A Woman’s Heart

In our practice we recently saw a 47-year-old woman with left arm pain. This pain had lasted several weeks and at first she thought it was from a pinched nerve. As her arm pain began to worsen, she also started to have some discomfort in the left side of her chest. Fortunately, she saw her physician who sent her to a cardiologist. Further testing found that the pain was caused by blockages in her heart arteries and led to urgent bypass surgery.
Steps to Cardiovascular Health
By William Ollerich, M.D., Ph.D., FACC
The Chattanooga Heart Institute
This patient is typical of many women who, when they begin to have arm or even chest pain, don’t associate it with heart problems. They feel they are too young to have heart disease and think it’s primarily a man’s disease. On the contrary, heart disease is by far the leading cause of death for both women and men and is a disease that does not just affect the elderly. It is the third leading cause of death in women ages 25-44 and the second leading cause in women ages 45-64.
It is true that women before the age of menopause have lower rates of heart disease than similar aged men but after menopause their risk of heart attack and stroke rises. The reasons for lower rates of heart attack and stroke in younger women is not clear. It is thought that the loss of naturally produced estrogens may contribute to the increased rates of heart disease after menopause. Yet, recent large clinical trials suggest that coronary events in women increased with the use of certain forms of hormone replacement. Currently, the American Heart Association does not recommend that women take hormone replacement therapy to reduce the risk of coronary artery disease or stroke.
 Symptoms
The symptoms that women experience are sometimes different than those typically associated with a heart attack. When most people think about someone having a heart attack, they think of a gripping, tight, pressure type pain in the chest that may go down the arm. While some people do experience these more typical symptoms, women may experience other atypical symptoms as well. These warning signs may be pain in one or both arms, the back, neck, jaw or stomach; shortness of breath with or without chest discomfort; breaking out in a cold sweat and nausea or vomiting, and lightheadedness. Some women experience chest discomfort but it only lasts a few minutes then goes away and comes back. It may feel more like uncomfortable pressure than a gripping pain. Any person experiencing chest discomfort with these other symptoms should be evaluated by their doctor.
Chest discomfort, caused by heart disease, is due to narrowing or blockage of blood vessels by plaques filled with cholesterol. This process of cholesterol deposition in arteries is called atherosclerosis. Significant narrowing in the arteries of the heart may cause chest pain or angina or a heart attack. Blockage of blood vessels to the neck may cause a stroke and blockages in the legs may cause pain or claudication. All of these diseases are caused by cholesterol plaques. There are a number of factors which increase the risk of these plaques developing at an earlier age. It is important to identify the factors which make cholesterol deposition more likely to occur and then modify or improve those factors to delay or prevent the narrowing or blockage of blood vessels.
 Risk Factors
Every woman should be aware of the risk factors for heart disease. If you have a history of early heart disease in your family, you are at a higher risk for developing heart disease. You should have your cholesterol checked and shoot for a goal of less than 200 for total cholesterol. A high blood cholesterol level is a significant factor in causing increased cholesterol deposits.
Another risk factor is smoking. A smoker’s risk of developing heart disease is 2 to 4 times that of nonsmokers. Also, cigarette smoking is an independent risk factor for sudden cardiac death in patients with heart disease—about twice the risk of nonsmokers.
Hypertension and diabetes both increase the likelihood of plaque formation. It is important to work with your doctor to control your blood pressure and blood sugar. It will take a combination of diet and exercise and possibly medications to control these diseases.
 A Healthy Lifestyle
Lifestyle changes can decrease your risk. If you’re overweight, begin a weight reduction program. People who have excess body fat—especially if it’s at the waist—are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart’s work and can also raise blood pressure.
It’s been proven that the size of your waist compared to the size of your hips is a better indicator of health risk than body weight or a body-mass index. Excess fat in the abdominal area is associated with early onset of heart disease. You’re at an increased risk of heart attack when your waist is larger than 35” for women and 40” for men.
To lower your risk for heart disease, and improve your overall health, begin eating a heart healthy diet. Limit unhealthy fats and cholesterol. The best way to reduce your intake of saturated and transfats is to limit the amount of solid fat (butter, margarine, shortening) that you add to food. Limit the amount of beef and pork and eat poultry and fish instead. Eat more fruits and vegetables. They’re low in calories and good sources of vitamins, minerals, and fiber.
Start exercising—just 30 minutes of activity several days a week can help. Walking is a simple activity that almost everyone can do. Start slowly and work up to a brisk walk of 30 minutes or more. Find an activity you enjoy and be consistent.
Talk with your doctor about your risk factors for heart disease and work with him or her to keep them under control.
 William Oellerich M.D, Ph.D., FACC is board certified in cardiology, echocardiography and internal medicine. He has had specialized training in nuclear cardiology, diagnostic cardiac catheterization, cardiac magnetic resonance imaging, autonomic pharmacology, cardiovascular pharmacology, and echocardiography. He has been published in the American Journal of Roentgenology, Neuroscience and The Journal of Pharmacology and Experimental Therapeutics.