Tag Archives: symptoms

#GoRedWearRed ~ Women’s Heart and Vascular Health

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Conference January 30, 2016 was a great opportunity for healthcare professionals to focus on current research and practice for Women’s Heart Health.

It takes dedicated research and study to understand how best to identify heart risk and heart disease in women and dedicated clinicians who will put the research findings into practice. The American Heart Association Wear Red Day, Go Red for Women campaigns work to educate women about heart and vascular disease ~ 

For Wear Red Day 2016, here are a few conference takeaways:

Dr Alton

Dr Alton

  1. Ischemic heart disease is not a “Man’s” disease ~ in fact heart disease is the leading killer of mothers, wives, aunts, daughters, sisters. Cardiac tests may include radiation exposure; ask about the tests your doctor is recommending – are there alternatives that don’t involve radiation.








Dr. Barac discussing CardioOncology

Dr. Barac discussing CardioOncology

2. Cardio Oncology focuses on heart health in the setting of cancer treatment; either history of cancer treatment or current – the goal is to be sure women can receive the most effective cancer treatments while protecting their heart function ~ As with all heart health, making sure you control risk factors for heart disease (hypertension or high blood pressure for example) also helps the heart stay strong during chemotherapy.


Dr Amburgey

Dr Amburgey

3. Consider pregnancy a stress test for your heart  It is important to follow up if you have hypertension in pregnancy, pre-eclampsia, or eclampsia or diabetes in pregnancy because these conditions may improve after delivery but are now included as risk factors for heart disease and stroke for women over the next 30 years.



Dr. Neff-Massullo

Dr. Neff-Massullo

4. Vascular disease is under-diagnosed in women ~ the role of hormone therapy and venous thrombo-embolism (VTE) or blood clots in veins is significant. While it is not recommended to test everyone who starts hormone therapy, it is important to speak up if you have a family history of blood clots or any signs/symptoms of blood clot (leg swelling, pain) – especially in the first 12 months of hormone therapy.


Test of venous disease ~ Doppler showing venous reflux

Test of venous disease ~spectral  Doppler ultrasound showing venous reflux

5. Venous disease can cause leg pain and swelling, over time can be disabling due to skin changes such as ulcers; compression socks and vascular procedures can help.





Dr. Rock-Willoughby

Dr. Rock-Willoughby

6. Women suffer from delay seeking treatment AND delay of diagnosis of acute MI (heart attack).    For Women: Don’t wait for symptoms to go away; it might not be chest pain; women can experience fatigue, sweats, shortness of breath, dizziness, nausea or abdominal pain – call 911. For Healthcare Providers : Think Nose to Navel ~ a program designed to reduce the time to EKG evaluation for women.

7. What’s a treatment that reduces risk of death, heart attack, and more heart procedures?  Cardiac Rehab. Why are referrals and enrollment not 100%? Why are both even lower for women? Make time for Cardiac Rehab and for Heart Health; it’s worth the effort.

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

Dr Albers introducing Dr Amin to discuss Atrial Fibrillation

8. Women are underrepresented in Heart Rhythm Disorders research; we know that being a woman increases stroke risk in atrial fibrillation. Be sure to ask your doctor if you have atrial fibrillation, if you need to be checked for atrial fibrillation, and if you should be taking a medicine to reduce your risk of stroke. Get involved and participate in clinical research.


McConnell Heart Health Center

McConnell Heart Health Center

Thanks to conference attendees  ~ the room was at capacity ~ more healthcare professionals learning about the diagnosis and treatment of heart and vascular disease in women.

Hello #HeartMonth

BW ARA labcoatThe OhioHealth Women’s Heart & Vascular Program CME event on Saturday 1/30 was a fabulous kick off to February ~ Heart Month ~ which includes #WearRedGoRed for Women Friday February 5 and the Go Red for Women Luncheon here in Columbus on Thursday February 25 to benefit the American Heart Association.

We appreciate the American Heart Association support for the conference (see registration table photo below) with Red Dress pins, wristbands, and great Know & Go cards for participants.

Screen Shot 2016-01-29 at 9.26.02 AM

The morning event at the McConnell Heart Health Center brought together health care professionals interested in learning about Women’s Heart & Vascular Health; from Heart & Vascular physicians with keynote presentation from Dr. Ana Barac discussing CardioOncology.

Dr. Mary Alton gave a great opening lecture on Women & Heart Disease, including Yentl syndrome.  She covered cardiac testing for women ~ or how can we choose the best way to learn about a woman’s heart function.

Dr. Barac presented current research in how to protect women’s hearts during chemotherapy for cancer; as well as the risk of high blood pressure (hypertension) and other risk factors that weaken a woman’s heart function when going through cancer treatments.

IMG_6674The OhioHealth Women’s Heart & Vascular Pregnancy Predicts Risk Program ~ why was this started & what’s a risk from pregnancy? was introduced by Dr. Laurie Amburgey, Maternal Fetal Medicine, and discussed by Dr. Ashley Chambers, Internal Medicine. Both providers discussed the fact that a woman’s heart risk with pregnancy issues like pre-eclampsia doesn’t stop with delivery of the baby. Dr. Chambers told us about the OhioHealth program to be sure women have appropriate risk factor management in the years after having a pregnancy that predicts Heart Risk.

Dr. Joddi Neff with Riverside Radiology and Interventional Associates gave a great “Ask the Expert” session on Vascular Medicine – (a big topic that could have its own conference) and focused on risk of blood clots with hormone therapy, and management of venous diseases for women.

Faculty & Course Director Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers

Women’s Heart & Vascular CME Faculty 
Clockwise from bottom left: Dr. Alton, Dr. Nicholson, Dr. Amin, Dr. Rock-Willoughby, Dr. Chambers, Dr. Amburgey, Dr. Neff-Massullo, Dr. Barac, Dr. Albers (Course Director)

Dr. David Nicholson and Dr. Jayme Rock-Willoughby with OhioHealth presented the session “From ER to CR” highlighting the “Nose to Navel” goal for early EKG for women with symptoms occurring in that anatomical range, and the Women’s Cardiac Rehab programming launched at the McConnell Heart Health Center in 2015 ~ an effort to get more women through Cardiac Rehab.

Dr. Anish Amin, a Heart Rhythm Specialist closed with an excellent talk on Women’s risk for stroke with atrial fibrillation (a heart arrhythmia).

More to come with take home points for patients from the morning sessions.




Lexie Sines, with OhioHealth CME

A Great Patient Story

BW ARA labcoatNice to start 2015 with a patient story to teach the importance of your circulation. Circulation includes structures that direct blood and fluids as they move or circulate through the body. Arteries (tubes that take the blood from the heart to the body), veins (tubes that return blood to the heart from the body), and a third part, named lymphatics, are structures that keep our bodies working.

In 2008 the Surgeon General of the United States published a call to action for Venous Thromboembolism, a problem that affects veins and can affect the heart, and is a leading cause of death. Venous thromboembolism refers to blood clots (also called thrombi (plural of thrombus)) that form in a vein in the setting of slow flow, inflammation, injury, or other factors.

The journal Vascular Medicine publishes patient information about vascular diseases – here is the paper on Venous Thromboembolism and Pulmonary Embolus. 

The patient story starts with me before I became a cardiologist or even a high school graduate. I ran on the track team in high school. My coach taught us not just track, but would also tell us he was teaching us how to stay fit and strong so that we would always know the discipline that training required — how to pace, how to stay active, how to prepare for a goal. At the time I had no idea what a gift his coaching was, but went on to apply it to 10 marathons, triathlon, biathlon, rowing, my practice, and my patients because staying active plays a key role in heart health. 

The patient is that coach. He called me in 2013 when my focus was on training for the Philadelphia marathon. I was ready to talk about the 20 miler, how the taper might go, etc. It took a minute to realize he actually had a symptom. He has remained active and exercises at a high level with swimming, calisthenics, weight lifting, and bicycling in addition to travel abroad for work. The symptom was shortness of breath, happening when exercising or at the end of a set of pushups (yes, a set of pushups as in one of multiple reps in multiple sets). He had been getting back to his home exercise regimen after travel to Europe when the symptom started. We talked about his travel for work, how his knees were faring (he had a career as a paratrooper which had inflicted degenerative change to the knees to say the least). While in Europe he had received an injection to the left knee and was evaluated in Germany when he had subsequent significant swelling. 

It was when he mentioned the last bit – the leg swelling – when it clicked: chance of Pulmonary Embolus (PE). In addition to the oddity of him actually experiencing/complaining of a symptom like shortness of breath, the possibility of PE expedited his evaluation. 

Screen Shot 2015-01-04 at 8.38.49 PMA computed tomography (CT) scan of the chest showed bilateral PE. Followup evaluation for deep venous thrombosis (DVT) was positive for a blood clot in the leg where he had had the swelling.  I have his permission to post the blood clot on the Internet so will show a still frame as well as a movie of the vein with grey DVT in the vein.

The blue arrows in the table (Table 1) point to the key symptoms he experienced, and to the shadowy grey clot as it appears on a lower extremity venous duplex (below) (the Vascular Medicine Journal patient information article by Dr.s Evans and Ratchford also has an example of a vascular ultrasound study in Figure 1, with a cross section view).

Screen Shot 2015-01-04 at 8.41.23 PM

Another blog post can be how to keep active people safe when an issue (like PE) happens.  My partner actually showed my coach the video (below) of the blood clot floating in the vein when he broke the news that the trans-Atlantic trip scheduled for later that week as well as leg squats were on hold until treatment progressed.

Another blog post can celebrate the heart healthy benefit of lifelong exercise; the patient’s echocardiogram showed normal function and heart findings of someone younger than chronological age. The leg ultrasound totally normalized after treatment. He did not develop post thrombotic symptoms or syndrome, which can prove challenging – as well described by Dr.s Evans and Ratchford in this Patient Information Page in Vascular Medicine Journal.

For now, I am thankful for my high school track coach calling with the symptom and agreeing to share a great story & add information about blood clots, DVT, and PE for HeartHealthDocs followers interested in education about Circulation & Heart Health.

What do Women need to know about Heart Disease?

Women’s Heart & Vascular* Health will be an ongoing topic at HeartHealth Doctors.  Why?  Ladies first applies for women and heart disease; but not in a polite, etiquette way- Since 1984 more women than men have died from heart disease.  *Vascular health is part of circulation, meaning the arteries and veins, the heart is the main active pump in our circulation.

Dr. Albers’ post for Women’s Health talks about the recent Heart of Women’s Health meeting at the American College of Cardiology’s Heart House in Washington DC.  Check out the article, or if you are pressed for time-  Here are 10 great tips for improving your heart health; presented at a breakout session of the Go Red for Women luncheon and seminar February 2013.

These 10 tips apply to anyone wanting to improve their heart health:

Women's Health