Cardiovascular disease looks different in women than men


Dear Doctors: I’m a 38-year-old woman in good health. I kept getting a tight chest while running, so my doctor did some tests. He said my heart looked fine. But when I went for a second opinion, I was diagnosed with microvascular disease. I’ve never even heard of that before. What is it?

Dear Reader: You’ve introduced a topic of great importance to women of all ages: the fact that cardiovascular disease often takes a different form -- and comes with different symptoms -- in women than in men.

An example is coronary microvascular disease, which is the diagnosis you have received. Also referred to as small vessel disease, it occurs more frequently in women than in men. It’s also often seen in women in their 40s, and even 30s -- younger than is typically associated with heart disease.

The depiction of heart attacks in film and on TV, sometimes referred to as a “Hollywood heart attack,” are marked numbness in the left arm and sudden and severe chest pain. This occurs due to plaque formation, which partially or completely blocks blood flow in the large coronary arteries that wrap around the heart. But coronary microvascular disease, or MVD, involves the network of much smaller vessels that branch off from the larger arteries and reach deep into the tissues of the heart. This leads to a different array of symptoms.

When the walls and inner lining of these vessels become damaged, blood flow to the heart muscle is reduced. This causes a symptom known as angina. It can include the sensation of chest tightness that sent you to your doctor, as well as chest pain. It can also cause discomfort or pain in shoulders, back or jaw. Additional signs of MVD can include shortness of breath and unexplained fatigue, which can occur during exercise or at rest. People with MVD also often have poor sleep. While the causes of MVD are not yet understood, newer research points to systemic inflammation as a factor. High blood pressure, as well as periods of low estrogen levels, are also believed to be risk factors.

The role of blockage to the coronary arteries in heart disease has been suspected for centuries. With the advent of electrocardiography machines in the 1920s, it gradually became established fact. But awareness of MVD is far more recent. Standard tests can fail to identify this type of heart disease. Instead, newer technologies, such as MRIs and PET scans, are required.

Elizabeth Ko, MD and Eve Glazier, MD
When it comes to treatment, the approach is evolving. Nitroglycerin may be used to manage chest pain. Cholesterol and blood pressure medications are prescribed as needed. Antiplatelet medications help to lower the risk of blood clots. Beta blockers may be used to manage abnormal heart rhythms and generally reduce stress of the heart and coronary vessels.

Up to 75% of patients with coronary microvascular disease are women. However, it is now increasingly being recognized in men, as well. With heart disease the leading cause of death in the U.S. -- more than all types of cancer combined -- it is important for all of us to eat a healthful diet, avoid tobacco and get regular exercise.

(Send your questions to [email protected], or write: Ask the Doctors, c/o UCLA Health Sciences Media Relations, 10960 Wilshire Blvd., Suite 1955, Los Angeles, CA, 90024. Owing to the volume of mail, personal replies cannot be provided.)