Coronary Microvascular Disease: A Woman’s Issue
Heart disease remains the number one killer of women and men in the U.S., but there are important differences in the types of coronary problems that affect each gender. Women are more likely than men to have heart disease in the network of small arteries of the heart, which is referred to as coronary microvascular disease (MVD),
MVD can be a challenge to diagnose and treat, but awareness of the condition is growing. Earler this year, the American Heart Association updated its guidelines for diagnosing women with sus-pected ischemic heart disease. (“Ischemic” refers to reduced blood flow to the heart.) Part of the guidelines emphasized the testing options best suited to diagnose MVD.
Awareness is key
Holly Anderson, MD, a cardiologist with Weill Cornell Medical Center, says that developing better diagnostic tools and alerting more physicians and patients to the nature of MVD is critical. It’s not uncommon for a woman experiencing angina (chest pain due to ischemia) and other symptoms to undergo standard testing, only to find no blockage in the major coronary arteries.
“Microvascular disease is more difficult to diagnose because we cannot see it as easily,” Dr. Andersen explains. “Women with angina and even heart attacks can undergo cardiac catheterization (angiograms), and their large arteries are normal. We used to scratch our heads. Now we understand that their disease is likely to be in the smaller arteries, which can get blocked with the same plaque that can block the large arteries.”
WHAT YOU CAN DO
If you suspect coronary MVD:
➤ Explain your symptoms in detail to your doctor; get a second opinion if you feel your condition isn’t being properly diagnosed.
➤ Learn the warning signs of a heart attack. In addition to chest pain, symptoms may include pain or discomfort in the arms, back, neck, jaw or stomach, a cold sweat, nausea, lightheadedness, and shortness of breath.
➤ If you have anemia (low red blood cell count), make sure you treat it; anemia may slow the growth of cells that help repair artery walls.
What is MVD?
In addition to arterial blockage, coronary MVD also can mean that the walls of the heart’s tiny arteries are injured or diseased. The small arteries can spasm and reduce blood flow to the heart muscle, resulting in ischemic heart disease.
“A woman’s heart is different from a man’s,” Dr. Andersen says. “It is smaller. The arteries supplying the heart are smaller, but are generally anatomically lo-cated in the same place. We don’t know exactly why women are more likely to have disease in the smaller arteries of the heart, but we know it occurs.”
She adds that the same risk factors that lead to coronary heart disease (CHD) also increase your odds of developing MVD. These include unhealthy cholesterol levels, high blood pressure, obesity, and smoking. Dr. Andersen also notes that diabetes may be an especially strong MVD risk factor for women.
Diagnostic tests
Among the early symptoms of MVD are episodes of angina that last more than 10 minutes. Some may last longer than 30 minutes. Other signs include shortness of breath, fatigue, and difficulty sleeping.
If you visit your doctor with these symptoms, a variety of tests may be ordered to help diagnose your condition:
▶ Coronary angiography: A special dye is injected, and X-rays reveal the interior of the larger coronary arteries.
▶ Stress test: This test measures the flow of blood in the heart during exertion. If coronary angiography doesn’t show blockage in the large coronary arteries, a stress test still may reveal reduced blood flow.
▶ Cardiac magnetic resonance imaging stress test: Radio waves are used to create a picture of the heart before and after the patient is given a medication that opens the coronary arteries.
▶ Nuclear heart scan: The test uses a radioactive “tracer” that is injected into the bloodstream. Cameras outside the body detect energy released by the tracer and create a detailed image of the heart and blood flow through the arter-ies.
Treating MVD
Once a diagnosis is made, treatment for MVD usually involves medications and lifestyle changes, Dr. Andersen says. Unlike CHD, MVD usually is not treatable with stents or bypass surgery.
To lower their risks, MVD patients are advised to manage blood pressure, cholesterol, and blood glucose levels, prevent blood clotting (through the use of blood thinners), and control and improve function of the endothelium (the lining of the arteries). Strategies that can help include smoking cessation, regular exercise, a diet rich in plant foods and low in processed foods, sodium, saturated and trans fats, and added sugars, and weight loss in obese individuals.
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