New technology can detect a dangerous, hidden condition that's most common in women.
Heart disease is the No. 1 killer of both men and women in the U.S. However, women can sometimes be less likely than men to receive a timely and accurate diagnosis.
One reason for the disparity is that heart disease in women often manifests in ways that are much more difficult to diagnose than in men. A key example: Women are more likely to have a condition called coronary microvascular disease, or CMD.
Unlike the more familiar coronary artery disease, which affects the heart’s large arteries, CMD refers to dysfunction in small arteries that feed the heart—but it can be just as dangerous.
Until recently, there wasn’t a good way to diagnose CMD. Standard diagnostic methods such as an angiogram—a procedure performed in a catheterization lab to obtain images of coronary arteries—don’t adequately visualize the small blood vessels involved with CMD.
A New Tool for Diagnosis
Patients knew that something was wrong. But their dangerous heart condition was essentially invisible to health care providers.
Now RWJBarnabas Health is offering a technology that allows doctors to quickly identify CMD and start a patient on appropriate therapies. Called the CoroFlow Cardiovascular System, the technology evaluates the health of small blood vessels by assessing the flow of blood through them.
The technology is expected to be particularly helpful to women, who represent 80 percent of CMD patients. “We know now that there are patients who have myocardial infarctions [heart attacks] and no obstruction in their big blood vessels but have so much disease in their small vessels that they truly did have a heart attack,” Dr. Skelding says— “just one that we couldn’t pick up with traditional tests.”
Managing Risks
As with an angiogram, a CoroFlow assessment is done in a cardiac catheterization lab. During the procedure, blood flow in small arteries is measured using specialized software and a thin wire placed in the arteries. Cardiologists use information from the test to determine whether small arteries are functioning properly. If CMD is diagnosed, patients can be treated with lifestyle changes or medications to control risk factors and reduce symptoms.
RWJBarnabas Health is one of the few health systems in the region that offer the CMD-detecting test.
“It’s important to have the right diagnosis,” says Dr. Skelding. “We don’t have a magic bullet for microvascular disease, but we know that aggressively managing patients’ risk factors through steps such as lowering blood pressure; reducing cholesterol, with medication if needed; eating a healthier diet; and exercising—all of those measures help blood vessels function better.”
Taking cholesterol medication may be helpful even if you don’t have high cholesterol, Dr. Skelding says. “We know that cholesterol-lowering medicines also stabilize blood vessels,” she says. “So if your cholesterol is normal but your blood vessels are not healthy, these drugs can help improve the condition of those blood vessels.”
What Is CMD?
Coronary microvascular disease is a disease of the endothelium, which is the lining of blood vessels—in this case, tiny blood vessels that nourish the heart. “The endothelium is one of the largest organs in your body, and its job is to keep blood vessels healthy,” says Kimberly Skelding, MD, Division Chief of Cardiovascular Services at Jersey City Medical Center. “When the endothelium is not functioning properly, it can prevent good blood flow to your heart and increase your risk of heart attacks.”
The heart’s tiniest blood vessels—some only the diameter of two strands of hair—are the last pathways for blood coursing through the heart. “We have many more tiny blood vessels than large ones,” Dr. Skelding says. “Even if blood is flowing through large vessels, when tiny ones aren’t functioning properly, proper amounts of blood don’t make it through the heart.”
Patients with CMD may experience chest pain and tightness; breathlessness; fatigue; and pain in the neck, shoulders, arms or back. “Both men and women have equal amounts of chest pain, but women tend to have more concomitant symptoms,” Dr. Skelding says—“more nausea, more shortness of breath, more fatigue.”
Risk factors associated with CMD include being female, smoking and having high blood pressure, high cholesterol, diabetes, obesity or sleep apnea. Research also suggests that people with rheumatologic and other inflammatory diseases run a greater risk of heart attacks from traditional blockages and a higher risk of CMD. “There are also likely genetic components to CMD,” Dr. Skelding adds.
No one plans on heart disease, but everyone should have a plan for it. To connect with an RWJBarnabas Health heart and vascular specialist, call 888-724-7123 or visit Heart and Vascular Care.
