While advancements in medical imaging have given physicians powerful new tools in the fight against heart disease, a recent statement by the American Heart Association (AHA), in the Februay issue of the journal Circulation, warns that tests are underutilized in female patients.
Cardiac imaging techniques including single photon emission computed tomography (SPECT) and stress ECG can accurately diagnose heart disease in both women and men. But physicians are less likely to refer women for these tests, according to the AHA.
Heart disease is the number one killer of women in the United States and strikes women on average 10 years later than men. Studies, however, continue to show that women are not being diagnosed or treated appropriately when it comes to their hearts.
"The choice of the optimal non-invasive diagnostic test for women with suspected coronary artery disease can be difficult and presents challenges that are not experienced in the evaluation of men," said Jennifer Mieres, M.D., chair of the committee that issued the consensus statement and director of nuclear cardiology at North Shore University Hospital in Manhasset, N.Y.
Gender differences exist in the clinical presentation and symptoms of coronary artery disease. According to the AHA, death after heart attack is more common in women than in men (38 to 25 percent). In addition, in patients who have no symptoms at all, the presentation of sudden cardiac death occurs more often in women than in men (63 to 50 percent).
Studies also show that heart attack symptoms may present differently in women. Women may experience indigestion, dizziness, nausea or vomiting, fatigue and discomfort between the shoulder blades, in addition to the most well known symptoms: squeezing chest pain, tightness in chest, shortness of breath and pain spreading to the shoulders, neck and arm.
Despite the large numbers of women at risk for heart disease, doctors seem to refer women for diagnostic testing less often than men. The authors of the consensus statement recommend changes in the existing practices:
"The current approaches to diagnostic testing may require some variation when applied to the female patient, and ongoing investigation is needed to fully appreciate the multifactorial role of reproductive hormones on the vascular system and diagnostic testing."
The outlook for women with heart disease is worse than that of men. The lack of recognition of symptoms and improper diagnosis plays a role in the high mortality rates among female heart patients. More research is needed to help practitioners identify and treat women in an expedient and effective manner.