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Is heart attack different for women?
How is a heart attack different for women? Why is this subject so overlooked? What are the consequences? A health issue that has been ignored for too long.
Laurie Levesque, february 2022
The male body: a universal standard?
Until recently, studies related to heart disease were primarily male-oriented and generalized to women. This is due to the evolution of health sciences in a patriarchal society, largely focused on “men’s issues”. However, did you know that one in three Canadian women has cardiovascular disease and that a woman is twice as likely to die of a heart attack as a man? (www.chumontreal.qc.ca/cardiof, french academiesb.comsite)
Nieca Goldberg, a young cardiologist and now director of the Joan H. Tisch Center for Women’s health, was one of the first to focus on women’s heart health. When she found that her patient had suffered a heart attack, she began research on women’s heart health and became a pioneer in the field. (Nedelman, 2017) She inspired many future studies showing that symptoms of heart problems are mostly more subtle in women than in men.
Research that is now more than essential given that, according to the University of Ottawa Heart Institute, coronary heart disease is the leading cause of premature death in women in Canada.
First Canadian and Quebec initiatives
Canadian Women’s Heart Health Summit In April 2016 the first Canadian Women’s Heart Health Summit was held in Ottawa. The event, hosted by the University of Ottawa Heart Institute and the Heart and Stroke Foundation, represented “the first national event focused on women’s heart health in more than 15 years” (University of Ottawa Heart Institute, 2017). Four recommendations* deemed necessary emerged from this summit :
- Transform clinical practices and raise awareness among practitioners.
- Create the National Women’s Heart Health Alliance to encourage collaboration in research and clinical care.
- Address the issue from a political perspective to raise awareness.
- Promote research growth.
*(University of Ottawa Heart Institute, 2017)
The second edition of the Summit was held in April 2018. With the theme State of the heart, its main goal was to focus discussions on women’s heart health at all stages of life. Experts from around the world and women who have experienced heart disease gathered for the event with the goal of discussing strategies to address gaps in women’s heart health. They also presented recent research findings, as well as shared scientific breakthroughs, prevention, treatment, and recovery (Lachance, 2018).
Research Chair in Women’s Heart Health The first research chair on women’s heart health in Quebec, awarded by the Heart and Stroke Foundation in collaboration with McGill University, was launched on July 1, 2019. Led by Dr. Natalie Dayan, Assistant Professor in the Faculty of Medicine at McGill University and Director of Obstetrical Medicine in the Division of General Internal Medicine at the McGill University Health Centre (MUHC), the project aims to :
- increase knowledge on the subject;
- find ways to reduce the risk of heart disease and stroke; and
- examine the benefits of breastfeeding immediately after delivery.
Quebec center of expertise dedicated to women’s cardiovascular health In 2021, the Centre hospitalier de l’Université de Montréal (CHUM) has announced that it will fund the construction of the Centre cardio F, the first Quebec center of expertise dedicated to women’s cardiovascular health. Cardio F’s mission is to address the lack of knowledge about the specificities of women’s diagnoses. Through clinical research, the Centre aims to better understand, improve, prevent, detect, cure and treat cardiovascular diseases in women throughout their different life trajectories.
Risk factors specific to women
Did you know that the risks are much higher for women? Indeed, this can be explained, among other things, by the many physical and hormonal changes that women go through during their lives, such as pregnancy and menopause.
From 12 to 50, her body produces estrogen, a hormone that protects her heart health, so this is the time when she is theoretically least at risk. However, some oral contraceptives, containing estrogen and progesterone, can cause high blood pressure and blood clots. These risks will increase significantly if a woman smokes or already has high blood pressure. During pregnancy, various health problems such as pre-eclampsia and diabetes can also interfere with cardiac well-being. At the age of 50, usually at menopause, the risk of a cardiac event increases drastically due to the decrease in estrogen levels. This period is also often accompanied by an increase in cholesterol, blood pressure and fatty tissue, factors that increase the risk of heart disease. (Heart and Stroke Foundation, n.d.)
Health care professionals have found that many women have experienced early warning signs* of a heart attack weeks or even months before the event. They call these signs “atypical” because few men report experiencing them.
Fatigue Unusual and severe drop in energy level that does not subside after several days. Sleep disorders Difficulty falling asleep or frequent nighttime awakenings, usually due to discomfort or pain that prevents sleep. Shortness of breath Feeling out of breath after an ordinary activity, but especially during an effort.
Indigestion Painful feeling of abdominal distension shortly after a meal, sometimes accompanied by pain or burning in the upper abdomen. Chest pain Mild discomfort, which may also feel like an indigestion. Anxiety Feeling nervous or fearful for no apparent reason or more often than usual. *(Canadian Heart Health Centre for Women, n.d. (b))
Unfortunately, the under-representation of women in past research on heart disease has resulted in low awareness of their risks and symptoms. As a result, they do not seek care and therefore do not get the care they need quickly enough.
Many women tend to underestimate the importance of their symptoms by attributing them to daily stresses and the pace of their lives with work, children and household chores. Some women also think it’s just a digestive problem, a side effect of a medication, or even that the symptoms will go away on their own.
Immediately before a heart attack, women usually experience chest pain, as do men. However, unlike men, they do not describe this pain as “stabbing”. Instead, it is felt as a pulling or pressing sensation in the abdomen.
Here are the symptoms* that women typically experience just before a heart attack occurs : Fatigue Significant and unusual drop in energy level that does not subside after several days. Difficulty breathing Breathing suddenly becomes very difficult, shallow. Radiant pain The pain spreads to the jaw, arm, shoulder and may extend to the back.
These symptoms are less common, but they can also occur : Cold sweats Sweating is sudden despite cool skin. Sometimes the patient complains of hot sensations or redness in the face. Nausea Heartache for no apparent reason, sometimes accompanied by vomiting. Dizziness Feeling weak or lightheaded. *(Source: Canadian Women’s Health Centre, n.d. (b))
Of course, the symptoms vary from woman to woman and do not necessarily all occur at once. Some women experience some of them gradually, while others experience them all at once. Signs may come and go over time, but it is important to call 9-1-1 as soon as the first symptoms appear or as soon as there is any doubt.
In recent years, researchers have observed physiological differences between the male and female heart. Specifically, they have found that in women, the heart and arteries are smaller and the heart rate is higher. Also, they noted that, unlike men, plaques that stick to the walls of the heart do not enlarge the arteries, but rather narrow them, promoting blood clot formation and obstruction.
As a result, tests for heart disease based on the human heart are inaccurate. As a result, this variation influences diagnosis, treatment, and therefore, survival rates for women. (Canadian Women’s Health Centre. n.d. (a))
Breaking down the misconception that heart disease is a man’s problem is critical to closing the sex and gender gap in health. Initiatives such as the Women’s Heart Health Research Chair are doing critical work to improve knowledge about the diagnosis and treatment of heart disease and stroke in women. Encouraging organizations and researchers who make this issue a priority will help save the lives of many women.
- Agence QMI. 28 octobre 2021. « CHUM : un premier centre d’expertise pour la santé cardiovasculaire de la femme ». Journal de Montréal. https://www.journaldemontreal.com/2021/10/28/chum-un-premier-centre-dexpertise-pour-la-sante-cardiovasculaire-de-la-femme [Last consulted on 11/02/2022]
- Canadian Women’s Heart Health Centre. N.d. (a) « What make women different ? ». University of Ottawa Heart Institute. https://cwhhc.ottawaheart.ca/education/what-makes-women-different [Last consulted on 14/02/2022]
- Canadian Women’s Heart Health Centre. N.d. (b) « Symptoms : Not Your Typical Heart Attack». University of Ottawa Heart Institute. https://cwhhc.ottawaheart.ca/education/symptoms [Last consulted on 14/02/2022]
- Heart and Stroke Foundation. N.d. « Women’s unique risk factors ». https://www.heartandstroke.ca/heart-disease/risk-and-prevention/womens-unique-risk-factors [Last consulted on 14/02/2022]
- Government of Canada. 2009. « What are the symptoms of a heart attack in women? ». https://www.canada.ca/en/public-health/services/chronic-diseases/cardiovascular-disease/what-symptoms-heart-attacks-women.html [Last consulted on 14/02/2022]
- University of Ottawa Heart Institute. February 2020. « Canadians: Wear red for women’s heart health on February 13 ». The Beat. https://www.ottawaheart.ca/the-beat/2020/02/10/canadians-wear-red-women’s-heart-health-february-13 [Last consulted on 14/02/2022]
- University of Ottawa Heart Institute. N.d. « Prevention & Wellness Centre : Gender ». https://pwc.ottawaheart.ca/education/heart-health-education/risk-factors/gender [Last consulted on 14/02/2022]
- University of Ottawa Heart Institute. June 2017. « Charting a Course for Women’s Heart Health in Canada ». The Beat. https://www.ottawaheart.ca/the-beat/2017/06/24/charting-course-women’s-heart-health-canada [Last consulted on 14/02/2022]
- Lachance, Judith. April 5. 2018. « Media advisory: The Canadian Women’s Heart Health Summit ». University of Ottawa Heart Institute. https://www.ottawaheart.ca/media-release/media-advisory-canadian-womens-heart-health-summit [Last consulted on 14/02/2022]
- La Presse Canadienne. 18 juin 2019. « Une première chaire sur la santé cardiaque des femmes au Québec ». La Presse. https://www.lapresse.ca/actualites/sante/2019-06-18/une-premiere-chaire-sur-la-sante-cardiaque-des-femmes-au-quebec [Last consulted on 11/02/2022]
- Nedelman, M. February 14, 2017. « For decades, women had heart attacks in silence ». CNN Health. https://www.cnn.com/2017/02/10/health/women-heart-attack-research/index.html [Last consulted on 11/02/2022]
Article written by Laurie Levesque, content creator for the Saint-Bernard Academy. Edited and formatted by Emilie Bedard, Head of Communications.