Since you asked – Does heart disease present differently in women?
With: Rachel Grimsley (RN, BSN, MSN)
You may be shocked to learn that heart disease is the number one killer of women. Not breast cancer, childbirth or domestic violence, but heart disease.
What the experts say
In the Your Health Unlocked podcast episode with Martha Gulati, MD, a cardiologist at Cedars-Sinai Heart Institute, we learned that women’s heart disease and heart attack symptoms are different. We also learned that women often do not receive the same level of care for heart disease as men.
What is Heart Disease?
Heart disease is a general term for various diseases that can affect the heart. These can include coronary artery disease, dysrhythmias such as atrial fibrillation, heart failure, and more [3]. Coronary artery disease is the most common form of heart disease and the number one cause of death for women with heart disease [3]. Coronary artery disease develops when plaque builds up in the walls of the arteries that supply this heart muscle, blocking blood flow to the heart.
What are the symptoms for men vs women?
Heart disease can go unnoticed or without symptoms until it reaches a point where it causes symptoms. Symptoms that may occur may include fatigue, shortness of breath and exercise intolerance. When the heart disease turns into a heart attack (acute coronary syndrome or myocardial infarction) is when additional symptoms begin.
When you think of a heart attack, you might imagine a man clutching his chest or holding his hand. What do you think about women?
Ninety percent of men and women experience chest pain or tightness when they have a heart attack [2]. In addition to breast pain, women often have three or more accompanying symptoms, including: [1,2]:
- Worry
- Chest pressure (like an elephant sitting on your chest)
- Tightness in the chest
- Chest discomfort
- Pain in:
- Shoulders
- Arms
- Neck
- Back
- Upper abdomen
- Jaw
- Breathing difficulty
- Fatigue
These symptoms may overshadow the initial chest pain, making it more difficult to diagnose women or leading to a medical bias not to look for heart disease in women.
How Does Treatment Differ?
The standard of care for heart disease and heart attack is the same for men and women. Treatment includes taking cholesterol-lowering medications, adjusting your diet to be heart-healthy, and increasing exercise. You may also have specific tests, such as blood tests, checking your blood pressure, electrocardiogram (ECG) or angiography.
Unfortunately, according to the experience of Dr. Gulati as a cardiologist and chair of the National Chest Pain Guidelines through the American College of Cardiology and the American Heart Association, women’s symptoms are still dismissed and treatment tends to be less aggressive than for men [2].
When someone has a heart attack and is taken to the hospital, when a heart attack is diagnosed, they are often taken straight to the catheterization lab, where their arteries are opened to restore blood flow to the heart [2]. However, statistically speaking, women are less likely to be taken to the catheter lab and less likely to receive the anti-clotting drugs that men often receive [2]. In addition, women are less likely to receive directed life-saving medical treatment within 24 hours, often leading to readmission to the hospital after treatment. After discharge, women are less likely to be referred for cardiac rehab [2]. Given that women receive substandard heart care before, during and after, it’s no surprise that heart disease is the number one killer of women, but it could be prevented in many cases.
To start taking charge of your heart health today, consider Life’s Essential Eight, from the American Heart Association [4].
- Eat Better
- Be more active
- Quit smoking (including vaping and smokeless/nicotine tobacco)
- Get healthy sleep
- Manage weight
- Cholesterol control
- Manage your blood sugar
- Manage blood pressure
What should I do if I think I’m at risk for heart disease?
At the National Women’s Health Network, we believe in self-advocacy, so we encourage you to learn more about heart disease, your risks, and advocate for heart health care that aligns with American Heart Association and American College of Cardiology Cardiac Care Guidelines.
Women have unique risk factors for heart disease. In addition to family history, blood pressure, and cholesterol, women should also consider the following as risk factors for heart disease [2]:
- High blood pressure or preeclampsia in pregnancy
- Preterm birth before 37 weeks
- Giving birth to a small-for-gestational-age baby
- History of early menopause
- Wolf
- Rheumatoid arthritis
- Breast cancer
If you think you are at risk for heart disease, make an appointment with your doctor and ask to have your heart thoroughly checked and see if you can be referred to a cardiologist.
If you have chest pains call 911 immediately and do not try to drive yourself to the hospital. If you suffer from a heart attack, you may pass out while driving, which could lead to an accident or not going to the hospital to save your life.
Sources
[1] Gulati, M. (2021, November 7). Guidelines for chest pain. https://drmarthagulati.com/martha-moments/f/chest-pain-guidelines
[2] Scheiber, A. (Host). (2024, February 22). Women’s Heart Health with Dr. Gulati (39) [Audio podcast episode]. In Your health is unlocked. National Women’s Health Network. https://nwhn.org/yourhealthunlocked-039/
[3] Centers for Disease Control and Prevention. (2024, January 9). Women and heart disease. CDC. https://www.cdc.gov/heartdisease/women.htm
[4] American Heart Association. (n). Life is necessary 8. Aha. https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8 [/vc_toggle]
We hope you found this information useful. If so, please consider joining the NWHN family to become a member here. Have a question of your own? Email us at [email protected]
The information on this website is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. All content, including text, graphics, images and information, contained on or made available through this website is for general information purposes only.
The continued availability of external resources is beyond the control of NWHN. If the link you are looking for is broken, please contact us at[email protected]to request more current reporting information.
