Heart Disease and Women

I was approached by a long-time family friend the other day and was shocked to learn that she had recently undergone coronary artery bypass grafting.  She always seemed so vibrant and full of life with an abundance of energy.  Recently, however, she had been experiencing a new symptom of occasional mild shortness of breath.  NO pain!  She mentioned it to her health care provider who was savvy enough to put her through an EKG(electrocardiogram) and cardiac stress test.  The EKG was negative for findings, however, she did not pass the cardiac stress test.  Shortly thereafter, she had three coronary artery bypass grafts.  Her words to me were, “Women are different.  I had no pain.  I could have died if I hadn’t mentioned the shortness of breath to my doctor, which I really didn’t think much about.”

Women often present with atypical symptoms of heart attack or pending heart attack.  I could tell many stories.  Such as the women who only experienced a “twinge” of discomfort between her shoulder blades while climbing stairs and actually was having a heart attack.  Or the women who presented to her health care provider with right shoulder pain thinking that she had pulled a muscle.  Her physical exam was negative for any cardiac findings. After three days of the pain progressively getting worse, she presented to the emergency department and was found to be having a heart attack.  And so on.  These scenarios are not meant to frighten anyone, but to alert you to the fact that WOMEN DO NOT PRESENT IN THE SAME MANNER OR NECESSARILY EXPERIENCE THE SAME TYPICAL SYMPTOMS WHEN HAVING A HEART ATTACK OR WHEN CARDIAC BLOCKAGE IS PRESENT AS IS OFTEN DIALOGUED.  Why is this?  No one seems to have the answer.  So what we do as health care providers is educate the public of what to watch for and when to seek immediate medical attention.


First, what is a heart attack or, otherwise known as, a myocardial infarction(MI)?  A heart attack occurs when the flow of oxygen-rich blood suddenly becomes blocked in one of the heart’s arteries.  The heart muscle is not able to receive the oxygen-rich blood supply due to the blockage and the heart muscle begins to die.  The most common cause of a heart attack is due to a build-up of a waxy substance called plaque in one of the coronary arteries.  This plaque accumulates along the walls of the arteries.  This is known as atherosclerosis.  Over time, the plaque can rupture inside the artery.  The body reacts by forming a blood clot on the surface of the plaque.  If the clot becomes large enough, it can completely block the flow of blood and a heart attack can occur. 

A less common cause of heart attack is when a coronary artery suffers a severe spasm or tightening, which stops the oxygen-rich blood flow.  There are several possible causes of coronary artery spasm that include: 1) certain drugs such as cocaine; 2) cigarette smoking; 3) exposure to extreme cold; and, 4) emotional stress or pain.

All coronary artery blockage has the same affect whether it be from plaque or severe artery spasm.  The heart muscle on the other side of the blockage dies and is replaced by scar tissue.  There are varying degrees of damage.  The heart muscle damage may go unnoticed, cause long-term and devastating health problems, or death.  Heart muscle damage may lead to heart failure and life-threatening irregularities in heart beats, known as arrhythmias.

Heart attacks are a leading killer of both men and women in the United States. The good news is that excellent treatments are available for heart attacks. These treatments can save lives and prevent long-term or life-threatening disabilities, especially if early treatment is received when the heart attack is occurring. Approximately half of all deaths from heart attacks occur within one hour of the onset of the first symptom and before the individual can reach the hospital.

Risk Factors

Approximately every 34 seconds in the United States, a heart attack occurs. Over 1 million individuals suffer a heart attack each year and many of them die. Heart attacks are the number 1 cause of death in the United States for both men and women.  Age does not always equate with cardiovascular health.  For instance, a middle-aged individual who eats a diet high in fat, smokes cigarettes, and leads a sedentary lifestyle(lacks physical activity), may very well have a poorer cardiac health status than an older adult who has maintained a healthy diet, leads an active life and exercises, and doesn’t smoke cigarettes. 

General risk factors for heart attack that can be controlled include: 1) cigarette smoking; 2) high blood pressure; 3) high cholesterol; 4) being overweight or obese; 5) eating an unhealthy diet that is high in saturated fat, cholesterol, and sodium; 6) sedentary lifestyle or a lack of routine physical activity or exercise; and, 7) high blood sugar due to diabetes or insulin resistance. When certain risk factors occur together, it is called metabolic syndrome. These include obesity(having a body mass index [BMI] over 30), high blood pressure, and high blood sugar. Having a waist circumference of 35 inches or greater places an individual at risk for metabolic syndrome. In general, a person who has metabolic syndrome is twice as likely to develop heart disease and five times as likely to develop diabetes as someone who doesn’t have metabolic syndrome.

Risk factors for heart attack that cannot be controlled include: 1) age; the risk for developing heart disease for men increases after age 45 and after age 55 for women(which is usually after menopause occurs); 2) family history of heart disease that appeared at an early age; before age 55 in a father or brother and before age 65 in a mother or sister; and, 3) preeclampsia which is linked to a lifetime risk of heart disease. This is a condition that can develop during pregnancy. The two main symptoms are elevated blood pressure and increased levels of protein in the urine.

There are some normal cardiovascular changes that are associated with aging.  These include:  1) heart valves lose elasticity and stiffen, thus decreasing the heart conduction ability; 2) the left ventricular wall thickens; 3) increased potential for postural hypotension(drop in blood pressure with position change to sitting and/or standing); 4) increased risk of arrhythmias(irregular heart beats); 5) arterial elasticity decreases, which increases the risk for systolic hypertension(reflected in the top blood pressure reading) and left ventricular hypertrophy(enlarged left ventricle); 6) increased risk for “silent” heart attack; 7) decreased blood perfusion to vital organs and distance parts of the body(due to the arteries stiffening); 8) veins thicken, which causes the tiny valves in the veins(especially the distant leg veins) to allow the backflow of blood, increasing the risk for varicosities(varicose veins) and lower leg swelling after sitting or standing for prolonged periods of time; and, 9) decreased cardiac ability to handle stressful activities such as shoveling snow.  Although these changes are associated with the older adult’s aging cardiovascular system, it doesn’t necessarily indicate the older adult will have debilitated cardiac functioning.  Being vigil in remaining physically active with an exercise program, not smoking cigarettes, maintaining a normal BMI(body mass index) or weight, eating a healthy diet, and controlling blood pressure and cholesterol, the older adult can lead a healthy life and maintain a healthy cardiac status.


Not all heart attacks occur with the sudden onset of crushing chest pain. In fact, symptoms of a heart attack may develop over a course of hours, days, or even weeks. Approximately one-third of heart attack suffers have no pain at all. These individuals are most likely to be older, females, and diabetics. Remember that we are all different, therefore, our symptoms may be different. In fact, some individuals have no symptoms at all. But, generally speaking, many heart attacks start slowly as mild pain or discomfort in the center or left side of the chest that often lasts for more than a few minutes, or goes away and comes back. This may be new chest pain or discomfort or a change in the usual pattern of chest pain or discomfort for those individuals with a known heart condition, such as angina, or occurring when at rest. Angina is chest pain or discomfort that usually lasts only a few minutes and occurs with activity and goes away with rest. Heart attacks that occur without any symptoms or very mild symptoms are called silent heart attacks. Even if symptoms are mild does not make the heart attack less deadly.

So, let’s discuss typical heart attack symptoms. These include chest pain or discomfort. This is often described as a feeling of heaviness in the chest, pressure, fullness, squeezing, or actual pain in the middle or left side of the chest. It can be mild or severe. It can be constant or come and go. There can be accompanying discomfort or pain in one or both arms, upper back, neck, jaw, face or upper part of the stomach. Shortness of breath may occur with the pain or discomfort or before other symptoms occur. Other symptoms include nausea, vomiting, or a sudden onset of dizziness, feeling lightheaded or breaking out in a cold sweat. Symptoms may, also, include a feeling of indigestion or heartburn, a loss of energy, feeling unusually tired or fatigue, and difficulty sleeping.

Not everyone having a heart attack has typical symptoms. If you’ve already had a heart attack, your symptoms may not be the same for another one. However, some people may have a pattern of symptoms that recur. The more signs and symptoms you have, the more likely it is that you’re having a heart attack. Specifically, in regards to women, they may experience no chest pain or discomfort at all. They may experience other symptoms such as shortness of breath, pressure or pain in the lower chest or upper abdomen, pressure or squeezing in the upper back, or become suddenly dizzy, lightheaded, faint, or extremely fatigued. Often, a women will dismiss her symptoms to the normal aging process, heartburn, or having the flu.


You can lower your risk of developing heart disease and preventing a heart attack from occurring in most cases. Even if you already have heart disease, you can still take steps to lower your risk of suffering a heart attack. These steps involve following a heart healthy diet that includes a variety of fruits, vegetables, whole grains, lean meats, poultry and fish, beans, and fat-free or low-fat milk or milk products. A healthy diet is low in saturated fat, cholesterol, sodium, and added sugars.

Work with your health care provider to determine your heart disease risk. Create a reasonable weight-loss plan that involves diet and physical activity. Be as physically active as your health allows. Physical activity can improve your overall health and sense of well-being. Talk with your health care provider about what types of activities are safe for you. Controlling your weight helps you control risk factors for coronary heart disease and heart attack. Stop smoking if you do smoke. Your health care provider can assist you with resources and other treatment plans if needed to help with this.


All chest pain should be evaluated by a health care provider. If you experience any of the above listed symptoms, never wait more than 5 minutes to get checked out. And PLEASE, go directly to an actual emergency department and NOT an urgent or prompt care unless an emergency department is not available. This wastes vital minutes, which in turn can have a fatal outcome.

Know the warning signs of a heart attack so you can act fast to get treatment for yourself or someone else. The sooner you get emergency help, the less damage your heart will sustain.

Do not drive to the hospital or let someone else drive you unless it is optimal to save life-saving minutes for you or the individual suffering with the symptoms. It is vital in any situation to call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room or meet the patient in route and begin life-saving treatment. Take a nitroglycerin pill if your health care provider has prescribed this type of treatment.

***REMEMBER***CALL 9–1–1 for help right away if you think you or someone else may be having a heart attack. You, also, should call for help if your chest pain doesn’t go away as it usually does when you take medicine prescribed for angina. Talk with your health care provider and develop a plan.

I hope you find this information educational and helpful. Please feel free to comment. As always, blessings until next time……………………………………………………………………


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