Women’s chest pain can be a commonly misunderstood and misdiagnosed condition, but Northwell Health’s newest program is seeking to address this issue.
“It treats a condition, or set of conditions, I should say, that disproportionately affect women,” the program’s Dr. Nisha Parikh said. “And when a hospital doesn’t have such a center, there’s this missing piece for women when it comes to heart disease diagnosis and treatment.”
Northwell Health launched its Advanced Chest Pain Program at the Katz Women’s Hospital at the Long Island Jewish Medical Center in New Hyde Park.
The program is tailored to diagnose a set of conditions called ischemia and non-obstructive coronary arteries.
These conditions are not associated with the traditional heart disease identifiers like artery blockages, which can make it more difficult to diagnose.
About 75% of patients with these bloodflow-restrictive conditions are women, according to Northwell Health. Heart disease is also the leading cause of death for women globally, according to the American Heart Association.
Parikh, system director of Northwell Health’s Women’s Heart Program and director of cardiovascular medicine at the Katz Institute for Women’s Health, said gender disparity in cardiology is what inspired her to pursue this field.
“So many of us in the field have noticed for decades that women’s cardiovascular symptoms tend to get dismissed,” Parikh said. “ And so, therefore, women are sort of under-recognized to have heart disease.”
Parikh said these disparities can be attributed to both an “implicit bias” in the healthcare system and a lack of education for women about heart disease and how it affects them.
But what makes this even more difficult, Parikh said, is also the advanced technology needed to diagnose ischemia, which mainly affects women.
“So it’s really a perfect storm,” Parikh said.
But Parik said this program is seeking to change the path of this storm.
The center serves as a clinical space with physicians and providers who have expertise in diagnosing these conditions. These include microvascular dysfunction and coronary artery spasms, which cause chest pains and heart attacks.
Patients, who may also be referred to the center, would be able to meet with physicians about their symptoms and undergo diagnostic testing.
Noninvasive testing includes a cardiac MRI, nuclear imaging, exercise or stress test, echocardiograph or electrocardiograph.
If necessary, patients would also be referred for potentially more invasive testing to diagnose their condition.
If diagnosed with a condition, the next step would be treatment. This, too, would be provided at the center.
The two main conditions that this program is geared to addressing are artery spasms and microvascular disease.
Ischemia refers to a condition causing a lack of blood flow to the heart but not caused by artery blockages as typically associated with heart disease.
One of the conditions most difficult to diagnose, Parikh said, is spasms in the arteries.
Arteries are muscular systems, and like any other muscle in the body can spasm, Parikh said.
Parikh described the blood vessel network in terms of water systems.
Blood vessels can be seen with the naked eye, comparing the size to that of a river, while microvessels that branch from the vessel are akin to a small tributary that runs off a river.
These small microvessels can also experience spasms.
The testing done at the center can locate dysfunction within these microvessels.
Parikh described artery spasms as a tube collapsing in on itself, closing the tube and impeding blood flow as it contracts. This can then transpire as the feeling of chest pain.
Because artery spasms are not constant, Parikh said arteries can appear to be normal when undergoing testing.
Like other conditions causing heart disease, Parikh said heart ischemia can be correlated with a poor diet or lack of exercise. But there is also likely a genetic component and an association with mental health conditions like anxiety for a small subset of patients, Parikh said.
Patients who may be referred to this program are those who have identified chest pain yet testing has not shown any blockages, or those with weakened heart muscles with as yet no known cause.
