The women’s heart underestimated? Whoever visits the Dutch Revascularzation & Electrophysiology Summit would not say it. The room is packed in the Nijkerk Congress Center Hart van Holland. To create enough space for the hundreds of cardiologists, heart surgeons and nurses, seats still have to be dragged. Normally it is always fairly quiet on the Friday morning of the two-day congress, says the Alkmaar cardiologist and co-organizer Raymond Hautvast. “Then we had the barbecue the night before … but no one wanted to miss this session.”
Yet that attention is far from self -evident, Yolande Appelman, intervention cardiologist at Amsterdam UMC, emphasizes. For years she has argued for more attention for cardiovascular diseases in women. Together with colleagues, she wrote a book about it, founded a gender working group and has made hundreds of heart catheterizations in women over the years. “But too often, women’s complaints are not recognized.” And that while no less than one in five women in the Netherlands dies of cardiovascular disease.
To attract extra public, the session is set up in a big way, as a talk show with doctors and patients. Moderator Eva Jinek tells at the start how she herself suffered twice with pregnancy poisoning- an important risk factor when it comes to high blood pressure and associated heart disease. At the table at the table, in addition to Appelman, Jeanine Roeters van Lennep, internist vascular medicine at the Erasmus MC and Tim van de Hoef, intervention cardiologist at UMC Utrecht.
How is it that cardiovascular disease often expresses themselves differently in women? What symptoms are there? And what can you do about it? Five lessons about the women’s heart.
1The X chromosome plays a crucial role
Anyone who puts a human heart on the cutting table cannot just see if it comes from a man or a woman. Yes, in general a women’s heart is a bit smaller and the walls are often a bit thinner and the barrels narrower, but otherwise there is no clear difference anatomically.
Nevertheless, cardiovascular disease often expresses themselves in women than in men: other symptoms occur and some disorders, for example, are much more common in women than in men. These differences mainly have a genetic cause, says Appelman. “A woman has two x chromosomes, a man one x and one y. and it is precisely the X chromosome that is strongly focused on the immune system. This initially makes women in favor, until they get into transition.” The production of the hormone estrogen decreases, while that hormone protects the inside of the vascular walls well. And so women start with a bitter ‘catch-up’ from about 40 years old when it comes to cardiovascular disease.
According to recent figures, there are more than 720,000 women in the Netherlands who suffer from a form of cardiovascular disease. Chronic diseases that they sometimes live through for half a century, because women die at older age from cardiovascular disease than men. Or like Appelman and Roeters van Lennep it in their book The Women’s Heart articulate: One that quicker, but women get sicker.
2Not everything revolves around chest pain
In the 1980s it was mainly men who died of cardiovascular disease, now it is the other way around. Sometimes this involves female-specific disorders such as the Tako-tsubo cardiomyopathy, also known as ‘broken heart syndrome’. In addition, in cases of severe stress, for example after the death of a beloved person, acute heart failure can occur: the blood is no longer pumped around, sometimes with fatal consequences. The precise physical cause is still unknown, but stress hormones may cause a sort of paralysis of the heart muscle. “90 percent of patients with syndrome are women,” says Appelman. “You see it especially with women after the menopause.” The name Takotsubo refers to Japanese pots to catch squid: in affected patients, the left room of the heart looks like such a pot.
In comparison with such a specific syndrome, a heart attack is much more famous and general. But the risk that it is not always recognized in time in women.
“A pressing, pinching pain in the heart region with appearance to the left shoulder: that is the classic image of a heart attack,” says Van de Hoef. One of the coronary arteries around the heart is blocked, so that insufficient oxygen -rich blood can reach the heart muscle. That can lead to a cardiac arrest, where the heart completely stops beating and you get out of knowledge in a few seconds. Coronary obstruction, cardiologists call such a blockade of the coronary artery: the blood vessel has become hidden, for example through artery sales.
But there is not always such an obstruction, says Van de Hoef. “There may also be a reduced blood supply without vasodilation taking place in the coronary arteries – because only the capillaries around the heart are hidden, or because vascular spasms occur: sudden, temporary contractions.” This is relatively common in women. “Sometimes chest pain arises, but that is not necessary. Symptoms are often different from the textbooks. Think of pressure between the shoulder blades or shortness of breath and often extreme fatigue.”
It is important that general practitioners and cardiologists always take a patient seriously, Appelman emphasizes. “Too often such complaints are waved away under the guise of stress or sleep deprivation. Doctors soon say ‘you have nothing’ if they cannot find the cause. While they can better say: something is wrong, but I don’t know what.”
3Women are not little men
Often medicines are prescribed, but they do not always work. In such a case, a coronary job test can offer a solution, says Appelman. “In addition, we consciously arouse cracks of the coronary arteries, to see if spasms occur, for example.” But such a test is not entirely without risk, and there is not always a solution available. “Sometimes an adapted lifestyle is the best motto, and that may mean that someone has to stop working or exercising intensively. The consequences are sometimes very drastic, while from the environment there is not always understanding. Then a woman hears her boss: we are all tired sometimes.”
Even when it comes to the dosage of medication, too little distinction is made between men and women. “In the best case, a small woman gets a lower dose than a tall man,” says Appelman. “But women are not simply small men; there must also be much better look at the precise influence of that medication in a female body. Are there interactions with hormone balance, is it safe to give a certain medicine during pregnancy? In many cases that is not even known.”
4Pregnancy is a stress test for your body
From the menopause, 80 percent of Dutch women have at least one risk factor that increases the risk of cardiovascular disease. “For example, that can be stress, or overweight. And very often smoking is the culprit,” says Appelman. But there are also female -specific alarm signals, including an early transition or migraine attacks with a so -called ‘aura’ of light flashes or colored spots on the retina. “In such a case, doctors must be extra alert.”
This also applies to pregnancy -related disorders, Roeters van Lennep adds. “Think of premature birth or repeated miscarriages. You can see pregnancy as a stress test for your body. How does your heart react if it has to work extra hard?”
A common risk factor is pregnancy poisoning or pre-eclampsia. There is a high blood pressure and sometimes damage to organs occurs. “A year after the birth, half of the women with severe pre-eclampsia still have too high blood pressure, but aftercare is hardly there-while you actually have to continue to monitor that blood pressure.” That is why she also regularly holds consultations in Erasmus MC for women who have undergone serious pre-eclampsia.
5The women’s heart does not exist
Finally: thinking in boxes is counterproductive. Even those who are born organic as a man but feels a woman or vice versa must feel heard in the consultation room. And moreover, Van de Hoef says: “It is not that an infarction in men is always accompanied by chest pain. More important than talking in terms of ‘men’s heart’ and ‘women’s heart’ is that we as cardiologists make the right diagnosis, and that a patient does not feel a threshold to talk about complaints.”
Or as Appelman puts it: “In the end you of course hope that the care for all patients is so good that the term women’s heart becomes completely superfluous.”