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How Does Heart Disease Affect Women?

In the United States, 1 in 4 women dies from heart disease. In fact, coronary heart disease (CHD)—the most common type of heart disease—is the #1 killer of both men and women in the United States.

Other types of heart disease, such as coronary microvascular disease (MVD) and broken heart syndrome, also pose a risk for women. These disorders, which mainly affect women, are not as well understood as CHD. However, research is ongoing to learn more about coronary MVD and broken heart syndrome.

This article focuses on CHD and its complications. However, it also includes general information about coronary MVD and broken heart syndrome.

Coronary Heart Disease

CHD is a disease in which plaque (plak) builds up on the inner walls of your coronary arteries. These arteries carry oxygen-rich blood to your heart. When plaque builds up in the arteries, the condition is called atherosclerosis (ath-er-o-skler-O-sis).

Plaque is made up of fat, cholesterol, calcium, and other substances found in the blood. Over time, plaque can harden or rupture (break open).

Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Heart With Muscle Damage and a Blocked Artery

Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture.

Figure A is an overview of a heart and coronary artery showing damage (dead heart muscle) caused by a heart attack. Figure B is a cross-section of the coronary artery with plaque buildup and a blood clot resulting from plaque rupture.

Plaque also can develop within the walls of the coronary arteries. Tests that show the insides of the coronary arteries may look normal in people who have this pattern of plaque. Studies are under way to see whether this type of plaque buildup occurs more often in women than in men and why.

In addition to angina and heart attack, CHD can cause other serious heart problems. The disease may lead to heart failure, irregular heartbeats called arrhythmias (ah-RITH-me-ahs), and sudden cardiac arrest (SCA).

Coronary Microvascular Disease

Coronary MVD is heart disease that affects the heart's tiny arteries. This disease is also called cardiac syndrome X or nonobstructive CHD. In coronary MVD, the walls of the heart's tiny arteries are damaged or diseased.

Coronary Microvascular Disease

Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B shows a large coronary artery with plaque buildup.  

Figure A shows the small coronary artery network (microvasculature), containing a normal artery and an artery with coronary MVD. Figure B shows a large coronary artery with plaque buildup.

Women are more likely than men to have coronary MVD. Many researchers think that a drop in estrogen levels during menopause combined with other heart disease risk factors causes coronary MVD.

Although death rates from heart disease have dropped in the last 30 years, they haven't dropped as much in women as in men. This may be the result of coronary MVD.

Standard tests for CHD are not designed to detect coronary MVD. Thus, test results for women who have coronary MVD may show that they are at low risk for heart disease.

Research is ongoing to learn more about coronary MVD and its causes.

Broken Heart Syndrome

Women are also more likely than men to have a condition called broken heart syndrome. In this recently recognized heart problem, extreme emotional stress can lead to severe (but often short-term) heart muscle failure.

Broken heart syndrome is also called stress-induced cardiomyopathy (KAR-de-o-mi-OP-ah-thee) or takotsubo cardiomyopathy.

Doctors may misdiagnose broken heart syndrome as a heart attack because it has similar symptoms and test results. However, there's no evidence of blocked heart arteries in broken heart syndrome, and most people have a full and quick recovery.

Researchers are just starting to explore what causes this disorder and how to diagnose and treat it. Often, patients who have broken heart syndrome have previously been healthy.

Outlook

Women tend to have CHD about 10 years later than men. However, CHD remains the #1 killer of women in the United States.

The good news is that you can control many CHD risk factors. CHD risk factors are conditions or habits that raise your risk for CHD and heart attack. These risk factors also can increase the chance that existing CHD will worsen.

Lifestyle changes, medicines, and medical or surgical procedures can help women lower their risk for CHD. Thus, early and ongoing CHD prevention is important.

More information about heart disease in women is available through the National Heart, Lung, and Blood Institute's The Heart Truth® campaign.

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®The Heart Truth and its logo are registered trademarks of the U.S. Department of Health and Human Services (HHS).




Other Names for Heart Disease




What Causes Heart Disease?

Research suggests that coronary heart disease (CHD) begins with damage to the lining and inner layers of the coronary (heart) arteries. Several factors contribute to this damage. They include:

Plaque may begin to build up where the arteries are damaged. The buildup of plaque in the coronary arteries may start in childhood.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina.

If the plaque ruptures, blood cell fragments called platelets (PLATE-lets) stick to the site of the injury. They may clump together to form blood clots.

Blood clots can further narrow the coronary arteries and worsen angina. If a clot becomes large enough, it can mostly or completely block a coronary artery and cause a heart attack.

In addition to the factors above, low estrogen levels before or after menopause may play a role in causing coronary microvascular disease (MVD). Coronary MVD is heart disease that affects the heart's tiny arteries.

The cause of broken heart syndrome isn't yet known. However, a sudden release of stress hormones may play a role in causing the disorder. Most cases of broken heart syndrome occur in women who have gone through menopause.




Who Is at Risk for Heart Disease?

Certain traits, conditions, or habits may raise your risk for coronary heart disease (CHD). These conditions are known as risk factors. Risk factors also increase the chance that existing CHD will worsen.

Women generally have the same CHD risk factors as men. However, some risk factors may affect women differently than men. For example, diabetes raises the risk of CHD more in women. Also, some risk factors, such as birth control pills and menopause, only affect women.

There are many known CHD risk factors. Your risk for CHD and heart attack rises with the number of risk factors you have and their severity. Risk factors tend to "gang up" and worsen each other's effects.

Having just one risk factor doubles your risk for CHD. Having two risk factors increases your risk for CHD fourfold. Having three or more risk factors increases your risk for CHD more than tenfold.

Also, some risk factors, such as smoking and diabetes, put you at greater risk for CHD and heart attack than others.

More than 75 percent of women aged 40 to 60 have one or more risk factors for CHD. Many risk factors start during childhood; some even develop within the first 10 years of life. You can control most risk factors, but some you can't.

For more information about CHD risk factors, go to the Health Topics Coronary Heart Disease Risk Factors article. To find out whether you're at risk for CHD, talk with your doctor or health care provider.

Risk Factors You Can Control

Smoking

Smoking is the most powerful risk factor that women can control. Smoking tobacco or long-term exposure to secondhand smoke raises your risk for CHD and heart attack.

Smoking exposes you to carbon monoxide. This chemical robs your blood of oxygen and triggers a buildup of plaque in your arteries.

Smoking also increases the risk of blood clots forming in your arteries. Blood clots can block plaque-narrowed arteries and cause a heart attack. The more you smoke, the greater your risk for a heart attack.

Even women who smoke fewer than two cigarettes a day are at increased risk for CHD.

High Blood Cholesterol and High Triglyceride Levels

Cholesterol travels in the bloodstream in small packages called lipoproteins (LI-po-pro-teens). The two major kinds of lipoproteins are low-density lipoprotein (LDL) cholesterol and high-density lipoprotein (HDL) cholesterol.

LDL cholesterol is sometimes called "bad" cholesterol. This is because it carries cholesterol to tissues, including your heart arteries. HDL cholesterol is sometimes called "good" cholesterol. This is because it helps remove cholesterol from your arteries.

A blood test called a lipoprotein panel is used to measure cholesterol levels. This test gives information about your total cholesterol, LDL cholesterol, HDL cholesterol, and triglycerides (a type of fat found in the blood).

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood. A woman's risk for CHD increases if she has a total cholesterol level greater than 200 mg/dL, an LDL cholesterol level greater than 100 mg/dL, or an HDL cholesterol level less than 50 mg/dL.

A triglyceride level greater than 150 mg/dL also increases a woman's risk for CHD. A woman's HDL cholesterol and triglyceride levels predict her risk for CHD better than her total cholesterol or LDL cholesterol levels.

High Blood Pressure

Blood pressure is the force of blood pushing against the walls of the arteries as the heart pumps blood. If this pressure rises and stays high over time, it can damage the body in many ways.

Women who have blood pressure greater than 120/80 mmHg are at increased risk for CHD. (The mmHg is millimeters of mercury—the units used to measure blood pressure.)

High blood pressure is defined differently for people who have diabetes or chronic kidney disease. If you have one of these diseases, work with your doctor to set a healthy blood pressure goal.

Diabetes and Prediabetes

Diabetes is a disease in which the body's blood sugar level is too high. This is because the body doesn't make enough insulin or doesn't use its insulin properly.

Insulin is a hormone that helps move blood sugar into cells, where it's used for energy. Over time, a high blood sugar level can lead to increased plaque buildup in your arteries.

Prediabetes is a condition in which your blood sugar level is higher than normal, but not as high as it is in diabetes. Prediabetes puts you at higher risk for both diabetes and CHD.

Diabetes and prediabetes raise the risk of CHD more in women than in men. In fact, having diabetes doubles a woman's risk of developing CHD.

Before menopause, estrogen provides women some protection against CHD. However, in women who have diabetes, the disease counters the protective effects of estrogen.

Overweight and Obesity

The terms "overweight" and "obesity" refer to body weight that's greater than what is considered healthy for a certain height.

The most useful measure of overweight and obesity is body mass index (BMI). BMI is calculated from your height and weight. In adults, a BMI of 18.5 to 24.9 is considered normal. A BMI of 25 to 29.9 is considered overweight. A BMI of 30 or more is considered obese.

You can use the National Heart, Lung, and Blood Institute's (NHLBI's) online BMI calculator to figure out your BMI, or your doctor can help you.

Studies suggest that where extra weight occurs on the body may predict CHD risk better than BMI. Women who carry much of their fat around the waist are at greatest risk for CHD. These women have "apple-shaped" figures.

Women who carry most of their fat on their hips and thighs—that is, those who have "pear-shaped" figures—are at lower risk for CHD.

To fully know how excess weight affects your CHD risk, you should know your BMI and waist measurement. If you have a BMI greater than 24.9 and a waist measurement greater than 35 inches, you're at increased risk for CHD.

If your waist measurement divided by your hip measurement is greater than 0.9, you're also at increased risk for CHD.

Studies also suggest that women whose weight goes up and down dramatically (typically due to unhealthy dieting) are at increased risk for CHD. These swings in weight can lower HDL cholesterol levels.

Metabolic Syndrome

Metabolic syndrome is the name for a group of risk factors that raises your risk for CHD and other health problems, such as diabetes and stroke. A diagnosis of metabolic syndrome is made if you have at least three of the following risk factors:

  • A large waistline. Having extra fat in the waist area is a greater risk factor for CHD than having extra fat in other parts of the body, such as on the hips.
  • A higher than normal triglyceride level (or you're on medicine to treat high triglycerides).
  • A lower than normal HDL cholesterol level (or you're on medicine to treat low HDL cholesterol).
  • Higher than normal blood pressure (or you're on medicine to treat high blood pressure).
  • Higher than normal fasting blood sugar (or you're on medicine to treat diabetes)

Metabolic syndrome is more common in African American women and Mexican American women than in men of the same racial groups. The condition affects White women and men about equally.

Birth Control Pills

Women who smoke and take birth control pills are at very high risk for CHD, especially if they're older than 35. For women who take birth control pills but don't smoke, the risk of CHD isn't fully known.

Lack of Physical Activity

Inactive people are nearly twice as likely to develop CHD as those who are physically active. A lack of physical activity can worsen other CHD risk factors, such as high blood cholesterol and triglyceride levels, high blood pressure, diabetes and prediabetes, and overweight and obesity.

Unhealthy Diet

An unhealthy diet can raise your risk for CHD. For example, foods that are high in saturated and trans fats and cholesterol raise your LDL cholesterol level. A high-sodium (salt) diet can raise your risk for high blood pressure.

Foods with added sugars will give you extra calories without nutrients, such as vitamins and minerals. This can cause you to gain weight, which raises your risk for CHD.

Too much alcohol also can cause you to gain weight, and it will raise your blood pressure.

Stress or Depression

Stress may play a role in causing CHD. Stress can trigger your arteries to narrow. This can raise your blood pressure and your risk for a heart attack.

Getting upset or angry also can trigger a heart attack. Stress also may indirectly raise your risk for CHD if it makes you more likely to smoke or overeat foods high in fat and sugar.

People who are depressed are two to three times more likely to develop CHD than people who are not. Depression is twice as common in women as in men.

Anemia

Anemia (uh-NEE-me-eh) is a condition in which your blood has a lower than normal number of red blood cells.

The condition also can occur if your red blood cells don't contain enough hemoglobin (HEE-muh-glow-bin). Hemoglobin is an iron-rich protein that carries oxygen from your lungs to the rest of your organs.

If you have anemia, your organs don't get enough oxygen-rich blood. This causes your heart to work harder, which may raise your risk for CHD.

Anemia has many causes. For more information, go to the Health Topics Anemia article.

Sleep Apnea

Sleep apnea is a common disorder that causes pauses in breathing or shallow breaths while you sleep. Breathing pauses can last from a few seconds to minutes. They often occur 5 to 30 times or more an hour.

Typically, normal breathing starts again after the pause, sometimes with a loud snort or choking sound. Major signs of sleep apnea are snoring and daytime sleepiness.

When you stop breathing, the lack of oxygen triggers your body's stress hormones. This causes blood pressure to rise and makes the blood more likely to clot.

Untreated sleep apnea can raise your risk for high blood pressure, diabetes, and even a heart attack or stroke.

Women are more likely to develop sleep apnea after menopause.

Risk Factors You Can't Control

Age and Menopause

As you get older, your risk for CHD and heart attack rises. This is due in part to the slow buildup of plaque inside your heart arteries, which can start during childhood.

Before age 55, women have a lower risk for CHD than men. Estrogen provides women with some protection against CHD before menopause. After age 55, however, the risk of CHD increases in both women and men.

You may have gone through early menopause, either naturally or because you had your ovaries removed. If so, you're twice as likely to develop CHD as women of the same age who aren't yet menopausal.

Another reason why women are at increased risk for CHD after age 55 is that middle age is when you tend to develop other CHD risk factors.

Women who have gone through menopause also are at increased risk for broken heart syndrome. (For more information, go to the section on emerging risk factors below.)

Family History

Family history plays a role in CHD risk. Your risk increases if your father or a brother was diagnosed with CHD before 55 years of age, or if your mother or a sister was diagnosed with CHD before 65 years of age.

Also, a family history of stroke—especially a mother's stroke history—can help predict the risk of heart attack in women.

Having a family history of CHD or stroke doesn't mean that you'll develop heart disease. This is especially true if your affected family member smoked or had other risk factors that were not well treated.

Making lifestyle changes and taking medicines to treat risk factors often can lessen genetic influences and prevent or delay heart problems.

Preeclampsia

Preeclampsia (pre-e-KLAMP-se-ah) is a condition that develops during pregnancy. The two main signs of preeclampsia are a rise in blood pressure and excess protein in the urine.

These signs usually occur during the second half of pregnancy and go away after delivery. However, your risk of developing high blood pressure later in life increases after having preeclampsia.

Preeclampsia also is linked to an increased lifetime risk of heart disease, including CHD, heart attack, and heart failure. (Likewise, having heart disease risk factors, such as diabetes or obesity, increases your risk for preeclampsia.)

If you had preeclampsia during pregnancy, you're twice as likely to develop heart disease as women who haven't had the condition. You're also more likely to develop heart disease earlier in life.

Preeclampsia is a heart disease risk factor that you can't control. However, if you've had the condition, you should take extra care to try and control other heart disease risk factors.

The more severe your preeclampsia was, the greater your risk for heart disease. Let your doctor know that you had preeclampsia so he or she can assess your heart disease risk and how to reduce it.

Emerging Risk Factors

Research suggests that inflammation plays a role in causing CHD. Inflammation is the body's response to injury or infection. Damage to the arteries' inner walls seems to trigger inflammation and help plaque grow.

High blood levels of a protein called C-reactive protein (CRP) are a sign of inflammation in the body. Research suggests that women who have high blood levels of CRP are at increased risk for heart attack.

Also, some inflammatory diseases, such as lupus and rheumatoid arthritis, may increase the risk for CHD.

Some studies suggest that women who have migraine headaches may be at greater risk for CHD. This is especially true for women who have migraines with auras (visual disturbances), such as flashes of light or zig-zag lines.

Low bone density and low intake of folate and vitamin B6 also may raise a woman's risk for CHD.

More research is needed to find out whether calcium supplements with or without vitamin D affect CHD risk. You may want to talk with your doctor to find out whether these types of supplements are right for you.

Researchers are just starting to learn about broken heart syndrome risk factors. Most women who have this disorder are White and have gone through menopause.

Many of these women have other heart disease risk factors, such as high blood pressure, high blood cholesterol, diabetes, and smoking. However, these risk factors tend to be less common in women who have broken heart syndrome than in women who have CHD.




What Are the Signs and Symptoms of Heart Disease?

The signs and symptoms of coronary heart disease (CHD) may differ between women and men. Some women who have CHD have no signs or symptoms. This is called silent CHD.

Silent CHD may not be diagnosed until a woman has signs and symptoms of a heart attack, heart failure, or an arrhythmia (irregular heartbeat).

Other women who have CHD will have signs and symptoms of the disease.

Heart Disease Signs and Symptoms

The illustration shows the major signs and symptoms of coronary heart disease.

The illustration shows the major signs and symptoms of coronary heart disease.

A common symptom of CHD is angina. Angina is chest pain or discomfort that occurs when your heart muscle doesn't get enough oxygen-rich blood.

In men, angina often feels like pressure or squeezing in the chest. This feeling may extend to the arms. Women can also have these angina symptoms. But women also tend to describe a sharp, burning chest pain. Women are more likely to have pain in the neck, jaw, throat, abdomen, or back.

In men, angina tends to worsen with physical activity and go away with rest. Women are more likely than men to have angina while they're resting or sleeping.

In women who have coronary microvascular disease, angina often occurs during routine daily activities, such as shopping or cooking, rather than while exercising. Mental stress also is more likely to trigger angina pain in women than in men.

The severity of angina varies. The pain may get worse or occur more often as the buildup of plaque continues to narrow the coronary (heart) arteries.

Signs and Symptoms Coronary Heart Disease Complications

Heart Attack

The most common heart attack symptom in men and women is chest pain or discomfort. However, only half of women who have heart attacks have chest pain.

Women are more likely than men to report back or neck pain, indigestion, heartburn, nausea (feeling sick to the stomach), vomiting, extreme fatigue (tiredness), or problems breathing.

Heart attacks also can cause upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach. Other heart attack symptoms are light-headedness and dizziness, which occur more often in women than men.

Men are more likely than women to break out in a cold sweat and to report pain in the left arm during a heart attack.

Heart Failure

Heart failure is a condition in which your heart can't pump enough blood to meet your body's needs. Heart failure doesn't mean that your heart has stopped or is about to stop working. It means that your heart can't cope with the demands of everyday activities.

Heart failure causes shortness of breath and fatigue that tends to increase with physical exertion. Heart failure also can cause swelling in the feet, ankles, legs, abdomen, and veins in the neck.

Arrhythmia

An arrhythmia is a problem with the rate or rhythm of the heartbeat. During an arrhythmia, the heart can beat too fast, too slow, or with an irregular rhythm.

Some people describe arrhythmias as fluttering or thumping feelings or skipped beats in their chests. These feelings are called palpitations.

Some arrhythmias can cause your heart to suddenly stop beating. This condition is called sudden cardiac arrest (SCA). SCA causes loss of consciousness and death if it's not treated right away.

Signs and Symptoms of Broken Heart Syndrome

The most common signs and symptoms of broken heart syndrome are chest pain and shortness of breath. In this disorder, these symptoms tend to occur suddenly in people who have no history of heart disease.

Arrhythmias or cardiogenic shock also may occur. Cardiogenic shock is a condition in which a suddenly weakened heart isn't able to pump enough blood to meet the body's needs.

Some of the signs and symptoms of broken heart syndrome differ from those of heart attack. For example, in people who have broken heart syndrome:

  • Symptoms occur suddenly after having extreme emotional or physical stress.
  • EKG (electrocardiogram) results don't look the same as the EKG results for a person having a heart attack. (An EKG is a test that records the heart's electrical activity.)
  • Blood tests show no signs or mild signs of heart damage.
  • Tests show no signs of blockages in the coronary arteries.
  • Tests show ballooning and unusual movement of the lower left heart chamber (left ventricle).
  • Recovery time is quick, usually within days or weeks (compared with the recovery time of a month or more for a heart attack).



How Is Heart Disease Diagnosed?

Your doctor will diagnose coronary heart disease (CHD) based on your medical and family histories, your risk factors, a physical exam, and the results from tests and procedures.

No single test can diagnose CHD. If your doctor thinks you have CHD, he or she may recommend one or more of the following tests.

EKG (Electrocardiogram)

An EKG is a simple, painless test that detects and records the heart's electrical activity. The test shows how fast the heart is beating and its rhythm (steady or irregular). An EKG also records the strength and timing of electrical signals as they pass through the heart.

An EKG can show signs of heart damage due to CHD and signs of a previous or current heart attack.

Stress Testing

During stress testing, you exercise to make your heart work hard and beat fast while heart tests are done. If you can't exercise, you may be given medicines to increase your heart rate.

When your heart is working hard and beating fast, it needs more blood and oxygen. Plaque-narrowed coronary (heart) arteries can't supply enough oxygen-rich blood to meet your heart's needs.

A stress test can show possible signs and symptoms of CHD, such as:

  • Abnormal changes in your heart rate or blood pressure
  • Shortness of breath or chest pain
  • Abnormal changes in your heart rhythm or your heart's electrical activity

If you can't exercise for as long as what is considered normal for someone your age, your heart may not be getting enough oxygen-rich blood. However, other factors also can prevent you from exercising long enough (for example, lung diseases, anemia, or poor general fitness).

As part of some stress tests, pictures are taken of your heart while you exercise and while you rest. These imaging stress tests can show how well blood is flowing in your heart and how well your heart pumps blood when it beats.

Echocardiography

Echocardiography (echo) uses sound waves to create a moving picture of your heart. The test provides information about the size and shape of your heart and how well your heart chambers and valves are working.

Echo also can show areas of poor blood flow to the heart, areas of heart muscle that aren't contracting normally, and previous injury to the heart muscle caused by poor blood flow.

Chest X Ray

chest x ray creates pictures of the organs and structures inside your chest, such as your heart, lungs, and blood vessels.

A chest x ray can reveal signs of heart failure, as well as lung disorders and other causes of symptoms not related to CHD.

Blood Tests

Blood tests check the levels of certain fats, cholesterol, sugar, and proteins in your blood. Abnormal levels may be a sign that you're at risk for CHD. Blood tests also help detect anemia, a risk factor for CHD.

During a heart attack, heart muscle cells die and release proteins into the bloodstream. Blood tests can measure the amount of these proteins in the bloodstream. High levels of these proteins are a sign of a recent heart attack.

Electron-Beam Computed Tomography

Electron-beam computed tomography (EBCT) is a test that looks for specks of calcium (called calcifications) in the walls of the coronary arteries. Calcifications are an early sign of CHD.

The test can show whether you're at increased risk for a heart attack or other heart problems before other signs and symptoms occur.

EBCT isn't routinely used to diagnose CHD because its accuracy isn't yet known.

Coronary Angiography and Cardiac Catheterization

Your doctor may recommend coronary angiography (an-jee-OG-rah-fee) if other tests or factors suggest you have CHD. This test uses dye and special x rays to look inside your coronary arteries.

To get the dye into your coronary arteries, your doctor will use a procedure called cardiac catheterization (KATH-eh-ter-ih-ZA-shun).

A thin, flexible tube called a catheter is put into a blood vessel in your arm, groin (upper thigh), or neck. The tube is threaded into your coronary arteries, and the dye is released into your bloodstream.

Special x rays are taken while the dye is flowing through your coronary arteries. The dye lets your doctor study the flow of blood through your heart and blood vessels.

Coronary angiography detects blockages in the large coronary arteries. However, the test doesn't detect coronary microvascular disease (MVD). This is because coronary MVD doesn't cause blockages in the large coronary arteries.

Even if the results of your coronary angiography are normal, you may still have chest pain or other CHD symptoms. If so, talk with your doctor about whether you might have coronary MVD.

Your doctor may ask you to fill out a questionnaire called the Duke Activity Status Index. This questionnaire measures how easily you can do routine tasks. It gives your doctor information about how well blood is flowing through your coronary arteries.

Your doctor also may recommend other tests that measure blood flow in the heart, such as a cardiac MRI (magnetic resonance imaging) stress test.

Cardiac MRI uses radio waves, magnets, and a computer to create pictures of your heart as it beats. The test produces both still and moving pictures of your heart and major blood vessels.

Other tests done during cardiac catheterization can check blood flow in the heart's small arteries and the thickness of the artery walls.

Tests Used To Diagnose Broken Heart Syndrome

If your doctor thinks you have broken heart syndrome, he or she may recommend coronary angiography. Other tests are also used to diagnose this disorder, including blood tests, EKG, echo, and cardiac MRI.




How Is Heart Disease Treated?

Treatment for coronary heart disease (CHD) usually is the same for both women and men. Treatment may include lifestyle changes, medicines, medical and surgical procedures, and cardiac rehabilitation (rehab).

The goals of treatment are to:

  • Relieve symptoms.
  • Reduce risk factors in an effort to slow, stop, or reverse the buildup of plaque.
  • Lower the risk of blood clots forming. (Blood clots can cause a heart attack.)
  • Widen or bypass plaque-clogged coronary (heart) arteries.
  • Prevent CHD complications.

Lifestyle Changes

Making lifestyle changes can help prevent or treat CHD. These changes may be the only treatment that some people need.

Quit Smoking

If you smoke or use tobacco, try to quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

If you find it hard to quit smoking on your own, consider joining a support group. Many hospitals, workplaces, and community groups offer classes to help people quit smoking.

For more information about how to quit smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) "Your Guide to a Healthy Heart."

Follow a Healthy Diet

A healthy diet is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. These foods can be fresh, canned, frozen, or dried. A good rule is to try to fill half of your plate with vegetables and fruits.

A healthy diet also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

Choose and prepare foods with little sodium (salt). Too much salt can raise your risk for high blood pressure. Studies show that following the Dietary Approaches to Stop Hypertension (DASH) eating plan can lower blood pressure.

Try to avoid foods and drinks that are high in added sugars. For example, drink water instead of sugary drinks, like soda.

Also, try to limit the amount of solid fats and refined grains that you eat. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

If you drink alcohol, do so in moderation. Research suggests that regularly drinking small to moderate amounts of alcohol may lower the risk of CHD. Women should have no more than one alcoholic drink a day.

One drink a day can lower your CHD risk by raising your HDL cholesterol level. One drink is a glass of wine, beer, or a small amount of hard liquor.

If you don't drink, this isn't a recommendation to start using alcohol. Also, you shouldn't drink if you're pregnant, if you're planning to become pregnant, or if you have another health condition that could make alcohol use harmful.

Too much alcohol can cause you to gain weight and raise your blood pressure and triglyceride level. In women, even one drink a day may raise the risk of certain types of cancer.

For more information about following a healthy diet, go to the NHLBI's "Your Guide to Lowering Your Blood Pressure With DASH" and the U.S. Department of Agriculture's ChooseMyPlate.gov Web site. Both resources provide general information about healthy eating.

Be Physically Active

Regular physical activity can lower many CHD risk factors, including high LDL cholesterol, high blood pressure, and excess weight.

Physical activity also can lower your risk for diabetes and raise your HDL cholesterol level. (HDL cholesterol helps remove cholesterol from your arteries.)

Talk with your doctor before you start a new exercise plan. Ask him or her how much and what kinds of physical activity are safe for you.

People gain health benefits from as little as 60 minutes of moderate-intensity aerobic activity per week. Walking is an excellent heart healthy exercise. The more active you are, the more you will benefit.

For more information about physical activity, go to the U.S. Department of Health and Human Services' "2008 Physical Activity Guidelines for Americans," the Health Topics Physical Activity and Your Heart article, and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Maintain a Healthy Weight

Overweight and obesity are risk factors for CHD. If you're overweight or obese, try to lose weight. Cut back your calorie intake and do more physical activity. Eat smaller portions and choose lower calorie foods. Your health care provider may refer you to a dietitian to help you manage your weight.

A BMI of less than 25 and a waist circumference of 35 inches or less is the goal for preventing and treating CHD. BMI measures your weight in relation to your height and gives an estimate of your total body fat. You can use the NHLBI's online BMI calculator to figure out your BMI, or your doctor can help you.

To measure your waist, stand and place a tape measure around your middle, just above your hipbones. Measure your waist just after you breathe out. Make sure the tape is snug but doesn't squeeze the flesh.

For more information about losing weight or maintaining a healthy weight, go to the NHLBI's Aim for a Healthy Weight Web site.

Stress and Depression

Research shows that getting upset or angry can trigger a heart attack. Also, some of the ways people cope with stress—such as drinking, smoking, or overeating—aren't heart healthy.

Learning how to manage stress, relax, and cope with problems can improve your emotional and physical health.

Having supportive people in your life with whom you can share your feelings or concerns can help relieve stress. Physical activity, yoga, and relaxation therapy also can help relieve stress. You may want to consider taking part in a stress management program.

Depression can double or triple your risk for CHD. Depression also makes it hard to maintain a heart healthy lifestyle.

Talk with your doctor if you have symptoms of depression, such as feeling hopeless or not taking interest in daily activities. He or she may recommend counseling or prescribe medicines to help you manage the condition.

Medicines

You may need medicines to treat CHD if lifestyle changes aren't enough. Medicines can help:

  • Reduce your heart's workload and relieve CHD symptoms
  • Decrease your chance of having a heart attack or dying suddenly
  • Lower your LDL cholesterol, blood pressure, and other CHD risk factors
  • Prevent blood clots
  • Prevent or delay the need for a procedure or surgery, such as angioplasty (AN-jee-oh-plas-tee) or coronary artery bypass grafting (CABG)

Women who have coronary microvascular disease and anemia may benefit from taking medicine to treat the anemia.

Women who have broken heart syndrome also may need medicines. Doctors may prescribe medicines to relieve fluid buildup, treat blood pressure problems, prevent blood clots, and manage stress hormones. Most people who have broken heart syndrome make a full recovery within weeks.

Take all of your medicines as prescribed. If you have side effects or other problems related to your medicines, tell your doctor. He or she may be able to provide other options.

Menopausal Hormone Therapy

Recent studies have shown that menopausal hormone therapy (MHT) doesn't prevent CHD. Some studies have even shown that MHT increases women's risk for CHD, stroke, and breast cancer.

However, these studies tested MHT on women who had been postmenopausal for at least several years. During that time, they could have already developed CHD.

Research is ongoing to see whether MHT helps prevent CHD when taken right when menopause starts. While questions remain, current findings suggest MHT shouldn't routinely be used to prevent or treat CHD.

Ask your doctor about other ways to prevent or treat CHD, including lifestyle changes and medicines. For more information about MHT, go to the NHLBI's Postmenopausal Hormone Therapy Web site.

Procedures and Surgery

You may need a procedure or surgery to treat CHD. Both angioplasty and CABG are used as treatments. You and your doctor can discuss which treatment is right for you.

Angioplasty

Angioplasty is a nonsurgical procedure that opens blocked or narrowed coronary arteries. This procedure also is called percutaneous (per-ku-TA-ne-us) coronary intervention, or PCI.

A thin, flexible tube with a balloon or other device on the end is threaded through a blood vessel to the narrowed or blocked coronary artery. Once in place, the balloon is inflated to compress the plaque against the wall of the artery. This restores blood flow through the artery.

Angioplasty can improve blood flow to your heart and relieve chest pain. A small mesh tube called a stent usually is placed in the artery to help keep it open after the procedure.

For more information, go to the Health Topics Angioplasty article.

Coronary Artery Bypass Grafting

CABG is a type of surgery. During CABG, a surgeon removes arteries or veins from other areas in your body and uses them to bypass (that is, go around) narrowed or blocked coronary arteries.

CABG can improve blood flow to your heart, relieve chest pain, and possibly prevent a heart attack.

For more information, go to the Health Topics Coronary Artery Bypass Grafting article.

Cardiac Rehabilitation

Your doctor may prescribe cardiac rehab for angina or after angioplasty, CABG, or a heart attack. Almost everyone who has CHD can benefit from cardiac rehab.

Cardiac rehab is a medically supervised program that can improve the health and well-being of people who have heart problems.

The cardiac rehab team may include doctors, nurses, exercise specialists, physical and occupational therapists, dietitians or nutritionists, and psychologists or other mental health specialists.

Cardiac rehab has two parts:

  • Exercise training. This part of rehab helps you learn how to exercise safely, strengthen your muscles, and improve your stamina. Your exercise plan will be based on your personal abilities, needs, and interests.
  • Education, counseling, and training. This part of rehab helps you understand your heart condition and find ways to lower your risk for future heart problems. The rehab team will help you learn how to cope with the stress of adjusting to a new lifestyle and with your fears about the future.

For more information, go to the Health Topics Cardiac Rehabilitation article.




How Can Heart Disease Be Prevented?

Taking action to control your risk factors can help prevent or delay coronary heart disease (CHD). Your risk for CHD increases with the number of CHD risk factors you have.

One step you can take is to adopt a heart healthy lifestyle. A heart healthy lifestyle should be part of a lifelong approach to healthy living.

For example, if you smoke, try to quit. Smoking can raise your risk for CHD and heart attack and worsen other CHD risk factors. Talk with your doctor about programs and products that can help you quit. Also, try to avoid secondhand smoke.

For more information about quitting smoking, go to the Health Topics Smoking and Your Heart article and the National Heart, Lung, and Blood Institute's (NHLBI's) "Your Guide to a Healthy Heart."

Following a healthy diet also is an important part of a healthy lifestyle. A healthy diet includes a variety of vegetables and fruits. It also includes whole grains, fat-free or low-fat dairy products, and protein foods, such as lean meats, poultry without skin, seafood, processed soy products, nuts, seeds, beans, and peas.

A healthy diet is low in sodium (salt), added sugars, solid fats, and refined grains. Solid fats are saturated fat and trans fatty acids. Refined grains come from processing whole grains, which results in a loss of nutrients (such as dietary fiber).

The NHLBI's Therapeutic Lifestyle Changes (TLC) and Dietary Approaches to Stop Hypertension (DASH) are two programs that promote healthy eating.

If you're overweight or obese, work with your doctor to create a reasonable weight-loss plan. Controlling your weight helps you control CHD risk factors.

Be as physically active as you can. Physical activity can improve your fitness level and your health. Talk with your doctor about what types of activity are safe for you.

For more information about physical activity, go to the Health Topics Physical Activity and Your Heart article and the NHLBI's "Your Guide to Physical Activity and Your Heart."

Know your family history of CHD. If you or someone in your family has CHD, be sure to tell your doctor.

If lifestyle changes aren't enough, you also may need medicines to control your CHD risk factors. Take all of your medicines as prescribed.

For more information about lifestyle changes and medicines, go to "How Is Heart Disease Treated?"




Living With Heart Disease

If you have coronary heart disease (CHD), you can take steps to control its risk factors and prevent complications. Lifestyle changes and ongoing care can help you manage the disease.

Having CHD raises your risk for a heart attack. Thus, knowing the warning signs of a heart attack is important. If you think you're having a heart attack, call 9–1–1 right away. For more detailed information about heart attack warning signs, go to the section on warning signs below.

Lifestyle Changes

Adopting a heart healthy lifestyle can help you control CHD risk factors. However, making lifestyle changes can be a challenge.

Try to take things one step at a time. Learn about the benefits of lifestyle changes, and make a plan with specific, realistic goals. Reward yourself for your progress.

The good news is that many lifestyle changes help control several CHD risk factors at the same time. For example, physical activity lowers your blood pressure and LDL cholesterol level, helps control diabetes and prediabetes, reduces stress, and helps control your weight.

For more information about adopting a heart healthy lifestyle, go to the section of this article titled "How Is Heart Disease Treated?" You also can visit the Health Topics Coronary Heart Disease Risk Factors article for more information.

Ongoing Care

Your CHD risk factors can change over time, so having ongoing care is important. Your doctor will track your blood pressure, blood cholesterol, and blood sugar levels with routine tests. These tests will show whether your doctor needs to adjust your treatment.

Ask your doctor how often you should schedule followup visits and blood tests. Between visits, call your doctor if you have any new symptoms or if your symptoms worsen.

You may feel depressed or anxious if you've been diagnosed with CHD. You may worry about heart problems or making lifestyle changes.

Your doctor may recommend medicine, professional counseling, or relaxation therapy if you have depression or anxiety. It's important to treat these conditions because they raise your risk for CHD and heart attack. Depression and anxiety also can make it harder for you to make lifestyle changes.

Heart Attack Warning Signs

If you have CHD, learn the warning signs of a heart attack. Heart attack signs and symptoms include:

  • Chest pain or discomfort. This involves uncomfortable pressure, squeezing, fullness, or pain in the center or left side of the chest that can be mild or strong. This pain or discomfort often lasts more than a few minutes or goes away and comes back.
  • Upper body discomfort in one or both arms, the back, neck, jaw, or upper part of the stomach.
  • Shortness of breath, which may occur with or before chest discomfort.
  • Nausea (feeling sick to your stomach), vomiting, light-headedness or fainting, or breaking out in a cold sweat.
  • Sleep problems, fatigue (tiredness), and lack of energy.

If you think you're having a heart attack, call 9–1–1 at once. Early treatment can prevent or limit damage to your heart muscle.

If you think you're having a heart attack, do not drive to the hospital or let someone else drive you. Call an ambulance so that medical personnel can begin life-saving treatment on the way to the emergency room.

Let the people you see regularly know you're at risk for a heart attack. They can seek emergency care if you suddenly faint, collapse, or have other severe symptoms.

Living With Broken Heart Syndrome

Most people who have broken heart syndrome make a full recovery within weeks. The risk is low for a repeat episode of this disorder.

To check your heart health, your doctor may recommend echocardiography about a month after you're diagnosed with the syndrome. Talk with your doctor about how often you should schedule followup visits.




Clinical Trials

The National Heart, Lung, and Blood Institute (NHLBI) is strongly committed to supporting research aimed at preventing and treating heart, lung, and blood diseases and conditions and sleep disorders.

NHLBI-supported research has led to a better understanding of how heart disease affects women. Research also has helped doctors learn more about heart disease, its risk factors, and ways to prevent and treat the disease.

The NHLBI continues to support research aimed at learning more about heart disease. For example, NHLBI-supported research includes studies that:

  • Examine heart attack risks and recovery in young women (aged 18–55)
  • Compare coronary artery bypass grafting (CABG) with angioplasty and stenting in patients who have diabetes and blockages in more than one coronary artery
  • Compare CABG with medical therapy alone in patients who have heart failure and coronary heart disease (CHD)
  • Explore whether exercise helps treat depression in people who have CHD
  • Examine how CHD risk factors affect healthy aging
  • Use magnetic resonance imaging (MRI) to evaluate heart vessel function after angioplasty or stent placement
  • Examine the role that hormones play in women's heart disease risk

Much of this research depends on the willingness of volunteers to take part in clinical trials. Clinical trials test new ways to prevent, diagnose, or treat various diseases and conditions.

For example, new treatments for a disease or condition (such as medicines, medical devices, surgeries, or procedures) are tested in volunteers who have the illness. Testing shows whether a treatment is safe and effective in humans before it is made available for widespread use.

By taking part in a clinical trial, you can gain access to new treatments before they're widely available. You also will have the support of a team of health care providers, who will likely monitor your health closely. Even if you don't directly benefit from the results of a clinical trial, the information gathered can help others and add to scientific knowledge.

If you volunteer for a clinical trial, the research will be explained to you in detail. You'll learn about treatments and tests you may receive, and the benefits and risks they may pose. You'll also be given a chance to ask questions about the research. This process is called informed consent.

If you agree to take part in the trial, you'll be asked to sign an informed consent form. This form is not a contract. You have the right to withdraw from a study at any time, for any reason. Also, you have the right to learn about new risks or findings that emerge during the trial.

For more information about clinical trials related to heart disease, talk with your doctor. You also can visit the following Web sites to learn more about clinical research and to search for clinical trials:




Links to Other Information About Heart Disease

NHLBI Resources

Non-NHLBI Resources

Clinical Trials

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™ Keep the Beat is a trademark of the U.S. Department of Health and Human Services (HHS).

® The Heart Truth is a registered trademark of HHS.

 
September 26, 2011 Last Updated Icon

The NHLBI updates Health Topics articles on a biennial cycle based on a thorough review of research findings and new literature. The articles also are updated as needed if important new research is published. The date on each Health Topics article reflects when the content was originally posted or last revised.

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