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Heart, Vascular & Thoracic Institute 30 Aug 2020

Women and Heart Attacks: What You Need to Know

​How gen​der plays a role in coronary artery disease

You may not know it, but heart attacks in women can be very different from those in men. Coronary artery disease, (CAD) is a leading cause of death among women as well as men and is a growing health concern. From risk factors to warning signs, there are many surprising differences between the genders.

It begins with physiology. Men’s and women’s hearts may look the same, but there are some very significant differences. A woman’s heart is usually smaller, pumps faster, and ejects less blood. When faced with stress, a woman’s pulse raises and her heart pumps more blood, whereas a man’s constrict and blood pressure increases.

Most people aren’t aware of these small differences, but they have a big impact on how CAD affects women. Familiarising yourself with the different risk factors and warning signs could help you to reduce your risk of having a heart attack in the future.

Warning signs in women

It is well known that the first sign of a heart attack is often a severe chest pain. However, in women more subtle symptoms can be present weeks before a heart attack strikes. Warning signs can include:

  • Dramatic fatigue:Asimple activity suddenly makes you feel very tired, or something that doesn’t normally cause you to exert yourself starts making you very fatigued.
  • Shortness of breath or sweating: Sudden breathlessness when you haven’t exerted yourself, a cold clammy feeling for no reason, or a shortness of breath which worsens when you lie down but is relieved when you sit up.
  • Pain: Sudden pain in the left arm is a common sign of a heart attack, but in women, this pain can be felt in either arm. A feeling of discomfort in the neck, back or jaw, which worsens when you exert yourself, but stops when you stop. Also, any pain that starts in the chest and spreads to the back or wakes you up at night.

Risk factors are different for women

There are several conditions that increase a woman’s chance of developing CAD. Endometriosis, polycystic ovary disease, diabetes and high blood pressure during pregnancy can all increase risk. This is in addition to more well-known risk factors, such as high cholesterol, obesity and smoking, which affect both men and women.

Women are generally older when they have their first heart attack

Heart disease affects women later in life than men, with the average age of a heart attack in women being 70, compared to 66 in men. Why? Estrogen is known to offer women some protection from heart disease. After the menopause, when estrogen levels drop, risk increases.

CAD is harder to diagnose in women

An angiogram is the method used detect narrowing and blockages in arteries and diagnose CAD. In women, CAD often affects the small arteries, which are harder to see on an angiogram, and therefore can go undiagnosed. If you are given the all clear following an angiogram but continue to have any of the symptoms listed above, you should see a cardiologist.

Protect yourself

Whether you are a man or woman, leading a healthier lifestyle is the first step you can take in reducing your chances of developing CAD and your risk of having a heart attack. Being proactive and making yourself aware of symptoms and risks can help you to protect yourself and your loved ones. If you have any concerns or think you may be experiencing early symptoms, speak to a cardiologist who specializes in heart disease in women.

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