By Ines Sherifi, MD, MSc
Did you know that, dimensionally, a woman’s heart is smaller than a man’s? And did you also know that some of the walls separating a woman’s heart chambers are thinner? A woman’s heart also beats faster and releases roughly 10% less blood with each heartbeat.
Diving right into the heart of the matter, let’s explore how women’s heart health is different from men’s—and why understanding these differences is crucial for everyone.
Biologically, a female’s arteries are smaller and harder to see on an angiogram (a procedure that uses X-ray imaging to view the heart’s blood vessels), especially if a blockage is affecting smaller arteries. That’s why women who continue to have symptoms after an angiogram should see a cardiologist who specializes in women with heart disease.
In men, stress causes the heart arteries to constrict, raising blood pressure. In women, stress raises the pulse rate, causing the heart to pump more blood.
Although heart disease is the leading cause of death for both women and men, biological sex makes a difference in the rate and severity of heart attacks.
Males are more vulnerable to heart attacks than females, with 420,000 hospitalizations a year compared to 350,000 for women. Men also have heart attacks at a younger age: 65 on average for a first heart attack, compared to 72 for women. This is because of the protective effect of estrogen, which lasts until after menopause and dissipates over time.
However, heart attacks are often more serious in women. They tend to be hospitalized longer and are more likely to die in the hospital. In the year following a first heart attack, women have a 50% higher chance of experiencing a deadly heart attack, and their odds of having a second heart attack within six years are nearly double those of men.
Risks for women
Sex-linked risk factors: Both sexes share the same familiar risk factors: high blood pressure, diabetes or pre-diabetes, high cholesterol, smoking, excess weight and a family history of heart disease. However, certain conditions that only affect women also raise their risk of heart disease, including:
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- Endometriosis
- Polycystic ovary disease
- Pregnancy-related diabetes and high blood pressure
Subtle, sometimes ambiguous symptoms: Men often describe their chest pain during a heart attack as a crushing weight on the chest. While some women also experience chest pain, others may have subtler symptoms that could be confused with more benign conditions such as heartburn, muscle pain or the flu. Unlike plaque rupture, which is often seen in men presenting with a heart attack, plaque erosion is often seen in women, which explains why symptoms in women are often subtle. In fact, it’s not uncommon for women to be unaware that they have had a mild heart attack and have sustained heart damage. This puts them at serious risk for a second, possibly fatal heart attack. Here are some signs you should never ignore:
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- Sudden intense fatigue, sometimes accompanied by a heavy feeling in your chest, particularly if the fatigue hits after a simple activity like walking your dog or finishing your regular exercise routine
- Shortness of breath, often without exertion—it may be accompanied by chest pain or sudden debilitating fatigue and get worse when you lie down
- A cold sweat
- Pain in the neck, arms, chest, back or jaw, especially if the pain starts in the chest and spreads to the back and/or wakes you up at night
If you think you or a loved one may be experiencing symptoms of a heart attack, don’t wait. Call 911 immediately. Learn more about women’s heart health at mymarinhealth.org.
Dr. Ines Sherifi is a cardiologist and cardiovascular imaging specialist at MarinHealth the medical director of MarinHealth’s Women’s Heart Health Program.
