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Understanding heart diseases in women

Post by Dr. Tasaduk Hussain Itoo on Thursday, September 29, 2022

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Women are affected by heart disease in different ways than men because of their biology and the differences in their lives and lifestyle. For example, women usually develop heart disease later in life than men do and older women more often die of strokes than men. Also the signs of a heart attack are different in women and men, which can lead to a delayed diagnosis and poorer outcomes for women. 

Cardiovascular diseases occurs more frequently as women age. The outcomes in older women with heart disease are often poorer than in men due to other illnesses that occur along with heart disease, including disability, mental health and psychological illnesses etc.

Heart disease includes a range of conditions that affect one's heart like Coronary Artery Disease (blood vessel disease of the heart); Heart Arrhythmias (heart rhythm problems); Congenital Heart Disease (inborn heart defects); Heart Valve Disease; Cardiomyopathy (disease of the heart muscle); and Heart Infections.

Heart disease signs and symptoms depend on what type of heart disease one have. However, the cardinal symptoms that warrant immediate medical attention include chest pain, shortness of breath and fainting.

Coronary Artery Disease

A build up of fatty plaques in one's arteries (atherosclerosis) is the most common cause of coronary artery disease. Unhealthy lifestyle habits, such as a poor diet, lack of exercise, being overweight and smoking can lead to atherosclerosis. Coronary artery disease symptoms may be different for men and women. For instance, men are more likely to have chest pain. Women are more likely to have other signs and symptoms along with chest discomfort, such as shortness of breath; nausea or vomiting; heartburn (indigestion); light-headedness or dizziness; sweating, pain in one or both arms, neck, jaw, shoulder, upper back or upper belly (abdomen) discomfort, and extreme fatigue. 

But chest pain is not always severe or even the most noticeable symptom, particularly in women. Women often describe heart attack pain as pressure or tightness. And it is possible to have a heart attack without chest pain. Moreover, women tend to have blockages not only in their main arteries but also in the smaller ones that supply blood to the heart — a condition called small vessel heart disease or coronary microvascular disease. And women are more likely than men to have a heart attack with no severe blockage in an artery (non-obstructive coronary artery disease).

Signs and symptoms in general

▪︎Chest pain, chest tightness, chest pressure and chest discomfort (angina).

▪︎Shortness of breath.

▪︎Pain, numbness, weakness or coldness in legs or arms.

▪︎Pain in the neck, jaw, throat, upper abdomen or back.

Heart Arrhythmias

One's heart may beat too quickly, too slowly or irregularly. Common causes of arrhythmias or conditions that can lead to arrhythmias include coronary artery disease; diabetes; drug abuse; excessive use of alcohol or caffeine; heart defects one is born with (congenital heart defects); high blood pressure; smoking; some over-the-counter medications and herbal remedies; stress; and certain valvular heart disease. Heart arrhythmia signs and symptoms include:

▪︎Fluttering in your chest

▪︎Racing heartbeat (tachycardia)

▪︎Slow heartbeat (bradycardia)

▪︎Chest pain or discomfort

▪︎Shortness of breath

▪︎Light headedness

▪︎Dizziness

▪︎Fainting (syncope) or near fainting

Congenital Heart Disease

Serious heart defects that one is born with (congenital heart defects) usually are noticed soon after birth. Some medical conditions, medications and genes may play a role in causing heart defects. Heart defect signs and symptoms in children could include:

▪︎Pale grey or blue skin colour (cyanosis)

▪︎Swelling in the legs, abdomen or areas around the eyes

▪︎In an infant, shortness of breath during feedings, leading to poor weight gain

▪︎Swelling in the hands, ankles or feet

Cardiomyopathy

It is a thickening or enlarging of the heart muscle, may depend on the type:

Dilated cardiomyopathy: It is the most common type, that may be caused by reduced blood flow to the heart (ischemic heart disease) resulting from damage after a heart attack, infections, toxins and certain drugs, including those used to treat cancer. It may also be inherited from a parent.

Hypertrophic cardiomyopathy: This type usually is passed down through families (inherited). It can also develop over time because of high blood pressure or aging.

Restrictive cardiomyopathy: This least common type of cardiomyopathy, which causes the heart muscle to become rigid and less elastic may be caused by diseases, such as connective tissue disorders or the build up of abnormal proteins (amyloidosis).

In early stages of cardiomyopathy, one may experience no symptoms. As the condition worsens, symptoms may include:

  • Breathlessness with activity or at rest
  • Swelling of the legs, ankles and feet
  • Fatigue
  • Irregular heartbeats that feel rapid, pounding or fluttering
  • Dizziness, light headedness and fainting

Heart Infection

Endocarditis is an infection that affects the inner lining of one's heart chambers and heart valves (endocardium). It is caused when germs reach one's heart muscle. The most common causes of heart infection include - bacteria, viruses, and parasites. Signs and symptoms can include:

  • Fever
  • Shortness of breath
  • Weakness or fatigue
  • Swelling in one's legs or abdomen
  • Changes in one's heart rhythm
  • Dry or persistent cough
  • Skin rashes or unusual spots

Valvular Heart Disease

The heart has four valves — the aortic, mitral, pulmonary and tricuspid valves — that open and close to direct blood flow through one's heart. Many things can damage one's heart valves -- one may be born with valvular disease, or the valves may be damaged by conditions such as, rheumatic fever, infections (infectious endocarditis), or connective tissue disorders -- leading to narrowing (stenosis), leaking (regurgitation or insufficiency) or improper closing (prolapse).

Depending on which valve isn't working properly, valvular heart disease signs and symptoms generally include:

  • Fatigue
  • Shortness of breath
  • Irregular heartbeat
  • Swollen feet or ankles
  • Chest pain
  • Fainting (syncope)

 

Complications of heart disease

Heart Attack

A blood clot blocking blood flow through a blood vessel that feeds the heart causes a heart attack, possibly damaging a part of the heart muscle. Atherosclerosis can cause a heart attack.

Heart Failure

Heart failure occurs when one's heart can't pump enough blood to meet one's body's needs. Heart failure can result from many forms of heart disease including heart defects, cardiovascular disease, valvular heart disease, heart infections or cardiomyopathy.

Stroke

The risk factors that lead to cardiovascular disease can also lead to an ischemic stroke, which happens when the arteries to one's brain are narrowed or blocked so that too little blood reaches one's brain. A stroke is a medical emergency that warrants immediate medical attention. The brain tissue begins to die within just a few minutes of a stroke.

Sudden Cardiac Arrest

Sudden cardiac arrest is the sudden, unexpected loss of heart function, breathing and consciousness, often caused by an arrhythmia. Sudden cardiac arrest is a medical emergency, which if not treated immediately results in sudden cardiac death.

Aneurysm

A serious complication that can occur anywhere in one's body. An aneurysm is a bulge in the wall of one's artery which if bursts may lead to life-threatening internal bleeding.

Peripheral Artery disease

When one develop peripheral artery disease, one's extremities, usually legs don't receive enough blood flow, which causes symptoms, most notably leg pain while walking (claudication).

 

Risk factors for heart disease

Age

Growing older increases one's risk of damaged and narrowed arteries and a weakened or thickened heart muscle.

Sex

Men are generally at greater risk of heart disease. The risk for women increases after menopause, low levels of oestrogen after menopause increase the risk of developing disease in smaller blood vessels.

Family History

A family history of heart disease increases one's risk of coronary artery disease, especially if a parent developed it at an early age. This appears to be a greater risk factor in women than in men.

Smoking

Nicotine tightens one's blood vessels, and carbon monoxide can damage their inner lining, making them more susceptible to atherosclerosis. Heart attacks are more common in smokers than in non-smokers.

Poor Diet

A diet that's high in fat, salt, sugar and cholesterol can contribute to the development of heart disease.

High Blood Pressure

Uncontrolled high blood pressure can result in hardening and thickening of one's arteries, narrowing the vessels through which blood flows.

High Blood Cholesterol

High levels of cholesterol in one's blood can increase the risk of plaque formation and atherosclerosis.

Diabetes

Diabetes increases one's risk of heart disease. Both conditions share similar risk factors such as obesity and high blood pressure.

Pregnancy Complications

High blood pressure or diabetes during pregnancy can increase the mother's long-term risk of high blood pressure and diabetes. These conditions also make women more likely to get heart disease.

Obesity

Excess weight typically worsens other heart disease risk factors.

Physical Inactivity

Lack of exercise is also associated with many forms of heart disease and some of its other risk factors as well.

Stress

Unrelieved stress may damage one's arteries and worsen other risk factors for heart disease. Emotional stress and depression affect women's hearts more than men's that may make it difficult to maintain a healthy lifestyle and follow recommended treatment for other health conditions.

Poor Dental Health

If one's teeth and gums aren't healthy, germs can enter their bloodstream and travel to their heart -- causing endocarditis.

 

Prevention for heart disease

In general, healthy lifestyle is the key. Recommendations include: 

Controlling high blood pressure: This is one of the most important things one can do to reduce their heart disease risk.Exercising, managing stress, maintaining a healthy weight and limiting the amount of sodium in diet and avoiding alcohol can all help to keep high blood pressure in check. In addition to recommending lifestyle changes, one may need to take medications to treat high blood pressure.

Controlling diabetes: One can manage diabetes with diet, exercise, weight control and medications.

Lower amount of cholesterol, saturated fat in diet: Eating less cholesterol and fat especially saturated fat and trans fats may reduce the plaque formation in arteries. Besides dietary changes, one may need to take cholesterol-lowering medications.

Exercising regularly: Exercise reduces risk of heart disease in many ways. It can lower blood pressure, increase level of high-density lipoprotein cholesterol, and improve the overall health of blood vessels and heart. It also helps in losing weight, control diabetes and reduce stress.

Eating diet rich in fruits and vegetables: A diet containing five or more daily servings of fruits or vegetables may reduce risk of heart disease. Following the diet which emphasizes olive oil, fruit, nuts, vegetables and whole grains may be helpful.

Quitting tobacco: Smoking raises the risk of heart disease for smokers and non-smokers exposed to second-hand smoke. So quitting tobacco use reduces risk of heart disease.

Avoid alcohol: It can be a risk factor for heart disease. Heavy alcohol consumption increases risk of high blood pressure, ischemic heart disease and heart attack.

Avoid drug abuse: Certain drugs, such as cocaine and methamphetamines, are established risk factors for ischemic heart disease.

Maintain dental hygiene: It is important to brush and floss one's teeth and gums often, and have regular dental check-ups. 

Anti-platelet drugs are commonly used as preventive medications: Platelets are cells in one's blood that form clots. Anti-platelet drugs make these cells less sticky and less likely to clot. The most commonly used anti-platelet medication is aspirin.

Anticoagulants: Drugs which include heparin and warfarin reduce blood clotting. Heparin is fast acting and may be used over a short period of time in the hospital. Slower acting warfarin may be used over a longer term.

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