Heart Disease in Women

Additional Info

• Audio File:uab/ua207.mp3
• Doctors:Pamboukian, Salpy
• Featured Speaker:Salpy Pamboukian, MD
• CME Series:Clinical Skill
• Post Test URL:https://cmecourses.som.uab.edu/mod/quiz/view.php?id=4858
• Guest Bio:Salpy Pamboukian, MD is Medical Director of Mechanical Circulatory Support Device, Director of Inpatient Services, Department of Medicine, Co-section Head, Advanced Heart Failure, Cardiac Transplantation, Pulmonary Vascular Disease and Mechanical Circulatory Support. 
  
  Learn more about Salpy Pamboukian, MD 
  
  Release Date: May 14, 2021
  Expiration Date: May 14, 2024
  
  Disclosure Information:
  
  Planners:
  
  Ronan O’Beirne, EdD, MBA
  
  Director, UAB Continuing Medical Education
  
  Katelyn Hiden
  
  Physician Marketing Manager, UAB Health System
  
  The planners have no relevant financial relationships with ineligible companies to disclose.
  
  Speakers:
  
  Salpy Pamboukian, MD
  
  Professor in Cardiology, Heart Failure and Transplantation Cardiology
  
  Dr. Pamboukian has no relevant financial relationships with ineligible companies to disclose.
  
  There is no commercial support for this activity.
• Transcription:UAB Med Cast is an ongoing medical education podcast. The UAB Division of Continuing Education designates that each episode of this enduring material is worth a maximum of 0.25 AMA PRA Category 1 credit. To collect credit, please visit uabmedicine.org/medcast and complete the episode's post-test.
  
  Welcome to UAB Med Cast, a continuing education podcast for medical professionals. Bringing knowledge to your world. Here's Melanie Cole.
  
  Melanie Cole: Welcome to UAB Med Cast. I'm Melanie Cole. And today, we're discussing heart disease in women. Joining me is Dr. Salpy Pamboukian. She's the Medical Director of Women's Heart Health and of Mechanical Circulatory Support Device at UAB medicine. Dr. Pamboukian, I'm so glad to have you join us today. This is a really great topic and so important. Just tell us a little bit about what you've been seeing in the trends as far as heart disease and women. Has anything changed in the last 10 years or so?
  
  Salpy Pamboukian, MD: Well, you know, over the last several decades, there has been a trend and a decrease in incidence in heart disease in the whole population. But over the last decade or so, this has kind of plateaued. So the incidence of heart disease has remained about the same. And we often forget that heart disease is the number one killer of Americans and the number one killer of women, which we often don't think about because, you know, there's a lot more attention focused on some female-specific diseases such as breast cancer. But we have to remember heart disease is the number one diagnosis that leads to death for women in the United States.
  
  Melanie Cole: As we're talking, Dr. Pamboukian, about heart disease versus something like an event, like a cardiac event, heart attack or something, symptoms are different in women and in men. Can you speak to that just a little bit? As far as heart disease, how would a woman know if she has blocked arteries or some sort of cardiovascular disease going on?
  
  Salpy Pamboukian, MD: Well, in general, we kind of classify symptoms as what we call typical or atypical. The typical symptoms are what we usually think about, chest pain, which may radiate into the arm or into the neck. But for women, often they manifest what we call atypical symptoms. So instead of that classic presentation, they may have symptoms that don't necessarily seem to indicate a cardiac cause. They may have sweating. They may have fatigue. They may have symptoms that they attribute to GI upset. So the message that I usually give women is if something new is happening in your body, you have to listen to that. And you have to get checked out by your physician and you have to sometimes prompt your physician to check your heart out if you have a concern that may be the source of your symptoms.
  
  Melanie Cole: Well, I'm so glad that you said that because into my next question here is that women, we do have to be our own best health advocates, that's for sure and especially when it comes to our hearts and heart disease and things. But so many of the signs and symptoms are similar. We're the caregivers of the world, Dr. Pamboukian, really, right? And we have to put our own masks -- a little ironic right now -- on before we can care of our loved ones. But so many of these symptoms are similar to stress and anxiety and, as you say, GI symptoms. For other providers, there are providers that women will describe some of these symptoms that may pass it off. And I'd like you to speak to those providers about hearing their patients, understanding how to counsel their patients, listening to these symptoms and trying to determine the cause.
  
  Salpy Pamboukian, MD: So, you know, stress and anxiety are very real. And especially, these days women are under tremendous pressure. We're juggling a lot at home and at work. We're a primary caregiver for so many people in our lives. So when I talk to other providers, I always stress to them, "You have to rule out heart disease first." You know, anxiety and other things like GI problems, we should put those things lower down in the list of things that we consider.
  
  So first off, make sure that woman is not experiencing a cardiac issue. And you know, that can be quite straightforward to evaluate in the office even, but you have to think about it. So rule that out first, and then after you've ruled out the things that are more dangerous or more life-threatening, then you can entertain other diagnoses such as stress and anxiety, but you just don't want to write things off to stress and anxiety right off the top.
  
  Melanie Cole: That's good advice. Now talk about diagnoses. Are we using stress testing? Are there other methods that are exciting in the field right now? What would you like providers to know about finding out what's going on?
  
  Salpy Pamboukian, MD: Well, you know, in a lot of ways, Melanie, the old ways are the best ways. So if you take a really good history, just sit down and take the time to talk with the patient. Do a good physical examination. You know, listen to the heart, listen to the lungs. In the office, we can often do an electrocardiogram. It's a very simple tool. But if the electrocardiogram is abnormal, that will lead us down a whole pathway of evaluation. And then after that, we can do lab work and that's when we start ordering other tests, such as an ultrasound of the heart, an echocardiogram, stress test with or without nuclear scanning, other types of cardiac imaging. And then ultimately, sometimes cardiac catheterization is what we need to do to fully evaluate the cardiac status.
  
  But, you know, always start simple with the things we know. Talk to the patient. Do a good physical exam. Get some basic lab works and get an EKG.
  
  Melanie Cole: Great advice. What's the latest info on aspirin a day because some physicians are still recommending that, some are not. It's become a little bit controversial. What are we saying?
  
  Salpy Pamboukian, MD: So the studies don't show that aspirin used on a daily basis is beneficial for primary prevention, meaning if you've never had a diagnosis of a heart problem, that taking a daily aspirin is really not worth the risk because, you know, aspirin also has side effects, the main one being bleeding. Now, the situation is very different for somebody who has been diagnosed with heart disease, specifically coronary artery disease. In those patients, aspirin is beneficial. It's really one of the cornerstones of treatment.
  
  So from a preventative standpoint, we do not recommend a daily aspirin. There's really other things that we could be doing that will lower our heart risk more so than taking a daily aspirin.
  
  Melanie Cole: So that's so interesting. What are we looking at as far as treatments? If disease is detected, whether it's cholesterol, you know, any of these things, atherosclerosis, anything that contributes to this, what are some of the latest treatments right now? Are we looking at medicational, non-surgical? Tell us what's going on.
  
  Yeah. It's a combination and I tell patients this, that medications is half the story. The other half of the story is lifestyle modification. So they really go hand in hand. Number one is we always work on risk factors, so the things that we know contribute to heart disease. Smoking cessation being number one. Treatment of high blood pressure, diabetes, cholesterol, weight management. These things are extremely important for mitigating risk for patients, really as primary prevention and also in those that have been diagnosed with heart disease.
  
  Then depending on the type of heart disease that a person's diagnosed with, if it's coronary artery disease, I mentioned aspirin and there are other anti-platelet agents we use, beta blockers, ACE inhibitors. If you have valvular heart disease, the treatment again may be medications. Sometimes surgical treatments may be recommended.
  
  And there's a whole host of treatments now that can be offered percutaneously or in the cath lab that we don't need to necessarily send patients for surgery these days. So, you know, there's just a whole host of treatments that are available, medical and surgical. And even some of our surgical options now are in the cath lab and done percutaneously, so less invasive for the patient.
  
  Salpy Pamboukian, MD: Well, certainly. And Dr. Pamboukian, as your armamentarium of therapies, as you just said, and available options for treatments are just expanding all the time for heart disease, tell us about the multidisciplinary approach at UAB Medicine for women and for men that have heart disease and why you feel that's so important because there are many people that can be involved from dieticians and cardiologists, I mean, just really a whole myriad.
  
  Melanie Cole: Absolutely. So to effectively manage heart disease these days, things have become so specialized that it really does take a village of people to attack the different aspects of heart disease when we're managing patients. So even amongst cardiologists, there are a lot of areas of subspecialty. So we work together in a multidisciplinary framework that we refer to as a heart team. So even when we're deciding treatments for these patients, you have a group of sub-specialized cardiologists that sit together and determine as a team what is the best course of management for these patients.
  
  And then you mentioned some of the other team members that we work with, including dieticians. We often refer patients for cardiac rehab, so we work with exercise specialists and, you know, even other ancillary professionals. Patients who have difficulties with medication, adherence and understanding their medicines, we can provide education with a pharmacist. So there's just a whole host of very specialized people that can really help manage the patient through the entire course of their heart disease.
  
  Salpy Pamboukian, MD: This is really great information. Wrap it up for us with a summary for other providers on what you'd like them to know about identifying risk, helping their patients to mitigate some of those risk factors, the controllable ones, and the importance of referral when they feel that their patients really need that extra help at UAB Medicine.
  
  Melanie Cole: Yeah, I would tell my colleagues out in the community, you know, keep heart disease at the forefront of your mind. It's still the number one killer in the US despite advances that we've made over the last few decades. Always rule it out, you know, at the top before you attribute symptoms to other less concerning disease processes. Work with the patient on risk factor modification. You know, as busy physicians, we sometimes don't have the time to counsel patients about exercise and weight loss. So utilize those resources that are available to you to help patients with risk factor modification. You know, make sure that they're on guideline-directed medical therapy. And if patients are failing to respond, there's a whole host of newer treatments available. And that's where we come in in the academic medical center, where if you're having difficulty getting your patient's symptoms under control or their disease under control, please, you know, feel free to give us a call and refer your patient and we can help you in getting that patient more effectively managed.
  
  Salpy Pamboukian, MD: Great information, Dr. Pamboukian. What a great guest you are. Thank you so much for joining us today. And a physician can refer a patient to UAB Medicine by calling the MIST line at 1-800-UAB-MIST. They can also visit our website at uabmedicine.org/physician. Please remember to subscribe, rate and review this podcast and all the other UAB Medicine podcasts.
  
  That concludes this episode of UAB Med Cast. I'm Melanie Cole.
  
  
• Hosts:Melanie Cole, MS