Learn about early signs and symptoms, and preventative means, to reduce your risk.
Did you know heart disease is the leading cause of death for women in the United States, killing 299,578 women in 2017—or about 1 in every 5 female deaths.
How do we prevent it, diagnose it, treat it, and live a quality life? Listen to Dr. Denisa Hagau, board certified cardiologist at the Mason City Clinic answers these questions and more. Listen to the podcast (transcript below):
To schedule a consult, call 641-494-5300
Welcome to Mason City Docs On Call, a podcast series with North Iowa specialists who educate us about how to stay healthy. I’m your host Carol Gifford. So, today, we’re going to talk about women’s heart health. 48 million American women have, or are at risk of heart disease. So, how do we prevent it? How do we diagnose it, treat it, and live a quality life? Here to help us talk through these questions is Dr. Denisa Hagau, a Board-Certified Cardiologist at the Mason City Clinic. So, welcome to the program, Dr. Hagau.
Thanks for having me.
So, tell us, how does heart disease manifest itself differently in women than men?
So, first, just to give you an idea of what heart disease we’re talking about today is the coronary heart disease, specifically the one that affects the blood vessels feeding the heart. We will not touch upon the muscle of the heart, cardiomyopathies we call them, or any valvular disease. So, heart disease refers right now to coronary heart disease. Women may have different presenting signs and symptoms compared to men, and they can be different in an acute situation like in an acute heart attack. And also before getting a heart attack, they may have different signs. So, I need to touch a little bit separately upon them.
During a heart attack, which is something that we want to prevent and that’s why we’re talking about all of this to try to prevent people or women and men from having a heart attack. That means acute, sudden blockage on the blood vessel feeding the heart, causing that part of the heart muscle to practically die, if not intervened upon. And that leads to heart failure and potentially then death. So, women may present differently. They may not get chest pain, they may just have sudden shortness of breath. But when I speak sudden, I mean, from a minute to another minute, just suddenly very tired, very short of breath, may develop sweating. Some women have epigastric discomfort or nausea, and they think they may have some acid reflux, which they never had in their life, but all of a sudden, that’s always a red flag. You don’t get acid reflux later in life, if you never had it before. So, that’s something you need to think about, maybe the heart actually.
Upper back pain or jaw pain or neck pain are also very common in women. Some women thought they had teeth pain and went to the dentist, when in fact there was angina. That’s during the acute situation. I had a few women having elbow pain only and significant fatigue. So, what prompted the emergency room visit, it wasn’t just elbow pain. Usually it’s associated with very significant fatigue and shortness of breath, to the point that impacts your day to day activity. So, that’s the acute situation. Chronically to diagnose heart disease before you have a heart attack, women may experience what we call angina or angina equivalent. This is just a fancy term saying that you have a pain that comes from the heart not getting enough blood flow.
And the way women may present is progressively just get getting more tired. More tired walking up the steps, carrying up the laundry, just more tired on a day to day activity. Some women again may have upper back pain or shoulder pain, not necessarily the left. This is a misconception, you may just have left arm or left shoulder pain, it can be equally on the right as well, or only on the right. Any sort of arm discomfort with activity, but not related to the caring or the physical part. That’s also worrisome for angina. So, when we try to diagnose, we usually recommend what is called a stress test, to see whether there’s an indication that the heart is not getting enough blood flow during a stressful situation. And there’s multiple types of it and it’s really depending on each patient individually.
But what we’re trying to assess is to see whether you have what we call ischemia. That’s just mean you’re not getting enough blood flow to the heart. People are very confused when they hear the term ischemia, because when we report the results of a stress test, we would comment on it, there is no ischemia, or there is a small ischemia. So, they always ask their primary provider, what do you mean? What is that? So, that just means lack of blood flow to the heart. So, these are the different signs for women compared to men symptoms.
I’m thinking about, for women, they might be getting older, they might be getting tired walking up the steps, and they might be like, “Well, I’m just getting tired.”
“And I might be getting a little-
Out of shape.
…over weight.” Exactly. And so, how do they know that it’s time to go see their primary physician or they need to go see a cardiologist? I mean, that’s such a general symptom. So, what is your recommendation to women? When is it just getting tired and maybe getting older and when is it maybe heart disease?
Very good question. Very good question. So, first of all, the biggest problem in women is that they do not go to the physician in time. They present later with a heart attack, as opposed to men. First of all, they present later after the symptoms went on, maybe for 24 hours. Second of all, it’s harder to recognize that a woman has a heart attack, so it goes even longer undiagnosed. And third of all, by the time you get to diagnosis and fixing, it’s late. So, first of all, women have to have a regular routine primary care appointment follow up. Is it an annual, is it a six months? Is it three months? It depends on your chronic condition. Very commonly, women may have high blood pressure, as we get older we get high blood pressure, and let’s say you just have an annual follow up for that, that should also include an annual cholesterol check, an annual sugar check because the high cholesterol, the high glucose, the high blood pressure, these are the key risk factors that will cause you to have coronary heart disease.
So, it really depends on how you feel in general. If you have a routine follow up and you’re doing well, and then you start feeling fatigued and short of breath when two weeks ago you were able to do the same amount of activity, that’s not aging, that does not come on that quickly. So, if you know your body and this just happens now, and you can pinpoint this happen after Thanksgiving and this and this, that’s something changed in your body. So, it’s a good indicator you need to check it out if you’re not sure. Primary providers are the first line of providers you should talk too.
So, getting back also to maybe who’s most at risk for heart disease in women. Is it genetic or is there something connected to lifestyle and weight or smokers? Can you shed some light on that?
I want to shed a lot of light on it, if I can. So, think about it 50/50. 50% may be genetics, but 50% is exclusively lifestyle. And unfortunately, we think about it only later in life to the choices that we make in terms of what we eat and how active we are, when can be kind of late for it. So, most risk factors, the most common one and the most important ones are again, elevated blood pressure, elevated cholesterol. Smoking is one of the biggest one, as well as diabetes. Someone in their 20s, having 20 pounds extra may think about as an aesthetic problem, and they don’t fit in the right size of clothes. And they’re trying to lose weight because of looks better to be skinnier. As opposed to someone in their 40s, which is not old, but in your 40s, if you already carried that extra weight with you for 20 years, that extra weight causes high blood pressure, which you don’t know, because you don’t have time to go and check it out. You’re too busy to take care of your children, husband, work.
That extra weight cause high cholesterol that goes untreated or unmanaged, that extra weight may cause type two diabetes. So, now, we’re talking about years of not treating the most important risk factors. If you add onto that smoking, you just have a perfect recipe for a heart attack. So, it’s a big, big lifestyle problem, which we need to understand we can change, but we have to do it in our early years, compared to in our 70s, when maybe too late already. It’s not impossible, it’s not irreversible, but it’s much better to start early than try to fix something that’s broken already.
Right. So, eating well?
Eating well is the first one, yes.
And not smoking?
Right, because then as years go on, I mean, it’s hard to change habits.
Hard to change habits, but not impossible. So, along the eating well goes for everybody in the family. As a woman, if you don’t have time to cook, we get the easiest things, which are the most unhealthy. They’re full of salt, which is detrimental because it increases your blood pressure. They may be full of sugar, which increases your cholesterol, as well as risk of diabetes. So, now, we’re adding to the entire family’s risks along with yourself. So, it’s important to implement this in the family from day to day, to try to decrease your risk.
Yes. So, when patients do come to you and they are identified with some level of heart disease and they haven’t had a heart attack yet, what are some of the treatment options that are available to them?
Very important. Once we diagnose someone with coronary heart disease, we need to fight all of these things that I just said. Someone elevated blood pressure, we focus on having an excellent blood pressure control with medications. It’s very important to understand why we give them medications because then people would take it much easier and they understand why is it for. We also recommend the baby aspirin. I know it’s a big debate now in the media and everywhere about aspirin. That’s for someone who has no heart disease, no history of stroke, no history of a myocardial infarction or a stent or a heart bypass. Baby aspirin is 100% recommending in someone with any evidence of coronary heart disease. So, that’s number one.
Number two is the cholesterol. Regardless of what’s your cholesterol level, people may say, “My cholesterol was always okay,” well, unfortunately you may have genes that you don’t know about and that cholesterol is too much for you coupled with your lifestyle choices and now we need to lower it. So, we have different targets for cholesterol level, for someone who has no heart disease or someone who has already diagnosed heart disease, and that’s much lower. For that, we always recommend lifestyle changes, but those take time and not fast enough. Subsequently, we do prescribe statin therapy. These are the cholesterol lowering medications.
Diabetes goes without saying. Someone having high sugar, that’s sticky. It’s just simple mechanics. Sticky makes the cholesterol stick to the blood vessel, causing less blood flow, causing high risk of heart attacks. So, whatever makes the blood cells stick, we need to decrease. Diabetes needs to be very well managed, so, the insulin or medications provided need to be taken accordingly. So, these are the treatments. We also have other medications specifically for the heart, that help lower the heart rate or how fast the heart beats.
Specifically, I’m talking about beta-blockers or Metoprolol, someone in that family. And these were proven to increase survival by a good 30% and decrease your chances of having a heart attack. So, when we prescribe it, we sometimes take it for granted that people know how important and how good these are, and we just prescribe without fully informing them how important this is and how much this helps you and that’s why you should be taking it.
Okay. Well, this is a lot of really good information. It sounds like we women have to be listening to our bodies. We have to be going to our doctors. We have to be eating well. And if we’re smoking, I think it’s a good idea we should stop smoking.
And it sounds like there’s a lot of really good medications out there if we do have heart disease, that can help mitigate some of the symptoms and effects of that. So, thank you so much. This is all really good information. And it’s just really interesting how heart disease really presents so differently in women than men. And I think that for a long time, women were thinking about heart disease or thinking that the symptoms were just very similar to men, and that’s a health risk in and of itself.
Just to underline that women die more of heart disease than all cancers combined. We have so much screening for all the cancers for good reason to prevent them from killing us, but unfortunately, we don’t apply the same for heart disease, which is still the number one killer. And we really need to focus on this and it’s a lifestyle problem. We got to understand, it’s a lifestyle problem and we got to switch it. It won’t work, it’ll catch up with us. It just will.
Well, thank you so much for being on the program.
Thank you for having me.
And women got to think about themselves more than just in February.
Thank you, Dr. Hagau.
Thank you for listening to Mason City Docs On Call. For more episodes, go to mcclinic.com/radio-podcasts.
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