Heart Diseases in Women and Risk Factors

OVERVIEW

Heart disease is the leading cause of death for women in the United States, causing about 1 in 5 female deaths, according to the CDC's page on women and heart disease. The most common type is coronary artery disease. It happens when narrowed arteries can't deliver enough blood to meet the heart muscle's oxygen demand.

The condition can stay silent for years and then cause angina, a heart attack or heart failure. Sometimes sudden cardiac death is the first sign of heart disease that had no symptoms.

Women's symptoms can differ from men's. Besides chest pain or pressure, women more often have pain in the neck, jaw, throat, upper abdomen or back, nausea, shortness of breath, or unusual tiredness that won't go away. Call 911 right away if you have these symptoms.

Risk Factor For Heart Diseases In Women

• Hypertension- high blood pressure is a major risk factor. A woman with hypertension has a much higher chance of developing heart disease later in life.
• Diabetes mellitus– diabetes strongly raises the risk of heart disease.
• Cigarette smoking- smoking damages both the lungs and the heart and blood vessels.
• Hyperlipidemia (high LDL cholesterol)
• Age- risk rises with age, especially after menopause; early menopause (before 40) raises risk.
• Family history- a family history of early heart disease raises a woman's risk.
• Pregnancy and reproductive history- high blood pressure during pregnancy (including preeclampsia), gestational diabetes, preterm delivery, polycystic ovary syndrome, and a first period before age 11 are linked to higher risk.
• Other factors- excess weight, physical inactivity, an unhealthy diet, heavy drinking, stress and depression.

HEART DISEASES IN WOMEN

Angina Pectoris

The pain of angina is central and diffuse in nature. It comes on gradually over a few minutes. It feels constricting, crushing, choking or dull and heavy, and may spread to the jaw and neck. It occurs with exertion and also with cold weather and emotional stress. The pain of angina pectoris is usually relieved by rest or nitrate medicine. In a heart attack (myocardial infarction), the pain does not go away, which helps tell the two apart.

Changing body position or breathing does not change angina pain, and it may come with nausea, vomiting, sweating and lightheadedness. Doctors usually start with an ECG and may order a stress test or an imaging test of blood flow to the heart muscle (myocardial perfusion scan). Lifestyle changes are an important part of treatment: quitting smoking, reaching a healthy weight, regular exercise, eating more fruits and vegetables, and limiting saturated fat. Many women also need medicines.

Myocardial Infarction

Chest pain is the most common symptom of a heart attack, and it can spread to the neck, jaw and arms. The pain is more severe and lasts longer than angina and may come with vomiting and collapse. It feels squeezing or tight, and signs of heart failure may be present. Some women have other symptoms, such as unusual fatigue, nausea or shortness of breath, with little chest pain.

An ECG, which may show ST-segment changes, is the first test. Blood tests for heart muscle damage (cardiac troponin) follow. Unstable angina does not raise these markers, so a rise points to a heart attack, one of the most serious heart diseases in women.

Congestive Heart Failure

Heart failure is a condition in which the heart cannot pump blood at the rate the body's organs and tissues need. It can be caused by weak pumping (systolic dysfunction) or a stiff heart that fills poorly (diastolic dysfunction). Left-sided heart failure is the most common type. The left ventricle can't pump enough blood out to the body, so pressure backs up into the lungs and causes pulmonary congestion and pulmonary edema.

Women with heart failure have difficulty breathing, especially with activity. They may also have orthopnea, shortness of breath when lying flat, and paroxysmal nocturnal dyspnea, sudden attacks of severe breathlessness at night. Fatigue and swelling of the legs and abdomen are also common.

Infective Endocarditis

Infective endocarditis is an infection of the inner lining of the heart (endocardium), usually involving the heart valves. Risk is higher in people who inject drugs, are on hemodialysis, have diabetes, have damaged or artificial heart valves, or have implanted devices such as pacemakers.

The mitral valve is most commonly involved, followed by the aortic valve. The tricuspid valve is more commonly involved in people who inject drugs. Symptoms include fever, chills, night sweats, poor appetite, anemia, and clubbing of the fingers. Immune-related signs include painful finger nodules (Osler's nodes) and spots on the retina (Roth spots).

Atrial Fibrillation

Atrial fibrillation is one of the heart diseases in women. Chaotic electrical signals fire throughout the upper chambers (atria), causing an irregular heartbeat. Doctors find an "irregularly irregular" pulse, and an ECG shows no P waves with irregular QRS complexes. Causes include high blood pressure, coronary artery disease, pulmonary embolism, rheumatic heart disease, atrial myxoma and an overactive thyroid. Treatment can include medicines to control the heart rate and prevent stroke, and electrical cardioversion to restore normal rhythm.

PERICARDITIS

Pericarditis is inflammation of the sac around the heart (pericardium). It is often caused by a virus and is sometimes autoimmune. The pain is sharp and often spreads to the neck and shoulder. It gets worse when lying flat or breathing deeply and eases when sitting up and leaning forward. A scratchy pericardial friction rub, caused by the inflamed layers of the pericardium rubbing together, is often heard in acute pericarditis.

Cardiac Tamponade

Fluid collecting in the sac around the heart is called pericardial effusion. Cardiac tamponade occurs when that fluid compresses the heart so it cannot fill properly, causing acute heart failure. It is an emergency. Classic signs are low blood pressure, muffled heart sounds and swollen neck veins.

Heart Diseases in Women: Final Words

Heart disease risk in women rises with age, especially after menopause. It is higher in women with diabetes, hypertensive disease, obesity, a family history of heart disease, or pregnancy complications. Coronary artery disease, including angina and heart attack, is the most common form. Heart failure, atrial fibrillation, pericarditis and valve infections also occur. Talk with your doctor about your personal risk and get regular blood pressure, cholesterol and blood sugar checks.

Sources

• About Women and Heart Disease, Centers for Disease Control and Prevention
• Heart Attack: Symptoms, National Heart, Lung, and Blood Institute (NIH)
• Pericarditis, MedlinePlus Medical Encyclopedia