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Leading Causes of Death for All Males and Females US 2004 A Total CVD (Preliminary) B Cancer C Accidents D Chronic Lower Respiratory Diseases E Diabetes Mellitus F Alzheimer’s Disease Source: CDC/NCHS/AHA Deaths in thousands
*2004 statistics are preliminary ; NCEP, National Cholesterol Education Program http://www.americanheart.org/presenter.jhtml?identifier=3018163. Accessed July 31, 2006 Thom T, et al. Circulation . 2007;113:e85-151 Year 400 420 440 460 480 500 520 1980 1985 1990 1995 2000 2004 Deaths in thousands Males Females NCEP I NCEP II NCEP III
57% of women who die suddenly from CAD had no prior typical warning symptoms
38% of women vs 25% of men will die within 1 year post-MI
Early recognition of symptoms, accurate diagnosis and proper treatment of CAD are of great importance.
Albert CM et al. Circulation 2003;107:2096-101; Women and Heart Disease Fact Sheet. http://www.womenheart.org/information/WH_fact_sheet_print.html . Accessed June 12, 2006 Heart Attack Symptoms and Warning Signs. http://www.americanheart.org/presenter. jhtml?identifier=4595 . Accessed June 15, 2006
ASNC Patient Management Strategy for CT Imaging & SPECT In Asymptomatic, Int-High Framingham Risk Low FRS Int-High FRS SPECT CCS > 400 or 90th %ile CCS <100 or <75 th %ile CCS > 100<400 or > 75 th <90 th %ile Cath - ? CTA Primary Prevention EBT-CT Mod-Severe Abnml Low Risk Mildly Abnml Primary Prevention Consider Re-Testing 3-5 Yrs Secondary Prevention Consider Re-Testing 2-3 Yrs Medical Rx Consider Re-Testing 1-2 Yrs Highlighted box indicates patients treated to secondary prevention goals Source: Shaw LJ, Berman DS, Bax JJ, Brown KA, Cohen MC, Hendel RC, Mahmarian JJ, Williams KA, Ziffer JA. The complementary roles of nuclear cardiology and cardiac CT in the current healthcare environment. J Nuc Cardiol 2005;12:131-142.
Source: Kwok AJC 1999, klocke et al JACC,, Shaw Eur Heart J 2005 Mar;26(5):447-56.
Improved CAD Detection & Prognostication through Visualization of Wall Motion, Perfusion, & Function SPECT Imaging: Visualize Wall Motion, Perfusion, & Function Echo Imaging: Visualize Wall Motion & Function
Gender Differences in Pathophysiology of CAD and Clinical Recognition of CAD in Women
Risk factors for CAD in Women and Prevention
Gender Differences in the Diagnostic Evaluation of Coronary Heart Disease
Percentage of Men with one vessel, two vessel, three vessel left main or no CAD on coronary angiography Reference: JACC 2003;41:158-68 N indicates Normal or <50% stenosis; one-vessel, two-vessel, three-vessel disease; LM: Left main disease
Percentage of Women with one vessel, two vessel, three vessel left main or no CAD on coronary angiography Reference: JACC 2003;41:158-68 N indicates Normal or <50% stenosis; one-vessel, two-vessel, three-vessel disease; LM: Left main disease
Cardiac arrest ~ 3x > in Men than Women, but lower
survival rates in Women
Pathophysiology: Cardiovascular II
Cardiac arrhythmias, drug-induced torsades de pointes, and long QT syndrome more prevalent in Women
At younger ages, prevalence of CHF > Men; after 75 reverses
Women with CHF more likely to have co-morbid diabetes and hypertension than Men.
1. Chest discomfort or uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts longer than a few minutes, or comes and goes. 2. Spreading pain to one or both arms, back, jaw, or stomach. 3. Cold sweats and nausea .