But More Likely to Miss Signs of Heart Attack

Women have some distinct advantages over men when it comes to heart disease with the average man beginning to have heart attacks at age 55 while women are more likely to start experiencing heart attacks at age 65.

But symptoms in women are different than in men. Therefore, women may be less likely to recognize the signs of a heart attack and seek medical help in those critical, early hours, said Tena Murphy, MD, clinical cardiologist, Heart Clinic Arkansas, Little Rock.

“We want to educate women how our symptoms are different from men,” Murphy said. “Men typically experience exercise related chest pain that radiates into the jaw, but women often have more unusual symptoms like isolated jaw pain, arm pain down into the elbow, or sometimes back pain. Sometimes women have profound fatigue, shortness of breath or dizziness. The key is understanding that if exercise precipitates the pain, that makes it suggestive of coronary disease.”

The most important risk factor for heart disease is family history. While someone has no choice over that, there is a choice for the second most important risk factor, tobacco use.

“If you stop smoking now, your risk for a heart attacks goes down immediately,” Murphy said. “Another important factor for a healthy heart is to maintain body weight as close to normal as you can. Controlling your weight will improve other major ricks factors—hypertension, diabetes and elevated cholesterol levels.”

Another major observation from 20 years of practice is that her patients who exercise do much better. Even if they have coronary disease, patients who walk 30 minutes per day on regular basis rarely come back in the hospital for heart problems.

“To me, exercise is almost a panacea or cure,” she said. “Exercise should be a commitment. It is important to stay physically active. It does a lot of things. It helps blood pressure and cholesterol levels, and improves mental attitude. It is a great stress reliever. I think for people who have high stress levels, which is the majority of society, doing some form of exercise 30 minutes per day is vitally important.”

She recommends walking 45 minutes a day, but uses lower recommendations for people who have been sedentary for a long time. For her largest patients, she advises tweaking food intake downwards only 300 calories a day while walking ten minutes daily. Those simple changes can result in losing a pound a week. Some of her patients have come in with weight losses of 20 or 30 pounds after just six months.

“It jump starts their metabolism,” Murphy said. “At the end of six months, they are able to breathe better and walk easier. There is not as much swelling in their legs. Their quality of life is much improved.”

She recommends the South Beach or Mediterranean diet, which allows lean meats and fish, fruits, grilled vegetables, and minimum amounts of white rice, pasta, potatoes and bread. Portions should be small. Make gradual changes that you can stick with.

Another key health issue Murphy would like patients to be aware of is sleep apnea.

“You don’t want to ignore sleep apnea because it can lead to problems with arrhythmia and sudden death, particularly in the middle of the night,” Murphy said. “It can cause…pulmonary hypertension, which can be fatal if the pressures get high enough and it causes disabling shortness of the breath.”

Symptoms can include disabling chronic fatigue. Some patients wake up gasping for breath. More commonly, a spouse will say their loved one was snoring and stopped breathing, to the point the spouse has to hit them to get them to breathe again.

Along with palpitations or arrhythmia, waking up tired, and being chronically fatigued or feeling sleepy during the day are classic symptoms of sleep apnea. If patients have those symptoms, but can fall asleep at the drop of a hat, that tells Murphy that person isn’t getting into good sleep patterns at night.

Murphy gets a lot of questions from her female patients about hormone replacement therapy. A women’s health initiative published in 2002 showed a small, but statistically significant, increase in cardiac problems for women on hormone therapy with estrogen and progesterone. The study also showed a slightly higher risk of breast cancer.

“After that there was concern and fear that hormones were bad,” Murphy said. “The pendulum swung in the direction of no treatment following that trial. What we know is that hormone therapy does treat the quality of life issues through menopause, and helps prevents bone loss or osteoporosis. As we get beyond 60, there is a concern about hormones influencing the development of breast cancer.”

She said the decision to take hormone replacement must be individualized in each woman’s case taking into consideration her risk factors for coronary disease, breast cancer, as well as the severity of menopausal symptoms.

Murphy doesn’t believe we have the final answers about the impact of hormone therapy on heart disease. But she thinks it may be indicated for women who are peri-menopausal, a six- to eight-year period of time before menopause, to help the symptoms of fatigue, insomnia, hot flashes, mood swings and heart palpitations.

“Many doctors including gynecologists believe these symptoms are so severe it is appropriate to use low dose hormonal therapy during this transitional time, but then try by age 60 to begin slowly weaning women off hormonal therapy because of the risk of breast cancer later in life,” Murphy said. “I like the middle of the road approach using hormonal therapy in the lowest effective dose and then tapering off over a six-month period of time by age 60.”

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