Ask Us Anything About… Heart Attacks – Men vs. Women

A woman sits on a couch using a blood pressure cuff. A man sits near her, looking on.

Heart disease is the leading cause of death in both women and men. That grim truth points to something the genders have in common. However, there are a lot of differences in men vs. women in the symptoms, treatments and outcomes of some common heart diseases. We learn more about those distinctions — and the importance of them — from Dr. Lenke Erki, a cardiologist at Penn State Health Holy Spirit Medical Center.

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Scott Gilbert – Ask Us Anything About Heart Attacks in Men Versus Women. I’m Scott Gilbert. Well, heart disease is the leading cause of death in both women and men. That grim truth points to something that genders have in common. However, there are also a lot of differences in men versus women in the symptoms, the treatments, the outcomes even of some common heart diseases. Here today to help us understand those distinctions and the importance of them and to take your questions is Dr. Lenke Erki. She’s a cardiologist at Penn State Health Holy Spirit Medical Center. Thanks so much for being here, Dr. Erki. Very glad to be talking with you. You know, first, some people may be wondering, other than the fact that, okay, February is heart month, why is it important for us to talk about and understand the differences in heart disease in men versus women?

Dr. Lenke Erki – Well, thank you, Scott, for inviting me. My pleasure. Number one is heart attacks occur both men and women. And it’s very important to recognize first the symptoms, as well as prior to having a heart attack, preventing a heart attack, risk factors. However, there are certainly differences between men and women. And I’m sure later on we can elaborate on but one major difference is that structurally women have smaller arteries. In addition, they have additional risk factors than men. For example, pregnancy.

Scott Gilbert – Yeah, for sure. And I was going to say, why are women more likely than men to die of a heart attack? Because I’ve heard those numbers are quite different.

Dr. Lenke Erki – Well, let me say at least good news that we have come a long way. But historically women were not really recognized as having a heart attack because as I will elaborate maybe later on the difference in symptoms. The way I always put it, with women, anything goes. So, many times women presented a lot later when it was too late. So, certainly the mortality was higher in women than men. So, that’s one reason.

Scott Gilbert – Yeah, definitely want to get into some of those symptoms. But you mentioned before structurally too some things are different there. I mean, let’s start with what we have in common. Hearts are basically the same, right? We’re talking atria and ventricles, so at least we have that in common, right?

Dr. Lenke Erki – That’s correct. However, the large sum difference is, as I mentioned, that women’s arteries tend to be smaller. And when we actually come to intervening on these arteries, when, you know, we find that plaque, the complications can be higher because we’re dealing with smaller arteries. Secondary are heart attack. So, you know, the conception is that heart attacks come from a plaque formation, which is cholesterol buildup. However, in women, these are, this cholesterol buildup can happen actually both in men and women in the large as well as in small arteries. However, women tend to have more buildup in the smaller arteries. And that is just as serious heart attack as what we call the big arteries. In addition, women tend to have the stress induced cardiomyopathy. Or it used to be called syndrome X, you know, a couple years ago, where some unexpected stress occurs in that either men or women’s life, and they come in with a heart attack, but women tend to have that kind of a heart attack more often than men.

Scott Gilbert – On that point, do we know why that physiological difference is the case, why women tend to manifest stress differently in that regard?

Dr. Lenke Erki – The speculation is that while there are a couple theories out there that there’s still a plaque formation, but it dissolves very quickly because many times when we do a heart characterization on these patients, we don’t find anything. The blood is flowing greatly, yet we see the tracing abnormalities. Another speculation is that it has to do with hormonal releases, stress, related to stress, which is different in men and women.

Scott Gilbert – You’re watching Ask Us Anything About… Heart Attacks in Men Versus Women. I’m Scott Gilbert alongside Dr. Lenke Erki. She’s a cardiologist at Penn State Health Holy Spirit Medical Center. And we welcome your questions for her in the chat. Feel free to drop any of your questions or comments in there, and we will make sure that we get to those here, whether it’s in the live interview, or even if you’re watching this interview on playback, we can get you a written response in the comment. So, should we dig a little bit deeper, doctor, on the risk factors? Because I feel like there’s a list of risk factors that women, or that men have, and women face all those same risk factors plus several more. That doesn’t seem fair.

Dr. Lenke Erki – Well, I think it’s by nature. But let me just mention a couple common risk factors, which, you know, we all hear, which is the high blood pressure, the high cholesterol, the diabetes, smoking certainly. Now, women, in addition, not to mention, let me go back to the common risk factors, because some of them can be changed and some of them unfortunately not. And the ones that we cannot change as well are, I’m going to mention gender, which is not quite true anymore. Second is age. And certainly, your family history. Those things you cannot change. So, these risk factors are common. However, women just in getting pregnant face another risk factor, because during pregnancy they have high blood pressure, they have high blood sugar, that can signal later on in life diabetes as well as the onset of high blood pressure. Third more, what we realize is that a lot of these inflammatory diseases, for example, Rheumatoid arthritis, is a risk factor, which, again, certainly can be both men and women. But between men and women, the major risk factor is pregnancy. The other major risk factor is the peri and postmenopausal state. As you know, estrogen, you know, women have that estrogen protection. Once they lose it, their risks go up.

Scott Gilbert – So, yeah, talk about that. When you say pregnancy as a risk factor, at what stage? Are you saying during pregnancy, after pregnancy, just all throughout?

Dr. Lenke Erki – During pregnancy at any time if, you know, the pregnant person or pregnant, I shouldn’t call it a patient because it’s not a disease, but a pregnant woman develops high blood pressure or high blood sugar, which can happen at any stage of the pregnancy, that can be diagnosed early, that can be diagnosed in third trimester, which I’m sure you are familiar with preeclampsia, which is, you know, high blood pressure, or high blood sugar, you know, pregnancy induced or onset diabetes, high blood sugar, which certainly can diminish after the child is born, but it signals an onset of diabetes and high blood pressure later on in life.

Scott Gilbert – You’re watching Ask Us Anything About… Heart Attacks in Men Versus Women. I’m Scott Gilbert, alongside Dr. Lenke Erki. We welcome your questions and your comments. Just make sure you add those in the comment field here on this Facebook post, and we will make sure that we get to as many of those as we can. Can we talk some more about symptoms some of the things that indicate someone is having a heart attack? As you kind of hinted at earlier, there’s some that both genders share. But, again, there are some that are a little bit stealth that women may experience and they may not realize that it’s a warning sign of a heart attack, right?

Dr. Lenke Erki – That’s correct. You know, again, both genders can experience, and the most familiar are I think we are with is chest pain, or angina. The other is shortness of breath. Now, I’m going to point out shortness of breath is actually a more frequent presentation in women than in men. We do not know why, but it is. Now, in women, as I mentioned earlier, anything goes. The symptoms are for reflux, which men tend to ignore when you ask are you having chest pain, no, I’m having GERD, GERD or reflux, you know, can be our presenting sign. However, with women, like a keep emphasizing, low threshold, anything goes. For example, shoulder pain, back pain, arm pain, headache, or just tired and fatigued. And many times that is why women are kind of told that, well, you know, you’re working hard, you have a lot on your shoulder. Yes, you’re tired and fatigued. So is everybody. That can be the only presenting symptom in a woman for a heart attack.

Scott Gilbert – So, so, as a cardiologist, that must mean that when trying to diagnose a heart attack, you have to take gender into consideration. And does that mean that there are different tests that you do, depending on gender?

Dr. Lenke Erki – No, absolutely not. The testing is pretty much the same. It’s really the emphasis is on the history and the recognition of that symptom. Coupled with certainly when you take the history, you take the risk factors into account, family history, and all that. So, you kind of develop a risk score. We have a scoring system that they use in the emergency room. We use it. And that gives us an idea, okay, what is the likelihood of these symptoms actually signifying a heart attack? Or a heart problem, I should say.

Scott Gilbert – Given that the list is so long, especially for women, of things that may or may not be a heart attack, is it common that people just kind of think this is going to pass, they kind of explain it away?

Dr. Lenke Erki – Oh, extremely common.

Scott Gilbert – Then live to regret it?

Dr. Lenke Erki – Yes, extremely common. And unfortunately, both genders. Men tend to do it the same way like I mentioned, reflux, it’s not just being I’m just having reflux, and for months and months they, you know, what they just don’t say anything to their loved ones or to anybody, yes, it’s very common to ignore the symptoms.

Scott Gilbert – All right, so with that in mind then, what’s your advice for people on when to call 911? And as a side note, I say that very deliberately because people should always call 911 rather than try to drive themselves to the ER if they think they’re having a heart attack, correct?

Dr. Lenke Erki – Absolutely, you are right. My advice is, number one is that be familiar with the symptoms. Be familiar with women’s symptoms, because your wife or your daughter or your mother might be the person who is experiencing new symptoms. So, and I know the American Heart Association puts out a very nice educational pamphlet, you know, regarding recognizing symptoms of heart attack. So, be familiar with those. The second is definitely if you even suspect that this might be a heart attack, call 911. Do not drive yourself, or do not even waste the time to drive your loved one, because that person might need immediate care which they can initiate in the ambulance.

Scott Gilbert – Great points, including about the American Heart Association and their information on their Go Red for Women page. We actually have a deep link we’re going to share in the comments here to that very page that you’re talking about, Dr. Erki, where the Heart Association explains the symptoms of heart attacks in men versus women. And as partners of the American Heart Association and their God Red for Women initiative, it’s definitely something we wanted to share as a very valuable resource to help people learn more about this important issue. So, steps to prevent a heart attack. Regardless of gender, are they pretty much the same things here in terms of mitigating risk factors? Because it seems like it does come down to a lot of the same things regardless, correct?

Dr. Lenke Erki – Yes, that is correct. Heart attacks or heart disease in general is 80% preventable. So, steps, number one is know your numbers. That’s what I always tell my patients. Know your blood pressure, know your cholesterol numbers, know your sugar numbers. So, those are very important numbers to keep in mind because they are major risk factors for heart disease or heart attack. Know your family history if you can. Do not smoke. Watch your diet. You know, we recommend, we don’t really endorse any diet, but we do recommend the low cholesterol, and that Mediterranean diet has gotten a lot of good results and reviews in the cardiac literature that we recommend. So, these are the things you can do, steps to take, certainly exercise is a major one. Get out even in a form of just walking. You don’t need to get on a treadmill or elliptical. Any form of exercise, keeping active is very important for the heart. Smoking I mentioned. Moderation, or even less alcohol. Alcohol has been in the literature lately because we used to say that moderate alcohol consumption is good for your heart. Now we are getting away from it because we’re realizing that even small amount of alcohol is not really good, not just for the heart, but for other reasons. But there is a rhythm that I would like to mention which is very important, atrial fibrillation, which is very closely related or connected to alcohol consumption.

Scott Gilbert – Oh, so there is a link between atrial fibrillation, that irregular heartbeat, and alcohol consumption in some people?

Dr. Lenke Erki – Yes. Well, it’s we recognize now that alcohol and amount of alcohol or even small amount of alcohol can have onset atrial fibrillation or people who already have atrial fibrillation, but let’s say we converted them back to normal, it can, again, revert back to atrial fibrillation. So, yes, there is a link between alcohol consumption and certainly a lot of other things and atrial fibrillation.

Scott Gilbert – And, you know, throughout all this, we’ve been talking about the differences in heart attacks in men versus women, but we go back to that number one point at the beginning, and that is what the genders have in common is that heart disease is the leading cause of death in both men and women. And that leads me to an interesting factoid you threw out there, and I want to underscore it. You said 80% of heart attacks are deemed to be preventable.

Dr. Lenke Erki – That is correct.

Scott Gilbert – Right? By mitigating those risk factors you just discussed, I imagine, right?

Dr. Lenke Erki – Yes, yes, yes. Even the risk factors like family history, you cannot change it, but you can modify it. You can modify it by not smoking, by knowing your numbers, by, you know, not drinking or drinking, you know, minimally, and, you know, those risk factors can be modified.

Scott Gilbert – Very important advice for a heart month and for all year round. Dr. Lenke Erki, thanks so much for your time today.

Dr. Lenke Erki – Thank you very much. My pleasure.

Scott Gilbert – Sure. Dr. Erki is a cardiologist at Penn State Health Holy Spirit Medical Center. And we thank her for her time. We thank you for watching. And if you found this information helpful as we hope you did, we hope that you’ll also share this through your Facebook feed to help this important, this important information reach more people again during this heart month. Thanks so much for watching Ask Us Anything About… Heart Attacks in Men Versus Women from Penn State Health. I’m Scott Gilbert.

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