Heart at­tacks not al­ways easy to di­ag­nose in women

The Saline Courier Weekend - - OPINION - D . GLAZIER

Dear Doc­tor:

A month ago, our 69-year-old mother be­came nau­se­ated and had pain in her jaw. Then she got so weak that my brother made her go to the ER. It turned out she’d had a heart at­tack. She never had chest pain, so she had no idea any­thing bad was go­ing on. Is that com­mon?

Dear Reader: The sce­nario you’ve de­scribed could hap­pen to at least half of the world’s pop­u­la­tion -- women. The symp­toms of a heart at­tack in women can be very dif­fer­ent from those in men, of­ten with lit­tle or no over­lap. A woman has a 50% higher chance of her heart at­tack be­ing mis­di­ag­nosed than a man, ac­cord­ing to the Cen­ters for Dis­ease Con­trol and Preven­tion. Many women hav­ing a heart at­tack won’t get ap­pro­pri­ate or timely treat­ment.

Heart at­tack is the term used to de­scribe what hap­pens when de­liv­ery of oxy­gen and nu­tri­ents to the heart is in­ter­rupted. This oc­curs when some­thing stops or slows the flow of blood through a crucial net­work of ves­sels that sur­round the heart, known as coro­nary ar­ter­ies. The block­age, which can be caused by a blood clot, plaque or a nar­row­ing of the ves­sels, pre­vents blood that is rich in oxy­gen and nu­tri­ents from reach­ing the heart tis­sues. With­out this blood flow, the heart mus­cles be­gin to die.

Re­cent re­search into heart dis­ease in women has found that female patients’ ma­jor ar­ter­ies are of­ten clear of plaque, but that the smaller coro­nary blood ves­sels are ad­versely af­fected. This also results in a de­crease or stop­page of blood flow -- and there­fore oxy­gen and nu­tri­ents -- to the heart. Women with this type of coro­nary block­age will have seem­ingly nor­mal an­giograms, which adds to the di­ag­nos­tic chal­lenges.

With quick treat­ment af­ter a heart at­tack, per­ma­nent dam­age can be lim­ited. How­ever, fewer women than men sur­vive a first heart at­tack, due in part to their symp­toms not be­ing rec­og­nized. Un­like men, who of­ten have the so-called “Hol­ly­wood heart at­tack,” with pain or numb­ness in the left arm fol­lowed by sud­den and some­times crush­ing chest pain, heart at­tack symp­toms in women are sub­tler. They in­clude the nau­sea, jaw pain and ex­haus­tion that your mother ex­pe­ri­enced; pres­sure in the chest that doesn’t read as pain; in­di­ges­tion or heart­burn; pain in the throat, neck or back; vom­it­ing; or short­ness of breath. Women ex­pe­ri­enc­ing th­ese symp­toms should seek emergency med­i­cal care and state clearly that a heart at­tack is sus­pected.

Fac­tors that in­crease heart at­tack risk for women -- and for men -- in­clude smok­ing, high blood pres­sure, poor diet, be­ing over­weight, physical in­ac­tiv­ity, diabetes and fam­ily his­tory. To re­duce risk, life­style changes are key. Eat more plant-based foods, limit an­i­mal fats, exercise, drink in mod­er­a­tion, main­tain a healthy weight and don’t smoke. If pos­si­ble, add some stress-re­duc­tion ac­tiv­i­ties, such as meditation, yoga or hik­ing.

Eve Glazier, M.D., MBA, is an in­ternist and as­so­ciate pro­fes­sor of medicine at UCLA Health. El­iz­a­beth Ko, M.D., is an in­ternist and as­sis­tant pro­fes­sor of medicine at UCLA Health.

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