Heart Health
What Does an Echocardiogram Actually Show?
Heart disease kills more women in the United States than all forms of cancer combined — a fact that the American Heart Association's Go Red for Women campaign works to raise awareness about. Yet it remains dramatically underdiagnosed in women — often because symptoms present differently, risk factors are evaluated differently, and both patients and providers have historically underestimated cardiovascular risk in women. This is a problem with real consequences.
Heart disease is the leading cause of death for women in the United States, responsible for one in five female deaths, according to the CDC. Yet surveys consistently show that most women do not perceive heart disease as their primary health threat. This perception gap has real consequences: women are less likely to receive aggressive treatment for cardiovascular events, and when symptoms do occur, they are more likely to be attributed to other causes.
The dominant cultural image of a heart attack is a middle-aged man clutching his chest. This image, while partially accurate, has created a clinical blind spot. Women are significantly more likely than men to present with atypical symptoms during acute cardiac events, symptoms that do not match the textbook chest pain description and are therefore more likely to be attributed to anxiety, indigestion, or stress.
The disparity extends beyond symptoms. For decades, most cardiovascular research was conducted primarily in men, and diagnostic criteria, treatment thresholds, and risk scoring tools were validated in male populations. Women were then treated according to these male-derived standards, leading to systematic underestimation of their cardiovascular risk.
In addition to shared risk factors like hypertension, diabetes, smoking, and family history, women have unique cardiovascular risk factors that are often not addressed during standard medical care. Hypertensive disorders of pregnancy, including preeclampsia, significantly increase lifetime cardiovascular risk even after the pregnancy resolves. Women who experience preeclampsia have two to four times the lifetime risk of heart disease compared to those without.
Premature menopause, whether surgical or natural, substantially increases cardiovascular risk. Estrogen has protective effects on the vascular endothelium, and its loss accelerates atherosclerosis. Polycystic ovarian syndrome, autoimmune conditions more common in women such as lupus and rheumatoid arthritis, and depression have all been identified as independent cardiovascular risk enhancers in women.
Standard cardiovascular risk calculators do not include pregnancy complications, menopausal status, or PCOS. A woman whose calculated risk scores as moderate may have a true risk that is significantly higher when these factors are considered.
Coronary microvascular dysfunction is a pattern of heart disease more common in women than men. Rather than one large coronary artery blockage, microvascular disease involves diffuse dysfunction of the small vessels throughout the heart muscle. This can cause the same symptoms, the same EKG changes, and the same degree of disability as obstructive coronary artery disease, but it does not show up on standard coronary angiography.
Women with this condition are frequently told their heart is normal after a negative angiogram, when in fact they have significant vascular disease that requires different management. Echocardiographic assessment of diastolic function and coronary flow reserve is increasingly recognized as valuable in identifying this pattern.
BlackPoint performs cardiovascular ultrasound in the comfort of your home, which matters particularly for patients who have experienced prior dismissal in clinical settings. Our reviewing cardiologist evaluates each study with attention to the full clinical picture, not just the standard risk calculator output. $397 per scan, no referral required.
Book your screening or reach out with any questions about your cardiovascular health.
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