Heart Attacks and Women

According to the American Heart Association, coronary heart disease is the leading cause of death in women.

Heart attacks and their aftermath tend to be more deadly in women. About one-quarter more women than men die within a year of having a heart attack. This may happen because women are generally older than men when they suffer heart attacks. Also, women don't respond as well as men to the treatments usually prescribed during or after a heart attack. 

 For many women, a heart attack may feel like a strange discomfort in the back or some other easily ignored sign, instead of crushing chest pain.

When women do go to the hospital, doctors may miss the diagnosis of heart attack because the symptoms are vague. Without a definite diagnosis, a woman may be sent home thinking that her symptoms don't mean anything serious. 

Studies confirm that heart disease may differ in women in ways that doctors may not realize. Heart disease, in many women doesn't occur from obvious blockages in arteries as it does in men.

Instead, for women, plaque spreads evenly along the artery wall or in the smaller arteries—areas hidden from an angiogram, the standard imaging test that measures blood flow in the big arteries.

Subtle symptoms

In women with this problem, which is called coronary microvascular syndrome, blood flow to the heart falls dangerously low. But they don't often feel the "elephant-on-the-chest" pain that takes place when large arteries shut down. Instead, they may have subtle symptoms. They may feel pressure or squeezing or shortness of breath. Symptoms may even pop up elsewhere in the body, such as the jaw. (This symptom of jaw pain can also appear in men having a heart attack.)

Many women with microvascular disease may continue to have symptoms and become sicker. They may be at an increased risk for heart attack within five years.

Some experts suggest that hormonal changes associated with aging or inflammation may explain why women's smaller blood vessels don't work right.

The stage for heart disease is set before menopause by factors such as high blood pressure, high cholesterol, extra weight (especially around the waist), and smoking—all factors that play a part in plaque buildup.

Warning signs

Women are more likely to have "nonclassic" heart attack symptoms than men. Still, doctors note, unexplained jaw, shoulder, back, or arm pain can also signal a man's heart attack even when the classic crushing chest pain is absent.

These are the most common warning signals for heart attack:

• Pain or discomfort in the center of the chest that lasts more than a few minutes, or goes away and comes back

• Chest discomfort with sweating

• Pain that spreads from the chest to the arm, neck, or jaw

• Shortness of breath, tiredness, or upset stomach; these are particularly common in women

If you are at risk for heart disease and have any of these symptoms, seek medical attention, up to and including calling 911, immediately. Time is a crucial factor in a heart attack because the longer the blockage remains untreated, the more heart muscle will die. Also, drugs that break down blockage in the arteries (thrombolytic therapy) must be given within the first few hours. 

Check your blood pressure

Before menopause, for instance, a systolic reading (the upper number) of more than 120 on your blood pressure reading seems to show you face an added risk, studies have found. Experts recommend that women have their blood pressure checked any time they go to a health care provider, including visits to an OB/GYN provider. 

High blood pressure is one of a cluster of symptoms called metabolic syndrome that also includes high cholesterol; high triglycerides, which are another type of blood fat; insulin resistance; and obesity.

Any woman found to have microvascular disease, metabolic syndrome, and other heart disease risk factors needs treatment.

This often means medication, but with mildly elevated numbers, lifestyle changes such as regular exercise and losing weight may help. The aim is to get your LDL ("bad") cholesterol below 130 mg/dL, your HDL ("good") cholesterol above 40 mg/dL (but above 60 mg/dL is preferable), your triglycerides below 150 mg/dL, and your waist size under 35 inches.

For women with high cholesterol, high blood pressure, or diabetes, however, medication is a must to help prevent heart disease. Exercise and diet are still important, but are secondary.

Preventing or controlling heart disease may mean making changes in the way you live. A healthy heart requires a personal action plan. But where do you begin? A complete medical checkup is a sensible first step, especially if you have multiple risk factors. Your health care provider can tell if you have cardiovascular disease or its risk factors, and if so, help you with a practical treatment plan. Even if you don't have any risk factors now, you can discuss ways to lessen your chances of developing them.