Heart Attack and Stroke Prevention in Women

 

How is heart attack different from heart failure?

A sudden blockage of blood supply and oxygen to heart muscles due to a clot in any of the major arteries of the heart can result in myocardial infarction.  This is commonly known as a heart attack, which can be fatal if not treated immediately.  If the patient survives, depending upon the seriousness of heart muscle damage and frequency of heart attacks, the heart functions less effectively in the long run.  This may lead to poor blood supply to other parts of the body.  This constitutes heart failure.  Both men and women are prone to these conditions.

Why are heart diseases under-diagnosed in women?

Recently, the World Health Organization said that heart diseases in women are under-recognised and under-treated.  In a recent study conducted across 10 Indian cities, it was found that about 60% of women in the age group of 30-45 years were vulnerable to coronary artery diseases (CAD).  In another single centre study in Ahmedabad, women were found to have a high prevalence of obesity, diabetes, hypertension and heart diseases, although the number of women who underwent invasive treatments for CAD was less than men.  The risk only increases after menopause since the protective effect of reproductive hormones wears off at this age.

There are several reasons for this gender gap in terms of CAD recognition and treatment.  Ignorance about general health issues is a prime contributor, with many women believing that their current lifestyle is adequate or even protective against heart diseases.  However, statistics indicate that the precursors of CAD, such as obesity, diabetes, hypertension, high cholesterol levels, stress and depression are on the rise among women of all age groups.  It is worth noting that conditions such as diabetes, hypertension and high cholesterol levels usually go undetected, or are discovered only during a routine check-up.  The longer these conditions are allowed to remain unchecked, the higher the risk of heart attacks.

Women of child bearing age who take oral contraceptive pills may experience side-effects such as water retention and weight gain, which can further increase the risk of CAD.  Also, there is an increasing prevalence of smoking and drinking among women, not just in the urban areas, but also in the rural set up, which adds to the overall risk of having a heart attack.

What are the signs and symptoms of a heart attack?

As with men, the following symptoms may be indicative of an impending or ongoing heart attack in women:

  • The most common complaint is central or left-sided chest pain, tightness, burning sensation, pressure or squeezing sensation, which lasts for more than a few minutes.
  • This pain may radiate to other parts such as the left arm, left side of the jaw, back or abdomen.
  • Difficulty in breathing, with or without chest discomfort.
  • Breaking out in a cold sweat, nausea and/or vomiting, or feeling giddy.

Of these, women are more likely to experience radiating pain to the back or jaw, shortness of breath and nausea and/or vomiting.  Since some of these symptoms overlap with those of gastritis and panic attacks, it is important that such attacks are properly assessed to rule out heart attacks.

What can be done during a heart attack?

  • Make the person sit down or lie down and try to calm her down.
  • Loosen any tight-fitting clothes.
  • Ask if she has been prescribed any tablets (nitroglycerine) to be taken while having chest pain, and help her take it.
  • A tablet of aspirin (up to 325 mg) can be given, after making sure that she has no history of aspirin allergy, asthma or bleeding gastric ulcers.
  • Call the emergency services and arrange for an early transfer to the hospital.
  • If the person has stopped breathing/collapsed/is without heart beats, cardiopulmonary resuscitation (CPR) can be commenced by giving 30 chest compressions and 2 mouth-to-mouth breaths.

Remember, however, that you need to know the right technique of doing CPR; otherwise you may end up causing more harm than good.

What can be done to prevent heart attacks?

1. Reduce obesity:

Since obesity is a modifiable risk factor for heart attacks, weight reduction is something that every overweight woman should aim to achieve.  It is worth noting that visceral fat (fat layer covering the internal organs), rather than fat under the skin is more dangerous.  Body-mass index (BMI = weight in kg/height in m2), waist-to-hip ratio and waist circumference are various indices that can be used to monitor the weight.

The benefits of losing 10kg in a 100kg subject are as follows:

  • Reduction in risk of developing Type 2 diabetes by 50%.
  • 10mmHg reduction in systolic and 20mmHg reduction in diastolic blood pressure.
  • 10% decrease in total cholesterol.
  • 20-25% reduction in premature mortality.

Reduce your weight by doing activities such as walking, jogging, cycling or swimming.  Whatever the type of exercise, it is important to bear in mind the limit to which you can exert yourself, particularly if you are already prone to heart diseases.  For this, an exercise regime based on the cardiovascular exercise heart rate can be selected by using the Karvonen formula.  It is calculated by noting the maximum heart rate after the maximum tolerated exercise (HRmax), resting heart rate (RHR) and heart rate reserve (HRR):

Step 1: calculate HRR; HRR = HRmax – RHR

Step 2: calculate optimum training heart rate range; 60-80% of HRR

Step 3: add RHR to above range

For example, in a 35 year old woman with a low heart attack risk, a resting heart rate of 70 beats per minute, and a maximum achieved heart rate of 150 beats per minute, the desirable heart rate to be achieved during exercise would be calculated as follows:

Step 1: HRR = 150 – 70 = 80

Step 2: 60-80% of 80 = 48-64

Step 3: 70 + above range = 118-134

Therefore the ideal cardiovascular exercise heart rate range in this case would be 118-134 beats per minute.

2. Diet and lifestyle issues:

  • Get yourself tested for risk factors of CAD such as diabetes, hypertension and high cholesterol levels, and keep them under control if you have them.
  • Keep your alcohol intake down to moderate quantities.
  • Stop smoking as it is a major risk factor for CAD.
  • Take a balanced diet comprising proteins (lean meat, eggs, pulses, soya); complex carbohydrates (oats, whole grain bread); essential fatty acids (fish, walnuts, flaxseed, sunflower oil, extra virgin coconut and olive oils); vitamins, minerals and fibers (fruits and vegetables).
  • Cut down on junk food such as chips, colas, fried snacks and sugary or salty treats
  • Do meditation and/or yoga to counter stress, anxiety and depression, and to achieve a healthy body-mind-spirit balance.

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