Chest Pain

Is a heavy feeling, a sense of pressure in the chest a sign of heart problems?

Yes, women are more likely than men to experience angina as their first symptom of heart disease. Angina is a sensation of heaviness, pressure or tightness in the chest, deep to the breastbone. It lasts from two to ten minutes and in women may be felt more strongly in the area just below the breastbone, where the ribs meet. It can also feel like a burning or gassy sensation. Angina pain can move across the chest into the shoulders and arm (usually the left), and into the back, neck or jaw.

Heart disease is of major concern to women, although its importance is often underemphasized. It is one of the most common health problems for post-menopausal women (accounting for over 50% of deaths in postmenopausal women), and the number one killer of women in the U.S. Because so much of the research that has been done on heart disease has focused on men, the risks for women have often been left unexplored. Risk factors and complications differ for women and men.

Risk factors for women include: menopause, high blood pressure, smoking, high cholesterol, diabetes, and obesity. Women who have gone through menopause have decreased levels of estrogen production, while estrogen has been shown to lower the risk of heart disease. For this reason, many women without a history of breast cancer choose hormone replacement therapy, weighing its benefits over its potential risks. Hormone replacement therapy has been reported to lower stroke incidence by 50%, while lowering risk of cardiovascular disease by as much as 40-50%. For women with a history of breast cancer hormone replacement therapy may not be a choice. For these women it is essential that they manage their risk for heart disease by closely monitoring the other known risk factors.

Blood pressure also rises with age and reaches higher levels than those appearing in men.. Smoking is known to bring on menopause more quickly, and have an antiestrogenic effect on women. Again, this undermines the protective qualities of estrogen in regards to heart disease. Women who are smokers and are on oral contraceptives greatly increase their risk for heart disease. Furthermore, women who are diabetics are more likely to suffer from obesity which presents additional risk.

Women are not only at risk for heart disease for different reasons than men, they also show a different set of symptoms. As I mentioned above, women are more likely to have angina be their first symptom. Other symptoms are: breathlessness, chronic fatigue, dizziness, edema (swelling of the ankles or lower legs), fluttering heartbeats, and gastric upset or nausea. But women not only show heart disease differently, they also are far more likely to have complications associated with a heart attack, such as shock or heart failure. And they are more likely to die at the time of the heart attack. African-American women have an even higher death rate.

Women are more likely to have more heart attacks, more likely to die of a heart attack, and more likely to have recurrent chest pains than their male counterparts.

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