February 2009

February is American Heart Month. How Do You Know if You Have Heart Disease?

What are the Symptoms of a Heart Attack? What are the Symptoms of Heart Disease?

One would think that something as dramatic as a heart attack would be easy to diagnose. However, women are often misdiagnosed when they are having one. This happens in part because they fail to recognize that their symptoms are indicative of a heart attack and because the doctors that they go to may fail to recognize the symptoms of a heart attack as well.

Why is this? For years heart disease was felt to be a man’s disease. It was only relatively recently that physicians and medical researchers realized that it is also very much a woman’s disease. Heart disease is the number one killer of men and women in the United States.

Now we know that women often do not have the same type of heart attack symptoms as men. Men generally present at a younger age than women do with crushing chest pain radiating to the neck or down the arm with sweating, nausea and shortness of breath. They will often describe the pain as “squeezing” or “heaviness,” and may say they feel like an elephant is sitting on their chest. This pain does not stop immediately, but persists for minutes to hours with exercise, and often at rest.

Women’s symptoms

Women are relatively protected from heart disease until menopause (unless they are diabetic). After menopause we catch up with men. So in general women present at an older age with heart disease than men, which is in part why the symptoms may be different. Those who are older in general are less likely to present with chest pain as a heart attack symptom.

Women having a heart attack will most often present with shortness of breath, weakness, overwhelming fatigue, dizziness, nausea, and anxiety. They may experience chest discomfort but they may also have arm pain, jaw pain or indigestion. They also can have pain in the upper back or abdominal pain.

Real women, real stories

Dr. R had one woman patient who presented with severe jaw pain and shortness of breath and another who presented with nausea, vomiting, diarrhea, fatigue, shortness of breath and dizziness. The first patient thought she had a tooth infection and the second patient thought she had the stomach flu. Both waited to seek help and both had severe heart attacks that left them with diminished heart function.

Is it possible to have symptoms of early CHD, before it has reached the stage of a heart attack?

Absolutely. The majority of women who have had a heart attack had symptoms the month leading up to the heart attack that they ignored. And many women had recurring symptoms over a longer period of time that they ignored because the symptoms seemed to go away on their own; but they came back. These symptoms include the ones mentioned above under “women’s symptoms” of a heart attack; they also include becoming short of breath, or getting chest symptoms, with any type of exercise that you were able to do before with no shortness of breath; getting more fatigued after doing an activity that previously did not fatigue you; and always feeling fatigued, or run down, even after you have rested.

What Should I Do if I have any of these Symptoms?

Easy: don’t wait to seek help. The take home lesson here is that we all need to listen to our bodies and not motor on if we think that something is seriously wrong. In addition, if we do think that something is wrong and our medical provider is not addressing our concerns, find another provider who will evaluate them. So, does this mean if you are dog tired for a prolonged period of time, or don’t ever to feel rested no matter how much you rest, you should see a doctor? Yes, especially if you have any of the risk factors. Don’t chalk your symptoms up to doing too much or working out too hard. Pay attention to what your body is trying to tell you.

If you are having a heart attack the goal is to protect your heart. Remember time is heart muscle. Do not wait- call 911 and if you are not allergic, chew an aspirin while you wait for the ambulance to arrive. Be smart, save your heart and save your life.

We discuss heart disease (and stroke) in much greater detail in our book. Also, for further information go to the following website: www.americanheart.org.

February is American Heart Month. Here are the Basics.

What Exactly Do I Need to Know about Heart Disease?

The most important thing to know about heart disease is that it is preventable. But, in order to prevent it, you must know the facts. Since it’s such a huge subject, what exactly do you need to know? 3 main things: 1) what puts you at risk for having it; 2) what symptoms to look for that may tell you that you have it; and 3) what you can you do to prevent it AND what you must do if you have the symptoms.

What Exactly Is “Heart Disease” Anyway?

Let’s talk about what we really mean when we say “heart disease.” There are several types of heart disease that one may get. These include: disease of the arteries that feed, or supply, the heart with the life-giving blood that has oxygen in it, known as coronary artery disease (CAD) or coronary heart disease (CHD); disease of the conduction system of the heart that keeps the heart beating at a regular rate and rhythm; diseases of the muscle of the heart, known as cardiomyopathy and myocarditis ; and disease of the valves and the inner lining of the heart, one of which is known as endocarditis.

By convention, whenever the term “heart disease” is used, it is referring to disease of the arteries of the heart, or CHD, which is far more common than the other types of heart disease.  Therefore, here we are only going to be talking about CHD. Stroke is mentioned because its cause is identical to that of CHD. What happens in a stroke is that the arteries feeding the brain with oxygenated blood are diseased, just like the arteries feeding the heart in CHD. Therefore, it makes sense that the risk factors that can lead to heart disease can also lead to stroke.

What Exactly are “Risk Factors?” What are the risk factors for CHD and stroke

A risk factor is exactly as it sounds: it is something that makes it more likely that you will get a disease or, that puts you at risk for getting it. Put another way, you are less likely to get a certain disease if you do not have the risk factors for it.

Unfortunately, we all become more at risk for heart disease as each year passes because one of the risk factors is increasing age. This is obviously a risk factor that you cannot change. The other risk factors that cannot be changed include: race, heredity, or having a family history of heart disease, and having already had a heart attack or stroke.

Having one or more of these risk factors that you cannot change does not automatically mean that you are definitely going to get heart disease, or have a heart attack or stroke. The risk goes up with the more risk factors you have. So, even though you cannot change this group of risk factors, you can still do something to help prevent CHD or stroke. And, what is that? You can make sure that you do not have any of the risk factors that can be changed as described below, or if you do have them, you are keeping them under control.

The risk factors for CHD and stroke that can be changed include: having high blood pressure; having high cholesterol levels; having diabetes; smoking cigarettes; being overweight and/or having your waistline be too large; being sedentary, or not being physically active; being depressed or stressed for long periods of time; being on hormone replacement therapy for too long.

How you can change these is obvious: keep your blood pressure, cholesterol, and diabetes under control; stop smoking; maintain a normal weight for your height, and a normal waistline measurement; do regular physical exercise; seek help for your depression and try to cut down on your stress levels; and discuss with your doctor whether you should or should not be on hormone therapy.

All of the above are also risk factors for having a stroke as well. However, there is an additional risk factor for stroke alone: an arrhythmia of the heart known as atrial fibrillation. With this problem, the heart beats way too fast and irregularly.

How Do I Even Know if I have Risk Factors?

The answer to that question is obvious with some of the risk factors: you obviously know if you smoke or used to smoke, if you are physically active, if you have gained weight or are very overweight, or are feeling stressed or depressed. You need to find out as much about your family history as possible.

Equally as important is getting a complete physical examination by your primary care provider, even if you are feeling fine. This will include a full evaluation of all your organ systems. With reference to your cardiac risk factors, it will include: checking your weight, height, and waist measurement, as well as your blood pressure, a heart examination, an EKG, and full panel of bloodwork including a fasting blood sugar and fasting cholesterol (lipid) levels. If an abnormality in your pulse (heartrate) is found on exam, the EKG will also include a longer strip just to look at your heart rhythm, especially to see if you atrial fibrillation.

If you have a family history of heart disease, other of the risk factors, symptoms, or are in midlife, your clinician will want to have you do a test of the heart when you are exercising, called an exercise stress test, and will probably want to do the type of stress test that involves taking pictures of the heart as well – called either a stress echo or a thallium stress test.

Paying attention to ourselves- our family histories and your risk factors – is a must now that we’ve reached midlife. Next, we’ll talk about the symptoms of heart disease.

February is American Heart Month.

Heart disease is the NUMBER ONE cause of death in this country, and that includes for us women! And one of the most important things to know about heart disease is that in most cases it is preventable. Because we know the factors that put us at risk for heart disease, many of which are related to choices we make in our own lifestyles, we can learn how to prevent this deadly disease.

This Friday, February 6, 2009, like the other first Fridays in February in prior years, is Wear Red Day.  The reason for this is to raise awareness about heart disease, especially in women.  That is not to say that men shouldn’t be aware of it as well, it’s just that for so many years, women didn’t think heart disease was a woman’s problem. IT IS. 

In the coming weeks of February, we are going to go over each of the risk factors for heart disease and how many of them can be changed. As you know, if you’ve read our book and/or have kept up with our blog here, we believe that knowledge is the ultimate power. If you learn about those things that can lead to various diseases, and then change those factors, your life can not only be a long one, but a healthy and vibrant one!

For starters this week, do two things. 

Read the part of our chapter on heart disease that is on this website by going back to the Home page, and clicking on the “Excerpt” page. Then click on “Chapter 3”.

The second thing you should definitely do this week? WEAR RED ON FRIDAY!  And when you  see friends, neighbors, family and coworkers, tell them why you are wearing red and why they need to learn about heart disease too.


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