Photo by Tim Marshall on Unsplash
When I was 27, my mother-in-law asked my husband, who was then 28 to get his cholesterol tested. My husband was tall and lanky with a normal body mass index (BMI) and we had a low stress lifestyle. Yet she was worried, because a distant relative had died suddenly from a heart attack at the same age.
To to put an end to his mother's worries worries, my husband decided to get tested. Since our insurance plan covered the tests, I decided to join him mainly for company. I mean, as far as I knew I was a healthy 100 pound girl with a BMI at the low end of the normal range, and no vices, except perhaps, if you considered my love for black tea.
So we were shocked to learn, that both our cholesterol and triglyceride levels were slightly elevated. While our numbers were not off the charts, in our twenties, being even in the slightly above borderline category, was frightening. It was too early, just too early. How could this be happening to us?
We made a few dietary changes and started regular exercise and within a year, we were able to get a numbers within normal range again. Ever since, we have been careful with our diet, exercise regularly and get annual tests and tweak our lifestyle if any of the numbers cause concern and things have been going fine for us so far. Knock on wood.
The number one killer!
The one thing my experience has taught me is, that one simply cannot be too careful when it comes to heart disease. Heart disease is the number one cause of death in women, affecting one in three or four women. And it is not restricted to old people either.
The most common form of heart disease is known as coronary heart disease (CHD) or coronary artery disease. The large coronary arteries supply blood to the heart muscle. However due to high cholesterol, plaque can build up in the walls of the major arteries causing a blockage. If the blockage is complete then the blood cannot reach the heart causing a heart attack. This article lists 4 other types of heart disease as well.
However many women experience some other heart diseases causing heart attacks.
Women often experience a slightly different type of heart condition called coronary microvascular disease (MVD). This may not show up in an angiogram and is difficult to diagnose, but a stress test will reveal that parts of the heart are not getting oxygen. This is caused due to damage in the smaller blood vessels of the heart resulting in the heart muscle not having enough oxygen rich blood or some parts of the heart muscle may be completely cut off from oxygen. This illustration clearly explains the difference between CHD and MVD.
The causes and risk factors for MVD are the same as those for atherosclerosis including diabetes, high blood pressure, obesity, smoking, unhealthy blood cholesterol levels and a family history of cardiomyopathy, which is a disease of the heart muscle.
In women MVD may also be caused by low estrogen levels at any time, but more commonly before menopause. Women who have high systolic blood pressure before menopause are also at risk for MVD.
MVD cannot be cured, but the goal of the treatment is pain relief, and to reduce the risk of a heart attack with medication for prevention of blood clots, and to treat risk factors like high cholesterol, high blood pressure, and anemia.
Spontaneous coronary artery dissection (SCAD)
Although SCAD accounts for only a few of the overall cases of heart attack, it is the cause of over 40% of the heart attacks experienced by women under the age of 50, and over 90% of patients with SCAD are women. The exact cause of SCAD is not known, however it is more common among postpartum women and 30% of women who suffer from SCAD, have recently had a child.
SCAD is difficult to diagnose, because it is asymptomatic until it causes a heart attack. Heart attacks due to SCAD occur because of a tear in the arterial wall. The tear tunnels within the wall of the artery blocking blood flow to the heart.
An intravascular ultrasound or optical coherence tomography screening is required to make a definitive diagnosis of SCAD.
The scariest thing about SCAD is it is happening to young women who have no traditional risk factors for heart disease and seem to be quite fit.
SCAD needs to be treated by repairing the damage to the wall of the artery and so far research suggests that conservative treatment methods emphasizing on blood pressure control medication is probably best.
Broken heart syndrome, which is usually a temporary condition and very rarely fatal is also more common among women.
And you thought you knew the symptoms
We always associate heart attacks with chest pain, and although it is the most common symptom, it is not universal. A study showed that one in 5 women under the age of 55, having a heart attack did not experience chest pain. The study also did not find any correlation between the intensity of the chest pain, and the severity of the heart attack.
Although for most women some form of chest discomfort occurs during a heart attack, it is not always severe and not even the most prominent symptom.
Women are more likely to have heart attack symptoms unrelated to chest pain like:
neck, jaw, shoulder, upper back or abdominal discomfort
pain in one or both arms
nausea and vomiting
shortness of breath
Oddly women's symptoms can occur when they are resting or asleep. It is really important to be aware of these symptoms, especially how they differ from the ones that are better known and more common among men, so one can seek timely emergency medical care.
Many women, especially those who are primary care givers to children or the family, tend to ignore symptoms and discomfort or procrastinate medical check ups and visits to the doctor. Lack of knowledge about symptoms of heart conditions and heart attacks specific to women also result in delays in women seeking medical help. It is important to realize, that one cannot be an effective care giver unless one is in good health. It is also important for women to educate themselves about symptoms of emergency medical conditions that are more common to women so serious symptoms are not overlooked and medical attention is obtained in a timely manner.
I am thrilled to be participating in the A to Z blogging challenge 2018.