Important Facts About Pregnancy and Heart Disease
What To Know About Signs Of A Heart Attack In Women After Rosie O'Donnell Survived One
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Heart attack symptoms are often missed in women. Here's what to know. (Getty, Canva)
Symptoms of a heart attack are too often missed or ignored in women — including former talk show host Rosie O'Donnell.
O'Donnell, 61, revealed she suffered a "massive heart attack," also known as a "widowmaker," in 2012 and entirely brushed off her symptoms.
HuffPost reported O'Donnell appeared on "The Best Podcast Ever" when she recalled the cardiac event. "She didn't think there was anything out of the ordinary when her arm began to hurt after helping a stranger into their car. That was, until her son told her she looked as pale as a ghost," the U.S. Outlet wrote.
"I should've died," O'Donnell said in the podcast, adding she Googled symptoms of a heart attack in women and had some of them, but didn't want to sound the alarms. Two days went by before she went to the hospital, where she learned she had a 100 per cent blockage of the left anterior descending artery, according to HuffPost.
I should've died.Rosie O'Donnell (via 'The Best Podcast Ever')
"And then I came to find out that the symptoms for a woman having a heart attack are very different than the symptoms for men having heart attacks."
The Heart and Stroke Foundation of Canada provided data that:
Two-thirds of all heart disease and stroke clinical research has focused on men
The number one cause of premature death in women in Canada is heart disease and stroke
Half of women who experience a heart attack have their symptoms go unrecognized
But how exactly are the symptoms different? Read on for everything you need to know.
Symptoms of heart attack for women: Common and often missedHeart attack symptoms can be very mild in women and sometimes without pain. (Getty)
Lindsay Love, the clinical manager of cardiac catheterization labs and the cardiac triage office at the University Health Network in Toronto, tells Yahoo Canada some symptoms of heart attacks are well-known and common.
"Lots of people cite having chest pain or discomfort. Sometimes it feels like a tightness or a heaviness, like something heavy is being pushed down on your chest," Love explained.
"I think the most stereotypical symptom is pain that radiates from the chest to the left shoulder, maybe down the left arm. There's also shortness of breath, sometimes with or without chest discomfort. The pain can also radiate or in or the from the chest up to the jaw," she said, adding sometimes people also experience nausea and vomiting.
Heart and Stroke also adds sweating and light-headedness to the list of symptoms.
Women, however, may not always have these stereotypical signs of a cardiac event.
I have seen women who have a missed heart attack.Lindsey Love
According to Love, symptoms can be "very mild," such as just sweating, or upper body discomfort without pain.
"Just general aching or discomfort, light-headedness or dizziness, sometimes just shortness of breath. Nausea is another common one," she listed.
"It can be something that someone will, I think, try to explain the symptoms as a result of maybe GERD or thinking that it's something GI related," she claimed. That's why heart attacks can go unrecognized.
In a "widowmaker" heart attack, symptoms would be more severe and fatal consequences can occur "very quickly."
Why are women's heart attack symptoms often missed?Stereotypical portrayal of heart attacks on TV can also contribute to the lack of awareness. (Getty)
Love said symptoms are most commonly missed because people don't know what to look out for, and women might be more likely to brush off issues.
"I'm not sure if women seek health care at the same frequency that that men do, or if sometimes men are encouraged in self-care, when women don't always put themselves first."
Stereotypical portrayal of heart attacks in media can also contribute to the lack of awareness.
"A lot of what people are aware of symptoms they see on television... In shows like 'Grey's Anatomy' or 'ER' back in the day."
Women don't always have like the typical signs and symptoms that you will see on TV, where people are like clutching their chest.Lindsey Love
The consequences of missing symptoms, however, can be dire.
Love explained in a heart attack, the most important thing is to have the blockage in the coronary artery opened up. "For the time that passes by that blood flow isn't restored to that heart tissue, there's a bigger chance that hurt tissue dies."
When heart tissue dies, it can mean less blood pumping into other parts of the body, leading to a variety of health problems like kidney issues, difficulty breathing, lying down.
It also means monitoring things like drinking and salt intake, Love explained, adding it's associated with "a reduced quality of life." And, it "would definitely mean an earlier death."
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3 Things To Do If Heart Problems Are Messing With Your Sleep
Good sleep can be tough to come by when you have a heart condition—nearly three quarters of people with heart failure in particular say they have trouble getting quality rest.1 And, as you might've guessed, crappy sleep itself can contribute to heart problems. One 2020 study of nearly 409,000 people found that those who slept fewer than seven hours per night, or who struggled with insomnia or serious daytime fatigue, had a higher risk of developing heart failure than participants who didn't have those issues.2 There's also a link between high blood pressure (which raises the risk of heart failure and stroke) and lack of quality sleep.3
Okay, so we get that there's a strong heart-sleep connection, but why? Richard Wright, MD, a cardiologist at Providence Saint John's Health Center in Santa Monica, California, tells SELF that scientists are still trying to sort out what's behind the link between bad sleep and heart failure—but hormones seem like one likely culprit. "We know that hormones that regulate sleep, like melatonin, are disrupted when you have heart failure," he says.4
At the same time: "Heart disease shares similar risk factors with common sleep disorders, creating a lot of overlap," Yonatan Greenstein, MD, associate professor of pulmonary and critical care medicine at Rutgers New Jersey Medical School, tells SELF. Those shared risk factors include having type 2 diabetes or high blood pressure. "That could be driving heart disease or making it worse," he says.
If you've got a heart condition, taking steps to save your sleep isn't just important for your comfort (though that's really important!)—it can improve your overall health, per the Centers for Disease Control and Prevention (CDC). Here's what could be causing crummy rest with a heart problem and what to do next.
Watch out for signs of sleep apnea.If you struggle to stay awake during the day, someone has complained about your snoring, or you wake up in the middle of the night gasping to catch your breath, there's a possibility you have sleep apnea, a condition that causes you to stop and start breathing throughout the night. It can affect up to 80% of people with heart-related problems like high blood pressure, heart failure, and atrial fibrillation (an irregular, fast heartbeat).5 One possible reason: Sleep apnea can contribute to worsened left ventricular diastolic dysfunction, meaning the heart's left ventricle stiffens. This puts extra strain on the organ, boosting someone's heart rate and blood pressure—and increasing their risk of heart failure.
You should undergo a sleep evaluation to get diagnosed with sleep apnea—so stay alert for signs to flag to your doctor. (A few other symptoms can include a parched throat in the morning, headaches, or even mood changes throughout the day, per the Mayo Clinic.)
"Sleep apnea is usually one of the first things we think of if someone is having trouble sleeping," W. Christopher Winter, MD, a neurologist and sleep medicine physician with Charlottesville Neurology and Sleep Medicine, tells SELF. "Luckily, there are a lot of ways we can combat it." Treatment can include a special mouthguard to keep your throat open or a CPAP machine, which delivers air pressure down your throat through a mask you wear as you drift off. In more severe cases, a doctor might recommend surgery to remove throat tissue. (Depending on your unique symptoms, they can guide you on what approach is ideal.)
Tweak your sleeping position.When you have heart failure, it's common for fluid to build up in your lungs as you lie down—which you might not even realize when you're back upright and going about your day, Sanjay D. Naik, MD, a cardiovascular disease specialist at NewYork-Presbyterian Westchester and ColumbiaDoctors, tells SELF. When you lie down at night, that fluid can inch toward your trachea (the tube that connects your voice box to your lungs) and upper lungs, which can make breathing a little difficult, Dr. Naik explains.
People With Severe Psoriasis Are At Higher Risk Of Heart Disease, Researchers Say
In the most extensive study to date to look at coronary blood flow and the link between psoriasis and heart disease, scientists reported a high prevalence of coronary microvascular dysfunction in more than 30% of people with psoriasis who had no symptoms of cardiovascular disease.
Those findings were published today in the Journal of Investigative Dermatology.
The researchers specifically looked at the coronary microvascular system and examined how much the small blood vessels could expand to allow for uninterrupted blood flow, called coronary reserve flow.
They reported that inflammation seems to decrease blood flow.
For the study, 503 people with psoriasis but without a diagnosis of cardiovascular disease underwent a Doppler echocardiogram to evaluate coronary microcirculation. More than 30% of participants had undiagnosed coronary microvascular dysfunction.
Previous studies have shown that people with severe psoriasis have increased cardiovascular morbidity and mortality. Still, there has been limited research on the mechanisms underlying the increased risk.
The researchers note there is growing evidence of inflammatory diseases, including psoriasis, psoriatic arthritis, rheumatoid arthritis, and inflammatory bowel disease, with a higher prevalence of endothelial and cardiovascular microvascular dysfunction in the absence of clinically apparent cardiovascular disease.
The researchers for this study wanted to further investigate the connection between psoriasis and coronary microvascular dysfunction.
Based on the study results, they determined that systemic inflammation plays a role in the development of coronary microvascular dysfunction, but there was no association with tobacco use, hyperlipidemia, or diabetes, all of which are typical risk factors for heart disease.
They said the study shows that inflammation interferes with many bodily processes.
"In this one, the inflammatory molecules in the blood from psoriasis activity interfere with the ability of blood vessels to contract and expand," said Dr. Cheng-Han Chen, an interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in California who was not involved in the study.
"This is consistent with other information on autoimmune disorders," Chen told Medical News Today.
"The main takeaway from this study is that severe psoriasis is associated with a high prevalence of coronary microvascular dysfunction, independent of conventional cardiovascular risk factors," said Dr. Stefano Piaserico, an associate professor of dermatology at the University of Padua in Italy and one of the of study authors.
"Psoriasis severity, duration, and the presence of psoriatic arthritis were identified as significant predictors of reduced coronary flow reserve. This highlights the importance of considering inflammation and psoriasis-related factors when assessing cardiovascular risk in severe psoriasis patients," Piaserico told Medical News Today.
Our blood goes through the aorta coronary arteries – the large blood vessels – and filters down to the small blood vessels, the microvascular system. After ensuring no blockage in the large blood vessels, the researchers focused on the microvascular system cells to find what caused the reduced blood flow.
"Coronary flow reserve is an integrated measure of both the coronary artery disease and the coronary microvascular dysfunction," said Dr. Jessica Kaffenberger, a dermatologist who specializes in psoriasis at The Ohio State University Wexner Medical Center who was not involved in the study.
"If a patient has coronary artery disease with stenosis (so blood vessels obstructed), they would have a lower [coronary flow reserve]," she told Medical News Today. "Similarly, if there is a dysfunction of the coronary microcirculation (blood vessels impaired), there would be a decrease in [coronary reserve flow]. In this study, all the psoriasis patients were found to have impaired coronary microvascular function since their angio-CTs were all clear."
Endothelial cells form a thin line in our blood vessels, regulating their relaxation and allowing them to expand and let the blood flow through.
"Endothelial cells can be damaged by psoriasis. Pro-inflammatory cytokines are released to help control inflammation in your body," according to Dr. Michael Garshick, the director of the Cardio-Rheumatology Program, which is part of the Center for the Prevention of Cardiovascular Disease at NYU Langone Heart in New York.
"However, too many cytokines can lead to excess inflammation and cause damage and lead to psoriasis," Garshick, who was not involved in the study, told Medical News Today.
You don't need to rush out to find a cardiologist if you have psoriasis or another autoimmune disorder, experts say.
Although autoimmune disorders are risk factors, they do not automatically lead to heart disease, they note.
"You should get regular checkups with your primary care physician," Chen said. "During your checkup, you should have your blood pressure tested, and your doctor could request a blood test to measure heart health markers, such as your cholesterol, which will let your doctor know if you need to see a cardiologist."
For people with coronary microvascular dysfunction, it is essential to target all risk factors for heart disease aggressively, Garshick explained.
"Even if they are not related to [coronary microvascular dysfunction]," he said. "For example, the researchers found that smoking did not contribute to the risk. However, it is a risk factor for heart disease and you should still address it. Work with your cardiologist to aggressively target all risk factors that pertain to you."
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