Women's Health
Why Heart Disease in Women Is Consistently Underestimated — and What to Do About It
Heart disease is the leading cause of death in women — killing more women than all cancers combined, according to the CDC. Yet the cultural image of a heart attack is still a middle-aged man clutching his chest. That disconnect costs women's lives. Here is what the research actually shows, and what you can do about it.
Heart disease looks different in women. This is not a metaphor. The same underlying pathology, whether coronary artery disease, heart failure, or arrhythmia, genuinely presents with different symptoms depending on biology, hormonal status, and the type of vascular disease involved. Understanding these differences is not just medically interesting. For women, it can be life-saving.
Men tend to develop obstructive coronary artery disease: single large vessel blockages that cause the classic presentation of crushing chest pain radiating to the arm or jaw. Women, particularly younger women, more frequently develop microvascular disease, plaque erosion rather than rupture, and multivessel disease that produces less localized, more diffuse symptoms.
Hormonal influences also shape how pain is perceived and reported. Estrogen modulates pain sensitivity and inflammatory pathways, which may explain why premenopausal women often underreport the severity of cardiac symptoms even when experiencing objective ischemia. After menopause, as estrogen levels decline, symptom patterns shift closer to the male presentation, though atypical symptoms remain more common in women.
Heart failure with preserved ejection fraction, sometimes called diastolic heart failure, is more common in women than men. The heart pumps normally in terms of ejection fraction but fails to relax and fill properly between beats. This produces shortness of breath, particularly when lying flat, ankle swelling, fatigue, and exercise intolerance.
These symptoms are frequently attributed to age, weight, or deconditioning before a cardiac cause is investigated. An echocardiogram that includes diastolic function assessment can identify diastolic dysfunction at an early and reversible stage, before it progresses to overt heart failure.
If you are a woman who has been told that your symptoms are anxiety, deconditioning, or simply stress, and those symptoms include any combination of unexplained fatigue, shortness of breath, chest pressure, or jaw discomfort, a formal cardiovascular evaluation including echocardiography is warranted.
Cardiovascular ultrasound provides objective structural information that complements clinical symptom evaluation. An echocardiogram assesses ejection fraction, diastolic function, valve function, and wall motion. A carotid duplex with IMT directly measures arterial wall health and atherosclerotic burden. These findings are independent of how a patient describes her symptoms and cannot be minimized or dismissed.
This objectivity is particularly valuable for women who have experienced having their symptoms downplayed. A report from a board-certified cardiologist showing a specific finding creates a documented clinical record that demands appropriate follow-up.
BlackPoint performs echocardiography and carotid duplex ultrasound at your home throughout Southern Maine. $397 per scan. No referral required. Results from Dr. Glenn Gandelman MD FACC within 24 to 48 hours.
No referral, no insurance hassle. Results from a board-certified cardiologist within 24–48 hours.