Wednesday, April 19, 2006

Microvascular disease in women - a real danger often overlooked

Puzzling differences have emerged between men and women with heart disease, making it plain that past studies, mostly on men, do not always apply to women. Researchers have come to realize that to improve diagnosis and treatment for women, they must sort out the differences.

"Every time we turn around, we find more gender differences, so it's important to study," said Dr. C. Noel Bairey Merz, a cardiologist at Cedars-Sinai Medical Center in Los Angeles.

Among the differences:
  • Women with chest pain and other heart symptoms are more likely than men to have clear coronary arteries when tests are performed, a surprising result that suggests there may be another cause for their problems.
  • When women do have blocked coronary arteries, they tend to be older than men with similar blockages and to have worse symptoms, including more chest pain and disability. And they are more likely than men to develop heart failure (most likely due to age of onset), a weakening of the heart muscle that can be debilitating and ultimately fatal.
  • When women have bypass surgery or balloon procedures for coronary blockages, they are less likely than men to have successful outcomes, and they are more likely to suffer from bad side effects.
  • Blood tests that pick up signs of heart damage in men do not always work in women.

For symptomatic women without clear atherosclerosis, the underlying problem may be a disorder called microvascular disease, a narrowing or stiffening of the smaller arteries that nourish the heart, vessels too tiny to show up on an angiogram. In microvascular disease, the small vessels lose their ability to dilate and increase blood flow to the heart. The cause does not seem to be fatty deposits such as the ones that can block the coronary arteries. Rather, the muscles in the arterioles thicken, and the walls may stiffen and begin to close in. The result is ischemia, lack of blood flow. Over time, it increases the risk of heart failure and heart attacks.

Three million women in the United States may have microvascular heart disease. Research, begun in 1996, included 936 women who had angiograms because of symptoms such as chest pain. The angiograms found that only a third had blockages in their coronary arteries. In men with similar symptoms, three-quarters or more would have had severe blockages.

Another third of the women had no blockages but did have low blood flow to the heart, most likely a result of microvascular disease. Among those with the disorder, the rate of deaths or heart attacks was 10 percent after four years, much higher than would be expected for women with normal angiograms.

The findings call for a major shift in the treatment of women with chest pain or other symptoms and normal angiograms, said Dr. George Sopko of the National Heart, Lung and Blood Institute. "Instead of tossing aside the angiogram and saying you're OK, let's make sure we are not missing anything."

High cholesterol and blood pressure are almost certainly among the causes of microvascular disease, and it is essential to treat them aggressively in women with chest pain and to urge women to exercise, avoid smoking and lose weight.

Read more on the WISE study and microvascular disease


At 9:42 AM, January 18, 2008, Anonymous Anonymous said...

I don't know if I'm more frightened or more relieved. I've had two stress tests in the past two years and am pronounced "fine". Still, I have had episodes of tachycardia and arrythmia and lately, chest pain and shortness of breath when I exercise. I've felt like a complete idiot when I complain of symptoms because tests don't lie, right? Now I find, maybe they do. I began this search after reading the latest Newsweek which describes coronary microvascular disease in women. It suggest that women find a women's cardiovascular center. Sounds like a good idea. Even though I live in a major city with enormous medical facilities -- civilian and military -- I believe I'm one of these women. I am not overweight and I exercise (hence being able to recognize these symptoms and changes), but I also have high blood pressure and a family cardiac history that's not friendly to women. Yikes!

At 11:04 PM, February 04, 2008, Anonymous Kat said...

Just like the previous comment, I am so relieved to read this article. Maybe I'm not crazy after all. I'm a 43 year old female. I have been having symptoms of arrythmia, shortness of breath, lightheadness, dizziness, passing out just by simply walking through the mall. Exercise isn't even an option. I get chest pains and tighness of chest, pain that radiates from my jaw to my left arm. Several times I have almost called an ambulance on myself thinking I was going to have a heart attack. I finally went to a cardiologist, all they told me after angiograms, nuclear stress test, ekg's and CAT scans is that I have a haert murmur, my arteries are clear and my symptoms may be phycosymatic. In other words its all my imagination. Which makes me nuts, when I'm walking through the mall or walking up a simple flight of stairs and I feel like I'm going to pass out, that's not my imagination, when I'm laying in bed trying to sleep and I can't because of arrythmia, its not my imagination. Is there anyone that specializes in microvascular disease.

At 9:09 AM, February 05, 2008, Anonymous Anonymous said...

see above

The endothelial dysfunction test is still the gold standard for diagnosis:

I would consider calling the Mayo Clinic or Cleveland Clinic and, from them, get the name of the closest heart center to you(usually university based)or make a few local calls to university heart centers in your area.

Best wishes to you!


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At 9:56 PM, April 07, 2010, Anonymous Christine said...

I have been having the same symptoms as Kat for over 10 years, and all tests have been negative, except for a 30% blockage in one coronary artery, which the cardiologists have told me is "nothing" and requires no intervention. A month ago I was in the hospital with acute bronchitis and a respiratory infection, treated with 4 rounds of antibiotics. The whole time, I was having rib muscle pain from coughing, of course. But I was also having an incredible pressure substernally, radiating into my left collar bone and left jaw. I was repeatedly told to "ignore the chest pain". I was even severely reprimanded by a physician for complaining of chest pain, and eventually was given a psychiatric evaluation, because I was afraid since I was too sick to take care of myself at home alone, the day they were discharging me. I went home, went down in the floor several times over a week, nearly passing out when I would get out of bed to go to the bathroom. I was even erroneously diagnosed with COPD.
One ER visit later and one primary care doctor visit later, I was sent to a cardiologist. The ECHO was negative. The blood tests were negative. The next day, I was having serious chest pain and much difficulty getting around due to shortness of breath. I was having sudden, severe swelling from my knees down and significant sudden weight gain. The cardiologist's office instructed me go to the Heart Hospital ER, which I did. Another heart cath later, and I was still at 30% occlusion and all heart labs within normal limits, being told, "it's not your heart". The next day, the Nurse Practitioner "experimented" on me, trying different medications to treat different possible origins for the chest pain. Gastrointestinal was negative. Inflammation was negative. One hour after a dose of Norvasc, which dilates the coronary arteries, I was completely chest pain free. I was then diagnosed with Microvascular Heart Disease. I am now taking Lasix, Potassium, and Norvasc daily. My near fainting spells have almost resolved. My shortness of breath is significantly better. My swelling is under control. And I am only occasionally having cheat pain, just a few times a day, not most of the day and night. My arrhrythmias and tachycardia is much better. I am normally a very active, very physically hard working person, living on a farm. I went from fit to totally debilitated in a few days.

So, you are not crazy. If physicians ignore your symptoms they are simply ignorant and foolish. I was so upset by having been subjected to a psych consult for being afraid of going home and dying alone because they were sending me home too soon! The cardiologist was also upset that I was sent home in the condition in which I was.

I, myself, am an advanced practice RN with cardiology experience, and I was ignored and treated as if "crazy". The next time you speak to a physician about your symptoms, I strongly encourage you to ask them to investigate this Microvascular heart/coronary disease!

At 3:11 PM, May 21, 2010, Anonymous Anonymous said...

I too have had a patent stent
catherization but have pain in
clavical, pain in jaw, pain in
cheeks, no one knows why. I
believe I have microvascular disease.

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