Go Red: A must for women with PD: By Dr. De Leon

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“Follow your heart but take your brain along.”

 

February is not only the month of love but is also more importantly the month in which we bring awareness to the 2 most important organs we have -our BRAIN & our HEART. Brain & heart health are extremely important for all but particularly for women with PD because the symptoms of a heart attack and a stroke are not similar to those of men in many cases. Thus, women may go un-diagnosed and are more likely to suffer long standing consequences. In fact in a study looking at women and stoke they found that most physicians still regard cardio/cerebrovascular disease as a man’s disease. Thus, women are not often offered the appropriate counseling. Only 22% of Primary care physicians and 42% of cardiologists felt equipped to deal with cardiovascular issues in women. These figures puts us at a significant disadvantage from a diagnosis and treatment standpoint.

A few years ago, I had an episode of severe sudden chest pain with exertion along with nausea, dizziness, and sweating. Of course being a physician I could not exclude a cardiac cause for my symptoms. However, when I went to the cardiologist his response was less than I would have expected given my condition because in his words ‘women simply don’t get heart attacks‘ especially at your age. Of course, no one wants a heart attack (and by the way I do have family history of young onset heart disease)  at any age but excluding an entire differential based on gender seemed a bit worrisome. My symptoms turned out to be caused by a combination of acute endocarditis along with malignant hypertension. Fortunately my blood pressure is now under control (at least for now) and my endocarditis has resolved.

 

However, you may be wondering why I am writing about strokes and heart attacks in a Parkinson’s blog?  Well, for several reasons. First, because those of us who suffer from Parkinson’s disease and other atypical Parkinson like Shy-dragger disease have autonomic dysfunction; with this problem comes severe alterations in blood pressure ranging from extremely low to extremely high as is my case. In my experience as a neurologist taking care of stroke patients i have found that it is the constant fluctuation from very high to very low that is most damaging along with the rate at which it changes (rapid change is more deleterious to vital organs like the brain and heart). Furthermore, high blood pressure is the single most important risk factor and leading cause for stroke. We often talk about low blood pressure in PD patients but rarely do we talk about high blood pressure. But even if our blood pressure did not rise the sudden drop can be equally detrimental to an organ that is critically dependent on blood flow and oxygen levels to function properly.

Second, patients with PD and other atypical Parkinson like MSA have tendency to have as part of disease sleep apnea. It is believed that half of those who have sleep apnea also have high blood pressure. Plus, the severity of the hypertension is directly related to the severity of sleep apnea. But, you don’t have to have severe sleep apnea to have problems. Even mild sleep apnea can alter your blood pressure putting you at risk for a stroke. This is crucial especially given the fact that most strokes occur in the early hours of the morning when we are at sleep.

 

Third, migraines with aura appear to be a risk factor of PD and who has more migraines other women? In fact recently, in a medical journal it was speculated that having an aura increases the risk of having atrial fibrillation yet another risk factor for developing stroke.

Finally, just because we have one medical problem i.e. Parkinson’s does not mean we are immune to developing other neurological disease or medical problems that come with age such as high blood pressure.
The good news is that high blood pressure is a modifiable risk factor. We might not be able to do anything about our gender, our age, or our Parkinson’s diagnosis but we can be proactive in making sure, we eat right, we exercise, and we talk to our physicians about any weight issues we might have which directly impact our risk for both apnea and high blood pressure. Also, it is important to monitor your blood pressure and discuss treatments if needed as well as stroke prevention treatments. The other good news is that although stoke studies have not shown aspirin to prevent strokes in a sub-study of women it proved to be extremely effective. ( I take my aspirin daily!) Lastly, I firmly believe that because we have a higher likelihood of developing apnea we should be frequently screened. Thus, speak to your physician about these issues especially if you have family history of cerebrovascular disease or if you are a young woman with PD and have migraines with auras, or are on birth control pills.

References:

Zedde m. Women and stroke: A matter of education?. Neurology. http://n.neurology.org/content/women-and-stroke-matter-education. Published 2019. Accessed February 3, 2019.

Chang BP e. Neurology Concepts: Young Women and Ischemic Stroke-Evaluation and Management in the Emergency Department. – PubMed – NCBI. Ncbi.nlm.nih.gov. https://www.ncbi.nlm.nih.gov/pubmed/28646558. Published 2019. Accessed February 3, 2019.

High Blood Pressure Symptoms | Sleep Apnea Guide. Sleep Apnea Guide. https://www.sleep-apnea-guide.com/high-blood-pressure-symptoms.html. Published 2019. Accessed February 3, 2019.

Aspirin May Lower Stroke Risk in Women with History of Preeclampsia – ScienceBlog.com. ScienceBlog.com. https://scienceblog.com/505555/aspirin-may-lower-stroke-risk-in-women-with-history-of-preeclampsia/. Published 2019. Accessed February 3, 2019.

Nogrady B. Increased risk of atrial fibrillation with migraine aura. Mdedge.com. https://www.mdedge.com/neurology/article/184528/headache-migraine/increased-risk-atrial-fibrillation-migraine-aura. Published 2019. Accessed February 3, 2019.

@copyright 2019

all rights reserved by Maria L. De Leon MD

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