Recognize & prevent heart attacks
Susan Biali, MD
"Im going to call an ambulance," I told my patient, a woman in her early 50s. She knew that something was wrong, but I knew she wasnt convinced that her symptoms were serious. Most women, and many men, arent aware of the more subtle signs of a heart attack
“I’m going to call an ambulance,” I told my patient, a woman in her early 50s. She knew that something was wrong, but I knew she wasn’t convinced that her symptoms were serious. Most women, and many men, aren’t aware of the more subtle signs of a heart attack.
My patient had come to the clinic where I was working that evening.
“But I can’t go to the hospital. I have too much to do tonight. I’ll be fine! I’m going home,” my patient insisted. I sighed, and steeled myself for battle.
As a general practitioner with two years of specialty training in emergency medicine, I was well-schooled in the ways that an atypical, potentially lethal heart attack might try to trick me, and my patients, into missing the diagnosis.
“I’ve been feeling so tired for the last few days,” she’d told me. “I can’t walk very far at all without getting short of breath. And I’m so sweaty! I feel terrible. Is it the flu?”
Diagnosing the Problem
The shortness of breath made me suspicious that the problem might be her heart. People going through a heart attack can feel breathless, particularly when exerting themselves or exercising. Sweating, or damp, clammy skin, is another sign, as is unusual and sudden fatigue.
She didn’t have any chest pain, but when I asked her if her chest felt tight or like something was sitting on it, she said yes. That was enough—I picked up the phone to dial 911. Not all heart attacks announce themselves with crushing chest pain.
According to the Public Health Agency of Canada, women over 55 are more likely to die from heart disease than any other disease. Unfortunately, we’re far more likely to worry about preventing or diagnosing other less common diseases such as cancer. We often think of heart disease as a condition of old age. Not so, as heart disease affects many women who are well under 65.
Understanding what’s happening during a heart attack can help you make sense of its symptoms. At the root of cardiovascular disease is a condition called atherosclerosis, which is a buildup of fatty plaques in our arteries, particularly the delicate arteries which deliver blood to the heart (our coronary arteries). As these plaques build up, our arteries get narrower, and less blood flows through to feed the hard-working heart muscles.
Is there a way of knowing if you have atherosclerosis? Unfortunately, unless you’re in the advanced stages, you probably won’t feel a thing. Plaques begin to build up in our arteries as early as adolescence. With today’s epidemic of childhood obesity, those fatty plaques are getting more of a head start than ever before.
If the plaque gets thick enough, its surface can rupture, triggering a blood clot that can completely block the artery, stopping blood flow to the heart. This damages the heart muscle and typically causes symptoms of chest pain and pressure. If this goes on for long enough (which may be just hours) the heart muscle starts to die irreversibly.
Recognizing the signs
If you identify the symptoms of a heart attack early enough and are rushed to a hospital for treatment, today’s emergency rooms are equipped with medications that can dissolve the lethal clot and restore the blood flow to your heart, preventing permanent damage. That’s why it’s so important for you to be able to identify the signs and symptoms of a heart attack in theearly stages.
So, what would a heart attack feel like? The classic symptoms are central chest pain, pressure, or tightness, accompanied by shortness of breath and sweating. Though your heart is located in the left side of your chest, the wiring of your nerves causes the pain to be referred to the centre of your chest, up into your jaw or shoulder, down your left arm, or into your back.
During a heart attack the chest pain or pressure won’t go away with rest. There’s a pre-attack condition called angina that can feel similar to a heart attack, but the key difference is that with angina, the discomfort in your chest goes away after a little while when you rest. Still, if you ever have any kind of chest pain with exertion, even if it goes away afterward, you need to tell a doctor about it, particularly if it’s becoming more frequent.
Some people experience a single symptom, such as jaw pain, and nothing else. Women are more likely than men to experience a heart attack that presents with vague, rather than classic, symptoms. Other sneaky symptoms might include a burning in the chest that feels like heartburn or nausea. You might feel dizzy or very anxious.
Identifying a silent killer
If you have diabetes, you need to be particularly aware. Your blood sugar may affect your nervous system, resulting in a silent heart attack that barely feels like anything at all, other than perhaps shortness of breath, sweating, and extreme fatigue. If you’re diabetic and suddenly feel really unwell, get medical attention immediately.
Personally, I hope that you never experience a heart attack. One reason I left my residency in emergency medicine to became a wellness expert and life coach is because I would rather help people stay healthy than try to save them when it’s too late. Luckily, the majority of factors that increase the risk of heart disease are preventable or treatable.
The standard risk factors that increase your chance of having a heart attack include a family history of early heart attacks, menopause, smoking, high blood pressure, increased cholesterol, extra weight and obesity, and diabetes.
Taking positive action
Give your heart its best chance to stay healthy by avoiding smoking, keeping active, maintaining a healthy weight, and eating a healthy diet. Learn how to manage or decrease any stress in your life, as stress can contribute to high blood pressure and, potentially, heart attacks.
If you’re over 40 (or younger if you’re overweight or a smoker), go to your doctor and get your blood sugar, blood pressure, and cholesterol levels checked. The sooner you find out, the more you can do to turn these levels around and prevent nasty consequences later.
The food you eat plays a huge role in keeping your arteries healthy. Thewell-established heart-healthy diet emphasizes good fats such as olive oil and the omega-3 fatty acids in fish, as well as fibre, whole grains, nuts, and many fresh fruits and vegetables.
Researchers have spent millions investigating supplements for the prevention and improvement of heart disease, with varying results. A few stand out from others on the shelf: fish oils and omega-3 fatty acids, flaxseed oil, and niacin.
Several studies indicate that fish oil supplements can lower triglycerides (a type of fat related to cholesterol), slow plaque buildup, lower blood pressure, and reduce the risk of heart attack in people with known heart disease.
In a study in the European Journal of Clinical Nutrition ( 2007), researchers found that flaxseed oil, high in omega-3 alpha-linolenic acid, lowered blood pressure in men with high cholesterol. The authors noted that this benefit “may constitute another mechanism accounting in part for the apparent cardio-protective effect of this fatty acid.”
Another article in the American Journal of Cardiology (2008) raved about the benefits of niacin for heart health, calling it the “most potent” agent for raising our good cholesterol and noting that it also lowers triglyceride and bad-cholesterol levels.
So there it is: for a happy heart, live healthily and always listen to your body. As for my clinic patient, the ambulance crew showed up and whisked her off to the emergency department, where her life was saved.
Know the sign
The signs of a heart attack in women can often go unnoticed and undiagnosed. According to research by the National Institutes of Health, women will often experience symptoms up to a month before actually having a heart attack. Here’s what to look for:
If you experience any of these symptoms, especially if you know you have risk factors for coronary artery disease, call 911 or attend your local emergency room immediately.
Strokes are commonly confused with heart attacks but are very different, occurring when blood flow to the brain is interrupted. Usually the interruption is caused by a blood clot. According to the National Stroke Association, it’s important for men and women to recognize these symptoms of stroke:
Women may also experience these unique symptoms:
If you experience any of these symptoms, it’s important to act fast—stroke damage can often be mitigated or even reversed if the patient arrives in Emergency within the first three hours of experiencing symptoms.