Important news on heart attacks in women
Heart disease is the number one killer of women in America.
At this point, I think it’s well described that heart attacks in women can present with different symptoms than men. This difference in symptoms between men and women is commonly reported, but sometimes I think this difference is overexaggerated.
It’s not that women so commonly have the typical symptoms of “an elephant sitting on my chest” that are classically described in men. It’s more that many different patients - men and women alike - can have what we call “atypical chest pain” that is actually representative of discomfort related to their heart. The other groups that commonly report these atypical symptoms are the elderly, diabetics, and patients with chronic kidney disease.
But apart from symptoms, women more frequently have a condition called MINOCA, or myocardial infarction with nonobstructive coronary arteries.
The case of a woman diagnosed with MINOCA is something that I actually see quite a bit. A patient reports symptoms of a heart attack (chest pain, tightness, neck pain, shortness of breath, nausea, or something else), has blood tests and an EKG that look like a heart attack, but then a cardiac catheterization does not show any severe blockages in the arteries that supply blood to the heart.
So what the hell is going on?
These patients often get told mixed messages - you had a heart attack, you didn’t have a heart attack, I don’t know what you had - but don’t get a formal diagnosis.
And when you don’t get a formal diagnosis, it’s tough to ensure that the treatment you’re getting is the right approach to prevent another event.
Luckily, smart people are studying this.
Exciting new research may help us diagnose and treat these MINOCA patients better
The HARP-MINOCA trial, led by Dr. Harmony Reynolds, just presented results at the American Heart Association conference this November.
They enrolled patients in this study who met the definition for MINOCA - symptoms of a heart attack, abnormal cardiac biomarkers in the blood, abnormal EKG, but no severe blockages in their coronary arteries - and did some additional testing to try to make a diagnosis.
Keep in mind, this is a group of patients who gets admitted to the hospital with a really scary diagnosis (“you’ve had a heart attack and we need to do a cardiac catherization on you!”) and leaves with a confusing report about what happened (“we know you don’t have any severe blockages, so you may or may not have had a heart attack”).
Understanding what’s going on in this group is really important!
The patients in this group underwent two additional tests: 1) a cardiac MRI and 2) a test called optical coherence tomography, which is a way of visualizing a blood vessel from the inside.
The combination of these two tests led to a diagnosis in 84.5% of these patients!
It’s really big news to make a diagnosis in a group of patients who previously didn’t get one!
What did they find about these patients?
The findings from this research are really interesting.
About 75% of the patients who received a diagnosis actually had a classic heart attack. The other quarter of them received who received an alternative diagnosis for their presentation had an etiology that wasn’t due to a typical heart attack - so their diagnosis and treatment are different than the first group.
Now, I don’t want you to get the impression that these patients were previously just told, “we don’t know what happened” and then sent on their way without any medical treatments.
The vast majority of cardiologists would prescribe some medications that would be used for prevention of another heart attack. So it’s not that these patients weren’t treated at all.
But it’s different as a patient to get a diagnosis and the appropriate treatment for that diagnosis than a guess about what happened and a bunch of medications that may or may not be appropriate for you.
It’s hard to argue that cardiac MRI is not the standard of care for these patients moving forward.
Not all important research is a randomized clinical trial about treatment. Sometimes getting more information about a diagnosis can be life changing for patients and practice changing for physicians.
This is that type of research.
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