MedStar Health Blog

When it comes to heart disease, men and women are not equal. Most of what we know about heart disease, and how we approach it today, is still largely based on research studies that originally focused on men. Not long ago, researchers assumed their study insights would apply to women as well. But newer studies are showing us that women’s heart health—and how women develop and experience heart problems—can be much different than that of men. Additional research is under way, at MedStar Health and other centers, but here are a few learnings that women and their doctors should know now.

1. A woman’s heart is physically different than a man’s.

In general, women have smaller hearts and blood vessels. In addition, women tend to develop plaques (waxy substances) in their vessels that look and behave differently than the build-ups and blockages we typically see in men.

This could make women more likely to develop different kinds of heart trouble than men usually experience. In particular, we think women may be more prone to developing coronary microvascular disease, in which damage to the inner walls of the smaller blood vessels can lead to spasms and decreased flow of blood and oxygen to the heart muscle.

Both arterial blockages that are more common in men and small-vessel coronary disease are serious and can cause the same symptoms, including chest pain and shortness of breath. The latter can be harder to detect with traditional tests.

2. Women may need different diagnostic tests than men.

Doctors often recommend a stress test and sometimes an imaging study called a coronary angiography to diagnose classic symptoms of heart trouble. While these are good at finding blockages in the large coronary arteries, they aren’t necessarily designed to detect the coronary microvascular disease that women are more apt to have.  So their symptoms may be dismissed.

If you continue to experience chest pain or shortness of breath after tests like these come back as “normal” or “nothing to worry about,” consider getting a second opinion. Choose a cardiologist who specializes in women’s heart health or is otherwise part of a specialty heart center, like MedStar Heart & Vascular Institute.  Other diagnostic tests, such as a cardiac PET scan or cardiac MRI, may be needed. These specialized tests are not available everywhere.

3. Women’s heart attack symptoms are often different than men’s.

Severe chest pain can be a sign of heart attack in both men and women. But women are much more likely to have subtle symptoms that are easier to ignore. These include:

• Chest discomfort that travels to your arms, neck, or upper back
• Sudden shortness of breath
• Nausea or vomiting
• Sweating
• Lightheadedness or dizziness
• Extreme fatigue
• Indigestion

If you experience signs like these, don’t hesitate to call 911 and get to an emergency room. Fast action can prevent extensive heart damage and even save your life.

4. Women have unique risk factors for heart disease.

Both sexes share the most common risk factors, including high blood pressure, high cholesterol, obesity, and type 2 diabetes. Women, however, have additional risk factors that men never or less commonly experience. Be sure to tell your doctors if you’ve had any of the following, so they closely monitor your heart health:

Early menopause: A recent study found that women who reached menopause earlier than age 50 had an up to 40% greater risk for cardiovascular disease than women who became menopausal in their early 50s, as is most common. A drop in the heart-protective hormone estrogen that occurs with menopause probably explains some of this elevated risk.

Chronic inflammatory diseases: Women are more likely to have many of these conditions, including lupus, psoriasis, and rheumatoid arthritis, which also raise the risk for heart disease. Ongoing low-level inflammation can irritate the blood vessels and may promote plaques and blood clots that can put the heart and vessels at risk.

Breast cancer treatment: Women (and men) who have undergone radiation or chemotherapy treatment to the breast area may experience more heart problems as a byproduct of these treatments. A recent study also found that women who have had breast cancer were also more likely to develop other conditions that increase heart risks, including diabetes, high triglyceride levels (fatty molecules in the blood), and atherosclerosis (stiffening of the arteries).

Pre-eclampsia: An estimated 6%–10% of women develop this dangerous increase in blood pressure late in pregnancy, which significantly increases the risk for hypertension, heart disease, and stroke later in life, even if their blood pressure returns to normal after delivery. 

How to Keep Your Heart Healthy

• Quit smoking or don’t start
• Get regular exercise. At a minimum, walk around at least 30 minutes per day 
• Eat healthy, including plenty of fruits, vegetables, whole grains, and fish or lean meat. Limit processed foods, salt, added sugars, and saturated and trans fats 
• Know your numbers. Maintain a healthy weight, blood pressure, cholesterol, and blood sugar level through lifestyle and any medicines your doctor has recommended 
• Limit your alcohol to no more than one drink per day

Learn more by taking our women’s heart disease risk quiz.

Cardiovascular medicine has been changing at an incredible pace over the past 25 years. But the 2020s may prove to be the most progressive and exciting decade yet. From new drugs and surgical devices coming our way, to new ways of monitoring and caring for our patients, a compelling wave of breakthroughs in technology and medicine is already breaking at MedStar Heart & Vascular Institute. That’s great news for our patients, who will benefit from increasingly personalized care and new treatment approaches that can help them live longer and better.

Here are just some of the innovations in cardiology that our heart health team—and patients—can look forward to:

Expanded Use of Telehealth in Cardiology

Think of it as a virtual house call! Telehealth services let you use live video on your computer or mobile device to connect remotely with your doctor or other care provider. As we gradually expand these services, patients will find greater convenience and more opportunities to share information with their doctor.

Although some medical appointments are better handled in person, telehealth can make simple consults, or even post-treatment follow-ups, accessible from home. Telehealth also encompasses use of patient portals, where you can access records and results and send requests directly to your care team. It includes a growing array of monitoring devices you can wear or use at home to record and transmit health information to your doctor. It’s even enabling primary care providers to virtually consult with specialists within and beyond their hospital networks.

In the years ahead, I’d expect telehealth might even connect small community-based care providers—like local pharmacies or urgent care centers—with the higher-level medical expertise provided by larger healthcare centers. At MedStar Heart & Vascular Institute, we’re already using an array of telehealth services across various specialties, and this month, we’re introducing Telehealth Cardiology visits for routine follow-up heart care at one of our centers. We anticipate that it will become standard across MedStar Heart entities very quickly.

New and Improved Health Monitoring Devices and Diagnostic Tests

We continue to see inspiring developments in non-invasive diagnostic tools. These include new blood tests that can identify treatable biomarkers and genetic mutations associated with specific heart problems, new imaging options such as imaging inflammation in the heart, and improved versions of traditional imaging tools such as cardiac MRI and CT scans that we’ve used for years. These will continue to transform what we do in cardiovascular medicine over the next decade.

The benefit? Your doctor won’t just be able to tell you what’s wrong, he or she will also use the tests and the enhanced information they provide to determine the best way to treat you. We’ll also be able to cross-reference your test information with a rich database of health outcomes data and make very accurately informed decisions about how to best approach your heart health and achieve the best possible outcomes.

In addition, over the next decade, watch for greater use of personal digital monitoring devices that allow you to continuously track and monitor your own health signs—like heart rhythm and blood pressure—and transmit them to your healthcare providers. That capability will increasingly enable both doctors and patients to identify or predict potential problems, even before symptoms occur. Thanks to innovations in technology and wireless communications, we’ll benefit from a wave of personal monitoring and diagnostic devices that are becoming smaller, easily implantable, and even more comfortable to wear.

New Treatments That Improve Heart Health Outcomes

Extraordinary breakthroughs in new cardiac drugs and devices will alter how we handle treatments over the next decade as well. There are more than I can possibly cover in this post, but, in general, we’ll see drugs that improve outcomes in treating and preventing heart disease, and new devices made simpler and safer while delivering the same excellent results.

I’m particularly excited about the advances we’re already seeing in cholesterol management with new adjunct drugs entering the market, including the recently approved prescription fish oil medication and the forthcoming new PCSK9 inhibitors. For the past 30 years, we’ve largely relied on statins to manage cholesterol profiles, but new adjunct therapies like these mean we’ll be able to provide even better outcomes for specific patients with or at high risk for heart disease.

Additionally, our knowledge about genetics and the underlying causes of conditions like heart muscle diseases that can lead to heart failure has exploded. Five years ago, we would have treated every case of heart muscle disease with the same set of drugs. Today, we’re identifying new treatment opportunities for newly identified issues, such as amyloidosis or sarcoidosis, as a cause of cardiomyopathy. Brand new drugs to treat specific issues like these are coming quickly to the forefront. Many new, targeted treatments with immunologic and biologic medications will allow us to improve outcomes for heart conditions that were previously difficult to treat. For instance, patients with diabetes —a common precursor for heart disease—should ask their doctors if it’s time to consider how some of these newer treatments may help protect the heart.

As for devices, we’re really excited about the first wave of non-invasive ways to treat heart valve disease. This includes minimally invasive approaches that allow us to replace or repair heart valves by accessing them through a blood vessel, rather than via open heart surgery. Some of these noninvasive treatments are already in successful use for aortic and mitral valve problems. We’ll undoubtedly be able to apply those same techniques to other valve issues in the near future, and many new platforms are in testing. Over the next decade, I expect that use of open heart surgery to treat a heart valve problem alone will become a thing of the past.

More Medical Care Within the Outpatient Setting

Thanks in part to telehealth, remote monitoring, and testing and surgical innovations, we’ll also see even more cardiology care moving from the inpatient hospital setting to the outpatient setting. This long-term trend has been accelerating. For instance, in the 1980s, cardiac catheterization required a 3-day hospital stay, yet it’s evolved into an outpatient procedure for patients who aren’t high risk. Most electrophysiology procedures, like implanting pacemakers and defibrillators, are now simply and safely handled as outpatient procedures.

In the near term, certain heart valve procedures that once required a 5- to 6-day hospital stay may also become outpatient or 1-day procedures, thanks to simpler, non-invasive surgical techniques and new devices. Over the next decade, we’ll have an even greater ability to deliver outstanding medical treatment safely, successfully, and more conveniently without disrupting people’s lives with an extended hospital stay.

More Empowered Patients, More Personalized Care

Overall, the 2020s will be the decade of the more informationally empowered patient—in cardiology and beyond. Equipped with smart devices and data-capturing technologies, connection to their electronic health records, and feeding anonymized data into augmented intelligence networks, patients and doctors will have more powerful interactions and information insights to work with.

This will better equip both you and your care providers to identify and predict problems early, so we can act early to help prevent and treat them. It will also allow us to better customize treatment care recommendations, with an eye to what’s really best for each individual.

The greatest payoff that I anticipate? Our patients will actually benefit from stronger healthcare and better outcomes, both at a lower overall cost.

This article was updated on March 30, 2020.

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It’s been just over two months since Chinese authorities reported the first case of a mysterious respiratory virus, with origins linked to a seafood and animal market in the large city of Wuhan in central China. In that short time, scientists and medical professionals around the world have worked at unprecedented speed to help halt its spread. 

To date, more than 110,000 cases of the aptly named 2019 Novel Coronavirus have been confirmed, mostly in mainland China. More than 37,000 cases have been reported in other countries so far, including the United States. 

1. People in America are currently at tremendously low risk for infection.

To date, only a few people within the United States have been confirmed to have the virus. Most had recently visited China or been in close contact with someone who had. While we know that person-to-person transmission is possible, current estimates indicate that this new coronavirus is less contagious than other viral infections, such as measles or chickenpox.   

Because of this and the quick action to limit travel to and from China, at the current time, Americans are highly unlikely to become infected with this new virus. In fact, your risk for developing influenza (or flu)—another serious respiratory infection—is much greater right now. You should take steps to prevent the flu, such as getting a flu vaccine.   

2. There are still important things scientists don’t know about this new virus.

While this new strain is clearly more severe than the common cold (also caused by certain coronaviruses), it remains to be seen how it will compare with similar first-of-its-kind outbreaks in recent years. They include SARS (Severe Acute Respiratory Syndrome), which started and spread from Asia in 2003, and MERS (Middle East Respiratory Syndrome), first reported in Saudi Arabia in 2012. Both caused severe illness and deaths early on, since they had never been encountered before. 

Thus far, we know most people infected with this novel virus have recovered. Those who have gotten worse, primarily the elderly and people with other medical conditions, have progressed from flu-like symptoms to pneumonia. To date, the fatality rate is thankfully lower than what we saw with SARS and MERS. But it’s too soon to know exactly what kind of toll it will take over the coming weeks. To play it safe, public health officials are responding by preparing for a worst-case scenario. It’s also possible that the virus will become less “pathogenic” or less harmful as it spreads person to person. Time will tell. 

Researchers also don’t know yet all the ways that this new virus is transmitted. Thus far, we think it probably spreads by droplets, spewed from a cough or sneeze, then inhaled into the respiratory tract. There may be other ways we haven’t confirmed yet.  

3. Virus transmission from animals to humans isn’t common, but it happens.

Based on preliminary data, the 2019 Novel Coronavirus appears to live in bats and probably transferred from them to other animals. Although it’s rare, animal viruses can mutate and evolve in ways that make them transferrable to humans, who then spread it to other humans. A crowded city setting like Wuhan, with markets selling swine, fowl, and other wild animals, may be a perfect mixing bowl for that kind of virus transfer to happen. The good news is that we’ve learned from experience with SARS, MERS, and other viruses to work together and mobilize quickly around the globe to help minimize the potential risks of these unexpected transmissions when they happen. 

5. Efforts to develop effective treatments and a vaccine are in high gear.

Thanks to the speedy work of Chinese scientists who identified the RNA sequence for this virus and published it worldwide, researchers have been able to quickly jump on developing and testing treatment options. Among them, scientists are studying whether certain therapies that were developed for SARS may work against this new strain. In addition, researchers are working on preventive options, including a potential vaccine. 

In the meantime, U.S. hospitals, like MedStar Washington Hospital Center, are fully prepared to evaluate patients for the virus and to provide supportive care for anyone who might develop severe symptoms. 

6. You should stay informed about the latest research on the 2019 Novel Coronavirus.

• Visit the Centers for Disease Control and Prevention website for daily updates at www.cdc.gov/coronavirus
• Ask your MedStar Health provider for the latest insights and recommendations on how to keep yourself and your loved ones healthy