A woman’s risk for heart attacks

AFFAIRS of the heart are usually reserved for relationships between men and women, but when it comes to cardiovascular health, there are subtle differences that women should know.

Dr Jomo James, internist, said a heart attack, also called a myocardial infarction, happens when one or more blood supply arteries to the heart muscle becomes blocked, causing damage to the part of the heart that gets blood from that artery.

 “You will often hear the term coronary artery disease referring to the disease or abnormalities of these vessels — also called coronary heart disease.  In this disease, fatty deposits called plaque, form on the walls of the coronary arteries. This plaque sometimes breaks open and causes blood clots to form within the vessel. Then the blood clot can block off the artery and keep blood from reaching parts of the heart muscle. That is the cause of most heart attacks,” Dr James said.

Dr James explained that although the risk factors for coronary artery disease or myocardial infarction and the nature of how this disease behaves are mostly similar for both genders, a few differences exist with regards to women. They include:

Incidence

“In the rate of new cases of myocardial infarction — the amount of new cases per year — what we call incidence of myocardial infarction is lower in pre-menopausal women, but increases dramatically after menopause to almost matching their male counterparts,” Dr James said. He explained that while the reasons aren’t clearly understood, one thought is that the female hormones confer some protection which is lost after the menopause.

Death

According to Dr James, women are more likely to die from a myocardial infarction than men. “The reasons differ, but women tend to get myocardial infarctions at an older age compared to men where the likelihood of combination with other co-morbidities or disease conditions exist, for example, diabetes,” he said.

Detection

Dr James said men are more likely to present early with the typical central chest pain associated with a myocardial infarction but women not only present late, but usually have diagnostic delays or problems with early recognition. “This is due to atypical presentations, for example neck pain or back pain and other myriad symptoms,” the internist said.

The risk factors of a heart attack can also be divided into modifiable and non- modifiable risk factors. Dr James said the modifiable ones are those risk factors that can be altered or changed by specific preventative measures. These include diabetes, hypertension, high cholesterol, a sedentary lifestyle with too little exercise, obesity, smoking, renal failure or kidney disease and poor diet choices.

Obesity, particularly central obesity with waist circumference above 35 inches in women compared to 40 inches in males, also increases the risk of a heart attack. Obesity is more common in women around the world and Jamaica is no different. Also, a diet high in fat and carbohydrate portends a higher risk for myocardial infarction, Dr James said.

However, non-modifiable risk factors are factors that cannot be altered or changed. Dr James said these include a woman’s age, with age over 55 conferring the greatest risk compared to men over 45, as well as a strong family history of myocardial infarction, especially in young family members with premature disease.

“Once a woman has reached over 50 and is post-menopausal, your physician can put together all your risk factors  and calculate a score that will determine your 10-year likelihood of having a myocardial infarction.  Like all assessment tools it is not absolute, but at least it can determine high-risk from low-risk women,” Dr James said.

Younger women aren’t immune to heart attacks and Dr James explained that for women younger than 40 to 45 years old, the risk factors are essentially the same. However, unique factors exist.

 “Smoking is the most common risk factor identified for myocardial infarction in this group. We have also seen high cholesterol due to genetic disorders and diagnoses of diabetes, obesity and hypertension at this age contributing to the development of myocardial infarction.

“Younger patients experiment more with illicit drugs that can cause myocardial infarction, for example cocaine. Rarely do we see congenital heart abnormalities that can lead to a myocardial infarction, for instance paradoxical embolism, where a clot moves through a small hole in the heart and clogs the coronary arteries,” he explained.

According to Dr James, other possible risk factors for young women are oral contraceptive pills primarily when combined with smoking, which may cause the blood to clot easily.

 Symptoms of a myocardial infarction include:

1) Pain, pressure or chest discomfort

2) Pain, tingling, in other parts of the upper body, including the arms, back, neck, jaw or stomach

3) Shortness of breath

4) Nausea, vomiting

5)Sweating or cold, clammy skin

6)Palpitations

7)Feeling dizzy or light-headed.

Dr James explained that if you suspect a heart attack, the following tests are usually ordered.

1)    An ECG, which measures the electrical activity of the heart

2)    Blood test. “During a heart attack the damaged heart muscles release chemicals that can be detected in the blood.”

3) An echocardiogram, which is basically an ultrasound that creates an image of the heart as it beats.

4)    Cardiac catheterisation. “During this test the doctor inserts a thin plastic tube into a large artery in the leg or arm and threads it to the heart. A dye is injected into the tube that shows up on an X-ray. This dye shows whether any of the coronary arteries in your heart are clogged.”

And treatments include:

1)    Oxygen.

2)    Medicines to ease the chest pain, medicine to  keep the blood from clotting, and medicines to control high blood pressure and to slow the heart rate down in order to decrease work of the heart.

3)    Definitive treatment aimed at reperfusion to open the clogged arteries. “These may take two forms — either through medicine in the vein to ‘dissolve’ the clots,  or a minor operation procedure by cardiac catheterisation called angioplasty. It involves inserting a metal tube into the clogged artery to prop it open. If you cannot have angioplasty or clot busters fail, then open-heart surgery may be indicated.

Coronary artery bypass grafting involves creating a detour or alternative path around the blocked vessels using your own veins or arteries. You’re likely to stay in the hospital at least five days after an uncomplicated myocardial infarction.”

 Dr James said despite a 10-year gender gap in the onset of increase risk of myocardial infarction in women compared to men, women catch up fast and are more likely to die. Early recognition of these risk factors may stem the tide.