A Silent Threat To Women’s Hearts That Many Don't Recognize


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Heart disease is the leading cause of death for Americans. It kills more women and men each year than all types of cancer combined. The latest data from the American Heart Association indicate that cardiovascular disease causes one death every minute among U.S. women, 398,035 deaths yearly. And the biggest villain among the heart conditions is coronary artery disease, a.k.a., hardening of the arteries, or atherosclerosis.

But many women — and too often their doctors — don’t recognize symptoms of heart disease, a trend identified in a survey by the Women’s Heart Alliance.

“Quite honestly, we need to do the same thing for heart health that we’ve done with breast cancer,” says Beth Battaglino, RN, who is CEO of the nonprofit HealthyWomen and a nurse at Riverview Medical Center in Red Bank, New Jersey.

A new patient advocacy and education site called Spread the Word that Battaglino and HealthyWomen are working on with Nurse Practitioners in Women’s Health aims to get women to talking with other women about heart disease. (Spread the Word is supported in part by the cardiovascular genomic diagnostic company CardioDx of Palo Alto, California, which manufactures gene tests for heart disease.)

Are You at Risk for This Quiet Killer?

If you are a woman with silent coronary artery disease (CAD), you may not realize that the arteries leading to your heart can get partially blocked by a build-up of plaque — fat, cells, and calcium — that sticks to blood vessel walls, according to the American College of Cardiology. But this can cause a heart attack, because heart tissue that’s starved of nutrient-rich blood supply dies. “Women do not understand it’s the No. 1 killer,” says Battaglino about heart disease. “Give her the tools to find out about her risk. Women will share their stories.”

Related: 10-Step Do-It-Yourself Heart Makeover

Battaglino was inspired to get involved in patient advocacy for women because she was impressed by Violet Bowen-Hugh, MD, a champion for women’s health who began the nonprofit national women’s health resource center now called HealthyWomen. “In 1988, a female ObGyn from West Virginia founded our organization. She believed all women needed to be educated, regardless of their socio-economic background, to make educated decisions about their own health,” she says.

Now Battaglino hopes that more women will join the conversation about CAD online, and become their own advocates in the doctor’s office. “Write a blog post. Go on social media. Share what you learned with friends and family,” she urges. “If we don’t take care of ourselves, we won’t be there to take care of those we love.”

Heart Symptoms in Women Vs. Men

Women can all too easily overlook or not notice the subtle symptoms of a heart condition like atherosclerosis — including arm or back pain. Often, they remain undiagnosed until after a heart attack or heart failure from arterial blockage, notes the National Institutes of Health National Heart, Lung, and Blood Institute.

“Symptoms present so differently in women than in men,” explains Battaglino. In women, coronary artery disease may mimic other common, less deadly ailments. Whereas a man is more likely to feel the typical angina — sharp chest pain — women need to be looking out for other possible symptoms, Battaglino says.

Women’s symptoms of coronary artery disease can include:

  • a feeling of tightness in your jaw

  • upper back pain

  • upper arm pain

  • upper abdominal pain

  • throat pain

  • stomach pain

  • weakness or fatigue that comes on suddenly

You, or a woman you love, could easily mistake the pain of coronary artery disease for a pulled muscle. Gut pains might seem like simple indigestion. Even sudden-onset fatigue is too often explained away by women who don’t realize it could be heart related. “Many women are often tired, and so could easily dismiss that. But it could be a sign of coronary artery disease,” says Battaglino.

When to Have the Heart-Health Conversation? Today

At your annual well-woman check-up, you can become your own patient advocate. You don’t have to wait until a cardiologist diagnoses you with heart disease. At your yearly visit, take advantage of the opportunity to find out more about how your heart is working.

“It’s so important to have the conversation about heart health when you visit the OB/GYN or primary care provider,” says Battaglino. “If they tell you your blood pressure is a little high, for example, ask what does that mean?” This way, you can understand what your heart is telling you in the results of routine, but vital, heart-health tests like blood pressure.

Related: Men Get Help Faster During ER Heart Attacks

When you get to the few precious minutes you have with your doctor, tell them about any symptoms that could point to heart disease. “You want to bring up anything that’s bothering you like indigestion, pain in the upper arm, back, or neck, tightness in the jaw. Remember, women present differently than men,” Battaglino says.  

She suggests writing down the questions you want to ask before you go in. This is good advice not only for yourself, but for family members who may be getting ready for their annual primary care visit. Battaglino says, “As a daughter, I want to be sure I’m letting my mom know, too, to have that conversation.”

The best way to get the most you can out of your visit is to prepare. Get the education and tools that can help you understand your heart and signs of heart disease from online heart-health resources, and share them with the women in your life.

A few places to find heart health info you can use are:

While you’re with the healthcare provider, be sure to talk about how you might be able to cut your risks for heart disease. This means a healthy diet, regular exercise, and curtailing any exposure to smoke, whether cigarettes, e-cigarettes, or second hand smoke.

Related: Half of U.S. Women Don’t Know Signs of Stroke: Do You?

And pay attention to staying current with all your vaccines while you’re there. If you’re a smoker, you may want to get the pneumonia vaccine, Battaglino points out. And if you’re not sure whether or not you were vaccinated against measles which has reappeared in the United States in the past year, ask your doctor about getting your MMR vaccine. If you have a heart condition, you may be at greater risk for infection and complications, which can be severe. Battaglino says about her patients, “They can have blood drawn and have titers taken, to find out if they need a [measles] booster or not.”

What You Should Know About Heart Tests

If your visit to primary care turns up a possible heart condition, be proactive and ask for a cardiac referral. “You’d go to primary care, then you’d see a cardiologist and based on that you’d see about tests. Understand the testing that’s available to you,” says Battaglino.

Related: Stress of Toxic Relationships: A Risk Factor for Heart Disease in Women

Getting the right tests just might put you on the path to avoiding a fatal heart attack. But heart tests have different benefits and health risks. Here are some of the heart tests that might come up, and their risks:

  • A CAD blood test is a sensitive genetic test that looks at gene expression. (The test is manufactured by CardioDx.)

  • An exercise stress test is an ECG (electrocardiogram) done while you walk or pedal, and can identify areas where blood vessels are blocked.

  • A CT coronary calcium scan, also called the Agatston Score, is a heart scan that shows areas where plaque has built up inside your blood vessels, even before symptoms appear. It exposes you to radiation of about 3 millisieverts (mSv, a measure of radiation dose).

  • A CT coronary angiogram is a another heart scan, one that identifies blockages. But note that it exposes you to significantly more radiation than a calcium scan, 12 mSv.

  • A nuclear stress test combines an ECG, small amounts of intravenous radioactive dye, and heart scans that include radiation exposure of about 10 to 24 mSv. (For comparison, a mammogram exposes you to about 0.4 mSv, and a dental exam to 0.005 mSv.)

Don’t be afraid to ask questions if you don’t know what the tests involve. There are two questions you should always ask about your heart test, according to Andrew Einstein, MD, PhD, of Columbia University Medical Center in New Your City:

  • Is there a good clinical reason I’m getting this test?

  • Do you modify the test for each specific patient?

The answer to the first question should of course be yes. And Dr. Einstein points out that it’s important that some tests be adjusted to suit the person, because a woman may need lower radiation doses based on her weight, the size of her heart, and age.

The best practice is to minimize your exposure to radiation, because you may be scheduled for several X-ray screening tests in a year by different doctors. Both your referring physician and the doctor who actually does the tests should discuss the risks of radiation exposure, according to the American Heart Association.

By Jennifer J. Brown, PhD


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This article originally appeared on EverydayHealth.com: A Silent Threat to Women’s Hearts That Many Don’t Recognize