Women Struggling to Recognize Heart Disease

Stacy Phillips, BSN, RN

Her alarm goes off, and it's another morning of struggling to get out of bed. After peeling herself out of bed, she shuffles to the bathroom and notices her feet seem even more swollen today than usual. She thinks, "I need to cut back and eat healthier.” Later she is whizzing around the kitchen, making breakfast, pouring coffee, and getting ready to head out the door, and wow, her indigestion is bothering her this morning. She feels so full, and these hot flashes are killing her. She is sweating now, and her jaw is aching; she must have ground her teeth again last night in her sleep. Suddenly, she is so exhausted. Her partner comes in and sees her. "You don't look so good. Are you OK?” "I'm fine. I need a little rest. The weekend can't come soon enough.” Later that morning, while at work, she passes out, and her co-workers call 911. She is transported to the nearest hospital, admitted, and diagnosed with heart disease.

These days, women are juggling their schedule between keeping up with children's activities, their partner's activities, and, oh, let's squeeze a career there. As a result, self-care keeps getting further pushed down on the "to do" list. "I just need a good night's sleep" or "I'll rest after XYZ is done" are a few common themes. Unfortunately, this constant struggle of go, go often leads to women ignoring or dismissing vital signs and symptoms of heart disease. Couple this with the fact that many women with heart disease sometimes have vague, dangerous symptoms.

Heart disease is the leading cause of death in women in the United States, with some statics showing it kills as many as 1 in 5 women. Despite these scary numbers, only about ½ of women recognize heart disease as the number one killer. Heart disease is 16x more frequent in women than breast cancer. In fact, in recent years, the death rate from heart disease has gone down in men but has slightly increased in women. The rise in the prevalence of diabetes has also contributed to the increase in heart disease in women. Diabetes can not only be a contributing factor to heart disease in women but also further complicate and worsen symptoms of heart disease in women.

Risk Factors

There are many risk factors for heart disease in women, so women need to be aware of these risk factors. Women need to take an active role in decreasing their risk factors. Risk factors for heart disease in women include:

Diabetes
Smoking
Decrease physical activity
Emotional stress and depression
Menopause
Pregnancy complications
Family history
Inflammatory diseases such as Lupus and Rheumatoid arthritis

Some women can have a genetic predisposition to heart disease, but many of these risk factors can be decreased with better daily life choices. For example, smoking is a huge risk factor that can be eliminated by quitting. Many hospitals and physicians' offices have programs and counselors that help persons quit smoking. Tight control of blood sugars and healthy food choices are other factors that women can control to decrease their heart disease risk. Small diet changes over time can have a significant impact on lowering HGB A1C levels (blood tests used to determine blood glucose levels). Daily meditations, physical activity, and scheduled "time outs" for a bit of peace and quiet can decrease emotional stress. Regular check-ups with your primary physician, including yearly labs to check cholesterol, HGB A1C, thyroid function, and stress hormones, can help mitigate risk factors and identify them early.

Symptoms

Symptoms of heart disease or a heart attack can be different in women than in men. These differences can result in women often ignoring or dismissing these symptoms. Symptoms of heart disease can occur about ten years later in women than men in part due to the drop in estrogen after menopause. Symptoms of heart disease in women can be:

Neck or jaw pain or aching
Shoulder or upper back pain
Arm pain in one or both arms
Sweating
Dizziness or lightheadedness
Suddenly feel tired or weak
Indigestion or nausea
Pain or pressure in the chest
Feeling full or aching in the upper abdomen

Women often overlook these symptoms or try to explain them as something else. "I am just feeling tired today,”; "it's just been a long week,”; or "I ate something that doesn't agree with me" are just a few of the common reasons women will come up with to try to explain these symptoms. Women, especially post-menopausal women, need to educate themselves on the symptoms of heart disease and monitor themselves regularly. Sometimes heart disease in women can present as general fatigue and shortness of breath. They can have swelling in their legs or abdomen. They can have persistent indigestion or nausea that is not relieved by medications. Women often complain of pain or aching in their jaw and arm or armpit. They can have feelings of fullness in their upper abdomen or pressure in their back or lower chest. Women can feel sweaty and think they are having a hot flash.

Women need to be an advocate for their health. Women with heart disease are often overlooked or misdiagnosed when they first go to the doctor. Heart disease in women has often been misdiagnosed as thyroid disease, depression, or menopausal symptoms. A woman may also have this diagnosis as well as heart disease. Women need to make sure their practitioners are listening to their symptoms and if women need to make sure they are being heard. An ECG is an easy, non-invasive test that physicians can order that provides a clear electrical picture of the heart. Women should not be afraid to ask for an ECG if they feel their symptoms may be related to heart disease. Women need to keep speaking up until they find answers.

References

Heart disease in women: Understand symptoms and risk factors

Lower Your Risk for the Number 1 Killer of Women

Women & Cardiovascular Disease

Heart disease in women: Unsuspected? Overlooked? Ignored?