STORY BY
When it comes to matters of the heart—both metaphorical and anatomical—men and women share many similarities, and some distinct differences. Our hearts look the same, they work the same and they “break” the same—most commonly from a heart attack caused by a narrowed or blocked artery.
But we feel our “heart break” differently. A man may feel searing chest pain or extreme indigestion when he has a heart attack. A woman may experience symptoms not nearly as dramatic, such as back pain, difficulty catching her breath or fatigue.
And while men as a rule know they are at risk for heart problems, women have not always been aware of their risks, even though heart disease is the No. 1 killer of women according to the American Heart Association. More than 480,000 women a year die from cardiovascular disease—about one a minute.
“I think most women know about breast cancer screening, and they know that once they get to a certain age to get their yearly mammograms, but they don't think the same of heart disease,” says cardiologist Dr. Poyee Tung, assistant professor of internal medicine at The University of Texas Medical School at Houston.
As a result, heart disease is often under diagnosed in women, Tung adds. She hopes that campaigns like the American Heart Association’s “Go Red for Women,” and the National Heart Lung and Blood Institute’s “National Wear Red Day” will make women more aware of their unique risks for coronary artery disease and how to prevent it. Women seem to be taking notice. According to 2005 survey conducted by the American Heart Association, 55 percent of American women know that heart disease is the leading killer of women, up from 34 percent in 2000. However, about one-third of women underestimated their own personal risk of heart disease.
But back to the question at heart. How is heart disease different in women than in men? Here’s what separates the girls from the boys:
We all have a distinct, male, image of what a heart attack should look like.
“We think of an old man with white hair, walking in the wind or snow, clutching his chest,” Tung says. “That is the way that Americans have always perceived heart attacks.”
Heart attack symptoms are more vague in women, she says. The pain may not be in their chest area at all, but rather in the jaw or in the back. Women having heart attacks may also feel tired or have trouble catching their breath, but dismiss their symptoms as minor. They are also more likely to have pain when they are at rest, pain awakening them from sleep and chest pain caused by emotional stress.
“Many women don't think it is a heart problem. They tend to think it is something else.” Tung says. “They think, ‘Maybe I'm too stressed, I have too many kids, I'm tired from work.’ They also think that they (heart attacks) just don't happen in women.”
The chances of developing coronary artery disease increase after menopause, probably due to decreasing levels of estrogen in women after menopause. Coronary artery disease begins an average of 10 years later in women than in men, usually hitting women in their 50s.
In the past, doctors prescribed hormone replacement therapy (HRT) to menopausal women to prevent coronary heart disease. Then results of the controversial Women’s Health Initiative study found that HRT doesn't help prevent cardiovascular disease in post-menopausal women, and may also increase a woman's chance of having a stroke. For that reason, many primary care physicians and cardiologists don't routinely prescribe HRT in a woman who is undergoing menopause, instead, recommending cholesterol-lowering medication and lifestyle changes.
However, heart disease can affect women of any age. Heart experts encourage women to find out their risk for heart disease at an early age, follow heart-healthy eating habits and exercise.
The typical cardiac stress test, in which a patient runs on a treadmill while hooked up to an EKG, is not always an accurate screening test for women with potential heart problems. Women tend to have more false positive results: The EKG looks abnormal when they exercise, even if they do not have an underlying heart problem.
Adding imaging to the standard stress tests--either with ultrasound or a nuclear camera--offers a much more accurate picture of what’s going on in the heart. An ultrasound of the heart is performed much the same way as an ultrasound is performed on a pregnant woman. A technician moves the ultrasound equipment over the woman’s chest for a picture of the heart at rest. Then the patient exercises. An ultrasound is taken again after the patient has exercised. If the patient can’t exercise, doctors may inject medicine into her heart to simulate exercise. If doctors want to see how the heart responds to exercise in real time, they can perform the ultrasound while the patient is reclined on her back and cycling.
In stress tests that use a nuclear camera, a small amount of a radioactive substance is injected into the bloodstream while the patient exercises. Then the patient lies down on a special table under a nuclear camera that takes pictures. The first pictures are made after the exercise test and show blood flow to the heart during exercise. The patient then lies quietly for two to three hours and another series of pictures is taken. These show blood flow to the heart muscle during rest.
Following all those diets and exercise plans may teach women a valuable skill. Women diagnosed with heart disease are more willing to stick to the plan their doctor recommends.
“In terms of coronary heart disease, women seem to respond better than men to medical therapy and they adhere better to medical regimens,” Tung says. “However, as a group, women fare less well than men after a heart attack. They are more likely to suffer from a second heart attack, have a stroke and develop disabling heart failure. This may be partly due to the fact that women are usually diagnosed later in their disease,” says Tung, who also sees patients at Memorial Hermann Hospital - Texas Medical Center.
Unfortunately, a woman’s instinct to put her family and friends first can get in the way of her best efforts to improve her health. “Family obligations and people to care for,” ranked among the top three major obstacles that women face in their decision to take preventative action against heart disease, according to a 2005 survey by the American Heart Association. The top two obstacles were confusion in the media, and a belief that a higher power determines health.
“Women have always been the caretakers in the family. We have always been taking care of others,” Tung says. “We need to also take care of ourselves.”
Know your risks: Tops on the list are high blood pressure, high cholesterol levels, being overweight, physical inactivity, smoking, diabetes and a family history of heart disease. African-American and Hispanic women are also at higher risk for heart disease. “Of course, there is nothing we can do about family history or ethnic background,” Tung says. “But we can do a lot about changing our diets, changing the way we live our lives, being active and losing weight.”
See your doctor: If you have a strong family history of heart disease—for example, you have a male in your family who had a heart attack before age 50—you may also be at risk for heart disease. “Don't wait until you are 40 to go to the doctor. Get yourself checked out.” Tung says. “If you haven't seen a doctor in awhile, it is very helpful to know where your cholesterol and your blood pressure stands.”
Live a healthy lifestyle: “The most important thing you can do for your heart is to really stay active, make sure you keep your weight in control and try to do some form of exercise most days of the week,” Tung says. You don’t have to run a marathon, she adds. Walking for 20 or 30 minutes on most days of the week will suffice. Also, eat in moderation, choose healthy foods that are low in fat and high in fiber and don't smoke.
Know your numbers: The American Heart Association recommends that a person without risk factors for heart disease should have an LDL (bad cholesterol) score less than 130. If you have risk factors of heart disease, your LDL should be less than 100. If you have major risk factors, like diabetes, aim for LDL less than 70. For blood pressure, aim for 130 over 80 or lower.
UPDATED: 1-30-2008
Editorial Board | Legal Disclaimer | Privacy & Security | Contact Us
©2000-2006 Office of Institutional Advancement, UT-Houston
Dr. Poyee "Pansy" Tung is an assistant professor in the Division of Cardiology at UT Medical School.
Microwaves and 'Erupted Hot Water Phenomena'
Hot-water eruption can occur if you use a microwave oven to super-heat water in a clean cup. ("Super-heated" means the water is hot beyond boiling temperature, although it shows no signs of boiling.)
A slight disturbance or movement may cause the water to violently explode out of the cup. There have been reports of serious skin burns or scalding injuries around people's hands and faces as a result of this phenomenon.
Adding materials such as instant coffee or sugar to the water before heating greatly reduces the risk of hot-water eruption. Also, follow the precautions and recommendations found in microwave oven instruction manuals; specifically the heating time.
