Tag: non-obstructive heart disease

Post-stent chest pain, revisited

~ Carolyn Thomas ~ 18 Comments

by Carolyn Thomas    ♥   @HeartSisters

A clinical review paper published in the European Heart Journal, under the intriguing section called “Controversies in Cardiovascular Medicine”, revealed a controversy that I’ve written about (and experienced in real life):  post-stent chest pain.1

This clinical review started with a polite acknowledgement that “procedural success is routinely achieved”  in heart patients when blocked coronary arteries are treated with an implanted stent. But immediately following the niceties about the success of the procedure, review authors threw in this zinger:

“Persistence or recurrence of angina after a stent is well-recognized and may affect 20–40 per cent of patients during short to medium-term follow-up.” 

Whaaaaat?!    That’s like the old hospital joke: “The operation was successful – but the patient died!”  And how can a stent procedure be dubbed a success if up to 40 per cent of patients suffer persistent or recurring chest pain afterwards? Continue reading “Post-stent chest pain, revisited” →

Do women need different treatment of coronary artery disease?

~ Carolyn Thomas ~ 9 Comments

by Carolyn Thomas  ♥  @HeartSisters

Cardiologist Dr. William Bestermann, in reviewing his own 40+ year career as a physician, now concludes that, in all of medicine, “there is no better example of the disconnect between what we know and what we do than in the case of women with coronary artery disease.” I’m a woman who has survived a widowmaker heart attack, and now lives with coronary microvascular disease, and I’ve only been writing about such sentiment for eight years. As Dr. B. explains bluntly:

“Every other week, I see a woman who has had symptoms of coronary artery disease and has been told that the problem is her esophagus – or worse – depression or anxiety.  She is told in effect: ‘Go home, take your anti-anxiety drugs, you will be fine!’  What she has been told is often wrong – too often, dead wrong!” Continue reading “Do women need different treatment of coronary artery disease?” →

Coronary Microvascular Disease: a “trash basket diagnosis”?

~ Carolyn Thomas ~ 34 Comments

by Carolyn Thomas  ♥ @HeartSisters

Dr. Juan Carlos Kaski, Head of the Cardiovascular Sciences Research Centre, St. George’s University of London in the U.K., explains an unusual cardiac diagnosis that I happen to share: Inoperable Coronary Microvascular Disease (MVD).

When I was at Mayo Clinic five months after my heart attack, cardiologists there referred to MVD as a “trash basket diagnosis” – not because the condition doesn’t exist, but because this disorder of the tiniest blood vessels in the heart is so often missed entirely. A correct diagnosis usually happens only after all other possible diagnoses are thrown out. It’s far more common in women and in people who have diabetes. It’s treatable, but can be very difficult to detect. Continue reading “Coronary Microvascular Disease: a “trash basket diagnosis”?” →

How a woman’s heart is different from a man’s

~ Carolyn Thomas ~ 16 Comments

by Carolyn Thomas    ♥  @HeartSisters

In many ways, the fact that my cardiac treadmill stress test results appeared “normal” was not a surprise, despite my textbook heart attack symptoms of crushing chest pain, nausea, sweating and pain radiating down my left arm. What we now know is that single-vessel heart disease, which is more common in women than in men, may be less likely to be picked up at all on a treadmill test.

Even though my left anterior descending coronary artery was 95% blocked, this didn’t show up. Similarly, for other women non-obstructive heart disease (again, more common in women) is harder to identify given our existing diagnostics. Women are more likely to suffer from coronary microvascular disease affecting the smallest blood vessels of the heart. And spasm conditions like Prinzmetal’s variant angina are difficult to catch at the best of times, but women can be just as dead after a heart attack caused by undiagnosed Prinzmetal’s as they would be due to fully-occluded coronary arteries.   Continue reading “How a woman’s heart is different from a man’s” →