Ruth Kam Heart & Arrhythmia Clinic
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A lot is said about the differences between men and women – the way they think, the way they feel, the way they are able to multi-task or otherwise. But is there a difference between a male heart and a female one?
It will surprise many to know that there is actually no difference between male and female hearts. All the structures present in male hearts are present in female ones. Relative to body size – the weight of the heart relative to total body weight – they are the same. A heart may grow larger in size because of high blood pressure, heart disease or hormonal disease, but this phenomenon is not gender-specific.
That said, there are certain heart conditions that are more prevalent among one gender or the other.
Men, for instance, are more prone to coronary heart disease and Brugada Syndrome.
Coronary heart disease is caused by narrowing of the arteries supplying blood to the heart. It is related to diseases such as hypertension, high cholesterol, diabetes and smoking. It presents as chest pain, breathlessness, palpitations or sudden death. Brugada Syndrome, on the other hand, is a disease of the ion channels and aff ects the electrical system, and therefore the heart rhythm. Th e symptoms include palpitations, fainting spells or sudden death.
Women are more prone to Long QT syndrome, which is, like Brugada Syndrome, a disease of the ion channels, which aff ects the heart rhythm and has similar symptoms.
Different symptoms for women?
There is an urban legend that women’s heart attack symptoms are diff erent from men’s. The truth is that the most common symptom in both men and women is chest pain. Let’s not forget that while trying to point out the diff erences between women and men.
If there is no chest pain, other symptoms such as giddiness, palpitations or indigestion are called atypical or unusual symptoms. They occur more commonly in women, especially those over 65.
It is unusual for women to suff er heart attacks before menopause. If a woman does have a heart attack before menopause, the prognosis is worse because it means that even with the protective eff ect of female hormones, other more potent risk factors may be present, such as diabetes, or inflammation of the blood vessels.
When angiograms are performed for chest pain, the proportion of patients with normal-looking arteries is higher in women, and this is called Syndrome X. The cause of the chest pain is thought to be vessel spasm. This happens because women generally have smaller blood vessels than men, and these may be more reactive to agents which cause constriction.
Under-diagnosed and under-treated
Heart disease is under-diagnosed and under-treated in women, and there are several reasons for this, involving patient, cultural and physician factors. Patients and doctors need to be made more aware of these so that they do not dismiss symptoms or fail to recognise them as heart disease symptoms. The same treatment procedures, and life-saving and life-changing therapies used to address coronary heart disease in men – such as bypass or stenting – should not be denied to women as a result of lack of awareness or ignorance.
For certain conditions, women may be at higher risk of complications. For example, in atrial fi brillation (a type of arrhythmia), women have a higher risk of stroke. Hence one’s gender is taken into consideration when deciding on clot prevention treatment.
For both men and women, the available treatment options for the most common conditions are the same, as follows:
CONDITION AVAILABLE TREATMENT(S)
Coronary heart disease Stenting, Bypass surgery
Heart arrhythmia, including atrial fibrillation Catheter ablation
Sudden Cardiac Deathn Defibrillator implantation
Excessively slow heart rate Pacemaker implantation
Valve problems Valve surgery
DR RUTH KAM
Cardiologist

MBBS (Singapore)
MRCP (Int Med) (UK)
M Med (Int Med) (Singapore),
FAMS (Cardiology), FRCP (Edin)
Ruth Kam Heart and Arrhythmia Clinic
3 Mount Elizabeth #08-06
Mount Elizabeth Medical Centre.
Tel: 6333 6866
www.arrhythmia.com.sg