Men’s and women’s hearts may beat, bleed, or break in the same way, but they are not the same.

Heart disease is the number one cause of death for both men and women in the United States, but women face a variety of challenges in preventing, diagnosing, and treating cardiovascular disease, from pregnancy risks to arterial function.

Twenty years after the RUSH Heart Center for Women opened and the national heart health awareness campaign Go Red for Women began, we are learning more about heart disease in women. Ta. Dr. Rupa Sanghani, director of the Women’s Heart Center, said that’s because of her research and focus on the issue.

“Our understanding of how heart disease develops in women, including its physiology, symptoms, and risk factors, has advanced significantly over the past 20 years,” she says. “What we’ve learned about diagnosis and treatment, and how the disease manifests, has led not only to increased awareness, but also improved ways to care for patients.” Also, further research involving women The need for clinical trials was also proven.

Common heart conditions in women, rare risks

For the past few years, a key message for women has been that heart attack symptoms in women may be more subtle than in men. Chest pain is the most common symptom of a heart attack in both men and women, but only about half of women experience chest pain, and those who experience chest pain may experience less severe pain than men describe.

Symptoms in women include:

• chest pain
• neck pain
• shortness of breath
• Lightheadedness
• syncope
• indigestion
• nausea
• vomiting
• Malaise

“Awareness is increasing, but people still don’t think their risks are real,” Sanghani said. “They don’t think they’re at risk. But all women are at risk throughout their lives, and heart disease affects women of all ages.”

If a patient has chest pain, tests of the coronary arteries may be done to find a blockage that is causing the pain. However, women with chest pain often do not have blocked coronary arteries, so the cause of their pain may not be understood and appropriate treatment may not be received.

Detect small blood vessel problems

3 Coronary artery disease, which causes blockages in the aorta, is the most common heart disease in men and women, but women also experience blockages in the microvasculature, the smaller blood vessels of the heart.

Sanghani said understanding the role of small blood vessels is one of the most important advances related to women’s heart health.

“Women may come to the hospital complaining of chest pain, or they may have an enzyme (troponin) detected in their blood that indicates they’ve had a heart attack, but the large arteries of the heart appear normal,” she says. says. “In the past, her heart disease may have been overlooked. Now we know there may be an abnormality in the small blood vessels.”

These blood vessels are small but important, making up two-thirds of the heart’s circulatory system. However, it is difficult to confirm them without advanced technology.

RUSH launched Illinois’ first cardiac PET scan program in 2019 to better diagnose heart disease, focusing specifically on blood flow down to small blood vessels. Positron emission tomography can detect problems in a way that other imaging cannot.

“We can look at blood flow at the tissue level,” Sanghani says. “We have also started a microvascular program that uses new techniques to check how the cardiovascular system responds to stress and observe how blood vessels contract and expand.”

Latest risk factors for women

In the 20 years since cardiologist Annabelle Borgmann, MD, founded the Women’s Heart Center at RUSH, new risk factors have become recognized or better understood. In addition to traditional risk factors such as diabetes, high blood pressure, smoking, lack of exercise, obesity, and family history, risk factors include inflammatory diseases such as lupus and rheumatoid arthritis, and most importantly, pregnancy.

“Pregnancy is a nine-month stress test,” Sanghani said. “It can portend not only current disease but also future heart problems.”

Heart problems, whether diagnosed or not, are a significant risk for pregnant women during pregnancy, childbirth, and beyond. It is the leading cause of maternal death and morbidity.

Problems that occur during pregnancy, such as high blood pressure and high blood sugar, often lead to chronic hypertension and diabetes later in life. This increases your risk of heart disease. To reduce that risk, these patients will need aggressive preventive care to manage blood pressure and cholesterol and address factors contributing to diabetes, such as high blood sugar levels and obesity, says cardioobstetricians. said Sanghani.

Knowledge about how men’s and women’s minds differ continues to evolve and includes some stark contrasts. For example, the mechanisms by which cholesterol blocks arteries are not the same. When plaque builds up in a man’s arteries, it usually forms distinct plaque clumps. This can be detected with a procedure called angiography, after which a stent can be placed to improve it. Blood flow. In women, plaque often forms a coating on artery walls rather than a lump, making it difficult to see even large arteries.

Women’s physiological responses to stress can also be dangerously different, Sanghani says. A woman’s heart can be acutely damaged by severe stressful events, such as news of a death in the family.

“The adrenaline rush caused by stress causes the main chamber of the heart to malfunction, affecting the heart’s ability to pump,” she says. “This is a biochemical response to stress.”

This condition, called broken heart syndrome, Takotsubo cardiomyopathy, or stress cardiomyopathy, is treatable and usually improves with supportive care.

protect your health

Dr. Sanghani advises women with heart disease, symptoms, or concerns to consult a cardiologist with experience in women’s heart health. Both women and men need mental care, from prevention to diagnosis and treatment.

Patients should feel free to speak up and ask questions.

“If you have chest pain or feel unwell and think it’s because of your heart, don’t be sent home without answers,” Sanghani says.