Women's Health Matters

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A woman must seek a heart specialist who can determine the best form of treatment for her particular situation. Treatment may include lifestyle changes, medication and/or surgery and other procedures.

Cardiovascular Rehabilitation

Cardiovascular rehabilitation (cardiac rehab) teaches people with heart disease about lifestyle changes that can strengthen their heart, prevent future heart problems, and improve their general health. Cardiac rehab programs, such as the Women's Cardiovascular Health Initiative (WCHI) program at Women's College Hospital, teach people how to exercise safely, eat a heart-healthy diet and minimize stress. A team of health-care professionals, which usually includes a doctor, nurse, dietitian, social worker, physiotherapist, occupational therapist and pharmacist, designs programs to suit the needs and circumstances of individual patients.

After a heart attack or bypass surgery, men are more likely to be encouraged to enter a cardiovascular rehabilitation program that teaches them how to exercise and modify their risk factors to prevent further heart disease. Women recovering from heart disease are much less likely to be referred to a rehab program, even though research has shown that participation in such programs can increase a woman’s life expectancy, and dramatically improve her exercise capacity and quality of life.

If your doctor doesn’t refer you to a cardiac rehab program, ask him or her if participating in such a program would be appropriate for you and if you can get a referral.

Common Medications for Heart Disease

ACE | ARBs | ASA | Beta-Adrenergic BlockersCalcium Channel Blockers
NitroglycerinPlavixThrombolytic Drugs


ACE (Angiotensin-Converting Enzyme) Inhibitors
ACE inhibitors are used to prevent the body's blood vessels from constricting. This reduces the work the heart must do to pump blood to the body. ACE inhibitors are used to treat high blood pressure, to prevent or treat congestive heart failure and to decrease a high-risk person’s chance of having a stroke or heart attack.

Side effects: dry persistent cough, nausea, headache, diarrhea, constipation, dizziness or lightheadedness, salty/metallic taste or an inability to taste for two to three months.

Very rare allergic reactions: rash, fever, chills, vomiting, aching joints, difficulty breathing, swelling of face, hands and feet.

ARBs (Angiotensin II receptor blockers)
ARBs have effects similar to those of ACE inhibitors and can be used if one has significant side effects from the ACE inhibitors. Many of these medications are not recommended for women who are pregnant or are breastfeeding. Check with your doctor if you are pregnant, plan to get pregnant or are breastfeeding.

Many people who take ARBs experience no side effects. Possible side effects vary depending on the particular medication but include: dizziness, lightheadedness, diarrhea, stomach problems, muscle cramps and respiratory infection.

ASA has been shown to reduce the tendency of blood to form clots, thus reducing the risk of heart attack and stroke. Recent research has shown that ASA is as effective for women as it is for men with known cardiovascular disease. There may, however, be differences in the effect of ASA on women and men who do not have cardiovascular disease. For this reason, ASA is not recommended as primary prevention for women.

Although this is an inexpensive, over-the-counter drug, it should only be used as treatment for heart conditions under the direction of a physician. ASA can be dangerous for patients with high blood pressure, severe liver and kidney disease, and asthma.

Side effects: nausea, indigestion, heartburn, ulcers and increased risk of bleeding.

Beta-Adrenergic Blockers
Beta-adrenergic blockers lower the heart rate, even during exercise or periods of stress, and decrease the force of the heart's contraction. They can be used to treat symptoms of coronary heart disease, high blood pressure and irregular heart rhythms, as well as other conditions.

Side effects: fatigue, gastric pain, constipation, diarrhea, nausea, vomiting, slow heart rate, congestive heart failure, impotence, decreased libido, trouble sleeping.

Less common side effects: difficulty breathing, cold hands and feet, depression, anxiety, confusion, dry and sore eyes, swelling of ankles, feet and lower legs, itchy skin or skin rash, stomach discomfort, frequent urination, unusual bleeding and bruising, hallucinations, fever and sore throat.

Other: This drug can mask signs of low blood sugar in people with diabetes and can aggravate asthma. Older patients tend to be more sensitive to the side effects and may become more sensitive to cold when taking beta blockers. If you are pregnant or plan on becoming pregnant, talk to your doctor before taking medications from this class. These drugs can have side effects on pregnant women and unwanted effects on newborn babies. These drugs are also passed onto babies through breast milk.

Calcium Channel Blockers
Calcium channel blockers relax blood vessels and increase the supply of blood and oxygen to the heart, by reducing the amount of work the heart must do to pump blood to the body. These medications are used to treat symptoms of coronary heart disease and high blood pressure.

Side effects: fatigue, heartburn, dizziness, lightheadedness, headache, nausea, diarrhea, constipation, swelling of the ankles and legs, slow heart rate, flushing, nasal congestion.

Nitroglycerin is used to relax the blood vessels and increase the supply of blood and oxygen to the heart. It is used to treat the symptoms of coronary artery disease.

Side effects: headache, dizziness, nausea.

An antiplatelet medication, called Plavix® (clopidogrel), which prevents excessive blood clotting, is sometimes prescribed for high-risk patients who are allergic to ASA. It can also be used in conjunction with coated ASA. Plavix is used after angioplasty and stent procedures and some heart attacks. Your doctor will discuss with you how long to stay on the medication.

Side effects: hemorrhage, increased bruising, stomach irritation, constipation, heartburn, headache, dizziness, joint or muscle pain, low platelet count, low white blood cell count or low red blood cell count (anemia).

Thrombolytic Drugs
A major advance in treating heart attacks is the immediate use of thrombolytic or clot-busting drugs, such as tenectoplase (TNK) or tissue plasminogen activator (TPA). These are also used to treat cases of ischemic stroke caused by blood clots. When given within three hours of the start of a stroke, some patients’ symptoms, such as numbness or the inability to speak, can be completely reversed.

Women and men get the same benefits (reduced mortality and less heart damage) from these drugs. However, women are less likely to be given them in the emergency room, partly because women are more likely to arrive at the hospital at a later stage than men. Women, especially older women, can have more bleeding complications with these drugs than men.

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  • A publication of:
  • Women's College Hospital