It’s concerned me for a while that so much health research is done on men. Then the facts are generalized to include women. This isn’t good for women, since our bodies are very different. So are our needs and the symptoms of health problems. Heart disease is the number one killer of women. Yet many people ignore symptoms in a woman having a heart attack because she’s not having the same ones as men. Dr. John A. Elefteriades and Dr. Teresa Caulin-Glaser want to change that!

I’m grateful that they wrote the recently released, The Woman’s Heart: An Owner’s Guide (Prometheus Books, 2008), dedicated to a woman’s heart. They kindly allowed me to excerpt some below. The authors examine the differences in the structure and function of the heart in women, exploring the effects of hormonal influence as well as the phases of the lifecycle. They provide a description of the symptoms of heart disease specific to women.

Even if you’re not a woman, become aware of the signs of heart disease in half the population!

The authors’ goal is to provide an “owner’s manual” for women to take care of their hearts; to be more attuned to female symptoms of heart disease. If you should develop or currently suffer from heart disease, this book will make you well versed on general options and expectations. Whether you’re a woman or you want to be more vigilant about the health of a woman you care about, pay attention to this book! If your love partner, or mom, female friend or YOU complain about symptoms that are often written off, you might save her life!

The Woman’s Heart
By John A. Elefteriades MD and Teresa Caulin-Glaser MD

When it comes to the health of hearts, the differences between men and women can have serious consequences. Because heart disease in women is often dissimilar to that of men, our medical system has been guilty of under-recognition and substandard scientific investigation and clinical treatment of women’s heart disease. The quintessential image of angina (the medical term for chest pain or discomfort due to disease of the blood vessels of the heart) usually shows a middle aged man clutching his chest in agony. This is the mental picture imprinted in physicians’ consciousness from the first day of medical school.

The physician has not been conditioned to think immediately of coronary heart disease in the female patient. Women, we are beginning to realize, may not feel heart attack pain in the same way men do. By virtue of her hormonal protections, the woman was considered to be practically immune to coronary artery disease until well after the change of life. This assumption likely affects how physicians regard the threat of a heart attack in their female patients. It also often prevents women from being appropriately screened for risk factors for heart disease before they reach menopause or have a heart attack.

For decades, virtually no scientific research addressed the specific manifestations of heart diseases in women. This phenomenon led to powerful regulations from the National Institutes of Health requiring enhanced enrollment of female subjects in heart research. In recent years, study after study has shown that heart disease eludes detection in women, even in the hands of otherwise superbly trained and widely experienced physicians. Furthermore, once heart disease is diagnosed, aggressive treatment and secondary preventive therapies in women are often less optimal as compared with those for men.

The concept that women are immune to heart disease is, simply put, a fallacy. After menopause, women catch up very quickly to men in the prevalence of coronary artery disease. Equally important, in women younger than fifty who do suffer a heart attack, the statistics are frightening: these women are twice as likely to die during their hospitalization for the heart attack as compared with men. Consider the following sobering facts:

MYTH: Breast cancer is the number one killer of women.
FACT: Cardiovascular disease kills the most women. While breast cancer claims 42,000 women in the United States each year, cardiovascular disease accounts for the deaths of 500,000 women in the United States annually. In fact, three times as many women die of heart disease each year as from all cancers combined. Virtually half of all female deaths are caused by heart disease.

MYTH: Only men are affected by heart attacks.
FACT: More women than men die of heart attacks each year. This has been true since 1984. Currently, women represent nearly 55 percent of all deaths from cardiovascular disease.

MYTH: Women and men have the same symptoms during a heart attack.
FACT: Women are often delayed in seeking or receiving care for heart attacks. The symptoms of heart attack may be different in women than in men. Men more often experience the classic chest pain and pressure, while in women, the symptoms may manifest themselves only as gastrointestinal discomfort/pain, shortness of breath, shoulder/ arm/upper back discomfort/pain, nausea, jaw pain, extreme fatigue, dizziness, or any combination of these. The woman herself or the treating physician may fail to recognize the symptoms and to reach the correct diagnosis.

MYTH: Only postmenopausal women are at risk for heart disease or have heart attacks.
FACT: Generally, women are protected from coronary artery disease until menopause. However, this is not absolute. Before the change of life, vascular disease is held in check by the woman’s hormones as well as a low likelihood of cardiac risk factors. The occurrence of heart disease in younger women is usually related to the presence of very strong risk factors such as a family history of heart disease, tobacco use, diabetes mellitus, or markedly abnormal cholesterol levels. Unfortunately, with the increasing incidence of obesity, smoking, inactivity, hypertension, and diabetes in teenagers and young women, we may see heart disease at increasingly younger ages in the future.

MYTH: Men are more likely than woman to die from a heart attack.
FACT: Men are at higher risk for all types of heart problems, compared with women. Although we tend to think of heart disease as a male phenomenon, certain cardiac illnesses actually occur more commonly in women. Among those ca
rdiac diseases are mitral valve prolapse, rheumatic fever, and ulcers of the aorta (the main artery of the body).

MYTH: The accuracy of diagnostic testing for heart disease is equal in men and women
FACT: Some noninvasive testing for heart disease can often lead to false positive results in women (that is, the test result suggests that heart disease is present when it is not). For example, in one of the most useful diagnostic tests for coronary artery disease—the nuclear stress test—the images can be misleading for one simple reason: the shadow of the left breast obscures the camera’s view of the heart’s shadow.

MYTH: Men are more likely than woman to die from a heart attack.
FACT: Heart attacks are more lethal in women than in men up to the age of seventy-five, when the death rates become equal. Younger women have a particularly high risk for death from a heart attack, compared with younger men.

MYTH: A woman who has not had a heart attack is not at risk for developing heart failure.
FACT: Almost 63 percent of deaths from heart failure occur in women. Untreated high blood pressure places a woman at a greater risk to develop heart failure compared with a man—even if she has never had a heart attack.

For all these reasons, it is imperative that women be well informed about recognition and treatment of heart illness.
Excerpted from The Woman’s Heart: An Owner’s Guide by John A. Elefteriades, MD, and Teresa Caulin-Glaser, MD (Amherst, NY: Prometheus Books, 2008). Copyright ©2008 by John A. Elefteriades and Teresa Caulin-Glaser. All rights reserved. Used by permission of the publisher.

John A. Elefteriades, MD is chief of cardiothoracic surgery and professor of surgery at Yale University School of Medicine and Yale New Haven Hospital and co-author of Your Heart: An Owner’s Guide and House Officer Guide to ICU Care.
Teresa Caulin-Glaser, MD, FACC is Director of Preventive Cardiology and Research at the McConnell Heart Health Center, Riverside Methodist Hospital, a clinical associate professor of Internal Medicine at Ohio State University and co-author of four medical textbooks and numerous journal articles.
Check out The Woman’s Heart: An Owner’s Guide

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