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Healthcare professionals must remember that heart attacks kill women too

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By vfiore
7 March 2018

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Typically, when we think of a person with a heart attack, we imagine a middle-aged man who is overweight, has diabetes and smokes. This is not always the case. Myocardial infarction, when the blood flow to the heart is suddenly cut off, affects the wider population too; including women.

Typically, when we think of a person with a heart attack, we imagine a middle-aged man who is overweight, has diabetes and smokes. This is not always the case. Myocardial infarction, when the blood flow to the heart is suddenly cut off, affects the wider population too; including women.

More than 30,000 women die from the condition in the UK each year. Yet when they survive an initial attack, there is a 50% higher chance than men of receiving the wrong diagnosis. Women often fail to recognize the signs and symptoms of a heart attack, which can be very different to the stereotypical picture of a middle-aged man with crushing chest pain.

  • Women generally present about 10 years later than men
  • Women present with a greater risk-factor burden
  • Women are less likely than men to have typical angina
  • Women who present to the Emergency department with new onset chest pain are approached and diagnosed less aggressively than men.
  • Women have more chances to present with angina than heart attack, but when they present with heart attack it is more fatal.

Many cases of heart attack in women go unrecognized, particularly at younger ages or in those with diabetes. The longer a heart attack is left undiagnosed and untreated, the more the heart muscle can be irreversibly damaged. There are around 300,000 female heart attack survivors in the UK, often living with heart failure as a consequence.

All women at intermediate or higher risk should be evaluated; results may differ from those seen in male patients.

Differences between men and women

  • Treadmill exercise testing has a higher false-positive rate in women (for the diagnosis of obstructive coronary artery disease).
  • The prevalence of significant coronary disease found at the time of angiography is lower in women than men presenting with chest pain. 
  • Most women with chest pain and no evidence of blockages on coronary angiography have cardiac syndrome X or microvascular disease, or far more rarely, takotsubo cardiomyopathy or coronary dissection.

Signs of heart disease

1. Never ignore unexplained weakness, tiredness, first onset chest burning or first onset breathlessness after the age of 40.

2. If any male family members had heart disease before 55, or before 65 for females, it amounts to strong family history

How cardiac arrest happens

  1. Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) refer to the sudden cessation of organized cardiac electrical activity. SCD is used if the patient dies; SCA or aborted SCD if an intervention such as CPR, defibrillation, cardioversion, anti-arrhythmic drug, or spontaneous reversion, restores circulation.
  2. There are many causes of abnormalities that can result in SCD. In all age groups, 65% to 70% are related to coronary heart disease.  Other structural cardiac disease is responsible for approximately 10%, arrhythmias (irregular heart beat) in the absence of structural heart disease for 5% to 10% and non-cardiac causes (15 to 25 percent) responsible for the remaining deaths.

In an emergency

Start CPR in all cases of sudden cardiac arrest and continue until medical help arrives along with a defibrillator.

Prevention

Coronary heart disease in women can be prevented. You can reduce the impact of your risk factors and improve your chances of preventing CHD by adopting healthy diet and lifestyle habits.

Author: Dr Kailash Chand OBE is honorary Vice President of the BMA, former Deputy Chair of BMA Council and Chair of Healthwatch Tameside

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