How a woman’s heart is different from a man’s

14 Nov

by Carolyn Thomas     @HeartSisters

In many ways, the fact that my cardiac treadmill stress test results appeared “normal” was not a surprise, despite my textbook heart attack symptoms of crushing chest pain, nausea, sweating and pain radiating down my left arm. What we now know is that single-vessel heart disease, which is more common in women than in men, may be less likely to be picked up at all on a treadmill test.

Even though my left anterior descending coronary artery was 95% blocked, this didn’t show up. Similarly, for other women non-obstructive heart disease (again, more common in women) is harder to identify given our existing diagnostics. Women are more likely to suffer from coronary microvascular disease affecting the smallest blood vessels of the heart. And spasm conditions like Prinzmetal’s variant angina are difficult to catch at the best of times, but women can be just as dead after a heart attack caused by undiagnosed Prinzmetal’s as they would be due to fully-occluded coronary arteries.  

Here are just a few ways in which our hearts are different than men’s hearts:

ARTERIES:  Women’s arteries have tiny openings – on average, 1.5 mm. Men’s arteries have openings of 2.5 mm. This difference makes some types of surgery much riskier for women. (When I attended a Mayo Clinic conference on women and heart disease in October 2015, I learned that early stents did not fit any female patients because the stents were too big).

In some women, arterial plaque builds up as an evenly spread layer along artery walls, which isn’t treatable using procedures such as angioplasty and stenting designed to flatten the bulky, irregular plaque in some men’s arteries. For some women, drug treatment — rather than angioplasty or stenting — may be a better option.

SIZE: A woman’s heart weighs 118 grams on average, about as much as a green pepper. A man’s heart weighs about 60 grams more. Larger hearts can be easier for cardiologists to work with, so when a woman receives a transplant, for example, it’s usually a man’s heart. Dr. Marianne Legato of Columbia University explains that not only do women have smaller hearts and smaller arteries, but their hearts also beat faster, even during sleep.

VALVES: Women’s valves are floppier than men’s, which may be why we’re born with more valve disorders, such as mitral valve prolapse, a condition that affects about 6% of women and can progress to the point where the valve between the upper and lower left chambers no longer closes properly and requires heart surgery for repair or replacement.

As reported in Healthline:

“What we’ve learned in heart surgery is that we have a 50% higher chance of letting women die during heart surgery, not because we don’t care or because we don’t try hard, but because women are different. Their hearts respond differently, their symptoms are different, their physical examination is different, and it all goes together.

“Frankly, heart surgery is the ultimate physical examination. We touch, we feel, we suture  – and women are different!”

HEART FAILURE: Women and men tend to experience different types of heart failure – a functional disorder in which the heart cannot pump enough blood throughout the body. Women have a higher chance of diastolic dysfunction, which means their hearts become stiff and aren’t able to relax between beats. Men are more likely to suffer systolic dysfunction, which means their hearts become weak and floppy and have trouble pumping blood.

Experts believe this may contribute to women being under-diagnosed with heart problems because diastolic dysfunction is harder to detect. A study last year published in the American Journal of Clinical Cardiology found that heart failure also affects women at an older age and often with a stronger heart compared to men. This means that while women can live longer with the disease, they also tend to have lower quality of life than men due to greater physical limitations with exercise, more heart failure-related hospital stays and depression.

Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, adds that the type of heart failure most commonly seen in women — known as heart failure with preserved ejection fraction — is caused by problems when the heart relaxes between beats, leading to elevated blood pressure that can cause the heart to stiffen. “But we don’t have a treatment for it. We need it, because it’s predominantly a female disease.”

Watch these two panel discussions on The Heart Of A Woman with female cardiologists for more on these gender differences, or this 2-minute video from the Mayo Women’s Heart Clinic about why women’s cardiac diagnoses lag behind men’s.

Read more about gender differences in women’s heart disease diagnosis and treatment.

See also:

11 Responses to “How a woman’s heart is different from a man’s”

  1. DailyRoyal September 20, 2017 at 6:21 am #

    That’s quite interesting to learn differences between male and female heart.


  2. Valerie October 28, 2016 at 4:33 am #

    Hey. Please give us a reason why the lady’s heart is smaller than the man’s


    • Carolyn Thomas October 28, 2016 at 4:48 am #

      Same reason that women, on average, have smaller hands, smaller feet, smaller waists than men do.


      • Colin March 1, 2019 at 9:24 am #

        So with this rationale, would a man of smaller stature have heart conditions, symptoms and challenges, more comparable to a female of similar stature than that of average male with heart issues?
        Is the issue more of a size than a gender issue?
        Makes me wonder about other organs, gallbladder, kidneys, etc that may also have ‘size’ challenges.


        • Carolyn Thomas March 3, 2019 at 6:05 am #

          Only if the same men had identical hormones, diastolic dysfunction and other biological realities as women do. As cardiologist Dr. Nieca Goldberg’s book title explained: “Women Are Not Just Small Men.”


  3. Siobhan November 23, 2010 at 2:19 am #

    I’m grateful for this article because of this excellent content material on women’s hearts. You genuinely did make my day 🙂


  4. East Coast November 16, 2010 at 11:24 am #

    Finally we’re learning more and more about important gender differences in Heart Disease.



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