A Woman's Heart
Scientists continue to struggle to understand why women have a different experience than their male counterparts when it comes to the diagnosis and treatment of heart disease.
Women respond to the same risk factors differently; for example, there is evidence that having a low HDL ("good" cholesterol) level is more predictive of the development of coronary heart disease (CHD) in women than high LDL ("bad" cholesterol) levels are. CHD death is more frequent in women than in men, often because we are older when we develop heart disease, and there is evidence from the Heart Estrogen Replacement and Women's Health Initiative studies that this is not related to the loss of estrogen at menopause.
A new study sponsored by the National Institute of Health indicates what many women already know; their heart disease is different. Women respond differently to conventional treatments, and have different symptoms, such as shortness of breath and fatigue rather than the chest pain or heaviness that men frequently have.
Now there is evidence that conventional heart disease tests may not identify CHD in women because they often have plaque build-up in the smaller heart vessels, rather than large, readily apparent blockages in the main arteries that are frequently the hallmark of CHD in men. In a current study called Women's Ischemia Syndrome Evaluation, or WISE, researchers have found that as many as 2/3 of women with CHD symptoms will appear to have normal coronary arteries on an angiogram. Of those women 1/2 will have a problem called coronary microvascular syndrome, where they develop evenly coated plaques in the small vessels of their hearts.
Unlike the large blockages that are frequently found in their male counterparts, these women's tiny blockages are not visible during the angiogram. The study's overseer, Dr. Noel Bairey-Merz of Cedars-Sinai Hospital in Los Angeles, reports that this type of arterial disease also appears to cause the blood vessels not to dilate the way they are supposed to, a problem that causes further restriction of blood flow through an already narrowed artery. Blood flow restriction causes a loss of oxygen to the heart muscle, causing the pain known as angina. Microvascular syndrome is primarily a problem for women; only about 20% of men have this type of CHD. Dr. Bairey-Merz points out that scientists are just learning about this syndrome because for many years women were not enrolled in studies.
What should women do who suspect that they have heart disease? If you have had a normal angiogram and continue to have symptoms of concern, talk with your health care provider. Microvascular disease is visible on MRI, and a simple questionnaire, such as the Duke Activity Status Index (DASI), can identify women who are likely to have unidentified microvascular syndrome. The questionnaire asks about the individual's ability to perform certain daily tasks, such as light housework; women who pass an angiogram but who score poorly on the DASI are at increased risk of having a heart attack.
Laurie
Related Topics: Diseases Linked to High Cholesterol, The Baby Boomer Heart
Technorati Tags: women, heartdisease
Women respond to the same risk factors differently; for example, there is evidence that having a low HDL ("good" cholesterol) level is more predictive of the development of coronary heart disease (CHD) in women than high LDL ("bad" cholesterol) levels are. CHD death is more frequent in women than in men, often because we are older when we develop heart disease, and there is evidence from the Heart Estrogen Replacement and Women's Health Initiative studies that this is not related to the loss of estrogen at menopause.
A new study sponsored by the National Institute of Health indicates what many women already know; their heart disease is different. Women respond differently to conventional treatments, and have different symptoms, such as shortness of breath and fatigue rather than the chest pain or heaviness that men frequently have.
Now there is evidence that conventional heart disease tests may not identify CHD in women because they often have plaque build-up in the smaller heart vessels, rather than large, readily apparent blockages in the main arteries that are frequently the hallmark of CHD in men. In a current study called Women's Ischemia Syndrome Evaluation, or WISE, researchers have found that as many as 2/3 of women with CHD symptoms will appear to have normal coronary arteries on an angiogram. Of those women 1/2 will have a problem called coronary microvascular syndrome, where they develop evenly coated plaques in the small vessels of their hearts.
Unlike the large blockages that are frequently found in their male counterparts, these women's tiny blockages are not visible during the angiogram. The study's overseer, Dr. Noel Bairey-Merz of Cedars-Sinai Hospital in Los Angeles, reports that this type of arterial disease also appears to cause the blood vessels not to dilate the way they are supposed to, a problem that causes further restriction of blood flow through an already narrowed artery. Blood flow restriction causes a loss of oxygen to the heart muscle, causing the pain known as angina. Microvascular syndrome is primarily a problem for women; only about 20% of men have this type of CHD. Dr. Bairey-Merz points out that scientists are just learning about this syndrome because for many years women were not enrolled in studies.
What should women do who suspect that they have heart disease? If you have had a normal angiogram and continue to have symptoms of concern, talk with your health care provider. Microvascular disease is visible on MRI, and a simple questionnaire, such as the Duke Activity Status Index (DASI), can identify women who are likely to have unidentified microvascular syndrome. The questionnaire asks about the individual's ability to perform certain daily tasks, such as light housework; women who pass an angiogram but who score poorly on the DASI are at increased risk of having a heart attack.
Laurie
Keeping your body healthy is an expression of gratitude to the whole cosmos - the trees, the clouds, everything.
Thich Nhat Hanh
Related Topics: Diseases Linked to High Cholesterol, The Baby Boomer Heart
Technorati Tags: women, heartdisease
43 Comments:
As a physician, how to I obtain a copy of the DASI questionnaire?
Thanks.
Dr. GYN
Hi Dr. Gyn,
Here's a referance: Hlatky MA, Boineau RE, Higginbotham MB, Lee KL, Mark DB, Califf RM, Cobb FR, Pryor DB. A brief self-administered questionnaire to determine functional capacity (the Duke Activity Status Index). Am J Cardiol. 1989 Sep 15;64(10):651-4
This may also be of interest:
http://eurheartj.oxfordjournals.org/cgi/content/full/24/16/1506
Take care, Laurie
I hope this information reaches all primary care and e.r.physicians and their staff members who have to make diagnoses. Yet another thing to add to the growing list of worries!
I know from personal experience the differences in heart attacks & disease in woman vs. men...but how do I convince my doctor that she needs to treat me differently because of it. "It is standard protocol..." is what I hear over and over and it makes me crazy!
I think I may have this condition ... Coronary Microvascular Syndrome... How is it treated and how serious is it ?
Susan
Dear Susan,
Please visit our Heart Failure/Heart Disease board to ask Laurie Anderson your questions about your condition.
Thank you!
WebMD Blog Administrator
i was in a very large, prestigious hospital ER just this a.m. with severe jaw and left arm pain, mild to moderate chest pain. have had chest pain for several years, but this was far worse than usual.
the drs, including a cardiologist, told me not to worry, since i had a normal angiogram last year. i said i had heard about a study that disproved that, and they acted as if i were nuts. they did a treadmill stress echo and said go home and you are cleared for any and all activties. i still feel like hell -- so i went online, and immediately found numerous multiple cardiology studies saying that angiogram was practically worthless, as was the stress echo i just had that will cost a fortune. any advice what to do now????
oh -- same poster here as ER visit above. i am looking at my paperwork: my troponin I levels were high, but Ck was not.
my glucose was 156 ( i went straight from bed to hospital, so no bfast -- would that make the difference?) and all else normal. i have had abnormal holter monitor test, abnormal nuclear and something else in past two years. but always told not to worry about the results bc i am 45 yr old active and healthy.
problem is, i have strong family history of heart problems (mom died at age 56 of undiagnosed heart disease -- drs were actually refusing to treat her when she died).
I have been told that I have a heart condition and I need to Know if any of the medication I have been given are counter acting each other because I am on several of them
I will print this and other articles I found on this topic and fax them to the cardiologist, who did my last heart cath. in Feb. 2006.
The heart cath. was normal (just like the one I had three years earlier) and the Dr. said my chest pain couldn't possibly come from my heart.
I think, he needs to be re-educated!
I can relate to the Microvascular Disease as I have been diagosed with this last month. Because the angiegram had three blockages of 60-70% and two at 40-50% and "couldn't" do bypass because it did not meet the % min. I then was told Microvascular. Then said I would probably have a heart attack within 5 years,
Do they wait until women have heart attacks unlike men?
Need help......
Driving home from work, I felt as if I was dying -I had no control over my body and my left hand was numb not only that I felt I was passing out.straight to emer and everythin looked good except my troponin was 10x higher than it should be. sent home and i still
have these symptons over again was
told by others it's anxiety or it's premenopuase. Lord I need to know- single mom with a six yr old
and afraid.
FYI for all of you ladies that are having chest pains and getting no where at the dr and er...DO NOT GIVE UP! It took 2 years and 9 differents cardiologists before I ended up in the Q-Wise study and they finally determined I am not nuts I do have micro vascular heart disease and it is treated with meds so keep trying to find someone in your area that can help...keep trying and never take no for an answer...you know when you dont feel right no matter what the tests say...my stress tests and echos are always normal but there are different tests that can determine if you have mhd, keep checking and if there is a teaching hospital in your area check with them they may have a Dr that is up to date on the news that women need different treatment for chest pain and heart disease...DO NOT GIVE UP!!!
my left arm has been numb all day.
. . . usable, but tingly and heavy none the less-
any ideas?
Dear The Rabbit,
Please seek medical attention today to ensure your good health.
I was diagnosed with coronary microvascular disease about one month ago. I had a heart cath that was clear, but showed the microvascular disease. I was given ecotrin and nitoglycerin pills to take if I needed them. I am having a difficult time finding info on line about this condition. I am not sure of what symptoms I should be concerned about. Was told to do everything I normall do, and I am very active, however, when I had recent chest burning in the center of my chest and called my doctor I was told it wasnt my heart as my heart cath was clear. I am a bit confused....
In the past 3 weeks, I have been to ER twice for left arm shooting pain, chest pain, trouble breathing, burning sensations, blood pressure goes way up or down as a result of these.. I can't continue my life as I was before. I can't drive or be in motion, my heart goes wild! I also have been hospitalized several times. Wearing a heart monitor (event monitor, halter?) now. I was able to record only one irregular rhythm that my cardiologist determined that I might have small vascular something, he immediately have me started on a Beta blocker "Atenonol".
WARNING: I lost 12 lbs in 3 weeks, and keep going down with same speed, fatigue as i have never been and very dizzy. Dr checking inner ear complications or allergies. Did the RAST allergy blood test this AM and will do a Head CT Scan and physical therapy for possible inner ear complications.
Dr also suggested that I should see a psychotherapist for anxiety.
I know I became ill all of a sudden, my life has turned upside down, and I know it is NOT from anxiety. How should i proceed, change my doctor?
Please find a support group through your hospital, local University teaching hospital or an online group - but people live, human beings you can look into their eyes, that's the best. GET INTO A GROUP FOR SUPPORT WITH WEEKLY MEETING ASAP.
i'm 24 years old and for a few years i've had a shooting pain in chest. it only last for a few seconds, a minute perhaps. however, it has always bothered me and i've even had some test done a few years back, in which the doc's said i was "fine." when i get this pain, i have to completely stop what i'm doing and relax for awhile and then it goes away. what can it be?
i'm having burning sensations under my left breast, i'm only 21, but there's a history of heart disease on both sides of my family, sjould i be worried?
what is the treatment for cardiac mycrovascular syndrone. I have not been able to see what is done, if anything. My cardiologist says there are no treatment options? is this true?
Don't listen to Heather and go out and find a hypocondria support group. Go to a good gastroenterologist. I am 44 and have had all of the symptoms you described. Back in my late 30's I went through the exact same ER routine due to the symptoms and because I do take an anxiety medication I was given the little pat on the head, you're okay honey now go home. Well it was not until last year that the pain symptoms had spread from my arm, back, chest, etc. to severe pain under my rib cage, particularly on the left side. I was having a great deal of difficulty breathing and decided to just walk in to my primary care physicians office which is much closer than the ER and I did not want to get the "poor pathetic little thing patronization that I have experienced at the ER". This new young physician in the practice examined me, took a thorough family history, and then had some chest and ab Xays done. The pain and difficulty breathing were due to my large intestine being extremely distended with gas. He further stated he believed I have Ulcerative Collitis and advised a colonoscopy. At the time he also suggested using an over the counter very mild laxitive to help clear what could be a small blockage. Because I am so sick and tired of everytime you go to a new Doctor or Hospital and they find out you take either an antidepresent or anti-anxiety drug they make you feel so patronized I decided that it might be best to do some research and try more natual treatment. I also did not want to get stuck on a lifetime of meds. or worry about the complications another med. could cause with my current meds. so I have modified my diet, take a very good over the counter probiotic called Sustinex and 1 teaspoon of ground flax seed with all the Omega's added to it (available at WalMart in a black jug). This regime has drastically reduced my symptoms to a point where I am usually asymptomatic unless I eat something I shouldn't that sets it off. I had to keep a food journal for awhile to help figure it out. Good luck and I hope my story helps you find a solution to your symptoms.
i have a problem with my heart disease. how can i prevent it? because my heart can't heartbeat like hard. i even take a breath well and drink a water more but still failed. i've always been cry when my heart can't heart beat and hard like freeze. please help me.
thanks.
Need advice. I have been experiencing a shooting pain in my left arm for years. It is very short and extremely sharp, but is gone by the time I react to it. This may occur for several weeks and then not again for months. It eventually always returns. The pain is on the outside of my left arm, between shoulder and elbow. I have been told (by friends) that this is probably a pinched nerve, not heart problems, but I am still very concerned. It has been going on for weeks now.
Last 5 months I notice before falling asleep there is a loud pulsation or heartbeat sound in my left ear. It made me think of a possible clogged carotid artery or something not right. What could be causing this new annoying sound in my ear. Thanks, anonymous
Hi I am 33 year old woman, Im mad after reading this article. I have suffered from angina for a year now. Today I go in for chest pain, both the paramedic and nurse said I had a previous heart attack according to the ECG in the abulance. The doctor refused to say I did. He is saying it is anxiety! They sent me home and I couldnt even walk because I was disoriented. The doctor said medically your fine, I dont know what is causing your symtoms. What do I do, my troponin was fine today, but Im worried about what has happened(the heart attack in the past). Where do I go? I have switched doctors and hospitals about 5 times now, Im getting nowhere. Im afraid Im going to die in vain and leave my loving husband and Im all he has, he doesnt have family and we dont have kids. O and my cath was normal. Someone please help me, thanks.
I am a 33 year old female smoker, I have been having recurring chest pain, mild to moderate, mainly at night when going to bed but rarely during thte day, Do I call 911 or make an appt with regular dr? Please send advice. Not sure what to do, no other symptoms, just chest pain, can't tell if left arm is slightly tingly or if it's imagination...
My husband thinks I'm over reacting and says it's prob just "gas" but he doesnt like to think of the other things it could be.
there is incredible pain right under my right breast bone. This has happened before. I've taken gas-x and the pain has eventually gone away. It isn't going this time. Is it gas or could I be having heart problems??
I too have the pulsating (heartbeat) in my left ear. I asked my ENT (ear nose and throat doc) and he told me that there's an artery that passes near the left ear and that I'm more then likely literally hearing my heartbeat. It started for me about a year ago (no other symptoms) but it's bothersome and happens about once a week at all times of the day. My ENT suggested that I have an MRI because he said there's a slight chance that it could be an aneurism or a brain tumor. Two weeks ago I changed from HMO plan to PPO and am going to have a MRI to rule out worse case scenario. I'll keep you posted.
SG
I need to know wheather I am okay or not. Sometimes I would do my usual routine of the day and then my heart just seems to beat hard in a way it seems I can't breathe. What does this mean?
hi doctor i have a bad pain under my left breast what should i do? any info would be appreciated
thanks
vedh
i have high blood pressure that now im medicated with , then they found out i have erregular heart beats from ekg ..pac's and pvc's and also sometimes im dizzy and have heartburn , acid refux ...but the stangest thing with this was last nigh i woke up with my hand so numb and heavy i thought oh no is this a stroke ?? or a tia ?? it felt like concrete ..so i took a baby asp and went back to bed hoping it was just the pressure of laying on it ..it came back ...i used my other hand to move it and after a while the feeling came back ..but the finger tips are still numb ..i would tell the doctor if he would do a real test like a ct scan or mri . i work in a ...should i worry about this or just let it be and see what happens next ??
Hi Doc.
I don't think there's anything wrong with me, but everyone keeps telling me that I need to go see a doc. So I thought I'd see.
To start off, I keep having sharp burning pains in my right lower breast, not all the time just every once in a while. I also have knots under my arm but closer to my breast that are sore and lumps that are like on my rib cage like it's part of my rib bone.
I don't know, but any info would help.
Thanks so much!!!!
do you have acid refux ?? you said burning and the other comment ...hummmmm .....how about a stress test
my mother was diagnosed with copd,fibromialga and sleep apnea.Just recently she was told that she had a blockage at the tip of the heart and at the right aorta.what i would like to know is can yo help me to understand what they are and what they mean.please i am truly a concerned daughter.
my mother was diagnosed recently with a blockage at the tip of the heart and the right aorta.She also was told that she has a 5mm hyperdense cyst i the upper right pole of the kidney.I am truly concerned and curious as to what this means.please let me know.
I have been having pain and presure in the center of my chest since about 1 Am in the morning and I have taken tums and zantac and tagments and it will not go away. I have also had a pounding in my right ear off and on all day. Also dizzy and nausea. Should I see a doctor are is it normal. All I know is it hurts and I want it to stop.Please help..
Oh it was yesterday morning it started not this morning sorry forgot to say that so it has been going on all day and night. thanks
left hand very tingly yesterday and today. I can use it but it just feels like it is asleep. comes and goes should I be worried it is very hot and humid were i am could that be the cause.
What is a PAC on the EKG?
My CRP blood level has been elevated (8.6) for the past month. Can someone explain what this is? And what can be done to lower my level. Any medication available for this?
i am so tired of new pains popping up frequently.i feel so stupid having to go to drs and explain what and how many things hurt and while i naming them off he looks at me like i am crazy. my hands hurt on top my fingers swell and click down and it is worse at night,my neck has 6 bulging discs,my left shoulder has a torn rotator cuff and torn cartilidge which keeps it snapping and popping,i have degenerative disc disease.now my head hurts ,mainly behind my left eye i see floaters frequently and at times my vision spaces out.my legs in the shin area and even the top of my feet burn and tingle and ache.it is worse at night and when i drive my ankles hurt too.at night my legs burn,sting and jerk. what is going on my body is going away quickly and even though i have been an excellant speller for years here recent i have to concentrate on the simpilist form or the easiest word i spell incorrectl or am second guessing myself. i have what i call brain blackouts where i am talking or just doing any activity and my mind just blacks out and i see or hear nothing for a split second and then my conversation or train of thought is gone.what is wrong with me or am i going crazy?
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