By ROB ROY, MSN, RN, CCRN, CNML
Women’s heart health deserves a special focus, and here’s why: Heart disease is the No. 1 killer of American women.
WHAT HAPPENS
Cardiovascular disease occurs differently in women. Women normally develop plaque in smaller coronary arteries that branch off larger vessels; therefore, women may have different symptoms of cardiovascular disease.
SIGNS AND SYMPTOMS
Signs and symptoms of heart diseases can be different for women than they are for men. Women experience heart attack symptoms that are uncommon in men, therefore they may not be aware that they are having a heart attack at all. Psychosocial issues are different for women: They are more likely to be unemployed, unmarried or widowed, live alone, be less physically fit, have fewer social supports, experience more depression and feel more obliged to return to responsibilities, according to a 2000 Journal of Internal Medicine article.
If any of these signs are present, don’t wait more than five minutes. Call 911 and get to a hospital right away.
- Uncomfortable pressure, squeezing, fullness or pain in center of chest
- Shortness of breath, nausea/vomiting and back or jaw pain
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach
- Shortness of breath with or without chest discomfort
- Breaking out in a cold sweat, nausea or lightheadedness
- Heart palpitations
DIAGNOSTIC TESTING
Some diagnostic tests that are routinely used to detect heart disease in men may be less reliable in women, including the exercise stress test. In addition, women often have harmless chest pain that can make diagnosis more challenging.
Echocardiogram (a sound study of the heart performed during exercise) and nuclear imaging (a study in which a nuclear dye is injected into the bloodstream and information is captured by a computer during exercise) may be more effective in women, according to a 2014 consensus statement from the American Heart Association.
Women should report unusual symptoms to their doctor and be persistent until their cause is determined.
TREATMENT
Treatments that work for men do not always work the same for women. Some therapies used to treat heart attack (thrombolytic drugs and aspirin) may be less effective, as well as underutilized, for women.
Women may not be equal candidates for existing therapies that cannot reach and treat small vessels, according to the Journal of the American Medical Association. Though diagnosis and treatment differ for men and women, Lakeland Regional Health delivers the best outcomes and safest care for our female cardiology patients.
As much awareness has been brought to women’s heart health and as many advances that have been made in procedures, research shows that women are less likely to receive lifesaving treatment. Why is this?
- Women are more likely to see only obstetricians/gynecologists or other primary care physician who focus primarily on reproductive health. They therefore end up not being screened as aggressively for heart disease as men.
- Women do not recognize that heart disease is their greatest health threat and are less represented in clinical trials.
- Women are less likely to be scheduled for stress testing or referred for a special X-ray test after initial treadmill testing.
- Women are less likely to be prescribed aspirin and beta blockers after a heart attack, in spite of beneficial effects of aspirin as shown in women over age 50 participating in the Nurse’s Health Study (Journal of the American Medical Association 1991; 266:521-527).4
- They are less likely to receive clot-dissolving treatments after a heart attack.
Despite the heart disease statistics, women still say they fear cancer the most. Women still overestimate the risk of cancer and largely underestimate the risk of heart disease, according to a recent American Heart Association poll. While awareness of heart disease as the leading cause of death for women increased from 30% to 54% from 1997 to 2009, only 16% of women consider heart disease their greatest personal health risk.
Generally speaking, women tend to have poorer outcomes than men after experiencing a cardiac event as well some medical procedures.
More women (26%) than men (19%) will die within one year of having a heart attack.
However, women are not at a full disadvantage. Even though many women present to the hospital with more risk , are typically older than men when they experience their first cardiac event and have more co-morbidities than men, they have equal if not better outcomes than men after receiving treatment. Women who underwent cardiac resynchronization therapy to treat heart failure had a 72% reduction of all mortality, whether it was heart failure or death.
With the opening in early 2018 of our Carol Jenkins Barnett Pavilion for Women and Children, we will be able to provide cardiac care specifically targeted to women’s special health needs.
As research into diagnosis and treatments continue to evolve, each woman must take responsibility for their cardiac wellness. That includes lifestyle changes, such as diet and exercise, and knowing your medical history and risk factors.
About the Author
Rob Roy, MSN, RN, CCRN, CNML, is Director of Lakeland Regional Health Medical Center’s Cardiovascular Service Line.