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By Madelyn Fernstrom, PhD

Men and women will always have their differences, but did you know these differences also extend to our hearts?

That’s important to know because heart disease is the leading cause of death for women in the United States. In fact, according to the Centers for Disease Control and Prevention, heart disease accounts for about one in every four female deaths in the country.

In honor of American Heart Health Month, we’re looking at the unique features of the female heart so you can keep your ticker as healthy as possible.

It’s important to note that heart disease treatment and prevention are the same for both men and women. That includes a healthy lifestyle, medications, or surgery. Also, chest pain is the most common heart attack symptom for both sexes.

But the four differences in a woman’s heart are key to understand, because it can impact how heart disease shows up in women, how it’s diagnosed and how it’s treated.

1. Women’s hearts and arteries are smaller.

What this means: It’s all about the hormones. Male hormones (testosterone) enlarge arteries, while estrogen and progesterone in women make them smaller. That makes women’s arteries more prone to blood clots or blockages from artery-clogging plaque. Smaller vessels may also contribute to migraines and other inflammatory diseases.

2. Plaque build-up in blood vessels that cause heart disease are often different in women.

What this means: Heart attacks are caused by plaque accumulation, but men’s plaque tends to be hardened, often impacting all three coronary arteries (heart arteries). Women might have blockage in one or two, but these deposits tend to be softer, making it more likely to dislodge and travel in the blood stream, potentially causing a heart attack.

3. Heart disease without blocked arteries occurs more often in women.

What this means: About one out of three women undergoing heart procedures do not have blocked arteries. Their heart disease appears to be caused, at least in part by low blood flow to the heart, which doctors don’t quite fully understand yet. This may be related to the smaller coronary arteries.

4. Women’s hearts are impacted by estrogen.

What this means: Estrogen protects younger women’s hearts. Heart disease risk remains low, compared to men, until menopause when the risks become similar. During menopause, it’s particularly important to have yearly checkups for blood pressure and blood cholesterol, in addition to maintaining a healthy diet and keeping up with physical activity.

Signs of a heart attack: Symptoms every woman should know

There are many symptoms of heart problems that are not crushing chest pain. It’s important to pay attention to these symptoms — and don’t ignore them — no matter your age. These symptoms may come and go before an actual heart attack occurs. You know yourself best. If you have any questions, don’t hesitate to call your doctor. Symptoms include:

-Nausea or vomiting

-Dizziness or lightheadedness

-Shortness of breath, with or without chest discomfort

-Discomfort, tightness, or pressure in the center of the chest, often lasting more than a few minutes (or it might stop, and then return)

-Pain in one or both arms, upper back, neck, jaw or stomach

-Paleness or clammy skin

-Fainting

-Breaking out in a cold sweat

-Inability to sleep

-Chronic indigestion

-Unusual fatigue when doing something you do all the time easily (For example, running to catch a train, vacuuming, riding a bike)

Many women ignore these “red flags,” assuming their hearts are immune to any trouble, especially before menopause.

The bottom line: If you’re not “feeling like yourself,” see your doctor. Studies show women often have one or more vague symptoms before a heart attack. Men don’t usually have that window.

Madelyn Fernstrom, Ph.D. is the NBC News Health Editor. Follow her on Twitter @drfernstrom.