FEATURE HEART HEALTH WOMEN AND HEART DISEASE The differences in symptom presentation and heart physiology between men and women with ischemic heart disease BY DR. WHITNEY BAXTER, ND C ardiovascular disease (CVD) remains the leading cause of morbid-ity and mortality in North America.(1) Five times as many women die from heart disease as they do from breast cancer. However, women are often unaware of their risks and how CVD can differ from men in both symptom presentation and location of disease in the heart vessels. Women are also under-represented in the re-search that is used for the development of diagnostic and clinical management guidelines.(2) These factors have led to delays in obtaining accurate diagnosis and appropriate evidence-based clinical management for women presenting with symptoms of ischemic heart disease. breath and/or heart palpitations. Though women often do present with chest pain, many women describe this experience differently than these classic symptoms, such as dullness, discomfort or burning, rather than overt pain. Women can also present with symptoms that may seem vague and don’t neces-sarily point to a cardiovascular origin.(1) Women’s symptoms of an MI can include:(1) • Extreme fatigue • Shortness of breath with, or with without, chest pain • Light-headedness • Cold-sweats • Nausea and vomiting • Indigestion and/or heartburn SIGNS AND SYMPTOMS OF A HEART ATTACK IN WOMEN WHY DO THESE SYMPTOMS PRESENT SO DIFFERENTLY? Many of us are aware of the signs and symptoms of a heart attack (also known as a myocardial infarction or MI). These include chest pain (described as squeez-ing pressure or heaviness) that can radi-ate to the jaw, arms, abdomen or back. Symptoms can also include shortness of The heart muscle requires a continuous supply of oxygenated blood via the cor-onary arteries. Ischemic heart disease (IHD) occurs when there is inadequate blood flow to the heart either from plaque obstruction in the coronary ar-teries (atherosclerosis), spontaneous plaque rupture, or other causes of mi-crovascular dysfunction.(3) Women have DR. WHITNEY BAXTER is a naturopathic doctor in Victoria, BC. Prior to becoming a naturopathic doctor, she worked as an exercise physiologist in cardiac rehab. It was here that she witnessed the value of a holistic approach to health care and understood that each individual’s physical, mental, and emotional health are interconnected. She has a general practice and enjoys working with mental wellness, digestive health and cardiovascular disease management and prevention. 16 Chiropractic and Naturopathic Doctor January/February 2021 less anatomical obstructive coronary artery disease (CAD) than men, and more often present with other causes of IHD. Historically, heart disease was synon-ymous with obstructive CAD. This in-volves a build-up of plaque in the coro-naries, which can, over time, lead to ischemia and/or a complete obstruction of blood flow causing a MI. However, recent evidence has shown that this obstructive CAD is less com-mon than other forms of ischemic heart disease and more than half of women with ischemia presented with no ob-structive CAD. (4,5) Women are more likely to have disease in the smaller ves-sels of the heart (6) (microvasculature) that branch out from the main coronar-ies. This different physiology can present instead as plaque erosion, coronary microvascular dysfunction, coronary vasopasm, microbemboli, or spontane-ous coronary artery dissection (SCAD; 90 percent of all SCAD cases are women).(7) These differences pose challenges in obtaining the correct choice of imaging and diagnostic studies for an accurate diagnosis and origin of ischemic disease. Another physiological difference be-tween men and women is the hormonal changes throughout life during preg-nancy and/or menopause. Due to estro-gen’s cardiovascular-protective effects, the decline in estrogen during www.Cndoctor.ca
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