The Facts and Figures
Often we think of heart disease as a man’s disease but this is not true…
HEART DISEASE IS AN EQUAL OPPORTUNITY KILLER!
In Northern Ireland two-fifths of deaths from heart disease are women, not men. In some towns it is actually a 50:50 split.
Since 1990 the number of women dying from heart disease in Northern Ireland has halved.
Heart disease is the number one killer of women in Northern Ireland today.
Heart disease kills almost three times as many women in Northern Ireland as breast cancer.
Heart disease is also the highest ranked disease on the disability adjusted life years (DALY) scale. In other words, heart disease not only shortens your life, it also shortens the number of healthy years you have.
On this page we want to look at the differences in heart disease between men and women, and find out more about the symptoms that women experience. You may be surprised…
A heart attack is when the blood supply to the heart is cut off. Without oxygen, the heart muscles may begin to die. Most heart attacks happen when fatty deposits from inside the artery walls break away and trigger the formation of a blood clot.
If a large portion of the heart is damaged in this way, the heart stops beating (known as a cardiac arrest), resulting in death.
Click here to find out more information about heart conditions.
Signs and Symptoms of a Heart Attack
When we think of a heart attack, we imagine a man, usually in late middle age, probably overweight, experiencing the “classic” sudden and severe chest pains, in other words, the “Hollywood heart attack”.
However research1 tells us that only one third of people who have a heart attack experienced the fast-onset “Hollywood heart attack” symptoms.
Symptoms can be categorised as fast-onset or slow-onset.
Fast-onset symptoms come on suddenly and are continuous and severe. They are usually the classic chest pains, but can be accompanied by other symptoms. Only one third of people experience these and there is no difference between men and women.
Slow-onset symptoms start gradually, and at first are intermittent and mild, but often become continuous and more intense in the hours, days and weeks leading up to the heart attack. For the majority of people (two-thirds) their only symptoms were the milder, intermittent slow-onset symptoms.
What are these slow-onset symptoms women should look out for?
In an international study2 of 1000 patients – 368 women and 777 men – all under the age of 55, researchers found that women were more likely than men to experience slow-onset symptoms in the period of time leading up to their heart attack. 85% of women said they had felt these symptoms compared to 72% of men.
Women also experienced a greater variety of symptoms, on average six different symptoms compared to men’s four.
It is important to remember that it is the overall pattern of symptoms that helps to determine whether you are having a heart attack.
STOP is an acronym for:
S – Something’s not right – symptoms can start slowly
T – Tightness or pain in the chest, pain in the arm, neck or jaw
O – Other symptoms such as shortness of breath, nausea or sweating
P – Phone 999 immediately – the ambulance crew will do an ECG.
What women say…
“I had terrible chest pains. The pains were so bad that I could hardly walk. I was also short of breath and sweating. I knew I was having a heart attack. No doubt at all. I knew I should be calling an ambulance. But I needed to pick up my grand–daughter from school so waited until she was safe before calling for help.” – Joyce
“I never thought for a minute I would have a heart attack. It resulted from a series of events that occurred during and after labour. I had a sharp pain in my left shoulder blade. Within minutes I had broken out into a thick clammy sweat. The pain continued down my left arm and I felt nauseous.” – Sinead
“Mammy had been running around getting everything prepared for my wedding. Despite feeling very unwell, she ignored it. She did not want to bother anyone. She didn’t want to spoil my day. By the time the wedding was over and she was going to bed, she had pains in her arm and chest but just took a painkiller and went to sleep. It was the Monday when she went to the doctor and they told her she’d had a heart attack.” – Hazel
Heart failure is when your heart cannot pump your blood around your body as it should. Whilst heart disease in general has been decreasing, heart failure has been rising.
Traditionally heart failure is associated with damaged to the heart muscle, usually after a heart attack or a heart virus. However, in recent years another type of heart failure has been recognised, which mainly affects women over 65, called Heart Failure with Preserved Ejection Fraction (HFpEF).
In fact amongst women over 65, more have HFpEF than “traditional” heart failure.
With “traditional” heart failure, patients have a reduced ejection fraction. Ejection fraction is the percentage of blood that is pumped out of the ventricles with each contraction. It’s a measure of the pumping efficiency of the heart.
However, in HFpEF, the ejection fraction is normal (preserved) but yet the patient still has other symptoms of heart failure, such as breathlessness. Instead of damage to the heart muscle, patients have stiffness in the left ventricle which means it cannot expand and so does not fill up with blood properly.
Having high blood pressure, especially a high diastolic reading (the bottom number), increases your risk of HFpEF, as do Atrial Fibrillation (AF) and getting older. But being a women also increases your chances.
Takotsubo Cardiomyopathy is also known as Broken Heart Syndrome. It affects more women than men but is very rare.
It is brought on by a severe shock, like the death of a loved one or a break-up.
It is a sudden, temporary weakness in the heart muscle. The front part of the heart stops moving and the left ventricle actually changes shape. It becomes the same shape as a Japanese octopus trap, which is what it is named after.
The patient becomes very sick, very quickly, but if they recover from this acute phase, their prognosis is very good.
Prevention is better than a cure! So it makes much more sense to make healthy choices that reduce your chances of developing heart disease.
There are some risk factors for heart disease that you can’t control:
Family history: if your siblings or parents had a heart attack at an early age (under 55 for men or under 65 for women), your own chances will be higher.
Age: the risk of heart attack increases with age.
Gender: the risk of heart attack increases with age, for both men and women.
Ethnic origin: people with an Afro–Caribbean or South–east Asian background have an increased risk of heart attack.
Medical history: If you have already have angina you have a greater chance of having a heart attack.
Genes: There are genetic conditions which makes your blood more likely to clot, or affect your blood pressure or cholesterol levels.
There are also risk factors you can control.
To reduce your risk of a heart attack:
Watch your weight
Keep physically active
Eat a balanced diet
Moderate your alcohol intake
Manage your stress levels
Get enough sleep
- Slow-onset and Fast-onset Symptom Presentations in Acute Coronary Syndrome (ACS): New Perspectives on Pre-hospital Delay in Patients with ACS.
Sharon O’Donnell, BNS, MA, PHD, Gabrielle McKee, BA, PHD, Mary Mooney, MSC, Frances O’Brien, MSC and Debra K Moser, DNSC, RN, FAAN.
The Journal of Emergency Medicine, Vol 46, No 4, pp 507-515, 2014.
- Sex Differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger
Nadia A Khan, Stella S Daskalopoulou, Igor Karp, Mark J Eisenberg, Roxanne Pelletier, Meytal Avgil Tsadok, Kaberi Dasgupta, Colleen M Norris, Louise Pilote for the GENESIS PRAXY team.
First published on December 13 2-16 as 10.1136/heartjnl-2016-309945.