presentación de powerpoint · 2017. 7. 6. · copd, tia, cva, ckd diagnostic evaluation algorithm...
TRANSCRIPT
![Page 1: Presentación de PowerPoint · 2017. 7. 6. · copd, tia, cva, ckd Diagnostic evaluation algorithm for women presenting with suspected ischemic heart disease (IHD) symptoms and intermediate](https://reader036.vdocuments.site/reader036/viewer/2022081518/6134c1b5dfd10f4dd73bef3f/html5/thumbnails/1.jpg)
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Presenters:
Sabrina Phillips, MD FACC FASE
Women’s Heart Health: Diagnosis
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No Disclosures
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Exercise Capacity is An Important Predictor of Death in Asymptomatic
Women
Martha Gulati et al. Circulation. 2003;108:1554-1559
Copyright © American Heart Association, Inc. All rights reserved.
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Maximal Predicted Heart Rate in Women vs. Men
Peak HR= 206-
0.88(age)
Peak HR = 220- age
Gulati et al. Heart Rate Response to Exercise Testing in Women. Circ 2010
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Nomogram of percent peak heart rate for age in asymptomatic female volunteers compared with the traditional estimate
Martha Gulati et al. Circulation. 2010;122:130-137
Copyright © American Heart Association, Inc. All rights reserved.
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Kaplan-Meier survival curves by heart rate response in maximal exercise stress testing in asymptomatic women
Martha Gulati et al. Circulation. 2010;122:130-137
Copyright © American Heart Association, Inc. All rights reserved.
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Kaplan-Meier survival curves by heart rate response in maximal exercise stress testing in asymptomatic women
Martha Gulati et al. Circulation. 2010;122:130-137
Copyright © American Heart Association, Inc. All rights reserved.
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Ischemic Symptoms in Women
• More often related to mental or emotional stress vs physical exertion
• Epigastric discomfort and nausea
• Fatigue and dyspnea
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Risk Stratification in Symptomatic Women
Low Risk
Premenopausal and no diabetes
Age 50-60 and capable of ADLs
Intermediate Risk
Age 50-60 and limited ADLs
Age 60-70
High Risk
Age > 70
Peripheral arterial disease
Diabetes (long history or poor
control)
COPD, TIA, CVA, CKD
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Diagnostic evaluation algorithm for women presenting with suspected ischemic heart disease (IHD) symptoms and intermediate IHD risk and intermediate-high IHD risk.
Jennifer H. Mieres et al. Circulation. 2014;130:350-379
Copyright © American Heart Association, Inc. All rights reserved.
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Acute Coronary Syndromes in Women vs Men
• Plaque erosion with distal embolization vs plaque rupture with occlusive thrombus
• Increased incidence of coronary microvascular disease
• Increased frequency of pathological vasoreactivity
• Spontaneous coronary artery dissection
• Takaotsubo
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High Sensitivity Troponin Improves Diagnosis of Myocardial Infarction in
Women• Women: > 16 ng/L
• Men: > 34 ng/L
Shah et al. BMJ 2015
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Survival free from death or recurrent myocardial infarction in women with suspected acute coronary syndrome
Anoop S V Shah et al. BMJ 2015;350:bmj.g7873
©2015 by British Medical Journal Publishing Group
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Non-obstructive Epicardial Disease ISClinically Significant
• Women with stable ischemic symptoms have increased risk of coronary events
• Myocardial ischemia is associated with higher mortality in symptomatic women vs men
• Women with non-obstructive CAD and stress test abnormalities should be classified as having elevated risk of ischemic evnets.
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