Women’s Heart Center

Traditionally, when patients tell their physicians they are experiencing chest pains or other heart-related symptoms, they will be tested for obstructive coronary artery disease. Tests such as a coronary angiogram, which uses X-ray imaging to see the heart’s blood vessels, look for conditions such as plaque build-up in the large coronary arteries that obstruct blood flow (atherosclerosis). Although women also develop atherosclerosis, obstructive coronary disease is more common for men and often appears to develop in men at an earlier age.

The issue is that a significant number of women tested with traditional methods do not show blockage in the large coronary arteries. Instead, their heart condition is more likely due to non-obstructive coronary artery disease such as microvascular dysfunction. This is when the smallest blood vessels – sometimes no larger than a strand of hair – are damaged, causing them to not dilate or increase the blood flow or cause spasms that can interrupt blood flow to the heart tissue.

Diagnosing microvascular disease requires additional testing that is not always standard, but at MemorialCare’s Women’s Heart Center, we specialize in providing much-needed, non-traditional cardiovascular testing to address women-specific heart issues.

The following are some of the top conditions that affect women’s heart health, and that the Women’s Heart Center specializes in.

• Microvascular dysfunction is a serious, yet under-recognized, type of heart disease that affects the smallest blood vessels, which branch off the coronary arteries, known as the microvasculature, and supply the heart with oxygenated blood. While the larger coronary arteries appear clear of obstructive plaque and allow the blood to pass through, these smaller vessels constrict blood flow, causing chest pains and other symptoms. If left untreated, it may lead to atherosclerosis, heart failure, heart attack, or stroke and poor quality of life.
• Microvascular dysfunction can involve various pathways and more specifically, it is endothelial dependent or non-endothelial dependent pathway.
• Vasospasms are the narrowing of the arteries. It is caused by spasms of the artery leading to the narrowing or contraction of the artery walls. Persistent contraction of the blood vessels is called vasoconstriction. Microvascular spasm is not as evident and requires special diagnostic testing.
• Cardio-obstetrics is a medical specialty that focuses on the diagnosis and management of cardiovascular complications that can occur during and as a result of pregnancy, such as:
  • Preeclampsia
  • Preterm Delivery
  • Spontaneous coronary artery dissection
  • Hypertensive disorders of pregnancy
  • Gestational diabetes
  • Pre-pregnancy cardiology issues
• Autoimmune diseases, such as rheumatoid arthritis and lupus, which are more common in women than men can cause chronic inflammation which can increase cardiovascular disease.
• Cardio-oncology is a medical specialty that focuses on the diagnosis and management of cardiovascular diseases caused by cancer therapies, such as radiation and chemotherapy, as an immediate effect or long-term complication. For example, if a woman is treated for breast cancer using certain, often older, radiation techniques, her risk of developing radiation-induced heart disease increases. 
• Depression and anxiety, which are twice as common in women than men, can also increase heart disease in women.

Treatment plans for microvascular disease are similar to ischemic or obstructive heart disease treatments but tailored to the individual patient based on the microvascular pathway involved. They include targeted medical therapy similar to ischemic or obstructive heart disease and tailored to individual pathways and patient's response. However, all patients with microvascular disease and obstructive disease are encouraged to have lifestyle modifications in the form of diet and exercise.

Heart disease, which can affect women of all ages, can present itself differently in men and women, making it crucial that women learn the symptoms that are more likely to occur in their gender to better advocate for their care.

While we have all come to identify crushing chest pains with heart disease, not all women experience those. Often, they are more likely to have symptoms unrelated to chest pains or their chest pain may be more of a feeling of pressure or discomfort. As a result, a woman with heart disease may be misdiagnosed with conditions such as gastrointestinal problems or anxiety.

While chest pains are still a common symptom, a woman is more likely to experience the following in addition to chest pain or separately:

• Extreme Fatigue
• Shortness of breath
• Nausea or vomiting
• Lightheadedness or dizziness
• Jaw, neck, or upper back pain
• Numbness in left arm
• Racing heart
• Cold sweats
• Heartburn

The risk factors for heart disease are the same for both men and women, with a few exceptions.

• High blood pressure
• Hypertension
• Diabetes
• Obesity
• Smoking
• High cholesterol
• Sedentary lifestyle
• Family history

Additional risk factors specific to women:

• Issues related to pregnancy
• Issues related to menopause
• Autoimmune diseases
• Prior cancer treatments
• Stress and Depression

While the Women’s Heart Center offers all traditional cardiac testing for ischemic heart disease – both invasive and non-invasive – it also includes testing specific to women’s heart issues, differentiating it from most other programs. To ensure a precise diagnosis, this includes the gold standard in invasive procedures, coronary function testing for microvascular disease and testing for vasospasm.

• Coronary functional testing (CFT) is an invasive test used to gain a comprehensive evaluation of coronary microcirculation. The testing begins with a coronary angiography, where dye is injected into the arteries to determine if there is any blockage. If no blockage is found, the microvasculature (system of capillaries, arterioles, and venules) is examined for dysfunction.
• CFT for microvascular vasospasm
• Stress and rest cardiac MRI
• Nuclear cardiac stress test (PET scan)

The Women's Heart Center is dedicated to providing quality cardiovascular care to all women aged 18 and older, from pre-conception planning and care during pregnancy to early menopause and beyond.

We encourage women in the community to seek care at the Center for chest pain and related symptoms, or even for a second opinion. It's important for women to pay attention to their bodies. If they continue to experience symptoms such as chest pain, chest pressure, chest tightness along with dizziness, fatigue, shortness of breath, chest pain radiating to the back, throat, or left arm – whether associated with activity or not – they should seek evaluation.

This is especially true if they were told they had a heart attack, but no blockages were found in their blood vessels; they feel they haven't received an accurate diagnosis in the past; they have been having recurrent symptoms with no improvement and the need to go to the ER for the similar chest pain complaints with no additional testing; or they have had a change in treatment plan. Under these circumstances, one must consider a second opinion or seek a women’s heart health specialist.