Treatment of heart disease in women

 

If you’re a woman with heart disease, you know that it can be challenging even to get a proper diagnosis. Because of persistent misconceptions in the general public and even in the medical community, women are less likely to be correctly diagnosed with heart disease, and we’re also more likely to die of heart disease than are men. So if you’ve gotten to the point of diagnosis, you’re better off than many women are — but now, what will you do about it?

 

While some heart disease risk factors can be mitigated by lifestyle changes — such as regular exercise, diet modification or stress management — many others also require medical treatment. “In addition to lifestyle changes, drugs and surgical therapies can improve outcomes by 50 to 80 percent,” says Sharonne N. Hayes, M.D., Director of the Women’s Heart Clinic at Mayo Clinic in Rochester, MN.

 

These drugs, surgical therapies and implantable devices are necessary for many women, and your treatment should be tailored to your specific diagnosis. Read on to discover the different medical treatments, what they do, and the problems that they treat.

 

Drugs

Depending on your diagnosis, the goals of heart disease medications include:

 

• Reducing symptoms
• Increasing the heart’s pumping capacity
• Increasing blood flow to the heart’s arteries
• Lowering your risk of having a heart attack, developing complications, or dying

 

The common drugs for heart disease are:

 

• ACE inhibitors and ARBs.  These medications lower blood pressure and reduce the heart’s work.
• Anti-platelet drugs.  These drugs thin your blood, reducing the risk of clots and therefore lowering your risk of heart attack.
• Beta blockers.  Beta blockers slow your heartbeat and decrease your blood pressure, reducing the workload on your heart.
• Calcium channel blockers.  These medications relax the arteries, improve overall blood supply and reduce your heart’s workload. They can also decrease blood pressure and reduce heart rate slightly.
• Nitroglycerin.  This medication dilates the coronary arteries and veins for increased blood flow to the heart.
• Statins.  This proven medication has been shown to reduce cholesterol production, improve endothelial function, and reduce the risk of heart attack and death.

 

Surgical Therapies

Some women with coronary artery disease will require surgery to treat narrowing or blockages in heart arteries. This can happen in an emergency situation (heart attack or cardiac arrest), or can be part of the treatment plan to remedy symptoms and evidence of reduced blood flow. Surgical therapies include:

 

• Coronary artery bypass graft (CABG).  In this surgery, the doctor takes an artery from another location in your body (typically your leg) and creates a new blood pathway to bypass a blocked or narrowed heart artery.
• Angioplasty (balloon and/or stent).  This procedure, done via cardiac catheterization, mechanically opens a narrowed artery to increase blood flow to the heart. A wire is inserted via the catheter tube, and a balloon is threaded through on the wire, sometimes with a stent around it. When in place, the balloon is inflated, expanding the stent as well. The balloon is then deflated and taken out, while the stent remains in the artery to keep it open.

 

Implantable devices

Once considered science fiction, implantable devices are now a common treatment for certain types of heart disease. These devices, some now as small as a quarter, are placed in the chest cavity, and have wires going into your heart. The device monitors your heart’s electrical and pumping activity, and provides electrical stimulation or shocks to get your heart pumping in a normal rhythm. Two types of implantable devices are available: pacemakers and defibrillators, both treating specific problems.

 

Pacemakers.

A pacemaker’s wires (leads) attached to the heart stimulate a normal, coordinated rhythm. Pacemakers prevent slow heart rates (called bradycardia) and heart block (an electrical current problem in the heart). They do not treat fast heart rates or palpitations – rapid heart rates are treated with medication. You may need a pacemaker if:

 

• Your heart rate is too slow
• You have certain types of heart blockages
• Drugs that you need to take for heart health slow your heart rate down too much
• You’ve had AV node ablation
• You need heart failure resynchronization

 

Pacemakers can be single- or dual-chamber — a dual-chamber pacemaker has two wires (leads), one implanted in the atrium, one in the ventricle.

 

Implantable Cardioverter Defibrillators (ICDs).

An ICD has a generator similar to a pacemaker, and its lead system consists of pace/sensor lead(s), which detect heart rhythm disturbances, and defibrillation leads, which shock the heart into a normal rhythm. Several types of ICDs are available, depending on your diagnosis and the issues the ICD needs to address. These include:

 

• AICD – Automatic Implantable Cardioverter Defibrillator
• PCD – Pacemaker/Cardioverter Defibrillator
• ICD – Implantable Cardioverter Defibrillator
• BiV – Biventricular resynchronization defibrillator (leads in left and right ventricles)

 

ICDs function to deliver two distinct therapies:

 

• Defibrillation – Ends an arrhythmia by delivering an electrical shock
• Cardioversion – Ends an arrhythmia by delivering a synchronized electrical shock

 

You may need an ICD if you have:

 

• Had a prior cardiac arrest
• Ventricular tachycardia (VT)
• Ventricular fibrillation (VF)
• An ejection fraction of less than 35 to 40 percent
• High risk of sudden cardiac death because of an inherited abnormality, such as Long QT syndrome
• Atrial fibrillation

 

Heart disease diagnoses and common treatments

Most women with heart disease will be on medication, some might need surgical therapy, and others may require an implantable device. Work with your cardiologist and heart health care team to devise a treatment strategy that’s right for your symptoms and diagnosis. Some of the more common types of heart disease are listed below, along with the most common treatments for them.

 

Chest pain (angina).

Most women with angina are on medication – both to relieve symptoms and prevent heart attack. Depending on results of testing, women with angina may be prescribed antiplatelets, statins, ACE inhibitors, and/or beta blockers. Angioplasty or bypass surgery may be performed to relieve symptoms or prevent heart attack.

 

Coronary artery disease.

If you have coronary artery disease, your heart needs more oxygen than it’s getting — and an artery blockage can tip this balance quickly, sending you into heart attack. Women with coronary artery disease need to either increase blood flow (oxygen supply), or decrease the heart’s workload (oxygen demand).

 

Increasing blood flow:

• Medications: calcium channel blockers, nitrates
• Surgical therapies: angioplasty, bypass

 

Decreasing workload:

• Medications: Beta blockers, calcium channel blockers, nitrates, ACE inhibitors

 

Congestive heart failure.

“Heart failure” represents a scary name for an often treatable condition. In heart failure, the heart muscle is weak, enlarged and stiff. The condition results in fluid buildup in the body, leading to shortness of breath, swelling (edema) and fluid in the abdomen (ascites). Medications for heart failure, which improve survival and reduce hospitalizations, include ACE inhibitors or ARBs, beta blockers, digoxin (which increases pumping force) and diuretics, including spironolactone (to reduce fluid buildup).

 

Long QT syndrome.

Long QT syndrome can be silent until a trigger causes your heart to beat extremely fast, often resulting in death. Typically, Long QT syndrome is suspected through family history, and diagnosed with a characteristic electrocardiogram reading during strenuous exercise. Most people with Long QT need an implantable cardioverter defibrillator implanted as a precaution.

 

Bradycardia.

If you have a slow or uncoordinated heartbeat, you may need a pacemaker to keep your heart beating in a coordinated rhythm.

 

These are only a few of the most common heart diseases diagnoses and possible treatments; consult your doctor for more information on specific symptoms and treatments.