Heart disease is the number one killer of women. However, women don't present with heart disease with the typical chest pains and clutching of the heart.
Dr. Maria Carolina Gongora Nieto, Assistant Professor of Medicine Consultant of Emory Women’s Heart Center Division of Cardiology at Emory University School of Medicine, discusses the nuances of heart disease symptoms in women.
Selected Podcast
Women & Heart Disease: The Unique Differences in Women’s Heart Disease
Featuring:
Dr. Gongora went to medical school in Bogota, Colombia, where she is from originally. She moved to Atlanta in 2005. Before starting her training in Internal Medicine and Cardiology at Emory University, Dr. Gongora did a post doctoral research fellowship in hypertension and renal disease. Her research was partially funded by the American Heart Association. During this time she published in recognized journals like the Journal of American College of Cardiology, Hypertension and Circulation. Also, she presented in nationally renowned meetings, like the American Heart Association, the American Society of Hypertension and the American Physiology Society meetings, among others. She has been a member of the American College of Cardiology, the American Physiological Society and the American Heart Association-Council for high blood pressure. She is board certified in Cardiology, Internal Medicine and Echocardiography.
Learn more about Maria Carolina Gongora Nieto, MD
Maria Carolina Gongora Nieto, MD
Dr. Gongora is a Board certified cardiologist at the Emory Heart and Vascular Center and Assistant Professor of Medicine (Cardiology) at Emory University School of Medicine.Dr. Gongora went to medical school in Bogota, Colombia, where she is from originally. She moved to Atlanta in 2005. Before starting her training in Internal Medicine and Cardiology at Emory University, Dr. Gongora did a post doctoral research fellowship in hypertension and renal disease. Her research was partially funded by the American Heart Association. During this time she published in recognized journals like the Journal of American College of Cardiology, Hypertension and Circulation. Also, she presented in nationally renowned meetings, like the American Heart Association, the American Society of Hypertension and the American Physiology Society meetings, among others. She has been a member of the American College of Cardiology, the American Physiological Society and the American Heart Association-Council for high blood pressure. She is board certified in Cardiology, Internal Medicine and Echocardiography.
Learn more about Maria Carolina Gongora Nieto, MD
Transcription:
Bill Klaproth (Host): Although heart disease may often be thought of as a problem for men; heart disease is the most common cause of death for both women and men in the United States. Here to talk about women and heart disease, the unique differences in women’s heart disease, is Dr. Carolina Gongora, a Board-Certified Cardiologist at the Emory Heart and Vascular Center and Assistant Professor of Medicine at Emory University School of Medicine. Dr. Gongora thank you so much for your time today. So, is it true that many women would not recognize the signs of heart attack in themselves?
Maria Carolina Gongora Nieto, MD (Guest): Yes, hello Bill, thank you for inviting me first of all. And I’m glad that we are talking about this important topic. And yes, it’s true. Unfortunately, our women population are not aware of how important it is, cardiovascular disease and that it is still even after breast cancer, the first cause of death for women in our country. And yes, it is unfortunately very unrecognized. And the risk factors that lead to cardiovascular disease are well underrecognized and undertreated in women more than men.
Host: Alright. You just mentioned risk factors. Let’s talk about that for a minute. What are risk factors for women when it comes to heart disease?
Dr. Gongora: So, risk factors are those factors or those problems that a woman can have on their health that increases the risk of having a heart attack or a stroke or any cardiac disease in general. The main risk factors that a woman can encounter throughout their lives – they are basically the same as in men, in addition to a few others. First, the number one risk factor is hypertension. Hypertension is a disease that affects almost 50% of our population by the age of 80 and it affects women and it affects more women than men after age 50. And the feedback that there are more women than men with hypertension. So, hypertension is the number one risk factor for cardiovascular disease.
And the others are most of them are known. Smoking, inactivity, obesity, diet, not healthy diet habits, and genetics play a significant role of course. And in terms of women especially, there are other risk factors that are only present in women which are those women for example that have hypertension or hypertensive disorder during pregnancy. Those women that develop gestational diabetes or hypertension during pregnancy. We know that is a significant risk factor for future cardiovascular disease. And rheumatological diseases like lupus and rheumatoid arthritis, they are conditions that increase inflammation systemically in all the body and we know that these diseases are more common in women. So, these are other risk factors particular to women that increase cardiovascular disease. Also, oral contraceptives, the use of hormones, specifically in patients that smoke and there are other risk factors as well like migraine with aura and those that are more common in women. Depression has an association to cardiovascular disease and unfortunately is more common in women. So, those are in general the risk factors that increase the risk of having cardiac disease being the number one cause of death.
Host: Well those are good to know and some of those that you mentioned I wouldn’t have associated that condition with heart disease or a higher risk of heart attack. So, thanks for going through those. So, speaking of the differences between men and women; what are the signs of heart attack more likely in women that may not be so in men?
Dr. Gongora: Well, so it is interesting, but it is in general having a heart attack and having an event or cardiac event in general it produces the same symptoms in men as in women. There are some variations of the symptoms in women, but the number one we mostly know about that the number one symptom is chest pain. Some people would call it chest discomfort, chest pressure, chest heaviness. Women and men experience this same type of heaviness and chest pain in general. But in women, there might be other signs of a heart attack. Besides the chest pain or the chest pressure; it can go to the neck, it can go to the jaw. It can radiate to the shoulder, sometimes it might be associated to nausea, to vomiting, dizziness, lightheadedness, just not feeling right. So, these other symptoms are more common in women than in men. Men have the typical chest crushing chest pressure that we see in the books when a man grabs their chest. Women have the same type of symptoms, but it can be radiating to other areas and sometimes it can be associated to other nonspecific symptoms like what I mentioned and also fatigue and tiredness. Those are the main differences in terms of presentation of a heart attack in men and in women.
Host: So, if a woman experiences any of those symptoms you were just describing; at what point should she think oh, oh, this is more than just a sore muscle, something could be going on here that I need serious medical attention? At what point should she reach out to her doctor or even consider a 9-1-1 call?
Dr. Gongora: Well this a difficult question because the only way for us even as physicians know is having like a complete story and to put everything in perspective, the risk factors, the type of symptoms, the long range problems. For a patient that doesn’t really know, it’s very difficult to know but you know yourself and if you are a woman that is having like different type – something that is new to you, any chest pressure, you are feeling more tired than usual, you are feeling that you having to catch your breath more, you are feeling shortness of breath and it doesn’t go away or just stays there for longer and it’s lingering and you can’t really – you are not used to these symptoms before; to be honest it is really difficult for a woman by herself just to say well this is this or that. I think whenever you have these types of symptoms you just have to consult your primary care physician or to discuss with your primary doctor to let them make that decision. In the case of when you should make the 9-1-1 call, that woman that presents with chest pain associated with shortness of breath that is lasting more than ten to fifteen minutes and you are feeling dizzy, short of breath, you have nausea, some palpitations and it just doesn’t go away; if you feel that you are not feeling right and this is just more than a regular ache; you should call 9-1-1 or head over to the emergency room of course to make sure it’s not a heart attack. Because we have ways to treat but of course it’s better if you catch the things on time in a timely manner. But always I tell women don’t try to diagnose yourself. I’ve seen a lot of patients thinking that it is reflux, that this is a muscle pain and they are waiting at home, self-medicating, waiting and it was actually – this was actually an incubating heart attack and when they go to the ER or to the hospital or to their primary care; it might be actually too late.
Host: So, let’s talk about prevention. We hear the term know your numbers. Good for a woman to know that too. Is that correct?
Dr. Gongora: Yes. Extremely important. You have to know your numbers and as I mentioned, risk factors are high blood pressure, smoking, high cholesterol, overweight, inactivity. You have to know your numbers because in the case of for example hypertension that I mentioned the number one risk factor, we call hypertension as the silent killer because you don’t feel it. You don’t feel it until it’s too late. So, you have to know your numbers. You have to take active action. You have to be proactive and go and ask your doctor what is my blood pressure, what is my blood pressure every year when I go to my regular checkup. What is a normal blood pressure? We have to know the normal blood pressure now by the recent guidelines from the American College of Cardiology and the American Heart Association is less than 120/80, so you want to know well, what is my blood pressure. Is this getting higher? Is it trending upwards in the last few years? And I want to know what my LDL or bad cholesterol is. I want to know what my HDL or good cholesterol is. And I want to know my weight. Am I in the red zone? Am I in the green zone? Am I at a good weight? I need to know my numbers and to see what my risks are and how I can make changes to get more into the red and the good zone and stay away from cardiovascular disease. It’s extremely important to know your numbers. Yes, correct.
Host: And at what age should a woman start paying attention to those numbers? What age should she start thinking about you know what I’m getting old enough now, I should start thinking about my heart health?
Dr. Gongora: So, now we are calling even children. Unfortunately, we have an epidemic of obesity in children and children are getting hypertensive believe it or not. So, the pediatricians actually started screening for obesity and for hypertension since early childhood. So, really since you are a girl, you should start – your parents need to get on top of your weight and make sure you are in a healthy weight and during your teenager years to start to get – you need to start getting – get aware of your numbers and we in general start screening for cholesterol at age 18 and then after that we start according to your risk factors, we started screening every five years with cholesterol and see what your cholesterol is and then everybody needs to check your blood pressure. So, really, since early in your teenager years, you have to start knowing your weight and your blood pressure.
Host: Well, that’s good to get that baseline information and lastly Dr. Gongora if you could wrap it up for us. What else should we know about women and heart disease?
Dr. Gongora: So, we have to know that as I mentioned before, and I cannot emphasize this enough it is the number one killer of women in our country more than cancer and more than other causes. And it’s preventable. It’s the number one – one of the main risk factors for example for cardiovascular disease is a number one preventable risk factor which is smoking. So, we have to be aware that cardiovascular disease kills us and that we can prevent that. We can make changes fortunately. And that if we know our numbers, we know where we are; and we can take a step to get into a good weight, a good cholesterol, avoiding smoking, drinking, exercising and being active; we can have a healthy longer life.
Women live longer than men, but we want to be healthy productive women to their society and to us and to our families. And lastly, women are the ones that bring the health to the families. We know that women are the head of the families in the sense of medical care. Women are the ones who teach our children and the husbands that they need to be healthy, that they need to come to the doctor and be checked and know their numbers. So, that’s why we insist on educating our women because they are the base of the health for the families and their society.
Host: Well, that’s a good way to wrap it up and really important. I think you said in there that this is preventable so pay attention to your heart health and don’t let it get out of hand. That’s for sure. Dr. Gongora thank you so much for your time. For more information please visit emoryhealthcare.org/
Bill Klaproth (Host): Although heart disease may often be thought of as a problem for men; heart disease is the most common cause of death for both women and men in the United States. Here to talk about women and heart disease, the unique differences in women’s heart disease, is Dr. Carolina Gongora, a Board-Certified Cardiologist at the Emory Heart and Vascular Center and Assistant Professor of Medicine at Emory University School of Medicine. Dr. Gongora thank you so much for your time today. So, is it true that many women would not recognize the signs of heart attack in themselves?
Maria Carolina Gongora Nieto, MD (Guest): Yes, hello Bill, thank you for inviting me first of all. And I’m glad that we are talking about this important topic. And yes, it’s true. Unfortunately, our women population are not aware of how important it is, cardiovascular disease and that it is still even after breast cancer, the first cause of death for women in our country. And yes, it is unfortunately very unrecognized. And the risk factors that lead to cardiovascular disease are well underrecognized and undertreated in women more than men.
Host: Alright. You just mentioned risk factors. Let’s talk about that for a minute. What are risk factors for women when it comes to heart disease?
Dr. Gongora: So, risk factors are those factors or those problems that a woman can have on their health that increases the risk of having a heart attack or a stroke or any cardiac disease in general. The main risk factors that a woman can encounter throughout their lives – they are basically the same as in men, in addition to a few others. First, the number one risk factor is hypertension. Hypertension is a disease that affects almost 50% of our population by the age of 80 and it affects women and it affects more women than men after age 50. And the feedback that there are more women than men with hypertension. So, hypertension is the number one risk factor for cardiovascular disease.
And the others are most of them are known. Smoking, inactivity, obesity, diet, not healthy diet habits, and genetics play a significant role of course. And in terms of women especially, there are other risk factors that are only present in women which are those women for example that have hypertension or hypertensive disorder during pregnancy. Those women that develop gestational diabetes or hypertension during pregnancy. We know that is a significant risk factor for future cardiovascular disease. And rheumatological diseases like lupus and rheumatoid arthritis, they are conditions that increase inflammation systemically in all the body and we know that these diseases are more common in women. So, these are other risk factors particular to women that increase cardiovascular disease. Also, oral contraceptives, the use of hormones, specifically in patients that smoke and there are other risk factors as well like migraine with aura and those that are more common in women. Depression has an association to cardiovascular disease and unfortunately is more common in women. So, those are in general the risk factors that increase the risk of having cardiac disease being the number one cause of death.
Host: Well those are good to know and some of those that you mentioned I wouldn’t have associated that condition with heart disease or a higher risk of heart attack. So, thanks for going through those. So, speaking of the differences between men and women; what are the signs of heart attack more likely in women that may not be so in men?
Dr. Gongora: Well, so it is interesting, but it is in general having a heart attack and having an event or cardiac event in general it produces the same symptoms in men as in women. There are some variations of the symptoms in women, but the number one we mostly know about that the number one symptom is chest pain. Some people would call it chest discomfort, chest pressure, chest heaviness. Women and men experience this same type of heaviness and chest pain in general. But in women, there might be other signs of a heart attack. Besides the chest pain or the chest pressure; it can go to the neck, it can go to the jaw. It can radiate to the shoulder, sometimes it might be associated to nausea, to vomiting, dizziness, lightheadedness, just not feeling right. So, these other symptoms are more common in women than in men. Men have the typical chest crushing chest pressure that we see in the books when a man grabs their chest. Women have the same type of symptoms, but it can be radiating to other areas and sometimes it can be associated to other nonspecific symptoms like what I mentioned and also fatigue and tiredness. Those are the main differences in terms of presentation of a heart attack in men and in women.
Host: So, if a woman experiences any of those symptoms you were just describing; at what point should she think oh, oh, this is more than just a sore muscle, something could be going on here that I need serious medical attention? At what point should she reach out to her doctor or even consider a 9-1-1 call?
Dr. Gongora: Well this a difficult question because the only way for us even as physicians know is having like a complete story and to put everything in perspective, the risk factors, the type of symptoms, the long range problems. For a patient that doesn’t really know, it’s very difficult to know but you know yourself and if you are a woman that is having like different type – something that is new to you, any chest pressure, you are feeling more tired than usual, you are feeling that you having to catch your breath more, you are feeling shortness of breath and it doesn’t go away or just stays there for longer and it’s lingering and you can’t really – you are not used to these symptoms before; to be honest it is really difficult for a woman by herself just to say well this is this or that. I think whenever you have these types of symptoms you just have to consult your primary care physician or to discuss with your primary doctor to let them make that decision. In the case of when you should make the 9-1-1 call, that woman that presents with chest pain associated with shortness of breath that is lasting more than ten to fifteen minutes and you are feeling dizzy, short of breath, you have nausea, some palpitations and it just doesn’t go away; if you feel that you are not feeling right and this is just more than a regular ache; you should call 9-1-1 or head over to the emergency room of course to make sure it’s not a heart attack. Because we have ways to treat but of course it’s better if you catch the things on time in a timely manner. But always I tell women don’t try to diagnose yourself. I’ve seen a lot of patients thinking that it is reflux, that this is a muscle pain and they are waiting at home, self-medicating, waiting and it was actually – this was actually an incubating heart attack and when they go to the ER or to the hospital or to their primary care; it might be actually too late.
Host: So, let’s talk about prevention. We hear the term know your numbers. Good for a woman to know that too. Is that correct?
Dr. Gongora: Yes. Extremely important. You have to know your numbers and as I mentioned, risk factors are high blood pressure, smoking, high cholesterol, overweight, inactivity. You have to know your numbers because in the case of for example hypertension that I mentioned the number one risk factor, we call hypertension as the silent killer because you don’t feel it. You don’t feel it until it’s too late. So, you have to know your numbers. You have to take active action. You have to be proactive and go and ask your doctor what is my blood pressure, what is my blood pressure every year when I go to my regular checkup. What is a normal blood pressure? We have to know the normal blood pressure now by the recent guidelines from the American College of Cardiology and the American Heart Association is less than 120/80, so you want to know well, what is my blood pressure. Is this getting higher? Is it trending upwards in the last few years? And I want to know what my LDL or bad cholesterol is. I want to know what my HDL or good cholesterol is. And I want to know my weight. Am I in the red zone? Am I in the green zone? Am I at a good weight? I need to know my numbers and to see what my risks are and how I can make changes to get more into the red and the good zone and stay away from cardiovascular disease. It’s extremely important to know your numbers. Yes, correct.
Host: And at what age should a woman start paying attention to those numbers? What age should she start thinking about you know what I’m getting old enough now, I should start thinking about my heart health?
Dr. Gongora: So, now we are calling even children. Unfortunately, we have an epidemic of obesity in children and children are getting hypertensive believe it or not. So, the pediatricians actually started screening for obesity and for hypertension since early childhood. So, really since you are a girl, you should start – your parents need to get on top of your weight and make sure you are in a healthy weight and during your teenager years to start to get – you need to start getting – get aware of your numbers and we in general start screening for cholesterol at age 18 and then after that we start according to your risk factors, we started screening every five years with cholesterol and see what your cholesterol is and then everybody needs to check your blood pressure. So, really, since early in your teenager years, you have to start knowing your weight and your blood pressure.
Host: Well, that’s good to get that baseline information and lastly Dr. Gongora if you could wrap it up for us. What else should we know about women and heart disease?
Dr. Gongora: So, we have to know that as I mentioned before, and I cannot emphasize this enough it is the number one killer of women in our country more than cancer and more than other causes. And it’s preventable. It’s the number one – one of the main risk factors for example for cardiovascular disease is a number one preventable risk factor which is smoking. So, we have to be aware that cardiovascular disease kills us and that we can prevent that. We can make changes fortunately. And that if we know our numbers, we know where we are; and we can take a step to get into a good weight, a good cholesterol, avoiding smoking, drinking, exercising and being active; we can have a healthy longer life.
Women live longer than men, but we want to be healthy productive women to their society and to us and to our families. And lastly, women are the ones that bring the health to the families. We know that women are the head of the families in the sense of medical care. Women are the ones who teach our children and the husbands that they need to be healthy, that they need to come to the doctor and be checked and know their numbers. So, that’s why we insist on educating our women because they are the base of the health for the families and their society.
Host: Well, that’s a good way to wrap it up and really important. I think you said in there that this is preventable so pay attention to your heart health and don’t let it get out of hand. That’s for sure. Dr. Gongora thank you so much for your time. For more information please visit emoryhealthcare.org/