Coronary Microvascular Syndrome:
The New Risk for Women
Donald Aulds, M.D.
The recently described risk for women is coronary microvascular syndrome (CMS). It is estimated that over three million women in this country have CMS that has not been diagnosed. The National Heart, Lung, and Blood Institute recently reported a study about CMS called the Women's Ischemic Syndrome Evaluation (WISE). The study reported that chest pain that is typical for angina is less likely to be associated with obstructive coronary artery disease in women than men. Women with chest pain in the absence of coronary artery disease are at low risk of adverse cardiac events, but are often undergoing frequent diagnostic evaluations and hospitalizations.
What are the symptoms that should be look for?
Women who have been diagnosed with CMS have usually experienced shortness of breathe or chest pain. When studies for the heart are done, no angiographic evidence of coronary artery disease is found. Usually no further studies are done. Recent studies have shown that when further studies are performed, as high as 52% of the participants had CMS.
What is the cause of CMS?
Unlike typical heart disease in which plaque accumulates in the large arteries of the heart, CMS has plaques that build up in small arteries of the heart. These arteries are too small to be seen on angiography, so they are missed in the typical studies to diagnose the cause of chest pain. The small arteries become narrowed that decrease the oxygen flow to the heart. This leads to the chest pain and an increase in the risk of a heart attack.
What are the implications of CMS?
Although over 80% of people with CMS are women, it is not exclusively a disease of women. Heart disease is responsible for nearly one half million deaths each year in our country. CMS has been shown to account for 15% of all coronary artery disease when both sexes are included in the statistics. No studies have yet reported what percent of cardiac deaths in women is related to CMS. The WISE study showed that women diagnosed with CMS had normal coronary angiogram but over 10% died or had a heart attack within four years. The study also showed that women with no blockage on angiogram had a 50% risk of having CMS which caused ischemic heart disease. Recently the National Institute of Health released a statement that when a diagnosis of CMS is missed, women are not treated for their chest pain and they remain at high risk for having a heart attack.
What can be done for undiagnosed chest pain?
If you are a woman and have experienced chest pain, shortness of breathe, fatigue or other symptoms of heart disease, talk to your physician about the risk of CMS. The main message for women is to pay attention to your symptoms. Don't always assume that there is no problem present even if studies do not show a definite problem. If symptoms are present, talk to your physician about studies that can be done to check for CMS.
What tests are available?
- Take a "functional capacity test" which is a questionnaire that evaluates your ability to perform activities. Studies have shown that women with normal angiograms, but a low capacity test are at increased risk of heart attack.
- MRI scan of the heart is helpful in some situations.
- Treadmill testing only detects 40% of heart disease in women with ischemic disease.
If you have symptoms, check with your physician for the best form of testing to see if CMS is present and whether you are at risk of having heart disease.
More about Dr. Aulds
Donald G. Aulds, MD is an Obstetrician and Gynecologist and currently serves as the Medical Director for both the Women's Center and the Best Start Program of North Alabama. He is a Diplomat of the American Board of Obstetrics and Gynecology and Fellow of the American College of Obstetricians and Gynecologists.
Dr. Aulds completed his medical education at Louisiana State University School of Medicine, New Orleans, LA and his Internship and Residency in Obstetrics and Gynecology at Ochsner Medical Foundation, New Orleans, LA.
Dr. Aulds has been an active member of the Huntsville Hospital Medical Staff since 1980.
