Diastolic Versus Systolic Heart Failure
Women develop diastolic heart failure 1-2 more often than men, and more frequently than systolic heart failure. Diastolic heart failure occurs when the heart pumps normally, but the ventricles become stiff and doesn't relax properly. This causes the pressure to rise in the heart and lungs. Systolic heart failure occurs when the heart is weak and doesn’t contract with enough force. In systolic heart failure there is not enough oxygen-rich blood being pumped throughout the body. The weak heart causes blood to accumulate, leading to a rise in pressure in the heart and lungs very similar to that seen in diastolic heart failure, but due to a different mechanism (ie. weak heart instead of stiff heart).
Causes of Heart Failure Unique to Women
The causes of heart failure in women are different than in men. Women with heart failure are more likely than men to have high blood pressure 3-5 valvular disease 6 , and diabetes mellitus 3,5,7 , and less likely to have congestive heart failure due to prior heart attacks (ischemic cardiomyopathy) 5.
However, women can still develop atherosclerosis (progressive narrowing of the arteries). In fact, although women with congestive heart failure develop coronary artery disease less often then men the frequency is still so high that it is the second leading cause for women with heart failure. 6 It is important to remember that women often have atypical symptoms such as shortness of breath, as compared to men whose primary symptom is often chest pain. Therefore, women like men need to be evaluated for blockages in the arteries.
Women with breast cancer who have been treated with chemotherapy including doxorubicin (Adriamycin) can also develop congestive heart failure due to the toxic effects that these drugs can have on the heart muscle (called drug toxicity) 8.
Another cause of congestive heart failure unique to women is peripartum cardiomyopathy. Peripartum cardiomyopathy is the rare development of heart failure within the last month of pregnancy or within five months after delivery. The cause of peripartum cardiomyopathy remains unknown 9.
written with Dr. Eileen Hsich, specialist in Women & Heart Failure