Healthcare and Medical News: cardiologist

08 July 2011

THE NUMBER ONE KILLER FOR WOMEN IS HEART DISEASE

Heart disease can sneak up on women in ways that standard cardiac tests can miss.

It's part of a puzzling gender gap: Women tend to have different heart attack symptoms than men. They're more likely to die in the year after a first heart attack.

In fact, more than 40 percent of women still don't realize that heart disease is the No. 1 female killer. One in 30 women's deaths in 2007 was from breast cancer, compared to about 1 in 3 from cardiovascular disease.

A new report says there's been too little progress in tackling the sex differences in heart disease. It outlines the top questions scientists must answer to find the best ways to treat women's hearts - and protect them in the first place.

Make no mistake: Heart disease is the leading killer of men, too. The illness is more prevalent in men, and tends to hit them about a decade earlier than is usual for women.

But while overall deaths have been dropping in recent years, that improvement has been slower for women who face some unique issues.

Sure, being a couch potato and eating a lot of junk food is bad for a woman's heart just like a man's. High cholesterol will clog arteries. High blood pressure can cause a stroke, say specialists at an Ecorse Stroke Care center.

But here's one problem: Even if a test of major heart arteries finds no blockages, at-risk women still can have a serious problem - something called coronary microvascular disease that's less common in men. Small blood vessels that feed the heart become damaged so that they spasm or squeeze shut.
Specialists who suspect microvascular disease prescribe medications designed to make blood vessels relax and blood flow a bit better, while also intensively treating the woman's other cardiac risk factors. But it's not clear what the best treatments are.

The report says part of the lack of understanding about such gender issues is because heart-related studies still don't focus enough on women, especially minority women. Only a third of cardiovascular treatment studies include information on how each gender responds even though federal policy says they should. Some Lincoln Park Heart Doctors urge direct comparisons of which treatments work best in women, and improved diagnostic tests.

Another issue: Even young women sometimes have a heart attack, and there are troubling hints that their risks are rising. There's been a small uptick in deaths among women younger than 45. Plus, high blood pressure, diabetes or related complications during pregnancy - a growing worry as more women start their pregnancies already overweight - aren't just a temporary problem but increase those mothers' risk of heart disease once they reach middle age. The report says too few doctors are aware they should consider that.

Then there are the questions of how best to tell which women are at high risk. Nearly two-thirds of women who die suddenly of heart disease report no previous symptoms, for example, compared with half of men. As for heart attacks, chest pain is the most common symptom but women are more likely than men to experience other symptoms such as shortness of breath, nausea and pain in the back or jaw.

Legislation pending in Congress would require better study of gender differences, and would expand a government program that currently screens poor women in 20 states for high cholesterol and other heart risks, offering smoking cessation and nutrition education to help lower those risks. Groups, which receive some funding from drug companies, and the heart association support the bill.
One young patient says women need to know more about heart disease - and to get pushy about any symptoms.

One woman of New Orleans was just 30 and seemingly healthy when she started getting short of breath and feeling a flutter in her chest during her daily workouts. Her primary care doctor thought it was panic attacks. Garden City Cardiologists found no obvious risk either - her cholesterol and blood pressure were normal - but ordered a stress test that signaled her heart fears were right. A further exam found severe blockages in two arteries that required stents to prop open.

Now 37, she says doctors' best guess is that a stressful lifestyle - a single mother, a full-time job, a part-time personal trainer, and studying for an advanced degree all at the same time - left her vulnerable even without obvious risk factors. Had she not been so fit, they said, her heart might not have held out as long before symptoms appeared. She's learned to be more laid-back, along with a healthier diet and keeping up that exercise.

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21 September 2010

Is it Safe for Students to Play Sports without Heart Exams?

USA Today

Most teenagers think they're invincible, and that goes double for talented teenage athletes. They're young, immortal, at the top of their game, the envy of their friends.

So when news hits that an apparently healthy, high school or college athlete has dropped dead in the midst of playing his or her favorite sport, millions of parents get understandably anxious.

The uppermost question becomes: Should my child be screened before participating in sports? What tests are needed? And how can we be sure that he or she is truly healthy enough to compete?

Everyone agrees that a medical checkup before participating in sports is crucial. But the agreement seems to stop there. At the core of the conflict over further testing is how extensively young athletes' hearts should be tested before they're cleared for athletic participation, say Livonia Heart Doctors.

Everyone should have a doctor who evaluates them, and the doctor should know the child is going to be participating in athletics.

That statement recommends cardiovascular screening for high school and college athletes before they start participating in athletics and at two- to four-year intervals. The screening should include a family history, a personal history and an exam "focused on detecting conditions associated with exercise-related events," according to a Lincoln Park Cardiologists recommendation.

But, there's more: "The AHA does not recommend routine, additional noninvasive testing such as a routine EKG (electrocardiogram, which assesses the heart's electrical rhythms)."

The American Academy of Pediatrics seems to agree. "Every athlete should have a thorough history (taken) from the athlete as well as the athlete's family," explained Dr. Reginald Washington, a pediatric cardiologist and chief medical officer at Rocky Mountain Hospital for Children in Denver and past chairman of the academy's committee on sports medicine and fitness.

The doctor should ask about any chest pain and dizziness, and whether the athlete has ever passed out or experienced a racing or unusual heartbeat, Washington said. The physician should also ask if the athlete's parents have had early heart disease, before age 55 for a man and 65 for a woman. And the physical exam, he said, should be thorough and include listening to the heart, taking blood pressure and feeling the pulse.

"If all of that is normal and the family history is normal, no further tests need to be done," said Washington, echoing the academy's stand.

But others disagree strongly, calling for universal and extensive testing of all young athletes to avert future tragedy.

Melvindale Heart Doctors and other experts contend that both an EKG and an echocardiogram — which is an ultrasound that measures heart size, pumping function and checks for faulty heart valves — are crucial to detect early signs of heart defects in young athletes because neither test alone will catch all potential problems.

In testing 134 high school athletes competing in the Maryland state track and field championships in 2008, for instance, no life-threatening heart defects were found but blood pressure abnormalities that required further testing and monitoring were detected in 36 athletes, some by EKG and some by echocardiogram, the Hopkins doctors reported at an American Heart Association session in late 2009.

Testing in 2009, according to a Hopkins report, found a serious heart valve disease in one track-and-field athlete and another with an undiagnosed heart condition that could require a transplant in the future. Neither athlete had reported any symptoms.

"If you are going to screen, it has to be comprehensive," Dr. Theodore Abraham, an associate professor at Hopkins' School of Medicine and its Heart and Vascular Institute, said in a prepared statement.

Other studies have found pros and cons to extra screening.

For instance, Harvard researchers who looked at 510 college athletes found that screening with a history and physical exam alone has an overall sensitivity of 45.5%, meaning it would find existing problems in about 45 of every 100 athletes screened. But adding an EKG to the screening boosted it to more than 90%.

However, the EKGs were also linked with a false-positive rate — suggesting a problem when none existed — of nearly 17%, according to their report, published March 2 in the Annals of Internal Medicine.

A separate study in that issue, on the cost-effectiveness of such screenings, reported that adding EKGs to screenings of young athletes saves two years of life per every 1,000 athletes, at a per-athlete cost of $89.

Screening policies differ from region to region across the country. In Houston, for instance, athletic trainers at 10 high schools are using laptop systems to give young athletes EKGs, and a doctor in the city has launched a program to provide heart screening to all sixth-graders, eventually hoping to screen all sixth-graders in Texas.

But there are downsides to such universal screening, others say.

"About 10% of kids who get EKGs are thought to have something the matter with them by the EKG," Thompson, the Connecticut doctor, said. "That drives additional testing, and nearly all don't have anything wrong."

The problem, he said, is not just wasted health-care dollars but the anxiety caused by additional testing, for athletes and their parents.

Thompson said he is not oblivious to parental worry or to the sad reality that some athletes die unexpectedly each year.

"Every single one of these deaths is an incredible tragedy," he said, adding that he will do extra testing if parents are very worried. "But when people have looked at this, the death rate in the U.S. is about one in every 250,000 athletes. There is not really conclusive research to show (extensive testing) saves lives."

Also, in mass screenings — where kids line up and are screened quickly — accuracy may suffer, said Detroit heart doctors. "A good, thorough ultrasound should take a half-hour," he said. "If you line up all the kids (at a school or on a team) to have a portable ultrasound, you will miss some of these subtle abnormalities."

But Sharon Bates, a parent who founded the Anthony Bates Foundation after her athlete son, Anthony, died unexpectedly in 2000 and was found to have had an enlarged heart, disagrees with the arguments against mass screenings.

Even if a problem picked up is minor, she said, you have a right to know, and it needs to be addressed.

Bates's son had passed the typical pre-athletic physical at Detroit heart center with flying colors, she said, yet he still had a major cardiac problem.

Her Phoenix-based foundation promotes universal screenings for all youth, not just athletes, she said.

As Abraham said, "What is the price for a single life?"