Matters of the heart

Years of gender-based cardiovascular research have found plenty of differences in men and women’s health. One out of two women will be diagnosed with heart disease in her lifetime. It’s the number one killer of women.

Fifty percent of the time, the first symptom of heart disease in women is sudden cardiac death.

A day after “Star Wars” actress Carrie Fisher died of sudden cardiac arrest, her mother, actress Debbie Reynolds, suffered a fatal stroke. Adrenaline released from intense physical or emotional stress like grief often acts as a trigger for strokes and heart attacks in post-menopausal women who lack protective hormones, according to a 2015 study in the New England Journal of Medicine.

Yes, you really can die of a broken heart. You can also have a heart attack from intense physical stress.

Last April, 66-year-old Ellen Segal, who had no risk factors for heart disease other than periods of physical stress related to a severe cough, felt a mild pain in her left arm, followed by extreme exhaustion and shortness of breath. Concerned, she went to her doctor, who ordered an electrocardiogram.  

The test showed an abnormality found in heart attacks: ST-segment elevation. “My doctor said, ‘Do you realize you had a heart attack sometime in the past week?’ Then he called an ambulance,” Segal said.

The interventionist cardiologist on call in the ER performed an angiogram on Segal to rule out a blockage in her coronary arteries, then did a ventriculogram, a test done during cardiac catheterization that evaluates the main pumping chamber of the heart, the left ventricle. The ventriculogram showed the entire tip of Segal’s heart was ballooned out and not moving — a telltale sign of “takotsubo cardiomyopathy” or “stress-induced cardiomyopathy.”  

Also known as “broken-heart syndrome” because it can also be caused by intense emotional stress, more than 90 percent of reported cases are post-menopausal women, according to the NEJM study. Up to 20 percent of women evaluated for heart attacks actually have stress-induced cardiomyopathy. Segal received treatment to reduce the stress on her heart and recovered with no long-term heart damage.

Many people still believe that heart disease is a man’s disease. But the death rate due to heart disease for men has been declining since 1984 — and it has been rising for women ages 60 and younger. Four times more women die from heart disease than men, according to the American Heart Association. And it isn’t just older women; the AHA reports the death rate for young women with heart disease is rising. Experts say there are several contributing factors; rising rates of Type 2 diabetes and obesity are playing a role, as well as the lack of recognition among younger women that heart disease is important. Heart disease kills five times more young women than breast cancer.

Dr. Noel Bairey Merz, a National Institute of Health researcher and cardiologist for women and director of the Barbara Streisand Women’s Heart Center at Cedars-Sinai Heart Institute, said that women need to advocate for new therapies and diagnostics to detect female-pattern heart disease and heart attacks.

“Today’s cardiovascular diagnostic and therapeutic strategies were developed for men. The majority of women having heart attacks present differently than men,” Merz said. “They’re also more likely to die than men.”

Matters of the heart3Men and women often experience different heart attack symptoms. While men tend to have intense chest pain, women may feel a dull ache in their left arms, jaws, chests, necks or backs. Women may also feel anxious, nauseous, fatigue, dizzy or short of breath.   

When a man has a heart attack, it typically is a circulatory problem caused by an arterial blockage or rupture that blocks blood flow to part of the heart. More often in women, arterial erosion, spasm, microvascular disease or intense emotional or physical stress cause heart attacks. Microvascular disease is an abnormal dilation of the blood vessels feeding the heart.

Angiograms can pick up male-pattern heart disease, but not the spread of fatty plaque more often seen in women with heart disease. In a recent TED Talk, Merz said that the difference between the fatty plaque in men and women reflects how differently they deposit fat in general. When men become obese, their bodies deposit fat in their bellies, similar to how they deposit lumpy fatty plaques in their arteries. When women gain weight, they often deposit fat all over their bodies. It’s the same with the even spread of plaque found in the eroded arteries of women with heart disease.

But there is hope for women: Catheters with intravascular ultrasound and cardiac MRIs can detect female-pattern heart disease, but more research is needed.

“Research on men with heart disease has been ongoing for 50 years. Research on female-pattern heart disease has been ongoing for 15 years — women are 35 years behind,” Merz said.

Scientists are studying how they can treat female-pattern heart disease more effectively than using stents, surgery and drugs. One promising field is stem cell therapy. “The biggest physiological difference between men and women is that women can bring new life into the world,” Merz said. “Women’s stem cells are robust — much more robust than men’s — and if used to treat damaged heart muscle, they may help heal the injured tissue.”

Managing risk factors for heart disease is critical. Too many women don’t move enough, get outside or maintain a healthy diet — and what’s worse, they often feel apathetic about the consequences. Women are also more stressed and over-stimulated today thanks to 24/7 media blitzes.

“During stress, it’s more common for women than men to experience reduced blood flow to the heart that can lead to chest pain or a heart attack,” said Dr. Carl Pepine, a world-renowned cardiologist for women.

“Critically important for women to know, epidemiological studies show that high blood pressure caries the greatest risk for mortality in women among all modifiable risk factors,” Pepine said.

The AHA now warns that too much added sugar may also increase the risk of heart disease. Refined carbohydrates and sugar-sweetened drinks add to this risk. Sugar addiction contributes to the chronic inflammation and insulin resistance of Type 2 diabetes — major risk factors for cardiovascular disease in both women and men.

Awareness, better lifestyles habits, better diagnostics and better treatments could lower the death rate for women with heart disease. It’s time to get onboard.  

Prevent Heart Disease

 The American Heart Association offers seven tips to help prevent heart diease:

  1. Manage Blood Pressure
    High blood pressure is a major risk factor for heart disease and stroke. When your blood pressure stays within a healthy range, you reduce the strain on your heart, arteries and kidneys, which keeps you healthier longer. 
  2. Control Cholesterol
    High cholesterol contributes to plaque, which can clog arteries and lead to heart attack and stroke. When you control your cholesterol, you are giving your arteries their best chance to remain clear of blockages.
  3. Reduce Blood Sugar
    Most of the food we eat is turned into glucose, or blood sugar, that our bodies use for energy. Over time, high levels of blood sugar can damage your heart, kidneys, eyes and nerves. 
  4. Get Active 
    Living an active life is one of the most rewarding gifts you can give yourself and those you love. Daily physical activity increases your length and quality of life.
  5. Eat Better
    A healthy diet is one of your best weapons for fighting cardiovascular disease. When you eat a heart-healthy diet, you improve your chances for feeling good and staying healthy — for life.
  6. Lose Weight
    When you shed extra fat and unnecessary pounds, you reduce the burden on your heart, lungs, blood vessels and skeleton. You give yourself the gift of active living, you lower your blood pressure and you help yourself feel better, too.
  7. Stop Smoking
    Cigarette smokers have a higher risk of developing cardiovascular disease. If you smoke, quitting is the best thing you can do for your health. 

Join the American Heart Association’s Palmetto Heart Walk at 8:30 a.m. Saturday, April 29 at Shelter Cove Community Park. You can start or join a team at or by contacting development director Carla Raines at 


Read an article written by Dr. Aaron Ford on broken-heart syndrome online at Ford is a cardiologist with Hilton Head Heart.

The Heart Hospital at St. Joseph’s Hospital offers advanced care for heart attacks with the Chest Pain Center Accreditation with Percutaneous Coronary Intervention from the Society of Cardiovascular Patient Care. The Chest Pain Center, a component of The Heart Hospital, responds quickly with advanced treatment for chest pain and heart attack patients.