Heart disease is the No. 1 killer in women, yet women are often undiagnosed or misdiagnosed, according to Odayme Quesada, MD, of The Christ Hospital Women's Heart Center.

"Women's heart disease is different than men's," says Dr. Quesada. "For instance, women are more likely to experience recurrent chest pain and even show evidence of heart damage – a disease known as ischemia with no obstructive coronary artery (INOCA) – but after testing and consultation, are told they are fine because there is no significant blockage in the heart arteries."

"It is important that these women seek a second opinion." Dr. Quesada continues, "In half of these cases, there's evidence of coronary microvascular disease that we can diagnose through a specialized test called coronary functional angiography or nuclear PET stress test."

Further, the symptoms of heart disease or heart attacks in women are often quite subtle, leading to delay in seeking treatment. While chest pain is the most common sign of a heart attack in both men and women, 62% of women have no chest pain at all, according to one study in the journal Therapeutics and Clinical Risk Management.

Instead, women often experience shortness of breath, cold sweats, malaise, extreme fatigue, nausea, vomiting or shoulder, neck, jaw or back pain when they are having a heart attack.

What causes heart disease, and what is the impact of family history?

"There are risk factors for heart disease that are common in both men and women including smoking, hypertension, diabetes, family history of early cardiac disease, says Dr. Quesada. "However, there are women specific risk factors that we need to make sure we think about such as hypertensive disorders of pregnancy, premature menopause, polycystic ovarian syndrome (PCOS), that are women specific and autoimmune diseases and psychosocial stress which tend to be more common in women."

Heart disease impacts younger women, too.

Heart disease is not just an older person's disease. "There has been an increase in the number of heart disease hospitalizations in young women ages 35 to 54," continues Dr. Quesada, "according to the Atherosclerosis Risk in Communities Study (ARIC), one of the world's most significant and longest-running heart health studies, funded by the National Heart, Lung and Blood Institute of the National Institutes of Health."

Listen to your body

Women who suspect they are having heart related symptoms are often told it's "in their head." When women have symptoms of stress along with heart disease, they are twice as likely to be diagnosed with a mental health condition.

"If you feel that there is something wrong, and you may have been falsely reassured, seek a second opinion with a specialist in women's heart disease," urges Dr. Quesada.

The Women's Heart Center at The Christ Hospital was created to address this overwhelming gap in women's cardiac care, says Dr. Quesada. "Our team of cardiologists, advanced practitioners, and specialized nurses provide women with a place where they are listened to, cared for, and diagnosed.

Small changes can make an important difference

There are also healthy habits that everyone can adopt to keep your heart healthy. Dr. Quesada recommends the American Heart Association's Life's Essential 8:

• Eat Better
• Be More Active
• Quit Tobacco
• Get Healthy Sleep
• Manage Weight
• Control Cholesterol
  
• Manage Blood Sugar
• Manage Blood Pressure
  

If you have any of these symptoms, call 9-1-1 right away:

• Chest pain or discomfort
• Upper back or neck pain
• Indigestion, heartburn, nausea or vomiting
• Extreme fatigue
• Upper body discomfort
• Dizziness, and shortness of breath
• Fluttering feelings in the chest (palpitations)
• Swelling of the feet, ankles, legs, abdomen, or neck veins