Listening to the Female Heart

A woman’s signs of cardiovascular troubles are more subtle & different than a man’s symptoms.

By Dr. Rob for MSN Health & Fitness

Q: Can you tell me the signs & symptoms of heart problems in a woman? I know they're different than for men. Sometimes I feel pain that runs for several minutes from my back, upper shoulder & down my left arm.

This seems to happen during periods of stress or too much activity. I've also been having shortness of breath with these pains along with a chest “aching.” My blood pressure has been running high, around 150 over 100.

These include but aren’t limited to:

• Chest pain that occurs in a predictable pattern (stress, activity, others).

• Unusual & unexplained fatigue.

• Sleep disturbances.

• Shortness of breath.

• Indigestion that may or may not be related to food.

• Pain in the left shoulder blade or upper back.

• Anxiety or feeling of uneasiness or impending personal doom.

Given the information supplied in your question, personal risk factors include but aren’t limited to:

While you did not mention your cholesterol, LDL, triglyceride or HDL levels, I am hoping you have had them checked and they are in a healthy range. If not, that would add to your risk for cardiovascular disease. Other cardiovascular risk factors that need to be considered include:

• Age 55 and older.
• Smoking.
• Excess alcohol (more than one drink per day for women).
• Diabetes.
• Metabolic syndrome.
• Physical inactivity.
• Waist measurement greater than 35 inches.
• Obesity (check body mass index to calculate your personal category).
• Race (black women have a greater risk of heart disease and stroke than white women).
• Overwhelming stress.

Many people think heart attacks happen in the familiar television fashion: A person clutches his chest from the pain and drops to the floor after passing out. Even though chest pain is the most common symptom, women are more likely than men to have a heart attack without this pain. In fact, many women have other or “atypical” symptoms that require prompt attention. These symptoms include but aren’t limited to:

• Chest sensation described as an ache, tightness or pressure.
• Unusual and unexplained fatigue.
• Shortness of breath.
• Indigestion, nausea or vomiting.
• Pain in the neck, shoulder or back.
• Sudden weakness, dizziness or lightheadedness.

As we have learned from the large, ongoing study known as the Women’s Health Initiative, along with other research on women’s cardiovascular disease, a woman’s heart has its own way of communicating in the face of illness. I highly encourage you to visit a family physician, general internist, cardiologist or other health care professional skilled in the diagnosis, prevention and treatment of women’s cardiovascular disease.

They're not just men with breasts

By DrRich

In this special section of the Heart Disease and Cardiology website, we'll deal specifically with the issue of heart disease in women. A special section is warranted because of two common misapprehensions held by both women and their doctors. These are that women don't really get much heart disease, and when they do, it behaves pretty much like the heart disease that men get. The real facts are that: a) heart disease is the number one killer of women, and b) when women get heart disease it often presents quite differently than it does in men. Failing to understand these two fundamental facts leads to a lot of preventable deaths and disability in women with heart disease.

In a recent survey conducted by the American Heart Association, 6 in 10 women said that the major threat to their health was breast cancer; only 1 in 10 said it was heart disease.

Worst of all, the symptoms of heart disease - and even the heart disease itself - can be quite different in women than in men. And since medical textbooks almost exclusively describe "typical" heart disease (that is, the kind men get,) doctors often fail to recognize heart disease when they see it in their female patients. The fact that heart disease is so common in women, and at the same time is underestimated and misunderstood by both women and their doctors, contributes in no small way to the high death rate.

The purpose of this special section is to tell women what they need to know about heart disease. There is a lot of information on this website about heart disease in general, but here, we'll emphasize the characteristics of the heart disease women get, trying to point out how heart disease in women is different from heart disease in men. We'll examine the differences in risk factors, in the symptoms of heart disease, in the diagnosis of heart disease, and in the heart diseases themselves. It is very important for women to understand this information - especially because there's a good chance their doctors don't.

source: about.com

By DrRich

Updated January, 2006

The risk factors for cardiac disease are similar between men and women, but there are some important differences.

While many women (and unfortunately, many doctors) apparently still do not know it, heart disease is the number one killer of women. About a half million women die of heart disease each year in the U.S. - indeed, more women than men die from cardiovascular disease. So it is as important for women as for men to control the risk factors that lead to heart disease. Aggressively managing risk factors can prevent or delay the onset of heart disease, even in women with strong family histories. In those who already have heart disease, control of risk factors can delay or even halt the progression of the disease, and strongly improve outcomes.

Non-controllable risk factors:

• Family history of coronary artery disease or stroke

• Age 55 or older

• Being post-menopausal, or having your ovaries removed

A family history of premature cardiac disease (less than 60 years,) especially in a sister or brother, may be a particularly important risk factor in women.

Women with such a family history should be aggressive in controlling cardiac risk factors.

Controllable risk factors:

• Obesity

• Sedentary lifestyle

• Smoking

• Hypertension

• High total cholesterol, and/or reduced HDL cholesterol

• Diabetes

• Metabolic syndrome

• Increased C-reactive protein (CRP)

• Use of birth control pills, especially if also a smoker

• Complicated pregancy (hypertension, diabetes, low birth weight)

Obesity and sedentary lifestyle: These two risk factors are more common in post-menopausal women than in men the same age. Women tend to be caregivers, and (research suggests) out of a sense of duty have a hard time justifying behaviors that are "just for me," such as regular exercise. As a result older women may be prone to inactivity and obesity, strong risk factors for heart disease and stroke.

Smoking is a particular problem for women, as it accounts for the vast majority of heart attacks in women under the age of 45, and is a phenomenal multiplier of risk in women with family histories of heart disease. And birth control pills make things even worse - the combination of smoking and birth control pills increases the risk of early heart disease by 20-fold.

Hypertension is a major risk factor for heart disease and stroke. It is very common in women over 55, and is heartbreakingly undertreated. But good treatment is well worth the effort - ask anyone who has had a stroke.

Cholesterol abnormalities greatly increase the risk of heart attack and stroke. Low HDL levels are a more important risk factor in women than in men. Evidence is mounting that achieving very low LDL levels, and/or substantially raising HDL levels, can actually halt or reverse coronary artery disease. In many women cholesterol can be controlled with diet and exercise, but often drug therapy with statins or other medicine is also needed.

Diabetes is growing in frequency, right along with one of its root causes - obesity. Diabetes should be thought of as a disease of blood vessels as much as a disease of sugar metabolism, as it greatly increases cardiovascular risk. The risk of heart disease in women with diabetes is increased as much as 6-fold.

Metabolic syndrome, particularly common in post-menopausal women, greatly increases the risk of heart disease and stroke. It is diagnosed by the presence of at least 3 of these 5 features:

• Central obesity (for women, a waist size greater than 35 inches)

• Triglyceride levels greater than 150 mg/dl

• HDL cholesterol ("good" cholesterol) less than 50 mg/dl

• Fasting blood glucose greater than or equal to 110 mg/dl

• Blood pressure greater than or equal to 130/85

Metabolic syndrome is probably an early stage of type II diabetes. While drugs can be used to help control various aspects of metabolic syndrome, the ideal treatment is exercise, diet control and weight loss.

C-Reactive Protein (CRP) is a relatively "new" risk factor that appears to be more important in women than in men. Increased CRP levels indicate active inflammation, and a high CRP level usually can be assumed to mean that blood vessel inflammation is present. Especially in women, inflammation is thought to be a major factor in the erosion or rupture of coronary artery plaques. Recent evidence suggests that reducing CRP levels (with statins) lowers the risk of heart attack in some patients with coronary artery disease. Here is a discussion of when you ought to have your CRP measured.

Finally, it now appears that women who develop certain complications during pregnancy - specifically preecclampsia (significant hypertension), gestational diabetes, or delivering low-birth-weight babies - have a signficantly higher risk of early cardiovascular disease and death. Women who develop these complications should begin to aggressively manage all their cardiovascular risk factors, and for the rest of their lives.