ࡱ> ed( / 0LDTimes New Roman(0(B 0 @ .  @n?" dd@  @@`` <*       0AA@ʚ;ʚ;g4BdBd@B 0ppp@ <4!d!dlpC 0<4ddddlpC 0 <4BdBdlhG 080___PPT10 pp? %G .Ischaemic Heart Disease-Implications of Gender  & Dr Kaye Birks School of Rural Health Monash University Australia Gender Competency Training for Medical Educators Seminar, April 2003 8P3E$A E  Aims eDescribe differences between women and men Natural history Clinical presentations Management Outcome,:fe Natural History of IHD Cause of death of approximately one third of women Greater age dependency Clinical onset is about 10-15 years later than for men )Natural History--Risk Factors young women) 2Family history maternal IHD NIDDM Smoking risk for sudden death Isolated raised total cholesterol  less risk Obesity risk ? explained by co-morbidity  Clinical Presentations In women angina common first presentation [54%] v. men [38%] Recognised MI [18%] men [30%] More atypical symptoms Pain free MI in older diabetic women More non Q wave infarcts&=   j Clinical Presentations xOlder Co-morbidities Unstable angina rather than acute MI Those with infarction less likely to have ST segment elevationx  Outcome differences More likely to die The younger the women the greater the difference when compared to male cohort < 50 years twice as likely to die After CABG younger women mortality 3.4% v. men 1.1% Over 75 years no difference in mortality  Outcome differences ?why  Women delay in going to hospital Missed diagnosis on admission Less likely to receive thrombolytic therapy More co morbidities Less likely to receive established treatments e.g. betablockers, aspirin Higher death rates for men before going to hospitalZHV   P   =   Outcome differences ?why  Different pathophysiology in premenopausal women Plaque erosions in young women, plaque rupture in men and older women Young women have less narrowing of arteries ?hypercoaguable state or coronary spasm Transmural MI with normal coronary angiography |      z     %   Management  Diagnostic testing less specific in younger women Less likely to have coronary angiography When performed more likely to have clinically insignificant disease Less likely to receive primary preventive treatments   Summary >Differences in natural history presentation management outcome0?>  Summary HImportant to highlight these differences in the undergraduate curriculumH  ` ` ̙33` 333MMM` ff3333f` f` f` 3>?" dd@,|?" dd@   " @ ` n?" dd@   @@``PR    @ ` ` p>> f(    6 P  T Click to edit Master title style! !  0   RClick to edit Master text styles Second level Third level Fourth level Fifth level!     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(2 lImplications of Gender      .-@Times New Roman-. f2 Dr Kaye Birks    .-@Times New Roman-. f(2 School of Rural Health    .-@Times New Roman-. f02 Monash University Australiaf   .-@Times New Roman-. f42 Gender Competency Training for      .-@Times New Roman-. f02 4Medical Educators Seminar, f   .-@Times New Roman-. f2 H April 2003   .-՜.+,0    qOn-screen Shown-sB  Times New RomanDefault Design/Ischaemic Heart Disease-Implications of GenderAimsNatural History of IHD*Natural History--Risk Factors young womenClinical PresentationsClinical PresentationsOutcome differencesOutcome differences ?why Outcome differences ?why ManagementSummarySummary  Fonts UsedDesign Template Slide Titles *_㇗ann maree nobeliusann maree nobelius  !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKMNOPQRSUVWXYZ[]^_`abcfRoot EntrydO)Current User\SummaryInformation(LPowerPoint Document(DocumentSummaryInformation8T