What you don't know about heart disease can kill you
BY LIBBY MCMILLAN Special to Florida Weekly

COURTESY PHOTO Dr. Elizabeth Cosmai-Cintron from Florida Heart Associates examines a patient.

Southwest Floridians, like other Americans, live in a world filled with pink ribbons, innocent-looking icons of awareness that many women also see as harbingers of a dreaded breast cancer diagnosis. Many a survey places breast cancer as the top female health concern. By the same token, Gulf Coast men (and those who care about them) worry about high cholesterol, high blood pressure, and the specter of a fatal heart attack. This year, however, women who die of heart disease in the United States will out-number men two to one.

"The most common heart attack symptoms will be typical of both men and women," says Dr. Elizabeth Cosmai Cintron, M.D., F.A.C.C. at Florida Heart Associates. Crushing chest pain, which may radiate into the jaw or arms, is often accompanied by profuse sweating. However," says Cintron, "women can have atypical symptoms more than men," which explains why women may not be picking up on the warning signs that there's big trouble.

DIGIORGI

Female symptoms of a heart attack can include extreme fatigue, extreme shortness of breath, pain confined to throat or jaw, a tingling in the fingers, flu-like symptoms, indigestion, or just not feeling so well. Other symptoms for women include occasional back pain or upper abdominal pain.

Lady luck…or not

A heart attack could go totally untreated, because there's no woman around that doesn't feel that way at times," says Professor Jeff Davis, who heads the Cardiovascular Tech program at Edison College. "So it's important to see a cardiologist in addition to a general practitioner, if heart disease runs in a woman's family. He or she "knows the specialized types of tests that would be helpful and predictive in women," Davis says.

High blood pressure and high cholesterol can be killers for females. Their heart disease warning signs have the double whammy of coming later in life, appearing 10 years later than men's signs start to show, Davis explains. "After menopause, women quickly catch up to men in the rate of heart disease. The big push is to educate the female population that the #1 killer is heart disease."

DAVIS

Why do so many more women die of heart disease than men?

"It's a combination," says Dr. Cintron. "Women present at an older age, so often times they have more medical problems that increase their risk of a worse outcome. Some women also ignore symptoms," she explains, "because they may be involved actively in the care of their family members or the home, so they sometimes place themselves second. Also, too, I think women in general tend to think that they're not as at risk for heart disease, especially in their '50s and '60s. They tend to think of other disease processes, like breast cancer."

Life-saving changes in the field

The field of cardiology has undergone some significant changes, which are saving countless lives every year.

"The indications for when to operate on (heart) valves have widened," explains Dr. Paul DiGiorgi, of Gulf Coast Cardiothoracic Surgeons. "Now patients are being referred early." Getting to a specialist earlier is far better than later, he explains, as those who address their valve problems early are experiencing faster recoveries, fewer complications and better long-term survival rates.

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"We're also using arterial conduits more now," he says of a heart bypass done via arteries, rather than veins. DiGiorgi, who performs about 300 heart surgeries per year, often uses bi-lateral mammary arteries for access, which provide what he calls "excellent longterm patency," a medical term meaning 'a lack of obstruction.' DiGiorgi explains that access via arteries over veins "significantly improves the longterm results for a bypass."

Heart surgeons are also using more minimally invasive techniques for valve surgery, and often opt for an "off-pump beating-heart bypass surgery" which keeps the infamous heart-lung machine out of the picture. Letting a patient's own heart do the work to pump his blood is less traumatic for the body than having a machine doing what nature intended, explains DiGiorgi.

Professor Davis also underscores the importance of minimally invasive work, explaining that today's cardiologists use these techniques to repair and replace heart valves, as well as to repair holes in the heart. Doctors can use a clam-shell device to repair a hole, he says, without even opening the chest. "You can put a new aortic valve in the patient, by making a tiny incision in the patient's leg. Doctors go through the leg," he says, "to access the femoral artery, which gives us access to the heart."

"Cardiac cath labs are saving patients from having open heart surgery," he says, of the real-world arena where his grad students work at Healthpark Hospital. "Sometimes, you're not putting the patient under anesthesia," he says. "The recovery time is much faster." Heartspeak 101

The term 'cath labs' is short for "catheterization laboratories," where a variety of procedures are performed, including coronary angiography studies (x-ray examination of blood vessels or lymphatics, following injection of a radiopaque substance); hemodynamic monitoring (monitoring the forces which circulate one's blood), and direct infarct angioplasty (an operation to repair a damaged blood vessel or unblock a coronary artery where tissue is dying or dead, having been deprived of its blood supply because of an obstruction).

If a cardiologist starts talking about "ablations to atrial fibrillations" (or if one's tv is always tuned to an ER-type program) then it will help to know that ablation is the removal of abnormal growths or harmful substances from the body by mechanical means like surgery. Consequently, atrial fibrillations take place in the two upper chambers on either side of the heart - where the blood comes in from the veins and is then forced into the ventricles. Fibrillations are rapid twitching which replace the heart's normal rhythm, and can affect pulse and circulation. A defibrillator counteracts this condition by applying a brief electrical shock to restore a normal rhythm.

New awareness, improvements

Not unlike the breast cancer awareness campaign, the message of early heart disease prevention is catching on.

"Even physicians are more aware of the importance of aggressive risk-factor modification," says Cintron. "Because we are identifying people earlier and are able to treat them more aggressively, with various statin medications (a form of cholesterol medication).

"We've progressed remarkably in terms of our stress tests with nuclear imaging," she says. Cintron also explains that in some patients, a computerized CT angiography (in which both x-rays and dye are used) can also be used to identify obstructive coronary artery disease.

There's also a stent that particularly appeals to heart surgeons.

"The drug-eluding stent is a drug alternative, which releases medication over time," says Cintron, "preventing the stent from having a build-up of platelets that could clog it over time. So it keeps the infrastructure clean, to allow for blood to pass, once an artery that's obstructed is open.

"They're not for everyone," says Davis, "but they are very beneficial in a significant amount of the population. The first 6-9 months are the danger zone. Having a preventative drug leaching out during this time positively affects the body's response mechanism," he says. "If you stop it at the front end, it hopefully will not happen. Davis says two of the new stents have been FDAapproved in the US, and there are even more in Europe. So that's kind of a new thing in interventional cardiology," he says.

Can medicines fend off trouble?

Medications like statins, beta blockers, and ACE inhibitors - they are wonderful medications," says Professor Davis. "They do have side effects, so patients need to consult their cardiologist," he says, "but they've definitely shown to decrease heart disease and prolong life.

What if neither healthy living or medicine helps, and a heart attack comes? "An aspirin is one of the most important drugs," says Dr. Cintron. "Women who are over the age of 65, or who have multiple risk factors, can get an added benefit by taking a baby aspirin daily." If the worst case scenario still occurs, a person who feels they're having a heart attack (or sees someone having a heart attack) should reach for the same bottle, after calling 911. "Chew that aspirin," says Cintron, and usually you want to take 4 baby aspirins, or a large aspirin - 325 mg - after you call 911."

Get heart-smart early

Prevention is easier than surviving a heart attack, and it can start right out of school. "I think that even at a young age - 20s and 30s - people should know what their blood pressure is, what their cholesterol is, and if they're at risk for diabetes," says Dr. Cintron. "There's a point," she says, "where they should be aware of their vital signs." Prevention is the best way to avoid a heart attack, period. "You shouldn't be a smoker, or should be making headway in quitting," she says. "Women should be exercising 30 minutes a day, most days of the week. And if you're overweight, you should be making an effort to lose that weight with diet and exercise."

Dr. Cintron stresses follow-up with a physician once your vitals have been established.

"By just going to your local Publix or pharmacy, (to check your blood pressure) that's not how you establish follow-up," she says. "Especially in the 50s or even 40s, people should have a physician that they feel comfy discussing how they're doing."