Royal Brompton specialists close the gender gap in cardiac care

Cardiovascular disease is the leading cause of death among women worldwide, yet women remain significantly underrepresented in both research and treatment pathways. This gap has serious implications for diagnosis, management, and outcomes. Women’s health experts across Guys and St Thomas’ Specialist Care work collaboratively to offer services that help aid earlier diagnosis and better monitoring of women at risk of cardiac complications.  

Dr Abtehale Al-Hussaini, a leading specialist in women’s cardiology at Royal Brompton Hospital, champions a sex-specific approach that recognises unique risk factors and conditions affecting women, so our patients can get the screening, diagnoses and cardiology intervention they need without delay.

Why are fewer women being diagnosed with heart conditions?

According to the British Heart Foundation, women have a 50% higher chance than men of receiving the wrong initial diagnosis following a heart attack. Clinical guidelines on heart attacks often adopt a sex-neutral approach that does not always take into consideration anatomical and physiological differences between the hearts of men and women. These differences can cause heart attack symptoms in women to present differently.  

“Women often have very different symptoms from men,” explains Dr Al-Hussaini. “They don’t always experience the classic chest-clutching pain or sweating. Instead, they may have dull aches, sharp pains, back ache, persistent fatigue associated with chest discomfort, or symptoms that are less acute, which can develop gradually over a couple of days.” 

Our women’s health experts have direct access to an extensive network of consultants with expertise in unique conditions affecting women, such as spontaneous coronary artery dissection (SCAD) and heart problems during high-risk pregnancies. They can also refer patients for advanced diagnostics. For example, our obstetricians caring for pregnant patients with cardiac complications, or gynaecologists managing menopause, can refer patients to our cardiology specialists for appropriate imaging and diagnostics, including innovative investigations such as fetal cardiac MRI scans.  

Dr Al-Hussaini shares, “women with heart disease are underrepresented across the UK and globally. Our specialists are addressing this by building a network of multi-disciplinary experts that work collectively to ensure patients receive the highest quality of care, across all specialties.”  

Dr Al-Hussaini supports this by collecting data from her patients and identifying non-conventional risk factors such as pre-eclampsia and eclampsia, metabolic syndrome and autoimmune disease. She also leads research on SCAD, a rare coronary disease mainly affecting women. 

She urges clinicians to investigate symptoms thoroughly and to refer patients for diagnostics if there are concerns. Even if a patient does not fit the typical picture often associated with cardiac events, it does not mean they are not experiencing one – which is often a concern for SCAD patients.

Spontaneous coronary artery dissection (SCAD)

SCAD is a rare but serious condition that can cause myocardial infarction. SCAD accounts for approximately 25–40% of heart attacks in women under 50. and mainly affects women in this age group. SCAD can occur suddenly, often with little warning, and typically without conventional cardiovascular risk factors, which can delay diagnosis and urgent intervention. 

“It’s a very under-recognised condition,” explains Dr Al-Hussaini. “Awareness of SCAD is essential so that clinicians can identify it, arrange the right management, and ensure appropriate follow-up. Often, we see young, healthy women with no other cardiovascular risk factors, so recognising and managing SCAD correctly is vital.” 

SCAD should be considered in young women presenting with acute coronary syndrome, particularly in the absence of traditional risk factors. Early recognition and cardiology referral are key to optimising outcomes. 

Dr Al-Hussaini is one of very few consultants offering private care for SCAD in the UK, and she also manages NHS patients with the condition. With expertise in a wide range of coronary procedures and diseases, she also offers heart risk screening consultations, which can identify risks and initiate early management before serious complications occur.

Managing heart health during pregnancy

Dr Al-Hussaini also has expertise in the impact hormone changes have on cardiovascular risk factors. Women with pre-existing heart conditions are more prone to cardiovascular complications during pregnancy, due to hormone changes and the strain put on heart and blood vessels. They should seek pre-conception guidance from our cardiologists so their condition can be effectively managed and monitored. 

Peripartum cardiomyopathy can develop in the last trimester of pregnancy or up to 6 months after delivery. It weakens the heart muscle and reduces its ability to pump blood effectively. Women who experienced complications such as pre-eclampsia or gestational diabetes remain at increased risk of heart complications after pregnancy, and should be referred for diagnostic testing and early cardiovascular risk factor screening, even before they develop symptoms. 

We are proud to offer the UK’s largest fetal cardiology service that integrates St Thomas’, Evelina London Children’s and Royal Brompton hospitals. Here, world-leading specialist obstetricians and fetal heart doctors work as part of a multi-disciplinary team to create informed birth plans, ensuring that both mother and baby receive appropriate treatment as early as possible. At Guy’s and St Thomas’ Specialist Care, we’re recognised as global leaders in obstetrics and gynaecology, reflecting our commitment to delivering exceptional care for women.

The effects of menopause and perimenopause on the heart

Menopause and perimenopause can increase the risk of coronary heart disease. This is due to a higher likelihood of weight gain, elevated blood pressure, increased fat around the heart, and an increased risk for metabolic syndrome. 

Oestrogen deficiency, caused by reduced ovarian hormone production, can also lead to higher cholesterol. Since oestrogen has a protective effect on the heart, its decline makes blood vessels more vulnerable to plaque build-up, increasing the risk of heart attack, stroke and coronary heart disease. 

Women who have experienced early menopause (before 45) have a 33% higher risk of heart failure (HF). Early menopause is also associated with coronary heart disease and rhythm problems. This is due to a decline of oestrogen levels which, over a longer period, results in higher LDL cholesterol, reduced HDL, and weakened blood vessels. 

Some women may be asymptomatic for heart complications, so it is important to encourage monitoring of cholesterol and other cardiac risk factors from perimenopause and after the age of 40. Across our sites, we offer extensive private heart screening services, to which our women’s health specialists can refer patients if they identify any areas of concern. This ensures that patients’ conditions are investigated, diagnosed and treated promptly if intervention is needed, providing peace of mind to both patients and their families.

When to refer to us

If a woman is at risk of developing, or currently has, a heart condition and is planning a pregnancy, is pregnant, or has recently given birth, she should be referred to our cardiology team. Referral is also advised for women going through menopause, and for those with symptoms or risk factors such as pre-eclampsia, family history of heart disease, high cholesterol or suspected SCAD. Cardiovascular screening is especially important for women with both traditional and non-traditional risk factors, as it plays a key role in preventing cardiac disease.