Heart problems in women are unfortunately still too often overlooked. Yet there are clear differences between a man’s heart and a woman’s heart. Women develop different heart diseases, with different symptoms, such as fatigue, nausea, and pain in the neck, back, or jaw. Hormones also play a bigger role in women. In this blog post, we take a closer look at these female symptoms and conditions. Because only with greater awareness, among women themselves and everyone around them, can we ensure that more women survive a heart attack or cardiac arrest.

What are the main symptoms of heart problems in women?

When something is wrong with your heart, there are well-known and clear symptoms that suggest a heart problem, such as chest pain. But there are also a number of vague symptoms that are less often associated with heart issues. In general, women experience these “vague symptoms” more often than men.

According to Mayo Clinic, a well-known academic medical center in the United States, women having a heart attack are more likely than men to experience the following symptoms:

• Pain in the neck, jaw, shoulder, upper back, or upper abdomen
• Shortness of breath
• Pain in one or both arms
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Unusual fatigue
• Heartburn, also known as indigestion

Mayo Clinic also notes that women often experience chest pain during a heart attack as a “pressing” or “tightening” sensation.

Why are heart problems in women often missed?

Women often experience different symptoms than men, which they don’t immediately associate with a heart attack or another heart condition. From recent research by Croí, the Irish heart and stroke charity, and Global Heart Hub, a non-profit organisation for people affected by cardiovascular desease, it appears that as many as half of all women are unaware that women can experience different symptoms than men during a heart attack.

On top of that, most research has been conducted on heart disease in men, which means current medical guidelines are much more focused on men. Women are diagnosed less often, and even when they are examined, interventions occur less frequently, according to research. There is also less attention given to heart conditions that are more common in women, such as problems in the smallest blood vessels. These conditions are harder to detect in initial scans. Issues in these tiny vessels, for example, do not show up on standard scans, and there are still no general treatment guidelines for them.

How big is the risk of heart problems in women?

Many people think that heart problems mainly affect men. But that’s not true. For both sexes, cardiovascular diseases have been the leading cause of death for years. 

The causes: why is a woman’s heart different?

what physical differences exist between a man’s heart and a woman’s heart?

Although the male and female heart look similar, they are not exactly the same. Women generally have a smaller heart than men, which means they also have smaller and more sensitive coronary arteries, the blood vessels that transport oxygen and nutrients to the heart. Because these vessels are narrower, women are more likely to develop problems in the tiniest branches of the coronary arteries, even when the larger vessels appear healthy. These small vessels may fail to dilate properly, for example during physical exertion, causing the heart muscle to temporarily receive too little oxygen.

In men, heart problems more often arise from blockages in the large coronary arteries. And because doctors typically look for narrowing in these large vessels, issues in the small vessels of the heart muscle are sometimes overlooked when the major arteries seem fine, even when women experience serious symptoms like chest pain and shortness of breath.

How do hormonal fluctuations affect a woman’s heart?

Women experience various hormonal changes throughout their lives. They can become pregnant and eventually go through menopause. And this also affects the heart.

As you age, the risk of heart problems increases. However, women typically develop these issues about ten to fifteen years later than men. This delay is due to menopause. The sex hormone estrogen appears to protect women to some extent against cardiovascular disease until that time. Estrogen helps keep blood vessels healthy and flexible, regulates cholesterol levels, prevents fat from accumulating in the arteries, and reduces the risk of inflammation and arteriosclerosis.

After menopause, women produce almost no estrogen, which means this protection gradually disappears and the risk of heart problems steadily increases. This also applies to women who experience early menopause. They face an increased risk at a younger age.

Pregnancy can also have lasting effects on women’s heart health. According to research supported by the British Heart Foundation, women who develop high blood pressure during pregnancy, or even the more severe condition pre-eclampsia, have an increased risk of developing heart and circulatory diseases later in life compared with those who had normal blood pressure during pregnancy. These findings suggest that pregnancy complications can act as an early warning sign of future cardiovascular risk. 

Typical “female” heart diseases

A tear in the coronary artery

One example of a heart condition that often occurs in women is SCAD, which means a sudden tear develops in a coronary artery. Blood can then enter this tear, eventually causing blood clots that lead to narrowing of the vessel. This is a rare cause of a heart attack, but for younger women, it is far less rare. According to the British Heart Foundation, at least 80% of SCAD patients are women. Also, it most commonly occurs among women between 45 and 53. However, because it often affects young people without risk factors such as obesity, smoking, or high blood pressure, the condition is frequently missed. Childbirth appears to be a risk factor. According to the British Heart Foundation, it can often occur during or soon after pregnancy. 

The heart pumps but doesn’t relax

Older women more often experience a form of heart failure where the pumping function remains intact. The heart pumps well, but it is stiff, making it harder to relax and take in blood. This condition is often missed because it usually comes with vague symptoms and the heart appears to function normally at first glance. Complaints such as fatigue, difficulty with physical exertion, fluid retention, and shortness of breath are easily attributed to other causes when tests show that the pumping function is still within normal limits.

Which other conditions increase the risk of heart problems in women?

There are also conditions that often occur in women and seem unrelated to the heart at first glance. Yet these illnesses pose a risk to heart and vascular health. Below are some important examples:

Migraine with aura

Migraine is much more common in women than in men. And there is growing evidence that people with migraine have an increased risk of cardiovascular disease, according to the American Heart Association. People with migraine with aura are especially at higher risk of cardiovascular diseases, such as stroke or heart attack. This is a form of migraine with temporary neurological symptoms before the headache, such as seeing flashes of light or feeling tingling sensations.

Chronic inflammatory diseases

Chronic inflammatory diseases occur more often in women than in men. In these autoimmune conditions, the immune system attacks the body itself, leading to a prolonged inflammatory response. This inflammation not only affects joints and organs but can also damage the inner walls of blood vessels. As a result, arteries lose their elasticity, and the risk of cardiovascular disease increases. Examples of such conditions include rheumatic diseases like rheumatoid arthritis and lupus.

PCOS

PCOS is a condition that only occurs in women, where the ovaries produce too many hormones. This condition is also associated with a higher risk of cardiovascular disease because women with PCOS often struggle with risk factors such as overweight, high blood pressure, and diabetes. If you suffer from this condition, it is especially important to eat healthily and stay active. According to the Cleveland Clinic, up to 15% of women of reproductive age have this condition.

Depression and sleep problems

Psychological factors such as depression are also risk factors for developing cardiovascular disease and occur more often in women than in men, according to research.
Sleep problems are also more common in women than in men and significantly increase the risk of cardiovascular disease. According to the National Institute on Aging (part of the NIH), research shows that women with persistent insomnia and short sleep duration have a 70–75% higher risk of cardiovascular disease.

What can you do?

For yourself: know your risks and symptoms

Know what your risks are!

• Have you experienced high blood pressure, pre-eclampsia or gestational diabetes during pregnancy? If so, it is important to be aware that you may be at greater risk of cardiovascular disease later in life.
• After menopause, the risk of heart problems increases. Be aware of this and pay close attention to your body’s signals. Did you go through early menopause? Then you will face this risk sooner.
• Do you suffer from conditions such as migraine with aura, PCOS, or an autoimmune disease? In that case, it’s also important to stay extra alert and listen to your body.

Know your symptoms!

• Do you have one or more of the vague symptoms mentioned above? Don’t ignore them. Visit your doctor or call emergency services (999) in severe cases.

For someone else: act immediately in case of cardiac arrest

Did you know that women are less likely to be resuscitated than men when they suffer a cardiac arrest? And that their chances of survival are also lower? Research by the American Heart Association shows that this is partly because bystanders fear touching women inappropriately and being accused of sexual misconduct. The fear of causing injury also plays a bigger role when it comes to women. Other research published in the journal of the European Resuscitation Council shows that women are less often depicted as recipients of CPR in educational materials.

Know that women can also suffer cardiac arrest and that it is always better to do something than nothing. Did you know that irreversible brain damage occurs after just six minutes during cardiac arrest? So don’t hesitate to start CPR and look for the nearest AED! And always call emergency services (999).

Here, you can learn more about how to deploy an AED in case of an emergency.

The right help

Cardiovascular diseases are the leading cause of death not only in men but also in women. Yet there is still too little awareness about typical “female” symptoms and conditions. With this blog post, we hope to take a step toward greater awareness. Take your symptoms seriously and share this information so that more women receive the right help in time.