Heart disease is often seen as a man's issue. But since 1984, more women have died each year from heart disease than men. It's the No. 1 cause of death and disability in American women.
So what should women do? Risk factors like obesity, high blood pressure and cholesterol still apply. Be alert to the subtle symptoms above, said Penn Medicine cardiologist Mariell Jessup, president-elect of the American Heart Association. And know that birth-control pills and hormone therapy can also raise women's risk for heart disease and stroke.
Erectile dysfunction may lead to more than just an awkward bedroom moment; it could signal an impending heart attack.
ED is a major risk factor for heart disease, as strong as smoking or a family history of heart attack. Doctors have recognized the link for years.
Not all ED patients get heart disease, said Paul Gittens, a Jefferson-trained urologist who practices at New York's Montefiore Medical Center.
But ED is "a great screening tool" since a man's erection, which relies on blood flow, can indicate the health of other blood vessels. Abnormalities will often hit the vessels of the penis before the heart's, because of their smaller diameter. Plus, men may notice an issue with erections right away, making them seek help.
If you notice less-rigid erections, get tested by a urologist. Strict diet and exercise can reverse ED's effects for a few, but for most, drugs like Viagra and Cialis are safe options.
Diet vs. regular soda
Two recent trials in the New England Journal of Medicine took major shots at full-sugar beverages. A study from Boston Children's Hospital showed that abstaining from sugary drinks for one year led to a reduction in weight gain in overweight or obese teens.
The other, from the University of Amsterdam, gave normal-weight elementary school kids identical-looking and -tasting drinks, but some diet and others regular. The diet group packed on less weight and fat than the full-sugar group. The authors concluded that artificial sweeteners could be used successfully by those who are at risk for gaining weight.
But some evidence suggests that regular diet-soda consumption primes people to consume more sugar in other foods, said Penn's Jessup. So "having a soda now and then is fine, just don't make it a staple of your diet."
The Bee Gees' song "Stayin' Alive" could help you perform a new kind of cardiopulmonary resuscitation, the heart association says. Called hands-only CPR, it calls for continuous chest compressions of 100 per minute, about the tempo of the disco hit.
So no more mouth-to-mouth? In the last decade, researchers found that rescue breaths didn't help survival from cardiac arrest and could even lower the chance of successful resuscitation, said Penn CPR expert Benjamin Abella.
During a heart attack, the blood has enough oxygen, so breaths are not needed for at least three to four minutes, Abella said.
Rescue breathing is still required for victims of drowning or choking, and ER professionals will likely stick to traditional CPR. But for the public, hands-only CPR is easy to learn and raises the chance that a bystander could help.
For those with an implanted defibrillator, the danger of a broken wire or infection in the heart may be a worry of the past.
In September, the FDA approved a less-invasive defibrillator that uses an electrode implanted just under the skin of the chest. Called a subcutaneous implantable cardioverter-defibrillator (S-ICD), it needs no wire leading directly into the heart, unlike typical defibrillators. "Most patients forget that it is there," said Drexel cardiologist Steven Kutalek.
ICDs help those at risk for sudden cardiac arrest or too-rapid heartbeat by electrically shocking the heart to keep it beating normally. Of 100,000 Americans a year who get an implanted defibrillator, Kutalek estimates that 10 percent or more will qualify for an S-ICD.
But it won't help those who also need pacing for too-slow heart rates. It will pace in an emergency for 30 seconds after a shock, if needed, but not long-term.
For those with an irregular heartbeat, called atrial fibrillation, blood thinners help prevent stroke by cutting the odds of clots forming and going to the brain.
For the last 50 years, patients had only one anticoagulant option: Coumadin, a drug first introduced as rat poison. But three new blood thinners - Pradaxa, Xarelto and Eliquis - have recently hit the market.
Coumadin requires intense dosage monitoring so patients don't get too much or too little. The new drugs, while equally good at preventing strokes, work faster than Coumadin. "They are quick-on and quick-off," said Abington Memorial Hospital cardiologist Adam Cohen, kicking in within hours, rather than days. Dosage is more predictable, and not as sensitive to diet.
But the new drugs lack an antidote, a fact alarming to many. Older users should be especially careful, said Michael Cohen, president of the Institute for Safe Medication Practices. Most of the reported bleeds from Pradaxa have been in the elderly, likely from excess dosage. And since many have poor kidney function, the drug can't clear the system as quickly.
Transcatheter aortic valve replacement
Some patients who need a new heart valve may not get one if they're unlikely to survive the operation.
Now, help comes in the form of a new prosthetic valve that requires no major surgery. The transcatheter valve, framed in tiny metal scaffolding, is compressed and threaded through a catheter going from a leg vessel up to the heart. When it reaches the aorta, a balloon inflates to set the new valve in place.
The aortic valve is a one-way gate, letting blood flow out of the heart but not back in. Narrowing of this valve, called aortic stenosis, stresses the organ, leading to chest pain and heart failure.
Without a new valve, prognosis is "worse than a lot of cancers," said Main Line Health cardiac surgeon Scott Goldman, with half of affected patients dying in two years.
The FDA approved the Edwards SAPIEN transcatheter heart valve in 2011, with Penn involved in clinical trials since 2007. (Penn is now testing a newer version.) Main Line Health, Cooper University Hospital and St. Mary Medical Center are among those doing the procedure.
But it's not known how long the valves will last, and Goldman warns that there may be more risk of stroke compared with surgical valve replacement.
A new way to lower blood pressure isn't a pill, but a procedure that zaps the arteries near your kidneys with radio waves.
Already widely used in Europe, renal artery denervation is undergoing U.S. clinical trials for its use in treating medication-resistant hypertension. Initial studies show a drop in blood pressure of 20 to 30 mmHg (the unit used to measure blood pressure) for up to two years.
What do kidneys have to do with blood pressure? Our sympathetic nervous system, which triggers our "fight-or-flight" response, stimulates our kidneys to release vessel-constricting enzymes. That's why we get a blood-pressure boost when stressed or excited.
The procedure involves threading a denervation device through a catheter into a renal artery. A burst of radio-frequency energy hits the artery wall, heating and scarring the surrounding nerves. Neuronal activity drops, and the body's arteries relax.
The care should "be a very exciting option" for hard-to-control hypertension, said St. Mary cardiologist Ronald Fields. But he does not foresee FDA approval before 2015.
Temple cardiologist Howard Cohen said the procedure appears safe on the few patients treated so far, but warns that no long-term follow-up has been done beyond two years.
Meeri Kim can be reached at email@example.com or 267-291-4560.