Coronary heart disease (also known as ischemic heart disease) happens when blood flow to the heart is decreased. This decreased blood flow is usually caused by a build-up of plaque – called “coronary atherosclerosis” – in the arteries, which starves the heart of oxygen and damages its muscle. The result is a heart attack and diminished blood-pumping ability.
A non-obstructive form of coronary disease – coronary microvascular disease – is more common in women. In coronary microvascular disease, arteries spasm and block the flow of blood to the heart. But it is possible for women to have both coronary microvascular disease and atherosclerosis.
Previously, the importance of non-obstructive coronary disease in women was not understood in research, which led to incorrect diagnoses and inappropriate treatments.
More recently, however, research has shown that women who have non-obstructive coronary artery disease or abnormal stress tests are at increased risk of heart attack.
The symptoms of coronary heart disease are also broader in women than they are in men. Pain may not be located in the chest, for instance, and the patterns and distribution of pain symptoms may differ from men’s symptoms.
AHA statement makes recommendations to patients and doctors
The American Heart Association’s (AHA) statement recommends that women with suspected coronary heart disease discuss the pros and cons of diagnostic tests with their doctor. Women may want to avoid some tests in certain situations; for example, a woman of child-bearing age may be reluctant to have tests that involve exposure to radiation.
The statement also says that doctors should evaluate whether a female patient is at a low, intermediate or high risk for coronary heart disease when deciding what tests are most appropriate for that patient.
Also, the authors urge health care professionals to now routinely consider how well their patient is able to carry out day-to-day activities when deciding on diagnostic testing. This is because women with low functional ability are now considered to be more at risk of heart attack.
In addition, the AHA statement also recommends the following:
- Women with the lowest risk should not undergo diagnostic testing
- Women at slightly higher risk should first undergo a treadmill exercise electrocardiogram
- Symptomatic women with warning signs may need to undergo cardiac magnetic resonance imaging (MRI) or cardiac computed tomography (CT) angiography.
“For decades, doctors used the male model of coronary heart disease testing to identify the disease in women, automatically focusing on the detection of obstructive coronary artery disease,” says Dr. Jennifer H. Mieres, lead author of the statement and professor of Cardiology & Population Health at the R Hofsrta North Shore-LIJ School of Medicine in Hempstead,NY.