Gender Gap: 8 Ways Women’s Heart Attacks Are Different From Men’s

Women and Heart Attacks

For both men and women, heart disease is the number one cause of death in the United States. Still, there are key differences in how it develops, presents, and is addressed between the sexes. 

Heart disease has a major impact on many women’s lives, but awareness about it has typically focused more on men than women.

Smaller Hearts and Blood Vessels

There are differences in male and female bodies that affect how heart disease develops. For example, women have smaller hearts and smaller blood vessels. This difference is significant because sometimes smaller vessels don't show up well on an angiogram — a picture taken of the blood vessels of the heart — so signs of blockages can be missed in some women. 

Women also tend to develop heart disease in the smaller blood vessels of the heart instead of the large coronary arteries commonly seen in men.

Risk Factors

Female reproductive health history and heart disease are closely related. Women with endometriosis were found to be three times more likely to develop some form of heart disease than women without it. 

Women who develop gestational diabetes during pregnancy or preeclampsia, a complication of pregnancy that causes high blood pressure and places stress on the organs, may also have an increased risk for heart attacks.

Symptoms

Many of the “classic” heart attack symptoms — like crushing chest pain — are based on research done on men. Women may experience chest pain, but may also have flu-like symptoms including:

• Nausea 
• Vomiting
• Dizziness
• Shortness of breath
   

However, almost two-thirds of women who die suddenly from heart disease had no prior symptoms.

Symptom-Mimicking Conditions

Women are more likely than men to develop several diseases that have symptoms similar to a heart attack, like chest pain and shortness of breath. 

•  Coronary spasm. In this condition, a vessel that supplies blood to the heart clamps down. This temporarily constricts the blood flow, mimicking a heart attack. 
• Coronary dissection. This is when the wall of a coronary artery tears. Patients are frequently women who may not have any history of heart disease.
• Takotsubo cardiomyopathy. Also called broken syndrome, this is an inflammatory condition that causes the heart to enlarge after a period of emotional distress. 

Some of these look-alike conditions can be less severe than a heart attack, but others are just as dangerous, so it's always important to check with your doctor if you're experiencing any symptoms.

Medications

Women are less likely to be prescribed drugs that control blood pressure or lower cholesterol after having a heart attack than men. Women are also less likely to be prescribed baby aspirin, a medication widely recommended for people with a history of heart attack. 

More research is needed to determine why women are less frequently prescribed these guideline-recommended medicines. 

Diagnostic Testing

The cardiac troponin test is a common tool used to determine if a heart attack has occurred. This test measures the levels of troponin — a protein that indicates the presence of damaged heart muscle — in the blood. 

Medical providers are beginning to understand that women need a lower level of troponin in the blood to indicate a heart attack. If providers are only going off the old standard that looked at results in men, women experiencing a heart attack could be told they are fine because their troponin wasn’t high enough.

Treatments

Women may need a different approach to treatment to get the best outcomes compared to men. For example, women have higher mortality rates for coronary artery bypass surgery, a type of open heart surgery that fixes blocked arteries in the heart. A more conservative approach to treatment may be more successful for some women.

Medical Bias Against Women

When being treated for a heart attack, women are more likely to experience medical bias. 

There is evidence that physicians may be less aware of risk factors of heart disease in women and some women feel their concerns are not taken seriously.