Can You Have a Heart Attack Without Blockage

past Carolyn Thomas ♥ @HeartSisters

Turns out that the kind of centre attack that I had (acquired by a 95% blockage in the big left anterior descending coronary artery) – the so-called widowmaker heart assail – may really exist relatively uncommon  in women. Y'all might judge that fact past its nickname.  It's not, subsequently all, called the "widower-maker" .

While cardiologists warn that heart disease can't be divided into male and female person forms, there are some surprising differences. Cardiologist Dr. Amir Lerman at the world famous Mayo Clinic in Rochester, Minnesota, told the Los Angeles Times recently:

"When it comes to acute heart attacks and sudden expiry from cardiac arrest, women accept these kinds of events much more often without whatever obstructions in their coronary arteries ."

Instead, it appears that a significant portion of women suffer from another class of middle disease altogether. It affects not the pike coronary arteries just rather the smaller arteries, called microvessels. These tiny arteries deliver blood directly to the heart muscle.

Ironically, I can now boast two diagnoses for the cost of one  – beginning, the widowmaker heart assail acquired by a fully occluded coronary artery back in 2008, and then, after several months of puzzling, ongoing cardiac symptoms – like chest pain, shortness of breath, and crushing fatigue – a second diagnosis of inoperable coronary microvascular illness .

In 2006, research published in the journal Circulation looked at the Women's Ischemia Syndrome Evaluation (WISE) study data on well-nigh 1,000 women referred for cardiac testing due to their symptoms(1). Here's what they plant:

• 62% had non-obstructive coronary artery illness – defined as blockages less than 50% of the artery
• 17% had ane coronary avenue vessel significantly blocked or narrowed
• 11% had two vessels narrowed
• fewer than ten% had three vessels affected

Dr. Noel Bairey Merz , a cardiologist at Cedars-Sinai Medical Center in Los Angeles, headed up the WISE written report, which began in 1996. The average age of her participants was 58, but a quarter were younger and pre-menopausal.

Researchers found that what's known as ischemic eye disease (any decreased claret flow and oxygen to the heart musculus) is often caused by a blockage within one or more coronary arteries that are feeding the eye musculus, but tin can also be due to at least ii other possibilities:

1. dysfunction of the smallest coronary microvascular arteries
2. coronary spasm

1. Coronary Microvascular Disease

They used a exam in which doctors beginning measured blood menstruation through the heart and then injected a drug that should have fabricated the arteries amplify and increased the flow. If the flow did non rise, the patient nearly probable had microvascular disease.

One third of the women in the L.A. study had depression blood catamenia to the center musculus caused by coronary microvascular disease .  For these women, the charge per unit of deaths or centre attacks was higher than would be expected for other women with normal angiograms.

According to the Texas Heart Constitute, coronary microvascular disease most likely happens when modest blood vessels in the eye tighten or constrict. This tightening reduces the blood flow to the heart musculus and causes the pain of angina pectoris (a Latin phrase that ways "strangling in the chest").

The encouraging news at first:  because these vessels are so tiny, early enquiry suggested that they may not increase the chance of a centre attack or death. But the Journal of the American Medical Clan reported in 2005 that the prognosis of patients with unstable angina and non-obstructive coronary artery disease is non benign and includes a ii% risk of expiry or heart assail at 30 days of follow-upwards(2).  (J AMA. 2005;293(4):477-484. doi: ten.1001/jama.293.4.477)

Problematically, coronary microvascular arteries are too pocket-size to detect with the standard cardiac tests that cardiologists would normally utilise to see larger vessels, so women in particular are ofttimes dismissed and sent habitation with a misdiagnosis in spite of severe and distressing cardiac symptoms.

For instance, in typical patients with coronary artery disease, coronary angiography – considered the 'gold standard' of cardiac diagnostics – usually shows a conspicuously blocked artery that slows blood flow to the center muscle.

Just in patients with coronary microvascular affliction, these test results are normal – fifty-fifty though symptoms may exist as debilitating as those experienced during a middle attack.

Dr. Noel Bairey Merz adds that angiograms that would clearly spot blockages in major heart arteries can miss coronary microvascular illness birthday. As a result, many women who have gone to their doctors with chest pain take gone home with a clean nib of heath – and nigh likely feeling very embarrassed for having fabricated a fuss over cipher.  She says:

"Historically, women accept been told that it was in their head."

Co-ordinate to the Harvard Heart Letter, the preferred diagnostic tool for correctly identifying coronary microvascular disease is coronary reactivity testing .

"Coronary reactivity testing is an angiogram-like test lasting 60 to xc minutes; information technology allows doctors to meet how very pocket-sized vessels supplying the middle answer to different 'challenges' from medications. "

Texas Heart Institute experts tell the states that up until recently, the just handling for coronary microvascular disease (besides sometimes known as Cardiac Syndrome X, a name that'due south generally hated by those of united states of america diagnosed with MVD because of its implication that this disorder somehow doesn't exist!) has been with these medications:

• Nitroglycerin (nitro) can widen or amplify the arteries and improve blood flow to your heart. Nitro can be given through a skin patch, pills, an ointment, or a spray. See more on nitroglycerin.
• Beta blockers "block" the chemical or hormonal messages sent to your heart. When you are under concrete or emotional stress, your torso sends signals to your heart to piece of work harder. Beta-blockers block the result these signals have on your heart, and so they reduce the demands on your heart.
• Calcium aqueduct blockers can assistance to proceed your arteries open and reduce your claret pressure level by relaxing the smooth musculus that surrounds the arteries in your body. The oxygen need of the middle is besides reduced by these medicines.

Physical exercise has also been shown to be helpful in managing MVD symptoms. A Swedish study reported in the Journal of the American College of Cardiology in 2000 suggested that existence out-of-shape is a "prominent feature" in patients diagnosed with  MVD. Researchers found that a thirty-infinitesimal conditioning on an do bicycle three times a calendar week resulted in increased exercise capacity with bottom chest pain for the MVD patients they studied.

As more physicians get educated about the widespread incidence of coronary microvascular disease, particularly in women patients, more treatments are becoming available, including my own particular current treatment for microvascular disease: wearing a portable TENS machine all mean solar day long to help increase blood menstruum to the middle muscle and thus reduce chest pain symptoms. Read more than on this underused, non-drug, non-invasive cardiac treatment in "My Honey-Detest Human relationship With My Little Black Box".

And emerging research has shown significant success using TENS neuromodulation to treat the chest pain of angina. In fact, the U.K. National Refractory Angina Group now recommends TENS therapy for the debilitating chest pain of angina:

"Neuromodulation owes its origins to Melzack and Wall'southward gate theory of pain that predicted that stimulation of vibratory afferent nerves would reduce or gate the transmission of pain traffic relaying through the spinal cord at the same point.

"Transcutaneous electrical nervus stimulation (TENS) was specifically designed to make utilise of this predicted upshot and was used to care for a diversity of pain atmospheric condition earlier it was shown to exist effective in angina.

"TENS neuromodulation should be offered every bit function of a multidisciplinary angina management programme based on the current guidelines. "

2. Coronary Spasm Disorders

Some other example of non-obstructive heart illness often seen in women is called Prinzmetal's Variant Angina , chest hurting caused by a spasm of a coronary avenue. While Prinzmetal'due south is not idea to cause a heart attack, chances of a cardiac event are higher in those with underlying heart conditions.

Nosotros don't even so know exactly what causes coronary spasms like Prinzmetal's.

I theory lies within the thin lining of the blood vessels called the endothelium . Ordinarily this artery lining produces a chemical (nitric oxide) that helps to widen the blood vessel, allowing blood to menstruum through with ease.

But if the artery lining is damaged or isn't working properly, the blood vessel may narrow and cause a coronary spasm. Levels of the artery-widening chemical are higher when estrogen levels are also loftier at sure stages of the menstrual cycle. A 2001 study published in the journal, Annals of Internal Medicine, suggested that during times when estrogen levels are high, women have fewer chest hurting symptoms(3). In add-on, smokers tend to have lower levels of nitric oxide in their blood vessels than non-smokers, and smoking is a major hazard factor for coronary spasm .

Symptoms of angina can also occur in the absenteeism of any coronary avenue disease. Up to thirty% of people with a heart valve trouble called aortic stenosis , which tin cause decreased claret period to the coronary arteries from the center, can have angina. People with severe anemia may have angina considering their blood doesn't conduct plenty oxygen. People with thickened eye muscles need more oxygen and can accept angina when they don't become enough.

Nosotros practice know that cardiovascular disease kills more women than any other cause , about half-dozen times more women each twelvemonth than chest cancer does, and in fact, more than all forms of cancer combined. Each twelvemonth since 1984, more women than men have died of cardiovascular disease. Men tend to develop heart disease on average ten years earlier than women practise.

Anatomically, male and female hearts expect near the same. When healthy, both should be about the size of a fist (a human being's middle is the size of a man's fist, and a woman's eye is smaller because information technology's nigh the size of a woman's fist). If you lot're a woman, yours weighs about the same as a dark-green pepper and, also similar a green pepper, has hollow chambers inside.

Both men and women have three main coronary arteries surrounding their hearts. These are the large blood vessels that wrap around the outside of the heart, supplying blood, oxygen and nutrients to heart musculus to keep each heart pumping properly – and thus the arteries most susceptible to life-threatening cardiac events through obstructive – or not-obstructive – middle conditions.

Just women who have a heart attack fare worse right after the event and also suffer a poorer quality of life .

Learn more about coronary microvascular affliction :

• in this LA Times feature
• on this 22-minute video about identifying hard-to-catch diagnoses in female patients via medical imaging chosen Diagnosing Cardiovascular Disease in Women with cardiologists Drs. Redberg, Shaw and Bateman
• in this 5-minute video about my eye sis Joan Jahnke of South Carolina, who went to Emory Centre & Vascular Center to accept her coronary microvascular affliction appropriately diagnosed and treated
• on these websites from Mayo Clinic and the Texas Heart Found .

♥

Notation from CAROLYN: Delight do NOT get out a comment here describing your current symptoms. I'1000 not a physician and cannot diagnose you online (nor tin anybody else). If you lot are experiencing pitiful symptoms, seek a medical opinion from your physician.

See also:

• Misdiagnosed: Women'south Coronary Microvascular and Spasm Pain
• No Blockages: Living with Non-Obstructive Heart Disease
• "I Rang the Bong Again. No One Came."
• Coronary Microvascular Disease: a "trash basket diagnosis"?
• His and Hers Heart Attacks
• When Your Artery Tears: Spontaneous Coronary Avenue Dissection
• The New State Called Centre Disease

1. Shaw L, "The Economic Burden of Angina in Women With Suspected Ischemic Heart Illness". Circulation. 2006;114:894-904.

2. Bugiardini R, Bairey Merz CN. "Angina with 'normal' coronary arteries: a changing philosophy". J AMA. 2005;293(4):477-484.

3. Kawano H, Motoyama T, Ohgushi M, Kugiyama K, Ogawa H, Yasue H. "Menstrual Cyclic Variation of Myocardial Ischemia in Premenopausal Women with Variant Angina".Ann Intern Med. 2001;135(11):977-981.

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Source: https://myheartsisters.org/2010/04/25/microvascular-disease-women-blockages/

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