Heart Disease in Women

In the last decade, doctors have discovered that women may have different symptoms, as well as a few gender-specific risk factors, for heart disease, the number one killer of women in America. Now that we know more about how heart disease affects women, doctors and hospitals have been changing how they approach this important issue.

Heart disease, also called coronary artery disease, involves the vessels that carry oxygen-rich blood to the heart. When these arteries become filled with plaque, you may be diagnosed with coronary artery disease, a dangerous, but generally stable condition.  If these plaques become unstable and rupture or break off, problems like heart attack, stroke, and death can occur.

Erlanger is the region’s first provider with a distinct focus on women’s unique heart-health needs. Our team includes academic cardiologists who are highly trained in helping patients prevent and manage female-pattern heart disease.

Symptoms

The main symptoms of coronary artery disease are similar among men and women. But women are more likely than men to experience shortness of breath, nausea, and back or jaw pain instead of  chest pain. Some women describe their symptoms as mild.

• Angina – chest pain or discomfort that occurs when your heart muscle is not getting enough oxygen-rich blood. You may feel angina as pressure or squeezing in the chest, with pain radiating to the shoulders, arms, neck, jaw, or back. In some cases, angina can feel like indigestion.
• Shortness of breath/heart failure – if the heart is not getting enough oxygen-rich blood, it will not pump correctly, leading to heart failure and fluid build-up in the lungs.
• Heart attack – when the flow of oxygen-rich blood to a section of heart muscle is cut off. The symptoms of heart attack are similar to angina (chest pain and pressure that can radiate to the shoulders, arms, neck, and jaw), but where angina symptoms may disappear with rest, heart attack symptoms do not. You may also feel dizzy or lightheaded, nauseous, feel a fluttering in the chest, or begin sweating. Women are more likely to complain of shortness of breath, nausea, and back, neck or jaw pain. Heart attacks must be treated quickly to avoid serious long-term effects and death.
• Arrhythmia – when the heartbeat seems too fast, or feels like it is skipping beats or fluttering. Some arrhythmias can cause your heart to suddenly stop beating, which is sudden cardiac arrest.

Causes / Risk Factors

Women have special risk factors for heart disease in addition to the general risk factors listed toward the end of this section. These special risk factors include:

• Menopause, a woman’s chance of being diagnosed with coronary artery disease is higher after menopause, although the reasons for this are not clearly understood.
• Hormone replacement therapy (HRT) is a complex issue and can be a potential risk factor because hormones are linked with the health of your blood vessels. You and your doctor should discuss the risk of heart disease and other health problems before starting hormone replacement therapy.
• Birth control pills might increase your risk of heart disease if you smoke and are older than age 35 or if you have a family history of atherosclerosis (coronary artery blockages, heart attack). Healthy, non-smoking women under age 35 probably do not increase their risk of coronary artery disease with low hormone pills.
• Preeclampsia (high blood pressure during pregnancy) and diabetes during pregnancy have been linked to a higher risk of heart disease later in life. Be sure to talk to your doctor if you have had any of these disorders of pregnancy.
• Immune diseases like lupus and rheumatoid arthritis have been linked with a higher risk of heart disease in women.

Other risk factors affect both men and women. These include:

• Smoking
• Abnormal levels of certain fats and cholesterol in the blood (high LDL, & high triglyceride/low HDL)
• High blood pressure
• High levels of sugar in the blood due to insulin resistance or diabetes
• Blood vessel inflammation
• Obesity
• Lack of physical activity
• Metabolic syndrome
• Psychosocial distress (anxiety, depression, perceived stress)
• Other causes of coronary heart disease include age and family history.

Diagnosis

If your doctor suspects coronary artery disease, he or she may order tests to confirm the diagnosis and see how far the disease has advanced. These tests may include:

• Blood tests – to check for cholesterol, blood sugar, and proteins in the blood.
• X-rays – pictures taken with a tiny amount of radiation.
• Electrocardiogram (ECG or EKG) – a test that measures the electrical activity of the heartbeat.
• Echocardiogram – an ultrasound movie of the inside of the heart.
• Transesophageal echocardiogram – a special type of ultrasound movie of the heart done through a tiny tube inserted through the mouth that sends sound waves to a receiver that produces a picture.
• MRI – an image using magnetic waves to look at the blood vessels connected to the heart and lungs.
• CT scan – multiple X-ray images to give a more detailed picture of the heart and lungs.
• Cardiac catheterization – a minimally invasive procedure that allows the cardiologist to get direct information about the blood pressure and the heart’s blood flow.
• Angiogram – an X-ray movie that's taken while a special dye is injected into a cardiac chamber or major blood vessel.

Treatment Options

Lifestyle change – Healthy eating, exercise, limiting sodium and alcohol, quitting smoking, and managing stress are all extremely important for people with or at risk of coronary artery disease. Your Erlanger doctor can point you toward resources such as our cardiac rehabilitation & cardiac wellness program for help in these areas.

Medications – Certain drugs can be an important part of treating coronary artery disease, including those that lower fats in the blood, maintain a healthy blood pressure, or prevent blood clots.

Angioplasty – Percutaneous Coronary Intervention (PCI), commonly known as angioplasty, is a procedure used to treat narrowed arteries found in coronary heart disease. 

Surgery – In some cases, patients will need surgery to repair, replace, or bypass the important arteries that lead to the heart. Erlanger performed the region’s first open heart surgery many years ago, and continues to be an innovator in all types of cardiac procedures.

Outcomes

Each patient’s outlook depends on the severity of the disease, the procedures needed to treat it, and the patient’s commitment to a healthy lifestyle.

If you follow your Erlanger doctor’s advice and treatment plan, you can reduce the risk of coronary artery disease and its effects.

Erlanger Cardiac Rehabilitation offers exercise and nutrition planning for those recovering from cardiac problems as well as those hoping to prevent disease.

Prevention

Risk factors specific to women, like menopause, hormone replacement therapy, and birth control pills, require a conversation with your doctor to evaluate exactly how these affect you.

Some risk factors, like age and a genetic predisposition toward heart disease, cannot be changed. But in the vast majority of coronary artery disease cases, a healthy lifestyle can prevent the condition, or reduce the possibility of complications like heart attack and stroke.

A healthy diet low in saturated fats and rich in fiber and nutrient-dense foods like vegetables, fruits and whole grains is the most important step you can take toward preventing heart disease. Being active, including regular exercise for the whole family is not only good for your heart, it can help with reducing stress, which is also a risk factor. The other crucial things are quitting smoking, limiting alcohol, and limiting sodium.

Resources

Erlanger is on the forefront of cardiology therapies for adults and children. The following resources are available for patients with congenital artery disease.

Women’s Cardiology Services - Erlanger Cardiology includes the region’s first providers with a distinct focus on women’s heart-health needs.