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Heart Disease in Women

What is heart disease?

Heart disease is a general term that includes many types of heart problems. It's also called cardiovascular disease, which means heart and blood vessel disease.

Coronary artery disease (also called coronary heart disease) is the most common type of heart disease in both men and women. It happens slowly over time when a sticky substance called plaque builds up in the arteries that supply your heart muscle with blood. The plaque narrows or blocks blood flow to the heart muscle and can lead to:

  • Angina - chest pain from lack of blood flow
  • Heart attacks - when part of the heart muscle dies from loss of blood flow
  • Heart failure - when your heart can't pump enough blood to meet your body's needs
  • Arrhythmia - a problem with the rate or rhythm of your heartbeat
How does heart disease affect women?

In the United States, heart disease is the number one cause of death in women. But women are often not diagnosed with heart disease as quickly as men are. That's because:

  • Women are more likely than men to have "silent" heart disease, meaning that they don't have symptoms.
  • Health care providers may not recognize heart disease in women because women's symptoms may be different from men's symptoms.
  • Women are more likely than men to have certain types of heart disease that can be harder to diagnose.

A delay in diagnosis may mean a delay in medical care that could help prevent serious problems, such as a heart attack. That's why it's important to learn about your risk for heart disease, the symptoms in women, and how to keep your heart healthy.

What types of heart disease do women get?

Women can get any type of heart disease. Like men, the most common type of heart disease among women is coronary artery disease. But there are certain types of heart disease which are less common, but affect women more often than men:

  • Coronary microvascular disease - Chest pain from spasms (sudden tightening) in the smallest arteries of the heart that pinch off blood flow. It typically happens during rest or routine activities. This serious condition increases your risk of having a heart attack or other heart diseases. This type may be harder to diagnose since blockages in smaller arteries can be harder to see on imaging tests.
  • Broken heart syndrome - Strong chest pain or other signs that look like a heart attack. It's caused by the stress of powerful emotions, such as deep grief, anger, or surprise. It can happen even if you're healthy. It mostly affects women after menopause and usually doesn't cause any lasting damage.
  • Variant angina - A rare type of strong chest pain from spasms in the heart arteries. The pain usually happens in a pattern during sleep. Variant angina rarely causes a heart attack.
Which women are more likely to develop heart disease?

Your risk for developing heart disease increases with:

  • Menopause. Women can develop heart disease at any age, but your risk increases after your periods stop, usually by age 55. Before menopause, your body makes more estrogen (a female hormone) which helps protect against heart disease. That's why women generally develop coronary artery disease 10 years later than men. During and after menopause, estrogen levels drop and your risk for heart diseases goes up. If your periods stop before age 40, your risk will be higher than other women your age.
  • Family history of heart disease. Your risk for heart disease may be higher if your:
    • Mother or sister had heart disease before age 65.
    • Father or brother had heart disease before age 55.
  • Problems during pregnancy, such as high blood pressure, gestational diabetes, anemia, and high blood pressure.
  • Use of hormonal birth control (pills, patches, or vaginal rings with estrogen and progesterone).
  • Endometriosis.
  • Polycystic ovary syndrome.
  • Inflammatory and autoimmune diseases.
  • Metabolic syndrome.
  • Mental health issues, such as stress, anxiety, or depression.
  • Health risks from a lack physical activity.
  • Obesity or being overweight.
  • Diabetes.
  • Low HDL cholesterol levels.
  • Mild to moderate high blood pressure.
  • Smoking.

If you have one or more risks for heart disease, ask your health care provider for help understanding your risk level. Ask if you need any heart tests to help catch heart disease early.

What are the symptoms of heart disease and heart attack in women?

When women have symptoms of heart disease, they may include:

  • Pain or discomfort in the chest that may be dull and heavy or sharp
  • Pain in the neck, jaw, throat, upper belly, or back
  • Nausea or vomiting
  • Unusual fatigue
  • Shortness of breath (feeling like you can't get enough air) during physical activity

Women who have coronary artery disease are more likely than men to have chest pain when resting or doing daily activities, rather than during exercise. They're also more likely than men to feel chest pain from mental stress.

Symptoms of a heart attack in women may also be different than in men. Chest pain is the most common symptom for both sexes. It may feel like crushing or squeezing. But women are somewhat less likely than men to have chest pain.

During a heart attack, women may feel:

  • Pressure or tightness in the chest
  • Pain in the upper back, arms, neck, jaw or throat
  • Dizziness
  • Unusual fatigue
  • Indigestion, heartburn, nausea, or vomiting
  • Stomach pain
  • Shortness of breath

Heart attacks usually don't look like the sudden, dramatic events we see in the movies. The symptoms may be mild or strong. They may start slowly. They can stop and then come back.

Can heart disease in women be prevented?

You can help lower your risk by:

  • Learning how to prevent heart disease and making heart-healthy habits part of your daily life.
  • Asking your provider about your personal risk for heart disease and the best way to manage your heart health.

Remember, women can have heart disease without symptoms. But if you pay attention to your risk for heart disease, you can take action to prevent problems or keep them from getting worse.

NIH: National Heart, Lung, and Blood Institute

Heart Failure

What is heart failure?

Heart failure means that your heart can't pump enough oxygen-rich blood to meet your body's needs. Heart failure doesn't mean that your heart has stopped or is about to stop beating. But without enough blood flow, your organs may not work well, which can cause serious problems.

Heart failure can affect one or both sides of your heart:

  • With right-sided heart failure, your heart is too weak to pump enough blood to your lungs to get oxygen.
  • With left-sided heart failure, your heart can't pump enough oxygen-rich blood out to your body. This happens when the left side of your heart becomes either:
    • Too weak to pump enough blood.
    • Too thick or stiff to relax and fill with enough blood.

Left-sided heart failure is more common than right-sided heart failure.

What causes heart failure?

Heart failure can start suddenly after a medical condition or injury damages your heart muscle. But in most cases, heart failure develops slowly from long-term medical conditions.

Conditions that can cause heart failure include:

  • Arrhythmia (a problem with the rate or rhythm of your heartbeat)
  • Cardiomyopathy
  • Congenital heart defects or other types of heart diseases that you are born with
  • Coronary artery disease
  • Endocarditis
  • Heart attack
  • Heart valve diseases
  • High blood pressure
  • A blood clot in your lung
  • Diabetes
  • Certain severe lung diseases, such as COPD (chronic obstructive pulmonary disease)
  • Obesity

Over time, left-sided heart failure can lead to right-sided heart failure.

Who is more likely to develop heart failure?

Heart failure can happen at any age. It happens to both men and women, but men often develop it at a younger age than women. Your chance of developing heart failure increases if:

  • You're 65 years old or older. Aging can weaken and stiffen your heart muscle.
  • Your family health history includes relatives who have or have had heart failure.
  • You have changes in your genes that affect your heart tissue.
  • You have habits that can harm your heart, including:
    • Smoking
    • Eating foods high in fat, cholesterol, and sodium (salt)
    • Having an inactive lifestyle
    • Alcohol use disorder (AUD)
    • Illegal drug use
  • You have other medical conditions that can affect your heart, including:
    • Any heart or blood vessel conditions, including high blood pressure
    • Serious lung diseases
    • Infection, such as HIV or COVID-19
    • Obesity
    • Diabetes
    • Sleep apnea
    • Chronic kidney disease
    • Anemia
    • Iron overload disease
    • Cancer treatments that can harm your heart, such as radiation and chemotherapy
  • You are African American. African Americans are more likely to develop heart failure and have more serious cases at younger ages than people of other races. Factors such as stigma, discrimination, income, education, and geographic region can also affect their risk of heart failure.
What are the symptoms of heart failure?

The symptoms of heart failure depend on which side of your heart is affected and how serious your condition has become. Most symptoms are caused by reduced blood flow to your organs and fluid buildup in your body.

Fluid buildup happens because the flow of blood through your heart is too slow. As a result, blood backs up in the vessels that return the blood to your heart. Fluid may leak from the blood vessels and collect in the tissues of your body, causing swelling (edema) and other problems.

Symptoms of heart failure may include:

  • Feeling short of breath (like you can't get enough air) when you do things like climbing stairs. This may be one of the first symptoms you notice.
  • Fatigue or weakness even after rest.
  • Coughing.
  • Swelling and weight gain from fluid in your ankles, lower legs, or abdomen (belly).
  • Difficulty sleeping when lying flat.
  • Nausea and loss of appetite.
  • Swelling in the veins of your neck.
  • Needing to urinate (pee) often.

At first you may have no symptoms or mild symptoms. As the disease gets worse, your symptoms will usually bother you more.

What other problems does heart failure cause?

Fluid buildup and reduced blood flow to your organs can lead to serious problems, including:

  • Breathing problems from fluid in and around your lungs (also called congestive heart failure)
  • Kidney or liver damage including cirrhosis
  • Malnutrition if fluid buildup makes eating uncomfortable or if your stomach doesn't get enough blood flow to digest food properly
  • Other heart conditions, such as irregular heartbeat and sudden cardiac arrest
  • Pulmonary hypertension
How is heart failure diagnosed?

To find out if you have heart failure, your doctor will:

  • Ask about your medical history, including your symptoms
  • Ask about your family health history, including relatives who have had heart failure
  • Do a physical exam
  • Will likely order heart tests and blood tests, including a brain natriuretic peptide (BNP) test

In some cases, your doctor may refer you to a cardiologist (a doctor who specializes in heart diseases) for tests, diagnosis, and care.

What are the treatments for heart failure?

Your treatment will depend on the type of heart failure you have and how serious it is. There's no cure for heart failure. But treatment can help you live longer with fewer symptoms.

Even with treatment, heart failure usually gets worse over time, so you'll likely need treatment for the rest of your life.

Most treatment plans include:

  • Taking medicine
  • Eating less sodium and drinking less liquid to control fluid buildup
  • Making other changes, such as quitting smoking, managing stress, and getting as much physical activity as your health care provider recommends
  • Treating any conditions that may make heart failure worse

You may need heart surgery if:

  • You have a congenital heart defect or damage to your heart that can be fixed.
  • The left side of your heart is getting weaker and putting a device in your chest could help. Devices include:
    • An implantable cardioverter defibrillator.
    • A biventricular pacemaker (cardiac resynchronization therapy).
    • A mechanical heart pump (a ventricular assist device (VAD) or a total artificial heart).
  • Your heart doctor recommends a heart transplant because your heart failure is life-threatening and nothing else is helping.

As part of your treatment, you'll need to pay close attention to your symptoms, because heart failure can worsen suddenly. Your provider may suggest a cardiac rehabilitation program to help you learn how to manage your condition.

Can heart failure be prevented?

You may be able to prevent or delay heart failure if you:

  • Work with your provider to manage any health conditions that increase your risk of developing heart failure
  • Make healthy changes in your eating, exercise, and other daily habits to help prevent heart disease

NIH: National Heart, Lung, and Blood Institute

Peripheral Arterial Disease

Peripheral arterial disease (PAD) happens when there is a narrowing of the blood vessels outside of your heart. The cause of PAD is atherosclerosis. This happens when plaque builds up on the walls of the arteries that supply blood to the arms and legs. Plaque is a substance made up of fat and cholesterol. It causes the arteries to narrow or become blocked. This can reduce or stop blood flow, usually to the legs. If severe enough, blocked blood flow can cause tissue death and can sometimes lead to amputation of the foot or leg.

The main risk factor for PAD is smoking. Other risk factors include older age and diseases like diabetes, high blood cholesterol, high blood pressure, heart disease, and stroke.

Many people who have PAD don't have any symptoms. If you have symptoms, they may include:

  • Pain, numbness, achiness, or heaviness in the leg muscles. This happens when walking or climbing stairs.
  • Weak or absent pulses in the legs or feet
  • Sores or wounds on the toes, feet, or legs that heal slowly, poorly, or not at all
  • A pale or bluish color to the skin
  • A lower temperature in one leg than the other leg
  • Poor nail growth on the toes and decreased hair growth on the legs
  • Erectile dysfunction, especially among men who have diabetes

PAD can increase your risk of heart attack, stroke, and transient ischemic attack.

Doctors diagnose PAD with a physical exam and heart and imaging tests. Treatments include lifestyle changes, medicines, and sometimes surgery. Lifestyle changes include dietary changes, exercise, and efforts to lower high cholesterol levels and high blood pressure.

NIH: National Heart, Lung, and Blood Institute

Sodium

Table salt is a combination of two minerals - sodium and chloride Your body needs some sodium to work properly. It helps with the function of nerves and muscles. It also helps to keep the right balance of fluids in your body. Your kidneys control how much sodium is in your body. If you have too much and your kidneys can't get rid it, sodium builds up in your blood. This can lead to high blood pressure. High blood pressure can lead to other health problems.

Most people in the U.S. get more sodium in their diets than they need. A key to healthy eating is choosing foods low in sodium. The Dietary Guidelines recommend that most adults eat less than 2.3 grams per day. That equals about 1 teaspoon of table salt a day. Some people are more sensitive to the effects of salt than others and should eat less. This includes people who have high blood pressure, diabetes, or kidney problems, or are African American or over age 50. Reading food labels can help you see how much sodium is in prepared foods.

NIH: National Heart, Lung, and Blood Institute

Stroke

What is a stroke?

A stroke happens when there is a loss of blood flow to part of the brain. Your brain cells cannot get the oxygen and nutrients they need from blood, and they start to die within a few minutes. This can cause lasting brain damage, long-term disability, or even death.

If you think that you or someone else is having a stroke, call 911 right away. Immediate treatment may save someone's life and increase the chances for successful rehabilitation and recovery.

What are the types of stroke?

There are two types of stroke:

  • Ischemic stroke is caused by a blood clot that blocks or plugs a blood vessel in the brain. This is the most common type; about 80% of strokes are ischemic.
  • Hemorrhagic stroke is caused by a blood vessel that breaks and bleeds into the brain

Another condition that's similar to a stroke is a transient ischemic attack (TIA). It's sometimes called a "mini-stroke." TIAs happen when the blood supply to the brain is blocked for a short time. The damage to the brain cells isn't permanent, but if you have had a TIA, you are at a much higher risk of having a stroke.

Who is at risk for a stroke?

Certain factors can raise your risk of a stroke. The major risk factors include:

  • High blood pressure. This is the primary risk factor for a stroke.
  • Diabetes.
  • Heart diseases.Atrial fibrillation and other heart diseases can cause blood clots that lead to stroke.
  • Smoking. When you smoke, you damage your blood vessels and raise your blood pressure.
  • A personal or family history of stroke or TIA.
  • Age. Your risk of stroke increases as you get older.
  • Race and ethnicity. African Americans have a higher risk of stroke.

There are also other factors that are linked to a higher risk of stroke, such as:

  • Alcohol and illegal drug use
  • Not getting enough physical activity
  • High cholesterol
  • Unhealthy diet
  • Having obesity
What are the symptoms of stroke?

The symptoms of stroke often happen quickly. They include:

  • Sudden numbness or weakness of the face, arm, or leg (especially on one side of the body)
  • Sudden confusion, trouble speaking, or understanding speech
  • Sudden trouble seeing in one or both eyes
  • Sudden difficulty walking, dizziness, loss of balance or coordination
  • Sudden severe headache with no known cause

If you think that you or someone else is having a stroke, call 911 right away.

How are strokes diagnosed?

To make a diagnosis, your health care provider will:

  • Ask about your symptoms and medical history
  • Do a physical exam, including a check of
    • Your mental alertness
    • Your coordination and balance
    • Any numbness or weakness in your face, arms, and legs
    • Any trouble speaking and seeing clearly
  • Run some tests, which may include
    • Diagnostic imaging of the brain, such as a CT scan or MRI
    • Heart tests, which can help detect heart problems or blood clots that may have led to a stroke. Possible tests include an electrocardiogram (EKG) and an echocardiography.
What are the treatments for stroke?

Treatments for stroke include medicines, surgery, and rehabilitation. Which treatments you get depend on the type of stroke and the stage of treatment. The different stages are:

  • Acute treatment, to try to stop a stroke while it is happening
  • Post-stroke rehabilitation, to overcome the disabilities caused by the stroke
  • Prevention, to prevent a first stroke or, if you have already had one, prevent another stroke

Acute treatments for ischemic stroke are usually medicines:

  • You may get tPA, (tissue plasminogen activator), a medicine to dissolve the blood clot. You can only get this medicine within 4 hours of when your symptoms started. The sooner you can get it, the better your chance of recovery.
  • If you cannot get that medicine, you may get medicine that helps stop platelets from clumping together to form blood clots. Or you may get a blood thinner to keep existing clots from getting bigger.
  • If you have carotid artery disease, you may also need a procedure to open your blocked carotid artery

Acute treatments for hemorrhagic stroke focus on stopping the bleeding. The first step is to find the cause of bleeding in the brain. The next step is to control it:

  • If high blood pressure is the cause of bleeding, you may be given blood pressure medicines.
  • If an aneurysm if the cause, you may need aneurysm clipping or coil embolization. These are surgeries to prevent further leaking of blood from the aneurysm. It also can help prevent the aneurysm from bursting again.
  • If an arteriovenous malformation (AVM) is the cause of a stroke, you may need an AVM repair. An AVM is a tangle of faulty arteries and veins that can rupture within the brain. An AVM repair may be done through
    • Surgery
    • Injecting a substance into the blood vessels of the AVM to block blood flow
    • Radiation to shrink the blood vessels of the AVM

Stroke rehabilitation can help you relearn skills you lost because of the damage. The goal is to help you become as independent as possible and to have the best possible quality of life.

Prevention of another stroke is also important, since having a stroke increases the risk of getting another one. Prevention may include heart-healthy lifestyle changes and medicines.

Can strokes be prevented?

If you have already had a stroke or are at risk of having a stroke, you can make some heart-healthy lifestyle changes to try to prevent a future stroke:

  • Eating a heart-healthy diet
  • Aiming for a healthy weight
  • Managing stress
  • Getting regular physical activity
  • Quitting smoking
  • Managing your blood pressure and cholesterol levels

If these changes aren't enough, you may need medicine to control your risk factors.

NIH: National Institute of Neurological Disorders and Stroke

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