Not Just a Man’s Disease

Left: Pamela Ham became the first person in Nevada to receive the world’s smallest pacemaker. Top Right: A monitor displaying fluoroscopy images of the Micra Transcatheter Pacing System implant procedure. Bottom Right: Dr. Arjun Gururaj holds the Micra Transcatheter Pacing System.

By Scott Kerbs, UMC Physician Experience Coordinator

While heart disease and other cardiovascular concerns are often incorrectly viewed as issues primarily affecting men, UMC hopes to change this perception among community members by raising awareness of heart conditions and their significant impact on women.

Heart disease is the No. 1 cause of death among both women and men in the United States, accounting for approximately one in four female deaths in 2013, according to the U.S. Centers for Disease Control and Prevention. In addition, the American Heart Association notes that women are less likely than men to survive a first heart attack.

Dr. Robert Wesley, a cardiologist at UMC, said women typically experience coronary heart disease later in life than men, but many women experience more aggressive forms of the disease. Coronary heart disease occurs when plaque accumulates in the coronary arteries, which provide blood to the heart.

“Coronary disease can be more rapidly progressive in women,” Dr. Wesley said. “The first presentation can be a heart attack.”

A 2012 report from the American Heart Association revealed that nearly two-thirds of women who die suddenly as a result of coronary heart disease did not experience any previous symptoms.

Dr. Richard Shehane, Co-Director of UMC’s Heart Failure Clinic, said women often experience atypical symptoms of a heart condition. In addition to the more common symptoms of chest pain and pressure, some women may experience one or more of the following symptoms: shortness of breath, palpitations, pain in the arms and neck, epigastric (upper-abdominal) pain and/or nausea, in addition to other signs.

“Community members should not ignore these types of symptoms,” Dr. Shehane said, noting that men may experience these atypical symptoms as well.

Dr. Shehane encourages women to seek appropriate medical care if they experience any symptoms of a heart condition, especially if they have one or more risk factors. The most common risk factors for heart disease include cigarette smoking, diabetes, high cholesterol, a family history of heart disease and high blood pressure.

On average, women experience heart disease about 10 years later in life than men, with the exception of women who smoke cigarettes, Shehane said, noting that smoking serves as the No. 1 risk factor.

In addition to the many issues associated with coronary heart disease, women may also experience additional risks if they have atrial fibrillation, a serious condition marked by an irregular heart rhythm that is rapid in many cases. Patients with atrial fibrillation have an increased risk of stroke, which is especially concerning for women.

“Atrial fibrillation is an independent risk factor for death. It tends to be more consequential in women, as the stroke rate is higher among women,” said Dr. Arjun Gururaj, who recently performed a groundbreaking procedure at UMC, implanting the world’s smallest pacemaker to assist a female patient with atrial fibrillation.

This was the first procedure of its kind in Nevada, and it involved implanting the wireless Micra pacemaker, which is roughly the size of a large vitamin, to help control the heart rhythm of Pamela Ham, a 67-year-old woman with atrial fibrillation.

“This technology is truly a revolution,” Dr. Gururaj said, describing the compact pacemaker as a game changer for patients that reduces the risk of many complications associated with traditional pacemakers, which require significant surgical procedures.

Developed by Medtronic, the Micra Transcatheter Pacing System is a “leadless” pacemaker that does not use wires, and it is attached to the heart after being guided through the femoral vein in the groin.

The procedure was successful, and Ham is expected to feel the full effect of the technology in several weeks after Dr. Gururaj programs the pacemaker during a follow-up appointment.

Ham, who looks forward to enjoying life without the fatigue and shortness of breath that have limited her activities for the past 18 months, said she encourages women to seek care if they have any symptoms that may indicate a heart condition. She initially wrote off her symptoms as the effects of aging, but she was able to receive the most advanced care available after realizing her need for medical attention.

Dr. Gururaj said primary care providers play a key role in helping patients identify potential heart issues and connecting them with the appropriate specialists.

In addition to recommending the American Heart Association guideline of 150 minutes of moderate exercise per week to reduce an individual’s risk of heart disease, Dr. Shehane said many women may also benefit from the assistance provided by dietitians.

Kathryn Spada, a Clinical Dietitian at UMC, said women who seek to improve their heart health through diet should focus on minimizing sodium, in addition to saturated fat and trans fat, the two types of fat that can build up in the arteries. She said keeping sodium at approximately 2,000 milligrams per day, or as low as 1,500 milligrams per day for people with heart disease, can assist in reducing an individual’s blood pressure.

Spada recommends checking the nutrition labels on all foods and selecting items with no more than 200 milligrams of sodium per serving.

“The best trick is to avoid using the salt shaker at all,” Spada said. “Instead, use more herbs and spices to flavor your food.”

She added that canned vegetables often contain high amounts of sodium, recommending fresh or frozen vegetables for a heart-healthy diet.

Spada encourages women who have concerns about their diet to seek personalized assistance from a dietitian.

“A dietitian can get really specific and provide individuals with the best meal plan possible,” she said.

Health care professionals of all disciplines at UMC urge women to pay close attention to their heart health and take steps to reduce existing risk factors. While many people are aware of the impact of heart disease on men, it is important to recognize that women’s hearts are not immune to this leading cause of death.

For more information about the services provided by UMC, please visit www.umcsn.com.