Understanding Women's Heart Health - Doctor Q&A

Heart disease can affect women at all ages, and particularly after menopause.

In Singapore, cardiovascular diseases (CVD) including heart disease and stroke are the leading cause of death among women.

Heart disease proves deadlier in women, and it is often undiagnosed or undertreated.

While chest pain remains the hallmark symptom of a heart attack, women are more likely to exhibit atypical symptoms such as:

• Shortness of breath,
• Nausea and vomiting,
• Back, neck or jaw pain, and
• Fatigue

Women are also more likely to dismiss these symptoms, and less likely to see a doctor when symptoms of heart disease appear, causing delays in diagnosis and treatment.

Prevention through early detection and management of cardiovascular risk factors offers the best protection against heart disease in women.

Key risk factors include:

• High blood pressure (hypertension)
• Diabetes (Type 2 Diabetes Mellitus)
• Obesity,
• Unhealthy diet,
• Sedentary lifestyle, and
• Smoking

By understanding and actively managing these risks, women can take control of their cardiovascular health and improve their outcomes.

Don't miss this chance to ask Dr Natalie Koh what you can do to lower your risk of heart disease!
 

Related articles:
Women's Heart Health: While Different, Never Less

Cardiovascular Diseases - Men are from Mars, Women are from Venus

Why women should protect their hearts against cardiovascular disease | NHCS News

Dr. Natalie Koh is a Senior Consultant with the Department of Cardiology at National Heart Centre Singapore (NHCS), where she leads the Cardiometabolic Service and a multimodal cardiac imaging portfolio.

She is certified in advanced Cardiac CT and Echocardiography, and co-founded the Cardiac CT Laboratory at Sengkang General Hospital (NHCS@SKH).

In 2023, she launched Singapore’s first academic Cardiac CT Perfusion service, advancing diagnostic precision for cardiometabolic disease.

She contributes to regional leadership through the Asia-Pacific Society of Cardiology and the Asia-Pacific Cardio Metabolic Consortium (Diabetes and Hyperlipidemia steering committees).

Her work has been recognized with awards including the 2021 Healthcare Manpower Development Clinical Fellowship Award.

1. Question by Siraj

Hi Dr,

My wife is 59 years old and has high blood pressure reading for some time.

Recently, the doctor at a polyclinic detected her potassium reading.

It was mentioned that it was due to her high blood for years.

What can we do to reduce her high blood and potassium please?

Thank you for your advice.

Answer by Dr Natalie Koh

Hi Siraj,

Suggest as a first step to repeating the blood test (and check kidney function) and reviewing her medications/supplements, as these are common causes.

In the meantime, avoid potassium supplements and “low-sodium” salt substitutes, and temporarily cut back on very high-potassium foods (e.g., coconut water, bananas, orange juice, tomato-heavy foods).

To bring blood pressure down, use home BP monitoring, reduce salt, exercise regularly, and follow the clinic’s plan to adjust BP medicines safely (especially if potassium remains high).

2. Question by Annie

Hi Dr,

I have done an angiogram recently.

And it was diagnosed with two arteries blocked. 4 stents were inserted.

After the Angiogram, I felt breathless and have palpitations frequently.

My blood pressure readings has shot up to 188 for systolic , 89 for diastolic and heart pulse 84.

May I know is it because of the surgery or the medication that triggers the breathlessness, palpitations and high blood pressure reading?

Appreciate your advice. Thanks.

Answer by Dr Natalie Koh

Hi Annie,

Breathlessness and frequent palpitations that started after 4 stents, together with a BP of 188/89, need same-day urgent medical review (and go to A&E now if there is chest pain, worsening breathlessness at rest, fainting, sweating, or a sustained fast/irregular heartbeat).

3. Question by Tay

Dear Doctor,

Will a low resting heart rate (around 40 to 50 beats/min) pose any problem for those who are not athletes?

Blood pressure is also low. I am not on any medication. Thanks.

Answer by Dr Natalie Koh

Hi Tay,

A resting heart rate of 40–50 bpm with low blood pressure can be normal in some people, but in a non-athlete it warrants a check especially if this is something new or associated with symptoms.

If you have dizziness, fainting/near-fainting, unusual fatigue, breathlessness, chest pain, or exercise intolerance, please seek prompt medical review (with an ECG and basic blood tests such as thyroid and electrolytes).

If you feel completely well and this has been longstanding, arrange a non-urgent review to document your baseline and exclude rhythm conduction problems.

4. Question by Rebecca

Dear Dr,

Last year one of my brothers had to undergo open heart surgery as he had 3 blockages. He is 65 and this year my 60-year-old brother also had to do a stent as one of his arteries was 90% blocked.

I have gone for a heart screening (Transthoracic echocardiography and IMT) last year and it shows ok.

Should I be worried that there is something sinister hiding in me despite my results?  I do 5km walks at least 5 days a week.

Thank you for your advice.

Answer by Dr Natalie Koh

Hi Rebecca,

Your echo and carotid IMT being normal is reassuring, but with two first-degree brothers having significant coronary disease, your inherited risk is higher, and echo/IMT cannot fully rule out “silent” coronary plaque.

Rather than worrying, I’d use this as a prompt for proper risk profiling (fasting lipids including LDL/non-HDL, HbA1c/diabetes screen, kidney function, blood pressure, consider Lp(a)) and set aggressive prevention targets with your doctor.

If you have any symptoms or multiple risk factors, discuss whether additional testing (e.g., coronary calcium score/CT coronary angiogram) is appropriate; your walking habit is excellent, keep it up.

5. Question by Olga

Hello Dr Natalie,

I am a 55-year-old Caucasian.

I had radiotherapy for stage 1 breast cancer three years ago. Ten fifteen-minute sessions.

I have been told by a cardiologist that this may cause me heart issues in the future.

Would you agree with that? Any specific ones I should be anticipating?

Please take time to answer, there is no rush. Thank you.

Answer by Dr Natalie Koh

Hi Olga,

Yes, I agree there can be increased long-term heart risk after breast radiotherapy, especially if the left breast/left chest was treated, but the absolute risk varies with modern techniques and your other risk factors.

The main issues we watch for over time are coronary artery disease, stiffening/valve disease, and (less commonly) heart muscle weakness or rhythm problems, usually developing years rather than months later.

The best next step is a baseline cardiovascular risk review (BP, lipids, diabetes, lifestyle) and to ask your oncologist which side/heart dose you received; then your cardiologist can advise if/when to do follow-up tests (often ECG/echo and sometimes coronary calcium scoring depending on risk).

Ref: F26