Women and Heart Disease
Under diagnosis and under treatment of heart disease in women contributes to excess mortality making early and accurate diagnosis of great importance. Women are more likely to develop unusual symptoms of heart disease; they exhibit a tendency to delay seeking medical advice. General differences in coronary artery disease most notably include mild deforms of typical heart attack symptoms, sudden weakness, shortness of breath, fatigue, discomfort in the back, arm, neck, chest, and jaw. Many women do not experience the “classic” heart attack symptoms of chest pain.
What was once thought of as a health concern primarily for men, heart disease has become the leading cause of death among American women, accounting for more deaths each year than all cancers combined. In fact, 50,000 more women than men die from heart disease each year. At an even greater risk are women with diabetes, with 80 percent of diabetic women dying from coronary artery disease (CAD). Despite these dire statistics, women continue to be overlooked and underdiagnosed for heart disease.
CAD results from the narrowing of the blood vessels that supply the heart. The blood vessels become narrow when fatty deposits build up inside the blood vessel wall. This is due to atherosclerosis. When the arteries become clogged, the blood flow to the heart muscle is reduced and a heart attack can occur.
RISK FACTORS
Among women, the increased likelihood of coronary artery and cardiovascular disease is associated with certain risk factors including cigarette smoking, physical inactivity, being overweight or obese, high cholesterol, high blood pressure, diabetes, age, race and family history.
RISK REDUCTION
Because women are more likely to develop unusual symptoms of heart disease, they exhibit a tendency to delay seeking medical advice. Early detection is key to reducing the risk of mortality among women. Gender differences in coronary artery disease (CAD) most notably include milder forms of typical heart attack symptoms, sudden weakness, shortness of breath, fatigue, discomfort in the back, arm, chest, neck and jaw. Many women do not experience the “classic” heart attack symptom of chest pain.
SCREENING FOR HEART DISEASE
Underdiagnosis and undertreatment of heart disease in women contributes to excess mortality, making early and accurate diagnosis of great importance. When heart disease is suspected, further evaluation may include myocardial perfusion imaging, echocardiography, and cardiac catheterization. Nuclear cardiology studies use small doses of radioactive material to assess myocardial blood flow, evaluate the pumping of the heart, as well as visualize the size and location of a heart attack. Among the types of nuclear cardiology studies, myocardial perfusion imaging is the most widely used.
MYOCARDIAL PERFUSION IMAGING (MPI)
MPI is a non-invasive nuclear imaging study to test for critical coronary stenosis, a narrowing of the coronary arteries due to atherosclerosis. This study is able to determine the degree and location of reduced blood flow to the heart as well as pumping function and existence of scarred heart tissue. MPI is able to establish the need for invasive procedures, avoid unwarranted hospital admissions or discharges, and to assess for long term prognosis. MPI allows for improved diagnostic accuracy over regular stress tests, as well as a study that is highly indicative of coronary artery disease. Many women who die suddenly of heart disease have had no previous symptoms. MPI is a highly accurate diagnostic test that results in early and effective treatment and improved outcomes for women at risk for coronary disease. A growing body of data supports the fact that noninvasive cardiac tests have different diagnostic accuracy in women. MPI has been shown to be accurate in the risk assessment and prediction of future cardiac events in women.
MPI is performed during stress and again at rest while monitoring for blood pressure and heart rhythm. Patients’ arteries are subjected to physiologic stress to maximize blood flow, usually through exercise, but a pharmacologically induced stress test may be performed when patients cannot exercise. In these patients, a medication infusion is given which dilates the arteries, eliminating the need for physical exercise.
A small dose of a radiopharmaceutical is injected into the bloodstream at maximum exercise. The patient then undergoes a 15 to 20 minute scan using a gamma camera (SPECT technology) to produce detailed images representing blood flow to the heart during stress.
Healthy heart muscle, receiving normal blood flow, will accumulate more imaging agent than cardiac muscle supplied by diseased coronary arteries. Scanning is repeated at rest, usually a few hours later, with no significant changes appearing in healthy hearts during either study.
WOMEN DIABETICS
Diabetic women are at an even greater risk of heart disease. Women with, or at risk for, diabetes are also at risk for heart disease. With a two to three times greater risk for heart disease, eighty percent of diabetics die of coronary artery disease. In diabetics, heart disease is often diagnosed at a more advanced stage with disease in more than one vessel. Diabetes care is more than managing blood sugar, it also requires monitoring cardiovascular disease risk factors.
For further information please see …
LOWERING BLOOD PRESSURE MAY HELP REDUCE WOMEN’S HEART DISEASE RISK.
WOMEN WITH STRESSFUL JOBS HAVE AN INCREASED RISK OF HEART ATTACK
