WebMD Live Events Transcript

The truth is that women experience heart disease differently from men. And one out of every two women will die of of it. Nieca Goldberg, MD, spokesperson for the American Heart Association's "Go Red" campaign, joined us Feb. 3 to answer questions about about your heart.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

MODERATOR:
Welcome to WebMD Live, Dr. Goldberg. In your book, Women Are Not Small Men , you discuss the differences in how women and men experience heart disease. Can you please explain those differences to our members?

GOLDBERG:
We always think of a picture of a heart attack as a 165-pound man. But, women also have heart attacks. In fact, more women than men die of heart attacks in our country.

Although chest pressure is shared by women and men, women frequently have symptoms like shortness of breath, unexplained fatigue, pressure in the lower portion of the chest that they easily mistake for a stomach problem or upper back pressure, so it's important for women to know all the warning signs of a heart attack.

Another difference is that women experience symptoms of a heart attack about 10 years later than a man, so you see more men in their 40s and 50s having a heart attack. However, if a woman under 50 has a heart attack, she's twice as likely to die of that heart attack. So, women of all ages need to learn how to reduce their risk of heart disease.

MODERATOR:
What are the risk factors for heart disease in women?

GOLDBERG:
The risk factors for heart disease in women include:

"If we screen women earlier, we have a greater chance of reducing the risk."

MODERATOR:
At what age should a woman get a cardiac evaluation?

GOLDBERG:
One of the most common tests we have to diagnose heart disease risk is a cholesterol test. The current recommendation is that women should have their first cholesterol test in their 20s. If the test is normal, it does not have to be repeated for 5 years. However, if it is abnormal and requires treatment, testing is more frequent.

Young women who are considering oral contraceptives for birth control should have their blood pressure and Cholesterol checked.

There are other tests women should have. If a woman is in her 50s and she has not had her heart disease risk factors checked, she should have her cholesterol and blood pressure checked and her sugar checked for diabetes. If she's never exercised and considering an exercise program she should have a stress test. In addition, women of any age who have diabetes should be evaluated for heart disease, particularly by stress testing and getting their cholesterol checked. Every woman should also be advised about quitting smoking.

If we screen women earlier, we have a greater chance of reducing the risk.

MEMBER QUESTION:
How important is a strong family history of heart disease? Am I doomed to get it?

GOLDBERG:
That's a very good question. If you have a strong family history of heart disease, that does increase your risk by 25 to 50 percent. I don't like people to feel they're doomed to get heart disease however, because we are getting better at evaluating the common risk factors in women and learning about new risk factors that place women at risk so that we can start our prevention programs earlier.

MEMBER QUESTION:
How do I know when to call the doctor? I'd hate to yell wolf, but heart disease is common in my family.

GOLDBERG:
I want women to get over feeling embarrassed for having symptoms. Women are very in tune with their bodies and if they feel chest discomfort, shortness of breath or unusual fatigue they should seek medical attention. For instance, if a woman is experiencing symptoms and she is also sweating and dizzy, and the symptoms won't go away, she needs to call 911. If a woman is experiencing symptoms while walking and they go away when she rests, she should call her doctor immediately.

"I think this is a dawn of a new era; women's hearts are finally being taken seriously. We have to stop people from ignoring women's hearts by increasing awareness and making women more assertive patients."

MEMBER QUESTION:
I have been feeling like my chest is very heavy, it is very difficult to take in deep breaths and I feel short of breath. Are these signs of anything I should consult my primary care provider about? Also, someone told me that spooning of fingernails is a sign of heart disease, is this correct?

GOLDBERG:
Having the symptoms of shortness of breath and chest discomfort when you're taking a deep breath may be a sign of inflammation of the heart. The answer is yes, you should talk to your primary care doctor about that. Your doctor may refer to an ultrasound of the heart, also known as an echocardiogram.

We've learned that certain changes in the fingernails can indicate disease elsewhere in our bodies. It should encourage you to see your doctor to be evaluated, but does not necessarily mean you have heart disease.

MEMBER QUESTION:
I feel my heart occasionally pound or maybe it's an irregular beat; I can't tell for sure. It only lasts for 1-2 seconds.

GOLDBERG:
This sounds like a symptom of the electrical system of the heart. Occasionally we may all experience a skipped or fast heartbeat. In general, if it's short lasting and not associated with shortness of breath, dizziness or feeling like you're going to faint, then it is probably related to stress or having too much caffeine. Or, a lot of over-the-counter cold medicines, for instance, have stimulants in them that may increase your heart rate.

If the symptoms should last longer and be associated with shortness of breath, light-headedness or fainting, then you should get evaluated. The evaluation will include an electrocardiogram, probably an ultrasound of your heart to look at your heart function, and a monitor that is placed to record your heart rate. There is a holter monitor that records for 24 hours or the doctor may give you a recorder to carry around and use whenever you have symptoms; that's called an event recorder.

MEMBER QUESTION:
I've been diagnosed with mild regurgitation of the mitral valve and tricuspid valve. I have shooting pains in my left breast at any time of the day. I have light headedness and heart palpitations daily. My doctor said my symptoms could be a cause of my regurgitation. My doctor also says this is something that I shouldn't worry about, that it might cause me a problem in thirty or forty years. I'm 33 now. I exercise 6 or 7 times a week and decreasing my exercise doesn't change my symptoms. What do you think?

GOLDBERG:
Leaky heart valves. First of all, heart valves are located inside your heart to maintain your blood flowing forward. They're like little doors that open and shut. When these valves, or doors, close incompletely it causes a bit of blood to go backwards; we call it leaking. If it's mild, generally the person will have a normal active life. If you experience other symptoms, such as palpitations, light-headedness or feeling faint, this may reflect an electrical issue with your heart and it can be evaluated with an electrocardiogram or heart monitor. If your symptoms are still troubling you, my advice would be to go back to your doctor to discuss them and have them re-evaluated.

"Women are very in tune with their bodies and if they feel chest discomfort, shortness of breath or unusual fatigue they should seek medical attention."

MEMBER QUESTION:
On Nov. 19th I suffered a "coronary spasm". The pain was unbelievable -- a stabbing between my shoulders. This led to a mild heart attack (non-q wave) and it was believed that the cold weather and extreme stress was the cause. I asked my doctor how common these spasms are and he said he's only seen one, about 5 years ago. Are coronary spasms common?

GOLDBERG:
Coronary artery spasms are not common overall, but appear to more common in women. A spasm is when the artery clamps down and stops the blood from flowing to the heart muscle. If it is prolonged, it results in a heart attack. The medications that are used commonly for coronary artery spasm are calcium channel blockers.

MEMBER QUESTION:
I infrequently get little heart flutters where my heart will slow down for a second or two, then seems to skip a beat, and then beats really hard once or twice. It's nothing I've been worried about because it happens so infrequently. However, last night it was happening every few minutes for several hours. Is this something I should be concerned about?

GOLDBERG:
This is also another symptom of an electrical problem or something coming from the electrical system of the heart. We commonly call this palpitation. If the symptoms keep coming back and make you feel short of breath, light-headed or faint, then you should get it checked out.

Other things can cause palpitations, like caffeine, not only coffee, but other caffeinated beverages. Chocolate has caffeine as well.

Occasionally, women will have palpitations when they're premenstrual or even during pregnancy because hormone fluctuations can precipitate palpitations. If you have a normal heart these symptoms may not be serious, however, if you have had a heart attack, or other heart problem, they should be evaluated quickly.

MEMBER QUESTION:
My dad and his father both died at age 48 of angina. I had my ovaries removed on Feb. 17, 2004 and I'm now on natural hormone replacement therapy (NHRT). I've gained 30 pounds and now weigh 190 pounds at 5'6" tall. My cholesterol was also high at 221. Am I now at risk for some serious heart problems?

GOLDBERG:
If you have an early family history of heart disease such as having a parent die at age 48 from heart attack or angina, you are at increased risk. Compounded with having high cholesterol or surgical menopause, that also increases your risk. It's very important for you to get your heart risk factors checked. If you're having any symptoms you should talk to your doctor about them because further testing may be necessary.

"... if a woman is experiencing symptoms and she is also sweating and dizzy, and the symptoms won't go away, she needs to call 911."

QUESTION

In the U.S., 1 in every 4 deaths is caused by heart disease. See Answer

MEMBER QUESTION:
I have a disorder that causes me to have immense chest pain surrounding the sternum and down the rib cage. I have extreme muscle spasms that start with sweating and breathing problems. I always have it checked out because I do have high blood pressure. Eventually will all of this strain and pain affect my heart? I think if I did suffer a heart attack I wouldn't know the difference.

GOLDBERG:
That's a hard question to answer without actually examining the patient. My best advice is to get your heart checked out and know your risk factors, because that will establish whether you are at risk for heart disease. There are many medical conditions that can cause chest discomfort, but it is important to make sure you have your heart evaluated to make sure you're not having a heart attack, and to measure your risks for heart disease.

MODERATOR:
Let's talk about the goals of the "Go Red for Women" campaign. What do you hope to accomplish?

GOLDBERG:
The Go Red for Women campaign is a national campaign from the American Heart Association that educates women to reduce their risk for heart disease. The goal is to empower women to take charge of their heart. Friday, February 4 is national Wear Red Day and we actually encourage women to wear red to remind them to take care of their heart. In addition, the American Heart Association also has information for health care providers to improve the evaluation of risk factors of the women coming into their offices.

I think this is a dawn of a new era; women's hearts are finally being taken seriously. We have to stop people from ignoring women's hearts by increasing awareness and making women more assertive patients. It's going to be a combination of both women and their health care providers to decrease risk of heart disease and improve overall health.

MODERATOR:
We are almost out of time, Dr. Goldberg. Before we wrap things up for today, do you have any final words for us?

GOLDBERG:
I just want all women to remember to take care of their hearts and share this information with their friends. I believe the best way to reduce women's heart disease risk is by women taking charge themselves.

MODERATOR:
Our thanks to Nieca Goldberg, MD, for joining us today. And thanks to you, members for your great questions. I'm sorry we couldn't get to all of them. For more information about the "Go Red" campaign, please visit the American Heart Association web site at www.americanheart.org. For more information about women and heart disease, please read Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women by Nieca Goldberg, MD.

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