While heart disease is often considered a man’s disease, it doesn't discriminate. It's the number one killer of both men and women in the United States.

Yet, many women may not be aware that heart disease is as big of concern for them as it is for the men in their lives. An estimated one in four women will die from some form of heart disease, and they often have unique risk factors and symptoms.

At Yale Medicine, an interdisciplinary team of doctors and experts is devoted exclusively to women’s cardiovascular health. Their goal is to empower women to know their risks, take steps to protect their hearts, seek treatment when needed and live their healthiest lives.

Cardiovascular disease (often called heart disease) is an umbrella term that includes many different conditions. Here are some of the most common types in women:

• Coronary artery disease: The most common type of heart disease in the United States, and a leading cause of heart attacks, it occurs when arteries become clogged with plaque and the heart can’t get enough blood.
• Arrhythmia: These conditions, such as atrial fibrillation or atrial flutter, are characterized by an irregular heartbeat.
• Diseases of the heart valves: Common valve diseases include mitral valve prolapse, mitral regurgitation, and aortic stenosis.
• Microvascular disease: This is caused by plaque in the small vessels that supply the heart muscle, which causes angina (chest pain). It's a more common problem for women than men.
• Cardiomyopathy and congestive heart failure: These are conditions caused by the backup up fluid into the lungs due to improper functioning of the heart.  
• Congenital heart defects: This term describes structural heart problems present from birth. Examples include abnormally formed heart valves or holes in the septum, which is the dividing wall between the right and left sides of the heart.
• Broken heart syndrome: This is the name used to describe a temporary condition that occurs when stressful or surprise situations cause sudden chest pain and tightness. It’s more common in women than men.

Many symptoms of heart disease are the same for men and women, but women also have others that are not as obvious or typical.

Among both sexes, the most common symptoms for several types of heart disease are:

• Chest discomfort or pressure, described as feeling like an elephant is sitting on the chest
• Unexplained shortness of breath
• Severe fatigue, known as “vital fatigue,” or fatigue that interferes with activities of daily living, such as making a bed.
• New feelings of chest discomfort or shortness of breath while exercising
• Nausea
• Lightheadedness
• Pain radiating down the left arm or into the jaw
• Heart palpitations 
• Swelling of the legs, feet, and abdomen

But not everyone with heart disease has all (or even most of) these symptoms, especially not all women.

“You can get the shortness of breath or the nausea without the chest discomfort,” says Lisa Freed, MD, director of the Women’s Heart and Vascular Program, a part of Yale Medicine’s Heart and Vascular Center. “Or you can get chest discomfort at times of extreme emotional stress, or chest discomfort that wakes you up in the middle of the night.”

Women are also more likely to feel sharp, burning pain in their chest, and to have pain in the neck, jaw, throat, stomach, or back. These are called "atypical symptoms."

Some risk factors for heart disease can’t be controlled, but many of them can be kept in check with diet, exercise, medication (if needed), and a healthy lifestyle. 

Common risk factors for women include:

• High blood pressure
• High cholesterol
• A sedentary lifestyle
• Being overweight or obese
• A family history of heart attacks or heart disease
• Age (The older you are, the higher your risk. However, women generally develop coronary artery disease 10 years later in life than men, unless they have diabetes.)
• Cigarette smoking

That final risk factor, cigarette smoking, is an even bigger danger to women than men—especially to young women. “A pre-menopausal woman who smokes is at a significantly increased risk for a heart attack,” says Dr. Freed. 

It’s also important to note that type 2 diabetes is considered an indicator of the presence of underlying cardiovascular disease. It is thought that if a woman has diabetes before menopause, it strips away the 10-year advantage that women have over men with respect to coronary artery disease.

Women who are concerned about their heart health can schedule a visit to Yale New Haven Health Women’s Heart & Vascular Program. At their first appointment, they will fill out a questionnaire and have a discussion with their doctor about their medical history, their diet and exercise habits, and any symptoms they may be experiencing

“We want them to know that they’re being listened to—that they tell us their symptoms and we take them seriously,” Dr. Freed says. The goal, she says, is to give women a diagnosis as soon as possible. “Either they end up finding that their cardiovascular health is good,” she says, “or we find risk factors that need to be managed, or we find coronary artery disease, or an arrhythmia that needs to be treated.”

Doctors also check patients’ blood pressure (using a blood-pressure cuff) and their cholesterol and blood glucose levels (using a blood test). Because abnormal levels are such important risk factors for heart disease, it is important for patients to know what these test results mean.

“We try to empower women to take control of their health and to know what their numbers are so that they can be treated more effectively," says Dr. Freed.

If a doctor suspects heart disease, he or she will order tests that may include:

• Electrocardiogram (EKG): Sticky patches connected to electrical wires (called electrodes) are attached to various spots on the arms, legs and chest. These patches record your heartbeat as it travels throughout the body. They may show whether the cardiovascular system has been damaged by heart disease or a heart attack.
• Stress Test: This test involves wearing electrodes while exercising (walking or jogging) on a treadmill. Another version uses chemicals to mimic the effects of exercise on the heart. These can be associated with echo, nuclear, PET or MRI technology.
• Echocardiography: This test uses sound waves to create a video of your beating heart. It can show the size and shape of the heart, and whether certain parts have been damaged.
• Computerized tomography (CT) angiogram of the coronary arteries: This is a special kind of CT scan that directly visualizes the coronary arteries.
• Cardiac MRI: This test looks at the structure of the heart in a more detailed manner than echocardiogram.
• Coronary Angiography: A dye is injected into the coronary arteries so that they show up better on special X-rays. Doctors can use these to trace the flow of blood through the coronary arteries and identify blockages.

Depending on the type of heart disease a woman has, her treatment options can vary. Here are some common recommendations:

Lifestyle changes: Following a healthy diet, starting a regular exercise routine, and quitting smoking can improve heart symptoms while also helping to prevent future problems.

People who have or are at risk for heart disease should limit how much salt, fat and added sugar they eat. They should also avoid drinking too much alcohol. For women, small amounts of alcohol may help keep the heart healthy, but more than one drink a day, on average, seems to have the opposite effect.

Medications: If a woman has high blood pressure and/or high cholesterol, medications can be prescribed to lower them and reduce her risk for further complications. A woman with or at risk for dangerous blood clots may also be prescribed daily blood thinning medications.

Interventional or surgical procedures: If a patient has a blockage in her arteries, she may need to have a medical procedure to repair the problem. For example, invasive cardiologists can use tools to open up blocked arteries. Surgeons can construct bypass routes for the blood to flow around the blockages.

Cardiac rehabilitation: Doctors may also prescribe cardiac rehabilitation to heart disease patients. This program includes regular meetings with cardiologists, exercise physiologists, nutritionists, and other health professionals. The goal of these meetings is to help patients strengthen and heal their hearts and develop healthy habits for the rest of their lives.

Because heart disease is often thought of a man’s disease, many people—even many doctors—don’t recognize that women are just as much at risk.

“That is not the case at Yale Medicine,” says Dr. Freed. “We’ve worked very hard over the past 17 years to make it a priority that when a woman came into the emergency room with chest discomfort, that she gets equal and immediate treatment just as a man would.”

Having a program dedicated solely to women’s heart and vascular conditions has allowed physicians at Yale Medicine to become world-class experts in this field. We are experienced in diagnosing and treating even rare forms of heart disease in women and have access to the most cutting-edge tools to assist them in doing so.

The Yale New Haven Health Women’s Heart and Vascular Program also engages in clinical research. This is especially important because historically, many of the large studies on heart disease have been done primarily on men.

Patients may have opportunities to try new treatments before they’re available elsewhere or be involved in clinical trials that may one day save other women’s lives.