Your Top Heart-Health Questions - Answered

Your Top Heart-Health Questions - Answered
Thursday, April 02, 2009

Heart disease strikes men and women alike, but more women die from it. To keep your ticker healthy, you need to arm yourself with information. We answer your most crucial questions…
Only older women need to worry about heart disease, right? Wrong! It was the third leading cause of death in women 25 to 44 years old, according to 2004 statistics from the Centers for Disease Control and Prevention.
So, no matter what your age, it’s important to recognize symptoms and know what you can do to prevent the most common heart disease, coronary artery disease (CAD). Here are some answers to 9 frequently asked questions:
1. How do I know if I have heart disease?Unfortunately, you may not be able to tell. Heart disease goes undetected in some people.
Coronary artery disease (CAD) occurs when the blood vessels that feed the heart become inflamed.
This can thicken the arterial lining and cause plaque to form, which can then block arteries. If the blockage completely cuts off blood to an artery or arteries feeding the heart, you can have a heart attack.
The blockage can also cause intermittent loss of blood flow to the heart. Consequently, you may feel chest pain or angina – a feeling of pressure, squeezing, pain or tightness in the middle of your chest. It usually occurs with any type of exertion and stops when the exertion stops.
However, women also may have many other symptoms that indicate CAD (See question No. 6).
Even if you don’t have symptoms, you still may have heart disease. It’s even more likely if you have any of these risk factors:
High blood pressure
Elevated cholesterol
Diabetes
Smoking cigarettes
Family history of heart disease
Obesity
Stress
Depression,
Sedentary lifestyle
If you have any risk factors, get tested for CAD immediately. Even if you do not have risk factors, it is recommended that you have a baseline EKG (electrocardiogram) at age 40. Most health care providers will evaluate you with an exam, blood tests, an EKG at rest, an EKG stress test (done while exercising) and, if necessary, an imaging study such as a stress echocardiogram.
If you have any chest pain, shortness of breath, unusual difficulty exercising, fatigue, dizziness or jaw or arm discomfort that doesn’t go away, chew an aspirin (if you’re not allergic to it) and call 911. If you have the above symptoms and they go away quickly but come back, see your clinician as soon as possible.
2. I just learned I have a heart murmur. What is it and does it raise my risk of a heart attack?The term “heart murmur” refers to an extra sound that’s sometimes described as a “whooshing” or “swishing” that occurs between the two normal beats of the heart. It’s usually caused by the flow of blood in the heart.
Heart murmurs may be present at birth (congenital heart murmurs) or they develop later in life. Generally, most heart murmurs are harmless, show no symptoms and need no treatment: These are called “innocent” murmurs.
During pregnancy, for instance, some women develop a heart murmur due to the more rapid blood flow through the heart. It usually goes away after delivery.
Another cause of an innocent murmur is anemia, or low blood count, which causes a more rapid flow of blood through the heart. It, too, usually resolves once blood count becomes more normal.
Innocent heart murmurs don’t put you at increased risk for a heart attack.
Some heart murmurs can indicate an underlying heart condition, such as a diseased heart valve. These “abnormal” murmurs must be followed up with testing and possibly treatment, and if severe enough, surgery.
Abnormal murmurs may cause symptoms such as shortness of breath, extra or skipped heartbeats, dizziness, fainting, and even chest pain.
One type of abnormal heart murmur, calcific aortic stenosis, can be a tip-off that you have CAD. That’s because, like CAD, it is your body’s formation of calcified plaque on the aortic valve that causes the stenosis. The calcified plaque also leads to the narrowing of arteries, which can lead to a heart attack. This murmur occurs mostly in older people.
Of course, you don’t always know if a newly diagnosed heart murmur is innocent or abnormal, so it’s important to have it thoroughly evaluated.
3. Does taking hormone replacement therapy have an effect on heart disease?The jury is still out on this. A study by the Women’s Health Initiative reported in 2002 that women on Premarin and Provera [see below] were at increased risk of having a heart attack and stroke.
The study followed women who were on average 63 years old, had controlled cardiac risk factors – such as high blood pressure or diabetes – and were given a combination of Premarin and Provera or Premarin alone. Premarin alone didn’t increase the risk for heart attack, but it did increase the risk of stroke.
Yet when the researchers looked again at women who started hormone therapy within 10 years of the onset of menopause (between 50 to 59 years old), they found no increased risk of heart attack. In fact, the hormones may offer some protection from heart disease, but this needs further study.
The transdermal (patch) form of estrogen may be a better alternative for women who have risk factors for cardiac disease because several studies have a found the patch to be less likely to cause blood clots. Natural progesterone also is less likely to cause blood clots than the synthetic version.
Blood clots can lead to heart attacks and strokes, but are not the only cause. Most heart attacks are caused by plaque.
However, there are other side effects of hormone replacement therapy, such as an increased risk of breast cancer, so each woman reaching menopause should have her treatment tailored to her unique medical needs. Also, you shouldn’t stay on hormone replacement therapy indefinitely; stop at or before five years, because your breast cancer risk may increase the longer you are on hormone replacement.
4. Can birth control pills increase my risk of a heart attack?Birth control pills are generally safe in healthy women under the age of 35. For older women, there’s a risk of heart attack; the pill has been linked to blood clot formation. The risk is higher for women who smoke, have high blood pressure, high cholesterol, diabetes or are obese. And in younger women who take the pill, the risk of blood clots increases dramatically in smokers.
5. If I get occasional pains in my chest, does it mean I have a heart problem?No, many things besides heart disease can cause chest pain, including indigestion or heartburn, gallbladder problems, a lung infection, coughing, a cracked rib or even strain of the muscles in the chest wall.
Generally, chest pain differs with each disease. For instance, the pain associated with indigestion is usually a continuous burning sensation in the center of the chest. It doesn’t change with activity but may be relieved with food or antacids.
Pay attention to your chest pain so you can describe it to your health care provider. What’s the nature of the pain (sharp, squeezing, burning)? How long does it last? Does anything specific bring it on or relieve it? Does the pain move to other parts of the body?
Even though all types of chest pain don’t indicate heart disease, you still should take this symptom seriously and get checked when you first notice it. Then, hopefully, you will recognize it if it occurs again and know what to do based on your doctor’s instructions.
6. How do I know if I’m having a heart attack?There are some classic heart attack symptoms that strike men and women alike: chest squeezing or pressure (often described as an “elephant sitting on the chest”) with or without nausea, shortness of breath or sweating, and pain going down the left arm and up the neck.
Generally, men feel symptoms with chest pain; women may feel them together or alone and without chest pain. So we may think the symptom points to a problem other than a heart attack. Common women-specific symptoms include:
Overwhelming fatigue
Dizziness
Shortness of breath
Sweating
Jaw, arm, upper back and/or abdominal discomfort
Nausea and lack of appetite
Coughing
Heart flutters
If you think you’re having a heart attack, call 911. If you’re not allergic to aspirin, chew one while waiting for the ambulance. It’s much faster to call an ambulance than have someone drive you to the ER. That is why, even though we women do not like to bother anyone, CALL 911!
7. Can lifestyle and stress really bring on a heart attack?Yes, both can have a huge impact on heart disease. Many risk factors for a heart attack are under our control, like high blood pressure and high cholesterol.
That’s why it’s so important to exercise regularly and eat healthy (such as the Mediterranean diet). Monitor your cholesterol, glucose and blood pressure and keep them in check with diet, exercise, and (in some cases) medication. If you have diabetes, keep your blood sugar under control. If you smoke, quit!
Many people don’t realize mood can also affect the heart. A recent study found that depressed women have a higher risk of sudden cardiac death and heart disease compared to those who aren’t depressed. Similar results were found with stressed-out or hostile women.
That is why it’s so important to address these issues with your provider and get help. To stay healthy, learn how to reduce your stress levels and manage stress that you can’t reduce.
8. Does an irregular heartbeat mean I’m at risk for a heart attack?Not necessarily. The heart normally beats regularly between 60 and 100 beats per minute. You can time your heartbeat from the pulse in your wrist or neck. Skipped or extra beats make the pulse irregular.
An irregular heartbeat has many causes, including abnormal electrolyte levels (sodium or potassium) in your blood, thyroid disease and lung disease. But CAD and diseased heart muscle after an attack can also cause irregular beats.
Many irregular beats are harmless, and, in fact, may be normal for you. But others have a serious underlying cause.
Just as with heart murmurs, have this checked out as soon as you notice the irregularity. In some cases, an irregular heartbeat will cause no symptoms and may be found by observing your pulse rate or during a physical exam.
9. If I suspect I have heart disease, what should I do?If you think you have heart disease, see your health care provider as soon as possible. If you’re having any of the symptoms mentioned in question No. 6, call 911 and chew an aspirin (only if you’re not allergic) while waiting.
Not sure if you have heart disease? Sit down right now, think about the risk factors and assess whether you have them. If you have one or more, see your doctor as soon as possible and request testing for heart disease.
If you are having intermittent symptoms, are pre-menopausal or are right at menopause – even if you have NO risk factors – request testing for heart disease from your clinician.
Remember, heart disease is the No. 1 killer of women in this country, and the incidence of heart disease in women goes up dramatically after menopause.