The hospital is examining microvascular angina, known as cardiac syndrome X, which may result in chest pain in women and may not be immediately diagnosed as a heart-related issue, Dankle says. While in the past there was no known link between microvascular angina and increased risk for cardiac events such as heart attack, newer studies are challenging that view, she says. Microvascular angina feels much like angina pectoris, which can produce chest pain or discomfort, a crushing or burning sensation in the chest, and pain or numbness in arms, shoulders, or jaw. While angina pectoris results from insufficient blood flow to the heart through the coronary arteries, microvascular angina results from inadequate blood flow through tiny cardiac blood vessels.
“Women may have an unexplained chest pain and are sent home with an antidepressant and anti-anxiety medication, when in fact they are having angina or chest pain related to their heart,” Dankle says. “I don’t know of any particular gender-based approach in patients admitted to the hospital for chest pain. But uncertainty in diagnosis of a female’s symptoms may require the assistance of a provider who specializes in women’s cardiology.”
There has been an increase in outpatient services in cardiac care for women, says Debra Rudquist, FACHE, executive of the cardiovascular service line for Fairview Health Services in Minneapolis. “Certainly having a women’s heart program helps educate women and brings them into the clinic,” Rudquist says. “A women’s heart program increases your outpatient volume and is another way to reach out to the community. More organizations are predicting more women coming in for cardiovascular service.”
While there are male cardiologists employed at the center, most are women, Dankle says. “I have learned that men don’t always speak ‘Venutian’ well and women tend to feel more comfortable with a female provider,” Dankle says.
The Bon Secours Richmond Health System has initiated a robotic heart surgery for mitral valve prolapse, a condition that occurs when a left-side heart valve does not close properly. The minimally invasive procedures have attracted more women patients because it results in reduced scarring and pain, and offers the prospect for a quicker return to normal activities, according to Marc Katz, MD, chief medical director for the Heart and Vascular Institute and head of the minimally invasive surgery program.
The cardiac surgery performed with the da Vinci surgical system uses robotic instrumentation to allow cardiothoracic surgeons to perform precise incisions through small openings, says Katz. He says Bon Secours Richmond Health System began the program in 2008. At least 50 procedures were performed, with a 96% success rate, he says.
Fewer insertion points have made the surgery appealing to women, he says. The procedure allows physicians to refrain from cutting the chest open, and the incision is similar that of minimally invasive abdominal surgery. The incision is five ports of one-half inch each instead of the 6 to 8 inches required for traditional surgery.
“We are seeing patients seeking it as an elective procedure, and their hospital stays are a fraction of what it may otherwise be,” says Katz. Women, in particular, have been interested in the procedure because of the nature of the small incision, “instead of a big scar,” he adds.