Women and heart disease: symptoms and diagnosis

Heart disease refers to a range of conditions that affect the heart. The term 'heart disease' or 'heart condition' is often used interchangeably with the term ‘cardiovascular disease’ (CVD). CVD refers to all diseases of the heart and circulation, including coronary heart disease, preeclampsia, atrial fibrillation, heart attack, congenital heart disease, heart failure and stroke.

CVD can affect any part of the cardiovascular system, and symptoms may not always be visible. Different CVDs may develop at the same time or lead to other CVDs. Some CVDs, such as preeclampsia and gestational diabetes, are specific to women.

Heart disease is the leading cause of death for women in Australia and globally

CVD is the number one killer of Australian women, and over half a million Australian women have CVD.

Every day, 109 Australian women have an acute coronary event, such as a heart attack or stroke – an estimated 40,100 events per year.

Every year, 22,000 women die from CVD – that’s 60 women a day – and over 200,000 women are hospitalised due to CVD.¹

But despite these sobering statistics, many women are unaware that they are also at risk of heart disease.

What causes heart disease in women?

There is no singular cause of CVD in women, but the primary underlying cause is atherosclerosis.

Atherosclerosis is the build-up of fatty plaques on the walls of the arteries. These plaques are made up of fat, cholesterol, calcium and other substances. Over time, the plaques harden, narrowing the opening of the arteries and restricting blood flow. These atherosclerotic plaques can break, forming a blood clot (thrombosis) that can further limit, or even block the flow of blood throughout the body.

There are several factors that increase the risk of CVD in women. Some risk factors can be changed, while others cannot.

Risk factors for women's heart disease that cannot be changed

• Increasing age: The risk of developing CVD increases with age, and CVD is most common in people aged 50 and over. The risk for women increases significantly once they have reached menopause. However, women of all ages can experience CVD, so it’s important to manage the risk factors that can be changed.
• Gender: While men are slightly more at risk of CVD than women, CVD is still a leading cause of death and disability in women. CVD risk in women can also be under-recognised and under-treated, and there are several heart health mistakes women can avoid. Some CVDs affect women more than they do men, and some CVDs are specific to women, such as preeclampsia and gestational diabetes.
• Family history: People with a family history of CVD may be more predisposed to developing CVD. An immediate family member, such as a parent or sibling, being diagnosed with CVD before the age of 60 may indicate a family history of premature CVD. This means that the chances of developing the same condition may be higher than normal.

Risk factors for women's heart disease that can be changed

• High blood pressure: High blood pressure can make the arteries hard and stiff, increasing the risk of atherosclerosis. Medication and dietary changes, such as lowering salt intake, can help to manage it. High blood pressure during pregnancy is known as preeclampsia.
• Preeclampsia: Women diagnosed with preeclampsia have over twice the long-term risk of CVD and stroke compared to women without. Managing the risk factors for CVD before and during pregnancy can help decrease the chance of developing preeclampsia.
• Diabetes: The risk of developing CVD doubles for people living with diabetes, and women with diabetes are more likely to develop CVD than men with diabetes. Some dietary changes can help manage diabetes as well as leading a healthy lifestyle.
• Stress: Stress can affect women’s hearts more than men’s. Long-term stress can damage the arteries and worsen other risk factors for CVD. Take the time for self-care and to address the issues that are causing the stress.
• High cholesterol: High levels of LDL cholesterol, the “bad” cholesterol, can increase the build-up of atherosclerotic plaque. Making dietary changes can help manage high cholesterol and medications are also available.
• Inactivity: Leading an inactive lifestyle can contribute to being an unhealthy weight and increase the risk of other risk factors like high blood pressure and cholesterol levels. It is important to make exercise or physical activity a regular part of your day. It is also important to stay active after a CVD diagnosis, under medical guidance.
• Overweight and obesity: Being overweight or obese can increase the risk of CVD as well as other risk factors like high blood pressure and high cholesterol. Tips for reaching and maintaining a healthy weight include eating a healthy diet and exercising regularly.
• Poor nutrition: An unhealthy diet high in saturated fat, trans fat, LDL cholesterol, salt and sugar can contribute to being an unhealthy weight and increase the risk of high cholesterol and high blood pressure. Try to eat a balanced, nutritious diet to help improve overall health and wellbeing.
• Smoking: People who smoke have a significantly increased risk of CVD, as it can increase the risk of atherosclerotic plaque. If you smoke, quitting is one of the best things you can do for your heart health.
• Alcohol: Long-term alcohol intake can damage the heart muscle, raise the levels of some fats in the blood, reduce our HDL “good” cholesterol and increase blood pressure. Limiting alcohol intake will help decrease these risks.

It is important to be aware of heart disease and heart attack symptoms in women. Symptoms can present themselves differently in women than in men, which can lead to a delay in seeking medical help.

The symptoms depend on the specific condition, and some symptoms and risk factors can be “silent”. For example, high blood pressure may initially cause no symptoms.

The most common symptoms of heart disease or CVD in women include:

• pain or pressure in the chest
• pain or discomfort in the arms, jaw or back
• shortness of breath
• nausea
• fatigue
• dizziness or light-headedness
• cold sweats.

Heart attack symptoms in women

The symptoms of a heart attack can be different in women than in men, so many women are unaware of the warning signs. In the event of a heart attack, women are also less likely than men to seek help quickly.

The most common heart attack symptom in women is the same as in men – chest pain, pressure or discomfort that comes and goes or last for a few minutes. However, this chest pain may not be as severe or noticeable in women as it is in men – women often describe heart attack pain as pressure or tightness in the chest. It is also possible to have a heart attack without chest pain.

Women are more likely to experience symptoms of heart attack unrelated to chest pain, such as:

• discomfort in the neck, jaw, shoulder, upper back or abdomen
• breathlessness and a general feeling of unwellness
• pain, tightness or discomfort in one or both arms
• nausea or vomiting
• heartburn or indigestion
• sweating
• light-headedness or dizziness
• unusual fatigue.

Women tend to have heart attack symptoms more often when resting, or even when asleep, compared to men. Stress can also trigger heart attack symptoms in women.

While heart attacks can be sudden, some women experience symptoms and warning signs hours or even days in advance, such as recurrent chest pain or pressure. A heart attack can only be diagnosed by medical tests.

It is important to seek medical help immediately if you suspect a heart attack.

Heart pain in women: when it is a warning sign

While men often experience central chest pain when having a heart attack, women commonly interpret this pain as indigestion simply because they do not expect a heart attack.

Seek medical help immediately if heart pain continues or is accompanied by other heart disease symptoms such as:

• discomfort in the neck, jaw, shoulder, upper back or abdomen
• breathlessness and a general feeling of unwellness
• pain, tightness or discomfort in one or both arms
• nausea or vomiting
• heartburn or indigestion
• sweating
• light-headedness or dizziness
• unusual fatigue.

Pre-heart attack symptoms for female patients

The most common pre-heart attack symptom for female patients is chest pain or discomfort that lasts for a few minutes or comes and goes. Women often describe this sensation as pressure or tightness in the chest. This chest pain may not be as severe or noticeable as in men who experience this pre-heart attack symptom.

Other heart disease symptoms that can occur pre-heart attack include:

• discomfort in the neck, jaw, shoulder, upper back or abdomen
• breathlessness and a general feeling of unwellness
• pain, tightness or discomfort in one or both arms
• nausea or vomiting
• heartburn or indigestion
• sweating
• light-headedness or dizziness
• unusual fatigue.

Seek medical help immediately if you experience any of these pre-heart attack symptoms.

Symptoms of heart blockage for females

There are many types of heart disease, with varying symptoms depending on the type.

Coronary heart disease, also known as coronary artery disease, is a common condition where the major blood vessels to the heart (coronary arteries) become blocked and narrowed, restricting the flow of oxygen-rich blood to the heart. Without enough oxygen, the heart cannot function properly.

Blockages can occur when fat, cholesterol and other substances build up and form plaque in the arteries through a process called atherosclerosis. The plaque can form a blood clot (thrombosis) that interrupts the flow of blood around the body, if it breaks away from the artery wall.

The symptoms of heart blockage depend on the severity of the disease. As symptoms can come and go, they may be unrecognised. Some people may experience no symptoms, while others may experience mild to severe ones. Symptoms may also become stronger or more frequent as the disease progresses.

The common signs and symptoms of heart blockage for females include the following.

• Chest pain (angina): If the heart does not receive enough oxygen due to blocked coronary arteries, there may be a feeling of pressure or tightness in the chest. This chest pain normally occurs in the middle or left side of the chest.
• Pain spreading to the arms, shoulder, jaw or neck: These signs and symptoms could indicate a heart attack, which can be triggered by a severely blocked coronary artery.
• Shortness of breath
• Fatigue

To help prevent CVD, it’s important to have regular heart health checks with your doctor. The earlier that heart disease is detected, the earlier that it can be treated and managed, perhaps preventing a more severe health issue.

In Australia, heart health checks are covered by Medicare. They usually take around 20 minutes.

During a heart health check, your doctor can determine your overall risk of CVD by considering a number of factors, including whether you have any of the lifestyle risk factors, such as high cholesterol levels and whether you smoke. They will also consider your family history of CVD, ethnicity, age and gender, as well as any other health conditions that you may have.

Your doctor will then use treatment guidelines to advise interventions you can take to reduce your risk, which may include medication.

Simple steps for women to prevent heart disease

Regardless of the outcome of a heart health check, there are simple steps everyone can take to help prevent CVD and improve heart health.

• Eat a heart-healthy diet that includes a variety of fruit, vegetables, wholegrains and healthy protein sources.
• Limit the amount of processed foods eaten, and check their nutrition labels. These foods can contain high amounts of saturated fat, trans fat, LDL cholesterol, salt and sugar that can negatively affect health.
• Avoid sugary drinks and stay well-hydrated with water instead.
• Choose healthier sources of fat, such as nuts, seeds and avocados.
• Make exercise or physical activity a regular part of your day. Aim for at least 30 minutes of moderate-intensity physical activity on most days, but any bit of activity helps.
• Maintain a healthy weight through regular exercise and a balanced diet.
• Limit alcohol intake. Drinking too much alcohol can raise the levels of some fats in the blood, reduce our HDL “good” cholesterol and increase blood pressure, all risk factors for CVD.
• Quit smoking. Quitting is one of the best things you can do for your heart health, as smoking significantly increases your risk of CVD.

CVD is the number one killer of women in the world, yet there is still no cure. The number of women with CVD is expected to continue to grow in coming years, highlighting the urgent need for more research into CVD.

The mission of the Heart Research Institute (HRI) is to prevent death and suffering from CVD. Our groundbreaking cardiovascular research to develop new treatments and preventatives for CVD is fighting the devastating impact CVD can have on women, their families and loved ones.

Over 70 per cent of the funding for our critical work comes from donors. This vital support helps keep our scientists in the labs so that we can continue pioneering life-saving heart research.

Donate to support crucial research into heart disease today.

HRI is conducting critical research to protect women from heart disease by investigating new ways to prevent, detect and treat the main underlying cause, atherosclerosis, as well as CVD as a whole.

The Vascular Immunology Group at HRI focuses its research on better understanding the causes of preeclampsia, the condition’s impact on women during pregnancy, the impact on long-term cardiovascular health, as well as the development of new drug treatments for preeclampsia. Preventing preeclampsia is likely to have a positive impact on pregnancy outcome, and could help prevent or reduce the risk of future heart disease in women.

Our Atherosclerosis and Vascular Remodelling Group aims to identify and gain insights from the genetic and molecular pathways involved in atherosclerosis and CVD, while our Cardiovascular-protective Signalling and Drug Discovery Group is investigating how to repurpose existing drugs for next-generation therapies for CVDs.