There was a time women reporting extreme fatigue and pain in the upper back were diagnosed with anxiety or the effects of menopause and sent home to relax. That’s quickly changing with the growing recognition that heart disease can look different in women. It is often more complicated to diagnose, too, which is one reason there’s a higher proportion of unrecognized or “silent” heart attacks among women than men.
Knowing the steps leading to diagnosis can help result in a quick and accurate finding and the best treatment for you.
Doctors may use well-established formulas, such as the Framingham Risk Score, when assessing a patient for heart disease. Such scores estimate the probability that a person will develop cardiovascular disease within the next 10 years. Your risk level is based on your age, sex, smoking status, blood pressure measurement, diabetes status, family risk and cholesterol levels. Healthcare professionals should take several additional factors into consideration, including medical and lifestyle history, family history of heart disease, possible early signs of heart disease and other conditions.
No matter what type of heart disease you have, your doctor will likely perform a physical exam and ask about your personal and family medical history before doing any tests. The tests needed to diagnose your heart disease will depend on what condition your doctor thinks you might have. The medical team also will give you a physical exam to check your blood pressure, weight, body composition and other factors. If heart disease is suspected, your family physician will refer you to a cardiologist or order diagnostic tests.
The traditional approach in diagnosis is to look for blockages in blood flow, but women with heart disease are less likely to have obstructions and more likely to have poorly functioning blood vessels. That means the arteries and capillaries aren’t working as they should, which reduces the amount of blood flowing to the heart muscle. Focusing too narrowly on finding obstructions can lead to misdiagnosis in some women, so medical guidelines have been rewritten to advise doctors to broaden their investigations.
There are many possible tests to help make a diagnosis of heart disease, ranging from a treadmill exercise test to sophisticated nuclear imaging. Your doctor or a cardiologist will decide which of the available tests are most appropriate for you while taking into consideration that some tests are less accurate in women.
One of the most common and cost-effective tests is the treadmill test. To investigate what is happening in the cardiovascular system, medical practitioners attach sensors to a patient and have him or her walk on a treadmill. Tracking blood pressure, breathing and any changes to an electrocardiogram (ECG) tracing helps to determine how the heart is handling the stress of increased demand for blood.
A significant number of women have unclear results from the treadmill test. In younger women, it’s believed that hormonal fluctuations can complicate results, while among older women – the group most at risk of heart disease – their fitness levels can make the treadmill activity a challenge. Research suggests an exercise stress test may sometimes be combined with an imaging test for greater accuracy.