Cardiovascular Conditions in Women

There are differences in both presentation and outcomes when comparing cardiovascular disease in men and women.

The initial presentation of coronary heart disease (CHD) in women is often similar to that of men. However, women may not identify their initial symptoms as signs of heart disease and therefore may not seek medical advice promptly.

Women experiencing heart attacks are significantly shown to experience little to no chest pain as compared to men.

While some women have no symptoms, others experience angina (dull, heavy, or sharp pain or discomfort), pain in the neck/jaw/throat or pain in the upper abdomen or back.

However, sometimes heart disease may be silent and not diagnosed until a woman experiences signs or symptoms of a heart attack, heart failure, an arrhythmia or stroke.

Carotid Artery Disease refers to blockages in the carotid arteries due to plaque buildup. Carotid arteries are blood vessels located in the sides of the neck that supply blood to the brain. Blockages in these arteries hinder blood flow to the brain, which can cause brain damage and lead to a stroke.

Carotid artery disease is caused by plaque buildup in the arteries. Plaque is made up of cholesterol, calcium and other tissues which block the artery, therefore restricting blood flow.

Female risk factors of carotid artery disease are similar to those of men and include high blood pressure, high cholesterol, personal or family history of cardiovascular disease, smoking, diabetes, increasing age, obesity and physical inactivity.  But other factors may affect a woman’s risk, such as pregnancy-related complications, such as gestational diabetes or preeclampsia, or medications such as hormone therapy or birth control.  Hormone changes can affect your blood vessels, raising your risk heart disease and stroke, especially for women with other risk factors, such as family history.  After menopause, a woman’s risk is greater for heart disease and stroke.

Call 911 if there are any signs of stroke:

• Sudden numbness, tingling, or loss of movement in the face, arm, or leg, especially on one side

• Blurry vision

• Sudden trouble speaking

• Sudden confusion or trouble understanding simple statements

• Sudden problems with walking or balance

• A sudden, severe headache that is different from past headache

Your heart rate is controlled by a natural electrical system that tells your heart when to beat.  Electrical signals usually travel through the heart in a regular pattern. If that electrical system is not functioning properly, your heart rate can be too slow, too fast or simply uneven.

Electrophysiology refers to the diagnosis and treatment of abnormal heart rhythms (arrhythmias).  

On average, women tend to have a faster baseline heart rate, and irregular beats may present differently in women as opposed to men.  Certain types of arrhythmias are more prevalent in women as well.

Noticeable arrhythmia symptoms may include:

• A fluttering in your chest

• A racing heartbeat (tachycardia)

• A slow heartbeat (bradycardia)

• Chest pain

• Shortness of breath

• Lightheadedness, dizziness or fainting

• Sweating

Peripheral artery disease (PAD) is a hardening of the arteries due to build-up or blockage in any area of the body other than the heart. The disease most commonly affects the legs, but it can also occur in the kidneys, neck or arms. These blockages keep extremities and organs from receiving oxygen-rich blood. PAD is a common and treatable disease, but it is often misdiagnosed as its main symptom of leg cramps is regarded by many as an inevitable consequence of aging. Ultimately, PAD can reduce mobility, lead to non-healing ulcers, gangrene, amputation or even death. 

In regards to PAD, women typically:

• Are undiagnosed or Present at an older age

• Present at a later stage of disease

• Experience more critical limb ischemia than claudication

• Are more likely to experience a ruptured aneurysm

• Are more likely to be on hormonal replacement (worse prognosis)

Recent studies have revealed that the prevalence of PAD is similar for men and women but women are less likely to be diagnosed with PAD. The amputation rate for ischemic PAD is similar for men and women but a smaller percent of women are able to return home.

Click here to learn more about Peripheral Artery Disease.

Heart valve disease occurs if one or more of the heart's valves don't work well.  In order to keep the blood flowing forward during its journey through the heart, there are valves between each of the heart’s pumping chambers. 

When one or more valves becomes stenotic (hardened), the heart muscle must work harder to pump the blood through the valve. Some reasons why heart valves become stenotic include infection and aging. If one or more valves become insufficient (leaky), blood leaks backwards which means that less blood is pumped in the proper direction. The physician may decide that the diseased valve(s) needs to be surgically repaired or replaced.

A common valvular condition in women is mitral valve prolapse. Affecting about six percent of all women, this condition is when one or both of the valve flaps is enlarged, preventing the valve from closing properly.  It occurs more prevalently in younger women.

Mitral stenosis is another common valvular condition among women.  This is the narrowing or blocking of the mitral valve, causing blood to flow back into the left atrium instead of into the left ventricle.  Three times more women than men have mitral valve stenosis, and women make up 70 percent of confirmed cases.  Rheumatic fever is the major cause of mitral stenosis.

Women’s valves tend to calcify at a later age than in men. In women of child-bearing age, it is preferred to repair the native valve when diseased.

When vein vessels become damaged or weak, blood flows backwards and causes the veins to stretch, swell and twist. This is referred to as venous disease. Women are more likely to develop venous disease than men, and pregnant women have an increased risk of venous insufficiency. 

Women are also typically undiagnosed for venous disease.  This is because this condition may not present itself until leg pain or skin problems emerge.

Symptoms of Venous Disease:   

• Swelling or heaviness in legs

• Leg pain or cramping

• Visible varicose or spider veins

• Discoloration of skin

• Dry or weeping eczema

• Leg ulcers

• Restless legs

One of the most common and visible signs of venous disease is spider veins – the small, purple or blue clusters of veins on the leg. Spider veins typically do not cause discomfort, but if they become painful it is important to meet with a physician who is qualified in the diagnosis and treatment of venous disease. Varicose veins are larger, bluish veins that may appear enlarged.

Venous disease can progressively get worse over time due to the pressure created by the backflow of blood in the legs. This may lead to additional spider and varicose veins, and in some cases can lead to swelling and venous ulcers at the lower calf and ankle. Even if only spider veins are present, you should consult a CIS vein specialist to determine the problem so that it can be treated.

Nearly half of all adults with high blood pressure are women. At age 65 and older, a woman’s risk for high blood pressure increases as well.  For a woman, health changes like pregnancy, birth control and menopause can increase the risk of developing high blood pressure. 

Gestational hypertension is a form of secondary hypertension caused by pregnancy that typically goes away after delivery. High blood pressure can be dangerous to the mother and baby. This is why high blood pressure is closely watched during pregnancy. 

Preeclampsia is related to gestational hypertension and is displayed through high blood pressure and high protein in the urine.

It is also important for women to have their blood pressure checked regularly after menopause.