Gender issues in CVD Flashcards
(37 cards)
Since 1984, more ______ than _____ die from CVD
-women than men
Younger men may have a greater incidence of CV events, but more women ______.
- die
- post-MI mortality is higher in younger women
- men get first event soon that women in all age groups, but more women die
__________ have less obstructive coronary artery disease at angiography in ACS.
-women
Women have more pathophysiology in men in what 6 categories?
- focal atherosclerosis
- diffuse atherosclerosis
- coronary vasospasm
- endothelial dysfunction
- small vessel disease
- spontanteous coronary artery dissection
CV deaths affect predominantly women over the age of _____.
- 65
- due to potential premenopausal cardioprotective effects
Positive effects of estrogen on the CV system
- decrease LDL, increase HDL
- facilitates NO vasodilation
- inhibits detrimental response of blood vessels to injury and development of atherosclerosis
Negative effects of estrogen on CV system
- increasing TGs
- increases inflam. marks like CRP
- prothrombotic effects: increase prothrombin and decrease antithrombin III–DVTs
Framington investigators reported a ______ fold higher incidence of CV events in post vs premenopausal women. Does HRT work?
- 2.6 fold
- HRT controversial; increased risk for breast cancer and not seen to be effective for establish atherosclerosis
Testosterone subfractions
- most not bioavailable as boudn to SHBG
- rest is weakly bound to albumin or free T
T/F: Testosterone deficiency in men may lead to increased CV risk
- true
- T deficiency: increasing inflammation, increased coronary intima-media thickness, worsens metabolic syndrome
- *conflicting data
5 Effects of T on CVS
- causes vasodilation independent of NOS
- may reduce angina threshold: improves exercise tolerance
- shorten QT interval
- reduced in pts with CHF
- increases exercise tolerance in CHF without effecting LVEF
T replacement therapy
- also controversial
- seen to increase DVT and PE risk, BPH and Prostate cancer, and increase hematocrit
Why are pregnant women often anemic?
-increase in plasma volume (by 50%) more so than increase in RBC, though both increase in pregnancy
Physiologic changes in pregnancy concerning CO, SV, HR, and TPVR
- increase CO, SV, and HR, increase blood vlume
- decrease TPVR, maybe dec BP
- decrease pulm VR
- increase venous P in lower extremities
What causes the increased venous P in lower extremities of pregnant women?
-fetus pushing on IVC
Hemodynamic changes of labor and delivery
- each uterine contraction= 500 ml blood released into circ to rapid increase CO and BP
- delivery blood loss is 400 ml or 800 with c-section
- after delivery, abrupt increase in venous return
What accounts fro abrupt increase in venous return to mom after delivery?
- autotransfusion from uterus: continues in 24-72 hrs after delivery–Pulm edema if CHF or valve issues
- baby no longer compresses IVC
high risk pregnancies mom profiles
- pulm HTN
- dilated CM, ej <40%
- symptomatic obstructive lesions (cannot change CO needed in preg): AS, MS, pulm stenosis, coarctation of aorta
- cyanotic lesions
- mechanical prosthetic valves
Pulmonary HTN is most commonly caused in childbearing years by what?
-secondary to a shunt in setting o VSD, PDA, or ASD
Regardless of the cause, pulmonary HTN carried very high mortality in pregnancy. Give stats for severe pulm HTN in Eisenmenger syndrome-
maternal mortality ~50% and perinatal mortality may exceed 25%
Current recommendations for pts with severe PHTN
-termination of pregnancy if it occurs
Issues with PHTN and pregnancy
- V load of pregnancy may compromise poorly functioning RV leading to heart failure
- if shunt exists, fall in PVR augments right-to-left shunting and may worse cyanosis
Stenotic lesions induce ______ overloaded state, with fixed valve orifices that limit heart’s ability to augment _____.
- pressure
- CO
How does MS cause exertional pulmonary edema?
- when MV orifice area is sufficiently reduced, blood moves from LA to LV onky if propelled by pressure gradient
- elevated LA P raises pulmonary venous and cap pressures
