Heart health for women: What makes every woman's heart different

Heart health for women requires special medical attention, as women's hearts age differently, become diseased differently and often show different symptoms than men's hearts.¹ Although cardiovascular disease is the number one cause of death in women, it is still often misjudged as a typical „male problem“. In the practice of Dr. Raphael Bruno, we dedicate ourselves to Heart health for women with the necessary differentiation and expertise. We are aware of the biological peculiarities and apply this knowledge to offer you precise, personalized and gender-sensitive cardiology.

The female heart: biological and hormonal characteristics

The differences in the Heart health for women start with biology. On average, women's hearts are smaller and lighter than men's hearts. The coronary arteries are also often finer and tend to develop different patterns of disease. The decisive factor, however, is the hormonal influence, particularly oestrogen.

• Before the menopause: Oestrogen has a natural protective function for the heart and blood vessels. It keeps the blood vessel walls elastic, has a positive effect on cholesterol levels and has anti-inflammatory effects.
• After the menopause: As oestrogen levels fall, this protection no longer applies. The risk of high blood pressure, high cholesterol levels and heart attacks increases rapidly in women.

These biological conditions are the reason why „one-size-fits-all“ medicine is not sufficient in cardiology.

Heart health for women: The „atypical“ heart attack

Probably the most important lesson in the Heart health for women is to recognize the symptoms of a heart attack, which may differ from the „classic“ textbook symptoms.² While the sudden, devastating chest pain can also occur in women, they often experience other, so-called „atypical“ symptoms.³ Unfortunately, these are often misinterpreted, which leads to a life-threatening delay in treatment.

Atypical warning signs in women:

• A strong but often unclear feeling of pressure or tightness in the chest, back or upper abdomen.
• Severe shortness of breath that is disproportionate to the exertion.
• Nausea, vomiting and stomach pain.⁴
• Inexplicable, extreme tiredness and weakness.
• Pain that radiates into the jaw, neck or between the shoulder blades.⁵

Every woman should be aware of these symptoms and call 112 immediately if they occur suddenly and severely.

Specific heart diseases in women: SCAD and Takotsubo

In addition to the different presentation of known diseases, there are also clinical pictures that almost exclusively or predominantly affect women.⁶ Knowledge of these specific diseases is a core aspect of modern Heart health for women.

• Spontaneous coronary artery dissection (SCAD): This causes a spontaneous rupture of the wall of a coronary artery, which leads to a heart attack. SCAD is one of the most common causes of heart attacks in younger women (< 50 years), particularly in connection with pregnancy or severe emotional stress.⁷ The vessels are often free of arteriosclerosis.
• Takotsubo cardiomyopathy („broken heart syndrome“): This is an acute dysfunction of the heart muscle that is triggered by extreme emotional or physical stress and affects over 90% post-menopausal women.⁸ The symptoms are similar to a heart attack, but the coronary arteries are unremarkable. The prognosis is usually good, but requires acute medical treatment.
• Microvascular angina: Women suffer more frequently from circulatory disorders of the smallest blood vessels in the heart. These cause typical chest pain (angina pectoris), but are not visible in a normal cardiac catheterization, which often leads to a misdiagnosis.

Breast pain in women - Possible causes

Risk factors in the focus of heart health for women

In addition to the classic risk factors (smoking, high blood pressure, cholesterol, diabetes), there are other factors that are responsible for the Heart health for women have a special or exclusive meaning.

• Pregnancy complications: High blood pressure, pre-eclampsia or diabetes during pregnancy are strong predictors of future cardiovascular disease.⁹
• Autoimmune diseases: Diseases such as rheumatoid arthritis or lupus, which affect women much more frequently, are associated with chronic inflammation, which accelerates arteriosclerosis.
• Depression and stress: Women often react more sensitively to chronic psychosocial stress, which is a risk factor for the heart in its own right.

Heart health for women: What you can do yourself

The good news is that you can have a huge impact on your heart health through your lifestyle. The Heart health for women is largely in your own hands.

• Know your numbers: Have your blood pressure, cholesterol and blood sugar checked regularly from the age of 40, or earlier if you are at risk.
• Get moving: A combination of endurance sports (3-5x/week) and strength training (2x/week) is ideal.
• Eat a Mediterranean diet: Lots of vegetables, fruit, healthy fats and fish, little red meat and sugar.
• Do not smoke: Quitting smoking is the single most effective measure.
• Pay attention to your soul: Learn stress management techniques and make sure you get enough sleep.

Frequently asked questions about heart health for women

Here we answer frequently asked questions from patients in our practice.

What is microvascular dysfunction?

This is a functional disorder of the smallest arteries in the heart. These vessels are responsible for the fine regulation of blood flow. If they are dysfunctional, they cannot dilate properly, which leads to an undersupply of oxygen and chest pain, even though the large coronary arteries are clear. This condition affects women disproportionately often and is an important aspect of Heart health for women.

Will I be heart-damaged forever after a „broken heart syndrome“?

In the vast majority of cases, the heart muscle recovers completely within weeks to months after a Takotsubo cardiomyopathy.¹⁰ However, it is a serious acute event that requires careful cardiologic monitoring and follow-up to ensure full recovery and rule out possible rare complications.

How dangerous is a spontaneous coronary artery dissection (SCAD)?

A SCAD is an acute heart attack and therefore a life-threatening event that requires immediate emergency medical treatment. However, the long-term prognosis after a healed SCAD is often better than for a heart attack caused by arteriosclerosis, as the remaining vessels are usually healthy. Follow-up care with a specialist for Heart health for women is crucial here.

Does the thyroid gland play a special role for my heart?

Yes, thyroid disorders are significantly more common in women than in men. Both hyperthyroidism and hypothyroidism can have significant effects on the heart, e.g. palpitations, atrial fibrillation or worsening heart failure. Checking thyroid levels is therefore often part of the cardiological work-up.

Why does my blood pressure rise during the menopause?

The drop in oestrogen after the menopause causes the blood vessels to lose elasticity and become stiffer. This leads to an increase in blood pressure in many women.¹¹ Regular monitoring and, if necessary, the timely initiation of therapy is a central component of Heart health for women in this phase of life.

Is hormone replacement therapy good or bad for my heart?

This question is complex. Hormone replacement therapy is no longer primarily recommended for heart prevention. However, it can significantly improve the quality of life of women with severe menopausal symptoms.¹² The decision must be made individually after carefully weighing up the benefits and risks together with the gynecologist and cardiologist.

I have migraines with aura. Is this a risk for my heart?

Yes, women with migraine with aura have a slightly increased risk of stroke. This risk is significantly increased by taking the pill and, in particular, by smoking. Comprehensive advice on risk factors is particularly important for these patients.

My stress test was normal, but I still have chest pain. What should I do now?

This is a classic situation in which the special features of the Heart health for women come into play. A normal exercise ECG does not rule out microvascular angina. Further, specialized examinations or a very precise drug test therapy by an experienced cardiologist are often necessary here.

Why should I go to a cardiologist who knows about gender medicine?

Because he takes your „atypical“ symptoms seriously, knows the specific female risk factors and interprets the examination results in a gender-specific context. This increases the chance of a correct and timely diagnosis and an effective treatment tailored to you.

Is stress more dangerous for women's hearts than for men's hearts?

Studies suggest that women can react to psychological stress with stronger physical reactions of the cardiovascular system. Diseases such as „broken heart syndrome“ clearly show how close the connection between the psyche and the heart can be in women. Stress management is therefore a particularly important aspect of Heart health for women.

Your heart is unique - protect it specifically

The Heart health for women requires sophisticated knowledge and special medical attention. Take your health into your own hands by listening to your body's signals and seeking advice from a specialist who understands your needs. Make an appointment to discuss your personal preventive care strategy.