Listening to the Female Heart
Q: Can you tell me the signs and symptoms of heart problems in a woman? I know they are different than for men. Sometimes I feel pain that runs for several minutes from my back, upper shoulder and down my left arm. This seems to happen during periods of stress or too much activity. I've also been having shortness of breath with these pains along with a chest "aching." My blood pressure has been running high, around 150 over 100. Are these symptoms of a heart problem?
I am worried because I am at risk for heart disease—my 41-year-old brother just had quadruple bypass surgery and I have high blood pressure and am on two medications for it. I see the doctor regularly, and just went for my regular check-up, but I'm worried that my symptoms could indicate something serious.
A: When it comes to women and heart disease, subtle signs may precede a heart attack by one week to many months, even six or more. Even though the following symptoms may be—and often are—caused by other medical conditions, they also could be pieces of a puzzle that say your heart is in trouble. These include but aren't limited to:
- Chest pain that occurs in a predictable pattern (from stress, activity, etc.)
- Unusual and unexplained fatigue
- Sleep disturbances
- Shortness of breath
- Indigestion that may or may not be related to eating
- Pain in the left shoulder blade or upper back
- Anxiety or feeling of uneasiness or impending personal doom
Personal risk factors include but aren't limited to:
- Stable angina. Although additional information is needed and further testing may be required (such as EKG, a pharmacologic stress test, electron beam computed tomography heart scan, and/or others), the aching chest pain you are experiencing may be a condition known as stable angina. If present, this type of heart pain happens in a predictable pattern and puts the affected person at a higher risk for a future heart attack.
- Shortness of breath. While there are many reasons for this symptom to occur (asthma, chronic bronchitis, emphysema, etc.), I am concerned because your shortness of breath occurs along with left shoulder and arm pain, which is often a symptom of serious heart trouble.
- Uncontrolled high blood pressure. No doubt about this one, as your pressure is not controlled. High readings definitely are linked to an increased risk for heart attacks and strokes. I would encourage you to keep a blood pressure diary for two weeks. Check your readings at least two times per day with a portable machine that has been verified as similar to the measurements at your doctor's office. If your blood pressure is indeed too high (greater than 120 as top systolic number and/or greater than 80 as bottom, or diastolic number), the dosing of your medications needs to be adjusted, or even changed. Your high blood pressure absolutely needs to be controlled and lowered to a safer range.
- Family history of cardiovascular disease. Your brother had significant heart disease, requiring a quadruple bypass at the young age of 41. This puts you in a higher risk category for heart disease.
While you did not mention your cholesterol, LDL, triglyceride or HDL levels, I am hoping you have had them checked and they are in a healthy range. If not, that would add to your risk for cardiovascular disease. Other cardiovascular risk factors that need to be considered include:
- Age 55 and older
- Excess alcohol (more than one drink per day for women)
- Metabolic syndrome
- Physical inactivity
- Waist measurement greater than 35 inches
- Race (black women have a greater risk of heart disease and stroke than white women)
- Overwhelming stress
Many people think heart attacks happen in the familiar television fashion: A person clutches his chest from the pain and drops to the floor after passing out. Even though chest pain is the most common symptom, women are more likely than men to have a heart attack without this pain. In fact, many women have other or "atypical" symptoms that require prompt attention. These symptoms include but aren’t limited to:
- Chest sensation described as an ache, tightness or pressure
- Unusual and unexplained fatigue
- Shortness of breath
- Indigestion, nausea or vomiting
- Pain in the neck, shoulder or back
- Sudden weakness, dizziness or lightheadedness
As we have learned from the large, ongoing study known as the Women's Health Initiative, along with other research on women's cardiovascular disease, a woman's heart has its own way of communicating in the face of illness. I highly encourage you to visit a family physician, general internist, cardiologist or other health care professional skilled in the diagnosis, prevention and treatment of women's cardiovascular disease as soon as possible.
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