Heart disease is the No. 1 cause of death for women. What to know about cardiac health.

The more the researchers learn about the human heart, the more they realize that men’s and women’s hearts are different.

Different things can go wrong with them. Or the same things can happen, but at different rates.

One example: Far more women — mostly older women — get a malady called “broken heart syndrome.” Yes, that’s a real thing.

To sort out all of this and more about women’s heart health, we talked to Monika Sanghavi, associate professor of clinical medicine at the Penn Heart and Vascular Center. She is director of the Women’s Cardiovascular Health Program at Pennsylvania Hospital and is part of Penn Medicine’s Women’s Cardiovascular Program and Preventive Cardiovascular Program.

Overall, a man’s heart and a woman’s heart serve similar functions and are anatomically similar with only a few structural differences. Women’s hearts are smaller. Their vessels are smaller.

However, to assume they will respond the same way to different stressors, medications, and disease is an oversimplification. For years, the medical community has assumed that if we study men, we can simply apply the same principles in women. We’re learning that is not the case.

For women, the genetic, hormonal, and physiologic milieu is different. The hormones are different. They experience unique life phases such as puberty, pregnancy, and menopause, which can affect the heart. For example, during pregnancy the blood volume increases by 50%, and the heart has to adapt to this change. Some of the changes don’t completely resolve after pregnancy.

Also, the heart-brain connection is probably different in women. Their hearts respond differently to stressors.

As we include more women in clinical trials, we are learning about additional differences. That’s why specific research for women is so important, so we can make sure we are treating women appropriately.

Yes. Some are related to pregnancy. Right after pregnancy, women can get what’s called peripartum cardiomyopathy — significant heart dysfunction. The heart function decreases and the patient may go into heart failure. Some women recover their heart function, but unfortunately some don’t.

In fact, we think of pregnancy as a stress test for women. Women who develop high blood pressure or diabetes toward the end of pregnancy — even if it resolves postpartum — are at higher risk of heart disease later in life.

Another problem, commonly known as broken-heart syndrome, happens predominantly in older women after a very stressful event. It can be mild or severe. The heart function drops dramatically and the shape of the main heart chamber changes to look like an “octopus pot,” which is where takotsubo, the name of the disease, comes from. The good news is that it almost always completely resolves.

Another disease, predominantly in younger women, is called SCAD — spontaneous coronary artery dissection. Basically, a blood pocket forms within the vessel wall and causes a heart attack. It affects usually young, healthy women who are very active and otherwise doing very well. It can happen after a strenuous workout or a stressful event in their lives. It’s one more example of how we don’t fully understand the brain-heart connection and how it is different for women.

One of the most common symptoms I see in women is palpitations — the sensation that your heart is racing, pounding, fluttering or beating harder. It doesn’t always mean a problem with the heart. For most people, palpitations are benign, perhaps due simply to skipped beats. But they can also indicate a serious heart rhythm abnormality.

If you faint or start feeling dizzy with palpitations, or if it is associated with chest pain or shortness of breath, that is a concern. If you’re just noticing a fluttering for a few seconds at a time, it’s important to cut back on caffeine and alcohol and see if symptoms improve.

Most people know the risk factors for typical coronary disease — high blood pressure, high cholesterol, diabetes, and family history of heart disease. I would argue that we should go one step further, and women should know their own numbers.

Specifically, women should know :

Beyond the numbers, know your family history. If a parent or sibling had a heart attack, bypass surgery, or the insertion of a cardiac stent, it’s important to know what age they were when this event happened. If your mother had a heart attack before age 65, or your father before age 55, that’s considered premature heart disease, and it would put you at an automatic increased risk of developing heart disease yourself.

Know your medications. Make a list — keep it in your wallet — and show it to the doctor every time you go. It can really help your care.

Keep the results of any major tests — catheterization, echo, stress test. If you’ve had an abnormal test result that you are following, it’s helpful to have a record of that, as well. It helps to have the results over time. As we’ve seen in Philadelphia, hospitals can close. Then all those records are gone. It helps also if you move. You’re in control of your health.

The guidelines were mostly to give physicians guidance when evaluating chest pain. But for the general population, a key point is that chest pain means so much more than just pain. It can mean chest pressure, tightness, burning, squeezing. It encompasses so many other chest discomforts.

A common idea is that women present with more atypical symptoms. But I think that’s not totally true, and the guidelines explain that a little bit better. The most common symptom of a heart attack is chest pain. But women often also report several other accompanying symptoms: jaw pain, shortness of breath, nausea, fatigue, and so on. What’s interesting is that women often associate their chest discomfort with stress or anxiety, whereas men are more likely to attribute them to musculoskeletal symptoms.

Women are more likely to ignore chest pain. They’re so busy taking care of everyone else that they often ignore themselves. But it’s important to note that heart disease is the No. 1 cause of death for women, as well as men.

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