A Woman’s Heart

Knowing the subtle signs of a heart attack

Women’s Health Heart Image 260 × 180

By Kiyon Chung, MD, Scripps Health

With both Valentine’s Day and American Heart Month on the calendar, February is all about keeping hearts happy. While coronary heart disease (CHD) remains the leading cause of death among both women and men—claiming one in four lives in the United States—the symptoms, screenings and preventive care for men and women can differ greatly.

For example, the most commonly recognized symptoms of a heart attack is a sudden crushing pressure sensation in the chest with radiation of pain to the left arm. While this is true for men, women are more likely to present with shortness of breath and can sometimes have very different symptoms, including persistent indigestion, unusual fatigue, nausea, and excessive sweating with minimal physical exertion. Some of these symptoms may be present for weeks to months before a heart attack.

Because women’s symptoms can be so easily mistaken for common complaints such as an upset stomach or lack of sleep, it is especially important for women to know their risk factors and have frequent, thorough screening exams for heart disease. According to the National Heart, Lung, and Blood Institute (NHLBI), more women are taking proactive steps toward protecting themselves against heart disease.

In 2009, 48 percent reported discussing heart disease with their doctor, up from 30 percent in 1997. Data also show that women who were aware that heart disease is their number one killer were 35 percent more likely to be physically active and 47 percent more likely to report losing excess weight than women who were unaware.

Along with increasing cardiovascular fitness and maintaining a healthy weight, women can significantly help reduce their risk of developing coronary heart disease by keeping their cholesterol levels in check, controlling blood pressure, avoiding tobacco, managing stress, and eating a healthy diet that is low in fat, especially animal fat.

New research on women and heart disease

In recent years, researchers have identified two other types of heart disease that are far more likely to affect women than men—coronary microvascular disease (MVD) and broken heart syndrome.

Coronary MVD, also known as cardiac syndrome X or non-obstructive CHD, causes damage or disease in the walls of the heart’s tiny arteries. Although death rates from heart disease have dropped in the last 30 years, they haven’t dropped as much in women as in men. According to the NHLBI, researchers suspect that falling estrogen levels during menopause may be partially to blame for MVD.

Estrogen helps to protect the heart, which is why women tend to develop heart disease about 10 years later in life than men. When estrogen levels drop during menopause, their hearts become more vulnerable to disease. If a women has other risk factors for heart disease such as high blood pressure or high cholesterol, MVD may be more likely to develop.

Another recently recognized condition known as broken heart syndrome is also more likely to affect women. Also called stress-induced cardiomyopathy or Takotsubo cardiomyopathy, broken heart syndrome results from extreme emotional stress, such as the loss of a loved one. The result can be severe heart failure.

While the symptoms of broken heart syndrome are often similar to those of a heart attack, including chest pain and shortness of breath, there is no sign of blockages in the arteries. There is much more to be discovered about the causes and treatment of broken heart syndrome, but fortunately the heart failure is usually short-term, and with proper medical therapy most patients make a full recovery.

Although not as well understood as coronary heart disease, researchers are continually learning more about these diseases and the risks they pose to women’s health. One fact is certain: regular checkups to modify one’s risk factors and maintaining a heart-smart lifestyle can help keep hearts happy.

Dr. Chung is a cardiologist with Scripps Health. All through February Scripps is celebrating heart health. Please join Dr. Chung for a free informative talk on women and heart disease on Feb. 11 from 6-7 p.m. at the Mission Valley YMCA, 5505 Friars Rd., San Diego. More information is available under Heart Care.