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Women and hidden heart disease

July 29, 2015 | UCI Health

For 20 years, Carrie Fill competed in club soccer, hockey and softball. Then, at age 31, she was benched by a little-known type of heart disease.

It started with a transient ischemic attack, or ministroke, followed by migraine headaches so severe Fill couldn’t work or play sports. Later, she developed crushing chest pain. Fill attributed the headaches to concussions she’d suffered and, like many women, figured her chest pain was stress-related. But Dr. Shaista Malik of the UCI Health Women's Heart Program, knew better.

MVD often undiagnosed — until now

Malik suspected Fill had coronary microvascular disease (MVD) — a form of heart disease that mainly affects women and isn’t detected by standard tests.

“Coronary microvascular disease is different from typical heart disease, where plaque builds up in the heart’s large arteries,” Malik explains. “MVD damages the tiny blood vessels that branch off the main arteries, reducing blood flow to the heart muscle.”

Until recently, coronary MVD, like many types of heart disease in women, was often undiagnosed. Now, a noninvasive test using technology called EndoPAT can help spot it.

A simple test for MVD

The EndoPAT test is simple:

  • A blood pressure cuff is inflated around one arm, briefly restricting blood flow.
  • When the cuff is released, a finger sensor measures how quickly blood returns to the arm.
  • Slowed blood flow suggests MVD, even in people who don’t have typical heart symptoms.

Some women, like Fill, have ministrokes and headaches as well as chest pain.

“Women often will have chest pain, but also additional heart disease symptoms compared to men, including nausea, fatigue and pain in the arms and neck,” Malik explains.

“Women who have any of these symptoms should be checked immediately. If standard tests are normal, doctors need to test for microvascular dysfunction. Heart disease is the leading cause of death in women, and we now have better ways to diagnose it.”

Diagnosis confirmed

Fill’s EndoPAT test was abnormal; a cardiac MRI and then a specialized angiogram called the Coronary Reactivity Test confirmed severely reduced blood flow to her heart. UC Irvine Medical Center is one of only three hospitals in California offering this test.

She now takes medication to treat MVD and is exercising again to improve her overall heart health. Her headaches and chest pain are much better, and she has a new job she loves: walking dogs.

“Dr. Malik saved my life,” she says. “If my heart disease hadn't been diagnosed, I might have had a heart attack or heart failure. I’m here today because I have great doctors.”

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