Nieca Goldberg, MD, a cardiologist and nationally recognized pioneer in women’s heart health. Her New York City practice, Total Heart Care, focuses primarily on caring for women. Dr. Goldberg is clinical associate professor of medicine and medical director of the New York University Women’s Heart Program. She is the author of The Women’s Healthy Heart Program and Dr. Nieca Goldberg’s Complete Guide to Women’s Health (both from Ballantine). She is a member of the Bottom Line/Women’s Health advisory board.
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Heart disease can sound so ominous that many women assume they have nothing to worry about if they are not suffering obvious symptoms, such as chest pain or shortness of breath. That’s not so.
Although men who have heart disease typically develop symptoms in their 40s or 50s, women usually don’t experience symptoms until their 60s — about 10 years after menopause. But that does not mean that women’s hearts are necessarily safe when they are younger.
What most women don’t realize: Arteries can clog little by little, perhaps even starting in adolescence. That’s why it’s so important to start early to prevent heart disease.
Diagnosis Dilemmas
Part of the problem in diagnosing heart disease in women is that its symptoms can be vague — fatigue, shortness of breath during exertion, anxiety, light-headedness. It’s common for a woman to go from doctor to doctor but hear repeatedly that the problem is “just nerves,” ordinary fatigue or stress.
If you experience any of the symptoms above, make an appointment with your doctor and insist on being evaluated for heart disease.
There is no single test for heart disease. Among the many possible diagnostic tools are tests for blood pressure, cholesterol levels, heart rhythm, heart muscle function and blood vessel problems. Some work well for women — and some do not. What you must know…
Electrocardiogram (ECG). This test gives a graphic record of the heart’s electrical impulses and is commonly used to see if the heart is damaged. It is quick, painless and noninvasive. However, even when a woman does have heart disease, her ECG may appear normal.
Exercise ECG (stress test). Sometimes the earliest signs of heart disease are evident only when a person is active. This type of ECG can detect clogged arteries by measuring heart function and blood pressure while you walk on a treadmill.
Sometimes this test is unreliable in women, so you may be sent for a nuclear exercise electrocardiogram (in which a radioactive substance is injected during exercise) to confirm the result. This test is more accurate than a regular stress test but may give false-positive results in large-breasted women. Another concern: Even after a positive stress test, doctors are less likely to send women for more testing.
Angiogram. This test is typically used in people who have abnormal stress test results. A dye is injected into the arteries and an X-ray is taken, allowing the doctor to see the degree of arterial blockage caused by buildup of cholesterol.
However, women with heart disease can have “normal” angiogram results. That’s because a woman’s cholesterol plaque tends to be more evenly distributed throughout the arteries than a man’s is. When this occurs, arteries can be stiffened and diseased by excess cholesterol, but the test may not show it. In addition, women are more likely to have disease in the tiny arteries of the heart — a condition that is difficult to detect.
If you have symptoms of heart disease but previous tests are inconclusive, consider requesting a newer test called computed tomography (CT) coronary angiography. It creates 3-D images of blockages in the arteries. Unfortunately, the test is not typically covered by health insurance and costs approximately $2,000.
BEST TREATMENTS
If you have heart disease, your prognosis largely depends on how quickly and effectively you are treated. Options include…
Medication. A variety of drugs — such as beta-blockers, calcium channel blockers, nitroglycerin preparations, aspirin and cholesterol-lowering statins — may be prescribed either individually or in combination to help control heart disease.
Problem: Most studies on heart disease medication have been conducted on men, not women — so there is little accurate information about the drugs’ effects on women. For instance, despite generally being smaller in size, women often are given the same dosages as men — increasing women’s risk for side effects, such as insomnia and depression.
Solution: To minimize risk for side effects, ask your doctor to start with the lowest effective dose and then increase the dose only as needed.
Surgery. Common surgical procedures for heart disease include…
Angioplasty, in which a deflated balloon is inserted into a blocked artery and expanded, pushing the blockage aside.
Stenting, in which a small mesh tube is inserted to hold the artery open.
Coronary bypass surgery, in which disease-free arteries from your leg or elsewhere in the body are used to “bypass” blocked heart arteries.
Problems: Women who undergo bypass surgery have a higher risk for stroke during and after surgery than men — in part because they may be more likely to have untreated high blood pressure or diabetes. After heart surgery, women also are more likely to experience postsurgical internal bleeding and/or continue having heart disease symptoms.
Strategy: These problems should not prevent you from getting one of these procedures if it is needed. Afterward, however, your doctor should monitor you with extra care.
Self-defense: If you have heart disease, it is best to be treated by a cardiologist. To find one near you, contact the American Medical Association (800-621-8335, www.ama-assn.org).
