8种心力衰竭使女性更加努力
Females have their own set of symptoms, but doctors often don’t recognize them—and other infuriating facts about this all-too-common heart ailment.
中心疾病控制与预防（CDC）估计，目前有超过600万美国人与心脏衰竭。It’s a chronic, progressive, and turns out, equal-opportunity disease, affecting just as many women as it does men. But you might not know that from the specific symptoms doctors look for, the equipment used to scan for this condition, or the lack of referrals women typically get after showing up to their doctors’ offices.
那么，什么给呢？Biologically female bodies often develop and experience heart failure symptoms that are not the same as their male counterparts—which can lead to ignored warning signs and even missed diagnoses in a world that has long and widely regarded men’s symptoms as classic ones, with women’s symptoms deviating from what is considered to be the norm.
If you’re a woman who is concerned about heart failure—maybe捕鱼手机版下载 在您的家庭中奔跑，或者您经历了一些令人不安的症状，例如短暂的或缺乏精力的呼吸 - 让我们的心力衰竭专家带动您解决心力衰竭有时会更加严重打击女性的所有原因。
心脏失败时会发生什么
当您患有心力衰竭时，您的心脏无法充分完成工作，那就是将足够丰富的氧气血液泵送到身体的其余部分。这可能会带来许多后果。
血液在您的肺部倒退，导致呼吸急促。
血液在您身体其他部位（例如腿和腹部）中恢复，导致肿胀。
您的肌肉，器官和其他必需品无法获得足够的氧气，使您疲劳，并且能够身体活跃。
Without treatment, the disease gets worse over time.
1.女性经常出现舒张期心力衰竭
心力衰竭有两种主要类型：收缩期和diastolic。
在收缩性心力衰竭中，心脏变得太虚弱，无法抽血，无法跟上人体的需求。这也称为心力衰竭，射血分数减少（HFREF）。射血分数（EF）是每次节拍的血液量与在节拍之间流入其中的数量相比。正常的EF为50％至70％。EF低于40％的心力衰竭。
Women are more likely to get the other type: diastolic heart failure, or heart failure with preserved ejection fraction (HFpEF). In this type, the heart remains strong, but it has become stiff. That makes it harder for it to relax between heart beats. The result: less blood can flow into the heart, so there’s less blood for the heart to pump out. Unlike HFrEF, HFpEF has few treatment options except for managing symptoms. That’s because there’s little evidence that currently available heart failure drugs provide any benefit to this form of heart failure.
“There haven’t been as many trials in HFpEF, and that’s a major problem,” says cardiologist Tamara Horwich, M.D., a professor of medicine at UCLA’s David Geffen School of Medicine and co-director of the UCLA Women's Cardiovascular Health Center in Los Angeles.
However, that is changing. Dr. Horwich points out that a type of drug called SGLT2 inhibitors reduces hospitalizations for heart failure as well as death from the disease. One such drug, Jardiance (empagliflozin) was approved for HFpEF in February.
霍里奇博士说：“对于为什么女性拥有更多HFPEF并不是一个简单的答案。”“我可以说这是对女性的完全偏见，但我认为这不仅仅是。定义和接受是一种更难的疾病。”
2.女人的寿命比男人更长
那里area few possible explanations for more diastolic heart failure found in women, says cardiologist Sitaramesh Emani, M.D., who specializes in advanced heart failure at the Ohio State University Wexner Medical Center in Columbus, OH.
First up? Age.
Emani博士说：“年龄是舒张期心力衰竭的高度关联的危险因素。”实际上，这可能是“可能的主要原因”。
为什么？妇女往往寿命更长，因此年龄越大，HFPEF和其他形式的心脏病就会越有可能。霍里奇博士解释说：“女性的寿命比男性的寿命更长，心力衰竭是一种衰老的疾病。”因此，只能遵循女性在65至84岁之间患心力衰竭的风险。
3. Diabetes and Other Conditions Affect Women More
但是其他解释更为复杂。例如，HFPEF的主要危险因素是糖尿病。And for some reason, diabetes is particularly worrisome for women in terms of heart failure, Dr. Horwich adds. “Take a man and a woman with diabetes, and the woman has the higher risk of getting heart failure than the man,” she says. “That’s not fully understood.”
Other HFpEF risk factors known to affect women more than men include stress,焦虑,肥胖Horwich博士指出，甘油三酸酯和高水平的甘油三酸酯是一种在血液中循环的脂肪。与糖尿病一样，尚不清楚为什么这些其他健康问题使女性的风险高于男性的心力衰竭。
One better understood cause of HFpEF in women is high blood pressure, or高血压。霍里奇博士说，女性通常会看到更年期后的血压升高，大约55岁。随着时间的流逝，由于高血压而导致的心脏压力会导致心脏僵硬，最终可能导致HFPEF。
根据美国心脏病学院的数据，在近8600万美国患有高血压的美国成年人中有超过一半是女性，女性的高血压率高于65岁以后的男性。克利夫兰诊所报告说，高血压使女性的心力衰竭风险增加了三倍，同时只会使男人的风险增加一倍。
4.怀孕是一种独特的心力衰竭风险
怀孕的并发症也可能导致心力衰竭，这是女性明显特有的原因。例如，产后或腹膜心肌病是一种罕见的疾病，可削弱心脏肌肉，最终会导致心力衰竭。
霍维奇博士说：“妇女在怀孕结束时或怀孕后可以患心肌病。”但是，这种情况的原因仍然未知，只有在找不到其他原因时才能诊断出来。
几个危险因素增加了产后心肌病的几率，包括肥胖，高血压和吸烟。有些妇女会完全康复，但另一些妇女可能会对自己的心脏永久损害。这种情况可能会在未来的怀孕中复发，并且在考虑未来的怀孕时需要与心脏病学和产科专家进行密切协商。
5.女性症状不足
Emani博士说，考虑女性心力衰竭的原因时，也可能会发挥另一个因素：医生对女性心脏病的看法。心力衰竭的两个主要原因是心脏病发作和冠状动脉疾病（CAD）。Both, says Dr. Emani, were historically under-recognized in women. The result: Doctors are often less likely to suspect a woman might have heart failure because they didn’t look for signs of previous heart attack or CAD.
Emani博士说：“我们认为我们对妇女和心力衰竭的了解可能会因我们自己认为如何看待女性的表现而有些偏见。”“传统的左臂或胸痛可能不是女性心脏病患者心脏病患者的症状。”
他继续说，这意味着医生应该寻找心力衰竭的微妙迹象，例如活动水平和能量的下降，而不是只专注于更深刻的症状，例如晚上的呼吸急促和胸部压力。
6.社会规范可以防止妇女寻求治疗
另一个捕获？女人倾向于只去看医生aftertheir heart failure symptoms have become severe, says Dr. Emani. Why? Because of social and cultural expectations, women often find themselves caring for others before caring for themselves.
“Women at times feel relied upon by family and other people close to them, so they may tough it out,” says Dr. Emani. By the time they do see a doctor, they may have severe shortness of breath and other symptoms. Which creates a vicious cycle in how they are diagnosed.
Emani博士说：“妇女可能不太可能提早挺身而出，但同样，医学界可能会较早或能够识别出症状，因为我们期望她们会迟到。”“这里可能在这里发挥着隐性的偏见。”
7. HFpEF Is More Difficult to Diagnosis
Horwich博士指出了女性的另一个并发症：HFPEF更难诊断。为什么？因为医生用来发现心力衰竭的主要工具是超声心动图，它使用声音波来创建心脏图片。霍里奇博士说，它擅长揭示心脏何时变得虚弱，但并不是很擅长检测何时变得僵硬。
提供了HFPEF的更高级测试，但在所有医疗中心都不可用。此外，医生在订购那些更复杂的测试之前首先需要怀疑心力衰竭：“您需要更多的时间，并且必须寻找心力衰竭，” Horwich博士说。
8.女性的推荐可能很难获得
根据2017年对妇女和心力衰竭的医学文献的评论，使情况更糟，女性不太可能被转介到心力衰竭专家或进行诊断检查。Emani博士说：“这对我们现场来说是一个主要的挑战：了解这种模式为什么存在以及我们可以采取的措施来克服它。”
为什么这样？埃玛尼博士说：“其中有些可能没有被认为是隐性的偏见。”“ [医生]可能认为这与心脏病或瓣膜疾病无关，因为这是女性患者。”
Dr. Horwich agrees: “Heart disease is still seen as a man’s disease.”
Be Your Own Female Heart Failure Advocate
“The most important thing,” says Dr. Horwich, “is to listen to your body.” You know when something feels "off" or wrong, even if your doctor discounts it at first.
Dr. Horwich describes a common scenario: a patient of hers complained of shortness of breath, and her doctor told her she was anxious because she had a new baby.
“It turned out she had postpartum cardiomyopathy with heart failure,” says Dr. Horwich. “She just kept going back and saying I know my body, I’m not anxious, there’s something wrong here.”
课程：坚持不懈。
Dr. Emani recommends knowing the signs and symptoms of heart failure and recognizing subtle changes that may be a warning sign, such as a drop in your energy level. “Bring that to your doctor’s attention,” he says.
另一个提示：了解您家人的健康史。
“If men in your family had heart disease, understand that it’s not going to skip the women,” says Dr. Emani.
And if you had complications during pregnancy, such as preeclampsia or gestational diabetes, be aware that you are at higher risk of cardiovascular disease later in life, particularly hypertension, adds Dr. Horwich.
她说：“重要的是要知道您处于危险之中，因此您将其与医生一起提高，并确保所有心力衰竭的风险因素都得到照顾。”
心脏衰竭：梅奥诊所。（2021.）“心力衰竭。”https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-20373142#:~:: text = heart%20Failure%20Occurs%20Occurs%20Curs%20WHEN%20WHEN%20WHEN%20THE COM20BLUE%20BLUE%20BLUE%20CYANOTIOT）。
女性心力衰竭：Cleveland Clinic. (2019.) “Heart Failure in Women.”https://my.clevelandclinic.org/health/diseases/17078 Heart-failure-in-in-Women
女性心力衰竭：卫理公会Debakey心血管期刊。（2017年。）“女性心力衰竭。”https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5935281/
