Cardiovascular conditions where women fare worse and why

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Cardiovascular conditions are often considered to be a problem primarily affecting male patients. However, conditions like heart failure and aortic disease also affect women and can be more deadly when they do.

In the UK, women are twice as likely to die from heart disease as they are from breast cancer. During pregnancy, women are at an increased risk of aortic problems because of the extra stress on their bodies. Tragically, aortic dissection causes 11% of maternal deaths.

Delays in seeking medical attention, symptoms being missed and treatment not being designed for women’s bodies are all factors in women receiving worse treatment than men for the same cardiovascular conditions.

Heart disease and heart attacks

Every year, 30,000 women are admitted to hospitals in the UK with a heart attack. Yet, women have a 50% higher chance of getting a wrong initial diagnosis than men.

The most common symptom of a heart attack is the same for both sexes: chest pain and discomfort that doesn’t go away. As well as this, women are likely to have other symptoms less obviously linked to their heart. These include chest pain that spreads to the jaw, neck, back, stomach, or one or both arms. Feeling faint, dizzy and nauseous is more common in female patients too.

For clinicians who are not aware of the differences in how women can present with heart failure, these symptoms can be misleading and result in the wrong diagnosis. Sadly, women whose heart attack is missed at first have a 70% higher chance of death.

Aortic aneurysm

While most aortic aneurysms (a swelling in the body’s main artery which can rupture) occur in male patients, research has found that when female patients do have aneurysms, they grow faster, are four times as likely to rupture and three times as likely to be fatal.

Female patients have fewer aortic aneurysms because the hormone oestrogen naturally protects against it. Because of this, when women do present at Emergency Departments with aortic disease, they tend to be in a worse condition. This makes it all the more important for clinicians to consider aortic aneurysm and perform an urgent CT scan to either confirm it or rule it out.

Where an aneurysm has been identified on a CT scan, the swelling can be repaired surgically before it ruptures and becomes an emergency. The standard threshold for operating to repair the swelling (before it ruptures) is when it reaches 5.5cm in diameter (or larger). This standard fails to recognise that women have smaller aortas to begin with. By waiting until the swelling reaches 5.5cm before intervening, an aneurysm in a female patient is actually more advanced and closer to rupture by the time repair surgery is considered. This may explain why women are at a higher risk of dying after repair surgery.

Aortic dissection

Symptoms of aortic dissection are similar in both male and female patients. These include a sudden painful tearing sensation, shortness of breath and stroke like symptoms. However, again there are other symptoms more often seen in female patients when they are having this life-threatening problem. Clinicians should be able to recognise these.

Female patients suffering aortic dissection are more likely to have low blood pressure and feel faint. Being in a state of shock or having an altered mental state is also more common in women having aortic dissection. This can create a barrier in communication between the doctor and patient, making a quick diagnosis more difficult.

For more information on aortic emergencies, please read our other article here: [link to Jackie’s aortic emergencies article]

Why are women getting worse treatment?

Unfortunately, it is not a new issue that women fare worse with treatment for cardiovascular conditions.

Historically, women have been underrepresented in the clinical studies and trials that shaped modern medicine. It is thought that researchers over the past decades excluded female participants from their studies out of fear of hormonal fluctuations and pregnancy skewing their results. Research into heart health has largely been by men, for men, with treatments developed being based on male bodies as a result.

Both clinicians and patients may also have the perception that heart attacks and aortic disease are problems typically seen in middle aged, overweight men. Having a low suspicion of heart attacks means that women wait longer to go to A&E. Once in hospital, they wait longer in A&E and receive less thorough investigations. All of this causes delay in diagnosis and treatment, and reduces women’s chances of getting better.

Middle aged female patients are particularly prone to being misdiagnosed with mental health conditions when they are actually having heart failure. Patients having heart attacks can have symptoms that feel like a panic attack, and so clinicians should carry out tests and investigations (like an ECG) before mistakenly making mental health central to their diagnosis and potentially missing something lethal.

Experts have urged that more research is needed into women’s heart health and aortic disease to improve survival and patients’ outcomes. There have been recent breakthroughs which give some hope; for example, researchers have developed a higher sensitivity troponin test for heart attacks which doubled the amount of women diagnosed as having one.

In the meantime, women are urged to stand up for themselves; if they think they are having a problem with their heart or aorta, make this clear to staff and request a scan. It may just save their life.

We’re here to help

Enable Law’s specialist team is experienced with claims for women who have not received the correct cardiology treatment, or fast enough treatment for cardiovascular problems and have been injured or lost their lives as a result.

If you have concerns about treatment that you or a loved one have received, please get in touch.

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