Temporary Coronary Artery Spasm
Heart disease looks different in women. “Women tend to have heart disease without blockages in big arteries,” says Holly Andersen, MD, Director of Education and Outreach at the Ronald O. Perelman Heart Institute at New York-Presbyterian Hospital/Weill Cornell Medical Center. Doctors suspect some cases are due to coronary artery spasms or a brief, sudden narrowing of the coronary arteries. Spasms can cause heart attacks, and symptoms appear as severe chest pain that lingers from 5 to 30 minutes.
“Broken Heart Syndrome”
Yes, that’s a real thing. Technically called takotsubo cardiomyopathy, the condition happens almost entirely in women, according to Dr. Andersen. “We don’t understand it completely, but it may have to do with an outpouring of adrenal hormones like norepinephrine in response to emotional or physiological stress,” she says. “It completely stuns the heart.” Stress alone is a bigger risk factor in heart disease for women than men. This one habit can help protect against the toxic effects of stress.
The term is short for spontaneous coronary artery dissection. Women are most at risk postpartum, when connective tissue tends to be loose. “Everything gets loose to allow for delivery,” says Dr. Andersen. With SCAD, the connective tissue in the middle portion of the artery tears, and the symptoms look similar to a heart attack. It’s often missed, she points out, but women can get an idea of where they stand. “Pregnancy is a window into the heart,” says Dr. Andersen. If you had gestational diabetes, high blood pressure, preeclampsia, or preterm labor, you’re more at risk for future cardio problems. This is what a heart-healthy day might look like.
Coronary Microvascular Disease
You might think the bigger arteries that supply blood to your heart are the most important, but the small ones matter, too. Although this condition isn’t as well understood and affects mostly young women, damage to small blood vessels can block oxygen from reaching the heart muscle, Dr. Andersen notes. It’s hard to diagnose, but one symptom is chest pain that lasts longer than 10 minutes. (In coronary heart disease, it can last five minutes or less.) It may also be accompanied by shortness of breath, sleep problems, fatigue, or lack of energy, according to the American Heart Association. These are the scary chest pains most often mistaken for a heart attack.
The condition is marked by an irregular heartbeat that can increase your risk of a stroke five-fold, according to the American Heart Association. Patients with this condition who are older than age 75, 60 percent are women, research shows. And dying from AFib and its complications is more common among women than men. Still, the AHA points out that AFib is often not taken seriously. Symptoms include fatigue, irregular heartbeat, dizziness, sweating, and chest pain. If you notice any of these, talk to your doctor—they do not mess around when it comes to heart symptoms.
It’s not all about chest pain
Women’s symptoms also look different than men’s. Dr. Andersen notes that 40 percent of women don’t have chest pain, but they know something is wrong. One big clue: pain in your chest, jaw, or arm when you exert yourself (say, climb up stairs) or are in emotional distress. “This doesn’t just happen once and a while, but every time,” says Dr. Hendersen. Women may also feel squeezing or fullness in the chest, shortness of breath, nausea, or lightheadedness. You may also think you have heart burn or indigestion. Here’s a cheat sheet to tell the difference between heartburn and a heart attack.
Women are more likely to wait
Women more often stall before calling 911, according to 2015 research in the Journal of the American College of Cardiology. In fact, 70 percent of women took longer than an hour to get to the hospital, compared to 30 percent of men—and women were 34 percent more likely to die at the hospital than men. “Women who believe they’re having a heart attack are more likely to close their eyes and pray it goes away,” says Dr. Hendersen. “If you think something is wrong, don’t wait,” she adds. Even if it does turn out to be something like indigestion, the ER doctors would much rather treat you for that—don’t let embarrassment or the fear of troubling others keep you at home. (Find out the secrets hospitals won’t tell you.)
Take it upon yourself to start the conversation with your doctor about your heart risk. For a rundown of what that visit should look like, visit the Women’s Heart Alliance. After taking your medical history (including your family history), you’ll need two screenings: blood work (cholesterol, triglycerides, and blood sugar) and a physical exam (blood pressure, BMI, and waist circumference). With all the info, your doc can assess your risk for heart disease and help you come up with an action plan. And while you’re at it, learn about the hidden risk factors of heart disease.