Women’s Heart Health, Part 2 – Women’s Heart Health Issues

Elderly woman holding chest

Heart disease is the most common cause of death for women in the U.S., with nearly 1 in 4 women, or 25%, dying from heart disease, according to the Centers for Disease Control (CDC.)

Some important facts about women and heart health:

  • The number of women succumbing to heart disease is on the rise and surpassing that of men.
  • Women experience far different heart attack and disease symptoms than men, with symptoms often brushed aside by women who experience them as fatigue or stress.
  • And, most importantly, women are more susceptible than men to experiencing silent heart attacks, even without showing previous indications of heart disease problems or symptoms.

February is American Heart Month and your local Capital Women’s Care team wants to share important information about specific heart problems more common to women as well as those more likely to occur in women and subsequent treatment options.

Common Heart Problems for Women

Women more often than men experience the following heart problems:

Atherosclerosis. This condition happens when plaque buildup over time occurs in the arteries, causing arteries to narrow and harden. When the plaque wears down or breaks open, a blood clot may develop and if the emerging clot blocks blood flow to the heart, it can cause a heart attack.

Diagnosis can be determined through a physical exam and depending upon its results may require further diagnostic tests including:

Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. Your doctor should tell you ahead of time if this test will be performed during your visit.

Doppler ultrasound. Your doctor may use a special ultrasound device to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages and the speed of blood flow in your arteries.

Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm, known as the ankle-brachial index. An abnormal difference could indicate peripheral vascular disease, which is usually caused by atherosclerosis.

Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.

Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity.

Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise.

An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm, blood pressure and breathing are monitored.

In some types of stress tests, pictures of the heart are taken, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.

Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked.

A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing blockages.

Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, plus aneurysms and calcium deposits in the artery walls.

Treatment for atherosclerosis may include statin, anticoagulant and/or cholesterol medications in less severe cases. Medical procedures such as coronary stent and angioplasty may be required based on severity of damage.

Heart failure. This condition occurs due to the heart not being able to properly do the job of pumping blood through the body. Heart failure is a serious medical problem because many organs, like the lungs and kidneys, are no longer able to get the blood they need for proper function.

Heart failure symptoms include:

  • shortness of breath
  • swelling in feet, ankles, and legs
  • and extreme fatigue.

Diagnosis includes physical exam and medical testing used to determine atherosclerosis, including the following testing options:

  • Echocardiogram. An echocardiogram uses sound waves to produce a video image of your heart. This test can help doctors see the size and shape of your heart and any abnormalities. An echocardiogram measures your ejection fraction, an important measurement of how well your heart is pumping, which is used to help classify heart failure and guide treatment.
  • Magnetic resonance imaging (MRI). In a cardiac MRI, you lie on a table inside a long tube-like machine that produces a magnetic field, which aligns atomic particles in some of your cells. Radio waves are broadcast toward these aligned particles, producing signals to create images of your heart.
  • Myocardial biopsy. In this test, your doctor inserts a small, flexible biopsy cord into a vein in your neck or groin and small pieces of the heart muscle are taken. This test may be performed to diagnose certain types of heart muscle diseases that cause heart failure.

Treatment for heart failure may include a combination of lifestyle changes, medications and/or devices and surgical procedures.

Irregular heartbeat (arrhythmia). Arrhythmia is abnormal rate or rhythm of your heartbeat. Your heart may beat too fast, too slow or with an irregular rhythm. Changes in heartbeats are harmless for most people.

As you get older, you are more likely to have arrhythmias, partly as a result of changing estrogen levels, especially during the onset and duration of menopause.

It's normal to feel a few flutters or for your heart to race occasionally.

If you experience flutters and other symptoms of heart attack, such as dizziness or shortness of breath, call 911 immediately.

However, the following heart arrhythmia situations require medical treatment and care if you are diagnosed:

Atrial fibrillation (AF or Afib).  Afib is a type of arrhythmia that makes it easier for your blood to clot because your heart cannot pump properly, which can lead to heart failure or stroke.

Afib symptoms include heart flutters, a fast heartbeat in addition to experiencing symptoms of dizziness and shortness of breath.

The severity, any other underlying medical issues and length of the AF condition determine your best treatment options. Treatment options may include one or more of the following: medications, nonsurgical procedures and/or surgical procedures.

Heart valve disease. Heart valve disease affects the valves controlling blood flow in and out of different heart areas.

A birth defect, older age or an infection can cause your heart valves to not open fully or close completely. This causes the heart to work harder to pump blood.

Heart valve disease can lead to stroke, heart failure, blood clots or sudden cardiac arrest.

Heart valve disease can cause problems during pregnancy, when your heart already is working harder to supply blood to your unborn baby. Your doctor can help you prevent problems during pregnancy if you know you have heart valve disease. However, some women don’t find out that they have a heart valve problem until they become pregnant.

Diagnosis may include some of previously discussed tests and monitoring your heart valve function with regular visits with your physician to lessen any further damage. Heart valve repair and heart valve replacement surgeries are treatment options in severe cases.

Heart Problems More Likely in Women

Some heart-related diseases and problems occur more often in women than in men. Heart problems that are more likely to occur in women include:

Chest pain and discomfort (angina). About 4 million U.S. women suffer from angina.

Angina also affects men, but women are more likely than men to get these specific types of angina:

Stable angina. This is the most common type of angina. Women with stable angina may experience chest pain during physical activity or times of stress. The chest pain usually goes away with rest. However, it can develop into unstable angina, the type of angina which happens most often during rest or sleep. Unstable angina can lead to a heart attack or cardiac arrest.

Variant (Prinzmetal's) angina. This type of unstable angina is rare and is caused by a spasm occurring in the coronary arteries, which carry blood to the heart muscle.

Prinzmetal’s angina is rare, representing about two out of 100 cases of angina, and usually occurs in younger patients than those who have other kinds of angina.

Triggers for the spasm can include exposure to cold weather, stress, smoking or cocaine use. The spasms can lead to painful attacks, often during rest or sleep.

This type of unstable angina rarely causes a heart attack and can be treated with medication.

Cardiac syndrome X. Cardiac syndrome X occurs when those with healthy, unblocked arteries have chest pain (angina) and coronary artery spasms, resulting in the artery pinching itself closed.

The cause of cardiac syndrome X is not known. Some possible causes include:

Coronary microvascular disease (MVD). In some women, cardiac syndrome X may be caused by MVD, a disease within tiny arteries located near the heart. These arteries are too small to see on an angiogram, a diagnostic test that takes X-ray pictures of the arteries.

Women with cardiac syndrome X caused by MVD are often younger than 50 years of age and face higher heart attack risk.

MVD affects about half of women with cardiac syndrome X.

Diagnosis occurs through physical exam and subsequent medical tests. Relieving pain is one of the main goals of treating MVD.

Treatments also are used to control risk factors and other symptoms. Treatments may include medications to improve cholesterol levels, lower blood pressure, decrease the heart's work or help prevent blood clots or control inflammation, relax blood vessels, improve blood flow to the heart and treat chest pain.

Hormonal changes. Changes in estrogen levels after menopause could make women more likely to have heart problems. Most women with cardiac syndrome X are postmenopausal or are going through menopause.

Broken heart syndrome. Broken heart syndrome, also known as stress-induced cardiomyopathy (or takotsubo cardiomyopathy), can happen even in those who are healthy.

Researchers don’t yet know its exact cause. Symptoms are often triggered by extreme stress, like intense grief, anger or surprise.

Women are more likely than men to experience broken heart syndrome. Experts think a stress hormones surge "stuns" the heart, causing intense, short-lived symptoms which usually don't result in permanent heart damage.

Most women who experience broken heart syndrome are older, between 58 and 75 years old. The syndrome is most likely due to estrogen levels dropping after menopause.

Broken heart syndrome can be misdiagnosed as a heart attack. The symptoms and test results are similar, but there are no blocked heart arteries. Instead, a part of the heart temporarily enlarges while the remainder heart area works normally.

Broken heart syndrome can lead to short-term heart failure, yet it’s usually easily treatable. Because broken heart syndrome often mimics the signs and symptoms of a heart attack, a coronary angiogram is often done to rule out heart attack. Those with broken heart syndrome often don't have any blockages in the blood vessels, while those who have had a heart attack usually have blockage clearly visible on an angiogram.

Treatment includes hospitalization and medications to reduce heart workload. Recovery usually occurs within a month, with follow up echocardiogram to monitor and evaluate heart health.

Silent Heart Attack and Women

Heart disease is much more common in women than many realize. Many women with heart disease don’t exhibit any symptoms. Only half of women who have heart attacks have chest pain.

Women are more likely than men to get other symptoms, including back or neck pain, indigestion, heartburn and nausea. These symptoms are often easy to ignore or pass off as stress or other health issue.

Most importantly, women are more likely than men to suffer silent heart attacks.

Women may never even know they have had a heart attack until they have an additional, more severe recurrence.
A silent heart attack does not cause obvious symptoms. Your doctor may discover a silent heart attack had occurred days, weeks, or months afterward via an electrocardiogram test.

Silent heart attack:

  • is more common in women than in men.
  • can happen to women younger than age 65. Younger women who have silent heart attacks without chest pain are more likely to die compared to younger men who have silent heart attacks without chest pain.
  • Is more likely to happen in women with diabetes. Diabetes can change how you sense pain, making you less likely to notice heart attack symptoms.

Sometimes heart disease may be “silent” and not diagnosed until you experience other symptoms or emergencies, including:

  • Heart attack: Chest pain or discomfort, upper back or neck pain, indigestion, heartburn, nausea or vomiting, extreme fatigue, upper body discomfort, dizziness and shortness of breath
  • Arrhythmia: chest palpitations
  • Heart failure: Shortness of breath, fatigue, or swelling of the feet, ankles, legs, abdomen or neck veins

If you experience any of these symptoms, call 9-1-1 immediately.

It’s important to see your doctor before you have heart health issues to determine your risk for heart disease and how you can reduce your risk.

If you do have symptoms, it’s important to see your doctor as soon as possible so they can test you for heart disease and provide treatment before permanent heart damage occurs.

Your local Capital Women’s Care team offers you and your family professional healthcare expertise you can trust, ensuring you and your family enjoy optimal health and longevity of life.


Heart attack symptoms | womenshealth.gov
Heart disease and women | womenshealth.gov
hds-heart-disease-and-women-1.jpg (475×403) (womenshealth.gov)

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