Women with Repeated Chest Pain, Nurse Practitioners, and the Multifunction Cardiogram

In the last post, I told the story of a single woman with repeated chest pain. That is an exceedingly common problem. In my own practice, I had 25 women like that. They were all the same. None of these women had been diagnosed in the usual care system. Oh, they had stress tests and heart catherization, but minimal or no heart artery blockage was discovered. They were told it is not your heart, it is your esophagus, or worse, your heart is ok, just go home and take your Prozac.

If a woman smokes, and she has chest pain relieved by nitroglycerin, her chest pain is very likely to be from her heart and she should be on optimal medical therapy (OMT). If a woman is diabetic or over 50 and her chest pain is relieved by nitroglycerin, she should be on OMT. The women I treated were very distressed. Chest pain related to heart artery disease is frightening. It is often severe and accompanied by shortness of breath and a sense of dread and doom. These women keep returning to the ER, the hospital and the cath lab and it becomes very expensive. If they don’t get an answer and a solution, it CAN be depressing. These women all got better on OMT and they were among the most grateful patients I ever treated. Within a year, their chest pain was gone. Because these women repeatedly return for expensive tests, hospitalizations, and ER visits, their care becomes very costly. In 2006, women with non-obstructive heart artery disease cost $750,000 each over their lifetime. Their care would be more expensive today.

Since they have minimal or no blockage, their pain pattern is different. It may come on with fatigue, emotion, or stress. It is often not related to exertion. Their disease is different, and the answers are different. The specific research on heart artery disease in women has been done, but women are not receiving the benefit. The testing is different. Stress tests and catheterizations do not make the diagnosis for many of them. There is a new kind of cardiogram that uses artificial intelligence to establish EKG patterns in patients with a known diagnosis of heart artery disease or heart failure. The metabolic changes and scarring change the electrical current pattern slightly and the multifunction cardiogram (MCG) is able to pick that up. My neighbor Jean had a normal heart catheterization but her MCG was very abnormal. The MCG score can improve with optimal medical therapy.

Nurse practitioners are predominantly women. Many of them will ultimately experience the women’s ischemia syndrome and some of them will die from it. Nurse practitioners can practice independently in over half of our states. Many towns in those states are over 100 miles from a cardiologist or a cath lab. A nurse practitioner armed with an MCG providing optimal medical therapy could provide exceptional care for these women and that should be a national priority. Half of our adult population is at risk. Neither the MCG nor OMT is available to most American women. That needs to change.