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 .
- Masoudi FA, Havranek EP, Smith G, Fish RH, Steiner JF, Ordin DL, Krumholz HM. Gender, age, and heart failure with preserved left ventricular systolic function. J Am Coll Cardiol. 2003 Jan 15;41(2):217-23.
- Vasan RS, Larson MG, Benjamin EJ, Evans JC, Reiss CK, Levy D. Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort. J Am Coll Cardiol. 1999 Jun;33(7):1948-55.
- Levy D, Larson MG, Vasan RS, Kannel WB, Ho KK. The progression from hypertension to congestive heart failure.
JAMA. 1996; 275:1557-1562.
- Philbin EF, DiSalvo TG. Influence of race and gender on care process, resource use, and hospital-based outcomes in congestive heart failure. Am J Cardiol. 1998 Jul 1;82(1):76-81.
- Jalal K. Ghali, MD; Ileana L. PiÃ±a, MD; Stephen S. Gottlieb, MD; Prakash C. Deedwania, MD; John C. Wikstrand, MD, PhD, on Behalf of the MERIT-HF Study Group. Metoprolol CR/XL in Female Patients With Heart Failure: Analysis of the Experience in Metoprolol Extended-Release Randomized Intervention Trial in Heart Failure (MERIT-HF). Circulation. 2002; 105: 1585-1591.*
- Lund LH, Mancini D. Heart failure in women. Med Clin North Am. 2004 Sep;88(5):1321-45.*
- Shindler DM, Kostis JB, Yusuf S, Quinones MA, Pitt B, Stewart D, Pinkett T, Ghali JK, Wilson AC. Diabetes mellitus, a predictor of morbidity and mortality in the Studies of Left Ventricular Dysfunction (SOLVD) Trials and Registry. Am J Cardiol. 1996; 77:1017-1020.*
- Perez EA. Doxorubicin and paclitaxel in the treatment of advanced breast cancer: efficacy and cardiac considerations. Cancer Invest. 2001; 19 (2): 155-164.*
- Pearson GD, Veille JC, Rahimtoola S, Hsia J, Oakley CM, Hosenpud JD, Ansari A, Baughman KL. Peripartum cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) workshop recommendations and review. JAMA. 2000 Mar 1;283(9):1183-8.*
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written with Dr. Eileen Hsich, specialist in Women & Heart Failure