Heart Problems

Heart Problems Commonly Experienced by Women

The following are common heart problems in women. If you experience any of the symptoms described below, contact your health care professional for an evaluation:

• Angina. If clogged arteries prevent enough oxygen-carrying blood from reaching your heart, the heart may respond with pain called angina pectoris. Episodes of angina occur when the heart's need for oxygen increases beyond the oxygen available from the blood nourishing the heart. Silent angina occurs when the same inadequate blood supply causes no symptoms.
• Physical exertion is the most common trigger for angina. Other triggers can be emotional stress, extreme cold or heat, heavy meals, alcohol and cigarette smoking. The pain is a pressing or squeezing pain, usually felt in the chest or sometimes in the shoulders, arms, neck, jaws or back.
• Angina suggests that coronary heart disease exists. People with angina have an increased risk of heart attack compared with those who have no symptoms. When the pattern of angina changes—if episodes become more frequent, last longer or occur without exercise—your risk of heart attack in subsequent days or weeks is much higher and you should see your health care professional immediately.
• If you have angina, learn its pattern—what cause an angina attack, what it feels like, how long episodes usually last and whether medication relieves the attack. Angina is usually relieved in a few minutes by resting or taking prescribed angina medicine, such as nitroglycerin.

Episodes of angina seldom cause permanent damage to heart muscle.

Heart attack pain may be similar to angina, but the symptoms of angina quickly disappear with rest. Heart attack pain, however, usually persists despite resting or taking nitroglycerin and should be evaluated immediately. Like angina, heart attack pain can be a pressure or tightness in chest, arms, back or neck. Often symptoms include shortness of breath, sweating, nausea, vomiting or dizziness. A heart attack is an emergency. A delay in treatment could mean more of the heart muscle tissue is permanently damaged. If you think you're having a heart attack, take an aspirin (which reduces blood clotting) and get medical help immediately.

• Silent ischemia. Sometimes atherosclerosis causes no symptoms. Silent ischemia is a condition caused by atherosclerosis, but isn't associated with the chest pain or other symptoms common to other types of heart conditions. This condition occurs when arteries with atherosclerosis can't deliver enough blood to the heart. An electrocardiogram (EKG or ECG), a measurement of electrical impulses produced by the heart, may indicate silent ischemia. However, without a heart checkup, a woman may never know that she has ischemia. This is why regular screening and checkups, particularly among women with heart disease risk factors such as diabetes, hypertension or a family history, are so important. People with diabetes are especially at risk for this condition because diabetes can cause nerve endings or "pain sensors" to be less sensitive, resulting in ischemia without accompanying pain.
• Heart attack. When the blood supply to the heart is cut off completely, the result is a heart attack. It can cause permanent damage to the heart muscle if blood flow is not restored as fast as possible. Typically, chest pain caused by a heart attack may be accompanied by discomfort in other areas of the upper body, indigestion, nausea, weakness and sweating. However, heart attack symptoms vary and may be considerably milder. According to the American Heart Association, women are somewhat more likely than men to experience some of the symptoms other than chest pain, particularly shortness of breath, nausea/vomiting, and back or jaw pain.

Symptoms that indicate your heart is in danger may be present for months or years before a heart attack occurs. Persistent unusual symptoms—shortness of breath, nausea, great fatigue, angina/chest pain, fainting spells and gas-like discomfort—may be red flags for heart disease. Discuss such symptoms with your health care professional, even if the symptoms come and go.

If you are at high risk for a heart attack, it is a good idea to develop an action plan with your health care professional in case one occurs. This might include:

• Keeping a list of all medications and how often you take each one with you. Also give a copy to a friend or family member who might be involved with your care if you're taken to the hospital. This list provides valuable information to the emergency department staff.
• Keeping a small-sized copy of your EKG in your wallet.
• Knowing who should be notified in case of an emergency.
• Cardiac syndrome X, or microvascular disease, is characterized by chest pain or ischemia without evidence of blockage in the large coronary arteries. Women are at higher risk than men for this condition. Syndrome X may be caused when the small blood vessels in the heart don't expand enough. Postmenopausal women and women who have had surgical menopause are at risk for experiencing symptoms of syndrome X because their declining estrogen levels may affect the small blood vessels in their hearts.
• Because this condition is a small vessel disease, it can't be seen on an angiogram (an x-ray with dye that identifies blockages in the blood vessels). Special imaging tests, such as PET scanning or MRI, may help with the diagnosis in the future. Today, however, syndrome X is usually a diagnosis of exclusion—meaning you may be diagnosed with this condition after tests provide no other cause for the chest pain. Some health care professionals use the same tests used to diagnose CAD, such as an EKG, echocardiography, or coronary angiography. Many women with syndrome X have no risk factors and are otherwise healthy.
• Medications commonly used to treat heart conditions may help to relieve pain caused by Syndrome X. The prognosis is generally excellent, but the symptoms can be debilitating.
• Cardiac arrhythmias. The normal cardiac rhythm is called "sinus rhythm" and the normal heart rate is 60-100 beats per minute. An arrhythmia occurs when the heart beats irregularly or abnormally slow (bradycardia) or fast (tachycardia). While many arrhythmias don't cause symptoms, some cause chest pain, dizziness, fainting and shortness of breath. Atherosclerosis, angina, valvular heart disease, weakened heart muscle (i.e., cardiomyopathy), blood clots, thyroid abnormalities or heart attack can cause this condition to develop.

Medications can help stabilize heart rhythms. Abstaining from caffeine, alcohol and cigarette smoking can also help. Pacemakers are often recommended to correct a slow heart rhythm.

Assessing Your Own Risk of Heart Disease

Because heart disease and its risk factors can be silent for so long, often with few symptoms until the disease is well underway, it's important to know your personal risk factors. That includes your knowing your family health history and your cholesterol and blood pressure levels. Two major studies published in the summer of 2003 found that nearly everyone who dies of heart disease, including heart attacks, had at least one or more of the conventional heart disease risk factors: smoking, diabetes, high blood pressure and high cholesterol.

A simple heart disease risk assessment tool based on the Framingham Risk Model can be found online at http://hp2010.nhlbihin.net/atpiii/calculator.asp. It estimates your 10-year risk of having a heart attack or dying of coronary heart disease based on your answers to questions about your personal risk factors. Your risk, whether very high, high, moderate or low, determines what steps you should take to reduce that risk, including whether or not you should be put on medication.

No matter what your age, if you suspect you have heart disease or are at risk of heart disease, talk to your health care professional about diagnostic tests such as an exercise echocardiogram or a nuclear stress test.