The Low-Down On The Diagnosis And Therapy Of Coronary Heart Disease In Women
By Ng Peng Hock
It is not easy to diagnose CHD in women who develop chest pain more often than men. The chances for these chest pains to progress to heart attack are rare. In one study, half of the women undergoing coronary angiography did not have significant heart artery blockage. But, women with classical angina symptoms had a 71 percent probability of having diseased coronary arteries. Nearly 90 percent of women suffering from heart attack had chest pains as the initial clinical presentation. This is similar to what men have experienced. Nevertheless, females are more likely to exhibit symptoms such as breathlessness, fatigue, nausea, or upper abdominal pain.
Diagnosis of CHD among women has often been a challenging task for doctors. Resting electrocardiogram (ECG) frequently shows non-specific abnormalities in women, regardless of whether there is underlying CHD. The conventional treadmill stress test also does not help much as a diagnosing tool for women. Non-invasive tests such as myocardial perfusion stress imaging and stress echocardiography may improve the sensitivity and specificity over the treadmill stress tests in the female population.
Several reports have documented that women with CHD have a worse outcome than their male counterparts. Compared to males, females have higher chance of complications after heart attack. This could be explained by:
- Older age of female CHD patients, usually 10 years older than male CHD patients.
- Increased likelihood of co-morbid conditions such as high blood pressure, diabetes, and heart failure.
- Differences in the size of the coronary arteries between men and women.
- A greater likelihood of urgent surgical or interventional procedures in women.
- Less aggressive approach generally adopted by doctors.
- Lower likelihood of referral for cardiac rehabilitation after a cardiac event
Pharmacological therapy using ACE inhibitors, aspirin, beta-blockers, nitrates and cholesterol-lowering drugs has been effective in both men and women.
A 1987 study showed that men were 6.3 times more likely than women to be referred to coronary angiography when their non-invasive tests were abnormal. Heart procedures such as PTCA (Percutaneous Transluminal Coronary Angiography) and bypass surgery were 15 to 27 percent more commonly carried out in men than in women with the diagnosis of CHD.
Complications during PTCA were higher for female patients. A slightly worse operative mortality was also associated with surgical treatment for women. After the heart bypass surgery, women have a lower likelihood of being free of angina than men do. Female CHD patients also experience greater disability and less return to work than the male patients. The rate of long-term survival and re-operation, however, are similar.
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