Women's Health
Heart Disease in Women: Why the Risk Is Higher Than You Think
Cardiovascular disease kills more women than all cancers combined, according to the CDC — yet women are less likely to be screened, less likely to receive a timely diagnosis, and more likely to die from their first heart attack. A major reason: the symptoms are different, and they are routinely dismissed.
Heart attacks in women are frequently different from the textbook presentation of crushing chest pain radiating to the left arm. This difference has consequences: women wait longer to call for help, are more likely to be sent home from emergency departments without a cardiac diagnosis, and have higher in-hospital mortality from heart attack than men. The gap is not explained by biology alone. A significant part of it is awareness.
The most common form of heart attack in men involves a single large coronary artery becoming abruptly occluded by a ruptured plaque. Women experience this pattern too, particularly older postmenopausal women. But women are also significantly more likely to experience heart attacks from plaque erosion rather than rupture, spontaneous coronary artery dissection, and microvascular spasm. These mechanisms do not always produce the dramatic ST-elevation pattern on EKG that triggers immediate catheterization.
The result is that women more frequently have heart attacks classified as NSTEMI, a non-ST-elevation myocardial infarction, which requires different diagnostic evaluation and is associated with delayed or less aggressive treatment in many hospital systems. Awareness of this pattern is essential both for patients and for the people around them.
Research published in Circulation found that 43 percent of women having heart attacks reported no chest pain at all, a pattern the American Heart Association highlights as a critical awareness gap. The presence or absence of chest pain is not a reliable indicator of whether a cardiac event is occurring.
Women presenting to emergency departments with atypical symptoms are more likely than men to have cardiac causes attributed to anxiety, panic attacks, or musculoskeletal pain before a workup is completed. If you are a woman experiencing the symptoms described above and your clinical evaluation has not included cardiac enzymes, an EKG, and imaging evaluation, advocate for that workup. Bring a family member if possible. Name specifically that you are concerned about a cardiac cause.
For women who are not in an acute situation but have cardiac risk factors or have experienced any of the symptoms above intermittently, a preventive echocardiogram and carotid duplex provide objective structural information about the heart and arteries that cannot be minimized or attributed to non-cardiac causes.
For women who have experienced a heart attack, serial echocardiography is used to monitor ejection fraction recovery, assess for mechanical complications, guide decisions about implantable devices, and evaluate the response to medical therapy. Women with preserved ejection fraction after MI require different management than those with reduced ejection fraction, and the echo is the tool that makes that distinction.
BlackPoint performs echocardiography and carotid duplex at your home throughout Southern Maine. $397 per scan. Results from Dr. Glenn Gandelman MD FACC within 24 to 48 hours. No referral required. For women with multiple risk factors, the Comprehensive Cardiac Package includes echocardiography plus carotid duplex in a single appointment.
Book your screening or reach out with any questions about your cardiovascular health.