Flashcards in Women and Cardiac Health Deck (22):
What is the number one killer of women?
What do women think is their biggest killer?
Which race is the most accurate in their awareness?
Heart disease - 500,000 per year
Still heart disease, but breast cancer is perceived a bigger threat than it actually is
White women are the most accurate, but other races have slightly improved
What is worrying about women's awareness of heart attack symptoms?
Only half would call 911 for the typical symptoms
Very low percentages are aware of the atypical symptoms
Who dies of heart disease more, men or women?
How is physician awareness of CVD in women?
What is the fundamental assumption in culture about HD?
Women started surpassing men in the mid 80s and have been higher ever since.
Only 8.3% of PCPs, 13.0% of OB/Gns, and 17.0% of Cardiologists think women are more at risk than men.
Heart Disease is assumed to be a man's disease.
What is the problem on the patient's side when it comes to HD symptoms?
What is the problem on the physician's side when it comes to HD symptoms?
Women tend to downplay the symptoms or explain it away to causes not relating to HD
If women come with a typical presentation of angina and no mention of anxiety and stress then they were usually treated like men. If they mentioned anxiety and stress however only 14% were treated for angina.
What are the typical symptoms of MI?
What are the atypical symptoms?
What do women do if they do not present with typical symptoms?
Chest pain,heaviness, fullness going to arm/shoulder/back/adomen; worse with exertion or stress; relieved with nitroglycerin/rest; shortness of breath, sweating, weakness, nausea, vomiting, lightheadedness
Not severe, not prolonged chest pain that can sometimes even be reproduced on palpation
Women will delay seeking care, attribute symptoms to other causes, will have been previously told that the symptoms are not cardiac and wait, ask other people before seeking care (seek care less if ask spouse)
How are the clinical outcomes for women compared to men?
Greater mortality post-MI
Great morbidity (disability by CHF) post-MI
Women more likely to die in hospital post-MI
Why are there differences in outcomes?
Women present later in life with CAD (about 10 years later)
More comorbidities on presentation
Get fewer studies
Get less meds
Worse outcomes post-op for CABG
Less likely to get referred for follow up care
What can be done about this discrepancy?
Increasing awareness of CVD in women
Following guidelines for CVD management in women
Increasing symptom recognition
More women in clinical trials about CVD
What are some risk factors that disproportionately affect women?
What is the role of stress in CAD?
Hypertension, diabetes, low physical activity, low or no alcohol use
Marital stress can push mortality up of CAD; Optimists fare better than cynics; stress reduction can reduce mortality rate
What are class III indications for preventing women's CVD?
Not considered to be useful/effective and may actually be harmful
Aspirin for MI in women < 65 yo
What is the danger of the Framingham risk calculator?
How effective is reducing risk factors by 55?
It only looks at 10 year risk for CVD, lulls young women and their physicians to not work towards reducing lifetime risk
Very effective (6.4% for overall CVD death as opposed to 20% for people who have two or more risk factors)
What are the high risk factors?
What about screening for hs-CRP?
Clinically manifest CAD/cerebrovascular disease/PAD
Ab aortic aneurysm
ESRD or CKD
Results in a 10 year risk > 10%
Do not routinely screen for hs-CRP, no evidence; only useful for fine tuning someone who is at intermediate risk
What are general risk factors?
BP > 120/80 or treated HTN
Total cholesterol > 200, HDL < 50 or treated for dyslipidemia
Family history of premature (M<65) CVD in 1st degree relative
Major risk factors for pregnancy?
Stenotic valvular lesions
NYHA III, IV or cyanosis
Severe pulmonary HTN
What are major factors for women?
Advanced subclinical atherosclerosis
Poor exercise capacity
Systemic immune collagen vascular disease (SLE related)
***Pre-eclampsia, gestational diabetes, pregnancy induced HTN****
***Polycystic Ovary Syndrome (PCOS)***
***Early menarche or menopause***
What are lifestyle adjustments to improve risk?
Weight maintenance: BMI < 25, Waist < 35 (even less for Asians)
What cardiomyopathies are women at greater risk for?
Takotsubo CM or Stress induced CM
What is the indication of statins in pregnancy?
Category X - Should be stopped in the months prior to pregnancy
All women will have lipid increase during pregnancy
When should aspirin be considered for women?
High risk women
Women over the age of 65 for MI
Class II for women under the age of 65 for ischemic stroke prevention
When should Beta Blockers be used for women?
When should ACE inhibitors/ARBS be used for women?
When should aldosterone blockers be used?
12 months or up to 3 years post MI or ACS with normal LVEF unless contraindicated
Women after MI, evidence of HF, LVEF < 40%, or DM, with the exception of childbearing women; ARBs if ACEi intolerant
Women after MI who do not have significant hypotension, renal dysfunction, or hyperkalemia who are already receiving therapeutic doses of a ACEi and a beta blocker, have LVEF < 40% with symptomatic HF
What are safe anti-HTNs in pregnancy?
Methyldopa, Hydralazine, Labetalol, Nifedipine