Time for a Heart-to-Heart*

By Dr. Herm Valenzuela

To all the ladies I've known before-

This health bulletin is a rehash of what I've previously condensed about C.A.D but this time is from a lady physician from Mt.Sinai M.C. just issued this week.

Coronary artery disease is the no.1 killer in the U.S. accounting for almost 1/2 M deaths in 2005. More than 16 M Americans live with C.A.D. and 1.3 M angioplasties were done in the U.S. in 2006. The survival rate for coronary intervention in N.Y. State is 99.2% - This is significant & encouraging (Source: Dr. Annapoorna Kini).

"The heart is a muscle that has to keep pumping for us to live, but it requires oxygen to function. It gets that 02 thru the coronary artery, a branch of the aorta. When fatty deposits block this blood flow to the heart, it becomes an extremely serious medical condition," says Dr. Kini. Coronary (baloon) angioplasty is a minimally invasive procedure to compress the lipid plaques to re-establish blood flow and using stents to help prop the vessels open.

According to recent studies, heart disease is a major cause of death for women-More than breast, ovaries & uterine cancers combined !The classic symptoms may not be felt all in women and they often have atypical (not the usual) symptoms: Weakness or unusual fatigue, lethargy, anxiety and even stomach pains or indigestion, instead of chest pains," Dr.Kini listed. "The problem is that women often disregard these signs because they seem so non-threatening. "She added. Getting to the doctor early or going to the E.R. when one is in doubt and you can't be seen at your clinic ASAP is the key to survival. For younger women, as most of you are, the no. 1 risk factor to watch out for is family history. Women who have developed blockages in their 30s & 40s usually fall in this group of people who are genetically predisposed. Perimenopausal (when the m'pausebecomes irregular) and post menopausal (in men it's called andropause) start having heart problem called "shadow diseases" - they come in twos or 3s as I've noted recently.

The second cluster of risk factors for C.A.D. depend on lifestyle, diabetes, obesity, hi-B.P., a sedentary lifestyle and smoking all put you in a higher risk. "If you have these risk factors, you could have C.A.D. blockages at an early age," Dr. Kini emphasied. "For women who have a blockage that does not yet impede the blood flow, the atypical symptoms often come and go and symptoms might last for 30-45 minutes, but then they go away and this pattern may recur for many weeks to months." She added.

For women who have any of the atypical symptoms plus the risk factors should have a stress test. For those who cannot walk on a treadmill- a dopamine induced stress test could be done. It is a drug that induces the heart to be stressed. Of course if you're short of breath while walking a few blocks or climbing 1 or 2 plights of stairs or your husbands prefers you to mow the lawn, is already a stress test- you need a coronary angiogram ASAP! Another increasingly common form of screening (depends on your medical coverage, in my opinion) is a CT angiogram that focuses on the heart. "If the cardiologist's intervention finds more than 80% blockage then a procedure is done ASAP. If it is less than 50%, you can stay on medication." Dr.Kini opined. In time new blood vessels (tributaries) starts to grow- hopefully and a by-pass surgery may not be done right away.

"Typically, women were asso. with having more complications or problems handling the angiogram. They have are more likely to have bleeding or a heart attack during the procedure and they have a longer recovery time afterward." Dr. Kini states. "But the new blood thinner, Angiomax has proven extremely successful in reducing the bleeding in the heart during angiograms.

Besides the traditional management for those who have C.A.D., even after a baloon angioplasty or stent or a by-pass procedure, blood thinners are usually Rx like aspirin and or Plavix= Clopidogrel bisulfate. A beta blocker (Inderal, Propanolol, Atenolol) is added sp. if hi-B.P is also present. These drugs actually decrease the heart rate in order to lower the B.P. and diminished the heart's need for oxygen.

To find a cardiac interventionist, log on to: www.americanheart.org.

*Consultant: Annapoorna Kini, MD
Asso. Director of the Cardiac Catheterization
Mt. Sinai Medical Center, NYC

H.C.V.