What are the symptoms of heart disease in women?

Short Explanatory Video

Woman with Heart Disease: How to Recognize Symptoms of Heart Disease

Introduction

Heart disease, one of the major causes of death in the world, is any condition that affects the heart’s function and structure. Several types of heart conditions can be called “heart disease”.

Most of the time, people believe heart disease to be a singular condition. However heart disease actually refers to a group of illnesses with many root causes. Remember that all heart diseases are cardiovascular diseases but not all cardiovascular disease necessarily considered to be heart disease. This is because cardiovascular disease refers to all types of disease conditions that affect the blood vessels and heart.

Types of Heart Disease

There are different types of heart diseases which are mostly classified according to how they affect the heart's structure or function:

Coronary artery disease (coronary heart disease)

This condition is the most common type of heart disease and is also one of the common causes of heart attacks, stroke and chest pains. This condition occurs when the arteries in your heart are blocked or become narrow.

Congenital heart disease

As the name suggests, congenital disease, which means a disease which is present from birth, is a group of birth defects that mostly affects the way the heart works. According to the NHS, 1 in 100 babies in the UK are born with congenital heart disease hence making it the most common type of birth defect.

Congestive heart failure

Congestive heart failure is a disease in which the heart inefficiently pumps blood. Regardless of its name, heart failure does not mean that the heart is about to stop working or has literally failed but rather that the muscles of the heart cannot contract properly.

Other heart diseases

Include (inflamed inner layer of the heart), heart rhythm problems, and endocarditis.

It is difficult to identify heart disease because it possesses several contributory risk factors such as diabetes, high blood pressure, high cholesterol, being overweight/obesity, physical inactivity, abnormal pulse rate and many other factors.¹

Statistics and Risk Factors of Heart Disease

There are many modifiable risk factors (risk factors you can control) for heart diseases such as:

Diabetes mellitus, high blood pressure (BP), high cholesterol levels, alcohol consumption, unhealthy diet, sedentary lifestyle (not enough physical activity), birth control and hormone replacement therapy, and cigarette smoking.

Women have a greater risk of heart disease with their risk changing over their lifetime. According to the CDC, heart disease is the leading cause of death in women as 1 in every 5 female deaths is a result of heart disease. Despite the increased risk of heart disease in women, most women are not aware that heart disease is their number one killer as statistics show that only 56% of women are aware of this. Statistics also show that heart disease is prevalent in white women and African women and is the leading cause of death amongst these races.⁽²⁾ Also coronary disease is the most common heart disease in women as 6.2% of women aged 20 years and above have this condition. This statistically translates to 1 in every 16 women above 20 years with coronary heart disease.⁽³⁾

It is important to know that apart from the non-modifiable risk of the sex of an individual, family history and age (the older you are, the more you at risk of heart disease) plays an important role in your risk of getting heart disease.

Causes (unique to women)

Gestational Diabetes

Gestational diabetes is simply diabetes diagnosed during pregnancy. This is because during pregnancy their placenta produces hormones causing sugar to build up in their blood. Gestation diabetes mostly progresses into type 2 diabetes after a woman has given birth. Women who have had gestational diabetes are two times more likely to have calcium in their arteries which is a major Marker of heart disease. Therefore the history of gestational diabetes and glucose tolerance after child birth is associated with Coronary Artery Calcium in women in a certain period of their life.^4. 

Gestational diabetes may sometimes be a risk factor for diabetes mellitus type 2. However, sometimes even in the absence of the progression of gestational diabetes to type 2 diabetes mellitus, women with gestational diabetes are still at risk of heart disease. Therefore early risk indicator surveillance and risk management is important in women with gestational diabetes⁽⁵⁾.

Depression

Depression is a major, however often overlooked, risk factor for heart disease. Depression is a group of related conditions which is mostly characterized by the rise and changes in the mood of a person. Depression is mostly characterized by a feeling of sadness, loneliness, rejection, guilt, worthlessness, suicide, changes in appetite, restlessness and sometimes fear. This condition therefore affects how you perform your daily activities like sleeping, eating, studying and working.

Women in their lifetime go through a series of hormonal changes which makes them more prone to depression and as such, are two times more prone to depression than men. Hormonal changes during menstruation, pre-menstruation, ovulation, pregnancy, miscarriage, postpartum period (this is the period after which a woman has given birth), menopause makes them at high risk of depression according to National Institute of Mental Health  and 1 in  4 women will suffer from major depression at some point in their lives.⁽⁶⁾

According to the American Heart association, depression and heart diseases are intertwined and as such depression has been linked to a poor score on seven important determinants of a healthy heart and as such people with severe depression are 3 times more likely to suffer from severe heart disease. Furthermore a study conducted by O’Neil, Fisher ⁽⁷⁾ supports the contention that depression is an independent risk factor of heart disease for women.

Pre-eclampsia

Pre-eclampsia which mostly starts 20 weeks after pregnancy is a complication which is characterized by high blood pressure. Other symptoms include protein in the urine, swelling of legs and water retention. This complication is mostly fatal to the mother and baby. Women who have had preeclampsia have three to four times the risk of high blood pressure and double the risk for heart disease and stroke. Women who develop preeclampsia appear to be at higher risk for heart disease later in life. A medical history of preeclampsia makes us aware of women who are at risk of heart disease later in life hence providing an opportunity to screen at the appropriate time and also implement strategies for the prevention, management and treatment of heart disease^{(8, 9)}.

Endometriosis

Endometriosis “from which we get the word endometrium'' that is the tissue which lines the uterus” is a gynecological condition in which the tissue which lines inside the uterus (endometrium) grows outside the uterus. This condition is mostly characterized by, abnormal menstrual flow (heavy), severe menstrual cramps and painful sexual intercourse. According to a study conducted by NIH, women who have endometriosis are at higher risk of heart attack than women who do not have endometriosis, with young women particularly more at risk .⁽¹⁰⁾

Polycystic Ovary Syndrome (PCOS)

In PCOS, women in their reproductive age produce higher than normal amounts of male hormones. Women with PCOS mostly have these symptoms: irregular menstrual cycle, acne, being overweight or obese, excessive growth of hair.  Studies suggest that women with PCOS have a twice as likely risk of a future cardiovascular event, like a heart attack or stroke.

Symptoms

Symptoms of heart disease are mostly the same for both men and women however there are some symptoms quite peculiar to women⁽¹¹⁾. Some women are asymptomatic that is to say they have no symptoms of heart disease however during rest or physical activities there some common symptoms of heart attacks in women such as:

• Pain around the region of the neck, throat, shoulder or jaw.
• Upper abdominal pain or back-pains
• Shortness of breath and feeling sick or wanting to vomit is mostly called Nausea.
• Discomfort around the chest area which mostly will wake you up in the middle of sleep at night.
• Chest discomfort when you are emotionally stressed

Other symptoms common to both men and women include:

• Angina: This is a chest discomfort which occurs as a result of reduced blood flow in the heart. Some people describe it as an elephant sitting on their chest
• Easy Fatigability
• Shortness of breath.
• Nausea
• The feet abdomen and legs swelling
• Chest discomfort while exercising
• Feeling dizzy or fainting (lightheadedness)
• Heart beating faster, or pounding (heart palpitations)   

Summary

Heart Disease is preventable or can be managed properly when the risk factors are managed properly to prevent further complications. Exercising regularly at least 30 mins daily, eating proper diet, quitting smoking and alcohol consumption, managing chronic diseases like (Diabetes, high blood pressure (BP), kidney diseases etc), obeying your doctors instructions and many good lifestyle practices will go a long way to reduce the incidence of heart diseases and death related heart conditions both in women and the population as a whole.