Women’s heart symptoms can look different, expert warns

A doctor can be seen pictured here with a stethoscope and a heart. (Pexels)

Heart disease remains the leading cause of death for women worldwide, yet it is still widely under-recognized, underdiagnosed and undertreated, according to one health expert.

“Wear Red Day,” which in Canada is recognized on Feb. 13 — being recognized Feb. 13, urges Canadians to learn the warning signs and understand the risks women face when it comes to heart health.

“We’re learning more and more each day about how heart disease uniquely affects women,” nurse practitioner and researcher Rachel Ollivier said in an interview with CTV Your Morning Thursday.

She noted those risks include conditions such as polycystic ovary syndrome (PCOS), a common condition that affects hormones and causes irregular menstrual periods. They can also include pregnancy complications like preeclampsia and gestational diabetes, as well as hormonal changes later in life.

Ollivier added that many women are still unaware of their risk, making education critical.

“We’re trying to raise awareness about what some of those symptoms of heart disease might be, and how to get screened,” she said.

According to the World Health Organization, cardiovascular disease accounts for roughly one in three deaths among women globally.

In Canada, similar trends persist. The Heart and Stroke Foundation reports that both heart disease and stroke are leading causes of death among Canadian women, and that women are less likely than men to receive timely diagnosis or treatment.

Symptoms can look different

While chest pain remains the most common symptom in both men and women, Ollivier noted that women often experience less typical warning signs.

“For women, they often, uniquely, experience chest pain that seems like more of a discomfort or a tightness in the chest,” she said. “They can sometimes experience left arm pain or jaw pain, severe fatigue, pain between the shoulder blades, or nausea and vomiting, as well.”

According to the University of Ottawa Heart Institute, because symptoms in women can be less specific, they can be harder to recognize as danger signs.

Ollivier said social factors also play a role.

“Women are often juggling multiple roles within their household and workplace, and sometimes these things get brushed off,” she said. ”That can happen within (a) health-care setting, as well.”

The Heart Institute’s website also said that women typically have higher heart rates, smaller hearts and arteries than men, as well as less buildup of plaque in those arteries, adding that the plaque behaves differently in women than in men.

“While male hormones enlarge arteries, female hormones make them smaller, making women’s arteries more prone to blood clots or blockages and more difficult to repair,” it added.

“We often see conditions such as spontaneous coronary artery dissection or microvascular dysfunction as being more common in women,” Ollivier said.

Menopause and risking risk

According to Ollivier, the risk also increases significantly between the ages of 40 to 60.

“Endogenous estrogen ... is cardio-protective,” she said. “As women enter the perimenopausal transition, that estrogen fluctuates and gradually declines, and that protection is lost.”

This shift can lead to higher cholesterol levels and changes in fat distribution, both of which increase cardiovascular risk, Ollivier explained.

She added that improving awareness among both patients and clinicians is key to reducing deaths.

“A lot of advocacy is around educating women and the general public about heart disease in women.”