Heart disease remains the leading killer in the United States among both men and women. With significant disparities in research studying the impact of heart disease between men and women, however, many women are simply unaware of the different ways heart disease presents in their bodies.
Subtle, ambiguous, deadly
During a heart attack, women often experience subtler symptoms than those of men. While they may feel the same crushing chest pain most men feel, their symptoms may also be ambiguous, easily dismissed as symptoms of the flu.
Women may feel nauseated or experience discomfort in the elbow or jaw, even the upper back. They could experience chest pain, but it could also be absent. They may feel pain in the abdomen or lower chest, or simply feel a sense of pressure in these areas.
Some women may report feeling extreme fatigue, and a sense of fainting, accompanied by shortness of breath, even with minimal activity.
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Other common symptoms of heart attacks in women may include:
- Pain in one or both arms
- Lightheadedness or dizziness
- Heartburn or indigestion
Consequently, women having heart attacks may mistake their own symptoms for that of something less serious. They may delay seeking assistance, which can have fatal consequences.
A woman experiencing any of these symptoms should report them promptly to her healthcare provider. She should not, however, drive herself to a medical facility. Advise patients to dial 911 in cases of emergency.
Women should also report irregular or “stuttering” heartbeats, especially if these symptoms occur after sporadic alcohol consumption. Missing the onset of atrial fibrillation could lead to an ischemic stroke or pulmonary embolism, both preventable with early detection of irregular rhythms.
A data disparity
The responsibility for assessing cardiac risk in women’s health is twofold. Healthcare professionals may passively overlook a woman at high risk for cardiovascular disease while actively counseling the woman’s male partner to cut saturated fat or lose weight.
Nicknamed “Yentl Syndrome” in a seminal paper by Bernadine Healy, M.D., this phenomenon describes situations in which women are misdiagnosed or provided with sub-optimal care because their symptoms do not match up with traditional male symptoms.
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Clinicians can assist their patients in identifying symptoms, as well as understanding and managing risk factors for heart disease.
Understanding the risks
The causes of heart disease are complex and varied. Some pre-existing risks cannot be changed, e.g. family history, genetic hypercholesterolemia, history of hyper-coagulopathy, menopause, etc. There are, however, a number of lifestyle factors that patients, both men and women, can adopt to help reduce the risk of heart disease.
Clinicians can use these factors to evaluate a patient’s risk with the Framingham Risk Assessment. Developed over the course of the multi-generational Framingham Study, a Framingham Risk Assessment is used in non-diabetic patients aged 30-79 years old who have not experienced a prior coronary event. The score assesses an individual’s risk for a cardiac event within the next 10 years.
The assessment draws on systolic and diastolic BP (or BP values on medication, if treated), age, gender, smoking status, total cholesterol, and HDL cholesterol. Healthcare professionals make use of multiple Framingham models with the goal of identifying high-risk patients. Clinicians can advise women who score a higher risk for myocardial infarction of the ways in which they can actively reduce their risk.
Modifying lifestyle factors
One of the biggest risk factors for heart disease is smoking. Cigarette smoking will lead to coronary artery disease three times faster than the time it takes to produce lung pathology for most.
Other modifiable risk factors include: BP, weight, cholesterol, and activity. Working on diet modification to replace saturated fats and reduce cholesterol is an excellent plan, as is the introduction of mild exercise, particularly walking.
If hypertension is present, medication may be needed to keep systolic and diastolic numbers within normal range. Newer guidelines from the American Heart Association establish 130/80 as borderline hypertensive, and 120/80 or below as ideal.
For patients that are clinically Stage I hypertensive (without a prior cardiovascular event), dietary modifications may be recommended, such as cutting out caffeine, salt, saturated fat, and excessive sugars.
Understanding the risk of BMIs greater than 25 and waist measurements greater than 35” (except for pregnancy) are also important for cardiac risk reduction, as is the need to realize the risk for diabetes or pre-diabetes via A1C values.
- Activebeat.com. “Heart attack red flags for women you should recognize.” Lockhart E., QOOL media 2020.
- Ajmc.com. “5 things to know about women’s heart health.” DiGrande S., February 1, 2019.
- CDC.gov. “Women and heart disease prevention.” US Department of Health and Human Services, USA.gov, 1-800-232-4636.
- Heart.org. “6 things every woman should know about heart health.” American Heart Association News, October 4, 2019.
- Mayoclinic.org. “Heart disease in women: Understand symptoms and risk factors.” Mayo Clinic Staff, October 4, 2019.