Ask Dr. Lo Silent Ischemia and Ischemic Heart Disease

by Dr. Thomas K. Lo

What Is Ischemia?

Ischemia is a condition in which the blood flow (and, thus, oxygen) is restricted or reduced in a part of the body. Cardiac ischemia is the name for decreased blood flow and oxygen to the heart muscle. Ischemia often causes chest pain or discomfort known as angina pectoris.

What Is Ischemic Heart Disease?

Ischemic heart disease is the term given to heart problems caused by narrowed heart arteries. When arteries are narrowed, less blood and oxygen reaches the heart muscle. This is also called coronary artery disease and coronary heart disease. This can ultimately lead to heart attack.

What Is Silent Ischemia?

Many Americans may have ischemic episodes without knowing it. These people have ischemia without pain—silent ischemia. They may have a heart attack with no warning. People with angina also may have undiagnosed episodes of silent ischemia. In addition, people who have had previous heart attacks or those with diabetes are especially at risk for developing silent ischemia.

Having an exercise stress test or wearing a Holter monitor—a battery-operated portable tape recording that measures and records your electrocardiogram (ECG) continuously, usually for 24-48 hours—are two tests often used to diagnose this problem.

What Should Women Know?

Heart disease is the leading cause of death for women. Women who have symptoms of ischemic heart disease are less likely than men to have obstructive coronary artery disease. However, they may be at greater risk for coronary microvascular disease and for serious complications of coronary artery disease, including blood clots in the heart’s arteries.

Why Does Ischemic Heart Disease Affect Women Differently?

Ischemic heart disease is different for women than men because of hormonal and anatomical differences. Before menopause, the hormone estrogen provides women with some protection against ischemic heart disease. Estrogen raises “good” HDL cholesterol and helps keep the arteries flexible, so they can widen to deliver more oxygen to the tissues of the heart in response to chemical and electrical signals. After menopause, estrogen levels drop, increasing a woman’s risk for ischemic heart disease.

What Conditions Affect Risk Differently for Women?

Eighty percent of women, ages forty to sixty, have one or more risk factors for ischemic heart disease. Having multiple risk factors significantly increases a woman’s chance of developing ischemic heart disease, and they are more likely than men to have medical conditions or life issues that raise their risk for ischemic heart disease. Some of these conditions are: anemia, especially during pregnancy; the use of hormonal birth control; endometriosis; high blood pressure after age sixty-five; inflammatory and autoimmune diseases; and lack of physical activity. Mental health issues, such as stress, marital stress, anxiety disorders, depression, or low social support; overweight and obesity; problems during pregnancy, including gestational diabetes and preeclampsia and eclampsia; diabetes; low levels of HDL cholesterol; and smoking are also risk factors.

Can Symptoms Differ for Women?

Although men and women can experience the same symptoms of ischemic heart disease, women often experience no symptoms or do not have the same symptoms men do.

Activity that brings on chest pain is different in men and women. In men, angina tends to worsen with physical activity and go away with rest. Women are more likely to have angina while they are resting or sleeping. In women who have coronary microvascular disease, angina often happens during routine daily activities, such as shopping or cooking, rather than during exercise.

In addition, with location and type of pain, women are more likely to describe their chest pain as crushing, or they say it feels like pressure, squeezing, or tightness. Men say their pain is aching or dull. Women more often say they have pain in the neck and throat. Men usually describe pain in the chest.

Other common signs and symptoms for women include nausea, vomiting, shortness of breath, abdominal pain, sleep problems, fatigue, and lack of energy.

The severity of symptoms can also vary. They may get worse as the buildup of plaque continues to narrow the coronary arteries. Chest pain or discomfort that does not go away, occurs more often, or while you are resting may be a sign of a heart attack. If you have “silent” ischemic heart disease, you may not experience any symptoms until you have complications, such as acute coronary events, including a heart attack. Women are also more likely than men to have no symptoms of ischemic heart disease.

What are the Signs, Symptoms, and Complications for men and women?

Signs, symptoms, and complications will vary based on the type of ischemic heart disease you have. An acute coronary event, such as a heart attack, may cause symptoms such as angina, which can feel like pressure, squeezing, burning, or tightness during physical activity and usually starts behind the breastbone, but it can also occur in the arms, shoulders, jaw, throat, or back. Other symptoms are cold sweats, dizziness, light-headedness, nausea or a feeling of indigestion, neck pain, shortness of breath, sleep disturbances, and weakness. Chronic ischemic heart disease can cause signs and symptoms such as angina, anxiety or nervousness, fatigue, and neck pain.

Can Ischemic Heart Disease Cause Serious Complications?

Some complications may be acute coronary syndrome (including angina or heart attack), arrhythmia, cardiogenic shock, heart failure, stroke and sudden cardiac arrest.

What Do Women Need to Know About Diagnosis and Treatment?

Doctors are less likely to refer women for diagnostic tests for ischemic heart disease. When women go to the hospital for heart symptoms, they are more likely than men to experience delays receiving an initial EKG, are less likely to receive care from a heart specialist during hospitalization, and are less likely to receive certain types of therapy and medicines. Younger women are more likely to be misdiagnosed and sent home from the emergency department after cardiac events that occur from undiagnosed and untreated vascular heart disease.

If you struggle with health issues and would like a free screening, call the Advanced Chiropractic & Nutritional Healing Center at 240-651-1650. Dr. Lo uses Nutritional Response Testing® to analyze the body to determine the underlying causes of ill or non-optimum health. Free seminars are also offered and are held at the office on rotating Tuesdays and Thursdays. The office is located at 7310 Grove Road #107, Frederick, MD. Check out the website at www.doctorlo.com.