THE ANGINA MONOLOGUES A Cardiac Surgeons Perspective on Heart Disease in Women

1
THE ANGINA MONOLOGUES A Cardiac Surgeons
Perspective on Heart Disease in Women

• Kathy E. Magliato, MD, MBA, FACS
• Director of Womens Cardiac Services
• Department of Cardiothoracic Surgery
• Saint Johns Medical Center
• Santa Monica, California

2
(No Transcript)
3
GUYS Dont fall asleep.
4
Sharp, Cutting edge, Side-splitting Discussion

• Hard-hitting facts about heart disease in women
  in an attempt to scare you into taking care of
  yourself
• Review the basics of cardiovascular disease and
  its risk factors
• Two take-away points
• How to stay away from ME
• How to recognize the symptoms of a heart attack
• So you have heart disease. Now what are you going
  to do about it? (spoken with a NY attitude)

5
THE FACTS
6
Heart Disease in Women

• 2.5 million US women hospitalized for
  cardiovascular illness each year
• EVERY YEAR since 1984, more women have died from
  heart disease than men
• 500,000 women die each year from cardiovascular
  disease (compared to 446,000 men)
• 1 in 2.4 women will die of cardiovascular disease
• every 30 seconds 1 woman in the US dies from
  cardiovascular disease

7
Poll What is the biggest health worry among
women?

• The number one response
• BREAST CANCER

8
The REAL FACTS

• 4 of women die from BREAST CANCER
• 44 of women die from CARDIOVASCULAR DISEASE
• IN FACT, CV DISEASE KILLS MORE WOMEN THAN ALL
  CANCERS..

COMBINED!!!
9
More women die of CVD than breast cancer at all
ages
Mortality rates per 100,000 women in the United
States
AGE (years)
RATE PER 100,000
0 1.25 2.5
3.75 5
15-24
HEART DISEASE
0 5
10 15
BREAST CANCER
25-44
0 40
80 120
45-64
0 600
1200 1800
65 and over
10
For women today, the best defense against heart
disease is
KNOWLEDGE
11
Risk factors for Coronary Disease

• Age
• Family History
• High blood pressure
• Diabetes Mellitus
• Cigarette Smoking
• High cholesterol

12
Coronary Disease Risk Factors

• Age
• female at least 55 years old
• male at least 45 years old
• Family History
• first degree relative - parent or sibling
• heart disease under age 55 if male relative
  heart disease under age 65 if female relative

13
Coronary Disease Risk Factors

• Hypertension (High Blood Pressure)
• Silent killer
• 2.5 million US women
• 50 of all women over age 55
• 2.5x more likely in African-American women

14
BLOOD PRESSUREknow your numbers!
15
Coronary Disease Risk Factors

• Diabetes
• 18.2 million people (6.3 of the population)
• Nearly one third are unaware they have diabetes
• BAD NEWS women with diabetes have a higher
  relative risk for heart disease than men with
  diabetes

16
Coronary Disease Risk Factors

• Smoking
• Heart attack risk 2-6 x greater in smokers
• Passive smokers have a 30 increased risk of
  heart attack
• If you use oral contraceptives, DONT SMOKE !
• 20.8 increase in heart disease

17
Coronary Disease Risk Factors

• Cholesterol
• Prevalence estimates for US Women
• Cholesterol
• gt200 58
• gt240 28

18
Coronary Disease Risk Factors

• Cholesterol
• Increased cholesterol, increased risk of coronary
  disease
• Goals
• good cholesterol (HDL)
• above 50
• bad cholesterol (LDL)
• below 160 if less than 2 risk factors
• below 130 if more than 2 risk factors
• below 100 if you have coronary disease

19
Two Key Take-Aways(how to stay away from me)

• Know your numbers
• Know the symptoms

20
Numbers

• Cholesterol Total, LDL, HDL,Triglycerides
• Blood Pressure
• Blood Sugar (diabetics)

21
Magliato NumbersOctober 10, 2006January 31,
2007
183
99
71
47
84/50
N/A
ZIP
22
Angina in Women

• Characteristics
• Crushing chest pain behind the breastbone
• Profuse sweating, shortness of breath, red face
• Fainting while clutching your chest
• Falling to the ground, in your driveway, while
  shoveling snow
• Just like you see on TV

23
NOT !!!
24
Angina in women is COMPLETELY different than men

• Characteristics
• Extreme fatigue
• Shortness of breath may be mild
• More subtle chest pain or pressure or NONE AT ALL
  
• Nausea
• Fainting
• Gas-like pains, indigestion
• Jaw and arm pain (especially left sided)

25
Angina

• What to do
• Stop your activity and rest
• Use prescribed medication
• Notify your doctor if
• The pain is new
• The discomfort persists more than 5-10 minutes
• The pattern or quality of discomfort changes
• Call 911
• DO NOT IGNORE IT !!!

26
How Angina is Treated

• Risk Factor Modification
• Medication
• Revascularization Procedures giving the heart a
  new blood supply
• Cardiac catheterization
• Angioplasty (open up blocked arteries)
• Stenting (implant a stent to keep the artery
  open)
• Done by a Cardiologist
• Coronary Artery Bypass Grafting (CABG)
• Open heart surgery
• Done by Me!

27
(No Transcript)
28
HEART CATHETERIZATION
29
Stent on a balloon catheter
30
Coronary Artery Bypass Grafting
31
THE ACTUAL SURGERY(Hey, weve all seen Greys
Anatomy)

• CLOSE YOUR EYES?

32
BEHOLD THE HUMAN HEART
33
HEART LUNG MACHINE
34
SAPHENOUS VEIN REMOVAL
35
ENDOSCOPIC VEIN REMOVAL
36
MEDIAN STERNOTOMY
37
(No Transcript)
38
SUB-MAMMARY STERNOTOMY
39
(No Transcript)
40
(No Transcript)
41
video
42
Whats New in Cardiac Surgerybesides robots and
stem cells

• Kathy E. Magliato, MD, MBA, FACS
• Director of Womens Cardiac Services
• Department of Cardiothoracic Surgery
• Saint Johns Medical Center
• Santa Monica, California

43
TOYS

• Percutaneous valve replacement/repair
• Watchman device
• Cormatrix scaffold
• NormaTec compression device

44
(No Transcript)
45
PARTNER trialPlacement of AoRTic TraNscathetER
Valve Trial
46
23 centers enrolling 1040 patients with aortic
valve stenosisStart date April 2007Estimated
completion date September 2014
47
(No Transcript)
48
EVEREST trialEndovascular Valve Edge-to-Edge
REpair STudy
49
video
50
video
51
Cormatrix Patch

• Decellularized material made from the small
  intestine of pigs
• Provides a scaffold upon which cells from
  adjacent tissue can grow
• Studies are underway to grind up the material and
  inject it into the heart to regenerate heart
  muscle
• May be more promising than stem cell therapy

52
(No Transcript)
53
(No Transcript)
54
(No Transcript)
55
(No Transcript)
56
Peristaltic Compression
57
Chronic Venous Insufficiency (CVI) Non-healing
wound active cellulitis
58
10 days later
59
NormaTec Compression Device

• Must be ordered by your MD (www.orderapsd.com)
• Most of the time it is paid for by your insurance
  
• MDs office will fax your insurance information
  to NormaTec
• NormaTec will check your insurance eligibility
• NormaTec will size of the device you need
• NormaTec will dispense the equipment to your home
  and notify your MD

60
NormaTec Compression Device

• A NormaTec nurse will
• teach you or your caregiver how to use the
  equipment
• Adjust the settings for your comfort level
• Provide your doctor with updates on your status
• CEO Laura Jacobs MD, PhD
• 800-335-0906
• LJacobs_at_NormaTecUSA.com

61
(No Transcript)