At the beginning of the 21st century, cardiovascular diseases have become one of the main causes of death in women. At the same time, doctors pay little attention to gender differences, and approaches to therapy are historically focused on men. Professor Angela Maas in the book “Women’s Heart” tells what is the difference and how women take care of their health. We chose a few facts from the novelty.
Due to stress: 9 facts about the female heart
Women’s heart beats faster
At rest, the heart rate (HR) in an adult male ranges from 60 to 80 beats per minute, or 100,000 beats per day. For professional athletes, this figure is significantly less (for example, 45 beats per minute).
However, in an ordinary person, physical activity, fear, or emotional stress accelerates the heart rate to 200 beats per minute. Unlike men, women’s heart beats more often – 3-5 beats per minute more. It is generally accepted that a normal resting heart rate should be below 70 beats per minute in men and below 80 in women.
And it’s also less
The mass of the heart of a healthy man is approximately 330 g, women – 250 g. The right and left coronary arteries to depart from this organ (1–3 min diameter), which are further divided into countless almost invisible small branches.
It is these arteries that must supply the myocardium with a sufficient amount of oxygen necessary for the efficient contraction of the heart. Coronary arteries are also smaller in women, which can make a percutaneous intervention or stent placement more difficult.
In addition, it is important to take into account the mass of the myocardium, and hence the pumping function of the heart, during its transplantation. Among men who received an organ transplant from a female donor (that is, a smaller one), mortality is higher than among those who received a heart from a man. But for women, the size of the transplanted heart is unimportant, it can be larger.
The accuracy of ECG results in women is lower
The electrical impulse that provides the contraction of the heart comes from the so-called sinus node, which is located in the wall of the right atrium. Record impulses using ECG – a method that was originally developed based on the average slender adult male.
Whose chest is different from the female. Not only does its size vary significantly, but women with large breasts also have to place the electrodes too low, which reduces the accuracy of the ECG results.
Since in most cases male standards are taken into account, in many women the cardiogram shows a deviation from the norm in cases where there is no pathology. These features are characteristic of most ECG parameters.
Pregnancy is a “stress test” for cardiovascular illness
The heart of a pregnant woman must pump more blood in order to adequately supply oxygen to the growing fetus and placenta. In the circulatory system of the future mother, changes occur quite early: already after eight weeks of pregnancy, the contractile function of the heart increases by 20%.
During the first and second trimesters, blood pressure decreases (partly because the resistance of most blood vessels decreases). The heart rate increases by 10-20 beats per minute, and the myocardium thickens and contracts more intensely. During pregnancy, the heart has to work with a vengeance.
Often during pregnancy, heart disease that existed long before is detected. In particular, shortness of breath and arrhythmia may occur due to previously undiagnosed mitral valve stenosis.
Women with congenital or acquired heart defects during pregnancy should be observed by a cardiologist with experience in managing such patients, and they are recommended to give birth in a hospital. This reduces the likelihood of severe complications in mother and child.
For women at increased risk of CVD, pregnancy can be seen as a kind of “stress test” for the cardiovascular system. Problems can manifest as recurrent miscarriages, high blood pressure, diabetes mellitus, or even HELLP syndrome (which includes hemolysis, elevated liver enzymes, and thrombocytopenia). These and other risk factors
The closer the menopause, the more tangible the effects of an aging heart
In women after menopause, vascular stiffness increases more sharply than in men of a similar age. This is especially true for the small arteries of the heart (the vasculature that provides the heart with oxygen). In other words, during menopause, the level of hormones decreases, due to which the vessels become stiffer, and then the general condition worsens.
The less estrogen, the less it relaxes the walls of small vessels. This means that the load on them increases and medium-sized arteries age faster. The first symptoms are usually shortness of breath and increased heart rate with sudden exertion, such as brisk walking or climbing stairs. Sometimes there is a feeling of suffocation, which is accompanied by palpitations and a feeling of squeezing behind the sternum.
Smoking brings menopause closer and increases the risk of myocardial infarction
In recent decades, women have begun to smoke as much as men. This addiction is characteristic of approximately 20% of the population, which is reflected in mortality from lung cancer. The harm of smoking is more and more noticeable in women with this disease.
In addition, their arteries age earlier: more than two-thirds of myocardial infarctions in women under 55 are due to smoking. The same applies to transient cerebrovascular accidents (TIMC – a type of stroke, after which recovery is possible) and vascular disorders of the lower extremities.
Among young women, the situation is even worse: compared to men, a myocardial infarction occurs twice as often due to smoking. Because of tobacco, signs of atherosclerosis appear earlier, including in women who have not yet reached menopause: in the body, the inflammatory response is stimulated and the blood coagulation system is activated.
In such women, menopause occurs on average two years earlier, and for this reason, the risk of vascular disorders at a young age increases. Passive smoking is no less dangerous: living with a smoking partner for more than 30 years increases the risk of myocardial infarction by 40%.
Diseases from stress
Emotional stress leads to an increase in heart rate and activates the hormonal system in the adrenal glands, as well as the coagulation and immune systems. Such stress can be chronic. Unexpected tragic events lead to it, for example, the loss of a child or the illness of a life partner.
It can be associated with an overabundance of domestic problems and household chores, and with a difficult divorce, an excessive workload, etc. Each of us faces stress every day. Men and women react differently to emotional shocks and psychosocial problems, which means different effects on the corresponding CVD. In recent years, we have increasingly observed special forms of myocardial damage in women, provoked primarily by emotional stress.
Arterial hypertension is extremely dangerous
Arterial hypertension in men is milder and more treatable than in women. This can be explained both by the frequency of stress and by the fact that women themselves admit that their too active life leads to hypertension. In addition, some are reluctant to take medications.
Indeed, women sometimes do not realize what long-term consequences the lack of therapy or its too late start can lead to heart failure due to cardiac hypertrophy, arrhythmia, myocardial infarction, stroke, kidney disease, and decline in physical performance. Some patients, accustomed to living with high blood pressure, require significant efforts to return to their normal level. Sometimes it takes weeks before they start feeling better again – some just get tired of waiting for relief and stop taking the drugs.
Myocardial infarction risk comes later
Typically, myocardial infarction in women develops 7-10 years later than in men (usually after 65 years), since before menopause they are at lower risk than their male peers. However, after 70 years, this difference disappears.
In young men, blood pressure and cholesterol levels are often elevated, and for women, on the contrary, such manifestations are characteristic after menopause: with age, they are more prone to an increase in blood pressure and cholesterol, as well as to the development of diabetes mellitus.
In any case, prevention should start at a young age, and young women and representatives of national minorities require the most careful attention.