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Coronary Heart Disease in Women PowerPoint Presentation

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Description : Check out this medical presentation on Angina, which is titled "Coronary Heart Disease in Women", to know about the problem of coronary heart disease in women.

Tags : Angina, Coronary Heart Disease, Women

Published on : May 25, 2021 | Views : 2395 | Downloads : 4

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Coronary Heart Disease in Women Elisabeth von der Lohe, MD, FACC, FSCAI Professor of Clinical Medicine (Cardiology) Medical Director, Women’s Heart Program Associate Director, Cardiac Catheterization Laboratories & Interventional Cardiology Krannert Institute of Cardiology Indiana University School of Medicine Disclosures:none
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B.R. 37 year old white female with diabetes mellitus for 6 years, no other risk factors; non-smoker 7/7/2008 presentation to her family doctor with left sided shoulder pain for the past 2-3 weeks; pain got worse with walking or climbing stairs; symptoms were felt to be secondary to an inflammed shoulder and ibuprofen was prescribed 7/11/2008 emergency room; left sided shoulder pain got worse. Also increasing shortness of breath while walking or doing any activities. Diagnosis of shoulder arthritis was maintained and patient discharged the same day 7/13/2008; went back to emergency room; excruciating shoulder pain, shortness of breath and sweating. EKG revealed a heart attack. Emergency heart catheterization
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Death Rates in Women Coronary Artery Disease Stroke Lung Cancer Breast Cancer Colon Cancer Endometrial Cancer Age (years) Death Rate per 100,000 6500 4500 2500 1600 1200 800 400 0 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85+ At Every Age, More Women Die of Heart Disease Than Breast Cancer National Center for Health Statistics. 1999:164-167.
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Cardiovascular Disease Deaths: Trends for Males and Females United States: 1979-2001 Source: CDC/NCHS © AHA, 2004
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What is Coronary Heart Disease ?
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For both men and women Smoking Diabetes High Cholesterol (in particular high LDL and/or low HDL) High Blood Pressure Obesity Sedentary Lifestyle For women only Menopause Birth Control Pills in Combination with Smoking Risk Factors for Coronary Heart Disease
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Perhaps the most important risk factor for coronary heart disease is the misperception that coronary heart disease is a men’s disease
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Source: Adapted from Krolewski 1991
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Menopause and the Risk of Coronary Heart Disease (modified data from “Menopausal status as a risk for coronary artery disease” Arch Intern Med 1995;155:57-61 Age (in years) Annual Occurence of Heart Attack/1000
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Relation between Smoking, Use of Birth Control Pills and the Risk of a Heart Attack (modified data from Rosenberg L et al.Myocardial infarction and cigarette smoking in women younger than 50 years of age. JAMA 1985;253:2965-2969) Use of Birth Control Pills Relative risk of a Heart Attack
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Women at High Risk - Established coronary heart disease Blockage of carotid artery Circulation problems of the legs Abdominal aortic aneurysm Diabetes Chronic kidney disease Source: Mosca 2004
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Chest pain or Angina Typical Angina: heaviness, pressure or squeezing sensation behind the breastbone with radiation across the chest, up the neck or down the left arm or “strangling” or “suffocating” sensation. caused or worsened by exercise and eased by rest usually lasts two to five minutes Atypical Angina (frequently encountered in women): shortness of breath extreme fatigue lightheadedness or fainting nausea and/or indigestion
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Diagnosis EKG Stress Test - Exercise or with Medication - with or without Imaging (Echo or Nuclear) Echocardiography (ultrasound of heart) Heart Catheterization
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Women’s Early Warning Signs of a Heart Attack Weeks before Heart Attack (95% of women) Unusual fatigue (70.7%) Sleep disturbance (47.8%) Shortness of breath (42.1%) Indigestion (39.4%) Chest pain (29.7 %) At time of Heart Attack Shortness of breath (57.9%) Weakness (54.8%) Fatigue (42.9%) Chest pain (57%) McSweeney, JC et al. Circulation 2003; 2619-2623
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Treatment of a Heart Attack Most important: restoring of blood flow to the blocked artery with either - Administration of a Clot buster (i.e tPA or TNK) or Mechanically (Balloon angioplasty or so called Primary Angioplasty) with or without stent placement Oxygen Medications such as Nitroglycerin, Beta-Blocker, Morphine and Blood Thinners (i.e. Heparin)
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Prevention of Coronary Heart Disease No Gender Difference !!! No Smoking Weight Reduction/Maintenance Regular Exercise Control of High Blood Pressure Reduction in High Cholesterol
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Diet Consistently healthy eating Healthy food selections: Fruits and vegetables Whole grains Low-fat or nonfat dairy Legumes Low-fat protein Fish Limit trans fatty acid intake (main dietary sources are baked goods and fried foods) Source: Mosca 2004
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Weight Maintenance/Reduction Goals BMI between 18.5 and 24.9 Waist circumference < 35 inches Weight loss goals 10% of body weight over six months or 1-2 pounds weight loss/week Reduce calories by 500-1,000 per day Source: Mosca 2004, ATP III 2002
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Weight Reduction No optimal way of weight reduction found (yet) Weight loss and weight maintenance should be achieved slowly Weight cycling increases the risk of heart disease
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Recommendations of the AHA for Physical Activity Aerobic exercise of moderate to vigorous activity for 30-60 min 3-4 days/week, best on all days Alternative: however count the minutes!! walking >4 hours/week in form of 10-min intervals
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Walking Compared with Vigorous Exercise for the Prevention of Heart Disease in Women Manson, JE et al.N Engl J Med 2002;347:716-25.
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Overweight as Compared with Physical Activity in Predicting Death from Heart Disease among Women Frank B. Hu et al. NEJM 2004;351:2694-703
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High Blood Pressure Optimal blood pressure < 120/80 mm Hg Medication are indicated when blood pressure > 140/90 mm Hg or > 130/80 mm Hg in the setting of diabetes Source: Mosca 2004
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Lipids (cholesterol and triglycerides) Optimal levels of lipids and lipoproteins in women LDL < 100 mg/dL HDL > 50 mg/dL Triglycerides < 150 mg/d (total cholesterol not that important) Source: Mosca 2004
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Interventions that are not useful/effective and may be harmful for the prevention of heart disease Hormone Therapy Antioxidant supplements (Vitamin E,C, and beta-carotene) Folic Acid (with or without B6 and B12 supplementation) Source: Mosca 2007
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Summary (1) Heart Disease is the leading cause of death in women in the United States Most risk factors are the same for men and women, but women are at particularly high risk if they have diabetes mellitus. Genderspecific risks are menopause and intake of birth control pills while smoking Diagnosis of Heart Disease in women is very difficult since many women have atypical symptoms such as shortness of breath and extreme fatigue
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Prevention of heart disease is crucial Almost 50 % of heart disease problems can be avoided by lifestyle changes Ineffective interventions such as antioxidants and hormone replacement therapy should be avoided Summary (2)
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Summary (3) In order to reduce heart disease in women, the importance of heart disease in the female population has to be recognized.