Contributor: Leslie Cho, MD 

A woman’s heart may look just like a man’s, but there are significant differences.

For example, a woman’s heart is usually smaller, as are some of its interior chambers. The walls that divide some of these chambers are thinner. And while a woman’s heart pumps faster than a man’s, it ejects about 10 percent less blood with each squeeze.

When a woman is stressed, her pulse rate rises, and her heart pumps more blood. When a man is stressed, the arteries of his heart constrict, raising his blood pressure.

Why do these differences matter? They matter because gender plays a role in the symptoms, treatments and outcomes of coronary artery disease (CAD).

1. Women have risk factors men don’t have.

Certain diseases that only affect women increase the risk of coronary artery disease, the leading cause of heart attack. These include endometriosis, polycystic ovary disease, diabetes and high blood pressure that develop during pregnancy. Endometriosis has been found to raise the risk of developing CAD by 400 percent in women under age 40.

Women also share traditional risk factors with men: high blood pressure, high blood sugar levels, high cholesterol levels, smoking and obesity. Like men, women can be impacted by a family history of heart disease, particularly when a father or brother was diagnosed with CAD before age 55, or a mother or sister was diagnosed before age 65.

2. Women are generally older when they have their first heart attack.

Men are at risk for heart attack much earlier in life than women. Estrogen offers women some protection from heart disease until after menopause, when estrogen levels drop. This is why the average age of for a heart attack is 70 in women, but 66 in men.

3. The symptoms of heart attack can be different in women.

Chest pain (also described as a crushing weight on the chest) is the most common symptom of heart attack in men. Some women also experience chest pain, but they are more likely to have different symptoms. Unlike the dramatic, chest-clutching pain seen in the movies, women often experience subtler symptoms for three or four weeks before a heart attack. Red flags include:

• New or dramatic fatigue. For example, a simple activity like making the bed makes you feel unusually tired. You aren’t exerting yourself, but you feel deeply fatigued or have a “heavy” chest. You may feel very tired, but can’t sleep well. Or you are suddenly worn out after your normal exercise routine.
• Shortness of breath or sweating. Watch for this especially when either symptom occurs without exertion and when either symptom is accompanied by a symptom such a chest pain or fatigue. Look for either symptom worsening over time after exertion. Other signs are shortness of breath that worsens when lying down and is relieved when you sit up and a cold, clammy feeling that occurs without cause.
• Pain in the neck, back or jaw. This is especially of note when there is no specific muscle or joint that aches or when the discomfort worsens when you are exerting yourself and stops when you stop. This pain can be in either arm, whereas it’s usually the left arm in men. Also, watch for pain that starts in the chest and spreads to the back, pain that occurs suddenly and may wake you up at night and pain in the lower left side of the jaw.

4. CAD in women is sometimes hard to diagnose.

An X-ray movie (angiogram) taken during a cardiac catheterization is the gold standard test for finding narrowings or blockages in the heart’s large arteries.

But CAD in women often affects the small arteries, which cannot be clearly seen on an angiogram. That’s why any woman who is given the “all clear” signal after an angiogram and continues to have symptoms should see a cardiologist who specializes in women with heart disease.

5. A heart attack is harder on a woman than a man.

Women don’t tend to do as well as men after a heart attack. They often require a longer hospital stay, and they are more likely to die before leaving the hospital.

This may be due to the fact that women who suffer a heart attack have more untreated risk factors, such as diabetes or high blood pressure. Sometimes, it’s because they put their families first and don’t take care of themselves.

6. Women don’t always get the proper medications after a heart attack.

After a heart attack, women are at greater risk of developing a blood clot that can cause another heart attack. For unknown reasons, they are not as likely to be given a drug to prevent such blood clots. This could explain why women are more likely than men to have a second heart attack within 12 months.

Protect yourself

Whether you are a man or a woman, it’s never too late to lower your chance of suffering a heart attack. Here is what you need to do:

• Quit smoking or don’t start
• Get regular exercise: at minimum, walk 30 minutes a day
• Eat a diet high in fruits, vegetables, whole grains and fish and low in animal products, simple carbohydrates and processed foods
• Maintain a normal weight, blood pressure, blood lipid and blood sugar levels.

It’s important for all of us to be proactive in reducing our heart attack risk.