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Heart Health

For Women, Improving Accuracy of Heart Disease Diagnosis

Diagnosing coronary heart disease in women has become more accurate through gender-specific research that clarifies the role of both obstructive and non-obstructive coronary artery disease as contributors to ischemic heart disease in females, according to a statement published in June 2014 in the American Heart Association journal Circulation.

A release from the associations quotes lead author Jennifer H. Mieres, M.D. as saying, “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. As a result, symptomatic women who did not have classic obstructive coronary disease were not diagnosed with ischemic heart disease, and did not receive appropriate treatment, thereby increasing their risk for heart attack.”

Ischemic heart disease, also known as coronary heart disease, occurs because of a decreased blood flow to the heart muscle, most often due to coronary atherosclerosis from the buildup of plaque in the coronary arteries. This plaque can result in obstructions in the arteries, which diminishes blood flow to the heart muscle, reduces the heart’s oxygen supply, and damages the heart muscle – resulting in heart attack and a decrease in the heart’s pumping ability.

Non-obstructive coronary artery disease and coronary microvascular disease, which is more common in women, occur because of damage to small arteries or the inner lining of the main arteries leading to the heart, which can cause them to spasm, blocking blood flow. Some women may have both coronary microvascular disease and plaque build-up in the small arteries,

In the past, there was a lack of recognition of the importance of non-obstructive coronary disease in women, leading to diagnoses of “false positive” stress tests and a lack of appropriate treatment. However, new research indicates that women with non-obstructive coronary artery disease and abnormal stress tests are in fact at an elevated risk of heart attack.

Women also experience a broader range of ischemic heart disease symptoms than men, and have a different pattern and distribution of pain symptoms, often not located in the chest. Additionally, women’s symptoms are frequently associated with mental or emotional stress, and are less likely to result from physical exertion compared to men.

The statement is intended for women who have the symptoms of ischemic heart disease, including the classic symptoms of left sided chest pain/pressure, jaw pain, upper back pain, widespread “indigestion,” and other symptoms not localized to the chest.

Recommendation highlights include:

*Women with suspected ischemic heart disease should discuss the benefits and risks of diagnostic tests with their healthcare provider – for example, a woman of child-bearing age may want to avoid tests that require exposure to radiation.

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