Tailored heart care to meet women’s unique conditions
Heart disease is the leading cause of death for American women, and yet, according to the National Institute of Health, one of the world’s foremost research centers, studies show that cardiovascular care for women is suboptimal when compared to men with similar conditions. Why? Women are less likely to receive cardiovascular therapies recommended by national guidelines, even though awareness of cardiovascular disease in women has increased.
The reasons for this disparity include:
- Differences in male and female physiology. Women have smaller hearts and narrower blood vessels yet are often underrepresented or excluded in research studies.
- Differences in symptoms in men and women. Women’s symptoms present differently from men and therefore, may be overlooked or misdiagnosed.
- Differences in testing for obstructive versus non-obstructive coronary artery disease. Women often require specialized or additional testing as their underlying causes of heart disease often differ from men.
At MemorialCare, we aim to improve outcomes for women by addressing the unmet needs of women’s cardiovascular health. Our Women’s Heart Center, part of our esteemed MemorialCare Heart & Vascular Institute, is dedicated to providing expertise in education, prevention, early diagnosis, specialized testing services, and timely management of women-specific cardiac presentations throughout their lifespan, from age 18 and above.
For more information or to make an appointment, call (657) 241-9051.
Meet the team
Under the leadership of Dr. Nissi Suppogu, a women’s heart health and disease specialist, the Women’s Heart Center addresses the unique gender differences in presentation and diagnosis of heart disease in women. In addition to her training in general cardiology, Dr. Suppogu is fellowship-trained in women’s heart health and disease, which involved two years of specialized training at the Women’s Heart Center at Cedar Sinai. She is an expert at assessing risk factors and diagnosing heart disease specific to women, providing appropriate treatment and preventing delays, thereby improving their outcomes.
What are the unique characteristics of heart disease in women that differ from men?
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.
What are the types of conditions that can affect a woman’s heart health?
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:
- 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.
How does one treat microvascular disease?
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.
Are there specific symptoms that women should be looking for?
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
What are the known risk factors for women’s heart disease?
The risk factors for heart disease are the same for both men and women, with a few exceptions.
- High blood pressure
- 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
What types of testing does the Women’s Heart Center offer?
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)
When should one seek help from the Women’s Heart Center?
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.
Locations & Appointments
Appointments with the Women's Heart Center team, as well as non-invasive testing will be conducted at MemorialCare Medical Group - Long Beach (Douglas Park), Suite 200, near the Long Beach Airport. Invasive testing will be done in the state-of-the-art catheterization laboratory at MemorialCare Long Beach Medical Center. For more information or to make an appointment, call (657) 241-9051.