Introduction

The word is out – heart disease in women is on the rise and the symptoms are very different than a man’s. And it’s not just older women who should be aware; women who have a family history of heart disease should pay close attention to heart disease risk factors and symptoms. As a woman, it’s important that you make yourself aware of what the risk factors are and what these symptoms might look like.

Education is the key and that’s what we’re focusing on in this chapter. For example, did you know that stress and depression affect women’s hearts more than men’s? We’ll actually take a closer look at a real condition called Broken Heart Syndrome in women. Or, did you know that smoking is a greater risk factor for heart disease in women than in men? And ladies, it’s important that you know that low levels of estrogen after menopause leave a woman vulnerable to developing cardiovascular issues in the smaller blood vessels (called Small Vessel or Microvascular Heart Disease).

We’ll start by taking a look at the structure of the main components of your cardiovascular system; your heart, arteries, and veins. Once you understand how these work, we’ll move on to how you can keep them in tip-top condition. Good old common sense is still the guiding principal behind a heart-smart lifestyle. Ensure you’re having regular check-ups with your primary health care provider, that your diet is packed full of healthy food, that you’re getting regular exercise, keeping alcohol consumption and stress levels to a minimum, and no smoking.

Anatomy & Physiology

The first thing that comes to mind when you hear the term “cardiovascular” is probably the heart. However, it’s called the cardiovascular system because it consists of much more than just your heart. It also includes the arteries which carry the oxygenated blood to every part of your body, and the veins which bring the deoxygenated blood back to your heart for a “refill”. In this chapter, we’ll be looking at the main components to give you an idea of how everything works together to keep us alive.

The Heart
The size and the weight of your heart give few hints to its remarkable power. Cradled by your lungs and resting on your diaphragm, this cone-shaped, hollow organ weighs approximately one pound. Enclosed by a double sac of membrane called the pericardium, the heart produces its own slippery fluid called serous fluid which allows it to beat effortlessly, without any friction, inside the pericardium.

The heart has four main hollow chambers: the right atrium (upper chamber), the right ventricle (lower chamber), the left atrium, and the left ventricle. Each chamber is lined with endocardium, a thin, shiny, continuous layer of single cells that also lines the blood vessels leaving and entering the heart. Because the ventricles are the main pump for the heart, they are thicker and more muscular than the atria.

The heart is equipped with two pairs of valves, also made of endocardium. These valves are responsible for unidirectional (one-way) blood flow through the chambers of the heart and operate alternately (one rests while the other is in operation). Responding to the pressure changes in the heart, they are responsible for the continuous forward motion of the blood.

The mitral and tricuspid valves are located between the upper (atria) and lower (ventricles) chambers of the heart. They hang loosely, allowing blood to flow from the atrium to the ventricle. However, as soon as the ventricle begins to contract, they snap shut, preventing the blood from flowing back into the atrium.

The other two valves in the heart, the pulmonary, and the aortic, are located at the exit from the ventricles, leading into the corresponding large arteries leaving the heart. When the ventricles contract, these valves fly open and are held flat against the walls of the arteries by the tremendous pressure of the blood pumping out of the ventricles. As the ventricles relax and fill again, these valves remain shut, keeping the blood in the arteries until the ventricles begin to contract again. All this happens automatically, in the blink of an eye.

You might think that with all this blood flowing through the heart, it wouldn’t need it’s own blood supply, but it does. The heart is serviced by the coronary arteries, which encircle the heart, bringing oxygenated blood to every part. The contraction/relaxation sequence of the heart is what pushes the blood through these arteries. The deoxygenated blood is removed via the cardiac veins.

Simplistically put, as the heart beats, the blood makes continuous round trips in and out of the heart, around the body, through the lungs and back again to the heart. In one day, your heart pushes six quarts of blood through the vessels over 1,000 times. That adds up to 6,000 quarts of blood being moved per day!

An artery is a blood vessel which carries blood away from the heart to the other tissues throughout the body. Except for the pulmonary artery (which carries blood to the lungs), arteries carry oxygen-rich blood.1

A vein is a blood vessel which carries blood to the heart. All veins, except the pulmonary vein, carry deoxygenated blood from the tissues of the body to the heart. 2

A capillary is a tiny vessel (its walls are only one cell layer thick) which transports and exchanges either oxygenated blood and nutrients to the tissues, or deoxygenated blood and waste products from the tissues, or lymph fluid. 3

The right side of the heart receives deoxygenated blood from the body (via the vena cava) and pumps it to the lungs via the pulmonary arteries.

The left side of the heart receives oxygenated blood from the lungs (via the pulmonary veins) and pumps it to the body via the aorta.

You might think we don’t know our left from our right, but when you look at the heart from this angle, you’re actually looking at it backwawrds. Left and right are determined, anatomically, by the left and right side of the body. This graphic then is, in effect, a mirror image. Are you confused yet? Here’s a great little video showing you how it all works.

Definitions & Symptoms of Cardiovascular Disease

First, a clarification. A cardiovascular disease is one that effects the whole, or parts of, the cardiovascular system, that being the heart and blood vessels. Heart disease is a category of cardiovascular disease which is specific to the heart and the blood vessels in the heart. Sometimes the two are used interchangably. Anything more specific is usually named for the part of the system which is primarily affected, i.e., Coronary Artery Disease (CAD).

Angina is severe pain, often spasmodic and accompanied by a choking feeling, especially choking pain in the chest (angina pectoris). 4 Sometimes the pain is in the shoulders, arms, neck, jaw, or back or it may feel like severe indigestion. Having angina does not mean you’re having a heart attack but it can mean you’re more likely to.

Heart failure occurs when the heart is not able to pump blood through the body as well as it should to meet the body’s needs. What it does not mean is that the heart has stopped but merely that it has become an inefficient pump. Warning signs include shortness of breath, persistent coughing or wheezing, swelling in the feet, ankles, legs or abdomen (your shoes might feel tight), fatigue, lack of appetite, nausea, confusion, impaired thinking, increased heart rate.

Heart arrhythmias are changes in the way your heart beats. While it’s normal to feel “flutters” or a “racing heart” now and again, if you experience dizziness or shortness of breath in addition to flutters or racing, call your doctor right away.

A heart attack occurs when an artery is severely or completely blocked and the heart is cut off from the blood it needs for more than 20 minutes. Barron’s Dictionary of Medical Terms defines it as “a disruption of the normal circulation of the heart, also known as a myocardial infarction.” Symptoms for women include the typical chest pain (although women are less likely than men to feel chest pain) which can last a few minutes or longer, go away and come back, and feel anywhere from mildly disturbing to very strong and disabling. Other symptoms include pain or discomfort in one or both arms, in your back, in your neck, in your jaw, or in your stomach. More symptoms include loss of appetite, shortness of breath, nausea, vomiting, feeling “woozy”, and/or breaking out in a cold sweat. Women, moreso than men, may experience the following “atypical” symptoms: heartburn, feeling weak or tired, coughing and heart flutters. If you experience the majority of these symptoms all at once, you need to seek medical treatment immediately. Ideally, treatment should start within one hour of the symptoms occuring.

However, keep in mind that signs of a heart attack can develop slowly over hours or even weeks before the heart attack occurs. Referred to as prodromal symptoms, these can even occur up six months to two years before their heart attack and include unusual fatigue, sleep disturbance, shortness of breath, chest pain, indigestion, anxiety, and pain in the shoulder blade or upper back.

In a study of 515 women who had heart attacks, 78% experienced at least 1 pre-heart attack symptom for more than 1 month, either daily or several times a week, before their heart attack. About 71% of these women experienced unusual fatigue and about 50% experienced sleep disturbance; many women (about 40%) rated both of these symptoms as severe.5

Heart Disease
Heart disease is a group of conditions relating to the structure and function of the heart and generally occurs when your heart’s constantly required supply of the blood and nutrients, arriving via the blood vessels, is interrupted. The most common example of heart disease is Coronary Artery Disease (CAD) which develops when plaque builds up in the arteries that supply the heart (coronary arteries) to the point where they become so blocked that the blood flow is severely restricted or cut off altogether.

The unfortunate thing about heart disease is that it often has no symptoms. The good news is that it is preventable if you manage the risk factors that are within your control. Consider taking the following precautions:

• Stop smoking.
• Exercise regularly.
• Keep your blood pressure numbers within normal range.
• Stick to healthy, nutrient-dense foods.
• Keep your weight within healthy limits.
• If you have diabetes, stick to the plan to manage it.
• Minimize alcohol consumption.
• Limit the amount of stress your experience.
• Have regular annual physicals.

Truly A Woman’s Issue
There has been some debate about whether or not women on the birth control pill or who are on menopausal hormone therapy (MHT) are at a higher risk for heart disease. Your primary health care provider is your first, best go-to source when making this decision. He/she will have your complete medical history and know, for certain, what’s best for you. During your next consultation, take in your questions and discuss this with him/her. Taking birth control pills is generally safe for young, healthy women if they do not smoke. However, birth control pills can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke.6 Menopausal hormone therapy (MHT) can help with some symptoms of menopause but there are risks, too. For some women, taking hormones can increase their chances of having a heart attack or stroke. If you’re considering using hormones, talk with your primary health care provider if you have questions about MHT.7

Coronary Microvascular Disease (CMVD)
Simply put, the heart has its own mini-circulatory system which lies on the outer surface of the heart just inside the pericardium (the sac which holds the heart).

There are two main coronary arteries, right and left, which are responsible for oxygenating and nourishing the heart. They branch off the ascending aorta, the large vessel which leaves the left side of the heart with oxygen-rich blood for the rest of the body, and encircle the heart in the atrioventricular groove. This groove, also known as the coronary groove, lies along the line where the atria and ventricles meet. Further grooves hold branches of the coronary arteries (carrying oxygenated blood to the heart), as well as cardiac veins (carrying deoxygenated blood away). The two coronary arteries branch off into smaller and smaller vessels which service the complete surface of the heart.

As you might have guessed, CMVD occurs when the walls of the coronary arteries are damaged or become diseased. However, it’s interesting to note that the usual culprit, plaque, is not to blame in CMVD.

Studies have shown that women are more likely than men to have CMVD. Many researchers think the disease is caused by a drop in estrogen levels during menopause combined with traditional heart disease risk factors such as diabetes or high blood pressure. 8 Other causes of CMVD could be inherited. More studies are currently underway to better understand CMVD and its causes.

Varicose Veins – Which woman hasn’t looked down at her legs at some point in time and felt discouraged by the encroaching patches of purple-y cobalt that are varicose veins; those swollen, meandering lines that lie just under the skin, bulging out like so many lengths of blue rope or patches of blue spider webs.

Aptly named, the word varicose comes from the Latin root word for “twisted”. Unfortunately, they are more common in women than men, can be inherited, caused by pregnancy or by standing for long periods of time, or by being overweight. The smaller varicose veins are called spider veins, show as red or purple under the skin, and usually accumulate in patches (or “webs”) around the knees, calves, thighs, or ankles. Spider veins are caused by swollen capillaries; the smallest of the vessels which carry blood.

Varicose veins can cause aching or stinging in the legs at the end of the day. They can feel hot to the touch, can cause legs to swell, and generally get worse with age. Some varicose veins are merely seen but never felt and cause no complications whatsoever.

Doctors aren’t really sure what causes varicose veins but what they do know for sure is that the problem lies with the valves within the veins. These valves are responsible for blood flow through the veins. When the valves stop working, blood collects in areas of the veins causing them to expand and resulting in the blood flowing in reverse. One explanation for varicose veins hypothesizes that they could be caused by naturally weak veins, which is why varicose veins are seen to run in families with inherited weak vascular systems.

Treatment of varicose veins includes pain management and minimizing impending complications (ulcerations or hemorrhaging). Compression hosiery can help stop the pain in mild conditions of varicose veins, whereas heavier stockings are used in advanced cases. Sclerotherapy is a procedure, done by a specialist, that involves injecting a concentrated saline or chemical solution into the vein which causes the vein to close up or collapse, redirecting blood flow to the healthier veins. Several injections are usually required to close a vein, with weeks of healing between each injection. Severe cases of varicose veins are handled with surgery.

While there is no cure for varicose veins, vitamin C can help with vascular integrity. Vitamin C is required for tissue growth and repair, helps reduce high blood pressure (thanks to its ability to enhance adrenal gland functioning), helps to prevent atherosclerosis, is essential in the formation of collagen, protects against abnormal blood clotting and bruising and promotes the healing of wounds. Vitamin C works synergistically with vitamin E and beta-carotene, having a greater outcome than the sum of their individual effects. Because the body does not make vitamin C, it must be obtained via diet or supplements.

Peripheral Artery Disease
As the name suggests, peripheral artery disease (PAD) affects arteries anywhere outside of the heart. Sometimes simply classified as poor circulation, PAD can cause pain and affect tissues, interfering with regular daily activities such as walking. Women with PAD have an increased risk of heart disease and stroke which is why it is so important to remain on top of symptoms and have regular consultations with your primary health care provider about any changes you experience.

The most common cause of PAD is hardening of the arteries (atherosclerosis). A build-up of plaque slows and eventually blocks blood flow and stiffens the normally flexible walls of the arteries, disallowing them to expand to accommodate more blood flow (i.e., during exercise). Atherosclerosis causes the same progression of congestion in the coronary arteries which causes Coronary Artery Disease (CAD). If it happens in arteries which supply blood to the brain, the end result is a stroke. The likelihood of developing PAD increases if you have diabetes and you smoke.

PAD is fairly common but, unfortunately, awareness of PAD is low. Because of the risk of heart disease and stroke that follows along with PAD, it is important to educate yourself and become aware of its symptoms which include:

• Cramping, aching, numbness, tiredness, weakness, or burning in your buttock, thigh, calf or foot that occurs when walking and goes away when you rest. This pain is called intermittent claudication. It does not usually occur while sitting or standing still.
• Numbness in your legs or feet when you are at rest. Your skin may appear pale and feel cool to the touch.
• Foot or toe pain or tingling that does not go away with rest, and may disturb your sleep.
• The pain may be worse when the leg is elevated and improve when you hang your legs over the side of the bed.
• A feeling that the hip or leg is “giving out” during walking
• Skin wounds or ulcers on your legs or feet that heal slowly or do not heal at all

Women over the age of 50 have a higher risk of PAD. This risk increases for a woman over the age of 70. Other risk factors include smoking or history of smoking, diabetes, high blood pressure or cholesterol, a family history of artery disease (PAD, heart attack, or stroke), previous heart attack or stroke, high levels of markers of inflammation in your blood, such as C-reactive protein and homocysteine.

Treatment for PAD usually involves making lifestyle changes, like managing your diabetes better or stopping smoking. Medications are sometimes prescribed to slow the progression of the condition. Nutritionally speaking, a heart-healthy diet is the one to follow and weight loss is important if it is necessary. Your primary health care provider will advise you on how much exercise is appropriate for your condition. Preventing PAD means managing all of the risk factors as outlined above; stop smoking, improve your diet, get your blood pressure and diabetes under control, and look to lower your cholesterol numbers.

The Proactive Approach

Broken Heart Syndrome (BHS)
Aptly named, BHS is a recently recognized heart condition caused from severe emotional stress (as after the loss of a loved one) which, in the extreme, can lead to complete heart failure. The clinical term for BHS is stress-induced cardiomyopathy. It typically affects more women than men, even if they have been healthy all their lives. BHS symptoms mimic those of a heart attack however, with BHS there is no evidence of blocked blood vessels and most people have a full and quick recovery.

Protecting your heart from heart disease includes taking preventative and proactive measures regarding your nutrition, fitness level and frequency, managing your weight, your choice of supplements, and your amount and quality of rest and sleep. The one last huge factor in protecting your heart is managing your stress.

Nutrition
A heart-healthy diet includes:

• Portion control
• Eating 8-10 servings of fruits and vegetables every day (raw, if possible)
• Selecting whole grains over “white” carbohydrates
• Limiting unhealthy fats (saturated, trans, cholesterol)
• Choosing leaner cuts/types of protein
• Limiting your intake of sodium
• Choosing lower-fat dairy products

Fitness
Aim for 150 minutes of physical activity per week. You can divide these minutes up whichever way it suits you however, maintaining a regular day and time for exercising will help you stick with it! Before you commence any type of physical activity, always check with your primary health care provider to see if there are any health issues blocking you from being active.

Managing Your Weight
The current wisdom still suggests you use the BMI scale (Body Mass Index) to ascertain an appropriate body weight for your height and body type. If you decide to try and shed a few pounds, do it in such a way that you’re more likely to keep it off. Try to avoid “diets of the day” or diet pills, and aim to lose up to two pounds per week, no more. Your primary health care provider can help you with this if you are unsure how to start.

Heart Smart Supplements
Coenzyme Q10 – A powerful antioxidant, aids circulation, and increases oxygenation. CoQ10 appears to be a giant step forward in the treatment and prevention of cardiovascular disease. A six-year study conducted by scientists at the University of Texas found that people being treated for congestive heart failure who took coenzyme Q10 in addition to conventional therapy had a 75% chance of survival after three years, compared with a 25% survival rate for those using conventional therapy alone.10

Omega 3 & 6 – Every living cell in the body needs Essential Fatty Acids (EFAs). Omega 3 and 6 help to reduce blood pressure, lower cholesterol, and reduce the risk of blood clots. They are also beneficial in the management of cardiovascular disease.

SAMe with B6, B12 and Folic Acid – Helps lower homocysteine levels in the blood.

Vitamin B Complex – B vitamins help to maintain healthy nerves and muscle tone. Since the heart is a muscle which relies on nerve impulses, B vitamins are important to a healthy heart. B vitamins work best when taken together in a complex.

Calcium and Magnesium – One depends on the other to work properly in the body and both are important for maintaining proper heart rhythm and blood pressure.

Garlic – Promotes circulation and helps reduce high blood pressure.

Stress
Everyone knows that elevated stress levels, left unchecked, can lead to other health problems. One of these other problems is high blood pressure; a major risk factor for heart disease. Blood pressure is defined by the Heart and Stroke Foundation as “a measure of the pressure or force of blood against the walls of your blood vessels (arteries)”. Consistently higher than normal blood pressure (anything over 140/90) strains the heart and can damage blood vessel walls. When damage occurs, the body rushes to fix this damage with plaque. A build-up of plaque narrows, and eventually blocks arteries and, if these arteries are in or lead to the heart, it will prevent blood from getting to the heart.

Other lifestyle choices can affect blood pressure as well, such as smoking, diet, and lack of exercise. Stress can actually be one of the easiest things to control if you’re motivated enough. Physical activity, time out with friends, healthy foods, and personal time away from everyone and everything else can all help to lower your stress levels and, at the same time, help lower your blood pressure.

Stress also puts excess pressure on your adrenal glands. In her book, Making Sense of Women’s Health, Dr. Marita Schauch says, “The hormones secreted by your adrenal glands influence all major physiological processes in the body: utilization of carbohydrates, fats, and proteins; regulation of blood sugar; functioning of the cardiovascular, gastrointestinal, immune and nervous systems; inflammation and allergic reactions; hormonal health and more.” Your heart pumps harder and faster in response to cascading adrenal hormones released during times of stress. Chronic stress is not only hard on your adrenal glands but it also means no reprieve from cascading adrenal hormones, leaving your blood pressure and heart rate too high for too long.

Homocysteine is an amino acid that is produced in the body in the course of methionine metabolism. This amino acid has been the focus of increasing attention in recent years because high levels of homocysteine in the blood are associated with an increased risk of cardiovascular disease. Further, it is known that homocysteine has a toxic effect on cells lining the arteries, making the blood more prone to clotting. Too much homocysteine is toxic to the vascular system and is very strongly associated with atherosclerosis.9 Chronic stress impairs proper digestion and absorption which can lead to a drop in vitamin B levels in the body. Deficiencies of vitamin B6, B12, and folate prevent adequate homocysteine conversion, leading to raised levels of homocysteine circulating in the blood.

So, do yourself a kindness and curb as much of your stress as possible and learn to deal with the rest in the beneficial ways as discussed above. Your digestion will thank you, your adrenal glands will thank you, and in turn, your heart will thank you.

Each woman reading this information will have a different take-away from this chapter on heart health depending on which issues are front and center in her life at the moment. However, one of the most important topics discussed regarding cardiovascular issues and women is stress. Stress is square one for so many other conditions to creep in and affect your health. And, as a woman, it’s probably in your nature to worry just a little bit more than your male counterpart about things such as children, aging parents, financial situations, home life, etc. And everyone reading this can probably add one or two things more to this list.

The good news is you can eliminate the majority of stress from your life just by taking a few simple steps each day to take better care of yourself. Limiting the stress in your life keeps your blood pressure at a healthy level, making it easier on your heart every day. Share your burdens with a trusted friend or family member, don’t carry them all alone. No woman is an island and it’s not a sign of weakness to ask for help. Feed your body the best you can every day with fresh foods, raw foods, nuts, seeds, whole grains, low-fat dairy products, and lean protein. Take yourself away from stressful environments each day and take a walk outside, go to the pool and swim a few laps, or get together with friends and laugh until it hurts. Before you go to bed each night, clear your mind of worrying thoughts and leave the day’s stress on a sheet of paper if you must; just make sure you’re getting the right amount and quality of sleep you need. There are ample choices of natural sleep aids to choose from before asking for prescription help and many ways to set up a bedtime routine that will inspire your best night’s sleep ever. The net benefits far outweigh the efforts you’ll make every day to take care of your heart, for yourself and for your loved ones.

 Heart and Stroke Foundation’s Eating Well with Canada’s Food Guide
 The Healthy Heart Handbook for Women
 Hormone Replacement Therapy and Your Heart – Mayo Clinic Report

 Heart Contraction and Blood Flow

 Your Heart’s Electrical System

 Varicose and Spider Veins