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Pregnancy and Heart Health: A Cardiologist Explains · Meaningful Medicine with Novant Health

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  Maggie McKay (Host): Meaningful Medicine is a Novant Health podcast bringing you
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  access to leading doctors who answer your questions they wish you would ask.
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  From routine care to rare conditions, our physicians offer tips to navigate medical
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  decisions and build a healthier future.
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  I'm your host, Maggie McKay.
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  Today, we're speaking with Dr.
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  Courtney Foxwell, a cardiologist who has an interest in women's
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  health and specifically cardiac care for pregnant patients.
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  Dr.
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  Foxwell, welcome.
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  It's so good to have you here.
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  Courtnay Foxwell, DO: Thank you.
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  Appreciate it
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  Maggie McKay (Host): This is such an interesting topic.
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  To start with, I imagine it could be scary to navigate a pregnancy while
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  managing other health conditions.
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  So how do you reassure a patient who is pregnant and has a heart condition?
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  Courtnay Foxwell, DO: Yeah.
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  So one of the things that, and honestly why we created this niche in cardiology,
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  is that we are having, you know, patients get pregnant later in life.
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  So essentially, they're going to have more, acquired
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  heart disease at that point.
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  And probably we just are doing a much better job of taking care of,
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  you know, children who are born with congenital heart disease so that
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  they're living into reproductive age.
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  So obviously, we have a need to take care of people who have heart
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  disease and when they're pregnant.
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  Biggest thing I always tell my patients is, you know, following closely with a
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  cardiologist, you know, a high-risk OB and then your regular OB is really gonna
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  be the best, most comprehensive care that you can get while you're pregnant We
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  know that just keeping a closer eye, more frequent appointments between all of our
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  specialties will certainly lead to more successful pregnancy and obviously, you
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  know, a healthy baby that, you know, as best as we possibly can, and healthy mom.
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  So that's typically what I try to start off with when I talk to them.
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  Maggie McKay (Host): So for women who want to become pregnant and they
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  know they have a heart condition, what's your advice to them?
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  Courtnay Foxwell, DO: So biggest thing is preconception counseling.
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  We wanna make sure that you're getting in with your OB and letting them
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  know this is something that you're interested in doing and, and then
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  getting in with cardiology itself because, you know, there are a subset
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  of patients who are quite a bit of risk.
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  They're very high risk, that sometimes it actually isn't
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  recommended to get pregnant.
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  And obviously we, you know, value and respect patients' decisions on,
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  on how they want to live their life.
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  But at least for them to know, you know, if they do end up pregnant and they
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  have a significant cardiac condition, what does that look like for them, you
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  know, outcomes-wise and how, you know, do they need to be diligent or not?
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  Is that something that they're willing to risk themselves for?
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  So, and, and I think everybody should have that decision if
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  they wanna do that or not.
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  But all those conversations are so much more important to have before
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  you're pregnant than if you, you know, come in while you are pregnant.
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  And, you know, certainly we still care for you either way, but at least then it
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  makes you have the most informed decision
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  Maggie McKay (Host): And do you also see women who become pregnant and then
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  later learn they have a heart condition?
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  Courtnay Foxwell, DO: Yeah, absolutely.
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  So we kind of see pretty much everybody at all stages There are many times
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  when patients don't necessarily know they have a cardiac condition until
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  they're pregnant because there's so many changes to your cardiovascular system
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  while you're pregnant that sometimes these, cardiac conditions don't show
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  themselves until you are pregnant because it's a lot of stress on your body.
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  So we certainly see that.
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  And then, you know, preeclampsia itself, you know, hypertension in
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  pregnancy, those kinds of things obviously don't present until you're
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  pregnant, so we see them as well
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  Maggie McKay (Host): And what are some common heart conditions that you
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  treat that pregnant women may face?
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  Courtnay Foxwell, DO: Again, preeclampsia, hypertension,
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  probably my most common conditions.
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  And then on top of it, there's also patients who have valve disorders,
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  so, you know, maybe a leaky valve, like a aortic valve or mitral
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  valve, or maybe stiff heart valves.
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  We'd have some patients with that Some people have heart disease
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  or actually have heart blockages.
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  They've had stents in the past.
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  It's not common certainly in, in patients that are younger, but it does happen.
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  So we manage those patients as well, or patients who have had heart conditions
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  when they were born and they're now, like maybe they had a valve replacement or some
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  sort of congenital surgery and now they're pregnant and we're, we, you know, care for
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  them Most common would be hypertension.
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  And then on top of it, anybody who has, something called SVT,
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  supraventricular tachycardia.
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  So that's just a, a tachycardia coming from the top chambers of the heart.
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  It's fairly common of an arrhythmia to see in patients who are younger
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  Maggie McKay (Host): And how do you collaborate with other
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  specialists, such as OB-GYNs, on caring for women who are pregnant?
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  Courtnay Foxwell, DO: So ACC, the American College of Cardiology,
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  that's kind of the, one of the big governing bodies for cardiology,
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  created a really great document about, you know, cardio obstetrics
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  and, and care of a pregnant patient.
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  And so one of the things that they really try to hone in on is, you know,
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  team-based care And the biggest thing is obviously very good collaboration
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  with your, maternal fetal medicine, your high-risk OBs, your general OBs.
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  Cardiac anesthesia should be involved as well because certainly the patients
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  that have cardiac conditions and maybe need an epidural, is that safe for them?
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  You know, or do they need something more?
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  So it's, it's a really good comprehensive on top of obviously the regular OB.
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  So coordinating between all of them can be tough of course.
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  but typically, and I know high risk, OB already does this, is they will have sort
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  of a powwow or a conference, and they talk about every patient and, and kind
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  of, you know, how they're doing and what's our, our plan for delivery and, you know,
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  what kinds of things could we, you know, potentially deal with or, or, you know,
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  what are some of the things that we want to anticipate in, in order to be prepared.
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  So I guess at this point, really, I just, I have all of their numbers and
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  I call them if I have any questions or need to talk to them about a patient.
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  Maggie McKay (Host): That's great.
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  When it comes to deliveries, how do you work together to
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  ensure safety for mom and baby?
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  Courtnay Foxwell, DO: Biggest thing is coming up with a really solid care
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  plan Obviously, I'm cardiology, so majority of the plan is gonna be coming
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  from the obstetrical side and coming from, you know, obviously the, the, the
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  general OB and then the high-risk OB I always like to come up with, if this
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  happens, we need to do this, or we need this specific type of monitoring based
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  on each patient's cardiac condition.
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  so I think really the biggest thing is just making sure we have everything
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  spelled out so that no matter when, because we know that, and, I know
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  every female knows this who's been pregnant, you can't really anticipate
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  when you're gonna go into labor.
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  So having a really good solid plan in place that's well-documented, so whoever,
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  because we know it can happen whenever, so whoever comes in contact with that
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  patient when they come into the hospital or, you know, I guess certainly if you're
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  doing an induction, but, you know, say they have spontaneous labor, that there
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  is a good plan in place that everybody can follow and be on the same page.
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  So I think that's really important.
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  Also gives providers who are seeing the patient a, a good peace of mind as well
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  that they have already-- the patient's already been established and gotten
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  testing done, and we know where they're at from their cardiac condition and what
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  is safe and, and how do we wanna, you know, monitor them while they're in labor.
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  Maggie McKay (Host): I know that men and women don't always experience
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  heart issues the same ways.
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  So what are some general signs that women should not ignore that should
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  prompt a visit to their care provider?
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  Courtnay Foxwell, DO: Yeah, absolutely One of the things that I always tell
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  my pregnant patients specifically too, because this is something that I
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  think we really struggle with in, in pregnancy, is symptoms that typically
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  gets told to you that this is just preg- you're just because you're pregnant.
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  You know, you, you have swollen legs because you're pregnant, or you're
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  short of breath because you're pregnant.
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  I always worry that we're going to miss things because we're just
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  chalking every symptom up to pregnancy.
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  And I'm, I'm sure OB probably has the same worry that I do, you know,
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  for pregnant patients as well.
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  so I always try to tell them, you know, if there's anything out of
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  the abnormal, even if it's overly cautious, I would rather look into
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  it, especially if we already know that you baseline have a cardiac condition.
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  I would rather do extra testing, because typically, you know,
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  obviously we're always gonna be doing testing that's safe for baby.
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  I would much rather do extra testing and be safe than certainly miss something and,
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  and, you know, have a really poor outcome.
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  And then in general, of course, just I always tell my female patients who, you
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  know, my non-pregnant female patients, females typically don't present like
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  males when it comes to, for example, like heart disease, like heart attacks.
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  So things that I always tell them to look out for is I want you to be notifying us
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  if there's any pain, does not necessarily have to be chest pain, that you notice
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  that's a- associated with exerting yourself and gets better with rest.
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  That's always concerning for a potential heart blockage.
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  Symptoms like acid reflux that just won't go away despite you've taken,
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  you know, everything over the counter.
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  I have some females where they just get pain down their arm, and they never
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  actually got chest pain or just jaw pain.
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  So typically, the symptoms are not gonna be what you would think of
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  and a lot of times can get ignored.
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  Or even I've-- I have some patients that have had, you know, nausea
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  and vomiting, which these are all really tough things to kind of tease
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  out because they can be quite vague and mean something else certainly.
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  but, you know, always to have kind of this in the back of your mind.
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  And at the end of the day, I always tell them, "You know
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  yourself, you know your body.
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  If this is something that is abnormal for you and you're
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  worried about it, let us know."
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  I would rather us be safe than sorry.
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  Maggie McKay (Host): Absolutely.
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  As we wrap up our conversation, I would just love to know what
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  drew you to this specialty
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  Courtnay Foxwell, DO: So kind of funny, I actually, in undergrad, I-- my major
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  was cardiac rehab, so I- I, you know, I studied to be an exercise physiologist,
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  so that's somebody who just, puts the patients on the treadmill and, and gets
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  them through the stress test portion of their, you know, cardiac care.
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  So th- I kind of started out with that, and then when I went to medical school,
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  I actually tried really hard to keep an open mind to other specialties, but,
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  certainly I still ended up in cardiology.
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  So here we are.
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  Maggie McKay (Host): That's awesome.
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  Well, thank you so much for sharing your expertise and experience today.
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  This has been so informative, and we really appreciate your time
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  Courtnay Foxwell, DO: Thank you.
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  I appreciate it
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  Maggie McKay (Host): Again, that's Dr.
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  Courtney Foxwell.
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  To find a physician, visit novanthealth.org.
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  For more health and wellness information from our experts,
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  visit healthyheadlines.org