Q&A with Dr. Bridget Beck: Women & Heart Disease

How are coronary diseases treated?

When it comes to treatment, there are more similarities than differences with men and women. Women and men have the similar benefit from both the common medications that we use as well, as the procedures. Women have more benefit from the cholesterol fighting medications called statins than men. Video 

How are blockages in the heart diagnosed?

We start by putting an IV either in the artery in the wrist or an artery in the groin and through that IV the entire procedure is done. This is not a surgery, but it is what we would call an invasive procedure. We take catheters which are like the world's longest, skinniest straws and those fit through the IV and we push them through the blood vessels towards the heart. Then we take the tip of that catheter and put it outside the opening of the heart artery and then squirt some dye into the heart artery. That allows us to see is there actually a blockage, and if so, how severe is the blockage, how many blockages are there; then we move on to determining what the appropriate treatment is. Video

What should you do if you think you’re having a heart attack?

If someone is worried that they are experiencing symptoms of a heart attack, they absolutely need to get to an emergency room –  and preferably a chest pain center—  as fast as possible. The main reason for that is that during a heart attack, your heart is not getting the blood that it needs. The longer you wait to get those symptoms addressed, and therefore start treatment, your heart muscles dying. In the meantime, chest pain centers such as Rose have been set up to make sure that they have process in place in order to ensure that this gets done in a very timely manner. Our people are trained to know exactly what to look for and what the next step is to get timely treatment. Video

How is cardiac testing different for women than men?

We're very lucky to get the women in the door in the first place. There's been evidence that shows even after an abnormal cardiac test, women are less likely to be referred to a specialist. The fact that we have them in front of us is the first step. But, there are some differences in our diagnostic testing spanning from our most basic testing – we consider a stress test—  all the way to our gold standard tests—  the heart catheterization. With our basic stress tests, women are much more likely than men to have a false positive result and therefore we need to keep that in mind to ensure women receive an accurate diagnosis. We may need to do additional testing or include pictures of the heart with our basic stress tests. For our gold standard tests the heart catheterization or angiogram, we’re actually going in through the blood vessels and looking at the heart arteries. There can be some differences between men and women.  With women, we're less likely to see an obvious blockage than with men. That could occur for several reasons, but also leads to diagnostic challenges where women may be less accurately diagnosed. Video

What are the symptoms of coronary disease?

When it comes to symptoms of coronary disease or a heart attack, there are actually more similarities than differences between men and women. Chest pain is the most common symptom for both men and women. That said, women are more likely to have shortness of breath or nausea which can lead to misdiagnosis the first time around. Video

What are the differences in heart disease between men and women?

Women with coronary artery disease are more likely than men to have a lot of the traditional risk factors. These include diabetes, high blood pressure, high cholesterol family history and smoking. While that is not necessarily a beneficial thing that gives us some clues that maybe these are people that we should be looking at as opposed to an otherwise healthy person. Possibly the most important for women seem to be diabetes, family history and smoking. Diabetic women are higher risk than men for a heart attack after a heart attack, diabetic women have double the risk of the second heart attack. Women with coronary disease are more likely to have a family history of coronary disease than men. Smoking is a stronger risk factor for women than men; half of all female heart attacks are related to smoking. Video

What is cardiovascular disease?

Cardiovascular disease is the leading cause of death in women. This includes coronary artery disease, strokes, as well as plaque in the legs and aorta. Cardiovascular disease actually kills more women every year than the next three leading causes of death combined. Despite this, women are actually diagnosed less frequently with heart disease. They are less likely to be referred to a specialist and therefore often diagnosed later in their disease process and don't do as well as men do. Video

What are tests for heart attack and disease?

Almost always, the first test is going to be an EKG, which is sort of an electrical picture of your heart that can show some significant abnormalities if someone is having a heart attack. If that is not obviously abnormal to begin with, we're going to do some further testing. This can be anything from lab work that can show us evidence of heart damage, to a stress test where we try and trigger symptoms and changes on an EKG to look for evidence of a blockage. If we find a blockage, the next step is a cardiac catheterization or angiogram. As I said, this is our gold standard test and the only way to be one hundred percent sure if there is a blockage or not one of the heart arteries. Video

What are the factors for heart disease in women?

With women, it is important to address their risk factors for heart disease. These include diabetes, smoking, high blood pressure, high cholesterol. If you have these risk factors, you need to be seeing your doctor on a regular basis and making sure those are as well controlled as possible. Other proactive things that women can do include dietary changes for weight management and getting at least 30 minutes of exercise a day at least five days a week. We recommend the Mediterranean diet, which focuses on healthy fats, fish and poultry, nuts and olive oil-based foods. It is also important for women to advocate for themselves. I see a lot more women who are bringing their husbands in to see me for symptoms than women who bring up their own symptoms. It is important for women to take care of themselves and pay attention to their symptoms. Video