By Rhian Davies, DO, MS, FACC, FSCAI, interventional cardiologist
Heart disease is the leading cause of death for adult women. Yet care for women still lags behind the vigilant testing and treatment typically provided to men.
Rhian Davies, DO, MS, FACC, FSCAI
For example, while the incidence of heart attack among men has fallen in recent decades, it has increased among women. Across the country, women hospitalized for heart attack are 10% less likely to receive medications like antiplatelet therapy and intensive treatments like revascularization. While WellSpan Health performs better than the national average, we remain vigilant for areas where care gaps can be closed. Additionally, WellSpan Health participates in cardiovascular clinical trials specifically designed to enroll women who are traditionally underrepresented in international studies.
PCPs are a critical ally in helping women get the care they need. They have the chance to intervene in the early stages of cardiovascular disease (CVD) — before heart attacks and other poor outcomes occur.
To have this impact, PCPs must do two things: Know the signs of CVD in women and lean in when those signs emerge.
Look for fatigue, referred pain
Standard signs of CVD can apply to both women and men, but certain symptoms are more common with one or the other. For example, men are more likely to experience the classic symptom of band-like pressure across the chest.
Women are more likely to present with:
- Fatigue and shortness of breath — the most common and most overlooked symptoms.
- Referred pain — often in the jaw or back or between the shoulder blades.
- Nausea — perhaps due to a blockage in the right coronary artery (RCA), which can cause diaphragmatic irritation because the inferior wall of the heart lies just above the diaphragm. An RCA blockage can stimulate the vagus nerve, which can cause nausea, vomiting or even fainting.
Providers often attribute these symptoms to stress, anxiety, or a GI problem. I have one patient whose jaw hurt every time she carried the laundry upstairs. She and her doctor spent more than two years trying TMJ treatment, inhalers, anxiety medication and other avenues before she was referred to me.
Knowing that these symptoms may instead be heart-related can save women from unnecessary intervention and get them the care they need much sooner.
Dig deeper and refer
For women with the above symptoms, the PCP’s first tool is the patient interview.
- Explore risk factors. High blood pressure, middle age, and preeclampsia or other issues during pregnancy all raise the risk for CVD.
- Ask about changes in daily activity. This is the biggest giveaway in my experience. What does the patient comfortably do day to day? Has anything become more difficult in the last few months? If so, assume it’s their heart until proven otherwise.
Don’t hesitate to refer to a cardiologist if you suspect the heart at all. We never mind seeing a patient.
How I evaluate women for CVD
I find a stress echocardiogram extremely valuable for new patients. It’s a three-step, noninvasive test with no radiation: I view the heart at baseline via ultrasound, the patient runs on a treadmill while I monitor by EKG, and then she stops and I view the heart again.
This enables me to assess the function of all four chambers and valves and determine what is likely causing the patient’s symptoms: Is it her conditioning or her heart?
Changing the landscape
Efforts to improve awareness of CVD in women have been ongoing for decades. The persistent gap in care and outcomes shows we must work harder to see women — recognizing their symptoms, including them in clinical trials and encouraging them in fields like mine.
I’m proud of the work we do at WellSpan Health to achieve those goals. We recently participated in the EMPOWER CAD trial — the first all-female trial investigating intravascular lithotripsy as a first-line therapy for calcified coronary artery disease. I also co-host a gathering for new and experienced women interventional cardiologists to discuss our cases and careers and the newest techniques and challenges in the field.
CVD isn’t a men’s problem, and vigilant care isn’t a man’s privilege. Let’s work together to give women the care they deserve.