Remember: heart problems in women

Women often underestimate their risk of heart disease. This is particularly fatal with a heart attack. Prevention is therefore particularly important. What women should watch out for

It is a mistake that diseases of the heart only affect men. When women go through menopause, their risk of cardiovascular disease also increases

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Heart problems are still considered a man's business. Wrongly. Overall, even more women than men die of heart disease, as the Heart Report 2018 shows. They only develop the diseases later, because women are probably better protected by their hormones, among other things.

After the menopause, however, their risk increases enormously: Cardiovascular diseases are also the number one cause of death in women. Biggest problem: When it comes to life-threatening heart attacks, women often take too long to get the correct diagnosis.

Acting quickly can be vital

"Many deaths could be avoided if those affected, but also relatives and doctors, responded more quickly to symptoms," says Christiane Tiefenbacher, chief physician in cardiology at the Marien Hospital in Wesel.

Women aged 65 and over are considered to be particularly at risk. But for them, of all people, it takes an average of four and a half hours from the onset of the heart attack symptoms to arrival in the emergency room. This is shown by the Medea study by the German Center for Cardiovascular Research. For comparison: for men over 65 it is around three and a half hours, for younger men a good three hours, and for younger women an average of two and a half hours.

"Women often don't get the idea that it could be important to their hearts. They also tend to clench their teeth and say to themselves: It'll be fine," reports Tiefenbacher. But people with risk factors such as high blood pressure, smoking, diabetes, high cholesterol and a family predisposition to heart problems should consider a possible heart attack - and call 112 immediately.

Not always crushing pain

However, many older women live alone and have no one to call the emergency doctor or call the emergency services. Tiefenbacher advises using a home emergency call system.
"You have a button hanging on your arm or around your neck that you can press even if you've passed out and can't get to the phone."

Heart medication - What women should be aware of

  • There are many effective drugs available to treat cardiac problems. A low dose is started to gradually discontinue therapy. The ideal dose is approached with regular blood tests.
  • As a rule, women are recommended the same dose in therapy as men - regardless of the fact that they often take up, metabolize and excrete drugs differently. Because of this, they also have more side effects.
  • For example, women get coughs more often from ACE inhibitors. Some beta blockers make your heart slower. Water tablets (diuretics) are more likely to cause them to have low sodium and potassium levels. In such cases, the doctor must adjust the therapy accordingly.

Typical symptoms of a heart attack are severe chest pain in both sexes - doctors call it annihilation pain. This often radiates: in the arms, in the jaw and neck area, in the upper abdomen and back. In addition, there are often general symptoms: those affected suddenly feel weak and turn pale. You feel sick and sweat. Often there is also shortness of breath. In older age, these complaints are not infrequently in the foreground - while the typical radiating chest pain is absent.

With women, many think it's the psyche

This is more common in women than in men. This is also because "because the coronary artery calcification usually begins 10 to 15 years later," explains cardiologist Birke Schneider, spokeswoman for the gender medicine working group of the German Cardiac Society.

But not only the heart attack is often detected later in women, but also the preliminary stage, coronary artery disease (CHD). The coronary arteries become increasingly narrow and can no longer supply the organ with sufficient blood. In addition to pressure and tightness in the chest, there are sometimes exhaustion and shortness of breath, and occasionally discomfort in the upper abdomen or back.

Healthy heart

Lifestyle is central to a healthy heart. This includes: exercise, losing weight, eating little meat, sugar and salt, but lots of vegetables, healthy vegetable fats, fruit and fish and not smoking.
The main risk factors are:

  • high blood pressure
  • diabetes
  • high LDL cholesterol
  • Smoke
  • older age; Disposition

Christiane Tiefenbacher, chief physician for cardiology at the Marien-Hospital Wesel

© W & B / Dominik Asbach

"When women complain about such unclear complaints, it is often not taken so seriously or blamed on the psyche," says cardiologist Tiefenbacher. Sometimes the family doctor initially suggests completely different causes, such as depression or gallstones.

Examination with a cardiac catheter

Most of the time, symptoms only appear when there is a high level of physical or emotional stress, sometimes when it's cold or after large meals. Then they disappear again. If the symptoms become noticeable in complete calm, this is an even stronger warning signal. Those affected should definitely consult a doctor.

Depending on the patient's risk profile (see box above), targeted examinations are carried out. Indications of circulatory disorders of the heart can be found, for example, in an exercise ECG. However, this is often not as meaningful for women as it is for men, reports Tiefenbacher.

Only an examination with a cardiac catheter can provide clarity. A thin tube is usually inserted through an arm or inguinal artery, advanced to the heart, and the blood flow to the coronary arteries is made visible with the aid of a contrast agent.

The doctor can treat immediately. If he discovers bottlenecks, he can expand them with a balloon and hold them open with a stent. In rare cases the blood flow in the very fine branches of the coronary arteries is disturbed. This cannot be recognized immediately - and is a special feature that, according to cardiologist Schneider, occurs especially in patients. Then further investigation methods have to be used.

Stressed heart

If the coronary arteries are not closed, but the heart still does not pump properly, the underlying cause may be the rare Tako-Tsubo syndrome - a so-called stress heart. Women are more likely than men; the symptoms are similar to those of a heart attack.

"Most of the time, it is preceded by great mental or physical stress," explains Schneider. Experts assume that increased stress hormones released in the process clog the pumping organ. "After menopause, women are probably more sensitive to this than men," says Schneider. The patients must be monitored and treated in the clinic. The disturbance usually disappears by itself.

Identifying and properly treating atrial fibrillation

  • The disease atrial fibrillation is a rhythm disorder of the atria of the heart chambers. The organ beats irregularly and often very quickly.
  • Symptoms Not every patient feels irregularities in the pulse. Some people feel strong palpitations, feel powerless, have shortness of breath.
  • The risk of atrial fibrillation increases the risk of stroke. In women even more than in men, says Renate Schnabel, cardiologist at the University Medical Center Hamburg-Eppendorf.
  • The diagnosis Because atrial fibrillation often only occurs in attacks, a long-term ECG of 24 to is often required for the diagnosis
  • 72 hours or more. "For people at high risk or around 70, it would make sense to do an ECG like this every year as a precaution," says Schnabel.
  • Therapy for women is often limited to drugs. They use technical methods much less often. For example, doctors can desert areas in the atrium or bring the organ back into the right rhythm with a light electrical impulse. According to experts, both sexes benefit equally from it.