Healio: Increased Physician Recognition Needed for INOCA, MINOCA
Healio recently featured remarks by Martha Gulati, MD, director of Preventive Cardiology in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, about the need for increased awareness and better diagnostic tools for two commonly overlooked heart conditions.
Ischemia with no obstructive coronary arteries (INOCA) and myocardial infarction with no obstructive coronary arteries (MINOCA) are two heart conditions that are more common in women than in men. INOCA is a chronic condition caused by reduced blood flow to the heart, and MINOCA is a type of heart attack. Both can cause a significant decline in quality of life, Gulati told clinicians during a presentation at the World Congress on Insulin Resistance, Diabetes & Cardiovascular Disease.
Gulati explained that, in the past, clinicians were taught if there were no obstructions (blockages) in a patient’s coronary arteries, then they couldn’t have a heart attack. But physicians now understand obstructive coronary disease is only one form of ischemic heart disease.
Gulati told clinicians many people living with INOCA or MINOCA wait more than a decade for a proper diagnosis. In the meantime, patients can receive the wrong treatment, be hospitalized repeatedly or experience even worse outcomes.
“When you see someone with nonobstructive coronary disease, I would encourage you to at least do some further testing, whether it is noninvasive imaging or coronary function testing,” said Gulati, associate director of the Barbra Streisand Women’s Heart Center at Cedars-Sinai.
She told clinicians that unlike coronary artery disease, in which a patient’s quality of life can improve after a heart attack, people with INOCA or MINOCA continue to experience physical, mental and social health challenges.
“We have work to do with these patients,” she said. “The functional-capacity declines should be a warning sign that they are not living life normally, and those are people you would consider for further testing and more aggressive medical management.”
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