Vive la difference!
Long live the difference, a phrase often used to celebrate the wonderful and intriguing ways women and men differ.
I know I’m treading on thin ice here. No difference in rights for sure; no difference in pay for the same work — amen; no difference in opportunities at work, home and school — certainly … but some differences in susceptibility to odd heart diseases.
For too many years we thought women were somehow protected from the ravages of the most common heart disease, atherosclerosis or hardening of the arteries. All sorts of reasons were proposed. Some reasonable, like thinking that estrogen or some other hormonal influence protects the delicate lining of blood vessels. Some preposterous, like believing women don’t face as much stress as men and therefore are saved from its negative cardiac effects.
Fortunately, today we acknowledge women are affected by hardening of the arteries almost as much as men, but we clearly see the symptoms of heart disease in women are often much subtler and nuanced than those in men. Faithful readers of this column know that whereas in men, the sensation of angina — or a reversible imbalance of the heart muscle’s fuel and oxygen supply and even the sensation of a heart attack, or myocardial infarction, a transition from muscles starving to muscles starving to death — are usually dramatic, in women, they can often be overlooked.
Common heart disease complaints in either sex include chest pressure (many people refuse to call it pain), or tightness; sometimes described as a squeezing, uncomfortable full feeling easy to confuse with indigestion or agita. These same sensations in the left shoulder or jaw, shortness of breath, lightheadedness, dizziness, a sense of terrible foreboding, perspiration and anxiety are other signals of heart trouble.
These all occur with women but too often their first cardiac alarms are more subtle and less dramatic. Women may not localize the tightness as narrowly in the mid-chest as men. Abdominal discomfort, lower chest aching and even arm pain, especially if related to exertion and simulating a cramp or “Charlie Horse” that dissipates with rest may be a warning of cardiac problems. Sudden, overwhelming fatigue, like someone suddenly pulled out your battery, is sometimes described by women during a heart attack. It seems the occurrence of discomfort in the back of the upper chest, near the shoulder, in the neck and jaw, and down the left arm, occurs more often in women.
It’s certainly true that heart attacks and angina can occur as the first warning that anything is amiss with your coronary arteries, but let’s face it, usually there are characteristics or risk factors that help set the stage for the ultimate arrival of trouble.
We’ve broken the predisposing factors into three groups: those who have no control over, including genetic predisposition based on genes and family history, gender, and previous medical history. You can’t change them so let’s move on to those factors that you have total control over. Smoking, exercise, diet and managing stress. We have and will continue to talk about these. There are several important risk factors you can’t totally control, but with the help and advice of medical professionals, you can manage them. Most require some measurement and may eventually be helped with medication. Body weight, waist size, blood pressure, blood cholesterol and other lipid (fat) levels, and blood glucose (sugar) levels are important numbers your medical team can help you with.
Next week we’ll talk about a rare but important disease in women who don’t have lots of risk factors but, quite unfairly it seems to me, become victims of a heart attack in their 40s and 50s.
If you or anyone you’re in contact with even thinks they may be having a heart attack call 911; don’t drive to the hospital; don’t wait. We can help, but only when we get the chance.
Dr. Alfred Casale is chairman of surgery for the Geisinger Heart Institute, co-director of the Cardiovascular Service Line for the Geisinger Health System and Associate Chief Medical Officer of the Geisinger Health System and Chair of the Geisinger Heart Institute. Readers may write to him via [email protected]