The internist and cardiologist is a member of the Scientific Advisory Board of the German Heart Foundation and advises women to pay attention to certain points when visiting a doctor to protect themselves from easily avoidable complications of their illness: For example, if women experience shortness of breath during minor exertion and are quickly exhausted, they should ask their doctor to perform an ultrasound of the heart (see information box). The German Heart Foundation provides information about cardiac insufficiency in women and many other aspects of heart failure during the nationwide Heart Weeks at www.herzstiftung.de
One reason is probably that women do not take the symptoms seriously. They suffer from shortness of breath when they climb the stairs, have thick legs or even a bloated stomach, are tired, feel weak and dizzy. The fact that a weak heart can be behind this does not occur to many of them. “Heart failure is very common in women, especially when the risk factors high blood pressure, overweight and diabetes are present at the same time,” explains Prof. Dr. med. Vera Regitz-Zagrosek.
Heart failure in women – an often misunderstood problem. In Germany, women account for around half of all those affected, and around a third more women than men die from it. According to the German Heart Report, 25,318 women died of heart failure in 2016, compared to 15,016 men.
When it comes to heart disease, many people think that these are typical “male diseases”. But women die much more often than men from heart failure, as reported by the German Heart Foundation. This is because heart failure is an often misunderstood problem.
Heart failure is a serious illness. The heart is no longer able to pump enough blood into the body. The heart pumps oxygen-rich blood through the left half of the heart into the blood vessels, through which it reaches the organs. After its journey through the body, the blood, which is now low in oxygen, reaches the heart again. Via the right half of the heart it flows into the lungs, is enriched with oxygen again and reaches the left half of the heart. The circulation starts all over again.
If the heart is too weak, it can either no longer pump enough blood and thus oxygen to the lungs or the body (systole) or no longer take in enough blood (diastole). The latter is much more common in women than in men, as we now know. Women’s hearts are stiffer and can therefore expand less and fill with blood. The experts speak of a so-called diastolic heart failure with maintaining pumping function.
With increasing age, women’s hearts become even firmer. This is because during the menopause, the estrogen deficiency leads to increased blood pressure and the formation of connective tissue in the heart. “This cardiac insufficiency caused by a lack of the body’s own estrogen cannot be compensated by hormone therapy,” emphasizes Regitz-Zagrosek, who is also a senior professor at the Charité, University Medicine Berlin. Women not only have firmer, but also smaller hearts than men.
“So far, however, women have been guided by the minimum value for men of 55 percent,” explains the Berlin cardiologist. “Experts are currently discussing that the minimum value for women is probably higher than for men. In addition, the ejection fraction usually increases with age, and more so in women than in men, because heart size and mass decrease in both sexes.
The smaller size is compensated for by the fact that their hearts work with a higher ejection fraction – as this measure is called in the trade – than men’s. The ejection fraction indicates what percentage of the blood in the heart is pumped into the body with each beat. In healthy men this is at least 55 percent of the blood in the heart, in healthy women probably more than 60 percent.
“This could once again contribute to the fact that the ejection fraction is considered normal, especially in many older women, even though they have long since suffered from heart failure,” the expert says. For example, about half of all patients with heart failure who are admitted to hospitals now have a supposedly normal ejection fraction. The majority of them are women.
Take care of your heart – Prof. Vera Regitz-Zagrosek advises women
Women often do not take heart failure symptoms seriously
Broken Heart Syndrome is a heart failure that occurs almost exclusively in women after the menopause. It is often a consequence of massive emotional stress. The symptoms are similar to a heart attack: shortness of breath, tightness in the chest, severe pain. “The heart contracts more at the base than at the top,” explains Regitz-Zagrosek. “Due to this imbalance in the contraction process, too little blood is expelled and the body is not sufficiently supplied”. This condition is also life-threatening. Those affected should immediately alert the emergency call (112).
Other special forms of heart failure also occur in women. For example, a life-threatening so-called peripartal cardiomyopathy (PPCM) can occur in the last third of pregnancy and about six months after birth. Alarm signals are sudden shortness of breath, weakness or fluid accumulation in the body. A doctor should be consulted immediately at the first signals.
WashingtonNewsday Health and Wellness.