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Heart Disease and Women

CVD is a general term used to describe diseases of the heart and the blood vessel system usually related to atherosclerosis (narrowing of the arterial blood vessel wall caused by formation of fatty plaques). Coronary heart disease (CHD), the most common form of heart disease, causes narrowing of the arteries supplying the heart and can cause cardiac ischemia, which results in angina symptoms (chest discomfort and radiating pain). If an artery becomes blocked, it can result in MI (death of a part of the muscle). A cerebrovascular accident occurs if a cerebral artery becomes occluded or ruptures, leading to tissue death. Although the basic facts of CVD are the same for both men and women, there are pronounced gender-based differences in its presentation, recognition, and treatment.
Gender Differences in Symptoms of Coronary Heart Disease
Most women with CHD present with typical chest pain, but many women also experience atypical symptoms (such as fatigue, shortness of breath, epigastric pressure, nausea, vomiting, numbness of the arms, and/or jaw pain). In contrast, men usually present with severe radiating substernal pressure accompanied by nausea. The quality of the chest pain or discomfort in women is usually less severe or milder compared to men. McSweeney et al. surveyed 515 women 4 to 6 months after they had an acute MI to determine what symptoms women experienced before the MI (prodromal phase) and what symptoms occurred during the MI (acute phase) that did not resolve until women sought treatment. They found that 57% of women in the study experienced chest pain in the month before the acute attack, but the intensity of the chest pain was mild. The remaining 43% did not experience any pain during the prodromal phase before experiencing an acute MI. Given that chest pain is considered a hallmark of CHD, women who do not experience chest pain may fail to recognize the seriousness of their symptoms, delay seeking medical treatment, or be misdiagnosed once they arrive at the hospital for treatment.
However, in order to act on atypical symptoms, women must be aware of the symptoms that can occur, and surveys have shown that they are not. In 2000, Mosca et al. conducted a national survey of 1000 women to assess their awareness, knowledge, and perception of heart disease and found a lack of awareness of heart attack warning signals. Although 67% of the women knew some of the "classic" signals of heart attack, such as chest pain, shortness of breath, pain in the arm, and tightness in the chest, only 10% were aware of the less common signals that women may have such as nausea, fatigue, and dizziness, and 7% of the women did not answer the question at all.
The survey results also revealed that most women learned about CHD from magazines (43%) and television (24%), and less so from their own physician (18%). The findings suggested that many women (90%) felt comfortable discussing CHD prevention with their doctor, yet most of them (70%) did not. The lack of provider–patient discussion about CHD may be related, in part, to the aforementioned gender-based myths associated with CHD. Wenger crystallizes the problem of traditional gender bias in heart disease: "... The community has viewed women's health almost with a 'bikini' approach, looking essentially at the breast and reproductive system, and almost ignoring the rest of the woman as part of women's health."
Finally, many women interpret their symptoms as insignificant, further increasing their risk for a heart attack as they devalue (or diminish) their symptoms. Women may also be more preoccupied with high-profile female health problems (e.g., breast cancer and osteoporosis). Clinicians also fail to recognize atypical symptoms of heart attacks in women.
In addition to failing to recognize symptoms, many women, particularly African American women, often delay seeking help for cardiac symptoms. Banks and Malone found that "African American women experienced trivialization of their complaints by clinicians and a focus on technological procedures over respectfully attending to their concerns, which provided further disincentives to seeking care." African American women may also experience different symptoms as their primary complaint—such as shortness of breath rather than chest pain—and interpret these symptoms differently compared to members of other groups

CVD is a general term used to describe diseases of the heart and the blood vessel system usually related to atherosclerosis (narrowing of the arterial blood vessel wall caused by formation of fatty plaques). Coronary heart disease (CHD), the most common form of heart disease, causes narrowing of the arteries supplying the heart and can cause cardiac ischemia, which results in angina symptoms (chest discomfort and radiating pain). If an artery becomes blocked, it can result in MI (death of a part of the muscle). A cerebrovascular accident occurs if a cerebral artery becomes occluded or ruptures, leading to tissue death. Although the basic facts of CVD are the same for both men and women, there are pronounced gender-based differences in its presentation, recognition, and treatment.

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