Many people think heart disease is mostly a problem for men. But heart disease caused by atherosclerosis, called coronary heart disease (CHD) or coronary artery disease (CAD), is the leading cause of death and disability in women after menopause. CHD is a broad term that includes angina (chest pain), heart attacks, sudden cardiac death syndrome, arrhythmias (abnormal heart rhythms), and heart failure due to a weakened heart, all caused by clogged cardiac arteries.
Women with coronary heart disease (CHD) are:
MORE likely to:
- have misleading "false positives" on noninvasive tests for CHD
- have coronary artery problems that don't show up on angiogram
- have "atypical" symptoms during a heart attack, like nausea or pain elsewhere in the body
- have no symptoms at all during a heart attack
LESS likely to:
- to be diagnosed as having a heart attack,
- to be admitted to a coronary care unit
A 50-year-old woman has a 31% risk of dying from CHD. By contrast, her risk of dying from breast cancer is only 3%. Deaths due to CHD have declined for men since 1984, but the same is not true for women. Each year CHD kills 50,000 more women than men.
Women have special problems in dealing with CHD. For one thing, women haven't been included in scientific research studies on heart disease to the same extent men have, so less is known about women and CHD. CHD is also more difficult to detect in women than in men. Coronary angiograms, the "gold standard" test for assessing coronary artery disease, may not spot the more diffuse buildup of plaques that often forms in the smaller coronary arteries of women's hearts. Men tend to have large, bulky, irregular plaques that are more easily detected by typical tests.
Angina is chest pain caused by reduced blood flow to the heart. When coronary arteries are narrowed or clogged, the heart has to work harder to push blood through the narrowed vessels. As they become increasingly blocked, the heart muscle becomes starved of oxygen, or ischemic. The result can be shortness of breath, fatigue, and pain in the chest, angina. People who have angina have sensations of squeezing, heaviness, pressure, and pain. Some say it's like someone is standing on their chest.
Women's angina symptoms can be different from those of men. For instance, women may have stabbing, sharp, or pulsating pain rather than the more typical squeezing pressure. They're also more likely to experience nausea and vomiting. Although women are more likely than men to experience angina, these differences may cause delays both in seeking treatment and in diagnosis.
Myocardial infarctions, or heart attacks, occur when a coronary vessel becomes completely blocked and oxygenated blood can't reach the heart muscle tissue, and the tissue is damaged or dies.
Women are less likely to be diagnosed as having a heart attack than men; frequently their symptoms may be misdiagnosed as indigestion or a panic attack. Women are also less likely to be admitted to a coronary care unit. This is partly because women tend to seek medical care later than men, and partly because women's symptoms can be more difficult to diagnose:
- Women are less likely to have chest pain during a heart attack and more likely to have "atypical" symptoms, like nausea or pain elsewhere in the body.
- Women are more likely to have no symptoms at all when they have a heart attack.
- Chest pain unrelated to heart attack occurs more frequently in women.
- Women are more likely to have coronary artery problems that don't show up on angiograms.
- Women have a higher number of misleading "false positives" on noninvasive tests for CHD.
Unfortunately, delays in receiving treatment for heart attack are likely to be harmful or even fatal. The most important factor in treating heart attacks is time. To be most effective, clot-busting treatment must be given within 1 hour of the start of the heart attack.
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