Saturday, July 04, 2009

Heart Attack in Women

Heart disease has in the last years become an equal opportunity killer. It is our nation’s number one killer with one quarter million deaths occurring each year. Years ago it was classically observed that heart disease was a man’s disease just as breast cancer was a women disease. But times and events are shifting. Heart disease kills more women than men. Five hundred thousand people have a heart attack each year. At the moment, heart attack is the leading killer of women. It kills more women than all the cancers combined. In middle aged women, heart attack kills more women than breast cancer. Women who have an acute myocardial infarction (heart attack) are more likely to die from it, less likely to get out of the hospital following a heart attack and more likely to succumb and die within a year than men are.

The symptoms of a heart attack differ between men and women. In men, the classic signs of mid-sternal chest pain after exertion that may radiate to the jaw or left arm or neck are seen. Pain is described as crushing, stabbing in nature. Women sometimes have similar symptoms, but more often they have more subtle and different ones. Many times, no pain occurs at all (in four of ten women). Angina occurs in women following mental stress and not physical exertion. More GI symptoms may be seen with nausea, vomiting, simple GI upset or indigestion as a presenting clue. Fatigue, dizziness or weakness may occur. A cold sweaty or clammy wet feeling is more common in women. A feeling of impending doom or anxious feeling is observed in women. Pain between the shoulders blades, along the bra line is felt, or in the jaw. A fast heart rate or swelling in the ankles can happen.

Women may not recognize their symptoms. Indeed, they suffer sleep disorders, shortness of breath and ankle swelling as heart disease symptoms that may occur a month before the heart attack. In addition, the disease is different. Men have larger artery disease that is amenable to surgery and can be seen by radiographic studies. Women have micro-vascular disease. This is not seen on invasive studies and is not surgically correctable. This may account for the poorer outcome. Many are quick to blame physicians for not diagnosing coronary disease in women, but even in men diagnosing a heart attack is sometimes very difficult and requires a high degree of suspicion and experience. Sometimes it is just an educated hunch that something is wrong.

So what should a woman do? Eat a healthy diet, exercise regularly and DO NOT SMOKE, or quit immediately. See your doctor for an exam and blood tests like cholesterol, glucose and thyroid. Check your blood pressure routinely and have it treated it if it is abnormally high. Are you overweight? Should I be on a baby aspirin a day? Do you have a family history of heart disease? Talk to your doctor now about all of the above. Prevention is better than the cure.


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