Understanding a Woman's Heart

Dr Stanley Chia, cardiologist at Mount Elizabeth Hospitals, explains why women's hearts need extra attention and how women can care for their hearts.

Although heart disease is frequently associated with middle-aged or older men, more women than men actually suffer from heart disease in many countries. Many people still think that heart disease is a man's disease, when in fact, heart disease is one of the leading killers in women worldwide.

Heart disease research has historically focused on men. However, because women's hearts are different from men's, diagnosis and treatment of heart disease in women often still lags behind men.

A major challenge in diagnosing heart disease in women is that the warning signs in women may be different from those in men. This results in many women delaying getting help for their heart problems.

Unique heart attack symptoms in women

The most typical heart attack symptom is a crushing chest pain – frequently described as a feeling of tightness in the chest that may radiate to the jaws or arms.

These symptoms, however, do not always affect women with heart disease. Some women do not experience these classic symptoms and may even have a heart attack without chest pain at all.

When a heart attack strikes, women are more likely than men to experience atypical symptoms such as

• Pain in the arms, back, neck, jaw or even stomach
• Gradual or sudden pain which may wax and wane, and is often mistaken as heartburn, gastritis or muscle ache
• Shortness of breath, nausea or lightheadedness
• Breaking out in cold sweat
• Feeling extremely tired while not doing any strenuous activities

Risk factors for heart disease in women

Common risk factors for heart disease, such as high blood pressure, high blood cholesterol levels and obesity can affect all patients. However, certain risk factors may play a more significant role in the development of heart disease in women compared to men.

Risk factors such as diabetes, metabolic syndrome, smoking, mental stress, depression and a lack of physical activity all have a greater impact on the progression of heart disease in women.

Women are also at higher risk for other types of heart disease.

Coronary microvascular disease is a condition that affects the heart's tiny arteries, and may be caused by low levels of oestrogen after menopause.

Patients may experience chest pain while they are resting or even sleeping, as the symptoms may be triggered by mental stress.

Women are also more likely to have a condition called broken heart syndrome, where extreme emotional stress can lead to heart muscle failure. In general, women tend to have heart disease 10 years later than men.

How women can care for their hearts

The good news is that heart disease is often preventable. Women can control many of the risk factors for heart disease through lifestyle changes and medication. They can lower the risk of heart attack by these important measures:

• Exercise regularly
• Maintain a healthy weight
• Do not smoke
• Have a balanced diet that is low in saturated fat and salt
• Take the medication your doctor has prescribed, such as blood thinners (aspirin), medication to lower blood pressure and cholesterol, and diabetic medication if you have high blood glucose levels

Most importantly, women must not ignore the warning signs of heart disease.

Listen to your body, and do not dismiss what you feel. Do not worry about over-thinking or feeling silly if you end up being wrong. It is always better to have your health checked!