Most people are familiar with what we think are heart attack symptoms, such as somebody having chest pain or trouble breathing. Those are usually big signs of heart attack. Those are very commonly described in men. They actually do happen in women as well, but what we have learned lately is that women also tend to have more vague and what we call atypical symptoms. They may or may not experience the chest pain or shortness of breath, but oftentimes will complain of back pain, jaw or neck pain, fatigue, nausea or even belly pain.
It’s still being studied. We think it’s probably a combination of factors. There are slight differences in the anatomy of women’s physiology, compared to men. For example, vessels of the heart are actually smaller. The distribution of cholesterol can be different in the vessels. We all know that women are subject to a wide variety and fluctuations of hormones. That can cause some vascular changes as well. We think that these factors all contribute to the varied presentation of symptoms in women compared to men.
If you have any new or worrisome symptoms, such as chest pain, trouble breathing, something that’s interrupting what you’re doing during the day, that definitely may be worth an emergency room visit, or even a call to 911, depending on how dramatic or severe those symptoms are.
If the symptoms are something that have been going on longer, are intermittent or a little less bothersome, I do still think they require attention. That’s something where I would call your physician, try to set up an appointment to review and see if any further testing needs to be done.
Unfortunately, everyone is at a risk for having a heart attack. The reason for that is there are actually several different types of heart attack, which people may not realize. Some are quite preventable through the things that we know, such as an appropriate diet, keeping your cholesterol low, watching your blood pressure, avoiding smoking. That’s where the bulk of heart attacks actually come from.
Unfortunately, there are other types of heart attacks that are what we call bad luck, where you can suddenly get a plaque rupture or the artery can tear and there are varied presentations. Some are more common in women. Some are more common in men. Some are actually more common in younger versus older patients.
Unfortunately, anybody can be at risk for a heart attack. We certainly know that people with certain risk factors, such as family history, tend to be at higher risk.
Part of the reason is most heart attacks are those classic type that are related to risk factors, such as obesity, diabetes, smoking, high cholesterol. Those tend to also go with more of an aging population. Women actually live longer than men, which then puts them at an increased risk. Everyone, unfortunately, is at risk for cardiovascular disease.
Sometimes people don’t realize that women’s risk is just as high. In some instances, they are even higher than men, depending on their family history, whether they’re menopausal, what types of complications they had during their pregnancies. The risk has actually always been there. Usually it’s just overshadowed by other things that are going on in people’s daily lives.
Fortunately, most of the things that you can do to reduce your risk of heart disease or heart attack are things you can do on your own.
There are things that we have been saying forever:
Aim for appropriate exercise, at least three to five times a week for a minimum of 30 to 40 minutes a day of cardiovascular exercise, meaning getting your heart rate up, getting off the couch, sweating a little bit, getting a little uncomfortable so that you’re huffing and puffing.
Then it really comes down to diet as well. We all know those things that are delicious maybe that we shouldn’t eat or can only eat once in a while versus the things that you should be eating every day, such as fruits, veggies and trying to avoid highly processed foods. Those certainly have a huge impact on reducing the risk of cardiovascular disease down the road.
Diet and exercise bring down the cholesterol. They reduce inflammation. They help keep the blood pressure under control. Avoid obesity, which is one of our biggest risk factors. At Scripps, we have some great ways to help patients with that. If they feel that they can’t do it on their own, we’ve got our cardiac rehab program. We’ve got our nutritionist here. Some people are really motivated and you can certainly do it on your own, but if you feel like you need a little help we’ve got programs here for that as well to reduce risk.
You should start paying attention from childhood. You can start as early as your teen years, young adolescent years. Healthy eating, exercise, avoiding smoking are habits that can really get ingrained quite early.
If there’s a family history, check in with your physician as early as your 20s to start establishing a baseline, seeing what the blood pressure looks like, seeing what the cholesterol looks like and determining whether this is somebody who needs aggressive diet and lifestyle modifications, somebody who just needs monitoring or somebody who actually needs aggressive testing and interventions upfront.
There’s a lot of good reasons to brush your teeth, but specifically we do know that you can get some infections of the heart valves that can be associated with dental infections, which was quite a common way to get that. We know that ongoing infections in various areas, specifically the mouth and teeth, increase the risk of inflammatory response in the body, which accelerates the development of heart disease as well.
A lot of people are really concerned about coming into the emergency room or going to see their doctor during these times with COVID exposure. But if you’re really worried that there’s something going on with your heart, if you’re having a worrisome symptom, you absolutely should not delay a trip to the emergency room or a trip to your physician.
We are taking all the precautions that we can here to keep our patients and our staff safe. Everybody is washing their hands, wearing their masks.
If you are having new or worrisome symptoms, don’t delay a trip. We are concerned about people sitting at home, having heart attacks or strokes or really worrisome symptoms, simply because they’re afraid of coming to the emergency room or catching COVID in the doctor’s office.
I would say that especially during these times, because people with underlying health conditions can actually be at higher risk for COVID and things like that, don’t let yourself get sick in any way. Whether it’s COVID, whether it’s heart disease, let us help you if you’re worried.
Lightly edited for clarity
Watch the San Diego Health video with host Susan Taylor and Dr. Uddin discussing the symptoms of a heart attack in men and women.