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The Healthy Heart Handbook for Women

FOR WOMEN WHO HAVE HEART DISEASE

If you have heart disease, it is extremely important to control it. Eating well, engaging in regular physical activity, and maintaining a healthy weight will need to quit. And if you have diabetes, you will need to manage it carefully.

You also may need certain tests, medications, or special procedures. This section explains each of these and how they can help to protect your heart health.

Screening Tests

In most cases, you will need some tests to find out for sure if you have heart disease and how severe it is. If your doctor doesn't mention tests, be sure to ask whether they could be helpful. Most screening tests are done outside the body and are painless. After taking a careful medical history and doing a physical examination, your doctor may give you one or more of the following tests:

  • Electrocardiogram (ECG or EKG) makes a graph of the heart's electrical activity as it beats. This test can show abnormal heartbeats, heart muscle damage, blood flow problems in the coronary arteries, and heart enlargement.

  • Stress test (or treadmill test or exercise ECG) records the heart's electrical activity during exercise, usually on a treadmill or exercise bike. The test can detect whether the heart is getting enough blood and oxygen. If you are unable to exercise due to arthritis or another health condition, a stress test can be done without exercise. Instead, you will be given a medicine that increases blood flow to the heart muscle and makes the heartbeat faster, mimicking the changes that occur when you exercise. This test is usually followed by a nuclear scan or echocardiography to see whether there are any problems with the blood flow to the heart.

  • Nuclear scan shows the working of the heart muscle as blood flows through the heart. A small amount of radioactive material is injected into a vein, usually in the arm, and a camera records how much is taken up by the heart muscle.

  • Echocardiography changes sound waves into pictures that show the heart's size, shape, and movement. The sound waves are also used to see how much blood is pumped out by the heart when it contracts.

  • Cardiac catheterization is a medical procedure used to diagnose and treat certain heart conditions. A long, thin, flexible tube called a catheter is put into a blood vessel in the arm or upper thigh (groin) and threaded up into the heart. Through the catheter, the doctor can perform diagnostic tests and treatments on the heart. The diagnostic tests include the following:

  • Coronary angiography (or angiogram or arteriography) shows an x ray of blood flow problems and blockages in the coronary arteries. A dye is injected into the catheter, allowing the heart and blood vessels to be filmed as the heart pumps. The picture is called an angiogram or arteriogram.

    • Ventriculogram is sometimes a part of the x-ray dye test described above. It is used to get a picture of the heart's main pumping chamber, typically the left ventricle.

    • Intracoronary ultrasound may be done during a cardiac catheterization to measure blood flow. It gives a picture of the coronary arteries that shows the thickness and other features of the artery wall. This lets the doctor see blood flow and any blockages.

COULD YOU HAVE HIDDEN HEART DISEASE?

Many women have undiagnosed heart disease—even after getting tested for it. New research shows that up to 3 million women in the United States have a hard-to-spot form of heart disease called" coronary microvascular syndrome," in which plaque spreads evenly throughout the walls of very small arteries, rather than building up in a larger, main artery. Even though women with this condition have insufficient blood and oxygen flow to the heart muscle, a standard angiogram (which is designed to pick up blockages in large arteries)is likely to show their arteries to be normal.

This means that women with heart disease symptoms should be prepared to speak up to their doctors. If you receive a "normal" angiogram but still have chest pain or other heart symptoms, ask your doctor whether you might have a problem with the functioning of your small arteries. To find out, you may be asked to undergo relatively simple tests, such as a questionnaire that measures how easily you can perform everyday tasks. This quiz, called the "Duke Activity Status Index," can help to predict your heart attack risk.

In addition, several new, highly sensitive screening tests have been developed. Ask your doctor about these tests:

  • Carotid doppler ultrasound uses sound waves to detect blockages and narrowing of the carotid artery in the neck. Both conditions can signal an increased risk for heart attack or stroke.

  • Electron-beam computed tomography (EBCT) is a superfast scan that provides a snapshot of the calcium buildup in your coronary arteries. It may predict whether you'll be at higher risk for heart disease in the future. This test is promising, but not foolproof, and requires careful evaluation by your doctor.

  • Magnetic resonance imaging (MRI) is a scan using magnets and computers to create high-quality images of the heart's structure and functioning. It is often used to evaluate congenital heart disease. The test can also detect severe blockages in coronary arteries in people who are having unstable angina or a heart attack, thereby allowing immediate treatment to restore blood flow to the heart.

ASPIRIN: TAKE WITH CAUTION

This well-known "wonder drug" can help to lower the risk of a heart attack or stroke for those who have already had one. It can also help to keep arteries open in those who have had a previous heart bypass or other artery-opening procedure, such as angioplasty. In addition, aspirin is given to people who arrive at a hospital emergency department with a suspected heart attack or stroke.

It's important to know that aspirin has not been approved by the U.S. Food and Drug Administration for the prevention of heart attacks in those who have never had a heart attack or stroke.

However, a recent large study has found that among healthy women, taking low-dose aspirin every other day may help to prevent a first stroke. Among women over the age of 65, low-dose aspirin every other day may also prevent a first heart attack. If you are considering taking aspirin for this purpose, keep in mind that it is a powerful drug with many side effects. It can also mix dangerously with other drugs, including some over-the-counter medicines and dietary supplements.

If you're thinking about using aspirin either to treat or prevent heart problems, talk with your doctor first. Only a doctor who knows your medical history and current health condition can judge whether the benefits would outweigh the risks. If aspirin is a good choice for you, be sure to take the dose recommended by your doctor.

If your doctor does advise you to take aspirin, be sure to continue practicing the "Big Four" heart healthy habits—eating nutritiously, getting regular physical activity, maintaining a healthy weight, and for those who smoke, quitting. Aspirin can be a useful treatment for some people, but it is not a substitute for a healthy lifestyle.

Table of Contents Next: Medications

Last Updated: February 29, 2012

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