot run away
• 13:13
  from our genetics.
• 13:14
  We cannot run away from our age,
• 13:16
  even though I try every day.
• 13:17
  [Laughter]
• 13:20
  And we cannot run away from sort
• 13:22
  of our genetic cultural
• 13:24
  background. Right,
• 13:26
  but if you know that,
• 13:27
  if you know that,
• 13:28
  then getting that early
• 13:30
  preventative evaluation is key.
• 13:33
  So there's a lot of women
• 13:35
  that come to see me with
• 13:37
  preconception counseling,
• 13:38
  women that have congenital
• 13:41
  disease,
• 13:42
  that are on certain medications
• 13:43
  that are not,
• 13:45
  as I like to call them,
• 13:46
  pregnancy friendly.
• 13:48
  So we do have to change the
• 13:50
  management in reference to those
• 13:52
  medications that are more
• 13:55
  consistent with medications that
• 13:57
  are safe for both the
• 13:58
  mom and the baby.
• 13:59
  And thank God we have plenty of
• 14:01
  options at this period of time
• 14:03
  for those women that actually
• 14:04
  develop any of one of those
• 14:05
  adverse pregnancy outcomes such
• 14:07
  as preclamshare or anything
• 14:08
  else. We have options that are,
• 14:11
  again,
• 14:11
  safe for the mommy and safe for
• 14:13
  the baby during the time of the
• 14:14
  pregnancy and then during the
• 14:15
  time of lactation breastfeeding
• 14:18
  that are safe for both.
• 14:20
  Sandra: I'm sure you'd love to see the
• 14:22
  preconception numbers go up
• 14:25
  significantly for people to come
• 14:27
  in before they actually
• 14:29
  run into trouble.
• 14:32
  Dr. Grayver: Yes. Yes. And it's interesting because the
• 14:34
  one thing that I learned in
• 14:35
  this program, I myself,
• 14:37
  is that once a woman makes it
• 14:39
  a goal to get pregnant,
• 14:41
  god help anyone that
• 14:42
  stands in Hawaii.
• 14:45
  But the key really is to
• 14:48
  understand the fact that
• 14:50
  pregnancy is really not as
• 14:51
  glamorous as some of the
• 14:52
  magazines make it and women
• 14:55
  can get in trouble.
• 14:56
  And women do develop symptoms
• 14:58
  that they completely brush off.
• 15:00
  Off. So yes,
• 15:01
  I would love to see those
• 15:03
  preconception numbers to go
• 15:04
  significantly up higher.
• 15:06
  Sandra: Awesome.
• 15:06
  So we have here at Northwell a
• 15:10
  cardio obstetrics program.
• 15:12
  Dr. Grayver: Yes
• 15:12
  Sandra: Can you tell us a little bit
• 15:14
  more about that?
• 15:15
  Dr. Grayver: So, Cardio-Obstetrics program.
• 15:16
  And I know it's going
• 15:16
  to sound funny,
• 15:17
  but that really is kind
• 15:18
  of my baby, really.
• 15:21
  Yes.
• 15:22
  The point of the program is for
• 15:24
  there to a seamless efficient
• 15:27
  way that OBGYN can immediately
• 15:31
  refer their patients post
• 15:34
  delivery with preclampsia or
• 15:36
  any other adverse pregnancy
• 15:38
  outcomes,
• 15:39
  or if those OBGYN feel that
• 15:43
  their patient actually needs to
• 15:45
  have preconception counseling
• 15:47
  because of the fact that they've
• 15:48
  had either cardiac surgery in
• 15:50
  the past as a child because they
• 15:51
  were born with congenital heart
• 15:52
  disease or developed something
• 15:54
  within their teenage years or
• 15:55
  their early twenty s and
• 15:56
  they need to be seen.
• 15:57
  So that is sort of a very
• 15:59
  seamless efficient way for
• 16:01
  patients to kind of cross over
• 16:03
  easily without OBGYN having to
• 16:05
  scramble which cardiologists
• 16:06
  they're going to see or not.
• 16:08
  And the other component of it is
• 16:09
  the fact that we have now chosen
• 16:12
  cardiologists that sort of
• 16:15
  became experts in the field,
• 16:17
  meaning that they've shown
• 16:18
  so much interest in it.
• 16:19
  They've done extra legwork,
• 16:22
  really to kind of understand the
• 16:25
  pathology pathophysiology as to
• 16:27
  what happens during the
• 16:28
  time of the pregnancy.
• 16:29
  How do certain drugs
• 16:30
  affect that?
• 16:31
  We've created a certain group of
• 16:33
  cardiologists and a certain
• 16:34
  group of OBGYN that really have
• 16:37
  that seamless transaction
• 16:38
  between their patients.
• 16:39
  It's a very,
• 16:40
  very unique program.
• 16:42
  It's one of the few
• 16:43
  in the nation,
• 16:44
  but one of the most
• 16:46
  rapidly growing.
• 16:47
  Sandra: When did the program begin,
• 16:49
  the Cardio Obstetrics program
• 16:51
  and what are your goals
• 16:53
  for the program?
• 16:55
  Dr. Grayver: So Cardio Obsess program
• 16:57
  officially started
• 16:58
  in September of 2020.
• 17:08
  Sandra: So was that after which wave?
• 17:11
  Dr. Grayver: It was after one of the
• 17:12
  original waves.
• 17:13
  So what happened was that my
• 17:16
  interest in Women's Heart
• 17:17
  program started to grow
• 17:20
  early on in my fellowship.
• 17:22
  And that's when Dr.
• 17:23
  Rosen took me on as a mentee.
• 17:27
  And I realized and subsequently
• 17:30
  when I was in charge of the
• 17:31
  cardiac intensive care unit,
• 17:33
  the CCU,
• 17:34
  there were too many women in my
• 17:36
  unit that did not carry the
• 17:38
  typical risk factors that I
• 17:39
  was taught in regarding to
• 17:40
  cardiovascular disease.
• 17:41
  And that's where Dr.
• 17:42
  Rosen and I started really
• 17:43
  thinking about the importance of
• 17:45
  the woman's heart program.
• 17:47
  And after the original wave of
• 17:51
  COVID when I served and
• 17:54
  ran the COVID unit,
• 17:56
  I came out of the COVID land
• 17:58
  realizing the fact that
• 17:59
  I really wanted to do.
• 18:00
  Do something more for longevity.
• 18:04
  And that's where Cardio
• 18:05
  B was born.
• 18:06
  It's for the entire
• 18:07
  health system.
• 18:07
  I'm in charge of the
• 18:08
  central region,
• 18:09
  which is the North Shore LHI and
• 18:10
  Catswoman's Institute on the
• 18:12
  east end. We have Dr.
• 18:14
  Kashibato and Dr.
• 18:16
  Eugenia Gianos on
• 18:18
  the western end.
• 18:19
  And it's a full thickness
• 18:20
  program,
• 18:21
  meaning the fact that we're not
• 18:22
  only seeing patients
• 18:23
  as an outpatient,
• 18:24
  but we all also see inpatient
• 18:26
  consultations as well when those
• 18:27
  women come in or other cardiac
• 18:29
  complications occur that needs
• 18:31
  to be urgently evaluated and
• 18:33
  potentially even monitored at
• 18:35
  the cardiac intensive care unit.
• 18:37
  And I want to make a difference
• 18:39
  in reference to, number one,
• 18:40
  the paternal mortality,
• 18:42
  which is really horrible
• 18:44
  in the United States.
• 18:46
  And since cardiovascular disease
• 18:48
  is the number one reason why the
• 18:51
  mortality of pregnant women or
• 18:54
  postpartum women is the highest,
• 18:57
  I really take it incredibly
• 18:58
  personally for me to make a
• 19:00
  little bit of amend in that
• 19:01
  atrocious number.
• 19:03
  Sandra: Wow.
• 19:04
  Your passion is just palpable,
• 19:06
  and I thank you for
• 19:07
  your service.
• 19:09
  Dr. Grayver: The one thing that has gotten me
• 19:12
  personally through that post
• 19:14
  COVID burnout is finding
• 19:17
  that passion,
• 19:18
  is finding the fact that I'm
• 19:19
  actually able to find something
• 19:23
  that I genuinely enjoy and bring
• 19:27
  in as much as possible of these
• 19:29
  women that I know if I can
• 19:33
  implement all of the necessary
• 19:36
  changes will make a monstrous
• 19:39
  change in their life.
• 19:41
  Sandra: For cardiac disease in general, women
• 19:45
  black women are three to four
• 19:48
  times more likely to develop
• 19:50
  cardiovascular disease than
• 19:52
  other ethnicities.
• 19:55
  Dr. Grayver: Yes
• 19:56
  Sandra: Is that the same for
• 19:59
  Dr. Grayver: Cardiobsetrics?
• 20:00
  Sandra: Cardio-obstetrics?
• 20:01
  Dr. Grayver: Yes. African American women are
• 20:04
  anywhere between actually 4
• 20:05
  to 6% higher to actually develop
• 20:08
  at risk pregnancy outcomes and
• 20:10
  preclampsia and gestational
• 20:12
  hypertension and gestational
• 20:13
  diabetes being the highest ones.
• 20:17
  And these are women that, again,
• 20:19
  did not have or did not know
• 20:21
  that they had any predisposing
• 20:23
  conditions.
• 20:24
  And it's not women that are at
• 20:27
  a higher BMI level or greater
• 20:30
  obesity. Not at all.
• 20:32
  It's a matter that, again,
• 20:34
  part of research that we
• 20:35
  definitely need to do is
• 20:37
  understanding the vasculature,
• 20:38
  the vasculature difference
• 20:39
  between an African American
• 20:41
  women and other ethnicities.
• 20:45
  Sandra: Very well. Well,
• 20:46
  this has been an interesting
• 20:47
  conversation. Dr. Grayver,
• 20:49
  thanks so much for joining me.
• 20:50
  Dr. Grayver: Thank you.
• 20:51
  It's great to be able
• 20:52
  to share it.
• 20:53
  If there are listeners out out
• 20:55
  there that have questions that
• 20:58
  not sure about something.
• 21:00
  You can always find us on the
• 21:01
  Catswomen's Institute.
• 21:03
  All you have to look up is
• 21:04
  cardio obstetrics at Northwell
• 21:06
  Health and you will be
• 21:08
  able to find us.
• 21:16
  Host: Get more expert insight from the
• 21:19
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• 21:21
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• 21:21
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• 21:24
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• 21:27
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