Heart Disease In Women

Mars, Venus, and Effectively Diagnosing Heart Disease

Are men from Mars and women from Venus?  I can’t keep it straight. Mars and Venus aside, men and women are different. No argument there. The rules applied to help improve communication similarly apply to effectively diagnosing health related issues - specifically heart disease and the symptoms associated with a heart attack. Gender differences play a critical role in how women experience, describe, and receive treatment for this silent killer.  

Heart Burn or Heart Attack

As ER physicians, we often rely on patients to supply us the information we need to make life saving decisions This plays a critical role, in the emergency department, when we try to determine if “chest pain” - one of the more common presenting complaints - is from a worrisome or non-worrisome cause.  Both physicians and patients struggle with this issue as the symptoms of heartburn or gastro esophageal reflux disease can feel very similar to that of cardiac pain.  It is not uncommon for patients to stay at home taking antacids for what they believe to be heartburn, when they might in fact be experiencing a heart attck. Adding to this difficulty is the significant difference in how women experience heart related symptoms when compared to men.  The difference in the nature and quality of symptoms may cause heart disease to slip under the diagnostic radar as women describe their unique symptom set to their attending physician.  With this in mind, there are some important facts to consider:

Women: The Facts About Heart Disease

• Between the ages of 45 and 64, one in nine women develops symptoms of some form of cardiovascular disease; a condition that represents 35% of all cause mortality in women.
• Women may experience chest pain of a sharp or burning nature rather than the classically described “elephant sitting on my chest” experience men relay.
• Women are more likely to experience pain in the neck, jaw, or back, as well as nausea in addition to chest pain.
• In a study involving 550 women, presenting with an acute myocardial infarction (heart attack), chest pain was absent in 43% of women.  These women instead experienced most commonly:  Shortness of breath (58%), weakness (55%), and fatigue (43%).
• Post menopausal status, diabetes mellitus, smoking, and a family history of premature or early coronary heart disease elevates a woman’s overall probability of coronary heart disease.
• Based on differences in symptom experience and description, women may be referred less often for diagnostic or therapeutic procedures for cardiac complications

Additionally, women may be more likely to have a falsely positive cardiac stress test, meaning the test suggests symptomatic coronary heart disease is present when it is not.  This has further implications as a positive stress test leads to coronary angiography, an invasive procedure that carries some inherent health risk.  Thus, women may more frequently undergo invasive procedures due to gender-based differences during preliminary diagnostic testing.

Being Informed Means Being Prepared

So what does it all mean?  Simply put, women and men experience illness differently.   Knowing this difference, may help women be better prepared for early recognition of symptoms that differ from those classically described and more applicable to men.  Knowing this difference, may help women feel empowered to ask questions of their physicians, share symptoms, and experience improved care specific to their age, gender, and unique needs. Best wishes for the best in health!