Ask The Doctors: April 2012 Women's Edition
Q. I know several women who had strokes after bypass surgery, and one died within the month. Now I need bypass surgery and am scared to have it.
A. There is no difference between the rates of stroke in women and men following bypass surgery. The overall risk depends on coexisting medical conditions that increase the risk of cerebrovascular disease. These risks are basically the same as those causing cardiovascular disease, with the addition of atrial fibrillation, patent foramen ovale (a hole between the upper chambers of the heart), sleep apnea, aneurysms and extensive aortic atherosclerosis.
Q. Do large breasts affect the ability to have robotic mitral valve surgery?
A. Usually not. The incision is made right under the breast. That being said, breast implants sometimes need to be removed and replaced after the procedure.
Q. What is a disease management program for heart failure?
A. A disease management program involves other medical care specialists, in addition to a doctor. For heart failure, this means nurses, nurse practitioners, nutritionists and cardiac rehabilitation specialists. A disease management program provides education and coaching on managing heart failure, such as sodium and fluid restrictions, multiple medications and exercise.
Q. When there is a history of cardiovascular disease in a family, when should an adult child start looking at her own risks in the absence of symptoms. What tests would you recommend ordering along with routine lab work?
A. A history of premature cardiovascular disease usually means a parent had heart disease before the age of 55 (man) or 65 (woman). We do not consider you to have a positive family history if your parents developed heart disease in as seniors (70s onward). Patients who have a significant family history should see a preventive cardiologist to better define their risk. European and Canadian guidelines recommend the biomarker lipoprotein(a) be checked in people with a history of premature coronary disease. You should have a lipid profile and blood pressure test in your 20s: How often you need them thereafter will depend on the results. You should eat a heart-healthy diet and exercise regularly to help prevent heart disease. It is not necessary to have CT angiography, a calcium scoring test, stress test or echocardiogram, unless you have symptoms.
Q. I have been having chest discomfort, and my doctor wants me to have a stress test. I read somewhere that women should have only certain types of stress tests. What test should I have to determine if I have coronary disease?
A. For women, we tend to prefer stress tests with radiation-free imaging studies. We recommend a stress echo, because it uses ultrasound and emits no radiation. A nuclear stress test can expose a patient to radiation levels equal to 900 chest x-rays.
Q. I learned I had atrial fibrillation when I underwent knee replacement surgery. I had a cardioversion after the surgery and now take Coumadin and Multaq. The doctor told me I should have a yearly check up. I have never experienced any symptoms, so if my heart goes out of rhythm, how will I know?
A. The ability to perceive atrial fibrillation (AF) varies from individual to individual, depending partly on how much heart rate is affected. It may be able to detect AF by monitoring your pulse, which will be irregular, if you are in AF. Ask your cardiologist about other options for detecting AF. As for your medications, Multaq (dronedarone) is an anti-arrhythmic designed to reduce your risk of AF. You are taking warfarin to lower the risk of stroke, which increases with AF.
Q. My wife has heart failure, but is generally doing well. But a few times a year she develops shortness of breath, has trouble walking and says she has no appetite. The next day, she is in the hospital. What can we do to prevent this?
A. Unfortunately, the natural history of heart failure involves the waxing and waning of symptoms. Medications can slow the development of additional problems, but may not prevent all future episodes. Make sure your wife is eating a low-salt diet and limits her daily fluid intake to two liters—about half a gallon. It is important to note that most canned and frozen foods are high in salt and should be avoided. She should weigh herself daily and ask her doctor whether she should increase her dose of diuretics to eliminate more water.