According to data from the Singapore Ministry of Health, cardiovascular disease is a major killer here, accounting for nearly one out of three deaths in 2015. Among women in Singapore, the leading cause of death is heart related disease and stroke combined, but many are still unaware of the dangers posed by this “silent killer”.
Common causes of heart disease are hypertension, coronary artery disease (CAD) and atrial fibrillation (abnormal heart rhythm). These conditions, if undiagnosed or not well controlled, can lead to heart attacks, sudden cardiac death, kidney or heart failure, stroke and dementia.
The most common trigger of CAD and heart attacks in women is atherosclerosis, which is the narrowing of the inner walls of the coronary arteries due to the build-up of plaque. Plaque is made up of fat, cholesterol, calcium and other substances found in the blood. Over time, plaque can harden or rupture, narrowing arteries and reducing or blocking the flow of oxygen-rich blood to the heart. This can cause chest pain, tightness or discomfort called “angina”.
Atherosclerosis is the “typical” form of CAD with “classic” symptoms of chest angina on exertion or, if more severe, even at rest. It is more common in postmenopausal women and men. Women tend to have this condition about 10 years later than men, likely due to the cardio-protective effect of oestrogen.
Atypical CAD in women
In the last 30 years, with great progress in typical CAD therapies, death rates from heart disease have dropped. However, they haven’t dropped as much in women as in men, which may be the result of atypical forms of CAD seen more often in women, particularly those who are premenopausal. The more common forms of atypical CAD are:
- Prinzmetal’s angina due to coronary artery spasms
- Cardiac syndrome X (CSX) due to coronary artery micro-vessel blockages
- Coronary artery erosions, where the problem is with eroding arteries rather than plaque or constriction
Instead of typical angina chest pains, women are more likely to experience atypical symptoms of CAD and heart attacks. These include:
- A hot or burning sensation or tenderness in the back, shoulders, arms or jaw
- Nausea, vomiting, indigestion, shortness of breath
- Unusual, extreme fatigue
- Atypical symptoms do not include anything that may be construed as chest pain. That is why in many cases, women – especially those with diabetes mellitus – may have no noticeable symptoms – the “silent” heart attack.
Another heart issue women are more prone to is commonly known as broken heart syndrome. It is a temporary heart condition where there is a sudden weakening of the heart muscle, which may be triggered by emotional stress – such as the death of a loved one, a sudden relationship issue or constant anxiety. It is more commonly seen in postmenopausal women, and often there is a history of recent extreme (usually negative, but sometimes positive) emotional or physical stress.
Thomson Cardiology Centre