We’ve all heard the experts tell us about the symptoms of heart attack, where a man gasps, clutches his chest and falls to the ground. In reality, a women's heart attack and heart disease symptoms may be very different.
Listen as Dr. Matthew Johnson, cardiologist at Bryan Heart, discusses the symptoms of heart disease and how women need to be aware of the differences.
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Women: Know Your Symptoms of Heart Disease
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Learn more about Dr. Matthew Johnson
Matthew Johnson, MD, Bryan Heart
Dr. Matthew Johnson is a cardiologist at Bryan Heart.Learn more about Dr. Matthew Johnson
Transcription:
Women: Know Your Symptoms of Heart Disease
Melanie Cole (Host): We’ve all seen in the media about the symptoms of a heart attack where a man gasps, clutches his chest and falls to the ground when in reality a heart attack victim could easily be a woman, and the symptoms could be very different. My guest today is Dr. Matthew Johnson. He’s a cardiologist at Bryan Heart. Welcome to the show, Dr. Johnson. So, let’s talk about women and heart disease and women and heart attack symptoms. First of all, women and heart disease, how much of a risk factor is heart disease for women and who is at risk?
Dr. Matthew Johnson (Guest): Yeah, heart disease is often underdiagnosed in women, and I think that postmenopausal women often have the risk of heart disease as men their age. It’s something that’s often overlooked and based on some of the symptoms aren’t classic and clear-cut like sometimes the male counterparts would be. Women and heart disease is a big problem. It’s the number one killer of women, actually when we look at statistics.
Melanie: Would a woman know that she has heart disease because some of the symptoms – and I’m going to ask you to give some of them – some of those symptoms mimic stress, anxiety bronchitis. We sometimes have all of these things and women; we sometimes put that stuff to the back burner when while we’re caring for everybody else in the family, so speak about the symptoms that you want women to pay attention to.
Dr. Johnson: Yeah, I a lot of time you hear physicians talk about chest pain, or ER doctors talk about chest pain, but that’s not always the case with myocardial infarctions or heart attacks. A lot of times the symptoms can be very vague, especially in women who don’t have that classic presentation of a chest heaviness or pressure-type sensation. Sometimes this can be vague symptoms, such as nausea like you were mentioning, or anxiety, sometimes shortness of breath, or sometimes just not feeling right. The one thing that we want to really stress is a lot of times if you’re having symptoms with exertion that’s relieved with rest, that should be a red flag to really let your primary care physician know or if you are seeing a cardiologist, let them know that you’re having some kind of change in that character of pain.
Melanie: That’s an important point is with exercise, the pain that subsides with rest, that’s an important red flag. When does somebody say that it’s time to really call the doctor if they’re nauseous, sweating, they’ve got any of this kind of symptoms, we still sometimes put it aside and say, “Oh, I must have the flu.”
Dr. Johnson: Oh, yes, we see this all the time. When someone has been dealing with something for even up to two, three weeks where they just really are convinced that it’s some kind of viral thing, upper respiratory thing. I think the key is daily exercise is so important in preventing heart disease, but it’s also your way of knowing if something’s changing. I always tell patients that I want them to exercise and our goal for them is to try to get 150 minutes in every week and that’s usually 30 minutes, five days a week is what we recommend. Not only is it good for them, but it’s also their tell-sign if something is changing. If they should have some exertional symptoms – and we just got caught in saying chest pain again, because that’s what they say in the medical world is, “Are you having any chest pain?” I don’t know how many times I’ve seen someone having a heart attack in the Emergency Room and we ask them, “Are you having chest pain?” and even though they’re sweating and they’re nauseous, they look up and say, “No, Doc, I’m not having chest pain. It just feels like an elephant is sitting on my chest.” We have to be careful because as a medical community we use chest pain for a variety of descriptive terms, but if there’s any symptom which may not even be chest pressure or heaviness -- it may be nausea or maybe shortness of breath that is out of proportion to what they would previously have had two, three months prior – but any kind of symptom that gets worse with exercise and is better when they sit down and rest, and their heart rate comes down, and their blood pressure comes down, that should be a red flag that they need to notify their physician and get evaluated.
Melanie: Dr. Johnson, in terms of numbers, and our annual physicals for women, what do you want us to know about the importance of blood pressure, cholesterol, possibly c-reactive protein, and stress in the role of heart disease as it contributes to a possible heart attack in women?
Dr. Johnson: I think that blood pressure management is an especially an important risk factor and prevention for coronary disease and stroke in patients. Our goal blood pressure over the last 15, 20 years has varied a little bit, but I tell patients we have that pre-hypertensive range now which we’ve established with the newest guidelines in that 120 systolic to 140 systolic range. We want to keep those blood pressures right around that 120 mark for the systolic number. We also want to see that down in the diastolic number, less than 85 or closer to 80 as far as a range to shoot for. Cholesterol is always one of those things we’ve also went back and forth with guideline numbers. I think identifying risk factors based on age, blood pressure, family history, smoking status, whether or not they’re diabetic all influence whether or not their physician might start them on cholesterol-lowering medication or not. Or patients with no prior history of coronary disease, or prior history of stent or bypass, they’re going to recommend shooting for a goal LDL or bad cholesterol level of at least less than 130 – probably even closer to that 100 range as far as the bad cholesterol level. We also want to encourage the diet component of this risk factor stratification. The American College of Cardiology and the American Heart Association recommend a heart-healthy diet. What really closely resembles what we consider a heart-healthy diet is a Mediterranean-style diet and that kind of diet is something that’s higher in fresh fruits and vegetables, lower in red meats, lower in dessert levels. And also the olive oil is not a huge component of what we think is the success of Mediterranean, but it is a better oil to use with cooking.
Melanie: As long as you’re bringing nutrition into it, let’s speak about nutrition’s role in the contribution to heart disease and if patients ask you, Dr. Johnson, “What should I be eating?” or, “What shouldn’t I be eating?” that might contribute to bad cholesterol, which could contribute to heart disease, what do you tell them?
Dr. Johnson: I start off with letting patients know that this is a life-long endeavor on changing and modifying their diets. The first thing is really getting some knowledge and getting some guidelines, and I think a nutritionist is a very beneficial tool here to help with patients’ understanding of what a great heart-healthy diet is. Fiber content is important – diets higher in fiber is very important, but also more of the bread-and-butter type of diet – I really want patients to mirror that Mediterranean diet with less red meat, less fried food, more protein sources from fish or chicken or even other protein sources rather than red meat. The red meat that they do have, I do recommend leaner cuts and smaller portion size for that. Living in Nebraska, it’s hard to get completely away from steaks and red meat, but I do think there are some cuts that are a little bit leaner and a little bit better from a cholesterol perspective. And the fresh fruits and vegetables and a diet higher in that are going to be very beneficial in helping lower that cholesterol.
Melanie: Wrap it up for us, Dr. Johnson, with your best advice for preventing heart disease, possibly preventing a heart attack in women, what you want them to know about living a healthy lifestyle, stress reduction, exercise, so that they can really know what to look for.
Dr. Johnson: I think the things that we’ve talked about are very important and really knowing their body when there’s something changing, or some symptom that might be coming on. I think stressing the diet, stressing an exercise pattern and again, trying to get that 150 minutes a week of cardiovascular workout.
Stress management is always hard, but it’s still a very, very important part of lowering that risk of heart disease, but understanding their body, understanding the symptoms that you have and really that knowledge that your symptoms of heart disease may not be the classic presentation that you’ve always heard about on TV or in the textbook – of that substernal heaviness or pressure – and to look for those other vague symptomatology that might persuade you to get in to see your physician or let them know that something’s going on.
Melanie: And if you’re concerned about your heart health, take our free, quick, and confidential Heart Aware Online Screening at bryanHealth.org/heartaware, that’s bryanHealth.org/heartaware. Thank you, so much, Dr. Johnson, for joining us today and thank you for the women of Alpha Phi for funding this special podcast series. You’re listening to Bryan Health Radio. This is Melanie Cole.
Women: Know Your Symptoms of Heart Disease
Melanie Cole (Host): We’ve all seen in the media about the symptoms of a heart attack where a man gasps, clutches his chest and falls to the ground when in reality a heart attack victim could easily be a woman, and the symptoms could be very different. My guest today is Dr. Matthew Johnson. He’s a cardiologist at Bryan Heart. Welcome to the show, Dr. Johnson. So, let’s talk about women and heart disease and women and heart attack symptoms. First of all, women and heart disease, how much of a risk factor is heart disease for women and who is at risk?
Dr. Matthew Johnson (Guest): Yeah, heart disease is often underdiagnosed in women, and I think that postmenopausal women often have the risk of heart disease as men their age. It’s something that’s often overlooked and based on some of the symptoms aren’t classic and clear-cut like sometimes the male counterparts would be. Women and heart disease is a big problem. It’s the number one killer of women, actually when we look at statistics.
Melanie: Would a woman know that she has heart disease because some of the symptoms – and I’m going to ask you to give some of them – some of those symptoms mimic stress, anxiety bronchitis. We sometimes have all of these things and women; we sometimes put that stuff to the back burner when while we’re caring for everybody else in the family, so speak about the symptoms that you want women to pay attention to.
Dr. Johnson: Yeah, I a lot of time you hear physicians talk about chest pain, or ER doctors talk about chest pain, but that’s not always the case with myocardial infarctions or heart attacks. A lot of times the symptoms can be very vague, especially in women who don’t have that classic presentation of a chest heaviness or pressure-type sensation. Sometimes this can be vague symptoms, such as nausea like you were mentioning, or anxiety, sometimes shortness of breath, or sometimes just not feeling right. The one thing that we want to really stress is a lot of times if you’re having symptoms with exertion that’s relieved with rest, that should be a red flag to really let your primary care physician know or if you are seeing a cardiologist, let them know that you’re having some kind of change in that character of pain.
Melanie: That’s an important point is with exercise, the pain that subsides with rest, that’s an important red flag. When does somebody say that it’s time to really call the doctor if they’re nauseous, sweating, they’ve got any of this kind of symptoms, we still sometimes put it aside and say, “Oh, I must have the flu.”
Dr. Johnson: Oh, yes, we see this all the time. When someone has been dealing with something for even up to two, three weeks where they just really are convinced that it’s some kind of viral thing, upper respiratory thing. I think the key is daily exercise is so important in preventing heart disease, but it’s also your way of knowing if something’s changing. I always tell patients that I want them to exercise and our goal for them is to try to get 150 minutes in every week and that’s usually 30 minutes, five days a week is what we recommend. Not only is it good for them, but it’s also their tell-sign if something is changing. If they should have some exertional symptoms – and we just got caught in saying chest pain again, because that’s what they say in the medical world is, “Are you having any chest pain?” I don’t know how many times I’ve seen someone having a heart attack in the Emergency Room and we ask them, “Are you having chest pain?” and even though they’re sweating and they’re nauseous, they look up and say, “No, Doc, I’m not having chest pain. It just feels like an elephant is sitting on my chest.” We have to be careful because as a medical community we use chest pain for a variety of descriptive terms, but if there’s any symptom which may not even be chest pressure or heaviness -- it may be nausea or maybe shortness of breath that is out of proportion to what they would previously have had two, three months prior – but any kind of symptom that gets worse with exercise and is better when they sit down and rest, and their heart rate comes down, and their blood pressure comes down, that should be a red flag that they need to notify their physician and get evaluated.
Melanie: Dr. Johnson, in terms of numbers, and our annual physicals for women, what do you want us to know about the importance of blood pressure, cholesterol, possibly c-reactive protein, and stress in the role of heart disease as it contributes to a possible heart attack in women?
Dr. Johnson: I think that blood pressure management is an especially an important risk factor and prevention for coronary disease and stroke in patients. Our goal blood pressure over the last 15, 20 years has varied a little bit, but I tell patients we have that pre-hypertensive range now which we’ve established with the newest guidelines in that 120 systolic to 140 systolic range. We want to keep those blood pressures right around that 120 mark for the systolic number. We also want to see that down in the diastolic number, less than 85 or closer to 80 as far as a range to shoot for. Cholesterol is always one of those things we’ve also went back and forth with guideline numbers. I think identifying risk factors based on age, blood pressure, family history, smoking status, whether or not they’re diabetic all influence whether or not their physician might start them on cholesterol-lowering medication or not. Or patients with no prior history of coronary disease, or prior history of stent or bypass, they’re going to recommend shooting for a goal LDL or bad cholesterol level of at least less than 130 – probably even closer to that 100 range as far as the bad cholesterol level. We also want to encourage the diet component of this risk factor stratification. The American College of Cardiology and the American Heart Association recommend a heart-healthy diet. What really closely resembles what we consider a heart-healthy diet is a Mediterranean-style diet and that kind of diet is something that’s higher in fresh fruits and vegetables, lower in red meats, lower in dessert levels. And also the olive oil is not a huge component of what we think is the success of Mediterranean, but it is a better oil to use with cooking.
Melanie: As long as you’re bringing nutrition into it, let’s speak about nutrition’s role in the contribution to heart disease and if patients ask you, Dr. Johnson, “What should I be eating?” or, “What shouldn’t I be eating?” that might contribute to bad cholesterol, which could contribute to heart disease, what do you tell them?
Dr. Johnson: I start off with letting patients know that this is a life-long endeavor on changing and modifying their diets. The first thing is really getting some knowledge and getting some guidelines, and I think a nutritionist is a very beneficial tool here to help with patients’ understanding of what a great heart-healthy diet is. Fiber content is important – diets higher in fiber is very important, but also more of the bread-and-butter type of diet – I really want patients to mirror that Mediterranean diet with less red meat, less fried food, more protein sources from fish or chicken or even other protein sources rather than red meat. The red meat that they do have, I do recommend leaner cuts and smaller portion size for that. Living in Nebraska, it’s hard to get completely away from steaks and red meat, but I do think there are some cuts that are a little bit leaner and a little bit better from a cholesterol perspective. And the fresh fruits and vegetables and a diet higher in that are going to be very beneficial in helping lower that cholesterol.
Melanie: Wrap it up for us, Dr. Johnson, with your best advice for preventing heart disease, possibly preventing a heart attack in women, what you want them to know about living a healthy lifestyle, stress reduction, exercise, so that they can really know what to look for.
Dr. Johnson: I think the things that we’ve talked about are very important and really knowing their body when there’s something changing, or some symptom that might be coming on. I think stressing the diet, stressing an exercise pattern and again, trying to get that 150 minutes a week of cardiovascular workout.
Stress management is always hard, but it’s still a very, very important part of lowering that risk of heart disease, but understanding their body, understanding the symptoms that you have and really that knowledge that your symptoms of heart disease may not be the classic presentation that you’ve always heard about on TV or in the textbook – of that substernal heaviness or pressure – and to look for those other vague symptomatology that might persuade you to get in to see your physician or let them know that something’s going on.
Melanie: And if you’re concerned about your heart health, take our free, quick, and confidential Heart Aware Online Screening at bryanHealth.org/heartaware, that’s bryanHealth.org/heartaware. Thank you, so much, Dr. Johnson, for joining us today and thank you for the women of Alpha Phi for funding this special podcast series. You’re listening to Bryan Health Radio. This is Melanie Cole.