Common tests can’t detect many heart cases in women

If you are a woman who has been experiencing recurring chest pain but heart tests show no abnormality, you may still have reason to worry. A ground-breaking research has found that tests like ECG and angiography often fail to detect certain heart conditions in women.

The research, based on a 10-year multicentre study in the US which evaluated more than 1,000 women, has added a new word in medical lexicon — Women’s Ischemia Syndrome Evaluation or WISE. In the main, it says the pathophysiology of heart problems in women is often completely different from men.

In women, heart problems are often because of small arteries not dilating when the heart requires more oxygen. This, along with the fact that the diameter of blood vessels in women is smaller, deprives the heart muscle of oxygen — a condition known as ischemia. Over time, ischemia increases the risk of heart attacks.

Blockages in minor vessels and capiliaries — known as microvascular disease — usually don’t register even in angiograms. Hence, the complaining woman is declared fit, and if still not satisfied, often dubbed hysterical.
‘‘This is a path breaking study. It alters our understanding of heart disease in women,’’ says Dr Deepak Natarajan, senior cardiologist, Indraprastha Apollo Hospitals.

The WISE study, commissioned by the National Heart and Lung Blood Institute, is the big medical discovery that America is buzzing with. First published in the Journal of American College of Cardiology in February, the findings made their way to mainline American press only recently.

Microvascular disease, doctors say, is a fairly well-recognised problem. But the scary part of the WISE study, as it points out, is this: ‘‘Noninvasive diagnostic methods which often confirm the diagnosis and assess disease severity in men are less reliable in women.’’ These non-invasive tests include stress ECG, a commonly used cardiac test.

The study has also found that even an invasive test like coronary angiogram, often regarded as the ‘‘gold standard’’ test for detecting cardiac ischemia is not always a reliable indicator in case of women. With the result that a lot of women suffering from microvascular disease are often dismissed with statements like ‘‘it’s all in your head’’ because conventional tests do not show any problems. HEART OF A WOMAN ‘Stress test more accurate’

According to Dr Deepak Natarajan, senior cardiologist, Indraprastha Apollo Hospitals, ‘‘The stress ECG test does not always work in pre-menopausal women because of the presence of estrogen hormone that tends to give false positive results. For women who complain of chest pain but have a clear angiogram and stress ECG, a stress echo or a stress thalium test can prove to be more accurate.’’ The Women’s Ischemia Syndrome Evaluation (WISE) study has found the Duke Activity Status Index, a 20-point questionnaire on how a patient fares in daily activities to be a reliable indicator on a possible heart condition in women.

According to Dr Ravi
Kasliwal, director of cardiology, Escorts Heart Institute and Research Centre, at least 50% of women with chest pain have clear angiograms. ‘‘In such patients, a test called brachial artery flow mediated vasodilatation can also be used to detect endothelial dysfunction which is the cause behind microvascular disease. For India, the WISE findings have a ominous ring because we are also the diabetes capital of the world. Diabetes and hypertension are the most important risk factors for cardiac problems.’’

Both Natarajan and Kasliwal emphasise the need to treat such patients not just for the condition itself but also to aggressively treat the risk factors present, like diabetes, hypertension and cholesterol.

 

lancymoor102

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slight discomfort in my right ankle

I feel a slight discomfort in my right ankle for about a week. It's not very painful but it's got me worried. I can walk, run without problems but the pain seems to be there when the ankle is not warmed up - in the morning and when I go to sleep. I can roll my foot but when I try to stretch it straight ahead I feel a slight pain. Can anyone tell me what the reason for the pain could be?
 
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