Eva woke up in the Coronary Care Unit of her city's teaching hospital. Surrounded by a team of resident-physicians and an attending cardiologist, she was the topic of that morning's rounds. She presented "atypical" heart attack profile on admission - crushing chest pains without blocked coronary artery(ies). Fortunately, the new facility has an intravascular ultrasound (IVUS) imaging equipment. It showed plaques throughout her entire left coronary artery. They said, she has "female pattern" coronary artery disease.
In 2006, Johnson and his colleagues published the results of their study on 673 women with persistent chest pains for at least one year. The investigation was undertaken because health care practitioners believed that chest pains without coronary artery disease are a low risk for cardiovascular events. This study showed that among those without coronary artery disease, women who had persistent chest pains had twice the risk for non-fatal myocardial infarction (heart attack), cerebrovascular accident (stroke), congestive heart failure (a condition in which the quantity of blood pumped by the heart is insufficient to meet the body's normal requirements for oxygen and nutrients), and cardiovascular deaths compared to women without chest pains.
Their research was published in the 2006 issue of the European Heart Journal.
Different Clinical Manifestation of Coronary Artery Disease between Men and Women
Atherosclerosis (hardening of the arteries due to the deposition of plaque(s) in the innermost lining of the arteries) develops differently in men and women. In women, plaques are spread/diffused throughout the entire length of the artery(ies) rather than being "lumped" or "localized" in one spot like the ones seen mostly in men.
Under IVUS imaging, flattened plaques can be seen throughout the narrower, but normal looking coronary arteries. The problem is even though these deposits are flat, they can still rupture, get dislodged, travel, block an artery and cause a heart attack. According to leading cardiologists, women with abnormal coronary arteries due to endothelial dysfunction suffer more cardiovascular episodes.
Treatment
Because the plaque is spread throughout the coronary artery, procedures aimed at relieving localized blockages such as angioplasty, stents, and bypass surgery are not useful. Intervention must be made with the use of prescription drugs such as anticoagulants (to reduce the risk of blood clotting), ACE inhibitors and Beta blockers (to protect the heart muscle). A healthier lifestyle: abstinence from smoking, healthy diet, stress management, moderate regular physical activity rounds the list of strategies aimed at improving cardivascular function.
Persistent chest pains, without the overt symptoms of coronary artery disease (blocked artery) may not be a "benign" condition. If this is happening to you, it's best to consult your primary care physician. Note: The information in this article is presented as an educational tool only. Always consult your physician or qualified primary health care giver.
References
Fogoros RN "Female Pattern" Coronary Artery Disease May 9, 2005
Midwall S et al. "In Women without Obstructive Coronary Artery Disease, Endothelial-Dependent and Non-Endothelial Dependent Coronary Reactivity Dysfuntion or Associated with Different Types of Adverse Outcomes. The NHLBI Women's Ischemia Syndrome Evaluation (WISE)" The American Heart Association Scienfitic Sessions 2007, Abstract 2870
C Bairey Merz et al. "A Randonmized Controlled Trial of Low Dose Hormone Therapy on Myocardial Ischemia in Postmenopausal Women with no Obstructive Coronary Artery Disease: Results from the NHLBI sponsored WISE" The American Heart Association Scientific Sessions 2007 Abstract 2450
Johnson BD et al. "Persistent chest pain predicts cardiovascular events in women without obstructive coronary artery disease:results from the NIH-NHLBI sponsored Women's Ischemia SyndromeEvaluation (WISE) study" European Heart Journal 2006;27:1408-1415
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