Experts Offer Virtual Second Opinions for Women With Heart Conditions

Newswise — LOS ANGELES (Dec. 14, 2023) -- The Smidt Heart Institute at Cedars-Sinai has expanded its popular Virtual Second Opinion Program to women living with or at risk of developing heart disease, the nation’s leading cause of death in women.

The institute’s specialists from the Barbra Streisand Women’s Heart Center are available to offer a convenient and customized second opinion via an easy-to-use online platform, giving women an opportunity to verify a diagnosis and explore treatment options, empowering them to make informed healthcare decisions.

Research shows that women with heart disease don’t always experience the same symptoms as men, making them vulnerable to being misdiagnosed. Led by women’s heart disease pioneer Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center, cardiologists in the Virtual Second Opinion program specialize in evaluating how sex and gender differences affect heart health and recommend treatment options with those unique differences in mind.

Heart conditions common to women include coronary microvascular dysfunction, coronary vasospasm, familial dyslipidemias, myocardial infarction with no obstructive coronary artery disease (MINOCA), novel cardiovascular disease risk factors, spontaneous coronary artery dissection (SCAD) and takotsubo cardiomyopathy.

Women who have genetic markers associated with an increased risk of heart disease, or those with a history of heart conditions who do not currently have symptoms, also are eligible to receive a preventive cardiology virtual second opinion from Cedars-Sinai, ranked best in California and #2 in the U.S. for Cardiology, Heart & Vascular Surgery by U.S. News & World Report’s “Best Hospitals 2023-2024.”

The Cedars-Sinai Newsroom spoke with the top women’s heart specialists to discuss how some heart conditions affect women differently and how a virtual second opinion can help.  

Tell us about coronary microvascular dysfunction.

Noel Bairey Merz, MD, director of the Barbra Streisand Women’s Heart Center and director of the Linda Joy Pollin Women’s Heart Health Program in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai: Coronary microvascular dysfunction is a type of heart disease in which there is abnormal blood flow in the tiny vessels in the heart. It can occur in men, but it’s more prevalent in women and affects women differently. Despite increased awareness of the condition, there is still much to discover. But the good news is that more education into sex and gender differences is becoming more prevalent in the cardiology field. And of course, the Women’s Ischemia Syndrome Evaluation study, an ongoing multicenter study that I am leading, sponsored by the National Heart, Lung, and Blood Institute, is helping change the way physicians approach heart disease in women.  

Why do women with heart disease often face problems getting diagnosed and treated?

Martha Gulati, MD, director of Preventive Cardiology and associate director of the Preventive and Rehabilitative Cardiac Center in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai: Multiple studies have shown that women often receive suboptimal treatment by their healthcare providers simply because some providers are not aware that heart disease symptoms in women are often different from those in men. For example, although 90% of men and women report having chest pain or pressure before a heart attack, women are more likely to experience additional symptoms, including profound fatigue, shortness of breath, jaw pain and shoulder pain. As a result, there is a real need for access to specialized cardiology experts for a virtual second opinion, especially for women. Many people are not aware that 2 in 3 American women have at least one risk factor for heart disease, and that 12 times as many women die of heart disease every year as die from breast cancer.

What is MINOCA—one of the conditions for which women can request a virtual second opinion from Cedars-Sinai?

Janet Wei, MD, associate medical director of the Biomedical Imaging Research Institute and co-director of the Stress Echocardiography Lab in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai: MINOCA is a heart attack that primarily affects women, and it’s caused by poor blood flow to the heart despite having no major blockage in the main arteries. One troubling aspect of MINOCA is that often when we diagnose a heart attack, we rely on a coronary angiogram to tell us if there’s a big blockage in the coronary arteries. So, with MINOCA, the angiogram can look normal because we don’t see a blocked artery, and then patients don’t know why they had a heart attack. Compared to heart attacks with obstructive coronary artery disease, MINOCA patients are more likely to be female and younger, and they’re also more likely to be Black or Hispanic/Latino. It's important that women—and providers—know that heart attacks can occur for a variety of reasons, and that the absence of obstructive coronary artery disease does not mean it’s not a heart attack.

The Virtual Second Opinion Process

Patients can request a Virtual Second Opinion by answering a few questions on the Cedars-Sinai website. They are then connected with a nurse coordinator who conducts a detailed interview and collects all necessary medical records.

Participants are then matched with a Cedars-Sinai physician with specialized expertise. The physician provides a detailed second-opinion report with an analysis of each participant’s past medical history and their previous doctor’s recommendations. The report also provides detailed answers to three questions participants can ask during enrollment. 

Participants also can take advantage of a live, virtual, 30-minute education session—from the comfort of their home—with their Cedars-Sinai expert to review the findings, ask additional questions and discuss actionable next steps.

Cedars-Sinai’s Virtual Second Opinion Program is available in Arizona, California, Colorado, Connecticut, Florida, Hawaii, Idaho, Montana, Nevada, New York, South Carolina, Utah, Virginia and Washington. 

Read more from the Cedars-Sinai Newsroom: First Lady Jill Biden Tours Cedars-Sinai Women’s Health Research Labs, Training Center