Archive | June 2022

How women differ from men in heart disease and why!

          Women and Heart DIsease+

Many many women and their doctors don’t know that heart disease is the number one killer of women. Furthermore, the heart disease that is seen in women is often not quite the same as heart disease in men.

Let’s remember from Part I that Heart disease is an umbrella term that includes heart failure, coronary artery disease (CAD), arrhythmias, angina, and other heart-related infections, irregularities, and birth defects

These facts lead to two common (and sometimes tragic) misapprehensions held by many women and their doctors: That women don’t really get much heart disease, and when they do, it behaves pretty much like the heart disease that men get.

The truth is that not only is heart disease very common in women, but also, when women get heart disease it often acts quite differently than it does in men. Failing to understand these two fundamental truths leads to a lot of preventable deaths and disability in women with heart disease.

If you are a woman, you need to know the basics about heart disease – especially heart disease as it behaves in women.

When women have angina, they are more likely than men to experience “atypical” symptoms. Instead of chest pain, they are more likely to experience a hot or burning sensation, or even tenderness to touch, which may be located in the back, shoulders, arms or jaw – and often women have no chest discomfort at all. An alert doctor will think of angina whenever a patient describes any sort of fleeting, exertion-related discomfort located anywhere above the waist, and they really shouldn’t be thrown off by such “atypical” descriptions of symptoms. However, unless doctors are thinking specifically of the possibility of CAD, they are all too likely to write such symptoms off to mere musculoskeletal pain or gastrointestinal disturbances.

Women are more likely than men to have heart attack symptoms unrelated to chest pain, such as:

      • Neck, jaw, shoulder, upper back or abdominal discomfort.
      • Shortness of breath.
      • Right arm pain.
      • Nausea or vomiting.
      • Sweating.
      • Lightheadedness or dizziness.
      • Unusual fatigue.

Heart attacks (or myocardial infarctions)  also tend to behave differently in women.

Frequently, instead of the crushing chest pain that is considered typical for a heart attack, women may experience nausea, vomiting, indigestion, shortness of breath or extreme fatigue – but no chest pain. Unfortunately, these symptoms are also easy to attribute to something other than the heart. Furthermore, women (especially women with diabetes) are more likely than men to have “silent” heart attacks – that is, heart attacks without any acute symptoms at all, and which are diagnosed only at a later time, when subsequent cardiac symptoms occur.

The Diagnosis Of CAD in Women Can Be More Difficult.

Diagnostic tests that work quite well in men can be misleading in women. The most common problem is seen with stress testing – in women, the electrocardiogram (ECG) during exercise can often show changes suggesting CAD, whether CAD is present or not, making the study difficult to interpret. Many cardiologists routinely add an echocardiogram or a thallium study when doing a stress test in a woman, which greatly improves diagnostic accuracy.

In women with typical CAD, coronary angiography is every bit as useful as in men; it identifies the exact location of any plaques (i.e., blockages) within the coronary arteries, and guides therapeutic decisions. However, in women with atypical coronary artery disorders (to be discussed in the next section), coronary angiograms often appear misleadingly normal. Thus, in women angiography is often not the gold standard for diagnosis, as it is for most men.

CAD In Women Can Take Atypical Forms.

At least four atypical coronary artery disorders can occur in women, usually in younger (i.e., pre-menopausal) women. Each of these conditions can produce symptoms of angina with apparently “normal” coronary arteries (that is, coronary arteries that often appear normal on angiogram). The problem, obviously, is that if the physician trusts the results of the angiogram, he/she is likely to miss the real diagnosis.

DALLAS, February 19, 2013 — A new study show women’s heart disease awareness is increasing.  A study with the number of women aware that heart disease is the leading cause of death nearly is doubling in the last 15 years, but that this knowledge still lags in minorities and younger women, according to the American Heart Association (AHA).

Among the study’s major findings, researchers comparing women’s views about heart disease in 1997 and today found:

  • In 2012, 56 percent of women identified heart disease as the leading cause of death compared with 30 percent in 1997.
  • In 1997, women were more likely to cite cancer than heart disease as the leading killer (35 percent versus 30 percent); but in 2012, only 24 percent cited cancer.
  • In 2012, 36 percent of black women and 34 percent of Hispanic women identified heart disease as the top killer — awareness levels that white women had in 1997 (33 percent).
  • Women 25-34 years old had the lowest awareness rate of any age group at 44 percent.

Among the women surveyed in 2012, researchers found:

  • Racial and ethnic minorities reported higher levels of trust in their healthcare providers compared with whites, and were also more likely to act on the information provided—dispelling the myth that mistrust of providers contributes to disparities.
  • Compared with older women, younger women were more likely to report not discussing heart disease risk with their doctors (6 percent among those 25-34 versus 33 percent for those 65 and older).

Risk Factors for Heart Disease in Women – Those we can’t change = Nonmodifiable Factors:

Age and Family History, Gender, Ethnicity.

The risk of having heart disease increases with age and this is due to stiffening of heart muscles which makes the heart less efficient in pumping blood around the body. You can determine your heart age by using this tool, developed by the British Heart Foundation:

Another risk factor you cannot change is if you have a history of heart disease among family members. This can double your risk, so if your mother, father, sister or brother has suffered from heart disease before the age of 60 you are at a greater risk of developing heart disease.

Modifiable Risk Factors – Those we can change are:

1-Smoking is the single largest preventable cause of death in Australia, and approximately 40% of women who smoke die due to heart disease, stroke or blood vessel disease. Smokers are 2-4 times more at risk of developing heart disease compared to non-smokers. In 2011/2012, over 1.3 million women in Australia smoked, and 89% of them did this on a daily basis. While these numbers are for women aged 15 and over, the largest group were in the 25-34 age group.

Passive smoking (exposure to the cigarette smoke of others) also causes an increase in the risk of developing heart disease, which increases further in people having high blood pressure or high cholesterol. Women who smoke and also take the contraceptive pill have a 10 times higher risk of having a heart attack.

2-Alcohol. Do you know that drinking too much alcohol increases the risk of heart disease? Excessive drinking causes more weight gain (due to increased calories!), increase in blood pressure and blood lipids. Over a long period of time it can weaken the heart muscle and cause abnormal heart rhythms. Try and not drink alcohol every day, limit it to two standard drinks at a time and aim for at least two alcohol free days a week and make sure you don’t increase the amount you drink on the other days. Periodically take a break from any alcohol for a week or more and you will notice many benefits including a better nights sleep.

3.High Blood Pressure or Hypertension. Your blood pressure is a measurement of how ‘hard’ your heart is working to push blood around your body, through the blood vessels. It can be a ‘silent’ killer and if you do not know your blood pressure then it is worth having it checked by your GP. Changing your lifestyle will reduce your blood pressure. A recent study suggests that keeping your blood pressure under 140/90 can increase your life expectancy by 5 years at the age of 50 years. You can assess your high blood pressure through your MD monthly or less expensive buy a b/p machine and check your b/p everyday especially if your on antihypertensive meds to make sure your b/p isn’t under 100/60 to prevent hypotension.

4.Diabetes. Do you have diabetes and if so, is it under control?

Diabetes doubles your risk of having heart disease. People who have uncontrolled diabetes are at risk of having heart disease at an earlier age. For pre-menopausal women, having diabetes cancels the protective effects of hormone present in women and significantly increases the risk of heart disease. Taking steps to find out what your blood sugar is and keeping it well-controlled is essential.

5.Obesity- Do you know your body fat content?  If you think that you are overweight then you put yourself at risk of having heart disease. Being overweight will increase your blood pressure and contribute to developing diabetes. In addition to that, women who carry weight around their middle (belly fat) as opposed to their hips are twice as likely to develop heart disease.

By taking the steps to reduce your weight, you can reduce your risk of heart disease. A great tool developed by National Heart Foundation of Australia calculates if you might be at risk:

6- INACTIVE-Are you physically active every day? Recent research indicates that “sitting is the new smoking” and being physically inactive can double your risk of having heart disease. It is important to get some exercise every day, such as a 30 minute walk where you raise your heart rate. It also raises your serotonin levels (feel-good hormone) and can reduce depression

7- STRESS-We could almost ask – do you know anyone who is not stressed?! However, while everyday life is stressful, those people who are almost constantly stressed are at risk of adopting unhealthy behaviours in order to reduce their stress levels. Examples include increasing their alcohol intake or smoking in order to relax; or tending to eat more junk food because they are often short of time. All of these factors increase their risk of heart disease.

Women, stress and the risk of heart disease

Along with poor diet, lack of exercise and smoking, unmanaged stress may increase the risk for heart disease. Now medical experts are discovering that mental stress affects women in different, and in some cases, more devastating ways, especially if they already have coronary conditions. One study that

Heart disease is the leading cause of death for men and women in the United States. Every year, 1 in 4 deaths are caused by heart disease. The good news? Heart disease can often be prevented when people make healthy choices and manage their health conditions. Communities, health professionals, and families can work together to create opportunities for people to make healthier choices. Make a difference in your community: Spread the word about strategies for preventing heart disease and encourage people to live heart healthy lives



“Legionnaires’ disease usually develops two to 10 days after exposure to legionella bacteria. It frequently begins with the following signs and symptoms: Headache, Muscle Aches, Fever that may be 104 F (40 C) or higher.”.


Part III Know the facts on Legionairres/Pontiac Fever history in NY & why it happens!

Legionnaires’ disease and Pontiac fever outbreaks occur when two or more people are exposed to Legionella in the same place and get sick at about the same time!  Outbreaks are commonly associated with buildings or structures that have complex water systems, like hotels and resorts, long-term care facilities, hospitals, and cruise ships. These are high population environments

These structural places use water shared with other people from the main water line.  Examples apartment buildings, hospitals, cruise ships, etc…  The most likely sources of infection include water used for showering, hot tubs, decorative fountains, and cooling towers (structures that contain water and a fan as part of centralized air cooling systems for a building or industrial processes).

Legionnaires’ disease and Pontiac fever outbreaks can be difficult to identify. Sometimes people travel to a common location, are exposed to Legionella, and then return home before becoming sick. State, territorial, and local health departments take the lead in investigating outbreaks. They also identify control measures to remove Legionella from the water identified as the source of infection. CDC is only involved in outbreak investigations when a health department requests additional assistance. 

On July 17, 2015, the Bureau of Communicable Disease of the New York City (NYC) Department of Health and Mental Hygiene (DOHMH) detected an abnormal number and distribution of Legionnaires’ disease (LD) cases in the South Bronx. This cluster of cases would eventually grow into the largest outbreak of LD in NYC history. states that “New York City is facing the largest outbreak of Legionnaires’ disease in its history.

The airborne respiratory disease has killed 10 people since early July, with 100 cases reported. So far, it’s been limited to the city’s South Bronx neighborhood.”  So it is in contained area. documents the following “In 2017, most Legionnaires’ disease cases (26%) occurred in Queens; however, the Bronx had the highest rate (7.0 cases per 100,000 people).”  So remember this is not new and at least yearly checked upon situation to prevent epidemics.  No panic is needed.




“Legionnaires’ disease and Pontiac Fever are collectively known as Legionellosis, a disease caused by Legionella bacteria. Managing Legionella and preventing worker exposures and Legionellosis cases depend on implementing an effective water management program. These programs focus on describing water systems and their components, identifying areas where Legionella could grow, deciding where control measures are needed and how to monitor them, planning response actions when control measures fail, and monitoring and documenting water management activities.”.

United States Department of Labor (OSHA Occupational Health and Administration).

Part II What is Legionairres/Pontiac Fever


Who to Test for Legionnaires’ Disease:

·Patients who have failed outpatient antibiotic therapy

·Patients with severe pneumonia, in particular those requiring intensive care

·Immuno-compromised host with pneumonia

·Patients with pneumonia in the setting of a legionellosis outbreak

·Patients with a travel history [Patients that have traveled away from their home within two weeks before the onset of illness.]

·Patients suspected of healthcare-associated pneumonia


Not everyone exposed to legionella bacteria becomes sick. You’re more likely to develop the infection if you:

·Smoke. Smoking damages the lungs, making you more susceptible to all types of lung infections.

·Have a weakened immune system as a result of HIV/AIDS or certain medications, especially corticosteroids and drugs taken to prevent organ rejection after a transplant.

·Have a chronic lung disease such as emphysema or another serious condition such as diabetes, kidney disease or cancer.

·Are 50 years of age or older.

Legionnaires’ disease is a sporadic and local problem in hospitals and nursing homes, where germs may spread easily and people are vulnerable to infection.


 Legionnaires’ disease can lead to a number of life-threatening complications, including:

·Respiratory failure. This occurs when the lungs are no longer able to provide the body with enough oxygen or can’t remove enough carbon dioxide from the blood.

·Septic shock. This occurs when a severe, sudden drop in blood pressure reduces blood flow to vital organs, especially to the kidneys and brain. The heart tries to compensate by increasing the volume of blood pumped, but the extra workload eventually weakens the heart and reduces blood flow even further.

·Acute kidney failure. This is the sudden loss of your kidneys’ ability to perform their main function — filtering waste material from your blood. When your kidneys fail, dangerous levels of fluid and waste accumulate in your body.

When not treated effectively and promptly, Legionnaires’ disease may be fatal, especially if your immune system is weakened by disease or medications.

You’re likely to start by seeing your family doctor or a primary care provider. However, in some cases, you may be referred to a doctor who specializes in treating lung disease (pulmonologist) or infectious diseases, or you may be advised to go to an emergency department.






Legionella bacteria can cause a serious type of pneumonia (lung infection) called Legionnaires’ disease. Legionella bacteria can also cause a less serious illness called Pontiac fever.  Legionella bacteria are found naturally in freshwater environments, like lakes and streams. The bacteria can become a health concern when they grow and spread in human-made building water systems.”.

Centers for Disease Control and Prevention (CDC)

Part I What is Legionairres/Pontiac Fever

Legionella was discovered after an outbreak in 1976 among people who went to a Philadelphia convention of the American Legion. Those who were affected suffered from a type of pneumonia that eventually became known as Legionnaires’ disease.

The first identified cases of Pontiac fever occurred in 1968 in Pontiac, Michigan, among people who worked at and visited the city’s health department. It wasn’t until Legionella was discovered after the 1976 Legionnaires’ disease outbreak in Philadelphia that public health officials were able to show that Legionella causes both diseases.

Legionella bacteria are found naturally in freshwater environments, like lakes and streams. The bacteria can become a health concern when they grow and spread in human-made building water systems like

  • Showerheads and sink faucets
  • Cooling towers (structures that contain water and a fan as part of centralized air cooling systems for buildings or industrial processes)
  • Hot tubs
  • Decorative fountains and water features
  • Hot water tanks and heaters
  • Large, complex plumbing systems

Home and car air-conditioning units do not use water to cool the air, so they are not a risk for Legionella growth.

However, Legionella can grow in the windshield wiper fluid tank of a vehicle (such as a car, truck, van, school bus, or taxi), particularly if the tank is filled with water and not genuine windshield cleaner fluid.

How It Spreads

After Legionella grows and multiplies in a building water system, water containing Legionella can spread in droplets small enough for people to breathe in. People can get Legionnaires’ disease or Pontiac fever when they breathe in small droplets of water in the air that contain the bacteria.

Less commonly, people can get sick by aspiration of drinking water containing Legionella. This happens when water accidently goes into the lungs while drinking. People at increased risk of aspiration include those with swallowing difficulties.

In general, people do not spread Legionnaires’ disease and Pontiac fever to other people. However, this may be possible under rare circumstances.


“Cholera is an acute diarrhoeal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. Cholera remains a global threat to public health and an indicator of inequity and lack of social development.”

World Health Organization (WHO)

Cholera and its history!

Cholera is an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria. People can get sick when they swallow food or water contaminated with cholera bacteria. The infection is often mild or without symptoms, but can sometimes be severe and life-threatening.

About 1 in 10 people with cholera will experience severe symptoms, which, in the early stages, include:

  • profuse watery diarrhea, sometimes described as “rice-water stools”
  • vomiting
  • thirst
  • leg cramps
  • restlessness or irritability

Cholera has been nicknamed the “blue death” because a person’s skin may turn bluish-gray from extreme loss of fluids.  As dehydration racks the body, blood would begin to thicken in patients’ veins; starved of oxygen, the skin would turns sickly shade of blue.  Lack of oxygen for over a several minutes can cause blue of the skin.


Cholera is treated with hydration (given either orally or intravenously), electrolytes, and antibiotics.

The History of Cholera:

The word cholera is from Greek: χολέρα kholera from χολή kholē “bile”. Cholera likely has its origins in the Indian subcontinent as evidenced by its prevalence in the region for centuries.

The disease appears in the European literature as early as 1642, from the Dutch physician Jakob de Bondt’s description it in his De Medicina Indorum.  (The “Indorum” of the title refers to the East Indies. He also gave first European descriptions of other diseases.) .

Early outbreaks in the Indian subcontinent are believed to have been the result of poor living conditions as well as the presence of pools of still water, both of which provide ideal conditions for cholera to thrive.  The disease first spread by trade routes (land and sea) to Russia in 1817, later to the rest of Europe, and from Europe to North America and the rest of the world, (hence the name “Asiatic cholera”). Seven cholera pandemics have occurred in the past 200 years, with the seventh pandemic originating in Indonesia in 1961.

The first cholera pandemic occurred in the Bengal region of India, near Calcutta starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, the Middle East, Europe, and Eastern Africa. ***The movement of British Army and Navy ships and personnel is believed to have contributed to the range of the pandemic, since the ships carried people with the disease to the shores of the Indian Ocean, from Africa to Indonesia, and north to China and Japan.***

The second pandemic lasted from 1826 to 1837 and particularly affected North America and Europe due to the result of advancements in transportation and global trade, and increased human migration, including soldiers.

The third pandemic erupted in 1846, persisted until 1860, extended to North Africa, and reached South America, for the first time specifically affecting Brazil.

The fourth pandemic lasted from 1863 to 1875 spread from India to Naples and Spain.

The fifth pandemic was from 1881–1896 and started in India and spread to Europe, Asia, and South America.

The sixth pandemic started 1899–1923. These epidemics were less fatal due to a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, like Germany in 1892 (primarily the city of Hamburg where more than 8.600 people died) and Naples from 1910–1911, also experienced severe outbreaks.

The seventh pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists (as of 2018) in developing countries.

Cholera became widespread in the 19th century.  Now Cholera cases are much less frequent in developed countries where governments have helped to establish water sanitation practices and effective medical treatments.

Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically cholera.  You’re most likely to get viral gastroenteritis when you eat or drink contaminated food or water. You may also be likely to get gastroenteritis if you share utensils, towels or food with someone who has one of the viruses that cause the condition. Many viruses can cause gastroenteritis, including: Noroviruses.



“Heart disease is the leading cause of death for men, women, and people of most racial and ethnic groups in the United States. One person dies every 36 seconds in the United States from cardiovascular disease. About 659,000 people in the United States die from heart disease each year—that’s 1 in every 4 deaths. Heart disease costs the United States about $363 billion each year from 2016 to 2017.2 This includes the cost of health care services, medicines, and lost productivity due to death.”

Centers for Disease Control and Prevention (CDC)