Women Who Have Heart Disease

The first noticeable symptoms of coronary heart disease in women may be angina, which is a periodic pain or discomfort in the chest that is caused by reduced blood flow to the heart. This pain usually occurs behind the breastbone and may travel down your left arm or up your neck, or be a squeezing, pressing sensation that does not change with breathing. It is typically caused and worsened by exercise and eased by rest. The pain usually lasts 2 to 5 minutes. Some women get a less typical angina.

The chest pain may last longer, occur in a location other than behind the breastbone, or not be worsened by physical activity and eased by rest. Some women have shortness of breath or indigestion.

If you have any of these symptoms, you should contact your doctor. With treatment, the outlook is good. Without treatment, however, the symptoms may recur and worsen, and even lead to a heart attack.

In most cases, you will need to have some tests to find out for sure whether you have coronary heart disease, and also to find out how severe your condition is. If your doctor does not mention tests, be sure to ask him or her whether tests could be helpful. (See " You and Your doctor: A Healthy Partnership") To get complete information about your condition, you may need more than one test. Most of them are done outside the body and are painless. The most common tests are as follows:

*An 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 bicycle. Some older women may not be able to exercise due to arthritis or another condition. In such cases, a stress test can be done without exercise by using a medicine that increases blood flow to the heart muscle and shows if there are any problems in that flow.

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

*A 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 then records how much is taken up by the heart muscle.

*Coronary angiography (or angiogram or arteriography) shows an x-ray of blood flow problems and blockages in the coronary arteries. A thin, flexible tube, or catheter, is threaded through an artery of an arm or leg up into the heart. A fluid is then injected into the tube, allowing the heart and blood vessels to be filmed as the heart pumps. The picture is called an angiogram or arteriogram.