By Erika Edwards—
NBC News
Symptoms of heart disease — the nation's leading cause of death — can be more subtle and varied in women than men, according to a review published Thursday in the journal
Circulation.
of the American Heart Association.
Understanding the differences in symptoms is especially important for women.
Corrine Jurgens, an author of the review and an associate professor at Boston College's Connell School of Nursing, said
women tend to be diagnosed with heart disease later than men,
when they may have other underlying conditions that could make identification of the subtle symptoms of heart disease much more difficult.
What's more, according to a 2020 report, also published in
Circulation
, there's a 10-year difference in awareness among women that
heart disease is actually their biggest health threat.
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"Many women are concerned about their risk of breast cancer, and perceive it as their greatest health threat," said Dr. Deirdre Mattina, a cardiologist at the Cleveland Clinic.
But
"we know that one in three women is going to die of heart disease"
each year, she added.
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For both women and men, signs of heart problems rarely occur in isolation.
"Symptoms tend to come in clusters," Jurgens noted, "it's very rare that someone comes in with just one symptom."
And while sudden cardiac events—heart attack or stroke, for example—certainly come on without warning, many symptoms worsen over time.
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Mattina noted that patients with heart failure, for example, may report that they are no longer able to walk as much as they used to, or a gradual decline in the ability to breathe fully.
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"We look for a pattern," Mattina said.
These are the most common forms of six different cardiovascular conditions that occur in patients.
1) Heart attack
A heart attack occurs when blood flow to the heart muscle is cut off or severely reduced.
Chest pain is the classic symptom, but other symptoms associated with heart attacks can be much more subtle, such as pressure or tightness in the chest that can sometimes radiate to the jaw, arms, and back.
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Men are about twice as likely as women to have a heart attack.
But women tend to have more symptoms than men that accompany a heart attack, such as
nausea, lightheadedness, extreme fatigue and cold sweats.
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Younger women, generally younger than 55, typically experience at least three symptoms during a heart attack.
These may be
pain in the jaw, neck, arms, or shoulders, palpitations in the chest, or heartburn.
2) stroke
A stroke occurs when blood flow to the brain is cut off or drastically reduced.
Signs of a stroke are drooping of the face, weakness of the arms, slurred speech, confusion and dizziness.
Immediate medical attention is necessary when a person suffers a stroke.
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According to the review, women tend to experience additional symptoms, such as headache, and more severe altered mental status.
It is essential that patients follow up with their doctors after a stroke, as it can affect cognitive function.
This can make it difficult for patients to identify any new symptoms.
3) Heart failure
Shortness
of breath
is the most common symptom associated with heart failure, which occurs when the heart doesn't pump blood as well as it should.
It often occurs after someone has a heart attack.
Jurgens says that heart failure symptoms can slowly build up over the course of up to three weeks before people realize they have a problem that requires urgent medical attention.
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Symptoms can include
upset stomach, vomiting, loss of appetite, fatigue, mood swings, and memory problems.
Women with heart failure have a greater range of symptoms, including sweating, unusual swelling, palpitations, and a heartburn sensation.
These symptoms, according to the review, are often accompanied by depression and anxiety.
Depression tends to be more common in people with heart failure and other cardiovascular diseases.
According to the review,
10% of people with heart disease suffer from depression,
compared to 5% of those without heart problems.
This can make it difficult for patients to know whether symptoms—fatigue, for example—are due to depression, heart disease, or both.
4) Heart valve disease
Heart valve disease occurs when one or more heart valves do not work properly.
Like heart failure, shortness of breath often manifests itself.
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This can lead to a complication called aortic stenosis, which occurs when the valve that allows blood to flow from the heart to the rest of the body narrows, restricting that blood flow.
While men are more likely to experience chest pain with valve disease, women tend to report more trouble catching their breath and exercising.
5) Abnormal heart rhythm
An arrhythmia, or irregular heartbeat, occurs when the heart's electrical signals fail, causing the heart to beat too fast or too slow.
The problem is often perceived as fluttering in the chest, especially in women.
Men do not usually experience any symptoms of irregular heartbeat.
But sometimes an arrhythmia can be accompanied by fatigue, chest pain, shortness of breath, and dizziness.
Black Americans are the most likely to manifest these symptoms.
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6) Peripheral vascular disease
Legs are not to be ignored when it comes to heart disease risks and their accompanying symptoms.
Peripheral vascular disease can lead to amputation and increase the risk of heart attack and stroke.
There are two types: peripheral arterial disease and peripheral venous disease.
Peripheral venous disease affects blood flow from the legs to the heart and can lead to blood clots and deep vein thrombosis.
Peripheral arterial disease occurs when cholesterol builds up in the arteries that carry blood to the extremities, usually the legs.
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In the case of peripheral artery disease,
"one of the main symptoms is difficulty walking
," explains Dr. Amy Pollak, a cardiologist at the Mayo Clinic.
Although there may be pain in the legs and feet, many patients report leg fatigue and sometimes heaviness or discomfort in the legs, she added.
It's "a symptom that many patients attribute to something else," Pollak said, "thinking it's arthritis, neuropathy, or aging."
In fact, women may also have accompanying conditions, such as osteoarthritis, that could mirror or mask the symptoms of peripheral artery disease.
Figuring out the cause of that leg pain or discomfort is key, Pollak stressed, because "it can be a really important clue to that great arterial tree that runs through our body, connecting our heart, brain and legs."
