Cardiovascular disease is the number one health threat to women over age 25. Each year, six times as many women die of cardiovascular disease than breast cancer. More women than men die each year from heart attacks, stroke and other cardiovascular conditions. Atrial fibrillation (AF) is the most common abnormal heart rhythm affecting 2-6 million men and women in the US. AF prevalence is expected to rise significantly over the next 40 years. AF is more likely associated with coronary artery disease in men, while AF is more likely associated with valve disease in women.
Each heartbeat begins with an electrical impulse within the heart's own electrical network called the conduction system. The electrical impulse of the conduction system starts in the atria (upper chambers of the heart) and travels down to the ventricles (lower chambers of the heart) to produce a heartbeat. Heart rhythms disorders, also called arrhythmias or dysrhythmias, are a problem with the conduction system that results in irregular heartbeats that are too fast (tachycardia), too slow (bradycardia) and/or irregular (extra or skipped beats). Depending on the specific type, heart rhythm disorders range from harmless to life threatening.
In a normal heart, the four chambers of the heart beat in a steady, rhythmic pattern. With AF, abnormal and chaotic electrical signals or pathways occur in the atria, causing an irregular heartbeat. The irregular heartbeat does not allow the atria to contract or squeeze normally, decreasing the amount of blood ejected from the heart with each heart beat. This can lead to heart failure. In addition, blood clots can form in the atria which can travel to the brain and cause a stroke. AF has been associated with a 4- to 5-fold increased risk of ischemic stroke(blockage in the brain vessel). Because of these side effects of AF, the identification and treatment of AF is very important. The earlier the disease is treated, the more successful the outcome.
Risk factors
The risk of developing atrial fibrillation increases as we age. On average, women tend to develop AF around 75 years of age (vs 67 for men), but younger women can also have it. The disease can be caused by many other factors, including:
- Hypertension (high blood pressure)
- Congestive heart failure
- Coronary artery disease
- Dysfunction of the sinus node (the "natural pacemaker" of the heart)
- Mitral valve disorders
- Rheumatic heart disease
- Pericarditis (inflammation of the sac surrounding the heart)
- Hyperthyroidism (overactive thyroid), diabetes, sleep apnea
- Excessive alcohol consumption
- Obesity
- Family history of atrial fibrillation
- Heart attack or open heart surgery
- European ancestry
Signs and symptoms
While some people show symptoms of AF, other people have no symptoms, which is why a routine physical exam is important. Some of the signs and symptoms of AF may include:
- Very rapid or irregular heartbeats - some women say they feel their heart flip-flopping in their chests, skipping a beat or fluttering
- Unexplained shortness of breath
- Chest pain
- Dizziness or feeling faint
- Fatigue
Research: Women & Atrial Fibrillation
Women with AF are slightly more likely to die prematurely than those without the condition, according to a study of more than 34,000 middle-aged women. These women also have a higher rate of nonfatal cardiac events, such as stroke, heart attack and heart failure (a condition in which the heart cannot pump enough blood to the body). Women with AF also have more risk factors for heart and vascular disease including high blood pressure, diabetes and smoking.
Researchers are studying why AF appears to cause more severe health problems in women than in men. 
This sex-based difference in patients with AF is concerning and not clearly understood.Women with AF, especially women over 75 years of age, have a higher risk of stroke than men do, even when taking blood thinning medication. A study of more than 80,000 hospital patients in Canada confirmed this fact. Because women with AF who are 75 years or older are at high risk of stroke that can be effectively prevented by blood thinning medication, they should receive this medication if it can be given safely. New strategies are needed to further reduce stroke risk for women with AF.
Recent studies represent important steps in the understanding of how AF affects women. However, a continued investment in AF research is needed to understand gender-related differences and to improve the treatment of AF in women. Researchers hope future studies will help discern the role of hormones and genetics in the development of AF and lead to new strategies for reducing stroke risk in women with AF. In addition, efforts to study how medical care might contribute to improved outcomes are needed - for example, how doctors recognize and manage atrial fibrillation and related problems in women versus men.
The American Heart Association 2011 guidelines for the prevention of cardiovascular disease in women emphasize the need for reporting of sex-specific analyses for both efficacy and adverse effects of preventive interventions to inform the development of future sex-specific guidelines.
Program for Women's Cardiovascular Health
Northwestern's Program for Women's Cardiovascular Health is founded on the principles of identifying cardiovascular disease in women of all ages and providing care that is designed specifically for women. Marla A. Mendelson, MD, the medical director of the Program, is committed to meeting the needs of women affected by cardiovascular disease through a multidisciplinary team approach. Dr. Mendelson is joined by associate medical director Vera H. Rigolin, MD.
To make an appointment: Call the Bluhm Cardiovascular Institute at 312-695-4965 or 1-866-662-8467.
For more information regarding atrial fibrillation:
Call the Bluhm Cardiovascular Institute at 312-694-AFIB (2342). Atrial fibrillation nurses, Jane Kruse and Mary Navarrete, are available to answer your questions.
Sources:
JAMA. 2012 May 9.
Arch Neurol. 2012 Sep 24:1-3.
http://circ.ahajournals.org/content/112/12/1687.full
http://womenheart.org/
http://www.nmh.org/nm/atrial-fibrillation-and-atrial-flutter
http://www.hrsonline.org/Patient-Resources/Heart-Diseases-Disorders/Atrial-Fibrillation-AFib#axzz2Hxp22eYA
http://circ.ahajournals.org/content/123/11/1243.full.pdf
http://www.ncbi.nlm.nih.gov/pubmed/21610247
Circulation 2012;125.
