It is imperative to diagnose heart conditions in women in a timely manner
New Delhi, 25th February 2018: Heart Care Foundation of India (HCFI) and NCD cell of IMA condone the untimely death of Padma Shri Awardee Ms Sridevi and dedicate a special campaign about prevention of sudden cardiac death among women to her. In 1999, she released health messages regarding prevention of heart disease. A 38-year follow-up from the Framingham Heart study evaluated the incidence of sudden cardiac death in women compared with men.
The study revealed that women had a lower sudden cardiac death (SCD) rate than men at all ages. The risk of sudden death among women with coronary heart disease is one-half that of men with coronary heart disease. A higher fraction of sudden deaths in women occur in the absence of prior overt coronary heart disease (63% vs 44% in men).
Speaking about this, Padma Shri Awardee Dr K K Aggarwal, President Heart Care Foundation of India (HCFI) and Immediate Past National President Indian Medical Association (IMA), said, “Sridevi was an artiste par excellence and we express our heartfelt condolences on her demise. At this juncture, it becomes imperative to spread awareness on the fact that it is more difficult to establish the diagnosis of heart disease in women. Women generally present about 10 years later than men and with a greater risk-factor burden. Women are less likely than men to have typical angina. Those who present to the emergency room with new onset chest pain are approached and diagnosed less aggressively than men. Many cases of heart attack in women go unrecognized, particularly at younger ages or in patients with diabetes. Treadmill exercise testing has a higher false-positive rate in women (for the diagnosis of obstructive coronary artery disease). The prevalence of significant coronary disease found at the time of angiography is lower in women than men presenting with chest pain. All women with intermediate or higher risk should be evaluated.”
Sudden cardiac arrest (SCA) and SCD refer to the sudden cessation of organized cardiac electrical activity. The event is referred to as SCA (or aborted SCD) if an intervention (e.g., CPR, defibrillation, cardioversion, anti-arrhythmic drug) or spontaneous reversion restores circulation. It is called SCD if the patient dies.
Adding further, Dr Aggarwal, who is also the Vice President of CMAAO, said, “The exact mechanism of collapse in an individual patient is often impossible to establish since, for the vast majority of patients who die suddenly, cardiac electrical activity is not being monitored at the time of their collapse. In case of a sudden cardiac arrest, start CPR 10 and continue till medical help arrives along with external electric shock machine. It may be advisable to opt for virtual autopsy along with blood molecular tests in cases of sudden cardiac death to know chances of similar episode in the family in future. It will be a strong family history of SCDs for Sridevi’s future generations if her SCD is linked to blockages in the heart.”
Screening for heart disease
Sridevi’s untimely death brings to forefront sudden cardiac death in women
Dr KK Aggarwal
Recipient of Padma Shri
The tragic and very untimely death of actor Sridevi, a Padma Shri Awardee, brings to forefront the topic of sudden cardiac death (SCD) in women. The passing away of a talented actor reiterates the need to identify women at risk and to manage these risk factors for better outcomes.
SCD is an unexpected death that occurs due to a cardiovascular cause. While those with heart disease are at a greater risk of sudden cardiac arrest leading to sudden cardiac death, it is the asymptomatic person, who appears healthy and has no known heart disease, who is most at risk of sudden cardiac arrest. SCD can be the first manifestation of coronary artery disease (CAD). Lifestyle factors that influence CAD risk might also have an impact on the risk for SCD. Hence, adherence to a low-risk lifestyle is associated with a low risk of SCD (JAMA. 2011 Jul 6;306(1):62-9).
According to a 38-year follow-up from the Framingham Heart study, which examined the incidence of sudden cardiac death in women in comparison to men, women are at lower risk for SCD than men. In women with underlying coronary heart disease (CHD), the risk of SCD is 50% less than in men with CHD. But, in the absence of prior overt CHD, the incidence of SCD is higher in women compared to men; 63% vs 44%, respectively. Among patients with heart failure, the absolute risk in women is only one-third that of men.
Phobic anxiety is associated with an increased risk of SCD in women. Some, but not all, of this risk can be ascribed to CHD risk factors associated with phobic anxiety such as diabetes, hypertension and high serum cholesterol.
Sudden cardiac arrest may not be as sudden as is usually thought. About 50% of victims of sudden cardiac arrest have some tell-tale warning signs that their heart is in danger of stopping in the month preceding their attack, which include any combination of chest pain and pressure, shortness of breath, heart palpitations, and flu-like sensations (such as nausea, back pain and/or abdominal pain). While less than 20% of those who experience symptoms actually reach out for potentially lifesaving emergency medical assistance.
Cardiac arrest is not the same as a heart attack. A cardiac arrest occurs when electrical activity of the heart is disturbed and the heart stops working, while a heart attack is the result of arterial blockage that cuts off blood flow to the heart. Heart attacks can increase the risk of cardiac arrest; however, heart attacks do not lead to sudden cardiac arrest but when sudden cardiac arrest occurs, heart attack is the most common cause.
Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) are same. If an intervention such as CPR or defibrillation, cardioversion restores circulation, it is called sudden cardiac arrest. But if the patient dies, it is referred to as SCD.
Ventricular tachycardia (VT)/ventricular fibrillation (VF) account for most such episodes, while bradycardia or asystole (no heart beat) make up the remaining.
CPR is a life-saving procedure in the event of a sudden cardiac arrest.
A heart attack in women presents differently compared to men. Women are less likely than men to have typical features of a heart attack. Women have more chances to present with angina than heart attack but when they present with heart attack it is more fatal. Many cases of heart attack in women go unrecognized, particularly at younger ages or in patients with diabetes.
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