Improving the Diagnosis of Heart Disease in Women

Dr. Shah’s team is studying 100 women over two years who get referred for coronary angiography to Yale New Haven Hospital and comparing outcomes for patients who receive the standard care with those undergoing the cutting-edge tests to detect coronary microvascular disease or vasospasm. His goal is to show the value of the new tests, already covered by insurance, so they become the standard of care for patients — mostly women — who have reduced blood flow to the heart but no obstruction.

Dr. Samit Shah has seen it too often.

Women come to a hospital Emergency Department or doctor’s office complaining of chest pain, shortness of breath, nausea, lightheadedness, jaw pain, or other symptoms considered concerning for a heart problem. The women might undergo standard testing to see if they have a critical cholesterol blockage in their arteries, the hallmark of obstructive coronary artery disease.

But only 50 percent of women presenting with these symptoms show a blockage after cardiac catheterization — a procedure in which a long, thin tube is inserted through the blood vessels to the heart — and an angiogram — an x-ray of the blood vessels taken to show the blood supply to the heart muscle. If a blockage is not detected, they are often sent home without additional testing or a clear diagnosis.

A New Standard
Dr. Samit Shah is studying the effectiveness of tests to detect heart conditions, more common in women, that elude a standard angiogram.

“Women are suffering because of this,” said Shah, an interventional cardiologist at Yale School of Medicine. “If we tell patients they have no blockages, but don’t do further testing, they will have ongoing symptoms and probably end up in the ER again. If we take the extra steps that we are now learning to take, we can make accurate diagnoses and help patients better manage their disease.”
Dr. Samit Shah

With this year’s Wendy U. and Thomas C. Naratil Pioneer Award from Women’s Health Research at
Yale, Dr. Shah is leading a team to demonstrate the effectiveness of validated, but not widely administered procedures for the many women who have reduced blood flow to the heart without blocked arteries or cholesterol build-up often associated with heart disease.

“ If we can give women a diagnosis, we can avoid future invasive procedures and help them to better manage their health. ”

- Samit Shah, MD, PhD

People with microvascular disease benefit from different medications than patients with coronary vasospasm, and sometimes when you mix them together, people do worse, Shah said. By demonstrating the effectiveness of these additional tests, he hopes to better target medical therapies to meet patients’ needs.

Dr. Samit Shah earned his M.D. and Ph.D. from University of Illinois School of Medicine and his B.S. from Pennsylvania State University. At Yale, he is an Assistant Professor of Clinical Medicine and a practicing interventional cardiologist who specializes in the invasive evaluation of coronary physiology as well as coronary and peripheral vascular interventions.

Dr. Shah’s scholarly work has focused on coronary physiology and peripheral vascular disease. He has active research projects at Yale regarding the invasive assessment of coronary physiology, including coronary microvascular disease and endothelial dysfunction, as well as the vascular effects of psychological stress.

Click here to read the full article regarding Dr. Samit Shah’s new study.


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