8. Why are women at a higher risk of complications and death after a heart attack in comparison to men?

Historically, a woman having a heart attack in this country will wait longer before presenting to the emergency room, will be less likely to have the classic symptoms of chest pain, will be less likely to have a diagnostic electrocardiogram, and will be less likely to receive a correct diagnosis. Even if the diagnosis is correct, a woman will be less likely to receive all the evidence-based therapies to appropriately treat the underlying heart attack. These significant delays in diagnosis and treatment lead to increased morbidity and mortality in women in comparison to men.

9. Is a heart attack in women always caused by underlying coronary artery disease?

About 10 percent  to 15 percent of women who experience a heart attack have no obvious blockages seen on cardiac catheterization. This is a substantially higher percentage than in men. This is because women are much more likely to develop certain conditions (see below) and it is important to recognize these conditions because early diagnosis is vital.

1. Coronary vasospasm which is a temporary tightening of the muscle wall of the coronary arteries and if the spasm lasts long enough it can lead to angina or even a heart attack.
2. Spontaneous coronary artery dissection (SCAD) is an uncommon occurrence that develops when a tear forms in one of the main coronary arteries or the smaller branches. This dissection can disrupt blood flow to the heart causing a heart attack or sudden death. It most commonly occurs in healthy women in the 40s and this condition needs to be diagnosed and treated quickly. It is rare that these patients have any underlying atherosclerosis.
3. Takotsubo cardiomyopathy or stress induced cardiomyopathy is a syndrome where patients present with chest pain, ECG changes and heart enzyme levels consistent with a heart attack. However, when the patient undergoes coronary angiography there is no significant coronary artery disease. A significant emotional or physical stress typically precedes the development of this condition. Nearly 90 percent of these cases occur in postmenopausal women. The condition is very uncommon in men.

10. What are the non-pharmacologic ways for a woman to prevent the development or progression of coronary artery disease?

There are several controllable ways to reduce your risk for heart disease.

1. Don’t smoke – Your chance of a heart attack doubles if you smoke one or more cigarettes a day!
2. Be active – Get at least 30 minutes per day of moderate exercise. Avoid inactivity and take the stairs, walk as much as possible and avoid long periods of not moving.
3. Eat a healthy diet – Aim for a heart healthy diet of whole grains, fruits and vegetables, and poly and monounsaturated fats. Limit the intake of salt, sugar and trans fats.
4. Reduce stress – Address, combat and reduce stress in your life.
5. “Know your numbers” – Maintain weight, cholesterol and blood pressure at appropriate levels
6. Visit your doctor – Discuss your cardiac risk with your doctor and the appropriateness of certain testing such as a calcium score and CT scans of the heart, stress testing, other imaging modalities and additional laboratory testing.