March 2007

A 70-year-old woman presented to the emergency department with acute onset of shortness of breath that awakened her from sleep.

A 76-year-old woman with a history of paroxysmal atrial fibrillation presents to your office to discuss whether she should take warfarin (Coumadin) for stroke prevention.

We examined data from a large cohort of subjects with atrial fibrillation to determine whether men and women had different risks for atrial fibrillation-related thromboembolism. Women with atrial fibrillation who were not taking warfarin had a 60% higher rate of stroke than did men, independent of other clinical risk factors for stroke. When taking warfarin, both women and men had significant reductions in stroke risk without differences by sex in the rates of bleeding complications. These findings support the addition of female sex to traditional stroke risk stratification schemes for assisting in antithrombotic decision making for patients with atrial fibrillation.

More than 15 years ago, atrial fibrillation was shown to be an independent risk factor for ischemic stroke in the Framingham study.

The epidemiologic finding that women with heart failure have better overall survival than men may be because of the higher prevalence of diastolic heart failure or heart failure with preserved ejection fraction (HF-PEF) among women.

Heart failure in the United States affects 4.9 million people, of whom 2.5 million are women.

We performed a whole-country study using linked health care records in Finland and showed that stable angina as the initial symptomatic manifestation of coronary disease occurs as frequently in women as it does in men. Among easily recognized subgroups, the absolute rates of prognostic outcomes were similarly high in women and men.

Each municipality in Finland is responsible for arranging health care for its inhabitants.

A 65-year-old woman with a history of anxiety disorder, dyslipidemia, and recently diagnosed celiac sprue was transferred to the heart center after presenting to a peripheral community hospital with marked fatigue, progressively worsening dyspnea on exertion, and bilateral lower extremity swelling with associated bilateral arm tingling.

Despite advances in echocardiography, magnetic resonance imaging, and the ability to perform an endomyocardial biopsy, the underlying etiology of nonischemic left ventricular (LV) dysfunction often eludes clinical detection.