It’s a common scenario. A woman in her 50s wakes up feeling nauseous. Dismissing it, she moves through her day, feeling a bit fatigued during her morning walk, even short of breath. Her friends urge her to go to the doctor after she experiences shooting pain in one arm. Despite thinking it’s nothing, she goes to the emergency room where she is put through a battery of tests. She is told there isn’t a blockage in one of the three main arteries, and that instead she may have a stomach issue or anxiety, and is sent home.
There is no major blockage, no chest pain. It couldn’t be a heart attack, right?
For years, the above scenario wouldn’t have merited a second thought. That’s because our understanding of heart attacks was, until recently, primarily based on men. And when men have heart attacks, they have chest pain due to blockages in heart arteries.
Doctors are now learning how different heart attacks and heart disease can be in men and women. “Broken heart syndrome,” the name used to describe a temporary condition that occurs when stressful or surprise situations cause sudden chest pain and tightness, is an example of a lesser-known type of cardiovascular disease that is more common in women than in men.
We spoke with Yale Medicine cardiologist Erica Spatz, MD, MHS, a clinical investigator for the Yale Center for Outcomes Research and Evaluation (CORE), which focuses on health care quality, about how the knowledge of women and heart disease is changing. Read on to find out more—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
Yes. Hormonal cycles can affect women’s cardiovascular health. In the pre-menopausal years, estrogen is protective of the heart—estrogen relaxes the arteries and promotes good cholesterol. In the peri-menopausal years, however, as estrogen declines, there is an emergence of cardiovascular risk factors such as high cholesterol and hypertension, including in women who previously had normal or even low cholesterol and blood pressure numbers. The incidence of heart disease in women starts going up around age 65—about 10 years later than in men, likely due to the protective effects of estrogen.