We’ve all seen movies or TV shows where someone has a heart attack and seen an actor clutch their chest or arm with a grimace. It’s a scary scenario, and even more scary when you consider that not all heart attacks look the same – and things get even more complicated for women. Instead of chest pain, a woman may experience profuse sweating, which may make her think she is having a hot flash instead of a heart attack. And besides, how can you be sure she isn’t developing heart disease?
Katie asked Dr. O, aka J. Nwando Olayiwola, MD, MPH, FAAFP, Chief Health Equity Officer of Humana Inc. under the tongue trick really works to stop a heart attack in its tracks.
What are some of the signs that you might have heart disease, which could lead to a heart attack?
Some of the signs are things like difficulty breathing, intermittent chest pain, and feeling your heart racing regularly. These are additional indicators your doctor talks about, such as glucose and hemoglobin A1C levels, cholesterol readings, blood pressure: elevated levels can suggest you are at risk for heart disease.
Symptoms of heart disease can be variable. It’s really interesting because in women sometimes the symptoms are not the classic crushing chest pain. In fact, this is why heart disease is often difficult to determine in women. Because a symptom can be intense sweating, which can be confused with hot flashes – but also could be a sign that you are having more serious problems. You may experience pain in one arm, more fatigue than usual, or difficulty breathing.
When patients tell me something is wrong, I tend to believe them because they are living in their bodies every day and they notice differences. It’s important to really know your body and trust yourself when you feel something is wrong.
Heart disease is called the “silent killer” for a reason – it’s so hard to know your arteries are clogged. That’s why prevention is so important, as well as knowing your numbers and adopting healthy habits. If not, your wake-up call could unfortunately be a heart attack.
What are the symptoms of an impending heart attack?
The symptoms are not always what people assume, particularly for women. We know that many people with heart attacks will have crushing chest pains and substernal pressure, and will feel like something is happening behind their chest wall. But many women don’t present this way: they can have many different symptoms of a heart attack, such as heavy sweating and feeling hot. Sometimes women have heart attacks that manifest as pain in the armpit. And sometimes there may not be actual chest pain, but symptoms like difficulty breathing and feeling very tired.
And that old idea of taking aspirin every day for heart health? Is this still recommended by doctors?
If there are no contraindications for someone, this is still considered a great practice for heart health.
I’ve also heard that if you’re having a heart attack, you should put a baby aspirin under your tongue. Does it really work?
If you suspect you are having a heart attack, you can take baby aspirin. So when you go to the hospital, they can obviously give you more targeted treatment. If you have aspirin sublingually, under the tongue, then it does not have to go through the entire digestive tract – it dissolves and enters the bloodstream much faster. If you only have regular aspirin, take it.
I know that postmenopausal women are at high risk for a heart attack and are often also on some type of hormone replacement therapy, which may increase the risk of other health problems. What is the latest thought on this?
The field of hormone replacement therapy is emerging and evolving all the time. I think it’s a very important personal decision for a woman, and one that should be taken in conjunction with her doctors.
Some studies have shown that unopposed estrogen, without any progesterone or other hormones for many years, poses cancer risks. So there’s a cost-benefit analysis you need to do: does the potential for osteoporosis outweigh the potential cancer risk? It’s a conversation I strongly suggest people have with their OB-GYN or primary care physician to learn what’s best, because it’s definitely not a one-size-fits-all affair. What might work for your sister might not work for you.
There have been some reports that Covid may be affecting heart health. What is the problem?
I think it’s still too early to know what the long-term impacts will be. With long Covid, there is a fear that we could have people with long term cardiovascular problems and enlarged hearts – what is called cardiomyopathy.
It is still too early to assess how this virus will behave and what the long-term effects will be. I feel that a new science is emerging every day, every minute. I don’t know if we have enough information yet to be sure we have an answer, but yes, there are some early indications that there are could be long-term challenges from the virus.
And the younger women? At what age should you really start focusing on your heart?
We can start focusing on our hearts since we’re kids, actually. Adopting good behaviors early is important when thinking about tracking risk factors for heart disease. Usually between the ages of 35 and 40 is when we start these tests, but we would certainly want to check earlier if you have a family history of early heart disease. Increasingly, at places like Walmart and CVS, you can get your blood pressure checked by your pharmacist, and it’s usually free. So there isn’t a lot of burden involved in getting a blood pressure reading. Then it’s just about making sure you have a follow-up plan when you get your numbers so you know what to do with them.