Coronary Heart Disease
Background
There are several challenges in diagnosing and treating coronary artery disease in women.
Subtle Symptoms: Women's symptoms of heart disease tend to be more subtle than men's symptoms. Often, women don't have the typical crushing chest pain that men have, and their heartburn or severe fatigue could be symptoms of many things. So, when doctors try to identify the cause of the symptoms, they often think of other health problems first before thinking of the heart.
Microvascular Disease: It is estimated that about 2 to 3 million women in the United States have "microvascular disease," which is more common in women than in men and affects the tiniest blood vessels of the heart. The disease prevents these vessels from providing enough oxygen for the heart to function well. Traditional tests for diagnosing heart disease focus on the larger coronary arteries, not the smallest ones.
Age: Women have less heart disease than men when they are young, partly because of the protective effects of estrogen. But when a woman does have a heart attack, it tends to be more serious, she has more blocked arteries and she develops more complications.
Symptoms
Women often describe a "fullness" or "tightness" in the chest, not pain, and they can have isolated discomfort in the jaw, left or right arm, or abdomen. Sometimes, women have unusual tiredness or shortness of breath for up to one month before a heart attack. Click here for more details.
Diagnosis
In women, it is not uncommon for plaque to build up along the length of an artery wall, rather than in just one spot. When this happens, it can be difficult to see using traditional methods such as a treadmill test. For women, an echocardiogram or a nuclear imaging exam—both combined with some kind of exercise—can provide a better picture of a woman's heart health.
Three other tests may also be beneficial:
- an intravascular ultrasound, which allows doctors to see arteries from the inside;
- a cardiac CT scan; and
- a cardiac MRI, which has been shown to help identify microvascular (or small vessel) disease.
Ask your physician about the best option for you.
Treatment
A number of treatment options do exist—from medication to angioplasty to surgery—but it's important to seek expert care if you have any of the symptoms described above.
Listen to Your Heart: Women at Risk is a public service campaign co-sponsored by NBC4 and CareFirst BlueCross BlueShield.
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