New guidelines for diagnosing heart attacks tell doctors to consider a key difference between women and men: the levels of a protein in heart muscle cells.
This change could help some women get the right diagnosis and treatment sooner, said Dr. Christopher deFilippi, a cardiologist at the University of Maryland Medical Center and a professor at the university’s medical school.
According to guidelines released in August by the American Heart Association, the American College of Cardiology, the European Society of Cardiology and the World Heart Federation, doctors should use different cutoffs for women and men when reading cardiac troponin test results.
Troponin can enter the bloodstream when a heart is injured, and a one-size-fits-all threshold can cause doctors to overlook heart attacks and other heart problems in women.
“Women have heart attacks at lower troponin test levels than men,” deFilippi told WTOP.
The troponin test may be especially important when a person arrives at the emergency room with possible heart attack symptoms. Doctors can use it when an electrocardiogram, or ECG, doesn’t give a clear answer.
“Some women will be diagnosed and receive appropriate treatment quickly, when they may have been missed before,” deFilippi said.
Most hospitals in the United States and central Maryland already use troponin levels lower than those recommended by the Food and Drug Administration, he said. The new guidelines go further by integrating these thresholds into the formal definition of cardiac damage.
“I don’t think for our region we’ve missed too many diagnoses, but I think it will still be helpful. For some, it’s going to make a difference,” deFilippi said.
Dr. deFilippi said the goal is not simply to diagnose more heart attacks in women. It’s about making sure they get the right diagnosis and treatment.
A simpler way to classify heart attacks
The new definition also changes how heart attacks themselves are classified.
The old system assigned numbers to heart attacks. The new system classifies them into three groups: primary, secondary and procedure-related.
The organizations behind the guidelines said the simpler categories should make diagnoses more consistent and better describe what’s happening in the body.
A primary heart attack is the type that many people are most familiar with. This happens when a sudden problem in an artery that supplies blood to the heart, such as a blood clot, blocks blood flow.
A secondary heart attack occurs when another health problem prevents the heart from getting the oxygen it needs. DeFilippi said this can happen when a person has a serious infection, is bleeding or has another illness that puts significant stress on the heart.
A procedure-related heart attack can occur as a complication of a heart procedure, such as having a stent inserted to open an artery or having heart surgery performed.
“The type of heart attack you have can really direct the type of treatment you receive immediately,” deFilippi said.
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