For many years the significance of heart disease in women was vastly underappreciated, and women were significantly underrepresented in cardiovascular clinical research. We now know that ...cardiovascular disease is the leading cause of death for women. Women and men share many similarities in the pathophysiology and manifestations of heart disease. However, as research advances with the continued inclusion of more women, knowledge about gender differences between the female and male heart, both on a physiological and pathophysiological basis, grows. These differences can be found in all domains of cardiovascular health and disease, including heart rhythm, heart failure, coronary disease and valvular disease. Further understanding of gender differences in the heart is crucial for advancing our ability to maintain a healthy population and identify and treat heart disease in both women and men. Specific examples within the spectrum of heart disease will be discussed in this review paper, and areas for further research will be proposed.
The guidelines (Figure 1) graphically explore the spectrum of clinical presentations such that the patient may initially have had chest pain, but at presentation either has minimal or no symptoms; to ...the patient with increasing chest pain or other symptoms; to the patient with persistent chest pain or symptoms; to the patient with cardiogenic shock or acute heart failure; and finally, the patient who presents with a cardiac arrest. Very high-risk features include hemodynamic instability or cardiogenic shock; recurrent or ongoing chest pain, refractory to medical management; acute heart failure presumed secondary to ongoing myocardial ischemia; life-threatening arrhythmias or cardiac arrest after presentation; mechanical complications 5; or recurrent dynamic electrocardiographic changes suggestive of ischemia. Analysis of these components may improve the delivery of care for patients with STEMI and will involve patient education for prompt presentation, the EMS system efficiency, the emergency room contact in the hospital, and transfer to the cardiac catheterization laboratory, ideally in under 90 min 10. The attainment and maintenance of treatment targets include a systolic blood pressure of less than 130 mmHg and a diastolic blood pressure under 80 mmHg as tolerated, LDL-C below 55 mg/dL, and a HgbA1c less than 7% 26, 27.
Preeclampsia, gestational diabetes, or pregnancy-induced hypertension identify a woman at risk for cardiovascular disease. This information should be incorporated into the routine cardiovascular risk ...assessment for women, as a basis for appropriate risk factor screening, counseling, and preventive interventions. There is need for development and validation of a clinometric tool to assess cardiovascular risk and guide management.
Current Status of Cardiac Rehabilitation Wenger, Nanette K., MD, MACP, FACC, FAHA
Journal of the American College of Cardiology,
04/2008, Letnik:
51, Številka:
17
Journal Article
Recenzirano
Odprti dostop
Current Status of Cardiac Rehabilitation Nanette K. Wenger Cardiac rehabilitation is increasingly recognized as an integral component of the continuum of care for patients with cardiovascular ...disease. Its application is a class I recommendation in most contemporary cardiovascular clinical practice guidelines. Despite the documentation of substantial morbidity and mortality benefits, cardiac rehabilitation services are vastly underutilized. The core components of cardiac rehabilitation have been detailedly delineated. Implementation of newly available performance measures offers the potential to enhance referral to, enrollment in, and completion of cardiac rehabilitation.
Cardiovascular Complications of Pregnancy Gongora, Maria Carolina; Wenger, Nanette K
International Journal of Molecular Sciences,
10/2015, Letnik:
16, Številka:
10
Journal Article, Book Review
Recenzirano
Odprti dostop
Pregnancy causes significant metabolic and hemodynamic changes in a woman's physiology to allow for fetal growth. The inability to adapt to these changes might result in the development of ...hypertensive disorders of pregnancy (hypertension, preeclampsia or eclampsia), gestational diabetes and preterm birth. Contrary to previous beliefs these complications are not limited to the pregnancy period and may leave permanent vascular and metabolic damage. There is in addition, a direct association between these disorders and increased risk of future cardiovascular disease (CVD, including hypertension, ischemic heart disease, heart failure and stroke) and diabetes mellitus. Despite abundant evidence of this association, women who present with these complications of pregnancy do not receive adequate postpartum follow up and counseling regarding their increased risk of future CVD. The postpartum period in these women represents a unique opportunity to intervene with lifestyle modifications designed to reduce the development of premature cardiovascular complications. In some cases it allows early diagnosis and treatment of chronic hypertension or diabetes mellitus. The awareness of this relationship is growing in the medical community, especially among obstetricians and primary care physicians, who play a pivotal role in detecting these complications and assuring appropriate follow up.