Women’s Heart Health

Ms. Levin presents a cogent warning to adult women of all ages to be alert to the many facets of heart disease (“Take It to Heart,” Hamodia Prime, Oct. 24, 2019). A small correction, and a few other points, may be helpful.

First, EEG isn’t a diagnostic tool for hearts; it records brain waves. An ECK (EKG) records the heart’s electrical activity, rhythm, conduction, and the 12 leads pick up on various functional or structural problems. It is the simplest, first test done to assess the heart, typically part of a complete annual physical.

Second, the factors behind microvascular artery disease not only overlap with those of standard coronary artery disease, they also coincide with the damage wrought by diabetes, especially adult onset, Type 2, except that poorly controlled diabetics can also develop microvascular disease in their kidneys, eyes, brain vasculature and lower extremities, too.

Research has yet to explain why [certain forms of heart disease affect] far more women than men, but while men tend to gain excess weight in their girth, a woman’s weight is widespread, including the buildup of deposits in or damage to their small coronary arterioles. Treatment modalities, so far, are the same for both genders, diabetics or not, which encompass sweeping lifestyle changes and a lifelong commitment to healthier living.

Just like most type 2 diabetes, coronary heart disease large or small vessel is (though not exclusively) a disease of excess, including excessive stress.

Asymptomatic healthy women, as men, should routinely request and undergo a baseline cardiac stress test, preferably with imaging, at age 50 or younger if they have a family history of heart disease or if they present at much younger ages with troubling symptoms. Though a fair number of women with abnormal stress tests undergo an unremarkable angiogram (less than 50% blockages), women are far more prone to having single artery disease than men, which requires angioplasty with stenting. Another unusual cause of severe chest discomfort, often experienced as severe heartburn, is coronary artery dissection, which again largely affects women, at younger ages. The inner portion of a coronary artery tears open, creating a “flap” blockage which can cause a heart attack or, worse, a fatality. Emergent treatment in the cardiac catheterization lab will repair the damage and save a life.

Still another problem that affects older women of normal weight, and no history of heart damage, is diastolic heart failure, in which the aging heart muscle of the left ventricle, which pumps out blood to the body with each stroke, stiffens over time, and cannot relax sufficiently to optimally fill with blood, thus reducing the output. Treatment, though not a cure, is usage of certain blood pressure medications.

For younger women presenting with symptoms suggestive of coronary artery disease, who undergo a thorough heart work up with multiple imaging tests that may not provide satisfactory answers, there is also a valuable screening questionnaire called the Duke Activity Status Index (DASI), with weighted questions that yield information on what (and why) routine daily activities bring on fatigue and/or shortness of breath in otherwise healthy women. Anemia, and depression, can also cause troubling symptoms. Younger women, overweight or not, may benefit from women-focused cardiology practices and teaching hospitals to get the answers they deserve to live healthier, productive lives.

Yocheved Lieberman, Chicago, former RN/cardiac nurse

The author replies.

Thank you for expanding on the issue of women and coronary artery disease. The biggest challenge for any health writer is the need to narrow down what is an enormous corpus of data into the permitted word count. Given that reality, we are forced to leave out information, relying on doctors to fill in as needed. Perhaps it is best to leave off with a friendly warning to all — all articles published in this domain contain critical, but a limited amount of, information. Always ask a professional regarding your particular situation.

Thank you and hatzlachah rabbah.