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Is it a heart attack? Women and chest pain

Manny Katsetos, M.D. [August 31 2010]

Chest pain can be a clear sign of heart attack, yet many women often wait as many as eight hours before getting help. While it's true that men have more heart attacks and have them earlier in life, women are less likely to survive a heart attack. The message? Don't ignore chest pain.

Coronary heart disease (CHD) affects women differently than it does men. It tends to occur in women about seven or eight years later than in men. Women are about five to 10 years older on average than men are when they experience a first heart attack, also called a myocardial infarction. Why the differences? Women have built-in hormone protection in their premenopausal years: Estrogen helps shield women from heart disease by helping to raise good cholesterol levels and lower bad levels. Once a woman reaches menopause, her estrogen levels drop and her CHD risk rises.

While women may be aware of the classic signs of an attack, such as chest pain radiating down the left arm and difficulty breathing, they aren't aware of symptoms they're more likely to experience. In fact, one-third of women experience the following symptoms often with no chest pain at all:

• sudden onset of severe weakness
• stomach upset or nausea with passing weakness
• mild burning sensation in the middle of the chest that extends outward
• vague chest discomfort
• palpitations, cold sweats or paleness
Many women aren't aware that simple lifestyle changes can dramatically reduce CHD risk. Both women and men can improve their heart health by:
• Not smoking. Women who smoke risk having a heart attack an average 19 years earlier than nonsmokers.
• Maintaining a healthy body weight.
• Eating a low-fat, low-cholesterol diet and limiting salt intake.
• Lowering high cholesterol.
• Controlling high blood pressure.
• Keeping diabetes under control. Women with diabetes are two to three times more likely to have heart attacks.
• Limiting alcohol use.
• Exercising regularly.

And remember: Report all chest pain to your doctor and describe your symptoms fully. Supplying details will help your doctor get to the root of your chest pain and come up with the best treatment plan.

Manny Katsetos, M.D., is a cardiologist at The Hospital of Central Connecticut. For information on Hospital of Central Connecticut physicians, please contact our free Need-A-Physician referral service by phone 1-800-321-6244 or online, www.thocc.org. Learn more about HCC's cardiovascular services