Aa
atypical angina?
I'm worried I might have angina. I'm 39, female, good weight, exercise 3x/wk. Never had chest pain, but sometimes when I exercise, I have pain in the upper left side of my abdomen, near the bottom edge of my rib cage, in an area about 2 inches from the bottom tip of my sternum. It can be a fleeting pain or can ache for 15-30 min. or more. Q#1: Is this particular area a place to feel angina? When I work out, my HR is about 125, my resting HR is 65. I also have occasionly felt a similar pain just walking around the house when my HR is under 80. On the other hand, I can climb up and down my steps 10xs or more to get my HR up to 160 and have no pain, no shortness of breath and feel fine. Question #2: If I had CAD bad enough to feel "angina" at rest (ie when my HR is under 80) would it still be possible to exercise strenuously with a HR of 160 and have no symptoms (like I can do)? I hope that if I feel this pain at rest then it couldn't be angina because unstable angina would preclude me from ever being able to exercise strenuously without symptoms.
I saw a cardiologist - she didn't "think" my symptoms were related to my heart, but she said to do a echo stress test for reassurance. My treadmill stress test was normal. I reached a heart rate of 185 with no symptoms, but they didn't get a great resting echo image because I was so nervous before the test that my HR was 110 before I began. Otherwise, echo was fine. Other general info about me: BP 115/70, Total Chol 162, HDL 44, LDL 108, no family history, non-smoker, no diabetes. I do have a lot of anxiety. Please advise. Thanks
I saw a cardiologist - she didn't "think" my symptoms were related to my heart, but she said to do a echo stress test for reassurance. My treadmill stress test was normal. I reached a heart rate of 185 with no symptoms, but they didn't get a great resting echo image because I was so nervous before the test that my HR was 110 before I began. Otherwise, echo was fine. Other general info about me: BP 115/70, Total Chol 162, HDL 44, LDL 108, no family history, non-smoker, no diabetes. I do have a lot of anxiety. Please advise. Thanks
Hi Andie
If your instincts are telling you there is something wrong, you should push to have it checked into further. That's what a nurse at a large hospital told me while I was in the cardiac care unit having atypical angina investigated. Although most of the doctors were nice, I do not believe that they actually thought there was anything seriously wrong...when I was handed maalox and sent home, it confirmed my feelings that the doctors did not feel there was anything wrong with my heart. If it weren't for the nurse, and my family doctor, who reassured me that it was "not in my head", I'd probably be in bad shape right now.
In fairness to the doctors, I have been told that my case was a little unusual and did not fall into some of the typical patterns.
I will "try" to summarize my history as you really don't need to be reading a novel haha, although it may be difficult.
June 2003 (female, age 39), no risk factors (with the exception of being a smoker), had tingling and numbness in both arms, shortness of breath, a feeling of bad gas, and an "uneasy feeling" while I was washing my car. I dismissed the symptoms. They continued off and on all day and evening and the pressure in my chest felt like a balloon inflating from below my breasts to my neck, and from shoulder to shoulder...I still dismissed it as gas.
The next day, numbness in left arm only, a feeling of indigestion (which I had only ever experienced when pregnant), extreme fatigue, shortness of breath. It continued off and on most of the day , and after dinner, while cleaning up, I tried to ignore what my body was telling me, but ended up slumped over the counter and it felt like there was an elephant on my chest. I was rushed to e.r. I had had a heart attack with a blockage in mid- LAD cleared and stented (the funny thing is that no one could tell me how I got a blockage when I do not have high cholesterol).
I was sent home and told to go into the cardiac rehab program for 3 months and strongly advised to reduce stress in my life.
I continued to have symptoms off and on,passed all tests, including a thallium stress test, given maalox and sent home.
Jan. 2004-my family doctor pushed to have an angiogram done (I was quite willing to go on with my life and hoped the symptoms went away, luckily he was not comfortable with my symptoms).
Angio showed restenosis in stent, had 2 more stents (drug coated). Felt great afterwards.
April 2004-symptoms started again, choking feeling, pressure, feeling of food stuck in my chest, extreme fatigue. I passed ecg, echo, stress test.
Family doc added tiazac (cardizam?)to the rest of the meds I was taking. It helped, but not a lot. I gave up on going to specialists, despite the fact that symptoms were getting worse or more frequent. instead, I started seeing a psychologist because I wanted to be objective to the fact that these symptoms may be in my head (she did not feel they were).
May 2005 another heart attack. I had been tired of having to rest off and on during the day or take nitro to relieve symptoms. So, this day, I decided instead of resting, I would go grocery shopping. The chest discomfort got worse in the store, I still shopped, came home and tried nitro. The nitro helped, but did not get rid of it completely. My husband wanted to take me to the er, and although I knew it was my heart, I did not want to go until I knew it was bad enough that it would show up on an ecg. I just couldn't stand the thought of having another doctor look at me like it was in my head, but I knew if I pushed myself a little more physically that day, I could make it worse and then they'd believe me(I know, I know, that was really stupid). I guess I left it a little too long. The good thing was that it was captured on an ecg and the proof was also in my elevated cardiac enzymes. Angio showed that the stents were clear and there were no new blockages , which really surprised the cardiologist. He was very good and said to me "you women humble me every day. I learn more and more each time I deal with a woman as your symptoms can be so unusual".
It sounds strange, but finally I felt validated. I actually was beginning to think the symptoms were in my head.
They still do not know for sure what is causing the problems, but think it is Prinzmetal or Variant Angina. But, I agreed to be part of a research study. It made me feel good that I may be able to help prevent this from happening to other women.
I live on a lot of medications, but life is good now...except when my medications are wearing off in the morning and at night. Although sometimes I have a few moments of feeling sorry for myself (a pity party, I call it haha), because of the major changes this condition has caused in my life. Then I give myself a kick and try to be grateful for the fact I'm still on the planet and I have learned a great deal in these past few years. I live my life differently, and I'm enjoying it to the fullest.
Good luck with everything. My purpose of "telling my story" so to speak, is not to scare you, but to give you some moral support if you truly are feeling there is something wrong inside and no one seems to be listening. You know yourself best. Go with that.
Take care, Janne
p.s. sorry about the long post.
If your instincts are telling you there is something wrong, you should push to have it checked into further. That's what a nurse at a large hospital told me while I was in the cardiac care unit having atypical angina investigated. Although most of the doctors were nice, I do not believe that they actually thought there was anything seriously wrong...when I was handed maalox and sent home, it confirmed my feelings that the doctors did not feel there was anything wrong with my heart. If it weren't for the nurse, and my family doctor, who reassured me that it was "not in my head", I'd probably be in bad shape right now.
In fairness to the doctors, I have been told that my case was a little unusual and did not fall into some of the typical patterns.
I will "try" to summarize my history as you really don't need to be reading a novel haha, although it may be difficult.
June 2003 (female, age 39), no risk factors (with the exception of being a smoker), had tingling and numbness in both arms, shortness of breath, a feeling of bad gas, and an "uneasy feeling" while I was washing my car. I dismissed the symptoms. They continued off and on all day and evening and the pressure in my chest felt like a balloon inflating from below my breasts to my neck, and from shoulder to shoulder...I still dismissed it as gas.
The next day, numbness in left arm only, a feeling of indigestion (which I had only ever experienced when pregnant), extreme fatigue, shortness of breath. It continued off and on most of the day , and after dinner, while cleaning up, I tried to ignore what my body was telling me, but ended up slumped over the counter and it felt like there was an elephant on my chest. I was rushed to e.r. I had had a heart attack with a blockage in mid- LAD cleared and stented (the funny thing is that no one could tell me how I got a blockage when I do not have high cholesterol).
I was sent home and told to go into the cardiac rehab program for 3 months and strongly advised to reduce stress in my life.
I continued to have symptoms off and on,passed all tests, including a thallium stress test, given maalox and sent home.
Jan. 2004-my family doctor pushed to have an angiogram done (I was quite willing to go on with my life and hoped the symptoms went away, luckily he was not comfortable with my symptoms).
Angio showed restenosis in stent, had 2 more stents (drug coated). Felt great afterwards.
April 2004-symptoms started again, choking feeling, pressure, feeling of food stuck in my chest, extreme fatigue. I passed ecg, echo, stress test.
Family doc added tiazac (cardizam?)to the rest of the meds I was taking. It helped, but not a lot. I gave up on going to specialists, despite the fact that symptoms were getting worse or more frequent. instead, I started seeing a psychologist because I wanted to be objective to the fact that these symptoms may be in my head (she did not feel they were).
May 2005 another heart attack. I had been tired of having to rest off and on during the day or take nitro to relieve symptoms. So, this day, I decided instead of resting, I would go grocery shopping. The chest discomfort got worse in the store, I still shopped, came home and tried nitro. The nitro helped, but did not get rid of it completely. My husband wanted to take me to the er, and although I knew it was my heart, I did not want to go until I knew it was bad enough that it would show up on an ecg. I just couldn't stand the thought of having another doctor look at me like it was in my head, but I knew if I pushed myself a little more physically that day, I could make it worse and then they'd believe me(I know, I know, that was really stupid). I guess I left it a little too long. The good thing was that it was captured on an ecg and the proof was also in my elevated cardiac enzymes. Angio showed that the stents were clear and there were no new blockages , which really surprised the cardiologist. He was very good and said to me "you women humble me every day. I learn more and more each time I deal with a woman as your symptoms can be so unusual".
It sounds strange, but finally I felt validated. I actually was beginning to think the symptoms were in my head.
They still do not know for sure what is causing the problems, but think it is Prinzmetal or Variant Angina. But, I agreed to be part of a research study. It made me feel good that I may be able to help prevent this from happening to other women.
I live on a lot of medications, but life is good now...except when my medications are wearing off in the morning and at night. Although sometimes I have a few moments of feeling sorry for myself (a pity party, I call it haha), because of the major changes this condition has caused in my life. Then I give myself a kick and try to be grateful for the fact I'm still on the planet and I have learned a great deal in these past few years. I live my life differently, and I'm enjoying it to the fullest.
Good luck with everything. My purpose of "telling my story" so to speak, is not to scare you, but to give you some moral support if you truly are feeling there is something wrong inside and no one seems to be listening. You know yourself best. Go with that.
Take care, Janne
p.s. sorry about the long post.
Here is the URL for another very recent article on Women and small vessel disease. (small percentage of men also can have small vessel disease) Hope this can be retrieved on this site.
http://www.MSNBC.msn.com/id/11117269/from/ET/
I wish I knew about Cardiac MRI's back before the MI appeared. We had one in this city but I was never referred.
Also, some Cardiac MRI centers do have the "added" Phosphrous 31 Nuclear Spectroscopy in addition. I asked the Center here why they do not have this 'added' and they told me it is still in experimental stages. This was 3 months ago. I will ask again soon.
Have a great day.
http://www.MSNBC.msn.com/id/11117269/from/ET/
I wish I knew about Cardiac MRI's back before the MI appeared. We had one in this city but I was never referred.
Also, some Cardiac MRI centers do have the "added" Phosphrous 31 Nuclear Spectroscopy in addition. I asked the Center here why they do not have this 'added' and they told me it is still in experimental stages. This was 3 months ago. I will ask again soon.
Have a great day.
I am not sure about the 64CT scan. I saw where Diane Sawyer had this done on Good Morning America last week and it was quick. They did say it had quite a bit of radiation and should not be repeated or other CT scans for a year or two afterwards. I am not for sure if this does pick up small vessles like the Cardiac MRI claims to do. With the Cardiac MRI, there is no radiation involved. This MRI took about an hour when I had it. You have to breathe in and I remember coughing and they injected dye, etc. It was quite a process but yet comfortable. They do an EKG first.
Ask your doctor if the 64slice CT scan picks up small vessels. OR, call the radiologist office who read this report and ask them.
Another thing you may want to do. Ask your doctor if you can have a RX for a small bottle of Nitrogylcerine. When you are having chest pain, see if the Nitro relieves the pains. Nitro can cause side effects so talk with your doctor about this.
Good Luck To You.
Ask your doctor if the 64slice CT scan picks up small vessels. OR, call the radiologist office who read this report and ask them.
Another thing you may want to do. Ask your doctor if you can have a RX for a small bottle of Nitrogylcerine. When you are having chest pain, see if the Nitro relieves the pains. Nitro can cause side effects so talk with your doctor about this.
Good Luck To You.
Al, I went to the post office today and lo and behold on the way home I had the start of one of my severe attacks. I have not had one since my last Cath/stent in May. This one started in my right upper abdomen and quickly felt a jolt in the lower right jaw and then a quick pain in the left upper chest and I grabbed for a Nitro. Normally, I try to cough my way out of an attack as I hate the side effects of Nitro. Pains subsided in 2 minutes but those side effects...whew, i.e. nausea, palps, weakness. No headache this time. Hubby had to cook dinner...pooor baby. LOL
I know how you feel when something "hits" us. It is scary to say the least. We think the worst and rightfully so.
I do not want another Cath as at this teaching place....I feel they will want to stent something...(-: I thought people were suppose to be somewhat awake for Caths but with me...they knock me out. I am never awake to say NO! )-:
If I ever go to the hospital, instead of the cath, I will ask for a Cardiac MRI. I like the Radiologist who heads this dept. He knows my case.
How are you feeling now, Al? Hope you are doing better tonight. Cozar? Any side effects? I may have to look into this. Could the new meds of caused last night?
Our best friends are from Pittsburg. Great hospitals in Pa.
I am also researching Stem Cells. I have my name on the call list to see if I am a candidate.
Have a good night.
I know how you feel when something "hits" us. It is scary to say the least. We think the worst and rightfully so.
I do not want another Cath as at this teaching place....I feel they will want to stent something...(-: I thought people were suppose to be somewhat awake for Caths but with me...they knock me out. I am never awake to say NO! )-:
If I ever go to the hospital, instead of the cath, I will ask for a Cardiac MRI. I like the Radiologist who heads this dept. He knows my case.
How are you feeling now, Al? Hope you are doing better tonight. Cozar? Any side effects? I may have to look into this. Could the new meds of caused last night?
Our best friends are from Pittsburg. Great hospitals in Pa.
I am also researching Stem Cells. I have my name on the call list to see if I am a candidate.
Have a good night.
Hi Al again. (-: Thanks Caroline for taking the time to post the article on this site. I had read this article a few weeks back and printed it out for my doctors. I too am on my Soap Box. Called the outspoken female for females,on heart disease. This article is me and so many other women in the world. yes, Microvascular disease was dismissed with me over and over again and the attacks are brutal. IF, they are diagnosed and treated in a quick mode, one is basically saving themselves from an MI. Since, I was lost in the crowd, I did have that heart attack. I hate to be brutal here but women's heart woes are still taking a back seat to that of the man. This country lacks female cardiolgists who seem to take that extra step necessary, for the female heart.
My heart attack was dx only with a Cardiac MRI. I asked for this test after reading up on the diagnostic abilities of Cardiac MRI Imaging 13 months ago. I asked for the heart cath. This showed severe blockages in 2 main arteries. I had to ask for Nitro and when Nitro relieved those severe angina pains, the docs were still not convinced. They thought it was gerd/reflux. Like Al stated, "we do know the difference" between gerd pain and that of heart related pain. There is a difference. Don't get fooled into believing that all heart pain in females are coming from the gut. It really saddens me to hear stories from and about women who are now severely diseased and or who have lost their lives to heart disease because they were not "listened" to. I have never worked so hard in trying to get help for me and when help finally came after suffering many battle wounds, it was too late. The MI had taken its toll. If more doctors would take that extra step, a Mother, wife, sister, friend could be saved.
My heart attack was dx only with a Cardiac MRI. I asked for this test after reading up on the diagnostic abilities of Cardiac MRI Imaging 13 months ago. I asked for the heart cath. This showed severe blockages in 2 main arteries. I had to ask for Nitro and when Nitro relieved those severe angina pains, the docs were still not convinced. They thought it was gerd/reflux. Like Al stated, "we do know the difference" between gerd pain and that of heart related pain. There is a difference. Don't get fooled into believing that all heart pain in females are coming from the gut. It really saddens me to hear stories from and about women who are now severely diseased and or who have lost their lives to heart disease because they were not "listened" to. I have never worked so hard in trying to get help for me and when help finally came after suffering many battle wounds, it was too late. The MI had taken its toll. If more doctors would take that extra step, a Mother, wife, sister, friend could be saved.
P.S. On the bottom of your last post, I see tx. Are you in Texas?
Al, I am so sorry this happened to you Mother. It should not of happened.
I was admitted for A-FIB a few months back also and three doctors involved had a different scenario as to what happened and how to treat this.
You asked how this can be with doctors having Mother's,wives, sisters? Many (not all) will look/turn away when that extra step may have to be taken. They would rather treat a text book classic than one who is in Fine Print....I often thought if I could use a disguised prominent last name would I get better treatment. "I" believe I would. I pick up the morning paper and often times in the Obits there are faces of pretty, middle aged women and many times: Cause of death, Heart Disease.
My father was 39 when he died suddenly of a suspected heart attack. His brothers never lived past 43. My Aunt was eating in a restaurant and died at the table. She had just been to her PCP the week before complaining of SOB. Doctor told her she would live to 100. Even with a terrible family history of heart disease, this went over the cardio's heads.
You read articles that make perfect sense, well written by "brand names" see yourself in these articles and jot down recommended treatment plan/tests...YET, when you discuss this to your Cardio Group...they balk at it and say the information is not true.
When my Cardio doc balked at some information I gave him about women and heart disease as it fit me to a tee, I asked him to call the female cardiologist at a large heart center to talk to her and I would pay for his call and his time. He refused. One of his office staff said "it was a man thing and she would have to call him"!!! She did not know my case...he did yet he was not willing to help me.
E-mailing this female doctor...she completely understood and felt badly for me.
And, we wonder why women are not receiving the care, treatment for heart disease.
In 2002, I had a Dobutermine Stress Echo for my angina pains. (had to ask for this too) The ECHO doctor at this large center, said everything was good and my pains are Microvascular and cannot be seen on any form of testing and for me to take Valium. I was given a false sense of security thinking if the large vessels are OK...then I will not have a heart attack. WRONG!
Al, I do not know what the answers are for women in getting good heart care. I am stagnant right now as it is so stressful beating a dead horse over and over again.
The big lottery was not won by me )-:. I had bought 5 tickets and if I had won, I was going to set up a Woman's Heart Center, housed with the best doctors around the country. It would be Non Profit and take in those also, that are less fortunate. Everyone deserves a chance to live and breathe the good air and smell the roses again.
Al, here is a virtual hug (((())))) from me. You have been through a lot.
God Bless us.
I was admitted for A-FIB a few months back also and three doctors involved had a different scenario as to what happened and how to treat this.
You asked how this can be with doctors having Mother's,wives, sisters? Many (not all) will look/turn away when that extra step may have to be taken. They would rather treat a text book classic than one who is in Fine Print....I often thought if I could use a disguised prominent last name would I get better treatment. "I" believe I would. I pick up the morning paper and often times in the Obits there are faces of pretty, middle aged women and many times: Cause of death, Heart Disease.
My father was 39 when he died suddenly of a suspected heart attack. His brothers never lived past 43. My Aunt was eating in a restaurant and died at the table. She had just been to her PCP the week before complaining of SOB. Doctor told her she would live to 100. Even with a terrible family history of heart disease, this went over the cardio's heads.
You read articles that make perfect sense, well written by "brand names" see yourself in these articles and jot down recommended treatment plan/tests...YET, when you discuss this to your Cardio Group...they balk at it and say the information is not true.
When my Cardio doc balked at some information I gave him about women and heart disease as it fit me to a tee, I asked him to call the female cardiologist at a large heart center to talk to her and I would pay for his call and his time. He refused. One of his office staff said "it was a man thing and she would have to call him"!!! She did not know my case...he did yet he was not willing to help me.
E-mailing this female doctor...she completely understood and felt badly for me.
And, we wonder why women are not receiving the care, treatment for heart disease.
In 2002, I had a Dobutermine Stress Echo for my angina pains. (had to ask for this too) The ECHO doctor at this large center, said everything was good and my pains are Microvascular and cannot be seen on any form of testing and for me to take Valium. I was given a false sense of security thinking if the large vessels are OK...then I will not have a heart attack. WRONG!
Al, I do not know what the answers are for women in getting good heart care. I am stagnant right now as it is so stressful beating a dead horse over and over again.
The big lottery was not won by me )-:. I had bought 5 tickets and if I had won, I was going to set up a Woman's Heart Center, housed with the best doctors around the country. It would be Non Profit and take in those also, that are less fortunate. Everyone deserves a chance to live and breathe the good air and smell the roses again.
Al, here is a virtual hug (((())))) from me. You have been through a lot.
God Bless us.
What about the 64slice CT scan on picking up microvascular disease in women? My cardiologist did that on me about a month ago because I continue to have atypical, brief though reocccuring chest pain. He said it all looked good. I was under the impression that they can see some of the smaller arteries from that procedure. I am really at a lose as to what to do from here. I have had 3 nuclear stress tests in the last 5 years, 2-3 echocardiogram. My cardio does seem to think I have coronary artery spasms which I am on medication for but I am at a lose as to what else I should do? The nuclear stress tests have been very clear showing no blockages at all and the echos show my heart is structurally normal and functioning well. But this topic greatly concerns me since I still have unexplained pains.
Thanks, Aldente! I've been on my soapbox lately!
Here's the WSJ article that I referred to:
Doctors Focus New Attention
On Heart Disease in Women
Latest Studies Spur Calls
For Better Testing, Treatment;
Exploring the Use of MRIs
By RON WINSLOW
February 14, 2006; Page D1
Recent research into how heart disease differs between the sexes is prompting calls for fresh approaches to improve its detection and treatment in women.
Provocative findings from a decade-long study argue that many women have a form of heart disease that is fundamentally different and harder to diagnose than in men. Thus, problems are often missed early on in women, when prevention and treatment strategies might be more effective in preventing heart attacks, heart failure and other serious consequences of heart disease.
To counter this, researchers say that women and their doctors need to be especially persistent in tracking down the problem when chest pain and other symptoms arise. Doctors also need to pay more attention to symptoms that occur more frequently in women, such as fatigue and shortness of breath. In addition, doctors are looking closely at certain tests, such as magnetic resonance imaging, that aren't commonly used now but could help detect hidden heart disease in women.
The findings are expected to stimulate new research into treatments. Women are more likely than men to report recurrent chest pain after such standard remedies as bypass surgery and balloon angioplasty, partly because those procedures don't always reach areas where disease occurs in women. But drugs such as statins, aspirin or ACE-inhibitors, already standard for high-risk patients, may be helpful for women who have the more-hidden form of disease.
Overall, researchers say, women need to be especially vigilant about strategies that can reducing the risk of heart disease, including staying fit, eating a healthy diet and avoiding or quitting smoking.
The impetus behind these messages is growing recognition that for many women, chest pain and other symptoms arise not from obstructions in the large arteries of the heart, as commonly found in men, but from tiny vessels that branch off those arteries to deliver blood to heart tissue.
As a result, disease in women is often not detectable via standard diagnostic techniques, including treadmill stress tests and angiograms, which use X-ray technology to let doctors watch how blood flows through key arteries. Indeed, based on such tests, doctors often tell women their arteries are clear and their hearts are fine. But, too often, the symptoms persist and women either muddle through or embark on a frustrating series of additional tests, researchers say. When the disease is finally diagnosed, it is often at an advanced stage, when its toll on women can be particularly harsh.
"So often these women who have open arteries [on an angiogram] are told they have no problem," says C. Noel Bairey Merz, a cardiologist and medical director of women's health at Cedars-Sinai Medical Center, Los Angeles. "We need to stop reassuring them."
Dr. Bairey Merz is chairwoman of the Women's Ischemic Syndrome Evaluation, a major study sponsored by the National Institutes of Health to examine gender differences in diagnosis and the role of sex hormones in heart disease. The study, launched in 1996, involved 936 women who were referred for angiograms because of chest pain.
In reports published earlier this month in the Journal of the American College of Cardiology, Dr. Bairey Merz and her colleagues identified a disorder of the small vessels in women, which they called "microvascular dysfunction."
The heart's primary job is to circulate freshly oxygenated blood to the brain and other organs throughout the body. To keep healthy, the muscle that does the work needs some of that blood too, and it is supplied by the coronary arteries. Blockages in those arteries starve the muscle of oxygen, leading to chest pain. Major obstructions in the large vessels often causes a heart attack.
Blockages in much smaller vessels, whether caused by disease or by functional problems in cells lining the vessel walls, similarly deprive heart muscle of oxygen-rich blood and can also cause heart attacks -- though not typically in the classic fashion of plaque that ruptures in a large vessel. Exactly how the obstructions in large and small vessels might lead to different outcomes for women isn't yet understood, researchers say. The main issue for now is that when the disease is hidden from conventional diagnostic techniques and the patients are given a clean bill of health, the problem is likely to get much worse before it gets treated, with more potentially dire consequences.
Estimates based on WISE data suggest that blockages in the tiny vessels that branch off the arteries may be the major culprit in as many as three million women. One likely reason for the gender differences is the impact of the sex hormone estrogen, which may protect women against heart disease in their younger years, but make them particularly vulnerable when levels plummet after menopause.
Researchers do note that some six million women in the U.S. have heart disease based on the conventional diagnosis of obstructions in the large arteries. Moreover, some men also develop disease in smaller vessels. Accurately evaluating chest pain symptoms is often daunting for doctors in both men and women patients.
But many heart experts are calling for more research to make sense of emerging differences. "We need to take this knowledge and create a systematic plan for how to deal with it," says George Sopko, project officer for the study at the NIH's National Heart, Lung and Blood Institute.
Researchers have long reported that women often lack the tell-tale chest pain that typically predicts serious disease in men. In women fatigue, trouble sleeping and shortness of breath may be symptoms of impending heart trouble that doctors miss. In addition, says Dr. Sopko, radiating chest pain that often accompanies the onset of a heart attack in men appears to occur less often in women, who are more likely to feel pain in the shoulder or arm. Women are also less likely to experience a fluttering of the heart, he says.
To detect heart disease in small vessels, doctors have a number of diagnostic tools to explore besides traditional angiogram and treadmill stress tests. Widely available techniques, such as thallium stress tests and stress echocardiograms can help doctors determine whether adequate blood flow is getting to heart tissue in patients whose chest pain persists despite having clear large arteries, Dr. Sopko says.
Researchers are also looking at other approaches that use magnetic resonance technology. One such test, known as phosphorous-31 nuclear spectroscopy, was a strong predictor of women in the WISE study who were likely to develop future heart trouble in women with chest pain but clear arteries on an angiogram. That test isn't routinely used, but is available at some research centers. In addition, WISE researchers are pilot testing a coronary angiography procedure using MR technology instead of X-rays in hopes that will also prove effective in detecting disease hidden from the conventional exam.
The issue of how to treat women with disease in the small vessels is still being explored. Dr. Sopko and other researchers recommend treatment with statins, ACE-inhibitors and aspirin in women with microvascular dysfunction even as they await results from future studies on whether they reduce heart attacks in such patients.
Another hindrance is awareness. Both the NIH and the American Heart Association have launched campaigns in the past couple of years to educate women about heart risks, but a recent study indicates only about half of women know that it is the leading killer of women.
Doctors Focus New Attention
On Heart Disease in Women
Latest Studies Spur Calls
For Better Testing, Treatment;
Exploring the Use of MRIs
By RON WINSLOW
February 14, 2006; Page D1
Recent research into how heart disease differs between the sexes is prompting calls for fresh approaches to improve its detection and treatment in women.
Provocative findings from a decade-long study argue that many women have a form of heart disease that is fundamentally different and harder to diagnose than in men. Thus, problems are often missed early on in women, when prevention and treatment strategies might be more effective in preventing heart attacks, heart failure and other serious consequences of heart disease.
To counter this, researchers say that women and their doctors need to be especially persistent in tracking down the problem when chest pain and other symptoms arise. Doctors also need to pay more attention to symptoms that occur more frequently in women, such as fatigue and shortness of breath. In addition, doctors are looking closely at certain tests, such as magnetic resonance imaging, that aren't commonly used now but could help detect hidden heart disease in women.
The findings are expected to stimulate new research into treatments. Women are more likely than men to report recurrent chest pain after such standard remedies as bypass surgery and balloon angioplasty, partly because those procedures don't always reach areas where disease occurs in women. But drugs such as statins, aspirin or ACE-inhibitors, already standard for high-risk patients, may be helpful for women who have the more-hidden form of disease.
Overall, researchers say, women need to be especially vigilant about strategies that can reducing the risk of heart disease, including staying fit, eating a healthy diet and avoiding or quitting smoking.
The impetus behind these messages is growing recognition that for many women, chest pain and other symptoms arise not from obstructions in the large arteries of the heart, as commonly found in men, but from tiny vessels that branch off those arteries to deliver blood to heart tissue.
As a result, disease in women is often not detectable via standard diagnostic techniques, including treadmill stress tests and angiograms, which use X-ray technology to let doctors watch how blood flows through key arteries. Indeed, based on such tests, doctors often tell women their arteries are clear and their hearts are fine. But, too often, the symptoms persist and women either muddle through or embark on a frustrating series of additional tests, researchers say. When the disease is finally diagnosed, it is often at an advanced stage, when its toll on women can be particularly harsh.
"So often these women who have open arteries [on an angiogram] are told they have no problem," says C. Noel Bairey Merz, a cardiologist and medical director of women's health at Cedars-Sinai Medical Center, Los Angeles. "We need to stop reassuring them."
Dr. Bairey Merz is chairwoman of the Women's Ischemic Syndrome Evaluation, a major study sponsored by the National Institutes of Health to examine gender differences in diagnosis and the role of sex hormones in heart disease. The study, launched in 1996, involved 936 women who were referred for angiograms because of chest pain.
In reports published earlier this month in the Journal of the American College of Cardiology, Dr. Bairey Merz and her colleagues identified a disorder of the small vessels in women, which they called "microvascular dysfunction."
The heart's primary job is to circulate freshly oxygenated blood to the brain and other organs throughout the body. To keep healthy, the muscle that does the work needs some of that blood too, and it is supplied by the coronary arteries. Blockages in those arteries starve the muscle of oxygen, leading to chest pain. Major obstructions in the large vessels often causes a heart attack.
Blockages in much smaller vessels, whether caused by disease or by functional problems in cells lining the vessel walls, similarly deprive heart muscle of oxygen-rich blood and can also cause heart attacks -- though not typically in the classic fashion of plaque that ruptures in a large vessel. Exactly how the obstructions in large and small vessels might lead to different outcomes for women isn't yet understood, researchers say. The main issue for now is that when the disease is hidden from conventional diagnostic techniques and the patients are given a clean bill of health, the problem is likely to get much worse before it gets treated, with more potentially dire consequences.
Estimates based on WISE data suggest that blockages in the tiny vessels that branch off the arteries may be the major culprit in as many as three million women. One likely reason for the gender differences is the impact of the sex hormone estrogen, which may protect women against heart disease in their younger years, but make them particularly vulnerable when levels plummet after menopause.
Researchers do note that some six million women in the U.S. have heart disease based on the conventional diagnosis of obstructions in the large arteries. Moreover, some men also develop disease in smaller vessels. Accurately evaluating chest pain symptoms is often daunting for doctors in both men and women patients.
But many heart experts are calling for more research to make sense of emerging differences. "We need to take this knowledge and create a systematic plan for how to deal with it," says George Sopko, project officer for the study at the NIH's National Heart, Lung and Blood Institute.
Researchers have long reported that women often lack the tell-tale chest pain that typically predicts serious disease in men. In women fatigue, trouble sleeping and shortness of breath may be symptoms of impending heart trouble that doctors miss. In addition, says Dr. Sopko, radiating chest pain that often accompanies the onset of a heart attack in men appears to occur less often in women, who are more likely to feel pain in the shoulder or arm. Women are also less likely to experience a fluttering of the heart, he says.
To detect heart disease in small vessels, doctors have a number of diagnostic tools to explore besides traditional angiogram and treadmill stress tests. Widely available techniques, such as thallium stress tests and stress echocardiograms can help doctors determine whether adequate blood flow is getting to heart tissue in patients whose chest pain persists despite having clear large arteries, Dr. Sopko says.
Researchers are also looking at other approaches that use magnetic resonance technology. One such test, known as phosphorous-31 nuclear spectroscopy, was a strong predictor of women in the WISE study who were likely to develop future heart trouble in women with chest pain but clear arteries on an angiogram. That test isn't routinely used, but is available at some research centers. In addition, WISE researchers are pilot testing a coronary angiography procedure using MR technology instead of X-rays in hopes that will also prove effective in detecting disease hidden from the conventional exam.
The issue of how to treat women with disease in the small vessels is still being explored. Dr. Sopko and other researchers recommend treatment with statins, ACE-inhibitors and aspirin in women with microvascular dysfunction even as they await results from future studies on whether they reduce heart attacks in such patients.
Another hindrance is awareness. Both the NIH and the American Heart Association have launched campaigns in the past couple of years to educate women about heart risks, but a recent study indicates only about half of women know that it is the leading killer of women.
I'm 28, male, 6'0, 240lbs.(so ~40 over), cholest: 200, hdl: 140, ldl:40, BP 140/80, never smoked, sedentary life, a lot of stress, taking Xanax now and then. Small family cardiac history.
5 weeks ago after 19 hours in airplanes, next day I started having shortness of breath mostly in the 2nd half of the day, regardless of doing exercise or not. After a few days I started feeling mild chest pain (3/10), sometimes behind the breastbone, sometimes a little to the left, wasn't going away in 15-30 min., lasted sometimes for hours, most of the time accompanied with shortness of breath. It doesn
5 weeks ago after 19 hours in airplanes, next day I started having shortness of breath mostly in the 2nd half of the day, regardless of doing exercise or not. After a few days I started feeling mild chest pain (3/10), sometimes behind the breastbone, sometimes a little to the left, wasn't going away in 15-30 min., lasted sometimes for hours, most of the time accompanied with shortness of breath. It doesn
I do have coronary artery spasms and am on a calcium channel blocker. I've had all the tests which say I'm fine even the 64slice CT Scan a few weeks ago because of continued chest pain. My cardiologist said everything looked good. He even said that from a cardiac standpoint I was going to live a long time. Then why does the pain still come and scare me? The pain is almost always sharp and stinging and brief but reoccuring often. Does this sound cardiac in nature? I just don't know what it is and when it is freguent I get worried. Like tonight it is sharp and painful not in the center of my chest but a couple inches to the left running vertically a few inches. It is low in my chest and runs underneath the breast area. Could this be angina too? Could I still have microvascular disease and what tests do you do to find out? Even if you have that what do they do to treat it? Any thoughts would be so appreciated.
Thank you so much for sharing your story and insight. You have my sympathy for the lost of your mother. My mom passed away recently at age 60 from cancer.
There is a lot of information in this forum for me to digest. The best I can figure right now is that my pain is probably not heart related - because otherwise, given that I sometimes notice the pain at rest, it would qualify as unstable angina and I really can't believe that I am in an emergency situation. Other than the discomfort, I feel perfectly fine - no shortness of breath or dizziness or anything like that. A couple months ago, I did go to the ER because the pain scared me so much. I agree with the advice that its not such a big deal once you get there - but my husband thought I was nuts when I told him I wanted to go to the ER. Anyway, I wish you all the best. Thanks again for taking the time to respond to my posts.
There is a lot of information in this forum for me to digest. The best I can figure right now is that my pain is probably not heart related - because otherwise, given that I sometimes notice the pain at rest, it would qualify as unstable angina and I really can't believe that I am in an emergency situation. Other than the discomfort, I feel perfectly fine - no shortness of breath or dizziness or anything like that. A couple months ago, I did go to the ER because the pain scared me so much. I agree with the advice that its not such a big deal once you get there - but my husband thought I was nuts when I told him I wanted to go to the ER. Anyway, I wish you all the best. Thanks again for taking the time to respond to my posts.
Thank you so much for your response to my question. I must not have worded my second question clearly. I was trying to determine if I could rule out the possibility that I could have unstable angina by the fact that I can exercise (symptom free) at a HR of 160. In other words, would someone with unstable angina definitely have symptoms during strenous exercise, given that they have symptoms even at rest.
Thank you for your comments. Are the risk factors for microvascular heart disease the same as for CAD? Is the prognosis similar? At 39 years old, do you have any significant risk factors for heart disease? Do you experience angina? I would really appreciate any additional information you could provide. Thanks again.
Andie,
If you can, search the Wall Street Journal on Feb. 14 or the Wash. Post or NYTimes on Feb. 2; they did a comprehensive story on the difficulty in diagnosing female-pattern heart disease.
I'm not suggesting that THAT is what you have. Your symptoms could be related to stress. (Are you under a great deal of stress? Does exercise and breathing help with the chest pain?) BTW, chest pain causes anxiety. Chicken or egg? Hard to say.
It may be worth your while to ask for a thallium stress test. The stress test you had is well-known NOT to help in diagnosing microvascular disease in women. There are other tests, too. I hope the CCF cardio can suggest which tests are better tailored for women.
You may also want to try a trial of nitro, or two weeks of an OTC antacid.
Just my .02. I'm 39 and went through a lot of frustrating tests before being diagnosed and treated for microvascular heart disease. I feel much better today -- exercise, diet and yoga help in addition to standard heart meds.
Best regards,
Carolina
If you can, search the Wall Street Journal on Feb. 14 or the Wash. Post or NYTimes on Feb. 2; they did a comprehensive story on the difficulty in diagnosing female-pattern heart disease.
I'm not suggesting that THAT is what you have. Your symptoms could be related to stress. (Are you under a great deal of stress? Does exercise and breathing help with the chest pain?) BTW, chest pain causes anxiety. Chicken or egg? Hard to say.
It may be worth your while to ask for a thallium stress test. The stress test you had is well-known NOT to help in diagnosing microvascular disease in women. There are other tests, too. I hope the CCF cardio can suggest which tests are better tailored for women.
You may also want to try a trial of nitro, or two weeks of an OTC antacid.
Just my .02. I'm 39 and went through a lot of frustrating tests before being diagnosed and treated for microvascular heart disease. I feel much better today -- exercise, diet and yoga help in addition to standard heart meds.
Best regards,
Carolina
Thank you for your comments. If angina goes away with rest,how is it that you can have an episode hours after you stop exercising. Do you mean that the episode lasts for hours after you exercise or that it begins hours after exercise? Do you have unstable angina? Can a pain that comes and goes all day long for 30 minutes or more at a time be angina? Do you know if angina pain in the jaw feels diferent from muscle tension pain in the neck and jaw - like that which results form stress and very tight shoulder and back muscles. Do you mind if I ask your age? Sorry so many questions, but I'm just trying to figue all of this out and I'm very anxious.
So here is the big question for those of you able to exercise.
Does the angina stay stable, or get slightly worse. I can exercise at 80% or above of my HR for an hour easy, and the pains, never, ever have been worse, 95% of the time better. I've NEVER had tightness when exercising, but DO get center tightness at times when not exercising.
Also, my pains are shooting for 95% of them. The center chest pain has rarely happened, usually under a stressful situation, and it will last for a while. But again NEVER during or after exercise.
I'll get bi-lateral tightness after a long day of talking at work (work a lot of trade shows) and the tighness is upper pectoral in nature.
I"m now leaning towards a GERD/Anxiety combo...
Does the angina stay stable, or get slightly worse. I can exercise at 80% or above of my HR for an hour easy, and the pains, never, ever have been worse, 95% of the time better. I've NEVER had tightness when exercising, but DO get center tightness at times when not exercising.
Also, my pains are shooting for 95% of them. The center chest pain has rarely happened, usually under a stressful situation, and it will last for a while. But again NEVER during or after exercise.
I'll get bi-lateral tightness after a long day of talking at work (work a lot of trade shows) and the tighness is upper pectoral in nature.
I"m now leaning towards a GERD/Anxiety combo...
One more question please: If you experience angina but continue to exercise at a constant intensity, would it definitly get worse or might it eventually go away. Thank you. Also, I forgot to mention that I can't seem to easily reproduce my upper abdominal pain with any kind of body movement.
Hello,
Thanks for posting.
Q#1: Is this particular area a place to feel angina?
I am glad you already saw a cardiologist. Based on the description you provided, it does not sound like angina. You are correct that stable angina will usually cause angina consistently at a certain level of exertion. Based on your history and the absence of significant risk factors, I have a hard time imagining that this is angina.
Question #2: If I had CAD bad enough to feel "angina" at rest (ie when my HR is under 80) would it still be possible to exercise strenuously with a HR of 160 and have no symptoms (like I can do)?
Stable angina typically causes chest pain at the same level of exertion. Unstable angina could cause symptoms like you described. This wouldn't mean you couldn't exercise long term, you would need to stop exercise when the angina is unstable. Unstable angina is a reason for hospitalization.
I hope this answers your questions. Don't give up on the exercise but stay in touch with your doctors if your symptoms continue.
Thanks for posting.
Q#1: Is this particular area a place to feel angina?
I am glad you already saw a cardiologist. Based on the description you provided, it does not sound like angina. You are correct that stable angina will usually cause angina consistently at a certain level of exertion. Based on your history and the absence of significant risk factors, I have a hard time imagining that this is angina.
Question #2: If I had CAD bad enough to feel "angina" at rest (ie when my HR is under 80) would it still be possible to exercise strenuously with a HR of 160 and have no symptoms (like I can do)?
Stable angina typically causes chest pain at the same level of exertion. Unstable angina could cause symptoms like you described. This wouldn't mean you couldn't exercise long term, you would need to stop exercise when the angina is unstable. Unstable angina is a reason for hospitalization.
I hope this answers your questions. Don't give up on the exercise but stay in touch with your doctors if your symptoms continue.
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