Heart attacks and women
Heart attacks are the number one killer of women, yet it might be the last thing we think of when experiencing symptoms.
"Women present atypically," says Steve Albrich, a physician assistant in the ER at Blue Mountain Health System."The most common symptom is chest pain for both men and women, but overall, I think women present more atypically. They describe symptoms such as a heaviness or pressure in the chest. I've also seen women come in and say they don't feel right. They're unusually fatigued, have nausea, upper abdominal discomfort."Symptoms may also include back pain into the shoulder blades, but this is less common than the classic chest pain.Albrich says with emergency medicine, one of the things they have to keep in mind is they must always rule out and do a work-up for heart attack or coronary artery disease."You can have CAD and not have ischemic heart disease," he says.Ischemia is a restriction of blood supply to the tissues, causing a shortage of oxygen and glucose necessary to keep tissue alive.Think you're having a heart attack?"Call 911," says Albrich. "Take four baby aspirin (324 mg or a regular aspirin, which is 325 mg) and chew them. It gets into the system a lot quicker that way."Albrich says a lot of people will take aspirin before going to the ER, or are already taking it daily as recommended by their doctor."If you take it in the morning, and you're having symptoms not too long after, take three more (low dose). If your symptoms are later in the day, and it's been awhile since you had the first one, take four. Aspirin affects the plaque's ability to adhere to the blockage in the artery. Once the vessel totally occludes or blocks, then you have structural damage to the heart wall."What happens in the ER?"We'll give aspirin," says Albrich. "Then, if they're really symptomatic, we would give nitroglycerin. It helps dilate the vessels in the heart and reduces the workload on the heart. The more the heart gets stressed, the more damage there is."After that, Albrich says staff would do a complete history and physical exam, an electrocardiogram and blood work, including cardiac enzymes, if they are looking to rule in or rule out a heart attack.One of the things they will be looking for in a patient's blood work is troponins."You can have a normal ECG (electrocardiogram), and still have elevated troponins," says Albrich."You could have some damage to the heart wall, not a transmural infarction, (which is the death of myocardial tissue from the endocardium to the epicardium as a result of a myocardial infarction), but that doesn't affect the full thickness of the myocardia, or the muscular tissue of the heart."We're trying to limit damage, like with a stroke. You want to dissolve that blockage so tissue doesn't die."If the medical staff has a high index of suspicion, the patient will be admitted."You can be having a heart attack and (cardiac) enzymes can initially be negative," says Albrich. "If the history is concerning, we would admit them and do three sets of blood work to check enzymes, each three hours apart."Further treatment would depend on the results of those and other tests.Heart health tipsFor heart health Albrich recommends increasing the amount of fruits and vegetables you eat, and reducing the amount of meat, carbohydrates and fat.Get 30 minutes of exercise four days a week. Quit smoking. And have regular follow ups with your doctor."If you have a family history of high cholesterol, and you're not being treated for it, go at least once a year for a physical and basic blood work," says Albrich."A lot of people are walking around who are diabetic, and don't know it. When sugars are elevated for a long time, it can cause inflammation to the vessels and damage nerves."And if you think you might be having a heart attack, Albrich says to take aspirin and go to the emergency room."Don't blow it off," he says. "If you're not having a heart attack, the worst thing that could happen is you come in and we send you home. But if you are, we can limit damage that's done early on."This is the second part of our series on women's heart health. Find part one, "Matters of the heart," at