Not all heart attacks are the same — and for women, they can be even more complicated.
We’ve all seen movies or TV shows in which someone has a heart attack, and watched an actor clutch his or her chest or arm with a grimace. It’s a scary scenario, and even scarier when you consider that not all heart attacks look the same — and things get even more complicated for women. Instead of chest pain, a woman might feel intense sweating, which could make her think she’s having a hot flash instead of a heart attack. And moreover, how can you be sure you’re not developing heart disease in the first place?
Katie asked Dr. O, aka J. Nwando Olayiwola, MD, MPH, FAAFP, the Chief Health Equity Officer for Humana Inc. to tell us how to spot a heart attack, the symptoms you might not know about, and whether that Aspirin-under-the-tongue trick actually works for stopping a heart attack in its tracks.
What are some of the signs that you might have heart disease, which could possibly lead to a heart attack?
Some of the signs are things like difficulty breathing, intermittent chest pain, and feeling your heart race regularly. These are in addition to indicators your doctor talks about, like your glucose and hemoglobin A1C levels, cholesterol readings, blood pressure: Elevated levels can suggest that you’re at risk for heart disease.
The symptoms of heart disease can be variable. It’s really interesting because in women, sometimes symptoms are not the classic crushing chest pain. In fact, that’s why heart disease is often hard to determine in women. Because one symptom could be intense sweating, which might get confused with hot flashes — but also might be a sign that you’re having more serious problems. You might have pain in one of your arms, more fatigue than usual, or difficulty breathing.
When patients tell me that something’s wrong, I tend to believe them, because they’re living in their body every day and they notice differences. It’s important to really know your body and trust yourself when you feel like something is off.
Heart disease is called “the silent killer” for a reason — it’s so hard to know that your arteries are getting clogged. That’s why prevention is so important, as well as knowing your numbers and adopting healthy habits. Otherwise, your wake-up call could unfortunately be a heart attack.
What are the symptoms of an impending heart attack?
The symptoms are not always what people assume, particularly for women. We know that many people with heart attacks will have crushing chest pain and the substernal pressure, and will feel like something is happening behind their chest wall. But many women don’t present that way: They can have a number of different symptoms of a heart attack, like intense sweating and a feeling of heat. Sometimes women have heart attacks that manifest as pain in their armpit. And sometimes there’s maybe not actual pain in the chest, but instead symptoms like having a hard time breathing and being very fatigued.
What about that old idea of taking Aspirin every day for heart health? Is that still recommended by doctors?
If there are no contra-indications for someone, that’s still considered a great practice for heart health.
I’ve also heard that if you’re having a heart attack, you should put a baby Aspirin under your tongue. Does that really work?
If you suspect you’re actively having a heart attack, you can absolutely take a baby Aspirin. Then when you go to the hospital, they’ll be able to obviously give you more targeted treatment. If you have the sublingual, under-the-tongue Aspirin, it doesn’t have to go through the whole digestive tract — it dissolves and gets into the bloodstream much quicker. If you only have a regular Aspirin, just take it.
I know that postmenopausal women are at high risk of heart attack, and oftentimes they’re also on some kind of hormone replacement therapy, which could increase their risk of other health problems. What’s the latest thinking on that?
The field of hormone replacement therapy is emerging and evolving all the time. I think it’s a very important personal decision to make for a woman, and one they should make in concert with their doctors.
Some studies have shown that unopposed estrogen, without any progesterone or other hormones for many years, does have cancer risks. So there’s a cost-benefit analysis you’ve got to do: Does the potential for osteoporosis outweigh the risk of potential cancers? It’s a conversation that I strongly suggest people have with their OB-GYN or primary care doctor to know what’s best, because it’s definitely not a case of one-size-fits-all. What might work for your sister may not be the same thing that works for you.
There’ve been some reports that Covid may be affecting heart health. What’s the deal?
I think it’s still very early for us to know what the long-term impacts are going to be. With long Covid, there’s a fear that we might have people that experience long-term cardiovascular challenges and enlarged hearts — what’s called cardiomyopathy.
It’s still quite early to gauge how this virus is going to play out, and what the long-term effects are going to be. I feel like new science is emerging every day, every minute. I don’t know if we have enough information yet to be confident that we’ve got an answer, but yes, there are some early indications that there could be long-term challenges from the virus.
What about younger women? At what age should you really start focusing on your heart?
We can start focusing on our hearts from the time we’re children, really. Adopting good behaviors early is important when you think about screening for the risk factors for heart disease. Usually between 35 and 40 years old is when we start those screenings, but certainly we’d want to check earlier if you have a family history of early heart disease. Increasingly, at places like Walmart and CVS, you can get your blood pressure checked by the pharmacist, and it’s often free. So there’s not a whole lot of burden involved in getting a blood-pressure reading. Then it’s just about making sure you have a follow-up plan when you get your numbers, so you know what to do with them.
