Women's Heart Wellness - Conditions We Treat

Your Women’s Heart Wellness doctor specializes in treating one or more of the following women's heart conditions:


High Risk Pregnancy

Your heart works extra hard during pregnancy, with an increased heart rate, lower blood pressure and up to 50 percent higher blood volume to feed the needs of your developing baby. During labor and after delivery there are additional fluctuations in blood flow, heart rate and blood pressure. It can take several weeks before your heart returns to pre-pregnancy normal.

It’s understandable that a heart condition can complicate your pregnancy. If you have cardiovascular disease, a Women’s Heart Wellness Program cardiologist will work with your obstetrician to evaluate potential risks and provide special care to ensure the safety of both you and your baby.

There are many cardiovascular conditions that can have serious effects on pregnancy. Some common ones are congenital heart disease (heart defect that you are born with) or rheumatic valve disease (from untreated strep throat leading to rheumatic fever). History of a mechanical heart valve and the use of blood thinners also may affect pregnancy. Sometimes there are conditions that develop during pregnancy, such as, preeclampsia (elevated blood pressure) or peripartum cardiomyopathy. All of these conditions requiring different types of monitoring and treatment to help ensure both the mother and the baby do well throughout the pregnancy, delivery and after 

Your Heart Condition and Pregnancy

 If you were born with a heart problem, your baby is also at risk of developing a heart defect.

Here are two examples off congenital heart defects:

  • Atrial septal defect: A hole in the wall separating the two upper chambers of your heart.
  • Ventricular septal defect: A hole in the wall separating the two lower chambers of the heart.

Other conditions, not congenital, that can complicate a pregnancy: 

Signs of Heart Disease During and After Pregnancy

Heart disease is the leading cause of the death in the United States among women who are pregnant or recently gave birth (the postpartum period).

Some symptoms to watch for during that time:

  • Extreme swelling
  • Unusual weight gain
  • Extreme fatigue
  • Chronic cough
  • Fainting
  • Shortness of breath
  • Chest pain
  • Abnormal heartbeat

A cardiologist, as part of your multidisciplinary team , can guide you through your pregnancy, and beyond, often with medication, dietary changes or exercise. They will also work closely with your primary team, primary cardiologist, and delivery team.

Here’s an example. A report in Circulation, the American Heart Association’s journal, indicated pregnant women with preeclampsia, a high blood pressure disorder, have a 71 percent higher risk of dying from heart disease or stroke in their lifetime. How can you prevent preeclampsia? While it can’t always be prevented, we know that a healthy diet, low in salt and regular exercise during pregnancy can help. 

It is important to get regular prenatal checks with your obstetrician, because if preeclampsia is caught early, with close monitoring and appropriate treatment, most women with preeclampsia can deliver a healthy baby. 

Monitoring Your Condition

Prenatal care includes regular checks of your weight and blood pressure, possibly supplemented with blood and urine tests. Every patient is different, so your Women’s Heart Wellness Program cardiologist will let you know how often you will be seen and if or when special tests need to be done.  

Here are two common types of tests that can give your cardiologist a clearer picture of how your heart is working: 

  • Echocardiogram: Ultrasound waves produce images of your heart to give more information about how the heart is pumping and how the valves are working. It is similar to the ultrasound you might have of the baby, but this one is for the heart.  
  • Electrocardiogram: Also known as an EKG (or ECG), this test records the electrical activity that travels through the heart with each beat.

If you are unsure if you need to see a cardiologist prior to conceiving, during, or after your pregnancy speak with your OB. If you feel that something is wrong please call 911 and seek emergent medical attention.

Postural Orthostatic Tachycardia Syndrome (POTS)

Postural orthostatic tachycardia syndrome, or POTS, is a disorder that affects autonomic regulation resulting in an elevated heart rate with a normal blood pressure when standing. There are many symptoms of POTS, but most commonly include dizziness, lightheadedness, weakness, fatigue and blurry vision when standing.

A reduction in blood returning to the heart, a rapid increase in heart rate and the resulting lightheadedness define orthostatic intolerance, the primary symptom of POTS.

It’s estimated that four to five times more women than men experience POTS, most often in young women less than 45 years old.

POTS is a common condition with approximately 500,000 Americans living with it. Unfortunately, because symptoms can be so varied and nonspecific, there can often be a delay in diagnosis.

What Does POTS Mean?

Let’s take it word by word.

  • Postural, as in posture, refers to the position of your body.
  • Orthostatic is upright posture.
  • Tachycardia means a heart beat of more than 100 beats per minute..
  • Syndrome is a group of symptoms that, collectively, are identified with a disease or other disorder.

What Causes Postural Orthostatic Tachycardia Syndrome?

Researchers have yet to determine what, specifically, causes POTS, though it can be inherited or acquired, possibly due to a prior infection from a virus. Often the symptoms start suddenly, but they can also gradually appear over a period of time.
The disease causes irregularities in the autonomic nervous system, or ANS, which controls your heart rate, blood pressure and breathing. This system normally maintains proper blood pressure levels whether you’re standing, flat on your back or sitting. Bed rest and inactivity can cause cardiac atrophy of approximately 1% per week, increasing the risk for orthostatic intolerance.

Patients with POTS often feel frustrated because they are not able to do the normal things they used to without having symptoms. Sometimes, even simple things like getting dressed or walking their children to the school bus can be too difficult.

Symptoms of Postural Orthostatic Tachycardia Syndrome

Besides dizziness, lightheadedness, weakness, fatigue and blurry vision when standing , here are other possible signs of POTS:

  • Palpitations
  • Anxiety
  • Gastrointestinal symptoms, such as nausea or abdominal cramping
  • Loss of consciousness or syncope
  • Headaches
  • Mental fogginess

Diagnosing Postural Orthostatic Tachycardia Syndrome

As part of a complete physical exam, your doctor will monitor your blood pressure while you’re seated, reclined and standing. POTS increases your heart rate by greater than 30 beats per minute or higher than 120 beats per minute within 10 minutes of changing your body position without significant change to your blood pressure.

Your doctor might also order blood tests and possibly a tilt-table test. In this test, you’re secured to table that is moved to different positions and angles. Your heart rate and blood pressure are among the vital signs monitored during the test.

Treating Postural Orthostatic Tachycardia Syndrome

With no known definite cause of this chronic condition and symptoms that vary from patient to patient, your doctor usually tries to manage POTS with a combination of medication and changes in diet and exercise.

Because the symptoms and triggers for POTS are so varied from patient to patient, there is no “one size fits all” for treatment. It often takes several attempts to find a therapy that works for the patient, but eventually, most patients have improved symptoms by one year and many fully recover.

Some treatments that can help:

  • Drinking more water (up to 80 ounces a day)
  • Eating more salt in diet; sometimes even salt tablets are prescribed
  • Smaller meals supplemented by snacks
  • Exercise training, especially reclined aerobic exercise (such as a rowing machine). Swimming has also been found effective
  • Wearing compression stockings
  • Better, longer sleep
  • Raising the head of your bed (maintaining blood levels in the legs during sleep)
  • Medications
  • Intravenous saline infusions

Spontaneous Coronary Artery Dissection (SCAD)

Spontaneous Coronary Artery Dissection, or SCAD, is a tear in the wall of aheart artery with internal bleedingthat can result in a blockage of blood flow to the heart muscle causing a heart attack.

It is estimated that about 0.1 to four percent of all heart attacks are caused by SCAD. Although rare, this condition accounts for an estimated 25 percent of heart attacks in women under age 50

SCAD, in fact, occurs almost exclusively in women. An estimated 85-90 percent of cases are typically women between ages 30 and 60.

SCAD is a rare and concerning condition that still has much uncertainty regarding ideal treatment and recommendations.

What Causes Spontaneous Coronary Artery Dissection?

The mechanism of SCAD is not fully understood. There may be some factors that increase risk, such as hormone changes surrounding pregnancy or delivery, hormone therapy, coronary artery tortuosity (twisty instead of straight arteries), extreme physical stress, and genetic conditions such as fibromusculardysplasia and Marfan syndrome.. Most of the time, a cause is not identified.

If you are diagnosed with SCAD it is important to work with your cardiologist to look closely for some of the possible associated conditions.

Spontaneous Coronary Artery Dissection Symptoms

Typically, SCAD presents just like a typical heart attack. If you experience unusual chest pain or think you might be having a heart attack, call 911.

A SCAD episode can include:

  • Chest pain, pressure or tightness
  • Rapid heartbeat
  • Sweating
  • Shortness of breath
  • Exhaustion
  • Pain in the back, jaw, arms or shoulders
  • Dizziness
  • Fainting
  • Nausea, vomiting

Diagnosing Spontaneous Coronary Artery Dissection

A diagnosis will start with a physical exam, a review of your medical history and any of these tests:

Treating Spontaneous Coronary Artery Dissection

Thorough assessment of the severity of the tear and the degree of damage to your artery and heart – will determine your treatment.

Most patients are treated with aspirin or another antiplatelet medication that prevents blood clots. If you have high blood pressure, you doctor might prescribe ACE inhibitors and beta blockers. Rarely, some patients also require a coronary artery stent or surgery.

You doctor will monitor your condition regularly. Even though SCAD is rarely fatal, upto 20 percent of patients experience SCAD again. You will work with your doctor to address any symptoms following your SCAD, the psychological stressors associated with this condition, and any reproductive issues.

Microvascular Angina

Angina is a type of chest pain caused by lack of blood flow to the heart. Most people with angina have coronary artery disease which is caused by a buildup of cholesterol and inflammation in the main arteries that supply the heart. Eventually the buildup can result in blockages that can lead to a heart attack.

Some people, especially women, can have angina without any significant blockages in the main arteries that supply the heart. This is called microvascular angina or small vessel angina. Microvascular angina is often underdiagnosed because confirming the diagnosis is much more complicated than for routine coronary artery disease. We do know that most patients with microvascular disease have some of the same traditional risk factors for coronary artery disease, like diabetes, high blood pressure, high cholesterol and/or tobacco use.

What Causes Microvascular Angina?

The cause of microvascular angina  is not fully understood, but it is thought that the very tiny blood vessels supplying the heart (microcirculation) have decreased ability to regulate blood flow resulting in symptoms of angina.  It is also thought that there is increased sensitivity of these small blood vessels to stimuli that constricts them. 

Microvascular Angina Symptoms

Most patients with microvascular angina have recurrent chest pain that typically lasts longer than typical angina (often more than 20 minutes) and is often triggered by physical or emotional stress. 

Microvascular angina can also produce:

  • Shortness of breath
  • Fatigue
  • Sleep problems
  • Pain or discomfort in jaw, neck, back, abdomen or arm

Microvascular Angina Risk Factors

Here are some risk factors for microvascular angina:

  • Unhealthy diet
  • Sedentary lifestyle
  • Tobacco use
  • High blood pressure
  • Obesity
  • Diabetes
  • Estrogen deficiency
  • Polycystic ovarian syndrome
  • Autoimmune conditions (lupus, rheumatoid arthritis)

Diagnosing Microvascular Angina

Most patient will have an ECG, stress test and cardiac catheterization to help diagnosis microvascular angina. Patients with an abnormal stress test but no significant blockages seen in the coronary arties on catheterization are more likely to have microvascular angina.  Sometimes, additional tests are done during the cardiac catheterization to help confirm the diagnosis.

Treating Microvascular Angina 

Patients with microvascular angina have a worse prognosis than the general population, therefore diagnosis and appropriate treatment is important. Relieving pain, controlling symptoms and minimizing risk factors are often achieved through a combination of medications, healthy diet and an exercise program.

Some medications that can be used include:

  • Aspirin
  • ACE inhibitors, beta blockers and calcium channel blockers (blood pressure)
  • Statins (lower cholesterol)
  • Long-acting nitrates (reduce chest pain by widening blood vessels)
  • Nitroglycerin (relaxes blood vessels) 

Learn More about Angina

Peripartum Cardiomyopathy

Peripartum cardiomyopathy is a rare form of heart failure that can happen between the last month of pregnancy and up to five months after childbirth.

It may be difficult to diagnose because characteristic swelling and shortness of breath resemble common third-trimester pregnancy symptoms – it’s uncertain how many cases occur in the United States, but the incidence is likely somewhere between 1 in 1,000 to 1 in 4,000 live births.

One interesting thing about peripartum cardiomyopathy is that there is definite geographic variation in incidence of this disease around the world, with some countries, such as Nigeria having high rates (1 in 100) and other countries, such as Japan, having very low rates (1 in 20,000). Some explanation for this variation may be differences in how the condition is diagnosed in different countries as well as certain genetic predispositions and cultural practices that may increase risk for development.

What Causes Peripartum Cardiomyopathy?

Researchers have been unable to define a clear cause of peripartum cardiomyopathy, but it results in an enlarged and weak heart with symptoms of heart failure

Symptoms of Peripartum Cardiomyopathy

Peripartum cardiomyopathy typically occurs between 36 weeks gestation and five months after delivery, but most often occurs within one month of giving birth. Symptoms of peripartum cardiomyopathy can overlap with normal symptoms of pregnancy, so it is important that you are getting regular checks with your obstetrician. If they are concerned, they will work closely with your Women’s Heart Health cardiologist to make sure you are being evaluated and treated appropriately. Some of the common symptoms include:

  • Shortness of breath
  • Rapid heartbeat or Palpitations
  • Fatigue, especially during physical activity
  • Swelling in legs, feet and ankles
  • Weight gain
  • Bloating, abdominal pain
  • High blood pressure
  • Increased urination at night
  • Difficulty lying flat
  • Waking up at night short of breath

Risk Factors of Peripartum Cardiomyopathy

These factors can increase your chances of developing peripartum cardiomyopathy:

  • Maternal age over 30
  • African descent
  • Pregnancy with multiple fetuses
  • High blood pressure, particularly preeclampsia and eclampsia
  • Diabetes
  • Use of some medications that prevent premature delivery

Diagnosing Peripartum Cardiomyopathy

Your Women’s Heart Wellness cardiologist, as part of a physical exam, following a review of your symptoms, will use a stethoscope to look for signs of fluid in your lungs, a rapid heart rate or other unusual heart sounds.

Additional tests might include:

Your cardiologist will assess your heart’s ability to pump blood with an echocardiogram. If the pumping efficiency has diminished (ejection fraction less than 45 percent) and there is no other explanation for the reduction, a diagnosis is made. The ejection fraction (EF) assesses the amount of blood pumped by the left ventricle with each contraction. A normal EF is between 55 and 70 percent.

The incidence of peripartum cardiomyopathy is rising in the United States. We don’t know if this is because of improved diagnosis or because women today tend to have more risk factors for developing it such as increased maternal age and additional cardiovascular risk factors

Treating Peripartum Cardiomyopathy

Typically, patients with peripartum cardiomyopathy are treated similarly to other patients with heart failure. A combination of medication and, lifestyle changes can help control your symptoms.

Medications often include:

  • Beta blockers: Help the heart beat slower, reducing blood pressure and enhancing blood flow by blocking adrenaline.
  • ACE (angiotensin converting enzyme) inhibitors: Prevents the production of angiotensin II, which narrows your blood vessels.
  • Digitalis: improves your heart’s pumping action.
  • Diuretics: These drugs reduce fluid retention by filtering excess water and salt from your body.
  • Anticoagulation: blood thinning medication that may be prescribed based on your heart’s pumping function to prevent clots from forming.


Most women have partial to complete recovery of their heart pumping function. Even with complete recovery, there can be recurrence of the cardiomyopathy, especially with subsequent pregnancies. Therefore, it is important to continue with routine follow-up with your Women’s Heart Wellness cardiologist and to get counselling prior to any future pregnancies.

Stress Cardiomyopathy

Stress cardiomyopathy, a mysterious condition commonly known as broken heart syndrome or takotsubo cardiomyopathy, can produceintense chest pain and other symptoms that can feel like a heart attack. In fact, about 5% of women having a heart attack actually have this condition. The good news is that most people with stress cardiomyopathy have full recovery with no long term damage to their heart.

Women are particularly vulnerable to stress cardiomyopathy. Researchers found that women are approximately 9 times more likely than men to experience stress cardiomyopathy. The majority of those affected are post-menopausal. Treatment includes consultation with a cardiologist and risk factor modification.

What Causes Broken Heart Syndrome?

The exact mechanism is not fully understood, but we think it has to do with a surge in stress hormones (like adrenaline or dopamine) in reaction to extreme emotional or physical stress, for example, learning about the sudden death of a family member, a divorce or a car accident. Fortunately, it’s almost always temporary and rarely fatal. The majority of patients recover within a month.

Stress hormones increase your heart rate, elevate your blood pressure and provide bursts of energy that in large quantities can
disrupt heart function.

What’s the Difference Between Broken Heart Syndrome and a Heart Attack?

Heart attacks are usually caused by blocked heart arteries. A blockage begins with a blood clot caused by the buildup of plaques or fatty material, a disease known as atherosclerosis, in the artery walls. The blocked artery can result in damage to the heart, reducing its ability to pump blood efficiently.

In broken heart syndrome, your heart’s arteries are not blocked but the heart’s pumping function is suddenly reduced..

Signs of Broken Heart Syndrome

Remember, this condition can closely mimic a heart attack. So look for:

  • Chest pain/pressure/tightness
  • Shortness of breath
  • Pounding heart (palpitations)
  • Dizziness
  • Sweating
  • Nausea, vomiting
  • General weakness
  • Passing out

Risk Factors

  • Sex: This condition affects far more females than males. We don’t know yet why women have this condition more than men, but we do know that they become more vulnerable after menopause, with most cases occurring in postmenopausal women.
  • Age: Women 55 and older are almost three times more likely than younger women to develop broken heart syndrome, according to a study.
  • Mental health: A history of anxiety or depression increases your risk.

Treating Stress Cardiomyopathy

There is no standard treatment for stress cardiomyopathy, but often we use similar medications that we use to treat heart failure, particularly beta-blockers, ace-inhibitors and diuretics. Fortunately, most patients fully recover in a few weeks but we often continue medications for longer with the goal of preventing a recurrence. We also focus on modifying risk factors for heart disease.

Learn More

Women’s Coronary Artery Disease

Coronary artery disease, characterized by blockages in blood vessels that supply the heart muscle with blood, accounts for 1 in 3 deaths of women each year in the United States. This disease is often associated with men despite these numbers; perhaps because women often experience it 10 years after their male counterparts.

Symptoms and risk factors of coronary artery disease are often different in women than in men. Your Women’s Heart Wellness Program doctor is particularly attuned to these differences and identifying coronary artery disease when it’s most treatable and least disruptive to your health.

What is Coronary Artery Disease?

CAD, as this disease is often called, is the most common type of heart disease. If you have coronary artery disease, it’s likely the arteries that transport blood to your heart muscle have stiffened and narrowed after accumulating plaque buildup on their walls. This condition, atherosclerosis, slows the flow of blood to the heart.

What’s Different About Coronary Artery Disease in Women?

Here are a few differences:

Coronary Arteries

Women’s coronary arteries are smaller than men’s, complicating medical imaging (angiography and stress testing), procedures to treat CAD (angioplasty) and cases requiring surgery (coronary bypass).

Cholesterol Levels

Women develop CAD about 10 years later than men, perhaps related to menopause. Before menopause, estrogen increases a woman’s HDL (good) cholesterol and decreases her LDL (bad) cholesterol – diminishing chances of heart disease. Post-menopause, women typically have higher levels of cholesterol. A combination of low HDL and high LDL can contribute to a higher risk of coronary artery disease.


A woman with diabetes has a greater risk of heart disease than a man with diabetes. Women with diabetes can also have hypertension, high cholesterol and obesity – all increasing their risk of heart disease. Diabetes also can alter the way women experience pain, increasing the odds of having a heart attack that doesn’t show typical symptoms.

Mental Health: Stress and Depression

A women’s heart, more than a man’s, is affected by stress and depression.


Smoking increases women’s risk of coronary artery disease more than it does men’s risk.

Symptoms of Coronary Artery Disease in Women

Women with coronary artery disease often don’t know it. Many don’t even know when they’re having a heart attack.

Here are some signs of heart disease:


Chest discomfort caused by lack of oxygen caused by reduced blood flow to the heart. You might feel pressure or tightness, a squeezing or maybe a sensation of heaviness. Physical exertion, extreme temperatures, stress, alcohol or smoking can contribute to an episode of angina. Learn More >>


An irregular or rapid heartbeat. You might feel shortness of breath, palpitations, dizziness or chest pain. Learn More >>

Transient ischemic attack (TIA) and stroke:

A TIA, often called a mini-stroke, is temporary restriction of blood supplied to the brain. Neurological symptoms – numbness on one side of your face, arm or leg or trouble seeing, talking or walking – last less than 24 hours. If symptoms last longer, you’re having a stroke. If you are having symptoms of a TIA or stroke, it is important that you act fast and call 911 for immediate medical help.
Learn more>>

Diagnosis & Treatment

Women’s Heart Wellness