Why is heart disease in women different?

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When still in practice, a friend of mine, diabetic, hypertensive and a smoker developed chest pains walking in the cold and going upstairs.  When seen in the ER, the cardiologist disagreed with my diagnosis of angina and CAD. After pleading with him, he agreed (reluctantly) to go ahead and schedule a cardiac catherization. A while later he called me that, to his surprise, it showed a blockage in the right coronary artery.

When I reviewed the films, it also showed a blood clot, as well as severe disease in all the other arteries. Despite my protests, a PCI (angioplasty) was done the next day; it failed acutely, the patient became very unstable and we operated as an emergency, performing five bypasses. This was neither the first, nor the last time situations like this happened: the patient was a 45 y.o. woman!

(Click on the picture to enlarge)

Women are often misdiagnosed, undertreated and told that their chest pain is an anxiety attack or the result of of a Hiatal Hernia or Gastro Esophageal Reflux Disease (GERD).

As a result, treatment when it happens is often delayed (as what my cardiology colleague, mentioned above would have done). In addition, women often have a different type of disease with a more diffuse presentation of CAD, and often have smaller coronary arteries, as opposed more localized blockages that are easier to treat.

On top of that, treatment when it happens has a higher failure rate for both PCI and CABG.

This holdsd true for specific groups of women at risk:

and women with an expanding waist line:

Read more about this here:


Hope this helps,

Dr T


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