For nearly three decades, cardiologist Dr. Arash Bereliani has treated patients with heart disease. But his latest book, What About Her Heart?, grew out of something more personal: the sudden loss of someone close to his family.
The experience forced him to reconsider a question that has shaped his work ever since: What happens when the symptoms, risk factors, and warning signs of heart disease in women don’t fit the traditional picture?
In What About Her Heart?, Bereliani examines the gender gap in cardiovascular medicine and challenges women to become more informed advocates for their own health. From overlooked symptoms and menopause to pregnancy history and the limitations of standard cardiac testing, he argues that understanding a woman’s heart requires moving beyond a model largely built around men.
Here, Bereliani explains what women should know about their hearts—and why being told that everything is “normal” shouldn’t necessarily be the end of the conversation.
You have been a cardiologist for nearly three decades, but this book began with a personal loss. What happened, and how did it change the way you practice?
I lost someone close to my family suddenly, and there had been signs. Not dramatic ones. Fatigue, some discomfort that got explained away, a general sense that something was off. Nobody connected them to her heart, including people who loved her and would have done anything to help.
That is the part that stayed with me. I had spent decades treating heart disease, and it still happened right in front of me.
It made me go back and look at my own patients differently, especially the women who came in with vague complaints that didn’t fit the textbook. I stopped asking myself whether their symptoms matched the classic picture and started asking why the classic picture never included them in the first place.
The title is a question: What About Her Heart? Who are you asking, and why did that question stay with you?
I’m asking about my own profession first.
We built modern cardiology on studies that were largely conducted in men and then applied those findings to everyone. When a woman doesn’t match those findings, the conclusion has too often been that she is the exception rather than that our model is incomplete.
But I’m also asking women directly.
A lot of women manage everyone else’s health. They track their kids’ checkups, push their husbands to get their cholesterol checked, and make sure everyone else is taken care of. Their own heart is often the last thing on the list.
The question is meant to interrupt that.
You write that modern medicine was not designed with women’s hearts in mind. What actually happens when a woman walks into an ER or a doctor’s office with heart symptoms?
Several things can happen, and none of them require anyone to be acting in bad faith.
Studies have consistently shown that women can wait longer to be evaluated, are less likely to receive an EKG quickly, and may be less likely to be referred for further cardiac testing than men with the same complaint.
Then there is the testing itself.
Standard cardiac tests are very good at finding a large blockage in a major artery, which is the most familiar pattern of coronary disease. Women can more often have disease involving the smaller vessels of the heart or patterns of plaque that don’t always present the same way. Those problems may not be captured by a standard angiogram.
So a woman can be told her arteries are “clean” and sent home when the more accurate answer is that we may have been looking with the wrong tool.
The end result is a woman who has been evaluated, cleared, and is still having symptoms, with no one following up.
Women are so often told their symptoms are just stress or anxiety. How can a woman tell the difference, and what should she do if she feels dismissed?
Stress and anxiety are real, and they genuinely cause physical symptoms, so I never want to dismiss that either.
The distinction I teach patients is pattern.
Anxiety usually rises and falls with what is happening in your life and your thoughts. Cardiac symptoms can be tracked with physical exertion. If you feel discomfort walking up a hill or carrying groceries and it eases when you stop, that is a pattern worth taking seriously.
New symptoms that appear with exertion and go away with rest deserve a workup.
If you feel dismissed, do two things.
First, ask directly for your concern to be documented. You can say, “I would like it noted in my chart that I reported chest discomfort with exertion and that we decided not to test.”
That single sentence changes the conversation because it moves the decision into the medical record.
Second, ask for the actual numbers, not just the summary.
“Your labs look fine” is not the same as seeing the results yourself.
And then get a second opinion if you need one. You are not being difficult. You are being your own advocate, and no good physician should resent that.
How do heart attack symptoms actually differ in women compared with men, and which warning signs should never be ignored?
There is a myth I want to correct because it has done real damage: people hear that women don’t get chest pain during a heart attack.
That is not true.
Chest pressure or discomfort is still the single most common symptom in women. The difference is that women may be more likely to experience additional symptoms alongside it, and sometimes those symptoms are the ones they notice most.
They can include shortness of breath, nausea, pain in the jaw, neck, upper back, or arm, breaking into a cold sweat, lightheadedness, and unusual exhaustion.
Many women also describe a stretch of days or weeks beforehand where they simply felt drained in a way that didn’t make sense.
The symptoms I never want ignored are chest discomfort accompanied by a cold sweat or nausea, shortness of breath doing something that never used to wind you, or sudden profound fatigue without an obvious explanation.
If symptoms come on together, call 911 rather than driving yourself.
Menopause and pregnancy both seem to play a bigger role in heart health than most women realize. Can you explain the connection?
Pregnancy is one of the most revealing cardiac stress tests a woman will ever take, and almost nobody treats it that way.
If you had preeclampsia, gestational diabetes, high blood pressure during pregnancy, or delivered preterm, your risk of cardiovascular disease later in life can increase meaningfully.
That history matters at 55 just as much as it did at 30. It belongs in every cardiac conversation you have for the rest of your life.
Menopause is another major turning point.
As estrogen declines, cholesterol patterns can change, blood pressure may rise, fat can redistribute around the abdomen, and sleep can become disrupted. All of those changes can push cardiovascular risk upward over a relatively short period.
The trap is that palpitations, fatigue, and shortness of breath can get filed under “menopause” when they can also be the heart asking for attention.
Both things can be true at once.
Only one of them gets checked with a cardiac test.
What are two or three everyday habits that genuinely protect a woman’s heart?
Walk for ten minutes after your largest meal.
It can help blunt the blood sugar and triglyceride response to a meal, and it’s one of the easiest habits to maintain because it attaches to something you already do.
Protect your sleep the way you protect your calendar.
Short and fragmented sleep can raise blood pressure and contribute to inflammation. Seven hours of sleep is not indulgent. It is part of taking care of your heart.
Add strength training twice a week.
Muscle is an important site for glucose disposal, and after menopause women can lose muscle more quickly. Two strength-training sessions a week can have a meaningful impact on long-term metabolic and cardiovascular health.
If a reader takes away just one thing from your book, what do you hope it is, and what is one step she can take this week to protect her heart?
I want women to understand that their heart is not simply a smaller version of a man’s heart.
And I want them to understand that “your tests were normal” can be a starting point rather than an ending.
One practical step this week is to talk with your doctor about your cardiovascular risk and whether additional testing, such as ApoB and Lp(a), is appropriate for you.
ApoB can provide information about the number of atherogenic cholesterol particles in the blood, while Lp(a) is a largely inherited cardiovascular risk factor that many people never have checked. Lp(a) generally only needs to be measured once.
Most importantly, ask for your actual results—not just the summary.
Knowing your own numbers is where every other decision starts.
A Different Question for Women’s Heart Health
For Bereliani, the central message of What About Her Heart? is ultimately bigger than any single symptom or blood test.
It’s about recognizing that women’s cardiovascular health deserves to be studied, discussed, and treated on its own terms.
For women who have spent years prioritizing everyone else’s health, the question in the book’s title is also an invitation to pause and ask something simple—but potentially life-changing:
What about her heart?
More info: https://www.drbereliani.com/
