Heart Disease in Women

The recent tragic deaths of cricket legend Shane Warne and Victorian Senator Kimberley Kitching have put heart disease back in the news. Many Australians think they know the ‘typical’ symptoms of a heart attack – crushing chest pain radiating from the arm, dizziness and anxiety. But these symptoms aren’t shared by many women.

Cardiology has long been an extremely male-dominated field of medicine; even now, women make up only about 15% of cardiologists. This gender imbalance filters down through the study of cardiovascular disease, with the majority of research on heart attacks conducted on men. Which then further pushes male-skewed data into medical textbooks from which the next generation of doctors learns.

But as Aussie medic Dr. Kate Miller reports, this gendered blind spot has led to misdiagnosis and underdiagnosis for women. For women who survive heart attacks, their outcomes are also worse.

Heart Attack Symptoms in Women

Most women will have the same symptoms as men – up to 70% will experience chest pressure or pain. But a significant portion of women – about a third – will have atypical symptoms.

These include breathlessness and fatigue, and discomfort in the chest, rather than pain. Nausea and minor heartburn, as well as sweating and dizziness, can also be primary indicators. Sometimes women have no symptoms at all

In general, the symptoms many women are likely to experience are very vague, meaning those experiencing them are less likely to go to the ER. Some of these symptoms, like sweating, are often dismissed by women as menopausal ‘hot flushes’, or thyroid-related.

Even the types of heart disease experienced by women are different. The structure of a female heart is different to a male one, smaller, with thinner walls and smaller blood vessels. They have faster heart rates than men, and more often suffer from microvascular disease – in the small vessels – rather than the usual coronary artery disease.

Women are also more likely than men to have tears in the coronary artery, as well as suffer from “broken heart syndrome” – a weakening of the heart’s main pumping chamber. Beyond that, premature menopause, endometriosis, and polycystic ovarian syndrome all increase heart risk. Pregnancy-related diabetes and hypertension also increase risk.   

Despite the myriad risk factors unique to women, the gender-biased perception of heart disease in medicine and society at large does little to support positive outcomes. Women are twice as likely as men to die a year after presenting with a heart attack.

They’re also more likely to present late, and less likely to undergo necessary investigations (like angiograms) or receive preventative treatment. Unsurprising, given our society’s long history of dismissing women’s health concerns as ‘hysteria’.

22 Aussie women die of heart disease every day – figures three times as large as breast cancer. And COVID hasn’t helped. At least 27,000 heart health checks were missed or delayed due to the pandemic. Women deserve better awareness and better support. It’s about time the medical field corrected this blind spot.  

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