On Tuesday evening, April 5, Navigating the Medical System featured a virtual lecture on heart disease in women, hosted by Congregation Etz Chaim.

Dr. Mel Breite, Founder and Director of the Navigating the Medical System Lecture Series, greeted everyone. He shared how only a few years ago medical journals finally began talking about heart disease in women, which presents differently in women.

Joanna Troulakis, MD, practicing cardiologist at NewYork-Presbyterian Queens, shared an informative lecture. She began with a brief explanation of cardiovascular disease, which involves the heart and blood vessels. It affects the circulatory system, the arteries, heart valves, and heart rhythm. Heart function is usually affected by one of the above.

She explained that coronary heart disease is a heart attack. Other heart issues include heart failure, valvular disease, arrhythmia, high blood pressure, high cholesterol, stroke, peripheral vascular disease, and congenital heart disease.

Heart disease is the number one killer of women and stroke is the number three killer. People think cancer is the leading health problem for women, but it’s not. Eight million women have heart disease, and the rate is two to three times higher after menopause. Women with diabetes are at higher risk for heart disease and stroke.

In general, women don’t know their own risks of heart disease. About 2.5% of women have undiagnosed diabetes. Symptoms of diabetes include frequent urination, fatigue, thirst, blurred vision. The main cause of death with diabetes is cardiovascular disease.

Thirty percent of women have high cholesterol and high blood pressure. It is important to keep an eye on your blood pressure. The cut-off for normal is 130/80. Treatment for high blood pressure includes losing weight and increasing physical activity. Over 240 is high cholesterol.

She shared that smoking causes plaque in the blood vessels, which increases blood pressure and arrhythmias.

With each five-unit increase in body mass index, the risk of heart disease increases 30 percent. Normal body mass index is 18.5-24.5, and 25-30 is overweight and above 30 is obese.

She recommended eliminating trans fats, high-fat dairy products, and avoiding cured foods, smoked foods, and canned foods. You want a high fiber and low sodium diet. Processed and fast foods contain a lot of sodium. Avoid processed meats, red meats, and eggs. White cheese is lower in cholesterol than yellow cheese. Thirty minutes of physical activity decreases the risk of heart disease.

Stress is another factor in cardiovascular disease. Ways to treat stress include yoga, diet, exercise, and psychological therapy.

Dr. Troulakis then detailed warning signs of a heart attack, which include pressure in the center of the chest, squeezing sensation, pain in the arm, neck, or back, cold sweat, nausea, and light headedness. These symptoms can occur in men or women. Symptoms in women may present in a vaguer way. It can present as abdominal pain, fatigue, light headedness, or a feeling of fullness. She explained that there are different kinds of heart attacks. The typical one is a clot blocking the coronary artery, which cuts off blood supply to the heart. This is common in younger male patients. The Type Two heart attack is due to a fixed amount of plaque and stenosis of the artery and is more common in older women. In older women, an infection can also cause a heart attack.

Stroke symptoms include numbness of face, arm, or leg on one side, trouble speaking, seeing, loss of balance, severe headache, confusion, trouble walking, or dizziness. These symptoms are the same in men and in women.

She then spoke specifically about cardiac disease in women. Spontaneous coronary artery dissection is more common in younger women, and it can happen in pregnancy.

Microvascular coronary dysfunction is when there are blockages of the smaller coronary arteries. Heart attack can cause chest pain and it could be that the big artery is completely open.

There is also another type of problem called stress induced cardiomyopathy, which is a disease of the heart muscle. In this disease the heart muscle is weakened, and it doesn’t squeeze strongly, usually due to blockage in an artery. It can be genetic or it can be caused by thyroid dysfunction or a virus. A very stressful event with extreme emotion can cause the heart to become acutely weak when there are no blockages of the artery. This is caused by acute release of adrenaline. It is reversible with time.

Cardio-oncology can occur with women who have breast or ovarian cancer. The chemo agents have toxic effects on the heart, and they will need periodic echocardiograms. Radiation to the breast can lead to coronary artery or valve disease.

She spoke about heart disease in pregnancy due to hemodynamic shifts. There is more fluid in the body, and the main organ that is affected is the heart. If a woman has a congenital heart defect, this can make staying pregnant more difficult. Women can develop hypertension during pregnancy or gestational diabetes, arrhythmias, valvular disease, or peripartum cardiomyopathy. Some blood pressure medications are not safe for the fetus. Cardiac issues will dictate the mode of delivery.

She then spoke about why women tend to delay care. They misinterpret symptoms or minimize symptoms. They minimize perception of risk, or they have competing obligations, or they don’t want to impose on their family, or they may be embarrassed by their symptoms.

Autoimmune disease and contraceptive drugs are risk factors for heart disease. Also, women are more prone to clotting. She shared that a pacemaker is more effective in women than in men.

Now, women are participating more in cardiovascular trials. In the past, women were underrepresented in these trials.

She then detailed risk factors, which include chronic kidney disease, high blood pressure, high cholesterol, being over age 55, smoking, being overweight, family history of early heart disease, stress, breast cancer treatment, and autoimmune disease.

You should see a cardiologist if you have chest pain, shortness of breath, palpitations, lightheadedness, dizziness, or leg swelling.

The lecture was followed by a Q&A session.

The community thanks Dr. Mel Breite, Congregation Etz Chaim, and NewYork-Presbyterian Queens for these informative, potentially lifesaving lectures!

 By Susie Garber