All women face the threat of heart disease. However, the risks and symptoms are different for women. In fact, more women die each year from heart disease than men.
Learn the unique but serious signs of heart attack and heart disease in women, as well as prevention advice, from Nirmala Akkapeddi, MD, Summit Medical Group internist.
Selected Podcast
Cardiac Health for Women: Why It’s Different
Featured Speaker:
Nirmala Akkapeddi, MD
Nirmala Akkapeddi, MD, specializes in preventive medicine, cardiac care, and women’s health. Dr. Akkapeddi has more than 30 years’ experience in internal medicine and primary care. Her expertise includes preventive cardiac care, women’s cardiac health, and nuclear medicine. Transcription:
Cardiac Health for Women: Why It’s Different
Melanie Cole (Host): All women face the threat of heart disease. However, the risks and symptoms are different for women, and in fact, more women die each year from heart disease than men. There are unique but serious signs of heart attack and heart disease in women that you need to be aware of and symptoms that you should not ignore. My guest today is Dr. Nirmala Akkapeddi. She’s an internist with Summit Medical Group. Welcome to the show, Dr. Akkapeddi. Tell us a little bit about what’s different between men and women when it comes to heart disease. Back in the day, men were the ones that were oft-studied. All the studies were done on men. But now, as the tides are shifting and more women than men are coming up with heart disease, what are you seeing, and what are the differences?
Dr. Nirmala Akkapeddi (Guest): Thank you for inviting me to come and talk and be on your show today, Melanie. I will give you some background information. Heart disease remains the leading cause of death in the United States. Many individuals are unaware of their coronary heart disease risk. Up to 50 percent of men and 64 percent of women who die suddenly of coronary heart disease had no previous symptoms. Even though over the last 30 years, the heart attack rates are dropping, in women between the ages of 39 to 44, there is a 1.3 percent increase in the rate of heart attacks and death in women. This is actually a survey conducted by the American Heart Association found that only 54 percent of women were aware that heart disease is a leading cause of death. The incidence also increases as the woman go into menopausal year. The reason for great disparity in diagnosing early on in women the heart disease is the way symptoms are manifested. Women with serious heart conditions do not present with chest pain radiating down the arm, with sweating and palpitations. These are the typical symptoms of somebody having a heart attack. On the contrary, women present with fatigue, sleep disturbance, anxiety, shortness of breath, and frequent indigestion. Only one-third of women report any chest discomfort or pain during the prodromal period of experiencing the heart attack. Because these symptoms are varied, a lot of women do not go and get the medical attention immediately. If they do and the provider then see these women, they’ll attribute their symptoms to anxiety and indigestion and so on and so forth. That’s the big difference in the way women and men present.
Melanie: As you say, a lot of women experience anxiety. That comes with shortness of breath and stress and maybe even heartburn or sleeplessness, things we women experience all the time. Dr. Akkapeddi, what do you as a physician do with those symptoms if one of us were to come to you and say, “I feel anxious all the time. I’m having a little bit of heartburn. I get short of breath”? What tests do you perform that might give you an indication that we have heart disease or at risk for a heart attack?
Dr. Akkapeddi: When a woman presents to my practice with these symptoms, first I will do a thorough evaluation, both physical exam, lab evaluation, and an EKG. As a part of history taking, it’s very important to assess the underlying risk factors, positive family history, the smoking history and any history of elevated lipids. And also, if the woman is experiencing fatigue, getting easily tired after doing minimal work. First I will take a thorough history, the thorough physical exam, and then we will assess the level of lipids. And there is one particular cholesterol, triglyceride component which we assay which is called ApoB. The ApoB, non-HDL-C levels are particularly useful than LDL-C to assess the cardiovascular risk, especially for women. In women, these levels, when they are high, they’re more indicative of the plaque burden in the coronary heart artery. Then of course, we’ll check the hemoglobin A1c, make sure that there is no underlying diabetes. And another important risk factor is smoking. Women smokers get 25 percent more heart attacks than men do. Then electrocardiogram is not always diagnostic because 25 percent of the time, the EKGs come back completely normal. However, since we know these risk factors and the atypical presentation of women, I will send them for further testing like calcium scoring, which is looking at the plaque burden in the coronary artery. That’s the initial assessment. Of course, if the electrocardiogram looks abnormal, I’ll send them to further testing, exercise stress testing. If exercise stress testing comes back abnormal, then nuclear stress test, so on and so forth.
Melanie: So it kind of builds itself up from there. If a woman has these symptoms, then you do the history, you get your blood work done and an EKG, get your labs. You’re looking at all of these inflammatory markers and cholesterol and plaques and things, and then maybe they need a stress test. Give us your best advice—we only have a few minutes left—for risk factor prevention, lifestyle changes, modifications, things that you tell a woman before she does have heart disease that you want her to know so that she doesn’t get heart disease and why she should come to Summit Medical Group for their care.
Dr. Akkapeddi: Summit Medical Group is very big on prevention, and so am I. As part of Summit Medical Group, our mission is to prevent the heart attack. When these patients come, I will counsel them about lifestyle changes consisting of dietary approaches to stop hypertension like diet called DASH—diet, smoking cessation, regular physical activity, and weight management. These are cornerstones of overall management. I also counsel them about other diets like Mediterranean-style diet. Particularly if it is supplemented with olive oil and nuts, it’s inversely related to the risk of cardiovascular disease in women, proven by different studies. The part of preventative aspect is thorough physical exam, assessing the underlying risk factors, and counseling them about diet. I cannot over-emphasize the importance of regular physical activity. Obesity, diabetes, abdominal obesity are all associated with high risk of heart attack in women.
Melanie: These are all the risk factors, as you’ve said. Obesity and diabetes, and that exercise is essential, good diet, seeing your physician if you do have questions. These are all essential. Thank you so much, Dr. Akkapeddi, for such great information. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.
Cardiac Health for Women: Why It’s Different
Melanie Cole (Host): All women face the threat of heart disease. However, the risks and symptoms are different for women, and in fact, more women die each year from heart disease than men. There are unique but serious signs of heart attack and heart disease in women that you need to be aware of and symptoms that you should not ignore. My guest today is Dr. Nirmala Akkapeddi. She’s an internist with Summit Medical Group. Welcome to the show, Dr. Akkapeddi. Tell us a little bit about what’s different between men and women when it comes to heart disease. Back in the day, men were the ones that were oft-studied. All the studies were done on men. But now, as the tides are shifting and more women than men are coming up with heart disease, what are you seeing, and what are the differences?
Dr. Nirmala Akkapeddi (Guest): Thank you for inviting me to come and talk and be on your show today, Melanie. I will give you some background information. Heart disease remains the leading cause of death in the United States. Many individuals are unaware of their coronary heart disease risk. Up to 50 percent of men and 64 percent of women who die suddenly of coronary heart disease had no previous symptoms. Even though over the last 30 years, the heart attack rates are dropping, in women between the ages of 39 to 44, there is a 1.3 percent increase in the rate of heart attacks and death in women. This is actually a survey conducted by the American Heart Association found that only 54 percent of women were aware that heart disease is a leading cause of death. The incidence also increases as the woman go into menopausal year. The reason for great disparity in diagnosing early on in women the heart disease is the way symptoms are manifested. Women with serious heart conditions do not present with chest pain radiating down the arm, with sweating and palpitations. These are the typical symptoms of somebody having a heart attack. On the contrary, women present with fatigue, sleep disturbance, anxiety, shortness of breath, and frequent indigestion. Only one-third of women report any chest discomfort or pain during the prodromal period of experiencing the heart attack. Because these symptoms are varied, a lot of women do not go and get the medical attention immediately. If they do and the provider then see these women, they’ll attribute their symptoms to anxiety and indigestion and so on and so forth. That’s the big difference in the way women and men present.
Melanie: As you say, a lot of women experience anxiety. That comes with shortness of breath and stress and maybe even heartburn or sleeplessness, things we women experience all the time. Dr. Akkapeddi, what do you as a physician do with those symptoms if one of us were to come to you and say, “I feel anxious all the time. I’m having a little bit of heartburn. I get short of breath”? What tests do you perform that might give you an indication that we have heart disease or at risk for a heart attack?
Dr. Akkapeddi: When a woman presents to my practice with these symptoms, first I will do a thorough evaluation, both physical exam, lab evaluation, and an EKG. As a part of history taking, it’s very important to assess the underlying risk factors, positive family history, the smoking history and any history of elevated lipids. And also, if the woman is experiencing fatigue, getting easily tired after doing minimal work. First I will take a thorough history, the thorough physical exam, and then we will assess the level of lipids. And there is one particular cholesterol, triglyceride component which we assay which is called ApoB. The ApoB, non-HDL-C levels are particularly useful than LDL-C to assess the cardiovascular risk, especially for women. In women, these levels, when they are high, they’re more indicative of the plaque burden in the coronary heart artery. Then of course, we’ll check the hemoglobin A1c, make sure that there is no underlying diabetes. And another important risk factor is smoking. Women smokers get 25 percent more heart attacks than men do. Then electrocardiogram is not always diagnostic because 25 percent of the time, the EKGs come back completely normal. However, since we know these risk factors and the atypical presentation of women, I will send them for further testing like calcium scoring, which is looking at the plaque burden in the coronary artery. That’s the initial assessment. Of course, if the electrocardiogram looks abnormal, I’ll send them to further testing, exercise stress testing. If exercise stress testing comes back abnormal, then nuclear stress test, so on and so forth.
Melanie: So it kind of builds itself up from there. If a woman has these symptoms, then you do the history, you get your blood work done and an EKG, get your labs. You’re looking at all of these inflammatory markers and cholesterol and plaques and things, and then maybe they need a stress test. Give us your best advice—we only have a few minutes left—for risk factor prevention, lifestyle changes, modifications, things that you tell a woman before she does have heart disease that you want her to know so that she doesn’t get heart disease and why she should come to Summit Medical Group for their care.
Dr. Akkapeddi: Summit Medical Group is very big on prevention, and so am I. As part of Summit Medical Group, our mission is to prevent the heart attack. When these patients come, I will counsel them about lifestyle changes consisting of dietary approaches to stop hypertension like diet called DASH—diet, smoking cessation, regular physical activity, and weight management. These are cornerstones of overall management. I also counsel them about other diets like Mediterranean-style diet. Particularly if it is supplemented with olive oil and nuts, it’s inversely related to the risk of cardiovascular disease in women, proven by different studies. The part of preventative aspect is thorough physical exam, assessing the underlying risk factors, and counseling them about diet. I cannot over-emphasize the importance of regular physical activity. Obesity, diabetes, abdominal obesity are all associated with high risk of heart attack in women.
Melanie: These are all the risk factors, as you’ve said. Obesity and diabetes, and that exercise is essential, good diet, seeing your physician if you do have questions. These are all essential. Thank you so much, Dr. Akkapeddi, for such great information. You’re listening to SMG Radio. For more information, you can go to summitmedicalgroup.com. That’s summitmedicalgroup.com. This is Melanie Cole. Thanks so much for listening.