February is American Heart Month, and it is the perfect opportunity to focus on the fact that heart disease is the leading cause of death in women. Over one in two women die of heart disease, with the number of deaths approaching one half million annually. Surprisingly, the majority of women surveyed were unaware that heart disease was the number one killer of women. Better education of what are the risk factors and how to modify them as well as earlier detection of disease with cutting edge new technology will dampen this killer. This takes on a special sense of urgency when one considers that compared to men, women are more likely to have sudden death as their initial presenting symptom. Obesity, smoking, high blood pressure, family history and elevated â€bad guy†cholesterol (LDL) are risk factors which negatively affect women and men equally. However, in regards to coronary disease, women are not simply â€small menâ€. Diabetes, low â€good guy†cholesterol (HDL) and elevated triglycerides seem to have an augmented negative effect in women. Diabetic women, for example, have five times the risk of developing heart disease than diabetic men. Modifiable risk factors are everyone’s first line of defense toward improving their cardiovascular risk. Weight reduction through diet and exercise along with smoking cessation are all necessary first steps taken for both yourself and the ones that love you. Your physician can provide safe, effective medications that lower blood pressure, lower cholesterol and control diabetes. Diagnosing coronary artery disease in women can be difficult as the types of chest pain women present with are not always the classic medical student’s description of crushing chest pressure. We have learned to be more complete in our diagnostic workup of both the female with typical cardiac chest pain symptoms as well as those presenting with atypical symptoms such as unexplained upper abdominal pain, shortness of breath, nausea and fatigue. Women develop coronary disease 10 years on average later than men. Since conventional stress testing strategies may be affected by their ability to exercise at a later age, false negative results occur more often, leading to later diagnosis with poorer outcomes. Non-invasive testing with multidetector LightSpeed 64-slice CT coronary angiography in the office setting is one of the new cutting edge technologies that can safely diagnose the female patient with an atypical chest pains and multiple risk factors. The test takes only minutes to do, requires a single 10 second breath hold during which contrast is given in order to obtain the most ideal images. Your Los Angeles Cardiologist would then in a matter of minutes be able to review with you these nothing short of astounding images that directly visualize the lumen and interior of the wall of your coronary artery, literally seeing the disease at first hand. He can then develop an action plan with you to eradicate it. This represents the cardiologist’s version of a mammogram in that it attempts to directly image the disease, if any, with a relatively painless, noninvasive outpatient test which has an extremely high degree of accuracy, especially in ruling out the presence of disease. Radiation exposure exists but is kept to a minimum by using new dose modulation techniques, thus enabling us to diagnose this silent killer earlier in as safe a fashion as possible. Ask your doctor to review your risk factors with you. Focus on risk factors that can be improved upon with diet, exercise, medications, etc. Stress tests are the standard of care in diagnostic workup patients with typical symptoms and multiple risk factors. However, I believe that these newer â€ground breaking†non-invasive CT heart scan - coronary angiograms may shed light into earlier detection of coronary disease in female patients, enabling treatment to begin earlier. Mason Weiss M.D., F.A.C.C. is a triple certified physician in internal medicine, cardiovascular diseases and interventional cardiology. He has practiced medicine for 23 years and is a physician partner with the highly regarded APEX Cardiology Los Angeles based team of physicians located at 501 East Hardy Street, Suite 200, Inglewood, CA 90301 Tel: 310-672-3900 www.apexcardiology.com.
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