Maxy sez: A Silent Threat to Women’s Hearts That Many Don't Recognize

 Many women are in the dark about the insidious blockage of blood flow to the heart called coronary artery disease.
By Jennifer J. Brown, PhD
Heart disease is the leading cause of death for Americans, killing more women and men each year than all types of cancer combined. The latest data from the American Heart Association (AHA) indicates that cardiovascular disease causes one death every minute among U.S. women, or 398,035 deaths yearly.

The biggest villain of all the heart conditions is coronary artery disease. Also called hardening of the arteries or atherosclerosis, it's caused by a buildup of plaque — cholesterol, inflammatory cells, and calcium — that sticks to blood vessel walls, explains the American College of Cardiology. But many women — and too often their doctors — don’t recognize women's symptoms of heart disease.

“Quite honestly, we need to do the same thing for heart health that we’ve done with breast cancer,” says Beth Battaglino, RN, CEO of the nonprofit HealthyWomen and a nurse at Riverview Medical Center in Red Bank, New Jersey.

Battaglino and HealthyWomen are working on a patient advocacy and education site called Spread the Word, which aims to get women talking with other women about heart disease. Spread the Word partners include Nurse Practitioners in Women's Health, Society for Women's Health Research, Coalition of Labor Union Women, and the cardiovascular genomic diagnostic company CardioDx of Redwood City, California, which manufactures gene tests for heart disease.

Are You at Risk for This Quiet Killer?
If you are a woman with silent coronary artery disease (CAD), you may not realize that the arteries leading to your heart can get partially blocked by plaque buildup. But this situation can cause a heart attack as heart tissue dies and is starved of a nutrient-rich blood supply.

“Women do not understand it’s the No. 1 killer,” says Battaglino about heart disease. “Give them the tools to find out about the risk. Women will share their stories.”

Battaglino was inspired to get involved in patient advocacy for women because she was impressed by Violet Bowen-Hugh, MD, a champion for women’s health who began the nonprofit national women’s health resource center that's now called HealthyWomen. “In 1988, a female ob-gyn from West Virginia founded our organization. She believed all women need to be educated, regardless of their socio-economic background, to make educated decisions about their own health," Battaglino says.

You or a woman you love could easily mistake the pain of coronary artery disease for a pulled muscle.
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Now, Battaglino hopes that more women will join the conversation about heart disease online and become their own advocates in the doctor’s office.

“Write a blog post. Go on social media. Share what you learned with friends and family,” she urges. “If we don’t take care of ourselves, we won’t be there to take care of  those we love.”

Heart Symptoms in Women vs. Men

Women can all too easily overlook the more subtle symptoms of a heart condition like atherosclerosis — including arm or back pain. Often, the condition remains undiagnosed until after a heart attack or heart failure from arterial blockage, notes the National Heart, Lung, and Blood Institute.

“Symptoms present (show up) so differently in women than in men,” explains Battaglino. In women, coronary artery disease may mimic other common, less deadly ailments. Whereas a man is more likely to feel the typical effects of angina — sharp chest pain — women need to be looking out for other possible symptoms, she says.

Women’s symptoms of coronary artery disease can include:

Feeling tightness in your jawUpper back pain
Upper arm pain
Upper abdominal pain
Throat pain
Stomach pain
Sudden weakness or fatigue
You, or a woman you love, could easily mistake the pain of coronary artery disease for a pulled muscle. Gut pains might seem like simple indigestion. Even sudden-onset fatigue is too often explained away by women who don't realize it could be heart related.

“Many women are often tired, and so could easily dismiss that. But it could be a sign of coronary artery disease,” says Battaglino.

When to Have the Heart-Health Conversation? 

You don’t have to wait until a cardiologist diagnoses you with heart disease — at yor annual well-woman checkup, you can become your own patient advocate. Take advantage of the opportunity to find out more about how your heart is working.

“It’s so important to have the conversation about heart health when you visit the ob-gyn or your primary care provider," says Battaglino. "If they tell you your blood pressure is a little high, for example, ask, what does that mean?” This way, you can understand what your heart is telling you in the results of routine, but vital, heart-health tests like blood pressure.

RELATED: 10-Step Do-It-Yourself Heart Makeover

When you get to the few precious minutes you have with your doctor, tell them about any symptoms that could point to heart disease. “You want to bring up anything that’s bothering you, like indigestion, pain in the upper arm, back, or neck, or tightness in the  jaw. Remember, women present (show symptoms) differently than men,” Battaglino says.

She suggests writing down the questions you want to ask before you go in. This is good advice not only for yourself, but also for family members who may be getting ready for their annual primary care visit.

Battaglino says, “As a daughter, I want to be sure I’m letting my mom know, too, to have that conversation.”

The best way to get the most you can out of your visit is to prepare. Get the education and tools that can help you understand your heart and signs of heart disease from online heart-health resources, and share them with the women in your life.

Women Heart
Remember, women present (show symptoms) differently than men,” Battaglino says.

She suggests writing down the questions you want to ask before you go in. This is good advice not only for yourself, but also for family members who may be getting ready for their annual primary care visit.

Battaglino says, “As a daughter, I want to be sure I’m letting my mom know, too, to have that conversation.”

The best way to get the most you can out of your visit is to prepare. Get the education and tools that can help you understand your heart and signs of heart disease from online heart-health resources, and share them with the women in your life.


While you’re with your healthcare provider, be sure to talk about how you might be able to cut your risk for heart disease. Important factors include a healthy diet, regular exercise, and curtailing any exposure to smoke — be it cigarettes, e-cigarettes, or secondhand smoke.

While you’re there, remember to check that you're current with all your vaccines. If you’re a smoker, you may want to get the pneumonia vaccine, Battaglino points out. And if you’re not sure whether or not you were vaccinated against measles — which has reappeared in the United States — ask your doctor about getting your MMR vaccine. If you have a heart condition, you may be at  greater risk for infection and complications, which can be severe.

Battaglino says about her patients, “They can have blood drawn and have titers [antibody levels] taken to find out if they need a [measles] booster or not.”

Heart Test Facts to Know

If your visit to primary care turns up a possible heart condition, be proactive and ask for a cardiac referral.

“You’d go to primary care, then you’d see a cardiologist, and based on that you’d see about tests. Understand the testing that’s available to you,” says Battaglino.

Getting the right tests just might put you on the path to avoiding a potentially fatal heart attack. Heart tests have different benefits and health risks. Here are some of the heart tests that might come up, what they identify, and, for some, their radiation exposure risks:

CAD Blood Test This sensitive genetic test may be considered to identify which genes are active. (The test is manufactured by CardioDx.)

Exercise Stress Test An ECG (electrocardiogram), with or without imaging of the heart with an echocardiogram, is done while you walk on a treadmill or pedal a stationary bicycle. This test can identify blood flow limiting coronary artery disease.

CT Coronary Calcium Scan Also called the Agatston score, this heart scan shows areas where plaque has built up inside your blood vessels even before symptoms appear. It exposes you to radiation of about 3 millisieverts (mSv, a measure of radiation dose).

CT Coronary Angiogram Another heart scan, this is one that identifies narrowing of individual coronary arteries. But note that it exposes you to significantly more radiation than a calcium scan — 12 mSv.

Nuclear Stress Test This combines an ECG, small amounts of intravenous radioactive dye, and heart scans that include radiation exposure of about 10 to 24 mSv. For comparison, a mammogram exposes you to about 0.4 mSv, and a dental exam to 0.005 mSv. This test can identify regions of the heart that have diminished blood flow during exercise or drug-induced stress.

Don't be afraid to ask questions if you don't know what the tests involve. According to Andrew Einstein, MD, PhD, associate professor of medicine at Columbia University Medical Center in New Your City, two questions you should always ask about your heart test are:

1. Is there a good clinical reason I’m getting this test?

2. Do you modify the test for each specific patient?

The answer to the first question should, of course, be yes. And Dr. Einstein points out that it's important that some tests be adjusted to suit the person, because a woman may need lower radiation doses based on her weight, the size of her heart, or her age.

The best practice is to minimize your exposure to radiation, because you may be scheduled for several X-ray screening tests in a year by different doctors. Both your referring physician and the doctor who actually does the tests should discuss the risks of radiation exposure with you, according to the AHA.