Going Red - women and heart conditions

It turns out life is just not fair for women.

Women may be more likely to experience emergency delays for heart care!
DALLAS, Jan. 14 - Women who called 9-1-1 complaining of cardiac symptoms were 52
percent more likely than men to experience delays during emergency medical services' (EMS)
care, according to a report in Circulation: Cardiovascular Quality and Outcomes.
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Women are more likely than men to die in hospital from severe heart attack!
DALLAS, Dec. 9, 2008 - Men and women have about the same adjusted in-hospital death rate for heart attack - but women are more likely to die if hospitalized for a more severe type of heart attack, according to a report in Circulation: Journal of the American Heart Association.
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We want a law passed: the Heart Disease Education, Analysis and Research, and Treatment for Women Act
American Heart Association Position
The American Heart Association, and its division the American Stroke Association, strongly supports the HEART for Women Act. This legislation would help ensure that heart disease and stroke are more widely recognized and more effectively treated in women. The association urges Congress to pass this important legislation this year.
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Rough diagram of pain zones in myocardial infarction (dark red = most typical area, light red = other possible areas, view of the chest).

If you have a heart attack symptom: call 911 immediately, don't wait three hours. The longer you wait, the more the muscles affected will deteriorate. What you loose in muscle tissue will be hard to get back.

While waiting for the emergency team:

• Get into a half-sitting position with knees bent


• Open a window so there is more oxygen in the room. Widen your collar if necessary.


• Aspirin is good, but take it only AFTER you've called the paramedics. U.S. guidelines recommend a dose of 162-325 mg. Australian guidelines recommend a dose of 150-300 mg.


• If you have it, take Glyceryl trinitrate (nitroglycerin = GTN) under the tongue or use GTN spray. Angina patients should have this with them at all time.

NB: don't do both. It's either the aspirin or the nitroglycerin. Mixing medication without medical expertise is not a good idea.

What the rescuer should try and find out while waiting for the ambulance:

• name, age


• nature of the pain


• when did the symptoms start


• what was the patient doing before the symptoms started


• what help has been given (including dosage)

It's also useful to monitor the pulse, breathing, level of consciousness and if possible, the blood pressure of the patient.

Coronary artery disease (CAD) (or atherosclerotic heart disease) is the end result of the accumulation of plaques within the walls of the coronary arteries that supply the muscle of the heart with oxygen and nutrients. It is sometimes also called coronary heart disease (CHD), but although CAD is the most common cause of CHD, it is not the only cause.

CAD is the leading cause of death worldwide. While the symptoms are noted in the advanced state of disease, most individuals with coronary artery disease show no evidence of disease for decades as the disease progresses before the first onset of symptoms, often a "sudden" heart attack, finally arises.

What happens is: after decades of slow growth of these plaques, some may rupture. The healing system of the body kicks in: platelets want to heal the wound. But the arteries are so small, that the result is a limited blood flow to the heart muscle.

The disease is the most common cause of sudden death, and is also the most common reason for death of men and women over 20 years of age. According to present trends in the United States, half of healthy 40-year-old males will develop CAD in the future, and one in three healthy 40-year-old women.

A distinction should be made between myocardial ischemia and myocardial infarction.
myocardial Ischemia means that the amount of oxygen supplied to the tissue is inadequate to supply the needs of the tissue. When the myocardium becomes ischemic, it does not function optimally. When large areas of the myocardium becomes ischemic, there can be impairment in the relaxation and contraction of the myocardium. If the blood flow to the tissue is improved, myocardial ischemia can be reversed.
myocardial Infarction means that the tissue has undergone irreversible death due to lack of sufficient oxygen-rich blood.

This is why it's so important to get help quickly: you don't want the heart tissue to be irreversibly damaged.

An individual may develop a rupture of plaque at any stage of the spectrum of coronary artery disease. The acute rupture of a plaque may lead to an acute heart attack.

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Atherosclerosis is a disease affecting arterial blood vessels. It is a chronic inflammatory response in the walls of arteries. What happens is white blood cells heap together. They are encouraged by the presence of lipoproteins that carry cholesterol. The fats don't get removed from the area in the veins. Normally HDL would prevent the clotting together, but that process isn't functioning well in atherosclerosis.
Atherosclerosis is commonly referred to as a "hardening" or "furring" of the arteries. It is caused by the formation of multiple plaques within the arteries.

The atheromatous plaque is divided into three distinct components:

1. The atheroma ("lump of porridge", from Athera, porridge in Greek,), which is the nodular accumulation of a soft, flaky, yellowish material at the center of large plaques, composed of macrophages nearest the lumen of the artery


2. Underlying areas of cholesterol crystals


3. Calcification at the outer base of older/more advanced lesions.

The following terms are similar, yet distinct, in both spelling and meaning, and can be easily confused: arteriosclerosis, arteriolosclerosis, and atherosclerosis.

Arteriosclerosis is a general term describing any hardening (and loss of elasticity) of medium or large arteries;
Arteriolosclerosis is any hardening (and loss of elasticity) of small arteries;
Atherosclerosis is a hardening of an artery specifically due to a plaque. Therefore, atherosclerosis is a form of arteriosclerosis.

Atherosclerosis, though typically asymptomatic for decades, eventually produces two main problems:

1. The atheromatous plaques, though long compensated for by artery enlargement, eventually lead to plaque ruptures and clots inside the artery. The clots heal and usually shrink but the artery is permanently narrowed. Sometimes it's even worse: the artery becomes closed and the organ it feeds gets insufficient blood supply.


2. The artery gets larger - so large that there is too much blood. In other words: an aneurysm results.

Complications
Most commonly, an infarction: soft plaque suddenly ruptures, causing the formation of a thrombus that will rapidly slow or stop blood flow, leading to death of the tissues fed by the artery in approximately 5 minutes.

One of the most common recognized scenarios is called coronary thrombosis of a coronary artery, causing a heart attack. Even worse is the same process in an artery to the brain: a stroke.
Similarly blood flow can become limited to other limbs or organs: the legs, the arms, kidney, etc.

Yet, many infarctions involve only very small amounts of tissue. These are so small that the person having the infarction does not notice the problem. Even when they do seek help, physicians may not recognize what has happened.

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