469720?1388149949
Lee Kirksey, MD  
Male
Cleveland , OH

Specialties: Peripheral Arterial Disease, PAD

Interests: vascular, specialist, treatment options
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Heart Disease and Women 101

Apr 16, 2008 - 7 comments
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vasculr disease

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vascular surgeon

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philadelphia

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claudication

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angioplasty

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cardiologist

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Heart Disease

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Amputation

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Stent



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Early Warning Symptom for the #1 Killer of Women Is Under-recognized
Heart disease is the #1 killer of women in the United States. Peripheral arterial disease (PAD)-clogged or narrowed arteries in the legs-is a red flag that the same process may be going on elsewhere because PAD is associated with other life-threatening vascular diseases. Through early detection, interventional radiologists can save women from future stroke, heart attack, and early death. To combat this major public health issue, Vascular Medical specialist recommend greater screening efforts by the medical community through the use of the ankle brachial index (ABI) test.

PAD Under-recognized in Women
Like heart disease, peripheral arterial disease is under-recognized in women. According to a survey of primary care physicians conducted in 2002, nearly all recognized that older people are more susceptible to PAD, and identified men as being susceptible to PAD. However, they mostly excluded women as likely to have PAD, which is incorrect. The prevalence is actually equal on the diagnostic ABI test. As vascular experts, interventional radiologists are partnering with primary care physicians to increase early screening.

Twelve to 20 percent of Americans older than 65 suffer from peripheral arterial disease but only one-third are symptomatic. Symptoms can include pain when walking that subsides at rest, leg cramps, pain at rest, numbness and skin discoloration, sores or other symptoms of skin breakdown. Women may be more likely than men to have PAD without experiencing symptoms; 50 to 90 percent are asymptomatic or have unrecognized symptoms of the disease, which could put them at greater risk of developing serious disease before it is diagnosed and treated. Specifically, women are also less likely to have intermittent claudication symptoms, i.e., pain when walking that subsides at rest.

Catching the Asymptomatic Warning Sign Early When Treatment is Most Effective
However, identifying PAD while asymptomatic may be life-saving for women, since it allows the easy, cheap identification of a systemic disease that may be treated. Treatment may greatly influence the woman's outcome. These treatments may include further investigation into the state of disease in the coronaries, which could lead to heart disease, and carotids, which could lead to stroke, as well as the legs, and treating the significant areas of blockage that are found. Treatment with lifestyle modification and medication may slow the natural advancement of the disease.

Risk for Heart Attack, Stroke and Death
The ABI, a comparative blood pressure reading in the arm and ankle, is used to screen for peripheral arterial disease. It is a direct measure of fatty plaque buildup in leg arteries and an indirect gauge of plaque accumulations throughout the entire cardiovascular system. Because atherosclerosis is a systemic disease, women developing plaque in their legs are likely to have plaque building up in the carotid arteries, which can lead to stroke, or the coronary arteries, which can lead to heart attack. Early detection of PAD is important because these women are at significantly increased risk, and preventive measures can be taken.

Women with PAD have four times the risk of heart attack and stroke.
A person with an ABI of 0.3 (high risk) has a 2 to 3 fold increased risk of 5-year cardiovascular death compared to a patient with an ABI of 0.95 (normal or low risk).


Get Tested for PAD If You

Are over age 50
Have a family history of vascular disease, such as PAD, aneurysm, heart attack or stroke
Have high cholesterol and/or high lipid blood test
Have diabetes
Have ever smoked or smoke now
Are overweight
Have an inactive lifestyle
Have a personal history of high blood pressure, heart disease, or other vascular disease
Have trouble walking that involves cramping or tiredness in the muscle with walking or exercising, which is relieved by resting
Have pain in the legs or feet that awaken you at night

About Peripheral Arterial Disease
PAD is a common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms at all. The most common cause of PAD is atherosclerosis, often called "hardening of the arteries." Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow. Left untreated, this insufficient blood flow will lead to limb amputation in some patients.

In atherosclerosis, the blood flow channel narrows from the buildup of plaque, preventing blood from passing through as needed, restricting oxygen and other nutrients from getting to normal tissue. The arteries also become rigid and less elastic, and are less able to react to tissue demands for changes in blood flow. Many of the risk factors-high cholesterol, high blood pressure, smoking and diabetes-may also damage the blood vessel wall, making the blood vessel prone to diffuse plaque deposits.

PAD Symptoms
The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don't heal.
Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.

Prevalence
PAD is a disease of the arteries that affects 10 million Americans.
PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.
PAD affects 12-20 percent of Americans age 65 and older.
PAD Treatments
Lifestyle

Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.

Angioplasty and stenting

Proceduralist developed angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the proceduralists threads a catheter through the femoral artery in the groin to the blocked artery in the legs. Then he or she inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.


To learn more about vascular interventions for PAD watch videos on PAD treatments cut and paste in your URL http://link.brightcove.com/services/player/bcpid1078667083

Comments
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by jay53, May 29, 2008
Your article is very interesting.  I was at the doc. about 3 mo. ago with what she said ways a superfisal bood clot.  Since then I have been haveing pain in my legs.  The foot and leg swells.  It has just started to get to were I am having a hard time walking.  I just walked to my garage and it hurt so back to just go there an back.  My foot wasn't numb this morning until I started walking on it.  Thanks for the great article.  I see my GP on Wed.

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by FEROSH391, May 29, 2008
I just would like to thank you very much for this article.  Yes I do have very severe pain but only on my right side when I stand on it.  I have M.S on my right side also.  Yes I do have heart desease in my family.  I am a smoker.  I don't have high blood pressure but I do have low blood pressure.  Please get back 2 me

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by pdxchrissy, May 29, 2008
I think women need to be bombarded with cardiovascular information.  If one was to listen to media info on women's health, you'd think that the only thing we die of is breast cancer!  I would like to know why some physicians find me to have a heart murmur and some don't.  Recently when I was having a physical with a new doctor, he was shocked at the way my heart sounded (heart murmur).  My blood pressure was high that day.  Aside from being told to keep an eye on my blood pressure I was sent on my way, nothing more being said about the murmur.  Is a heart murmur serious?  How can I tell if it is getting worse?  What should I do?  Am I at risk for a heart attack/stroke?  I am a 56 year old woman, 5'7", 120lbs, no junk food, smoking or alcohol.  What do I need to do to take care of myself?  Are there other women out there with heart murmurs who could shed some light on the subject?  I'd appreciate any feedback.

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by medoohsa, May 29, 2008
I had a heart attack at 43 years old.  If there's any question in your mind about the health of your heart, get to a cardiologist now.  Don't wait for people on a blog.  You do NOT want to be a heart attack "survivor," if you can head it off and stop it in its tracks.

By the way, I had none of the classic symptoms of a heart attack - women seldom do - so don't wait around for that either.

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by Tjoyce, May 29, 2008
Dear Dr. Kerskey,
    Thank you very much for this informative article.  I am 56 years old, 50 lbs overweight, don't smoke and try to eat healthy.  My high blood pressure is semi controlled by a combination of two medications and have borderline high cholestrol which I prefer to address through diet and excercise.   Your article could very well be a life saver for me because I have persistent swelling around my ankles and will ask for this ankle brachial index test to further determine what I can or should do to prolong my life.  Thank you, Tjoyce  (Toni)

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by rocky511, May 31, 2008
I as well have persistent swelling around the ankles, particularly as the weather becomes warmer or after long periods of rest/ I have recently had a radical hysterectomy and oorphpectomy and as a result have begun a vigorous walking program. Now that my iron count is no longer being affected and treatment for that occured prior to surgery, I am making a conscious effort to take care of the complete body: inside and outside. I am approx 40 lbs overweight, have not had problems with high blood pressure however, the swelling is bothersome. I will be seeing a promary care physisican later in June. Any advice you could provide would be much appreciated. Thank you  

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by HeartStrong21, Aug 13, 2008
Heart Disease is the number one killer of women in the United States today!

But 80% of heart attacks and strokes are PREVENTABLE.

Take a Look at the Facts:

Every minute of every day one woman dies of heart disease.
Women are six times more likely to die of a heart attack than from breast cancer.

For many years heart disease was considered a man’s disease. However, since 1984 more women in this country die every year from heart attacks than men.

Hispanic/Latino women are more likely to develop heart disease risk factors at
a younger age.

African American/Black women often have a greater number of heart disease risk factors and a higher death rate from heart disease.

The standard tests used to diagnose heart problems can be less accurate in women.

Women often do not have the same heart attack symptoms as men.

Recent studies have shown on average it takes a woman 30 to 60 minutes longer to get to the hospital than a man when they are experiencing a heart attack. Once they arrive at the hospital it takes longer to be diagnosed and
treated.

Lack of Awareness About Heart Disease Can be a Woman’s Greatest Risk !

Although women’s awareness has been increasing over the years only 57% are aware that heart disease is their number one killer.

For more info about women and heart disease check out www.heart-strong.com



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