Women and Heart Disease: Signs and Symptoms are Different from Men

Kelly Epps-Anderson, MD, is an interventional cardiologist at Inova Heart and Vascular Institute. She is board certified in interventional cardiology and cardiovascular disease and has clinical interests in preventative care, women’s heart health, coronary artery disease and structural (valvular) heart disease. She is based at the Inova Cardiology – Fairfax office located at the Inova Specialty Center, across the street from Inova Fairfax Hospital.

Many women do not think heart disease is their greatest health threat. Yet heart disease is the number one killer of women in the United States – more than one-third of women who die in the U.S. each year die of heart disease. In fact, heart disease is more deadly than all forms of cancer combined. While 1 in 31 American women dies from breast cancer each year, heart disease is the cause of 1 out of every 3 deaths among women.

Unfortunately,  heart disease and related risk factors are often missed in women, which makes them more vulnerable to slower diagnosis and inadequate treatment. Not only are women inclined to underestimate their risks, but also their symptoms may be vague. This means they may seek emergency care later in the course of their heart attacks, and therefore suffer worse outcomes.

Symptoms of heart attack in women

Most women who die suddenly of coronary heart disease (64 percent) had no previous symptoms. And when they do have symptoms, they may be different from those of men. In a study of women who had heart attacks:

• Only 43 percent complained of chest pain
• 58 percent had shortness of breath
• 55 percent complained they felt weak
• 43 percent had extreme fatigue

In addition, women often describe other symptoms including a dull pain in the back, jaw or shoulders, nausea and abdominal pain, or dizziness and lightheadedness. In fact, many of the symptoms women describe can be mistaken for the flu. Importantly, for up to a month before their heart attacks, many women report vague symptoms, including sleep disturbances and anxiety.

Risk factors throughout the lifespan

Women also need to understand that while heart disease is typically associated with the aging process, they can develop heart disease at any time in their lives. Women are most at risk:

• During pregnancy, when increased blood flow to support the baby can also stress the heart muscle. Women who develop complications during pregnancy, such as high blood pressure, gestational diabetes or preeclampsia, are at higher risk of heart disease even 10 to 15 years later. (For those who suffered from severe preeclampsia, the risk is nine times greater.)
• During and after breast cancer treatment because both radiation and chemotherapy can damage the heart. Inova cardiologists partner closely with our oncology team to perform risk assessment and surveillance of patients. When indicated, we prescribe medications to protect the heart in patients who are at high risk of cardiotoxicity.
• After menopause, which generally occurs around age 50. The risk of coronary artery disease triples after menopause. While menopause doesn’t cause heart disease, it is associated with certain health changes that do increase the risk, such as elevated blood pressure and cholesterol, diabetes, physical inactivity and weight gain.
• When diagnosed with autoimmune diseases such as lupus, rheumatoid arthritis and psoriasis, which more than double the risk of cardiovascular disease.

Other risk factors include smoking and family history. Women who learn they are at higher risk should focus on a heart-healthy lifestyle that includes exercise and proper nutrition.

Remember this: While heart disease is the top killer of women, 80 percent of it is preventable – by knowing and managing risk factors and understanding the early signs and symptoms.

If you are concerned about managing your risk factors, Inova Cardiology is here to help. Call 877-634-6682 to schedule a cardiology consultation or visit inova.org/cardiology to learn more about our award-winning team of heart specialists.

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