For many years, what we knew about heart disease came from research that mainly studied men. As women have increasingly been included in heart disease research, it has been discovered that women and men experience heart attacks very differently.
“Half of women who have heart attacks have symptoms different from the chest pain or pressure that men typically experience,” says UCI Health cardiologist Dr. Jin Kyung Kim, who specializes in women’s heart health. “They may not have any symptoms or they may experience heart palpitations or heightened anxiety.”
This can be especially dangerous, Kim says, since neither the woman nor her doctor may recognize what’s happening. A heart attack may not be diagnosed or the diagnosis may be delayed, costing precious treatment time.
“With a heart attack, time is muscle,” explains Kim, who also is a professor of medicine at the UC Irvine School of Medicine. “We have to open the artery to return blood flow to the heart as soon as possible.”
Recognizing a heart attack
For women, the symptoms are often atypical so it can be difficult to recognize when a heart attack is underway. But, generally, Kim advises staying alert for the following symptoms, especially if they’re new, sudden or severe:
- Shortness of breath
- Anxiety
- Tightness, squeezing or dull pressure in the middle of the chest that spreads to the left arm or jaw
- Tightness and pressure associated with shortness of breath, sweating or palpitations
Diagnosing a heart attack
A few other factors make it harder to diagnose heart problems in women even once a blood test reveals an attack has occurred.
One is that women tend to have smaller blood vessels and are more prone to microvasculature disease, which involves problems in smaller arteries that branch out from larger ones.
Blockages of these smaller vessels are often missed by angiograms. Moreover, not all cardiologists are trained on sex differences in the wide spectrum of heart disease, Kim notes.
"When a woman presents with symptoms thought to be atypical or routine tests don't show the expected findings, the doctor may not proceed with further appropriate or specialized tests to make the correct diagnosis," she says.
Less common heart conditions
Another factor is that women are more likely to have less common heart diseases that can mimic a heart attack, such as:
- Stress cardiomyopathy, which is not due to coronary blockage
- Spontaneous coronary artery dissection (SCAD), which is caused by a tear in the coronary arterial wall
About 90% of patients with stress cardiomyopathy are women and its prognosis is much better than a typical heart attack if properly diagnosed.
SCAD can also be easily missed because it occurs to women lacking traditional heart disease risk factors of heart disease. It may be fatal if not recognized and treated promptly.
Preventing a heart attack
Being in tune with your symptoms, knowing your family history and taking good care of yourself are the same recommendations doctors make for men and women.
There’s one exception, however: An aspirin a day is not recommended for women as it is for men.
“There is no good data showing that women will benefit from taking an aspirin a day,” Kim says. “It is not recommended except for women who are 65 or older and have had a stroke, have a high risk of stroke or other cardiovascular disease, such as known heart disease.”
Safeguarding your cardiovascular health
Data show that up to 80% of heart disease is preventable with common sense, healthy habits. Here are tips to safeguard cardiovascular health:
“I do not recommend stress tests indiscriminately,” Kim says. “It’s best to have all the other things sorted before cardiac testing. If there’s something abnormal in the tests or in your history, then a referral to a cardiologist is a good idea.”
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