Cardiologists have long known that menopause increases a woman’s heart disease risk. But these days, they’re also asking about periods and pregnancy.
Maleeha Haq, MD, a cardiovascular disease and interventional cardiology specialist at AdventHealth Tampa, understands the importance of this intimately. When Haq was pregnant, she had preeclampsia and gestational diabetes.
“I realized that increases my cardiovascular risk and that I’d have to be monitored periodically throughout my life,” Haq says.
Heart disease is the No. 1 cause of death for U.S. women, according to the Centers for Disease Control and Prevention. Here Haq, who is passionate about women’s heart health, shares how coronary artery disease is different for women, as well as risk factors and symptoms.
Why Heart Disease is Different for Women
Coronary heart disease, which develops when plaque builds up inside the arteries that deliver blood to your heart, is the most common kind of heart disease.
And unfortunately, heart attacks can happen when this plaque build-up becomes so severe blood can’t reach your heart.
Symptoms for coronary artery disease present differently for women than they do men for several reasons due to analogic and philosophical differences, including:
- Hormone levels
- Narrow blood vessels
- Plaque build-up that’s more difficult to detect
- Smaller heart
- Blood count
- Thinner ventricular walls
“A lot of times, women don’t complain as much, or they’ll seek care later than men,” Haq says. “And by the time they do, they may have already had an event, or the disease may have already manifested in a more severe way because they waited to relay their symptoms to a doctor.”
Coronary Artery Disease Risk Factors in Women
While symptoms can look different, when it comes to coronary artery disease risk factors, they are much the same for women and men.
These include:
- Age (getting older)
- Anemia
- Certain autoimmune diseases
- Chronic kidney disease
- Diabetes
- Family history
- Heavy alcohol use
- High blood pressure
- High LDL cholesterol
- Low HDL cholesterol
- Not exercising or getting enough sleep
- Obesity
- Smoking
- Stress
- Unhealthy diet
However, Haq says we now know of several important gender-specific risk factors, including:
- Early onset puberty or menarche
- Diabetes during pregnancy
- Hypertension, elevated blood pressure or preeclampsia during pregnancy
- Menopause with an increased risk for those who experience early menopause
- Miscarriages
“When I see patients who were referred by gynecology during pregnancy because they have preeclampsia, I tell them your story doesn’t end here,” Haq says. “If your blood pressure gets better after you’ve had this baby and you never need medicine for 10 years, that doesn’t mean that you can’t go on to develop an issue later. It’s crucial for you to be constantly aware of that.”
Coronary Artery Disease Symptoms in Women
Some women may not experience coronary artery disease symptoms, which is why regular screening and well checks are important. Other women may experience more subtle symptoms.
“They may present with fatigue, or they may simply feel like they can’t do as much as they were doing,” Haq says.
Additional coronary artery disease symptoms in women include:
- Dull chest ache or pressure
- Nausea, sometimes with vomiting
- Pain in the back, neck, jaw, throat, upper abdomen
- Palpitations, a fluttery feeling in the chest
- Shortness of breath
- Swollen abdomen, ankles, feet or legs
Haq has seen many women who have come to her presenting with atypical symptoms after being dismissed by other physicians.
“I have tried to have a more compassionate approach, screening them based on their presentation symptoms and risk factors,” Haq says.
For some women, a heart attack is the first symptom of coronary artery disease. Heart attacks in women can be so subtle that it’s possible to not realize you’ve had one. Heart attack symptoms in women can include:
- Chest pressure or pain that remains or comes and goes
- Dizziness or lightheadedness
- Heartburn
- Pain in the arms, neck, jaw, shoulder, upper back or stomach
- Shortness of breath
- Sweating
- Sudden cold sweat, lightheadedness, nausea
- Unexplained extreme fatigue
“Take your symptoms seriously,” Haq says. “Know your risk factors. Be aware of them and know when to share your symptoms. If you’re concerned, don’t downplay them or don’t minimize them if they’re new symptoms that are changing the quality of your life. Even if it’s mild, do something about it because prevention is better than a cure.”
Listen to Your Heart
Our specialists at AdventHealth Medical Group Heart Care at Tampa are experts in heart health for women. If you have questions about your coronary artery disease risk or possible symptoms, contact us today.
Maleeha Haq, MD is a fellowship-trained interventional cardiologist with board certifications in internal medicine, cardiovascular disease, interventional cardiology and adult comprehensive echocardiography. She specializes in the evaluation, management and treatment of coronary artery disease and has special training in non-invasive cardiac testing including echocardiography and
non-pharmacologic and pharmacologic stress testing.
