Stroke is the leading cause of death among women in developing world-Dr. Nusrat Majeed

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 Women and Heart Disease Session during CARDIO CON 2016

Stroke is the leading cause of death among women
in developing world-Dr. Nusrat Majeed

Cardiologists and Obstetricians should jointly manage pregnant
patients with cardiovascular disease-Prof. Tayyab

FAISALABAD: One of the sessions during the CARDIO CON 2016 held here during November 2016 was devoted to Women and Heart Diseases. It was chaired by Prof. Khalida Soomro along with Dr. Sultana Habib and others. Dr. Maria Viqar from USA was the first speaker who pointed out that women are most commonly affected by sick sinus syndrome. Most of them are usually younger than forty years of age. AF is seen more in men but remain unchanged in women. Other diseases which are more common in women include congestive heart failure, hypertension, diabetes, stroke, TIAs, vascular diseases, cardio metabolic events and ventricular arrhythmias. They also suffer from inherited arrhythmias syndrome.  Majority of the physicians cannot recognize a long QT when they see one.  She advised the audience not to rely on computers but do their own measurement. Women who suffer from syncope are younger than men. She also talked about palpitation and its management in women.

Dr. Nusrat Majeed from Islamabad spoke about disease burden and emerging risk factors of CVD in young women. Speaking in her usual style, she remarked that it is not correct to say that young women have only broken heart but it is diseases heart which is overloaded. In the past it was not so uncommon to hear that I am too young to have heart attack. Now women in their 30s suffer from heart attack. They come with chest pain and abdominal pain. Stroke is the leading cause of death among women in developing world. They complain of pain in legs, cold sweat skin, light headedness, chest pain, pressure, fullness, upset stomach and shortness of breath. She was of the view that one should always do carotid scanning in these patients. IHD in women is a big problem. Their symptoms are different and so are the diagnostic modality, she remarked.

Dr. Shahadat Hussain from Bahawalpur discussed heart failure in women and peripartum cardiomyopathy. CVD, he said, is a leading cause of death in women apart from breast cancer.  Compared to men, women have lower LV mass and gentle contractility. They have less procedures including ICD, CRT. He also discussed the signs and symptoms. Discourage pregnancy in women with persistent cardiac dysfunction. They need vigorous treatment for AHF using oxygen, diuretics and vasodilators.  After delivery warfarin may be used.  ACE Inhibitors and Aldactone were mentioned as absolute contraindications in pregnancy

Prof. Khalida Soomro spoke about management of pulmonary hypertension in pregnant women. Women with PAH, she said,  may become pregnant with symptoms. Some of them have high maternal age at first parity and some of them are also smokers. CCBs have good prognosis and uncomplicated course of pregnancy.  At times it is difficult for mothers to accept termination of pregnancy at a late stage. It requires skills and multidisciplinary approach. Early anesthetics are used in labour to prevent increase in cardiac output. Pregnant PAH women die of Heart failure and cardiovascular collapse. Majority of the deaths are noted in early postpartum period.

Dr. Amber Ashraf’s presentation was on Management of   Pregnancy with IHD and Hypertension.  CAD, she stated,  is increasing in women with increase in age.  Pregnancy increases risk of AMI three to four fold. PCI in second trimester is advised with upper limb approach. One must avoid Aspirin in the first trimester otherwise it is a drug of choice for treatment of AMI in pregnancy. ACE Inhibitors and Statins are contra indicated in pregnant females. Do not do thrombolysis close to term. BMS is preferred option in pregnancy. CABG should be avoided in second trimester and early third trimester.

Dr. Sultana Habib from NICVD Karachi discussed how to manage ant icoagulation in pregnancy with prosthetic heart valves. She laid emphasis on education of the patient and identification of risk factors, prompt treatment and following anticoagulation guidelines. She opined that more evidenced based trials are needed.

This was followed by an excellent presentation by Prof. M. Tayyab from AIMC Lahore who discussed pregnancy with congenital heart disease and risk of congenital heart defects in fetus. He  pointed out that in pregnancy there is increased hemodynamic burden of cardiovascular system. Symptoms mimic disease. He then talked at length about the signs and symptoms of heart disease in pregnancy. There is hormonal increase in pregnancy and loose body to make the delivery easy. They have increased heart rate and they have increase in circulatory blood volume, increase in cardiac output. Despite normal ECG in pregnancy, there can be sinus tachycardia. ECG may be more helpful in arrhythmias in pregnancy. Speaking about fetal outcome he mentioned intrauterine growth retardation, pre-term birth, low birth weight and spontaneous abortion. With cyanotic CHD the fetal loss could be up to 45%. ASD is the commonest congenital lesion. Echo is required   for diagnosis. Pre conception closure is recommended. He also talked about Tetralogy of Fallout another common problem, congenital aortic stenosis, bicuspid valve and then discussed implications in their management. He suggested that while managing these patients, cardiologists should be involved from pre pregnancy stage. Treatment is recommended for cyanotic conditions. He also highlighted indications for termination of pregnancy. He concluded his presentation by stating that signs and symptoms mimic disease.  Labour is the most dangerous time. Twenty four hours’ time after delivery is very critical. For managing these patients, combined care by cardiologists and obstetricians is recommended.

Dr. Fayyaz Hussain Shah spoke about risk assessment of pregnant women with structural heart diseases. He suggested discussing pregnancy with women of child bearing age. Pregnancy is a challenge to cardiovascular system and women with PAH should be advised against pregnancy.