San Diego Health: Women’s Heart Disease – Signs and Symptoms

(bright music) – Hi, I’m Susan Taylor with Scripps Health in San Diego, California. When we think about a heart
attack, what comes to mind? Pain in the chest, shortness of breath? Heart disease is the
number-one killer for women. It takes the lives of
nearly twice as many women as all forms of cancer combined. Ladies, have you ever been tired, dizzy, had neck pain,
jaw pain, indigestion? How many of you went to urgent
care for those symptoms? How many of you blew those symptoms off? We’re always tired, right, because we’re running from work to pick up
the kids from soccer or piano, rushing to get home,
put dinner on the table. Maybe we’ve had one too many hot dogs to give us that upset stomach. And the neck pain, well,
we’re carrying a lotta weight. Maybe we’re carrying strollers. Maybe we’re caring for our older parents and we’re picking up wheelchairs. Maybe we’re carrying too many groceries, or we’ve been lifting
heavy weights at the gym. But those four symptoms, tired, dizzy, neck pain, jaw pain, indigestion, are all symptoms of a
heart attack in women. And in some cases, those
symptoms will show up more than a month before the heart attack. Now, don’t freak out. We’re gonna put it all
in perspective for you. I’d like to introduce you to two of our stellar female cardiologists from the Scripps Women’s Heart Center, which is located on the campus
of Scripps Memorial Hospital in La Jolla, California,
just off Genesee Avenue, Doctors Poulina Uddin and Christina Adams. Thank you both for being here. – [Doctors] Thank you. – So, we touched on a couple of this. Are heart attack symptoms for women, are they ever the classic
symptoms that men get, the sharp chest pain?
– Yes. – Or is it more subtle a lot of the times? – It can be more subtle, but it’s really important that women do recognize the classic symptoms,
left-sided chest pressure. And, in fact, a lotta patients
will correct us and say, “It’s not pain, it’s pressure,
shortness of breath.” – Some kind of stigma with the terms they just don’t want to admit. But yeah, they will have the classic symptoms sometimes, for sure. – But you brought up a
really important point. These subtler symptoms
at the gastric pain, unusual fatigue, shortness of breath, women we know have higher pain thresholds. So typically, we’ll say,
“Oh, it’s not this.” Or we’re not actually taught, also, that heart disease is a woman’s disease. Typically it’s been taught,
even with physicians, that this is more of a
male-dominant disease. And we do have higher pain thresholds. So we kind of negate the symptoms. – So, how long could these
heart attack symptoms last? – Yeah, so that’s a great question, because some people will say, “Oh, well I always have indigestion. “I’ve had it for years.” But all of a sudden,
they’ll come in one day, and I’ll say, “Well, why did you wanna see “your doctor today for a
symptom you’ve had for years?” And oftentimes, they’ll say, “Well, it was “really different today,”
or, “It was worse today.” So, that’s one presentation. But then other times, we
see somebody who says, “I was perfectly fine
until all of a sudden “a week ago, I started to have all “these nonspecific or vague symptoms.” So that’s the really tricky part about it. Depending on how active somebody is, what their baseline risk factors are, the presentation can be
something that just suddenly came on a few days ago,
or it could be something that’s going on for months
to years unrecognized. And I think that’s kind of where our job comes in a little bit to help tease out, “Okay, is this just aches
and pains you’ve always had, “or is there actually
something serious going on “that needs a little more work up?” – And is it something
that comes in a cluster, all of these symptoms together? – Not necessarily. So, as you pointed out, two
weeks before a heart attack, women are more likely to
describe unusual fatigue. The day of presentation,
it typically tends to accelerate into more specific symptoms of shortness of breath or chest pain. But what I always tell women is, and this is why we really emphasize, I want people doing moderate
to vigorous exercise regularly. – Absolutely.
– Because if you’re noticing a change in your exercise tolerance, if you notice that, you know
what, my workouts have changed, I can’t do my normal activity, I used to walk this hill regularly, now it’s giving me more trouble, that can be a very early sign that we need to check some things out. – Those are the red flags. And it’s actually very helpful. I know we both do this even after. Let’s say a woman has
already had a heart attack or had a stent or something,
and they’re saying, “Well, how do I know if
this is gonna happen again? “What symptoms should I look out for? “Can I exercise?” They become very nervous,
obviously, for obvious reasons. And so we say the same thing again. Once we feel that everything’s
kind of compensated, we say, “You better start
exercising again and see.” Because what we really wanna know is a change from your
normal, functional routine. It may not be chest pain. It may just be fatigue
or shortness of breath. But if somebody says,
“Well, gee, normally I can “get on the treadmill for
30 minutes no problem, “and this past month I really get tired “after 10 minutes or 5 minutes,” we know something has come up. And they don’t necessarily
have to use the word chest pain or jaw pain, just something different. – So, when do you blow the symptoms off, and when do you go to the emergency room, or when do you go to urgent care? – That’s tough. (laughs)
– That’s tough. So, the first thing we always tell women is, one, know your numbers. So, get a baseline, good evaluation with your primary care provider. What’s your cholesterol? Do you have diabetes? How’s your blood pressure running? Is your weight normal? What’s your family history? Have an idea of, “You know what, “I’m actually a low-risk person.” “I’m an intermediate-risk person.” And then, again, I push this all the time. Get into a regular exercise program, okay? The reality is, people want to know, is this heart disease, or is this not? Well, there is no magic
bullet for diagnosis. In fact, we even know that stress tests don’t necessarily predict heart attacks. They help to restratify,
is this chest pain, is this cardiac, is this not cardiac? – What do you mean restratify?
– So, for example, when somebody will come in and say, “You know what, I want
a cardiovascular workup. “I wanna make sure my heart
is healthy or strong.” There’s several different
types of tests we can do. Obviously, we’ll do an EKG. Sometimes we’ll do an echocardiogram, which looks at the walls of the heart and the valves and the
structure and the function. And then sometimes we’ll
recommend a stress test. And even with stress
tests, there’s several different types depending
on what we’re looking for. And what I always tell patients is, the stress test, if it’s normal, gives us pretty good confidence in the 90 to 95% range that
maybe everything’s okay. But it can miss things. And actually, in women, it can miss things more often than in men. It can either miss something that’s there, or it can over-diagnose something. It can actually be at what
we call a false positive, where it makes it seem like
something there that’s not. And so what we have to do is put it in the context of what
Dr. Adams is saying. Well, does this person have
a strong family history? Do they have a lot of risk factors? Are these symptoms typical or atypical, kind of like the ones you had mentioned. – But acutely, though, acutely, listen to your woman’s intuition. – Absolutely. – If this is weird, if this is concerning, and so many patients will say, “I don’t know how to explain it. “This just doesn’t feel right.” That’s kind of your
Spidey sense going off. And you’re saying, “You know
what, let’s check this out.” – So, check it out, do you go to the ER? – Absolutely.
– Emergency room? Or you go to urgent care?
– Yeah, I think so. – Or is there– – I think it’s whatever’s closest to you, depending on what you’re feeling. If you’re saying, “Okay, I’ve had this “nagging ache for a couple months. “I wanna get it checked out.” You could maybe call your
doctor and see what they say. But if something’s new that feels scary and unusual to you, and
when you were asking, what do you blow off, we
actually say blow off nothing. If you really don’t
know, it’s something new and you don’t know what’s happening, we say either call 911,
go to the emergency room, have somebody drive you
there, whatever it is. – Yeah, ’cause there are
some acute blood tests that can be done to make sure that you’re not having an acute event, say, “Okay, nothing’s happening
right at this moment.” And then you can actually
continue with the workup. And then you can possibly do a stress test, even as an outpatient. It doesn’t necessarily mean you’re going to be admitted to the hospital. But women need to be aware
that changes in symptoms, they need to know their
numbers, they need to say, “These are new symptoms for me. “I don’t know what it is,
but I can’t explain it,” definitely get it checked out. – Okay. In just a couple of minutes,
we are gonna talk about the importance of brushing your teeth. – Very important.
– So, hold on to that thought for a couple of minutes. Talk about the role of
hormones and menopause in terms of women and heart disease. – Hot topic.
– Another tricky one. (laughs) – Well, hot topic.
– Somewhat controversial, too. – Well we definitely know
that after menopause, some very important
things happen with women. The blood pressure tends to go up. The good cholesterol drops. The bad cholesterol goes up. Our metabolism goes down. Weight tends to increase
– The worst-case scenario. I know, and then you feel bad. – That’s why after menopause, women tend to catch up with men in
regards of heart disease. Women are more likely to be diagnosed with heart disease post-menopausal,
a decade later than men. Now, there are gonna
be new recommendations coming out about hormone replacement. The consensus still is, we do not use hormones to prevent coronary disease. It’s far more complicated than just saying, “Estrogen is protective.” It’s the same thing, though. Exercise, know your numbers,
use hormone replacement therapy if you’re having side effects of menopause or you’re having
post-menopausal symptoms. – Yeah, knowing that it will probably be recommended to be a temporary thing. So, for example, the guidelines have changed on that throughout the years. There was a time where women were just using estrogen or progesterone because of menopause symptoms pretty liberally. And that’s changed more recently, because there’s been
some studies that suggest a possible increased risk of
stroke, possible blood clots. And the truth is, it’s not the same for every woman, as you could imagine. It depends on, is this somebody who’s had a lot of blood clots before? Is this somebody who’s had
cancers that run in the family? And so the recommendation would actually be different for different women as far as how much hormone replacement therapy they can actually take,
whether or not it’s safe. And so that makes it even more tricky, because a lot of women will
say, “Well, my neighbor’s “taking her whatever, and she feels great. “Can I take the same thing?” And the answer is, not necessarily. So that makes it tricky, too. – But also interestingly,
recently, just released in circulation, again,
a growing understanding of the association between breast cancer, particularly certain
breast cancer treatments, and an increased risk of
cardiovascular disease. So what we really want to impress upon women is, again, knowing your risk. If you had breast cancer and you had certain radiation therapies or certain chemotherapeutic agents,
that also may increase your overall cardiovascular risk. But this is what makes
it more complicated, because women are presenting at later ages with more comorbidities, meaning they have more risk factors. But again, typically with
higher pain thresholds, more difficult symptoms
to really ascertain, is this cardiac, is this non-cardiac. Women just need to say, “Hey,
I gotta get checked out.” – So, when you should you really start paying attention to your heart? – Oh, I love that question. So, I actually think it’s never too soon. And the reason is, A, you just wanna get into those good habits of establishing with a physician or healthcare provider and, like Adams says,
knowing your numbers, knowing your personal risk profile, which is very different than
your friend or your neighbor. But the other thing,
too, is, we focus a lot on heart disease, coronary disease. But that doesn’t actually
take into account all of the other things that could possibly be going on in
the cardiovascular system, blood pressure, arrhythmias, particular electrical
abnormalities, valvular issues. And those don’t necessarily always come on at later age or menopausal. Some of them are congenital. They can be there from birth. Some can develop in the 20s or 30s. And so I think that, I don’t know, just like you see a
pediatrician when you’re little, I think as people get
into their early 20s, it’s time to at least establish care. – Yeah, but very importantly–
– And then decide. – Pregnancy, though. So, we tell women, pregnancy
is a woman’s first stress test. So, we now know that women
who have preeclampsia, high blood pressure, even borderline high blood pressure during pregnancy. – Or gestational diabetes.
– Gestational diabetes. Even if those risk
factors completely go away after the delivery of the child, that increases your
risk of coronary disease 20 or 30 years down the road.
– Interesting. – So you kind of already
have the first glimpse of, “Hey, I’ve gotta get down
that lifestyle changes. “I’ve gotta get my numbers, because I know “that that’s the first glimpse
of a cardiovascular risk.” – Yeah, and if you think about it, at that point, let’s say
the women is pregnant, then the next several years are spent really focused on the child’s
health and the family. And so if something did
come up during pregnancy, if it resolves after, that’s– – Well, you don’t think about it. – Exactly, that’s a great–
– ‘Cause we put everybody else before ourselves.
– Time to ignore things, but not really.
– That’s your glimpse. And that’s why cardiovascular disease really should be more of
a preventative component. Once you have the heart attack,
once you have the stents, it’s really hard to reverse disease. What we’d prefer is that our culture shift towards preventing cardiovascular disease. – So, what are the questions
you should be asking yourself? – Oh. – Well, okay. So first of all–
– Firstly, there’s a few. – Yeah, so, do you know your numbers? – And by numbers, we mean, what’s your cholesterol–
– Cholesterol. – [Both] Blood pressure. – Waist circumference, okay? What’s my family history? And be specific. What age did Mom or Dad have
a heart attack or have stents? Okay? Am I a lifetime nonsmoker? Do I have any other, what we call inflammatory diseases,
lupus, rheumatoid arthritis? We now think that inflammation is a associated risk
factor of heart disease. So, we know key patients who have kinda chronic inflammatory
states are at increased risks. – And then, oh, sorry. – [Susan] No, go ahead. – The other thing, too, which we haven’t even talked about yet,
but I’m sure we will, is actually just regular old stress, just the daily stressors in life. Do you have a very stressful job? How do you cope with stress? Do you have symptoms
with stress or anxiety? Are you a caregiver for somebody, let’s say perhaps a
spouse or an aging parent? Those have actually been shown to contribute significantly,
just from the stress alone, the inflammation, the fact that it may keep somebody from exercising
or having a proper diet. – Yeah, we typically tend to
take poorer care of ourselves, poor sleep–
– And then take great care of someone else.
– Less diet, when we’re undergoing stress. And we know that traumatic events that have even occurred during
childhood or young adulthood, we do know that that
does increase the risk. – Well, and you talk
about traumatic events. They talk about women, “She
died of a broken heart.” – Yeah, yeah.
– But there’s actually a physical response–
– That’s a real thing. – To a traumatic event.
– Yeah. – Can you explain that?
– Absolutely. So, it’s actually called
Takotsubo cardiomyopathy. It’s got a Japanese name. It’s named after a octopus
trap, because that’s the shape that the heart takes when it happens. But really what’s happening is it’s purely a extreme stress response that causes a physiologic response in the body. So, for example, a woman, and it doesn’t have to be a woman, but it
is more common in women, will present with all the symptoms of a classic heart attack, chest pain, maybe shortness of breath, and they’ll go to the emergency room, and their EKG and maybe even their
lab work will indicate that they’re having a heart attack. But if you go and you look at their coronary arteries, they’re
actually wide open. There’s no obvious blockages. But if you look at the
shape of their heart, it will dilate a little
bit like that octopus trap. And it’s presumed that
that is a physiologic response to extreme stress
hormones circulating in the body. – It’s one of the greatest examples of the link between
the head and the heart. – Yes, and if you ask those
people, and like I said, it doesn’t have to be women,
but if you ask those people, “What happened to you?”
usually they’ll tell you something really severe,
like, “I had a really “bad car accident,” or, “My
spouse just passed away,” or, “I’m bankrupt,”
something very traumatizing. And the good news about that is, oftentimes, it actually does improve, and people can go
completely back to normal. But as Dr. Adams was
saying, it really highlights that somebody, just the
influence of stress alone, how damaging that can be to the heart. – Has an effect on the heart, absolutely. – So, let’s come back to this, because we teased this
a couple of minutes ago. Talk about the importance
of brushing your teeth. – Ha-ha. You mentioned the inflammation. And so it’s an area that, so
let’s just say that you’ve got gum disease or something
that you’re unaware of. You’ve got a chronic low-grade
amount of inflammation. That’s enough to cause a
systemic response in the body, similar to what Dr. Adams was referring to with lupus or other autoimmune issues. So that’s one big factor. And we’ve actually seen in people who have had coronary disease or stents before, sometimes if they’ve got poor dentition or a lot of inflammation in
the mouth or other areas, they tend to form scar faster within those stents that they already have. Not to mention, let’s say if somebody goes with an uncontrolled tooth infection or something for a while, it can actually increase the risk of endocarditis, which is infection on the heart valves. – [Susan] So you’ve got
bacteria in the mouth. – Yeah, and it can enter the bloodstream. And we see that actually quite often. – We do, and I think the
takeaway is that, again, we’re learning more and more about the risk factors of heart disease. It’s not always just cholesterol, diabetes, high blood pressure,
family history, smoking. There are newer, novel markers that are signs of chronic inflammation. Again, and going back
to people that we know have chronic inflammatory states, they have more aggressive
coronary disease, they have flares with their
inflammatory disease states. – Yeah, we do see that
a lot when they’re– – So, how do you reduce
inflammation in the body, then? – Exercise. So, exercise is what– – Yeah, and also what you put in. I mean, diet has a huge–
– Well, an anti-inflammatory diet, right? So, we really stress, and most of the anti-inflammatory diet
is also anti-cancer. It’s great for diabetes. But it’s getting rid
of those simple sugars, the white flour, the white
rice, the breads, the pastas, all the–
– We tend to say– – Empty calories, right. – The more packaging something comes in, probably it’s less good for
you, I know that’s, (laughs) the more little wrappers
and things you have to open. We’re big fans of kind
of whole, real foods where you can actually
understand what it is that you’re eating and recognizing where that food product came from. – Lots of fruits and
vegetables and greens, grains. All right. I mean, Scripps has opened
this new Women’s Heart Center. It’s heart care for women by women. There’s four female cardiologists. You are two of the four. Why is it important to have
a Women’s Heart Center? – [Poulina] Oh. – You know, again, because this is the disease of women in America right now. This is a highly preventable disease, but it happens to be the number-one killer of women in the United States. And we ignore care. We get less aggressive care, historically. We are involved in less research studies. – Yeah, I think that’s a really
important point, to bring up the awareness of that.
– We have different presentations. It needs to be part of our kinda public collective consciousness of saying, “This is a disease that I
can actually improve upon.” And you’re going to be taking
better care of your families if you understand your
own inherent disease. Women are always taking care of everyone. But women have to understand,
this is a woman’s disease. This is the disease that’s killing women in America right now. – So, what do you offer at
the Women’s Heart Center? – So, we offer the full spectrum, what we wanna say all of cardiac care. And we’ll take everybody. If somebody just wants to talk about, “Hey, I feel fine but I just wanna know, “what’s my baseline risk?” we’ll sit with them, we’ll figure it out, and we’ll determine if there’s any need to do any advanced testing or stress testing, some of
those things we talked about. So, we’re happy to take care of what we call primary prevention. But we’re all cardiologists,
board-certified in more than a couple of
things between all of us. And so we’ll do whatever they need. If somebody wants to come in, if they need a stent, if they need a pacemaker– – But specifically, the
heart center for women. We made it a very different
type of clinic experience. So, before you even come
in for your appointment, you’ve completed about an
11, 12-page questionnaire, which really gets to the
meat of, how is your health? What’s the family history? What are your other associated risks that a lotta women don’t
even know about yet. We ask about pregnancy. We ask about hormone therapy. We ask about breast cancer risk. So, by the time they
come into their visit, we’ve reviewed their entire, their medical chart.
– We already know them. And we discuss it with each other even before the patient comes in. – We’ve possibly ordered labs. The idea is a really comprehensive visit. So, these women who necessarily don’t need to see a cardiologist, but who just say, “I wanna know my overall risk. “I wanna better understand what I should “be looking for,” they
leave that visit knowing, “These are my numbers,
these are my goals,” right? “This is what I gotta look out for.” And maybe we’ll see them back in a year. – Or maybe we’ll see them back in a month, depending on what’s going on. – But it’s about knowledge. It’s about empowerment. It’s about letting women not be so anxious about heart disease, but really having a better understanding. – Yeah, also not being
afraid to come in and say, “You know what, maybe
I do have chest pain. “Maybe I do have coronary artery disease.” And that’s okay. And we actually have a support group that goes with it, as well, for women. And it meets once a
month in Rancho Bernardo. And so that’s there, as well. What we had talked about when we tried to create how we
want the office visit to go for the Women’s Heart Center, we said, we want them to leave
as an absolute expert on their overall health.
– Overall personal risk. – Yeah, it doesn’t even
just have to be cardiology. But just, what we don’t want
is somebody walking away saying, “I don’t know what my doctor said. “I don’t understand.” And unfortunately, we find that a lot, where people are intimidated
to ask their questions, or they think they
understand and they go home and they realize they actually didn’t really know what we were talking about. And so that was our goal, is for them to leave saying, “I totally get it. “I have a plan for the next
whatever, year, six months.” – Here’s my starting
point to lower my risk. – Exactly. So, like you said, they feel empowered, and they’re ready to make these changes. – [Susan] Knowledge is power. – [Christina] Absolutely. – Final thoughts? – Final thoughts. – Well, I think that
one of the things that, I think 2018 is turning out to be a year about women empowerment. We all know that. And there has been a lot of
rising consciousness about, what do women need to do for themselves? And I would encourage every woman in California and the
United States to really say, “You know what, this is the year “I’m gonna set some health goals. “I’m gonna work with my physician “to meet those health
goals, and I’m gonna feel “more empowered to say, you know what, “I’ll thank my cardiologist when “I’m 90 and I’m feeling fantastic.” But we wanna change the course of where this disease is going. Most heart disease, people
should know, is preventable. – Exactly, and I think that knowledge isn’t there, or maybe it’s becoming there. And the other thing,
too, as you were saying, I mean, it’s the time for women to not feel stigmatized or guilty or any of those things when
they take time for themselves, not be worried about what the label of a diagnosis is, but
to actually just learn, what are these terms we’re talking about, and then maybe even go on to teach it to their mothers or their
daughters so that it’s a cycle that just keeps going,
is what our hope is. – And if you have those
four symptoms in a cluster, tired, dizzy, neck pain,
jaw pain, indigestion? – [Christina] Get it checked out. – Go to the–
– Never blow it off, we say. – Get it checked out.
– You got it. – Get it checked out. – Maybe brush your teeth. (laughs) – Thank you both so much.
– Thanks, Susan. – Doctors Adams and
Uddin, we appreciate it. If you would like more information about women and heart disease and our Scripps Women’s Heart Center,
just click on the link. If you would like more health information, we take care of you from
head to toe at Scripps. So we urge you to please subscribe to our Scripps YouTube channel and also follow us on social
media at Scripps Health. I’m Susan Taylor. Thanks so much for joining us. It’s our mission at Scripps to help you heal, enhance, even save your life. (bright music)

One Reply to “San Diego Health: Women’s Heart Disease – Signs and Symptoms”

  1. Great video on preventable heart health! I haven't had a heart attack but i do have hypertension, My cardiologist doubled my valsartan in June and blood pressure still high, so cardiologist doubled it again, so now my dosage is quadrupled! A heart scan was done and showed i have a mild anyersm in my aorta but my Cardiologist said, not to worry about it there is nothing i can do! I also have high LDL but my HDL is very good. I just turned 60 years old and want to do all I can to prevent heart disease. I would love to be under your care but I live in Florida and Indiana:-(

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