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- Hi, I'm Susan Taylor with Scripps Health
in San Diego, California.
When you think about a heart attack,
what comes to mind?
Pain in the chest, shortness of breath?
What about indigestion or pain in the jaw?
Because heart attack symptoms can be very different
in men and women.
Joining us to talk about heart attack symptoms
and treatment is Dr. Poulina Uddin.
She is a cardiologist with Scripps Clinic
in La Jolla, California.
Thanks so much for being with us, doctor.
- Thank you for having me. - Sure.
All right, so let's start with the basics.
Let's talk about the heart attack symptoms in men and women.
- So most people are familiar
with what we think are heart attack symptoms.
Somebody obviously having chest pain or trouble breathing.
Those are usually big signs of heart attack
and those can happen.
Those are very commonly described in men.
They actually do happen in women as well,
but what we have learned lately
is that women also tend to have more vague
and what we call atypical symptoms.
So they may or may not experience the chest pain
or shortness of breath,
but oftentimes will complain of back pain,
jaw or neck pain, fatigue,
nausea, or even belly pain.
So sometimes the symptoms can be a little more tricky
to tease out in women compared to men.
- And why are they different?
These symptoms different between men and women?
- That's a great question.
It's actually still being studied.
We think it's probably a combination of factors.
There are slight differences
in the anatomy of women's physiology, compared to men.
For example, vessels of the heart are actually smaller.
The distribution of cholesterol can be different
in the vessels.
And then, of course, we all know that women are subject
to a wide variety and fluctuations of hormones.
That can cause some vascular changes as well.
And so we think that these factors all contribute
to the varied presentation of symptoms
in women compared to men.
- All right, so if you have these symptoms,
what should you do?
- So what I tell my patients
or what I would like anyone to know
is if you have any new or worrisome symptoms.
Something that is definitely new, a change,
chest pain, trouble breathing,
something that's interrupting
what you're doing during the day
definitely may be worth an emergency room visit,
or even a call to 911,
depending on how dramatic or severe those symptoms are.
If the symptoms are something
that's perhaps been going on longer,
intermittent, a little less bothersome,
I do still think they require attention,
and that's something where I would call your physician,
try to set up an appointment to review
and see if any further testing needs to be done.
- So who is at risk for having a heart attack?
- Well, unfortunately, everyone is at a risk
for having a heart attack.
And the reason for that
is there are actually several different types
of heart attack, which people may not realize.
And some are quite preventable
through the things that we know.
Appropriate diet, keeping your cholesterol low,
watching your blood pressure, avoiding smoking.
And that's what the bulk of heart attacks
actually come from.
Unfortunately, there are other types of heart attacks
that are what we call bad luck
where sometimes you can suddenly get a plaque rupture
or actually the artery can tear
and there are varied presentations.
Some are more common in women.
Some are more common in men.
Some are actually more common
in younger versus older patients.
And so, unfortunately, anybody can be at risk
for a heart attack.
And we certainly know that people with certain risk factors,
family history, tend to be at higher risk.
- According to the CDC,
the Centers for Disease Control and Prevention,
heart disease is the leading cause of death
for both men and women in the U.S., why is that?
- That's a great question.
I think part of the reason is, as I said,
most heart attacks are those classic type that are related
to those risk factors of obesity, diabetes,
smoking, high cholesterol, and those tend to also go
with more of an aging population as we have.
Women actually live longer than men,
which then puts them even at increased risk.
And I think what's important to realize is that,
as I mentioned before, everyone, unfortunately, is at risk
for cardiovascular disease.
Sometimes people don't realize that women's risk
is just as high, and in some instances even higher than men,
depending on again their family history,
whether they're menopausal, what types of complications
they had during their pregnancies.
So the risk has actually always been there.
Usually it's just overshadowed
by other perceived more important things
or things that are going on in people's daily lives.
And so the risk has always been high.
I just think, unfortunately,
sometimes it's on the back burner
because there's so many other things to think about.
- So how do you reduce your risk for getting a heart attack?
- So, fortunately, most of the things that you can do
to reduce your risk of heart disease or heart attack
is actually something you can do on your own.
And there are things that we have been saying forever.
It's really appropriate exercise.
At least three to five times a week
for a minimum of 30 to 40 minutes a day
of cardiovascular exercise,
meaning getting your heart rate up, getting off the couch,
sweating a little bit, getting a little uncomfortable
so that you're huffing and puffing.
And then it really comes down to diet as well.
I mean, I think we all know those things that are delicious
maybe that we shouldn't eat or can only eat once in awhile
versus the things that you should be eating every day.
Fruits, veggies, trying to avoid highly processed foods.
And those certainly have a huge impact on reducing the risk
of cardiovascular disease down the road.
Diet and exercise bring down the cholesterol.
They reduce inflammation.
They help keep the blood pressure under control.
And, of course, most importantly, avoiding obesity,
which is one of our biggest risk factors.
We actually have some great ways to help patients with that.
If feel that they can't do it on their own,
we've got our cardiac rehab program.
We've got our nutritionist here.
So some people are really motivated
and you can certainly do it on your own,
but if you feel like you need a little help
we've got programs here for that as well to reduce risk.
- So when should you start paying attention to your heart?
- That's a great question.
I will actually tell people
you should start paying attention even from childhood.
If there's a strong family history,
even as early as your teen years, young adolescent years,
where those habits develop of healthy eating, of exercise,
avoiding smoking, those things really,
really get ingrained quite early.
And so people should be paying attention
from the time that they're children.
But really if there's a family history,
check in with your physician as early as your 20s
to start establishing a baseline,
seeing what the blood pressure looks like,
seeing what the cholesterol looks like
and determining whether this is somebody
who needs aggressive diet and lifestyle modifications,
somebody who just needs monitoring
or somebody who actually needs aggressive testing
and interventions upfront.
- And what's the importance of brushing your teeth?
- Well, there's a lot of good reasons to brush your teeth,
but specifically we do know that you can get some infections
of the heart valves that can be associated
with dental infections,
which was actually quite a common way to get that.
We also know that ongoing chronic,
what we say ongoing infections in various areas,
specifically the mouth and teeth,
increase the risk of inflammatory response in the body,
which accelerates the development of heart disease as well.
- Any final thoughts, doctor?
- You know what I would say is I know in these times
especially with the pandemic,
a lot of people are really concerned
about coming into the emergency room
or going to see their doctor during these times
with COVID exposure, and I would like to tell people
that if you're really worried
that there's something going on with your heart,
if you're having a worrisome symptom,
you absolutely should not delay a trip to the emergency room
or a trip to your physician.
We are taking all the precautions that we can here
to keep our patients and our staff safe.
Everybody is washing their hands, wearing their masks.
And so if you are having new or worrisome symptoms,
don't delay a trip.
We are concerned about people sitting at home,
having heart attacks or strokes
or really worrisome symptoms, simply because they're afraid
of coming to the emergency room
or catching COVID in the doctor's office.
So I would say that especially during these times
because people with underlying health conditions
can actually be at higher risk for COVID
and things like that, don't let yourself get sick
in any way.
So whether it's COVID, whether it's heart disease,
let us help you if you're worried.
- Dr. Uddin, thanks very much.
We appreciate you taking the time.
- Thank you.
- Scripps is consistently ranked
by U.S. News and World Report
as among the nation's best for heart care.
If you'd like more information
on heart attack symptoms and treatment,
just click on the link or go to scripps.org/videos.
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I'm Susan Taylor, thanks for joining us.
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