Posted in cardiology -Therapeutics, Cardiology -unresolved questions, cardiology women, Cardiology-Coronary artery disese, echocardiography, MVPS, valvular heart disease, tagged annular vt, mac, mitral annular calcifcation, mitral valve calcification and cad, posterior mitral annulus calcification, vpds in mac, vpds in mitral annular calcification on April 19, 2013 |
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Why should mitral annulus gets calcified ? . Degenerative calcification can be benign in elderly . If it occurs prematurely (say < 55 years ) there is enough reasons to worry . This may represent a systemic vascular inflammation and is considered a surrogate marker for athero- vascular -sclerosis . A study from Cidar Sinai , Los angels has well documented the link way back in 2003 !
This is a large study involving 17 735 patients (who were investigated for symptoms of CAD ) were screened.
The incidence of MAC was high (As expected !)
- 35% > 65 years
- 5 % < 65 years
Angiography revealed more surprises .
- The incidence of angiographic CAD among those who had MAC and no MAC was 88% v68% respectively ,( p = 0.0004),
- Left main coronary artery disease was (14% 4%, p = 0.009)
- Triple vessel disease was (54% v33%, p = 0.002).
Image source S.Atar , Heart 2003 : 89, 161-164
This study concluded , CAD is more aggressive in patients with MAC. It can also be an independent predictor of high risk CAD .
Further Implications of MAC
- MAC is more common in women, especially diabetics .
- Degenerative Mitral regurgitation is common ,rarely mitral stenosis
- Recurrent VPDs and even trouble some mitral annular VT is possible
- Extensive calcific lesions in coronary artery is also reported with MAC.
Link between Stroke and MAC .
This was well proven by this paper published in NEJM in 1992.
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Acute coronary syndrome is the number one cardiac emergency .In any coronary care unit there are vital differences between men and women in terms of ACS presentation and outcome . Though there can be variation in ethnic , geographical factors .The following is an observation from one of the Asia’s oldest and largest coronary care unit over a period of 40 years . (Madras medical college Chenna ,India )
There is very significant gender advantage in the incidence of ACS. The male female ratio is consistently around 4: 1 .This Indicates for every day , men suffer from ACS by four fold more .This is a very hard data can not be ignored . Women present to the hospital much later than men .This may be due to increased tolerance of pain, social issues waiting for their spouse to arrive etc
- There is a significant difference in the pattern of ACS in men and women . Men present with STEMI and women present with more of NSTEMI . In NSTEMI the gender ratio is dramatically equal 1 :1 .
- Explosive chest pains are less common in women .
- For some unknown reason diabetes afflicts women with a greater ferocity !
- Similarly it appears obesity and dyslipidemia has more significance in women
- Sudden cardiac death and primary VF is many fold less common in women.
- Mechanical complications like mitral regurgitation and ventricular septal rupture are several fold higher in women (Weak muscle low muscle mass ?)
- Thrombolytic success is slightly lower in women than men .
- The overall outcome in ACS is same as men .Some say women fare worse .This is important because while they are protected heavily against development of CAD once they develop it the outcome seems exempted from the gender advantage .The reason for this is not clear
Women show their unique way in ACS too ! Some of them are true advantages while few are disadvantages .The mechanism for these differences can not be entirely attributable to presence or absence of estrogen . The hard fact is , women always score over men in the tolerance levels and deal effectively stress situations . It would appear Women’s body easily nullify adrenergic triggers .
Reference less cardiology .
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