Coronary Artery Disease in Women

What is coronary artery disease?

Coronary artery disease is also called CAD. It is when the arteries in your heart narrow or become blocked. CAD may cause angina (chest pain), a heart attack, or congestive heart failure. CAD is a leading cause of death in women in the United States.

What are the causes of coronary artery disease?

CAD is caused by cholesterol (fatty deposits) and cells that cause inflammation. These collect inside your artery walls (blood vessels) and cause plaque to form. Oxygen cannot get to your heart muscle when your arteries get narrow or blocked. When a part of your heart muscle does not get oxygen, you may have chest discomfort or pain. The discomfort or pain causes you to slow down or stop what you are doing. When the blood begins flowing through the artery again, the discomfort and pain go away.

CAD is more common in women after menopause (permanent absence of monthly period). Risk factors for CAD include smoking, high blood pressure, high cholesterol, and diabetes. Eating unhealthy food, being overweight, and having a family history of heart disease may also increase your risk. Depression, anxiety, or not being physically active may also increase the risk of having CAD.

What are the signs and symptoms of coronary artery disease?

In women, symptoms of CAD may not be obvious. You may not have any symptoms of CAD until the artery blockage gets very narrow. When this happens, you may feel tired or weak, or have nausea (upset stomach) or vomiting (throwing up). You may also have back or shoulder discomfort or pain.

Abdominal (stomach) pain or discomfort in the jaw, teeth, neck, or arms are other symptoms of CAD. You may have a feeling that something bad is going to happen. Chest pressure, discomfort, or pain (called angina) may be present. You may have stable or unstable angina.

Stable angina:

The most common symptom of stable angina is chest pain. The pain may start below the sternum (breast bone). It may feel crushing, tight, or heavy. It may move to the neck, jaw, shoulders, back, or inner arms. You may have pain under the sternum that feels like indigestion (burning). The pain often starts slowly and may only last a few minutes.

Stable angina may be triggered by cold air or getting upset. Physical activity like walking or shoveling snow may also cause pain. Angina may feel different to each person. Rest or medicine usually makes stable angina go away.

Unstable angina:

Unstable angina is chest pain that happens more often or with less activity than it had in the past. Unstable angina may start while you are resting or exercising. Rest may not relieve the pain. Unstable angina should not be ignored, as it may place you at a higher risk of having a heart attack.

How is coronary artery disease different for women than for men?

Women with CAD are less likely to have chest pain than men. They may also be older than men when they first have symptoms. Women with signs and symptoms of possible CAD may wait longer to see their caregiver. It is sometimes harder for caregivers to diagnose CAD in women than in men.

For some women, treatment may be delayed and some tests may not be offered. Women are not always offered treatment that may help them live longer, such as medicine and cardiac rehabilitation. Women may also receive less information and advice than men from caregivers about heart disease and how to prevent it.

How is coronary artery disease diagnosed in women?

You may need to go into the hospital for tests and treatment. Caregivers may do tests to learn if the arteries in your heart are partly or completely blocked. Following are tests that may be done for both men and women who have signs and symptoms of coronary artery disease. Women should ask their caregivers about these tests.

12-lead ECG:

This test, also called an EKG, helps caregivers look for damage or problems in different areas of the heart. Caregivers may need to prepare your skin by shaving off some hair, or cleaning it with a gritty lotion. Sticky pads are placed on your chest, arms, and legs. Each sticky pad has a wire that is hooked to a machine or TV-type screen. A short period of electrical activity in your heart muscle is recorded. Caregivers will look closely for certain problems or changes in how your heart is working. This test takes about 5 to 10 minutes. It is important that you lie as still as possible during the test. You may need this test more than once.

Echocardiogram:

This test is also called an echo. It is a type of ultrasound, using sound waves to show pictures of the size and shape of your heart. An echo also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen.

This test is done while lying down on your back. Clear jelly will be squirted on your chest to help the ultrasound sensor slide easily. The sensor will be rubbed across your chest to see your heart from different angles. You may hear a barking or whooshing noise, which is the sound of your blood flow. Caregivers may ask you to pedal a bike during the test (exercise echo) or you may get medicine before the test to increase blood flow to your heart muscle (stress echo). This test can tell how well your heart is pumping. An echo can also find problems, such as fluid around the heart or problems with your heart valves.

Exercise stress test:

This test helps caregivers see the changes that take place in your heart during exercise. It checks for blockages in the arteries of your heart. An EKG is done while you ride an exercise bike or walk on a treadmill. Caregivers will ask you how you are feeling during the test. They want to know if you have chest pain or trouble breathing.

Exercise stress test with imaging:

A stress test may be combined with an echocardiogram or nuclear isotope imaging. These give caregivers extra information about possible blockages in the heart arteries.

Stress test with medicine:

If you cannot walk or exercise, you may be given medicine that causes your heart to work harder. You will be hooked to the stress test machine. The medication stresses the heart and is combined with either echocardiogram or nuclear isotope imaging.

How is coronary artery disease treated?

You may need to take heart medicine, lose weight, make diet changes, and begin exercising. If these changes do not help or if the stress tests show the arteries in your heart are badly blocked, you may need a procedure to look at the coronary arteries. A procedure called a cardiac catheterization ("heart cath") with angioplasty and stent may be done to open the artery.

Cardiac catheterization:

This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.

What treatments are available for blocked coronary arteries?

Angioplasty:

A percutaneous coronary angioplasty (PTCA) or angioplasty may be done to open an artery blocked by plaque. Plaque is fatty material inside your arteries. A special tube with a balloon on the end is threaded into the blocked artery. Once the tube is in the artery, the balloon is filled with contrast dye. As the balloon fills, it presses the plaque against the artery wall. Pressing the plaque against the artery wall opens the artery up so blood can more easily flow through it.

Coronary intravascular stent placement:

Coronary intravascular stent placement is also called coronary artery stenting. It is often done with percutaneous transluminal coronary angioplasty or PTCA. The stent is a small mesh wire that is inserted into an artery to keep it open so blood can flow through it. When the stent is expanded by the balloon, it attaches to the artery wall and keeps the artery open.

Cardiac rehabilitation:

Cardiac rehabilitation includes information about cardiac disease, medicines, and lifestyle changes you may need to make. It also includes exercise programs which may be done in a rehabilitation center or at home.

Coronary artery bypass surgery:

Coronary artery bypass surgery (CABG) is open heart surgery. A CABG is usually done because one or more of the arteries on your heart are blocked.

What medicines are used to treat coronary artery disease?

Your medicines may include the following:

ACE inhibitors:

ACE Inhibitors are medicines that keep your blood vessels relaxed and open. This helps keep oxygen-rich blood flowing into your heart. These medicines may be used to treat high blood pressure.

Anti-platelet medicines:

Anti-platelet medicines, such as aspirin, keep platelets from sticking to a damaged part of your artery. Platelets are a part of your blood that come together to heal injury. They may cause a blockage in your artery and keep blood from going to your heart.

Beta blockers:

Beta blockers keep your heart pumping strongly and regularly. This helps to keep the heart from having to work so hard to get oxygen.

Blood pressure medicine:

This medicine may be given to lower your blood pressure. Keeping your blood pressure under control protects your heart, lungs, brain, kidneys, and other organs.

Blood thinners:

This medicine keeps clots from forming in the blood. Clots may cause heart attacks, strokes, or death.

Cholesterol lowering medicines:

These medicines may help to lower blood cholesterol.

Clot busters:

This medicine helps break apart clots. It is given IV and may be given at the same time as other blood thinners. This medicine could save your life because blood clots in the heart, lungs or brain can kill you. Be careful because you may bleed or bruise easily.

Hypoglycemic medicine:

This medicine may be given to decrease the amount of sugar in your blood. Hypoglycemic medicine helps your body move the sugar to your cells, where it is needed for energy.

Nitroglycerin:

Nitroglycerin relaxes the arteries of your heart allowing the heart to get more oxygen. Nitroglycerin may help to relieve your chest pain.

What life style changes should I make?

If you smoke, you should quit. Speak to your caregiver if you need help with this.

Exercise when your caregiver says it is OK. Ask your caregiver about what kind of exercise you should do and how to get started.

Eat foods that are low in fat and salt. You should also eat high fiber (roughage) and high nutrient foods, such as fruit, vegetables, and whole grains. Instead of fatty meats, eat more fish, chicken (without skin), and soy products. Avoid eating too much junk food, foods that are fried or cooked in butter, and highly salted food. Talk to your caregiver about taking vitamins or over-the-counter medicines.

If you are overweight, talk to your caregiver about how to lose weight.

You will receive medicine if you have high blood pressure. Do not miss any doses of your medicine. Talk to your caregiver if you think you are having side effects from your medicines.

You will also need to take medicine if you have diabetes. Do not miss any doses of your medicine.

How alcohol (beer, wine, vodka, and other adult drinks) affects CAD depends upon how much you drink. Binge drinking (drinking a lot at one time) or regularly drinking three or more drinks daily can damage the heart and blood vessels. Stop drinking if you drink too much, or too often. Scientists have found that drinking small or moderate amounts, like one or two servings of alcohol daily, may protect the heart and vessels. Ask your caregiver if it is safe for you to drink alcohol.

Where can I find support and more information?

You may feel scared, confused, and anxious because of your CAD. These feelings are normal. Talk about them with your caregiver or with someone close to you. Ask your caregiver about support groups for people with heart disease. Such a group can give you support and information.

Contact the following for more information about CAD and heart disease.

American College of Cardiology
9111 Old Georgetown Road
Bethesda, MD 20814
301-897-5400
800-253-4636 Ext: 694
http://www.acc.org/

American Heart Association National Center
7272 Greenville Avenue
Dallas, TX 75231-4596
800-242-8721
http://www.americanheart.org

National Health Information Center
P.O. Box 1133
Washington, DC 20013-1133
301-565-4167
800-336-4797
http://www.health.gov/NHIC

WomenHeart The National Coalition for Women with Heart Disease
818 18th St, NW, Ste 930
Washington, DC 20006
202-728-7199
www.womenheart.org