by Sheri B. Doniger, DDS
We are all familiar with the signs and symptoms of heart attacks being gripping chest pain, radiating to the jaw and arm, but did you know that men have these symptoms more often than women do? In fact, women may have very different symptoms and, occasionally, no pain at all.
Recently, many articles and television programs have highlighted the very different signs of heart attacks in women. As dental professionals, we need to be aware of these signs, and be able to alert patients of the risks of ignoring them.
According to the American Heart Association, "Coronary heart disease is the leading cause of death in American women." Coronary heart disease (also referred to as angina, coronary artery disease, or ischemic heart disease) is the most prevalent cause of death in the United States, accounting for one in every five deaths.
Within six years of a woman's first heart attack (a recognized myocardial infarction), 35 percent will have another heart attack; 14 percent will develop angina; 11 percent will have a stroke; and 6 percent will experience sudden cardiac death. These are alarming statistics.
The American Heart Association's 1999 statistics on heart attacks and angina demonstrated that coronary heart disease is the leading cause of death in the United States. The NIH's National Heart, Lung and Blood Institute's "Atherosclerotic Risk in Communities" study data showed an incidence of more than one million new and recurrent cases of coronary attack per year with a 40 percent mortality rate. These statistics may vary.
With one in five women having some form of cardiovascular disease, the likelihood of one being in your care at any given time is high. Cardiovascular disease includes heart attacks as well as angina, stroke, high blood pressure, congestive heart failure, and congenital cardiovascular defects.
One of the more pertinent statistics from the AHA states: "In 63 percent of women who died suddenly of coronary heart disease, there were no previous symptoms of this disease." More than 6.4 million women suffer from angina and/or coronary artery disease. Still, many women have heart attacks that go unnoticed. More than 400,000 women have angina (pain or discomfort in the chest or adjacent areas because of insufficient blood flow through the coronary arteries).
Thirty-eight percent of women with recognized myocardial infarctions die within a year. Myocardial infarction occurs when there is a blockage to one or more of the coronary arteries. This blockage usually occurs because of atherosclerotic plaques that build up on the arterial walls, constricting the blood flow through the lumens. These plaques also can cause blockage and subsequent rupture of the arterial walls because of arterial pressure and weakness. Blood clots or thrombosis also will occlude the less-than-patent arteries. If this blockage occurs, there is usually a pain incident associated with the event.
Women tend to have their initial heart attacks at an older age than men do. They are protected by estrogen until menopause. Estrogen keeps cholesterol in check: the good HDL cholesterol up and the bad LDL cholesterol and triglycerides down. During menopause, estrogen levels start decreasing. After menopause, estrogen that was produced by the ovaries ceases.
Risk factors for both sexes include: heredity (male family member having a heart attack before the age of 40 or a female family member having a heart attack before the age of 50); high cholesterol; hypertension; obesity; diabetes; and an inactive, unhealthy lifestyle (smoking and/or eating high fat foods).
Triggers for heart attacks for both sexes include arterial blockage, stress, exercise, and heavy meals. While male triggers appear to be physical, female triggers appear to be emotional. Some studies have indicated that men have physical exertion (such as shoveling snow) prior to heart attacks while women experience emotional stress.
Heart attack symptoms
As stated, many women do not experience the crushing chest pain normally associated with a myocardial infarction or heart attack. Women's symptoms can include the expected symptoms of angina, diaphoresis and shortness of breath. As with their male counterparts, the chest pain or pressure may be centrally located and can last a few minutes.
Non-chest pains occur more frequently in women. Women are more likely to present with neck, jaw, or back pain. The pain could also radiate down both arms, starting from the back, with a deep throbbing or aching in the arms. The discomfort may only be mild. Nausea or flu-like symptoms are common. Non-chest pain symptoms such as musculoskeletal or neurologic pain also can occur. Many women who are familiar with the traditionally recognized symptoms of angina tend to dismiss these symptoms. Some women may have no pain at all.
Other ways heart attacks present can be with clammy sweating, dizziness, lower extremity edema, anxiety, general malaise, heartburn, vomiting, and nausea not relieved by antacids. Chronic breathlessness or waking up short of breath at night can be another symptom. Women will experience extreme fatigue, with or without activity. The mere act of moving from one area of the house to the other or putting on clothes may be too strenuous.
The failure to recognize women's heart attack symptoms could be the cause of higher death rates and pursuant disability due to heart attacks. Women tend to have their first myocardial infarction at an older age (usually over 60). They may have concurrent conditions such as diabetes, arthritis and osteoporosis. Aches and pains are common and these crucial symptoms may be overlooked or dismissed. Many of these symptoms can be misdiagnosed: nausea from indigestion or gastritis; or fatigue from activity or chronic fatigue syndrome.
Women do tend to downplay many of the symptoms as well. Women frequently wait longer to call for emergency assistance. The sudden onset of weakness, body aches and a feeling of general "un-well-being," coupled with back or neck discomfort and nausea are usually attributed to the flu. Women also have a tendency to wait longer to seek treatment.
Coronary artery disease is no longer a male-dominated arena, as women have overtaken the mortality statistic. Lifestyle alterations (low fat and low sodium diet, smoking cessation, increased aerobic exercise), in addition to proper and timely health care will increase the chances of a long and healthy life.
We all want a long, active, and healthy life.
With proper counseling and education, women will be more aware of the signs and symptoms to alert of a cardiac event.
For ourselves and for our patients, we all need to be aware of the distinctively different signs and symptoms of women's coronary disease.
This article is dedicated to my mom, Bernice R. Doniger, who died of heart failure on July 31, 2001.
What can you do to help?
We have much to offer in the dental office for our patients. Monitoring of blood pressure and questioning our patients concerning their diet and exercise can assist them in the long and short run. We can discuss the risk factors that are reversible and offer alternatives. Recommending smoking cessation will help their cardiac health and their oral health. Evaluating diet diaries to assess both cariogenicity and "heart-smart" content of the food consumed will be a dual assist in the patient's overall health. Increasing fruits and vegetables, consuming lean meats, poultry and fish high in omega-3 fatty acids, checking food labels for hidden sodium and fat content are all nutritional suggestions that could be made.
Recommend a consultation with a physician if the blood pressure is consistently elevated above 140 systolic or 90 diastolic (stage 1 hypertension classification). Discuss exercise of any form as a means to "work off" stress and "work out" the body as a dual contribution for decreasing stress and weight. Walking is an excellent example of exercise that can be performed at any age and ability level. Remind patients to take their prescribed medications in the dosage dispensed. Many times, patients take it upon themselves to stop or alter prescription drugs. We need to remind them to do as their physician requested until a change is required.
Recommended Web site references
Sheri B. Doniger, DDS, practices in Lincolnwood, Ill. She graduated from the University of Illinois College of Dentistry in 1983 and obtained her bachelor's degree in dental hygiene from Loyola University of Chicago in 1976. She can be reached at (847) 677-1101 or [email protected].