February is American Heart Month, so take some time this month to learn more about heart disease prevention and the advanced tools and procedures being used to treat heart and vascular conditions. The Heart Hospital Baylor Plano is making this easy to do! Throughout February, we're posting special content on our website to give you tools, tips, and education to show your heart some tender, loving care.
One of the primary concerns for women as it relates to heart disease after menopause has to do with decreased levels of the hormone estrogen. Estrogen affects far more than reproductive health. That's why it's important for women to watch for the following changes after menopause:
Women should work with their health care provider to develop a plan to head off heart disease during and after menopause.
The Reynold's Risk Score was initally developed to better predict the 10-year risk of heart attack and stroke in women. While it is now considered an effective tool for men as well, it is especially useful for women as it gives greater consideration to CRP levels - a marker for inflammation, which studies have shown to be a greater risk factor for heart disease in women. The Reynold's Risk Score consists of:
Women generally need to consume fewer calories than men to have enough energy throughout the day while staying heart healthy. The U.S. Department of Health and Human Services' Office of Women's Health says a healthy meal consists of:
The American Heart Association offers the following recommendations to improve or maintain overall cardiovascular health:
Although heart disease remains the top cause of death for both men and women, the risk in women too often is not recognized in a timely manner. As a result, many women at high risk never learn the appropriate preventive strategies shown to reduce the risk of heart disease and related negative health consequences.
“Even for women who regularly see their primary medical provider, gender-specific risk assessments for heart disease may be lacking,” says Deepika Gopal, MD, FACC, FSCCT , FASE, medical director of Cardiac MRI and Women's Cardiovascular Health at The Heart Hospital Baylor Plano.
Dr. Gopal says that while advances have been made in identification and treatment of heart disease in women, she believes that gender-specific risk assessments often aren’t emphasized enough. “It is very important that physicians caring for female patients focus on women-specific risk factors – both traditional and non-traditional.”
Accurate assessment of risk is important, particularly in women, as the preventive therapy for a certain cardiovascular condition may be different. Thus, current guidelines support specific assessment of stroke risk in women to determine the appropriateness of using aspirin as therapy.
Traditional Risk Factors…with a Caveat
Heart disease does have many risk factors that apply to both sexes, which need to be tracked and monitored throughout life:
Even with some of these traditional risk factors, though, there are subtle, yet important differences between men and women.
“It has been shown that cardiovascular disease risk in a diabetic woman is considerably higher than in a man with diabetes, even when adjusted for other risk factors such as age and hypertension,” asserts Dr. Gopal.
Just for Women
“The most important component of risk assessment in women is also the recognition of non-traditional risk factors,” says Dr. Gopal.
Most significantly, is the role of two factors unique to women: pregnancy and menopause. Associations between pregnancy-specific complications, such as preeclampsia (pregnancy-related high blood pressure) and gestational diabetes, and future risk for long-term high blood pressure and type 2 diabetes have become more widely recognized, and have the potential to lead to heart disease. That is why current guidelines recommend screening for these conditions in women after they give birth.
Additionally, the cardiovascular health status of women before and during pregnancy may contribute to the future cardiovascular disease risk of their children.
Meanwhile, menopause – a natural part of women’s life-cycle – also is tied to heart disease risk. While menopause itself is not a risk factor, the hormonal and biological changes that occur once a woman has completed menopause may significantly increase risk of heart disease.
“A decline in estrogen after menopause appears to be part of the reason for the marked increase in heart disease risk after menopause, but there are other factors being explored as well,” says Dr. Gopal.
Besides pregnancy and menopause, inflammatory autoimmune conditions such as systemic lupus erythematosus, psoriasis and rheumatoid arthritis are known to be associated with increased risk of certain types of heart disease in women. Depression and other psychological and social factors have been linked to increased risk in women – but not necessarily men – as well.
“Traditional risk assessment tools used by physicians, such as the Framingham Risk Score, significantly underestimate risk in women by classifying most women as having low risk for cardiovascular disease,” explains Dr. Gopal. “This is why it’s important for physicians caring for women to use alternative tools, such as the Reynold's Risk Score, which incorporates a marker of inflammation.”
Getting Risk Right
In addition to having the right gender-specific risk assessment through their doctor’s office, Dr. Gopal believes that coronary CT calcium scoring is an invaluable tool for women – and men – who may be at risk of heart disease.
“This screening test allows us to look for early plaque in the coronary arteries,” she explains, “and thereby offers risk stratification and the chance for early initiation of preventive therapy regardless of what traditional and non-traditional risk factors may or may not be present.”
To diagnose and treat blockages in the arteries of the heart, cardiac catheterization is widely considered the go-to minimally invasive technique. Cardiac catheterization involves inserting a catheter, a thin flexible tube, into a blood vessel in the leg or arm and guiding it to the arteries in the heart with the help of special imaging equipment. Unlike surgery, which requires large incisions, the catheter is inserted through a small nick in the thigh or arm and stents are inserted to treat blocked arteries. This typically means less discomfort and a quicker recovery.
Millions of Americans struggle with heart rhythm disorders, called arrhythmias, which indicate a problem in the heart's electrical system. Arrhythmias can lead to stroke, heart failure, and a number of other life-threatening medical issues. Often, the source of an arrhythmia is diseased tissue in the heart. At leading heart centers like The Heart Hospital Baylor Plano, specialists employ advanced anatomical mapping systems to steer catheters through the heart to find the diseased tissue and eliminate it by using hot or cold energy delivery – a process called ablation. Learn more about arrhythmia and available treatments by visiting our
Heart Arrhythmia page on our website.
While diseases in veins and arteries in the body's extremities have long been able to be addressed with minimally or non-invasive techniques, problems with major arteries running through the center of the body, like the aorta, have typically required major surgery to fix.
However, new techniques and surgical tools are now allowing vascular disease specialists at select hospitals, including The Heart Hospital Baylor Plano, to offer minimally invasive repair of the aorta in hard-to-reach locations, such as the chest and stomach cavity.
Robots aren't toys or tools used in manufacturing any more. They are also eliminating the need for invasive surgical procedures, including many heart and lung procedures. Through tiny incisions, robot technology allows surgeons to see inside the body in extreme detail, and perform operations from a control console with miniature tools — including lasers and scalpels — which are attached to robotic arms.
Robotic-assisted surgery typically offers several advantages over traditional surgery, including shorter hospital stays, smaller incisions and a quicker recovery time. At The Heart Hospital Baylor Plano, more than 80 percent of lung procedures in 2015 were performed using minimally invasive robotic-assisted surgery.
From cell phones to televisions to computers, when it comes to technological advancement, the trend has been smaller and faster. When it comes to medical procedures, that trend has largely been mirrored. Procedures that once took hours, now may take as little as 45 minutes. And procedures that once involved long incisions are now being conducted with tiny tools that may only require an incision the size of a razor nick.
Nowhere has this trend in health care been more evident than cardiovascular medicine, where minimally invasive and noninvasive procedures, along with shorter hospital stays, have come to define care at the nation’s leading heart care programs.
According to Srinivas Gunukula, MD, on the medical staff and medical director of the Center for Advanced Cardiovascular Care at The Heart Hospital Baylor Plano, it’s a trend that is expected to accelerate, as new technology and techniques expand into different areas of heart and vascular care. “The portfolio of minimally or noninvasive procedures – as well as the types of conditions that can be addressed through these methods – has exploded over the past 10 to 15 years,” he says. “And it’s about to grow a lot more as new tools and techniques to replace or repair the heart’s valves move out of clinical trials and gain wider adoption.”
Dr. Gunukula cites transcatheter aortic valve replacement (TAVR) and transcatheter mitral valve replacement (TMVR) as examples of game changers that will allow many patients to avoid major heart surgery.
TAVR: Out of Trials, Into the OR
While the heart is a complex organ, at its most basic, it is a muscle divided into four chambers. The heart also has four valves that control the flow of blood both within the heart and out into the major arteries that circulate blood throughout the body with every beat.
The aortic valve connects what is perhaps the body’s most vital artery – the aorta – with the heart. It opens to allow blood to flow out of the heart and closes to keep the blood from flowing backward into the heart. When the aortic valve doesn’t function properly, it may need to be repaired or replaced. Until recently, replacing it has involved major surgery.
“TAVR is much less invasive than traditional valve surgery,” says Dr. Gunukula. “The recovery period is usually much shorter and easier, and can result in a hospital stay as short as one day.”
With TAVR, surgeons – guided by imaging equipment – thread a wire in a hollow flexible tube called a catheter through the body’s blood vessels across the diseased aortic valve in the heart. An artificial replacement valve is then sent over the wire through the tube and deployed to function in place of the body’s damaged valve. (Note: To submit an inquiry and learn more about TAVR at The Heart Hospital Baylor Plano, go to TheHeartHospitalBaylor.com/TAVR. One of our TAVR nurses will contact you within 24-48 hours.)
The U.S. Food and Drug Administration (FDA) has approved TAVR for use in patients who need aortic valve replacement, but who are at high risk for open heart surgery. In the future, TAVR could become the standard approach for all patients in need of aortic valve replacement.
Beyond the Valves
In addition to valve disease, there are a number of other new – or coming-soon – minimally-invasive or non-invasive techniques being used to treat cardiovascular conditions ranging from atrial fibrillation to peripheral vascular disease to aortic disease to lung disease and more.
These procedures are creating better outcomes and quicker recoveries for many patients. And that’s something that will never go out of style.
This rare congenital defect occurs due to the improper formation of one of the heart's key valves—the tricuspid. This causes the valve to fail and leak. It may lead to an enlarged heart or heart failure, and can be accomplished by other heart conditions.
Symptoms: abnormal heart beat; bluish lips; easily fatigued
Standard treatment: close monitoring, along with medication to control irregular heartbeats; surgical repair or replacement of the tricuspid valve may also be needed.
Atrial septal defect (ASD) and ventricular septal defect (VSD) both describe holes in different walls separating chambers of the heart. ASD is a hole in the wall separating the upper chambers of the heart, while VSD occurs in the lower chambers. Often going undetected until early in childhood, these congenital heart defects can potentially cause long-term damage to the heart or lungs.
Symptoms: shortness of breath; fatigue; failure to thrive; irregular heartbeat
Standard treatment: depending on the size of the hole, surgical repair to close it may or may not be necessary.
A serious congenital heart defect, transposition of the great vessels occurs when the aorta and pulmonary artery — the two main vessels carrying blood away from the heart and into the body — are reversed. This switch changes the way blood flows and means that blood that is properly oxygenated is not circulating throughout the body.
Symptoms: bluish skin hue; feeding issues; clubbing of fingers/toes
Standard treatment: immediate IV medicine upon birth; catheter-based procedure or surgery to allow oxygenation of the blood followed by definitive surgery to put the arteries in their proper place within the first weeks of life.
Affecting about one out of every 2,500 births, tetralogy of Fallot causes mixing of oxygen-rich and oxygen-poor blood leading to the circulation of low oxygen containing "blue" blood. For this reason, it is called a "blue baby" syndrome. Often, the amount of oxygen in the blood isn't sufficient for the body's needs. The cause of this structural defect is abnormal separation of the aorta and pulmonary artery — the two large blood vessels carrying blood away from the heart — during heart development.
Symptoms: bluish hue to skin, lips, and inside of the nose and mouth; extreme fatigue; shortness of breath.
Standard treatment: surgery to increase blood flow to the lungs; and/or surgery correcting the structural issues inside the heart to allow greater oxygenation.
Like many health challenges, heart disease is often thought of as an “old person’s disease.” Although it is true that the risk of heart disease rises with age, there are a number of cardiovascular conditions that impact millions of younger Americans each year.
The National Institutes of Health, for example, funded a study showing that strokes among adults under age 55 grew from about 13 percent in 1993 to 19 percent 12 years later. Additionally, the American Heart Association reports that about 7 percent of men and 6.2 percent of women under the age of 60 have been diagnosed with coronary heart disease.
While these statistics show that “traditional” heart disease is a threat to men and women of every age, there is another form of the disease that will affect millions of Americans during their lifetime that often doesn’t get much attention: congenital heart defects. It’s a form of heart disease that requires lifelong specialized care.
Big Issue. Little Press.
“Congenital heart defects are the most common birth defect,” explains Ari Cedars, MD, medical director of the Adult Congenital Heart Disease Center for Baylor Scott & White Health and on the medical staff of The Heart Hospital Baylor Plano “They affect one percent of live births in one form or another.”
That’s about 40,000 babies born in the United States each year.
Congenital heart defects include a wide range of conditions that may impact either the heart’s structure, rhythm and/or its overall function. According to the Children’s Heart Foundation, about 25 percent of defects are considered “critical,” meaning they require surgery within the first year of life. Sadly, twice as many children die each year from a heart defect than all forms of childhood cancer combined.
Some congenital heart defects — typically critical defects — can be discovered via ultrasound during pregnancy, giving parents time to prepare. However, often, it’s parents and pediatricians who first notice potential signs of a defect in a child who fails to hit milestones, has low oxygen saturation or who shows signs of a heart issue during a physical exam.
“Pediatricians are pretty well attuned to signs of congenital heart disease,” Dr. Cedars says.
Congenital Versus Genetic Heart Defects
Congenital heart defects are not usually an inherited trait, though Dr. Cedars recommends expectant parents have a prenatal screening conducted if either the mother or father has a defect. Additionally, genetic heart defects passed from one generation to the next often don’t present until later in life, and often present in a way completely different from congenital defects.
Living a Full Life
Most types of congenital heart defects can be effectively treated through monitoring, medication, surgery or a combination of all three. Typically, treatment begins during childhood, but it shouldn’t end there. Dr. Cedars emphasizes how important care is throughout adulthood. Even if the defect was addressed earlier in life, results are rarely permanent.
“Congenital heart defects require regular follow-ups even if they have been repaired,” he says. “The majority of repairs deteriorate over time in some type of predictable fashion.”
Adults with congenital heart defects are two to three times more likely to be hospitalized, and have a much higher probability of heart failure, abnormal rhythms and other cardiovascular-related illnesses.
“A lot of these hospitalizations and complications can be prevented if patients are closely monitored by someone who is familiar with their particular heart disease and know what deterioration to look for,” says Dr. Cedars.
So while congenital heart defects may be unavoidable for many Americans, with consistent follow-up care, many of the problems that accompany these conditions are avoidable.
Who is the screening for?
Individuals who don't have symptoms but are at medium risk of heart disease.
What does it involve?
A CT scanner takes pictures of the heart in thin sections. The screening takes about 15 minutes and involves exposure to low doses of radiation.
What does it measure?
Calcium deposits that build-up in the coronary arteries. A score is assigned based on the amount of calcium present.
What do the results mean?
A high score may indicate a need for other tests and treatments that could help avoid a heart attack.
Why have the screening?
High body fat is a top risk factor for heart disease and many other health challenges.
What does it involve?
Weight should be appropriate for height and body type. Body mass index (BMI) is calculated by weight (in kilograms) divided by height squared (in meters).
What does it measure?
BMI measures relative amount of fat to body composition.
What do the results mean?
A BMI of 25-29.9 indicates being overweight, while 30 or higher is obese. Steps are likely needed to control weight.
Why have the screening?
High blood pressure, sometimes called 'the silent killer,' can lead to heart attack, stroke, kidney failure and other serious health conditions.
A cuff around the arm which is tightened and then relaxed over the course of about 30 seconds.
The amount of pressure blood is putting on the walls of arteries when the heart beats (systolic) and in between beats (diastolic).
What do the results mean?
Consistent readings above 120 for systolic and 80 for diastolic should be discussed with a health care provider.
Studies have shown that high cholesterol is a major risk factor for heart disease.
Drawing a blood sample (usually from the arm).
The amount of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol and triglycerides in your blood.
Total cholesterol of 240 mg/dL or higher, or LDL cholesterol of 160 mg/dL, indicate high cholesterol. Based on other risk factors, a change in diet, lifestyle or adding medication may be needed.
December 2016 provided a stark reminder of how potent and indiscriminate a killer heart disease still is, with the deaths of several major icons before their time, all reportedly due to various forms of cardiovascular disease. From the small screen it was Alan Thicke, age 69. From the big screen, it was Carrie Fisher, age 60. And from the music world, it was George Michael, age 53.
In all three cases, these celebrities’ passing from apparent cardiovascular illnesses appears relatively unexpected. While there have been tremendous advances in cardiovascular treatments over the past two decades, what about disease detection?
“I think most people know by now that diet, exercise and not smoking are the cornerstones of preventing heart disease,” says Trent Pettijohn, MD, on the medical staff at The Heart Hospital Baylor Plano and vice president of Medical Staff Affairs. “But there are a number of screening options that people should be aware of and take advantage of depending on their age, sex and risk factors.”
Screenings for All
There is no simple way to catch all heart disease before it begins or before it becomes life-threatening. However, the American Heart Association (AHA) recommends a number of routine tests for everyone beginning in early adulthood. Starting at age 20 for adults at normal risk of heart disease, the AHA recommends:
In addition, the AHA recommends a blood glucose test at least every three years starting at age 45.
“Consistently receiving these screenings is a great starting point for potentially heading off a significant cardiovascular event by making earlier intervention possible,” says Dr. Pettijohn.
Getting an Important Score
People identified at medium risk for heart disease – meaning a 10 to 20 percent chance of having a heart attack in the next ten years based on risk factors (age, weight, blood pressure, gender, family history, high cholesterol, smoking, diabetes) – may want to consider a coronary calcium score screening. All adults should regularly talk to their physician about their risk.
“A calcium score screening is a non-invasive imaging procedure that actually measures calcium build-up, which is a sign of blockage, in the coronary arteries,” explains Dr. Pettijohn. “A high score may mean it’s time to be more proactive about preventing heart disease through medication or indicate the need for additional testing.”
To be eligible for this screening at The Heart Hospital Baylor Plano or The Heart Hospital Baylor Denton, a doctor’s referral is usually required. Men 40-65 years-old and women 45-70 years-old can self-refer if they also have one of the following risk factors:
Consistency Is Key
Heart disease typically develops slowly over many years. That’s why regular check-ups, screenings and conversations with your physician throughout life are vital to catching it early, when it’s most preventable or treatable.
Physicians are members of the medical staff at one of Baylor Health Care System's subsidiary, community or affiliated medical centers and are neither employees nor agents of those medical centers, The Heart Hospital Baylor Plano or Baylor Health Care System.