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I'm a woman, experiencing symptoms of heart disease. I've had several tests, and am waiting for follow-up exam. Will I need treatment and how active can I be? 

I am a 54 year old female. I went to a cardiologist because I have had heart attack symptoms and I get very short of breath with any activity. I tire extremely fast and miss an active life. I have a family history of heart disease, both mother and father. I have untreated high cholesterol for 5 years. Echocardiogram findings: Ejection fraction 55%. Normal left ventricular function. Trace to mild mitral regurgitation. Exercise Cardiolite spect evaluation - impression: cannot rule out very mild reversible perfusion defect along the anterior and anteroseptal wall. This could be due to breast attenuation artifact. Preserved left ventricular function with ejection fraction 69% with normal motion thickening. EKG negative, chest pain negative exercise treadmill testing. I was scheduled for follow-up appointment for test results last week but due to emergency surgery my appointment was rescheduled for March. What does this all mean? Will I need treatment and how active can I be? Thank you.

submitted by Cindy from West Virginia on 2/15/2013


Deborah Meyers, MDby Texas Heart Institute cardiologist, Deborah E. Meyers, MD  

Dear Cindy, Thanks for your question. I really understand from your letter how genuinely concerned you are. And frankly, what you describe likely warrants further consultation with your cardiologist. 
You are a 54 year old woman  with the risk factors of hyperlipidemia and a strong family history of heart disease whose symptoms are limiting your life and your activity.  You do not mention how old your parents were when they began to suffer from heart disease. If it was early in life ( 40’s or 50’s) that would raise concern. You  also do not say if you have high blood pressure or if you are a past or current smoker or a diabetic. These factors would add to your risk profile.
Your stress test was done with imaging which is particularly important in woman, as treadmill tests alone are a bit less reliable in women than in men. Your result however is a bit equivocal with the findings that you describe of “a reversible defect in the anterior and anteroseptal wall” . Sometimes breast tissue can confuse the interpretation of these images, but in light of your ongoing symptoms, you need to discuss a diagnostic angiogram with your doctor. This is the “gold standard” test that will definitively rule out atherosclerotic coronary disease as a possible culprit of your symptoms. In the meantime your doctor may wish to give you some medication until all of the testing is completed to address your risk factors and symptoms.
Until you see your doctor to discuss these results I suggest that you participate in “symptom limited activity”. This is a fancy way of saying listen to your body. You can do things as long as the activity does not cause you distress, and you should be able to speak comfortably with activity. If you are getting so breathless that you have trouble speaking comfortably then slow down, stop, or rest. If you have chest pain that persists beyond 15 minutes you need to go to an emergency room.  
It is great that you are seeking treatment and advice for these troubling symptoms. Lots of times women simply do not understand that heart disease is very much a women’s health issue. They think that this is a male disease, and that could not be further from the truth.
All of the very best to you.   

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Updated February 2013
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