Could You Have Hidden Heart Disease?

Farzan Filsoufi, MD, Advises Women to Beware

New research shows that many women have undiagnosed heart disease even after getting tested for it—three million women in the United States have a hard-to-spot form of heart disease called coronary microvascular dysfunction (MVD) that isn't detected by standard diagnostic tests.

Dr. Farzan Filsoufi, leading cardiothoracic surgeon at Mount Sinai Medical Center advises, "Women who have an angiogram (which is designed to pick up blockages in large arteries) is likely to show their arteries to be normal. If you receive a 'normal' angiogram but still have other heart symptoms, ask your doctor whether you might have a problem with your small arteries and request a functional vascular imaging test."

Studies have shown that women are more likely than men to have coronary MVD and autopsy studies support this approach. They show that women who die of heart attacks often have pathology different from that of men. In women, plaque is more likely to be deposited uniformly around the inside of the small vessels – the possible result of chronic inflammation. In men, plaque tends to build up in isolated accumulations.    

Many researchers think the inflammation associated with MVD heart disease is caused by a drop in estrogen levels.  Estrogen may decrease inflammation, so when too little is available, the risk of heart disease may rise, especially in premenopausal or menopausal women.

Heart disease is the leading cause of death worldwide. According to the American Heart Association, almost two-thirds of women who die suddenly of coronary heart disease had no previous symptoms.

Women need to know that certain seemingly unrelated symptoms – unexplained fatigue, depression, shortness of breath – could be preludes to a serious cardiac event. 

Dr. Filsoufi strongly advises, "Even if you're not sure you're having a heart attack, act quickly—call 911 immediately. Hospitals have clot-busting medicines and other artery-opening procedures that can stop a heart attack.  These treatments work best when given within the first hour after a heart attack starts."