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Ask Stanford Med, Cardiovascular Medicine, Women's Health

Ask Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart health

Ask Stanford Med: Cardiologist Jennifer Tremmel responds to questions on women’s heart health

Thank you for taking the time to submit questions about the growing body of research on women and cardiovascular disease and other issues related to women’s heart health. Here are my responses.

@ntopliffe asks: What are the differences between a male and female heart?

If you simply looked at a male and a female, you wouldn’t be able to tell the difference – although the female heart may be slightly smaller than the male heart because women are generally smaller. However, the pathophysiology of male and female hearts is often very different. Women and men can have different types of coronary plaque. Women, especially young smokers, develop plaque that erodes while men develop plaque that ruptures. In addition, women appear to be more likely to have functional problems with their arteries, such as endothelial dysfunction, coronary vasospasm and microvascular disease.

These functional problems can cause symptoms even though the heart arteries look perfectly normal. Women, particularly young women, are more prone to having dissection of their heart arteries. This appears to be strongly related to hormonal changes and is most frequent in the months after giving birth. Finally, women and men  often get different types of heart failure. Men develop hearts that don’t pump well, while women develop hearts that don’t relax well.

MCG asks: Past studies show that the number of heart attacks is rising among women and falling among men. What factors are contributing to this gender gap in heart attack prevention?

There are a number of gaps between women and men that lead to disparate outcomes between the sexes. In particular, physicians tend to underestimate a woman’s cardiovascular risk, which leads to less aggressive risk factor modification, testing and treatment. Women also underestimate their own risk and don’t recognize that heart disease is the leading cause of death for their gender. Therefore, they may be less proactive about prevention and less cognizant of concerning symptoms. Specific risk factors, such as smoking and obesity, are unfortunately prevalent among women. Ultimately, it’s up to each person to decrease her own risk.

Erin asks: I’ve heard that heart attacks have somewhat different symptoms in women than men. What symptoms should women watch out for?

The most common symptom in both women and men is chest pain. But for women this may not be the most prominent symptom. It is also worth noting that, while doctors use the word “pain”, it may not actually feel like a pain. Instead, it may feel like a burning, tightness, pressure or some other sensation. A better word than “pain” might be “discomfort.” This discomfort may radiate, or seem to originate, in the jaw, back, mid-stomach or either arm. One of the distinguishing factors between women and men is that women tend to report more associated symptoms. These may include classic symptoms such as shortness of breath, nausea and vomiting – but may also include several less classic symptoms including fatigue, dizziness and palpitations. In general, women report a greater number of less common symptoms, with women being significantly more likely than men to report less than four symptoms.

While it is most common for both genders to get their symptoms with physical exertion, women may also experience their symptoms at rest, during sleep and with emotional stress. Likewise, women may have an increased frequency of symptoms around the time of their menstrual period.

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