Women and Heart Attacks
For both men and women, heart disease is the number one
cause of death in the United States. Still, there are key differences in how it
develops, presents, and is addressed between the sexes.
Heart disease has a major impact on many women’s lives, but
awareness about it has typically focused more on men than women.
Smaller Hearts and
Blood Vessels
There are differences in male and female bodies that affect
how heart disease develops. For example, women have smaller hearts and smaller
blood vessels. This difference is significant because sometimes smaller vessels
don't show up well on an angiogram — a picture taken of the blood vessels of
the heart — so signs of blockages can be missed in some women.
Women also tend to develop heart disease in the smaller
blood vessels of the heart instead of the large coronary arteries commonly seen
in men.
Risk Factors
Female reproductive health history and heart disease are
closely related. Women with endometriosis were found to be three times more
likely to develop some form of heart disease than women without it.
Women who develop gestational diabetes during pregnancy or
preeclampsia, a complication of pregnancy that causes high blood pressure and
places stress on the organs, may also have an increased risk for heart attacks.
Symptoms
Many of the “classic” heart
attack symptoms — like crushing chest pain — are based on research done on men.
Women may experience chest pain, but may also have flu-like symptoms including:
Nausea
Vomiting
Dizziness
Shortness of breath
However, almost
two-thirds of women who die suddenly from heart disease had no prior symptoms.
Symptom-Mimicking
Conditions
Women are more likely than men to develop several diseases
that have symptoms similar to a heart attack, like chest pain and shortness of
breath.
Coronary spasm. In this condition, a vessel that
supplies blood to the heart clamps down. This temporarily constricts the blood
flow, mimicking a heart attack.
Coronary dissection. This is when the wall of a
coronary artery tears. Patients are frequently women who may not have any
history of heart disease.
Takotsubo cardiomyopathy. Also called broken
syndrome, this is an inflammatory condition that causes the heart to enlarge
after a period of emotional distress.
Some of these look-alike conditions can be less severe than
a heart attack, but others are just as dangerous, so it's always important to
check with your doctor if you're experiencing any symptoms.
Medications
Women are less likely to be prescribed drugs that control
blood pressure or lower cholesterol after having a heart attack than men. Women
are also less likely to be prescribed baby aspirin, a medication widely
recommended for people with a history of heart attack.
More research is needed to determine why women are less
frequently prescribed these guideline-recommended medicines.
Diagnostic Testing
The cardiac troponin test is a common tool used to determine
if a heart attack has occurred. This test measures the levels of troponin — a
protein that indicates the presence of damaged heart muscle — in the blood.
Medical providers are beginning to understand that women
need a lower level of troponin in the blood to indicate a heart attack. If
providers are only going off the old standard that looked at results in men,
women experiencing a heart attack could be told they are fine because their
troponin wasn’t high enough.
Treatments
Women may need a different approach to treatment to get the
best outcomes compared to men. For example, women have higher mortality rates
for coronary artery bypass surgery, a type of open heart surgery that fixes
blocked arteries in the heart. A more conservative approach to treatment may be
more successful for some women.
Medical Bias against
Women
When being treated for a heart attack, women are more likely
to experience medical bias.
There is evidence that physicians may be less aware of risk
factors of heart disease in women and some women feel their concerns are not
taken seriously.
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