Cardiovascular disease is the number one killer of women in America. Unfortunately, A a study by the American Heart Association (AHA) found that only one-third of women identified heart disease as a leading cause of death for women, and only eight percent of the study participants viewed heart disease as their greatest health threat.

Know the symptoms
Compounding the problem is the fact that many women don’t recognize the symptoms of a heart attack. The same AHA study revealed that while 65 percent of women know that chest pain can be a heart attack symptom, only 30 percent knew that shortness of breath also is a symptom. More alarmingly, less than 10 percent of the women in the survey knew that nausea and fatigue are common symptoms among women who’ve experienced a heart attack.

"Every person experiences his or her own symptoms when having a heart attack," said Curt Rimmerman, M.D., F.A.C.C., who holds the Gus P. Karos Chair in Clinical Cardiovascular Medicine. "The symptoms aren’t gender-based. They might range from the typical —such as the feeling that an elephant is sitting on your chest or pain in your left arm — to general discomfort in the chest, nausea, fatigue, shortness of breath or even a tooth ache. A heart attack might present itself as an unusually rapid heart beat related to the level of exertion."

Stress imaging study recommended for women
While Dr. Rimmerman encourages women to learn the symptoms of a heart attack, he also recommends that they become more proactive and assertive about their cardiac care with their healthcare providers. He notes this is especially important when it comes to cardiac diagnostic tests.

"The EKG stress test is a good procedure for a man who’s resting EKG is normal," said Dr. Rimmerman. "But when performed on a woman, an EKG stress test tends to provide false positives. For female patients, we’ve found that a stress imaging study -- such as a radionucleide stress test or a stress echocardiography test — provides the best results and helps prevent unnecessary cardiac catheterizations."

Are you at increased risk?
Dr. Rimmerman noted that coronary risk factors - such as family history, smoking, inactivity, poor eating habits and excess weight - are the same for men and women, with one notable difference. The body's own estrogen seems to have a bit of a protective effect for women, slightly reducing their heart attack risk, but this protection disappears with menopause.

"Studies show that by age 70, men and women are equally at risk of dying from coronary artery disease," said Dr. Rimmerman. "We’ve also learned that post-menopausal women don’t tend to respond as well to bypass surgery, angioplasty, and stenting. We haven’t yet learned why this happens, which makes it more important that women recognize the symptoms of a heart attack and that they undergo pre-emptive screening.

What’s the best way for a woman to lessen her chances of dying from a heart attack? Exercise, eat well, don’t smoke and know her family’s heart health history. Most importantly, know the symptoms of a heart attack.

"If you suspect you might be having a heart attack, don’t delay. Get medical help as quickly as possible," emphasized Dr. Rimmerman. "The longer you wait, the more your heart muscle will suffer irreversible damage. When it comes to heart attacks, time truly is muscle."

© Copyright 2006 The Cleveland Clinic Foundation. All rights reserved.
Reviewed by Dr. Rimmerman