With most of the research into heart disease focused on men, how heart disease affects women is not nearly so well known, even though more women die of cardiovascular disease than men. In 1998, a study by the National Center of Health Statistics revealed that 46% of women perceived their most serious health threat as breast cancer and only 4% indicated they believed heart disease was the most serious threat. In fact, at that time the real incidence of heart disease in women was 36% and breast cancer was 4%. Hopefully, women are better informed now.
We’ve known for a long time that there are none of us who escape an increased risk of heart disease as we get older. It’s also fairly common knowledge that smoking, a high-fat diet, obesity, high blood pressure, diabetes, a family history of heart disease and an inactive lifestyle raise anyone’s risk at any age. Since 1998, we’ve learned more about how the risks for heart disease change during a woman’s lifetime and how symptoms of a heart attack can differ from what most men experience. We now know that women who have not yet experienced menopause seem to enjoy some unique risk-lowering benefits as a result of estrogen and that these benefits are lost with menopause.
At about the age of 50, the age when natural menopause often begins, a woman’s risk for heart disease increases dramatically. (The same rise in risk applies to younger women who undergo early or surgical menopause and don’t take estrogen.) In addition to changes in estrogen, the effects of aging usually affect heart health. Blood pressure may rise with menopause. Cholesterol levels may change. Certain types of fat in the blood may increase. Unknown factors are also likely to be at work. More research focused on heart disease in women suggests that these factors may be better understood in the future.
Meanwhile, we need to adopt practices that lower the risk of heart disease while also learning more about how to identify heart attack symptoms. For example, both men and women may have a tightness, squeezing, pressure or pain in the chest, shortness of breath, sweating, or pain that spreads to shoulders, neck, arm or jaw. They may also have a feeling of heartburn without indigestion, nausea or vomiting, as well as sudden dizziness or a brief loss of consciousness.
According to the American Heart Association, women also report experiencing an uncomfortable pressure, squeezing, fullness or pain in the center of the chest that can last more than a few minutes, goes away and comes back. They can feel pain or discomfort in one or both arms, the back, neck, jaw or stomach, as well as shortness of breath with or without chest discomfort. Some women report a sense of impending doom.
Because heart attack symptoms in women may be misinterpreted, women are more likely to die from their first heart attack. Rather than reporting a crushing pain in the chest, as men often describe a heart attack, women may feel pain under the breastbone. They may report indigestion, difficulty breathing, abdominal pain, nausea or unexplained fatigue. If they are elderly or have diseases such as arthritis or diabetes, these symptoms may be incorrectly attributed to another cause or disease, delaying medical intervention.
If you experience symptoms of a heart attack, the first step is to accept that you may be having one. Denial can be deadly. Dial 911 for an ambulance. A patient being transported in an ambulance will begin receiving life-saving medical treatment while en route to the hospital. Only ambulances with medical personnel are equipped to revive a patient if her heart suddenly stops beating.
To lower your risk of a second heart attack, participate in both inpatient and outpatient heart rehabilitation programs. Inpatient rehabilitation should include comprehensive daily medical management by a board-certified rehabilitation specialist and rehabilitation nursing focused on development of self-management skills. Medical management should include respiratory care and wound care if surgery was performed. Every heart patient should receive individualized rehabilitation, including one-to-one therapeutic exercise and functional retraining by an interdisciplinary team. These therapies should include a program that addresses gait and mobility, training in how to safely accomplish activities of daily living, and nutritional instruction and counseling.