womens health 15

© 2008 McGraw-Hill Higher Education. All rights reserved.

Chapter Fifteen

Managing Cardiovascular Health and Chronic Health Conditions


Women and Heart Disease

• Coronary heart Disease (CHD) is still the leading cause of death of U.S. females

• In 2003, all cardiovascular diseases claimed the lives of 483,800 women, a decrease from 1999 when CV diseases claimed the lives of 512,904 women

• Although heart disease is more prevalent in men, it is infinitely more deadly in women. Thirty-eight percent of women who have heart attacks die within 1 year, whereas only 25 percent of men die within the same time frame

• Researchers have found that the specialized cells that make up the cardiac electrical system and the heart muscle itself are different in men and women, thus impacting the symptoms as well as the treatment

• Women are less likely to be diagnosed appropriately because of varying or unpredictable symptoms or lack of healthcare provider knowledge


Characteristics of the Heart

• 4 chambered pump (atria, ventricles)

• Size of a fist

• Weighs about 1 pound

• Function - creates pressure to circulate blood throughout the body

• Location – left center of the thorax (between lungs)


The Vascular System

• Refers to the blood vessels• Arteries carry blood away from the heart• Veins carry blood back into the heart• Because a women’s heart and blood vessels are

typically smaller compared to men, there is more difficulty with treatments and greater chances of blockage of an artery


Types of Heart Disease

• Atherosclerosis• Angina Pectoris• Myocardial Infarction

(MI)• Congenital Heart

Disease

• Arrhythmia• Congestive Heart

Failure (CHF)• Endocarditis• Mitral Valve Prolapse

(MVP)


Children and Heart Disease

• Cardiovascular disease in the number 2 cause of death under the age of 15

• Most CVD in children is related to congenital heart defects, but more children are developing risk factors for heart diseases

• Nearly 1 million adolescents between the ages of 12-19 have MetS • Metabolic syndrome (MetS) in adolescents is defined as three or

more of the following: Waist circumference at or above the 90th percentile for age and sex Serum triglyceride level of 110 mg/dL or higher High-density lipoprotein (HDL) cholesterol level less than 40 mg/dL or lower Blood pressure at or above the 90th percentile for age, sex and height Elevated fasting glucose of 110 mg/dL or higher


Contributing Factors to Heart Disease

• Menopause and estrogen loss• Birth control pills• High triglyceride levels• Excessive alcohol intake• Individual response to stress


Risk Factors for Heart Disease That Cannot Be Changed

• Increasing Age

• Male Gender

• Heredity

• Race


Risk Factors for Heart Disease That Can Be Changed

• Tobacco smoking• Physical inactivity• High cholesterol

• High blood pressure• Diabetes mellitus• Obesity and

overweight


Screening and Diagnosis for Heart Disease

• Women often have false positive results from a traditional stress test, e.g., treadmill test

• Results are better from stress-echocardiograms– Non-invasive technique using a treadmill test and

ultrasound pictures of the heart– Ultrasound pictures allow cardiologists to see the

heart contractions during peak exercise


Stroke

• Blockage of vessel to the brain

• Types – Cerebral hemorrhagic and Ischemic Strokes

• Diagnosis – CAT scan, MRI

• Treatment – clot dissolving drug therapy (TPAs), carotid endarterectomy, or endovascular procedure


Risk Factors for Stroke

• Age• Race• Heredity• Gender• Experience of a

previous stroke• Blood lipid profile• Smoking

• Hypertension• Heart disease• Diabetes• High red blood cell

count• Carotid artery disease• Transient ischemic

attacks (mini-strokes)


Osteoporosis

• A bone weakening disorder which results in bone mineral loss and increases the risk of skeletal frailty and fracturing

• Manifests itself during childhood, although perceived as a geriatric disease

• Primary prevention focuses on increasing peak bone mass between the ages of 30-35 years

• The greatest bone density loss occurs in women during the first 5 years after menopause

• Nearly half of all women over the age of 50 are predicted to have a bone fracture during their lifetime related to bone loss


Risk Factors for Osteoporosis

• 1. A small, thin frame (low body mass index)

• 2. Caucasian or Asian • 3. Family history of osteoporosis• 4. Estrogen deficiency • 5. Excessive thyroid medication• 6. Prolonged use of cortisone-like

drugs for asthma, arthritis, or cancer

• 7. Low lifetime calcium intake• 8. Sedentary lifestyle• 9. Cigarette smoker• 10. Excessive alcohol intake

• 11. Personal history of fractures after age 50

• 12. Current low bone mass• 13. Being female• 14. Anorexia nervosa • 15. Amenorrhea• 16. Vitamin D deficiency• 17. Advanced age• 18. History of fracture in primary

relative• 19. Gastrointestinal mal-

absorption syndromes


Protective Factors Against Osteoporosis

• Exercise– Weight bearing activities acts as a protective factor against bone

loss, e.g., walking, weight training– The greatest increase in bone density occurs at the site of

maximum stress and repetition• Diet

– Calcium and Vitamin D are two major nutrients needed to prevent osteoporosis

– Peak bone mass can be increased by drinking milk during childhood and adolescence, increasing levels beyond the current RDA standards

– Studies show that American women and girls take half the amount of calcium recommended for growth and maintenance of bone tissue

• Measuring Bone Mineral Density (BMD)– Multiple types of BMD tests exist, and they are painless and

noninvasive


Treatment for Osteoporosis

• Drug therapy include:• Bisphosphonates (Fosamax, Actonel)• Parathyroid hormone (parathormone)

• HRT is no longer considered a treatment option due to the associated risks for:

• Strokes• Thromboembolism• Cancer• Other diseases

There is no cure for osteoporosis; however, it can be treated and prevented


Diabetes Mellitus

• Diabetes is a chronic disorder of carbohydrate metabolism with a deficiency in insulin production or alteration in the effectiveness of insulin production

• Two types:• Type 1 Diabetes: insulin dependent

– Pancreas produces little or no insulin– Daily injections of insulin are needed

• Type 2 Diabetes: non-insulin dependent– Insulin is produced but the body is resistive in using it– Accounts for 90% of all diabetics– Linked to obesity and physical inactivity


Blood Sugar Regulation


Gestational Diabetes

• Carbohydrate intolerance during pregnancy appearing around the 24th week

• May be related to large quantities of hormones that the placenta produces

• Women who experience this will have a normal glucose level after the pregnancy

• Babies born with mothers with gestational diabetes are at more risk for certain health problems

• Women with gestational diabetes are higher risk for:• Preeclampsia• Urinary Tract Infections• Ketonuria


Asthma

• Asthma is a chronic, incurable disease of the lungs• Characterized by inflammation and narrowing of the air

passageways leading from the mouth and nose into the lungs

• Women and children with asthma suffer periodic episodes, or attacks, with mild to severe symptoms

• These symptoms include: • shortness of breath• wheezing, coughing • chest pain• tightness or any combination.

• In severe cases, an asthma attack can lead to the death


Types of Asthma

• There are two types– allergic: triggered in susceptible individuals by

exposure to common air-borne pollutants – non-allergic: triggered by allergens but is often

triggered by other factors including stress, anxiety, extreme weather changes, exercise, viruses, and bronchial illnesses including colds and flu, or lung infections

• For some patients, however, asthma symptoms may disappear or lessen upon adulthood, as asthma is most often diagnosed during childhood


Epilepsy

• Chronic brain disorder characterized by recurrent seizures (abnormal electrical activity)

• There is no known cause for the majority of seizures

• Seizure preventing drugs can control about 75% of seizures

• Factors to consider for people with epilepsy are:• Psychosocial and Economic considerations• Birth Control, Conception, and Pregnancy


Arthritis

• An inflammatory condition of the joints, characterized by swelling, pain, and/or difficulty moving which persists longer than 2 weeks

• Arthritis or chronic joint symptoms affect approximately 66 million U.S. adults in the U.S. (1 in 3 adults)

• Women are more likely than men to have arthritis and the prevalence of arthritis increases with age

• Treatment includes:• Rest• Exercise• Heat/cold treatments• Medication• Surgery

• Types of arthritis– Osteoarthritis (degenerative joint disease)– Rheumatoid arthritis (autoimmune, chronic inflammatory disease)


Systemic Lupus Erythematosus (SLE)

• SLE is a chronic, autoimmune, rheumatic disease of the connective tissue

• Inflames the joints, muscles, and vital organs• It is 10-15 times more frequent in women than in men• Lupus is three to four times more common in women of

color, particularly African American, Hispanic, Asian, and Native American women

• Treatment for SLE is very similar to arthritis and preventive measures are important such as avoiding sunlight, partaking in exercise, and proper nutrition


Fibromyalgia• Fibromyalgia is a common and chronic musculoskeletal

syndrome characterized by widespread pain in the muscles, ligaments, and tendons, fatigue and multiple “tender points” on the body where there is increased sensitivity to touch or slight pressure

• The American College of Rheumatology (ARC) states that fibromyalgia affects 3 to 6 million Americans with 80-90 percent being women

• Fibromyalgia is generally diagnosed during middle age (between 30 to 50 years of age), but the symptoms may exist much earlier

• It does not damage the joints, muscles or internal organs and with time, many women experience improvements in their condition


Multiple Sclerosis (MS)

• Chronic debilitating disease that affects the Central Nervous System (CNS)

• MS is thought to be an autoimmune disease that causes damage to and loss of myelin (fatty white tissue that surrounds the protects nerve fibers of the CNS)

• The exact cause of MS is still unknown but believed to be triggered by the following factors:

• Genetics• Gender• Environment

• The onset of MS is between the ages of 20-50 years and is 2-3 times higher in women than men

• Diagnosing is very difficult and there is no cure, however, medications such as steroids can be helpful in reducing flare ups for a short term basis


Alzheimer’s Disease (AD)

• Most common form of dementia (gradual, progressive loss of brain cells that can lead to death)

• Characterized by confusion, progressive memory loss, and behavioral disturbances

• The exact cause of AD is unknown, however a genetic component seems to be implicated

• Increasing age is the leading risk factor but is not considered a normal aspect of aging

• No treatment can stop the progressive loss of brain cells but current drug treatments can help minimize the symptoms for a period of time


Chapter Fifteen

Managing Cardiovascular Health and Chronic Health Conditions

womens health 15

Health & Medicine