September 03, 2010
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Coronary Heart Disease in WomenThe purpose of this article was not to "show up" doctors as prejudiced but rather to find ways to improve the diagnosis and treatment of heart disease in women and African Americans. One explanation for these types of findings is that women get coronary heart disease at a later stage of the disease than men but, in the New England Journal study, everything was the same — age, risk factors, and symptoms — except sex and race. Nevertheless, there was a significant difference between the referral rate of black women compared with black men, white men and white women. Let me assure you that the difference was small, about 7%,(2) and these were model patients, not real patients. Still, it indicates that we in the medical profession must be alert and careful and not make assumptions based on race and sex. As for the public — you, the reader, a Gallup poll, conducted in 1995 by the American Medical Women's Association and the American Heart Association, found that 80% of the women surveyed did not know that heart disease is the leading cause of death in American women. Thirty-two per cent of doctors, in the same poll, did not know it either. The idea that women don't get heart attacks is deeply ingrained in our society. My purpose, in this article, is not just to correct a mistaken impression about the incidence of coronary heart disease in women. It is also to get both doctors and patients to change the way they act because timely diagnosis translates into lives saved and severe disease avoided. What Is Coronary Heart Disease?
The three main coronary arteries wrap around the heart and supply heart muscle with oxygen and nutrients. Each artery supplies a particular area of the heart and there is very little overlap. This absence of "collateral" or overlapping circulation means that, if one vessel gets blocked, the neighboring artery cannot take up the slack. The heart muscle supplied by the blocked artery, now deprived of nutrients, will die. We call this tissue death a heart attack ("myocardial infarction").
Coronary heart disease is the leading cause of death in men and women in the United States. It can kill you quickly or slowly. It can kill you instantly or in a few hours by triggering fatal arrhythmias (disturbances in heartbeat) or can cause a profound state of shock (very low blood pressure) that cannot be reversed. In a completed heart attack, in which the clot permanently blocks off the artery, the muscle supplied by the blocked vessel dies. It is irreversibly damaged, will never be restored and, eventually, forms a scar. Because of this missing muscle, the heart loses power. If you lose a significant portion of muscle or have more than one heart attack, the heart cannot do an adequate job pumping and you will develop "heart failure," characterized by weakness, shortness of breath and swelling of the legs and other parts of the body. These are the two extremes of what can happen with heart attacks. Most people fall somewhere in the middle, making it through with some damage but not enough to cause heart failure.
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