Heart Attack in Women

Definition

A heart attack occurs when an artery that carries oxygen-rich blood to the wall of the heart (myocardium) becomes completely blocked. The resulting lack of oxygen causes tissue to die in the part of the heart supplied by the blocked artery. A heart attack is also called a myocardial infarction (MI).

Causes

Most heart attacks are indirectly caused by coronary artery disease, a form of heart disease. This condition results from atherosclerosis, a condition in which fatty deposits (plaques) build up on the walls of an artery. This narrows the arteries and restricts blood flow to the wall of the heart. A complete blockage of blood flow sufficient to cause a heart attack is usually triggered by an event such as a blood clot forming on a plaque, which often leads to its rupture. Spasm of the artery usually contributes to the blockage.

Risk Factors

The risk factors for having a heart attack are similar to those for developing coronary artery disease.

Uncontrollable risk factors include:

• Early menopause
• Postmenopausal status
• Increasing age
• African American descent
• Family history of cardiovascular disease

Controllable risk factors include:

• Smoking or exposure to secondhand smoke
• High blood pressure
• High levels of low-density lipoprotein (LDL) cholesterol
• Low levels of high-density lipoprotein (HDL) cholesterol
• Sedentary lifestyle
• Diabetes
• Obesity and overweight (especially when focused around the waist)
• Psychological stress
• High blood levels of the amino acid homocysteine
• Smoking while taking birth control pills (especially in women over age 35)

Symptoms

The symptoms of a heart attack may be different in women than in men and may be overlooked by some physicians and patients. While chest pain is typically the most common symptom in men (and often occurs in women), extreme fatigue after physical activity is the most common complaint in women suffering a heart attack.

Other common symptoms include:

• Nausea and vomiting
• Severe fatigue
• Dizziness, fainting
• Feelings of heart burn or indigestion in the upper abdomen
• Pain that radiates into the arms (on the right side more than the left)
• Pain high in the back, jaw, or neck
• Heart palpitations
• Profuse sweating
• Shortness of breath
• A fear of impending death

Diagnosis

The following tests may be done to confirm the diagnosis of a heart attack:

Electrocardiogram (ECG) - records the electrical activity of the heart; it is used to see if the heart was damaged and where the damage is located

Blood tests - measure the levels of enzymes in the blood that are released when the heart muscle is damaged

Echocardiogram - uses high-frequency sound waves to visualize the heart's structure and function

Myocardial perfusion scan - uses small doses of a radioactive substance injected into the bloodstream to visualize how well blood is nourishing the heart wall

Treatment

Studies show that heart attacks are more often fatal in women than in men. This makes it especially important for women to recognize the symptoms and receive immediate care.

Medical attention within the first two hours after the symptoms start can significantly reduce the amount of heart damage. An electric shock using a defibrillator along with intravenous medication may be administered if the heartbeat is dangerously irregular. Supplemental oxygen is usually given to increase oxygen in the blood and minimize tissue damage.

Additional drug and surgical treatments are listed below.

Prevention

To decrease your chances of developing coronary artery disease, and thus having a heart attack, try to do the following:

• Eat a diet low in saturated fat and trans-fatty acids
• Eat plenty of fruits, vegetables, and whole grain foods
• Eat foods containing vitamins B₁₂, B₆, and folic acid
• Maintain a healthy weight
• Exercise regularly
• Quit smoking
• Control diabetes
• Minimize psychological stress
• Take aspirin daily if recommended by your doctor
• Take cholesterol-lowering drugs if prescribed by your doctor
• Drink alcohol in moderation (no more than one to two drinks per day)
• Consider hormone replacement therapy if recommended by your doctor