Tag: heart disease

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More Women Die From Heart Disease Than Cancer

“Cardiovascular disease is responsible for half of all deaths among women aged 50 and older in Canada and the United States,” says an article in the Canadian Medical Association Journal (CMAJ March 13, 2007). Heart attacks and strokes account for more deaths in women than all cancers combined.

We know heart disease is a number one killer in men and women. We also know sudden cardiac arrest is the leading cause of death in Canada, claiming about 40,000 people each year. About 95 per cent of them die before reaching the hospital. Can you imagine two-thirds of Medicine Hat’s population dying each year from heart attack? Scary, eh! So, if you are going to have a heart attack then you better be in the hospital or pretty close to it. The other options – stay healthy.

Most women worry about cancer of the breast, ovary, uterus and cervix. It is natural to worry about these cancers but it is also important to take care of your heart health. Scientists bear some of the blame for ignoring women’s heart health issues in the past. Most research studies previously were restricted to men. But in the last few years there has been significant interest in women’s heart health issues.

So, ladies, heart month of February is not over yet. Start a plan for yourself and your family. Make a list of things you can do to prevent heart disease.

Let us start with obesity. We are a nation of too many obese people. Central obesity is a more important risk factor for heart disease than body mass index in both sexes. So losing body fat is important. There are two things to do to lose excess fat: exercise and eat less. This isn’t rocket science but you need the discipline and determination of an astronaut.

It has been found that diabetes increases the risk of cardiovascular disease among women to a greater extent than it does among men. If you are a diabetic then make sure it is under control. Discuss with your doctor if you need to take any medications to prevent heart disease.

Differences in cardiovascular presentation – one recent study suggests that men report more severe chest pain and sweating and that women report less severe pain and more nausea. Does that mean man get more attention than women? Quite likely. Women with atypical symptoms and no severe chest pain are more likely to remain undiagnosed. Women have more silent heart attacks than men. Physicians should remember this and pay more attention to women’s chest symptoms.

It has also been shown that women with acute heart attack are less likely than men to receive thrombolysis (clot busting immediate therapy) or revascularization (bypass surgery).

Women’s heart health is getting more attention now. Hopefully, this will reflect in the future studies in a positive way. So, ladies, do your part and stay healthy that means your family will be healthy as well.

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What Is New In Preventing Heart Disease?

So, here we are, into February. An important month after you have recovered from Christmas and New Year celebrations. Valentine’s Day, Family Day and heart month fall into February. And as a bonus, this year the Valentine’s Day falls on the same long weekend as the Family Day. It should be a good weekend for the whole family to bond and have fun and have lots of chocolates……yum!

Ok, let us get back to our heart. If you do not have a good heart or a strong heart then you cannot have much fun. That is why for me each month is a heart month. The reason for that is quite simple – heart disease and stroke is the number one killer.

So, today I will devote this space to see if there is anything new to report about preventing heart disease. I will summarize the American Heart Association’s Scientific Sessions Report (November 8-12, 2008, New Orleans, Louisiana) published by the Canadian Medical Association.

How do you assess cardiac risk factors in individuals whose risk is not readily apparent? Do we have a scoring system, biomarkers of cardiovascular risk or genetic testing which would determine their life-time risk of cardiac disease?

No, we don’t. Lot of research is going on but clinically useful data is yet to come. But management is clear in patients who are obviously at high or low risk. These patients are identified by their age, body mass index, cholesterol levels, smoking and family history.

Is there any justification for the use of Statins to prevent heart disease in people with average or low levels of cholesterol to prevent heart disease?

In a study called JUPITER (Justification for the Use of Statins in Prevention: an Intervention Trial Evaluating Rosuvastatin), patients with normal cholesterol levels were tested for high-density C-reactive protein (hsCRP). They found the rates for a first major cardiovascular event and death from any cause were significantly reduced among those who received rosuvastatin compared with those who received placebo. The clinical implications and cost effectiveness needs further investigations before this can be recommended to the general public.

Other important presentations at the conference were:

-After a heart attack, early intervention within 24-hours (angiography, angioplasty, coronary artery bypass) is just as safe and effective as delaying treatment more than 36-hours for low-risk unstable angina patients and those without ST-elevation heart attack. They also found there was a trend toward better outcomes among those receiving early treatment. So, if possible, it would be nice to get on the table for an angiogram within 24-hours of a heart attack.
-Regular intake of vitamin C and E failed to protect against major cardiovascular events. These vitamins are among the most widely used by the general population. So spend your money carefully.
-A large trial involving heart attack survivors has confirmed the safety of folic acid and vitamin B12, but failed to show that they have a protective effect against heart disease or stroke.

Well, February is a good month to get back into regular exercise, laughter, meditation, organic/healthy food, stress relief and to stop smoking. That sounds like my favourite pet ELMOSS. And February is a good month to consume my favourite dark chocolates….yum.

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Erectile Dysfunction May Be An Early Sign Of Heart Disease

Erectile dysfunction (impotence) may be an early sign of heart disease.

Greek researchers evaluated the incidence of asymptomatic coronary artery disease in 26 men with erectile dysfunction and found 23 per cent had coronary artery disease confirmed by angiography (x-rays of the coronary vessels).

Italian researchers studied 162 patients and found the prevalence of erectile dysfunction was high (66 per cent) among those with chronic angina and multivessel disease and low (18 per cent) among those who had had an acute myocardial infarction with only one vessel affected.

Patients with erectile dysfunction, with no obvious cardiac problems, are at a risk of a heart attack within two to three years. In these kinds of patients, erectile dysfunction is considered to be a warning sign of heart attack to come. For this reason, it is being suggested that patients with erectile dysfunction, with no obvious cardiac symptoms, should be evaluated for cardiovascular disease.

There are several reasons why patients with heart disease will have erectile dysfunction. Atherosclerosis (clogging and hardening of the blood vessels) narrows the blood vessels and reduces blood flow to your heart, brain, extremities and the penis. Reduced blood supply to the penis causes erectile dysfunction.

Certain medications taken for heart disease can cause erectile dysfunction (high blood pressure pills and diuretics). It is also important to remember medications taken for impotence may not be safe when combined with certain heart medications (for example nitrates). There is a connection between depression, heart disease and erectile dysfunction. Feeling anxious can also lead to erectile dysfunction. Fear of having a heart attack while having sex can lead to impotence.

Usually, this is an unfounded fear. After a heart attack, you can resume your sexual activity as soon as your doctor says ok. Sexual intercourse seldom causes heart attacks. Having sex with your usual partner in a familiar setting doesn’t lead to a particularly high blood pressure level or heart rate. Even if you’re at high risk of having a heart attack, weekly sexual activity only slightly raises the risk. In fact, regular sexual activity leads to a happy and satisfactory relationship and is good for your heart.

There are a number of risk factors that can contribute to both heart disease and erectile dysfunction. These factors are well known: diabetes, obesity, high cholesterol level, smoking and high blood pressure fall into this category. So, erectile dysfunction may have multifactorial cause and will require investigations and long term planning to get the situation under control.

Let us go back to the real life scenario – you have erectile dysfunction but have no other obvious health problem. What should you do?

First, you have to look at your personal scenario. Is your relationship with your partner stressful or unpleasant? Are you living or working in an environment which is depressing? Such factors will affect your performance in bed.

Your next step is to talk to your doctor. After evaluating your history and physical examination, your doctor will decide on what kind of investigations to undertake. Your doctor may decide to refer you to a urologist, a cardiologist or to a psychiatrist.

So, don’t be shy. If you are having problems maintaining an erection during sexual intercourse then see your doctor. It may save your life and your sex life.

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Last Laugh: Arrested Developments

Dr. Noorali Bharwani comes to the awkward conclusion that as a surgeon he has certain skills but as for the general doctoring skills others seemed to have-uh, not so much.

Cartoon from article in Medical Post.
Cartoon from article in Medical Post.

When it comes to cardiac arrest, we, the surgeons, do not get any respect.

When it comes to severe trauma, a general surgeon is expected to be “captain of the ship” and take command of resuscitation and stabilization of the patient. This is because we know the first three letters of the alphabet: ABC (airway, breathing and circulation).

When I was a general surgical resident, I was not part of the cardiac arrest team. I confess, beyond ABC, I have difficulty remembering what to inject and where to inject drugs during cardiac arrest. Should they be given subcutaneously, intravenously or intra-cardiac? What does the ECG say? I can read a flat line (by that time it is too late anyway) but I would have trouble interpreting anything else.

I am not totally useless. I can intubate a patient, perform a tracheotomy, do a cut down on a vein and place an arterial line. Beyond that my medical knowledge is not that strong.

I was beginning to develop a complex. I was jealous of the internal medicine residents who acted so smart. Their white coat pockets bulged with concise pocket guidebooks, hammer, tuning fork, flashlight, different coloured pens and a stethoscope hanging down their necks. They would know the precise dosage of medications and would know exactly what to give at what stage of the cardiac arrest.

In order to regain my confidence and self-esteem, I decided to do three months’ elective in ICU as part of my surgical residency program.

Word of my limited knowledge of cardio-respiratory medicine must have reached the medical staff of ICU because the only procedures I was assigned to do were tracheotomies, intubations, cut-downs for venous excess and insertion of an arterial line.

This further exasperated my frustration and low personal esteem. It did not get any better when I went into practice. One day, I had done a right hemicolectomy on an elderly patient. Within the first couple of days after surgery, he developed severe chest pain and went into cardiac arrest. This was about two in the morning. The nurse phoned me to say the cardiac arrest team was there to resuscitate the patient and she was letting me know what was going on. She said the ER physician was dealing with the cardiac arrest.

I felt guilty that I wasn’t there to be “captain of the ship” and save my patient’s life. By the time I dressed and rushed to the hospital the patient had died. I could see the straight line on the ECG, the pupils were fixed and dilated, he was not responding to painful stimuli, he had no heart or breath sounds. Like a true captain I called off the resuscitation process.

Last summer, I was on a transatlantic flight with my family. I was trying to relax with soft jazz music beaming through my earphones. Suddenly the music stopped and I heard the captain say: “This is the captain speaking. Is there is a doctor or a nurse on board? Please identify yourself.”

I was reluctant to identify myself knowing my limited capacity when dealing with medical problems. At the request of my family, and not wanting my children to see me being a wuss, I pressed the overhead button. The air hostess came.

“I am a surgeon. Is there anything I can do to help?” I asked.

“Oh, don’t worry,” she said. “We don’t think the lady needs any surgery. She is having chest pain and is short of breath. We found a nurse. She is managing the case quite well.”

Although I was relieved to hear everything was going well without my services, I wondered what would have happened if my services were needed. Would I have failed to save somebody’s life?

That question weighed heavily on my chest (no pun intended). I started to get nightmares. In my sleep, I would recite the protocol of managing cardiac arrest. One night, my wife shook me and woke me up. Apparently, I was trying to give her mouth-to-mouth resuscitation while massaging her chest. She said I had been doing that every night since we got back from our holidays. Except, this time I was getting a little too excited!

“Honey, you don’t have to be that rough. If you want something then just ask nicely,” she said.

Why didn’t she say that before?

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