Heart disease is often thought of as a man's disease, but did you know more women die of heart disease per year than any other cause of death, including breast cancer? Each year, 455,000 women die of heart disease as compared to 410,000 men. Moreover, heart disease causes 1 in 3 women’s deaths each year, equating to the death of approximately one woman each minute.
Women are not only more likely to die from heart disease; they also have higher mortality rates due to complications after a heart attack. Though this might be frightening to hear, this reality is due to the misconception that men’s and women’s hearts are the same and that their symptoms of heart disease and heart attacks are the same. A 2011 study focused on heart disease and women, conducted by the Agency for Healthcare Research and Quality (AHRQ), found that women were twice as likely to die within one year of having a heart attack than men who also suffered a heart attack.
“Women don't always get the same classic heart attack symptoms as men, such as crushing chest pain that radiates down one arm. Those heart attack symptoms can certainly happen to women, but many experience vague or even ‘silent’ symptoms that they may miss,” said Dr. Sushma Koneru, cardiologist and women’s health expert at UnityPoint Clinic - Cardiology - Methodist Plaza.
Gloria Schulte, Patient Services Manager of UnityPoint at Home, knows this from personal experience. Gloria started having discomfort in her neck and shoulders and attributing her physical pain to indigestion and fatigue, so she dismissed her symptoms. “My arms felt heavy from time to time, but I blamed that on physical activity. My chest felt a bit tight, but I assumed it was more indigestion,” Gloria said. “A heart issue was not on my list of concerns.” Gloria checked into the emergency room to ease her worrying and was shocked to find out that her symptoms were that of a heart attack. Though Gloria Schulte prided herself on living a healthy lifestyle, she was not immune to having a heart attack. “No one has zero risk
; we can only reduce our risk,” Gloria states.
Some symptoms women experience during a heart attack include pressure or fullness in the upper body, anxiety or panic attacks, coughing, nausea or vomiting. Since the symptoms of heart disease are broad, it is vital to know your risk factors and to meet with your doctor to determine if you are at risk of a heart attack. “Don’t assume that a lack of severe chest pain means you are not having heart issues,” Gloria said. “It’s better to be embarrassed and told that you are okay than to wait too long to receive care.”
Women’s Hearts are Different
Not only are their symptoms different, but women’s hearts are structurally different as well. Women’s hearts are 2/3 the size of men’s. Even though women are smaller than their male counterparts, this difference in body mass does not account for all of the difference in heart size. To make up for having smaller hearts, a woman’s heart rate is generally faster than a man’s. Men average at about 70 beats per minute while women average at about 78 beats per minute, causing the female heart to work harder over the course of her life-time.
Women’s hearts also have narrower arteries and their heart valves tend to be more flexible and relaxed. Because women have smaller arteries, it becomes more complex for cardiologists during heart surgeries.
The Anatomy of Women’s Hearts
A woman’s heart is divided into four chambers: left atria, right atria, left ventricle and right ventricle. There are also four valves that separate the ventricles. The right atria and right ventricle are separated by the tricuspid valve while the left atria and left ventricle are separated by the mitral valve.
The pulmonary valve closes off the lower right ventricle that sends deoxygenated blood to the lungs through the pulmonary artery. The aortic valve separates the oxygenated blood, which is carried throughout the body from the other chambers of the heart. The purpose of the valves is to close and prevent backflow or leaking into an atrium or ventricle once it has left. This is what creates the one-way circulation that moves blood throughout the body.
A distinction that needs to be made is that, in general, arteries carry oxygen-rich blood to the rest of the body while veins carry deoxygenated blood to the heart. The exceptions being that the pulmonary artery carries deoxygenated blood to the lungs to become oxygenated, and then the pulmonary veins carry the oxygen-rich blood back to the heart. This is essential to understanding the types of heart disease that can affect women.
Heart disease is a term used to cover a broad spectrum of disorders that affect the heart. While the disorders listed below have their own classifications, they also fall under the umbrella term of heart disease.
Most Common Forms of Heart Disease and How They Affect Women
Coronary Artery Disease (CAD), also known as coronary heart disease, is a disorder in which the narrowing of arteries causes a decrease in blood flow to the heart. The deprivation of oxygenated blood to the heart can lead to heart failure. The narrowing of the arteries is an enormous problem for women because women’s arteries are narrow to begin with compared to men’s arteries. Sex hormones such as estrogen and testosterone have shown to be the cause of this difference. Testosterone, the male hormone, enlarges arteries while estrogen, the female hormone, does the opposite.
When women see a decline in estrogen during menopause, they regularly see an increase in bad cholesterol, LDL, and a decrease in good cholesterol, HDL, worsening coronary heart disease problems. This decline in estrogen is usually a two-fold problem. Firstly, a decline in estrogen makes arteries more stiff and inflexible. Secondly, the increase in bad cholesterol can cause clotting of the arteries. Hormone replacement therapy has not been shown to be an effective solution.
Angina is associated with coronary heart disease, in that deprivation of blood flow to the heart can cause chest pains. Angina usually occurs during a physically exerting task when physical activity creates a demand for more oxygenated blood to the heart. Since there is a decreased flow of blood to the heart, it becomes suffocated, resulting in pain and chest pressure. The pain typically lasts a few minutes and goes away after physically taxing activities have stopped.
Heart Attack is when plaque that has accumulated along the walls of the artery breaks away and moves into the bloodstream. The plaque starts to clot the blood, blocking the coronary artery. The heart cannot receive oxygen and the muscle begins to die.
Peripheral Artery Disease (PAD) is a disorder in which narrowed or blocked arteries limit blood flow to the rest of the body, suffocating the limbs. As with CAD, the disorder becomes worse after menopause as the female body stops making estrogen. This causes the arteries to become more brittle and increases LDL or bad cholesterol. PAD symptoms typically begin with leg pain because of the lessened flow of blood to the limbs.
Valve Disease can occur within any of the four heart valves. These valves include the tricuspid, mitral, pulmonary or aortic valves. The valves are like walls within the heart that prevent blood from flowing into an area they don’t belong. Two issues can occur within the valves to cause valve disease. Stenosis is the blockage of a valve that causes blood to be trapped in a valve, making it harder to leave the heart to supply the body. Regurgitation is when a valve doesn’t close properly, causing leaking to occur. This can cause blood to run back into the heart, making the heart work twice as hard to pump the same amount of blood. Since 60% of all valve replacements occur in women and pregnancy can increase the risk of valve disease, it is important to understand your risk factors.
Risk factors for heart disease increase dramatically over a woman’s lifetime. Speak with your doctor about scheduling regular screenings to become aware of your risks and to take steps to reduce them.
Heart Disease Risk Factors Checklist:
- High blood pressure
- High LDL cholesterol
- High blood sugar
- Lack of exercise
- Family history
90% of women have a least one of these risk factors. It is important to speak with your doctor about your risks to begin regular cardiovascular screenings and allow for early detection of heart disease.
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UnityPoint Health has leading cardiologists that are knowledgeable about heart disease and its effects on both women and men. Whether you are looking for preventative screenings, treatment or disease management, UnityPoint Health is here to provide you with the care that you need.
If you think that you may be at risk for heart disease, call your primary care doctor or message them through MyUnityPoint to communicate your health questions or concerns.