Women's Heart Advisor July 2013 Issue

Ask The Doctors: Women's 07/13

Q. I’ve just had a hysterectomy and my doctor is recommending I start estrogen therapy to manage my menopause symptoms, but I read that this may increase my risk of atrial fibrillation. Is it worth taking estrogen therapy if it can hurt my heart?

A. Atrial fibrillation (AF) is the most common chronic arrhythmia diagnosed in women, increasing in prevalence from 0.1 percent in those younger than 55 to 9.1 percent among those 85 years or older. There is growing evidence to suggest that sex hormones may play an important role in the impact of AF in women. The Women’s Health Initiative (WHI) postmenopausal hormone therapy (PHT) placebo-controlled trials randomized women who had not undergone hysterectomy to estrogen plus progestin (E+P trial) or estrogen only (E-alone trial) for women who had undergone a hysterectomy. After an average follow-up of 5.6 years, 323 women were diagnosed with new- onset AF in the E+P group, compared with 288 cases in the placebo group. Estrogen-alone therapy was associated with a significant increase in the diagnosis of new-onset AF. After combining the E+P and E-alone trials, the rate of incident AF was significantly higher for women on hormone therapy who also had diabetes at baseline, was age 70 to 79 years and had a body mass index above 30 kg/m2.

Results from these trials are the first to examine the relationship between PHT and the risk of AF and other cardiovascular events. Currently, we only recommend the use of hormone replacement therapy for a short duration of time to treat menopausal symptoms. Data from these studies on the link between AF and hormone therapy are interesting, but additional research is needed to determine the definitive connection between the increased risk and the best duration of treatment for postmenopausal women.

Q. I occasionally have symptoms of heartburn and/or another type of reflux, which seem to mimic those of a heart attack. How do I know when these symptoms are actually signs that I should seek medical care?

A. This is a good question, and one that women should understand. A pain or burning sensation in the chest could be indicative of a heart attack, or less life-threatening conditions such as heartburn. Anytime you experience new or unusual pains or other feelings in your chest, it’s important to seek medical attention.

The symptoms connected with a heart attack and heartburn has some differences, although it is often difficult to distinguish them. Typically, a heart attack feels like your chest is being squeezed or crushed and the pain often extends to the shoulder, back, throat, jaw, and arms. Most patients experience lightheadedness and have trouble catching their breath; some also have cold sweats and nausea. Not all heart attacks come on suddenly. In fact, most people diagnosed with a heart attack have had symptoms for a while, beginning with mild pain or discomfort. In some cases, the discomfort comes and goes for a while. If you have severe, crushing chest pain that lasts for more than a few minutes, or other symptoms of a heart attack, call 911 and get immediate medical help.

Heartburn does not actually involve your heart. The condition is called this because its symptoms are typically located in the chest. Heartburn is caused by small amounts of digestive acid escaping from the stomach and moving toward the throat, which irritates the esophagus, and produces the common “burning” feeling described by those who experience it. Other symptoms include a feeling as if small amounts of food or liquid are coming back up your throat, often causing a bitter or acidy taste.

The list below shows some differences between common symptoms of heart attack and heartburn:

Heart Attack:
- Chest discomfort in the center of the chest that lasts for more than a few minutes, or goes away and comes back. This can feel like uncomfortable pressure, squeezing, fullness, or pain.
- Discomfort in other areas of the upper body, including one or both arms, the back, neck, jaw, or stomach.
- Shortness of breath. Often comes along with chest discomfort, but can also occur before chest discomfort.
- Other symptoms. May include breaking out in a cold sweat, nausea, or light-headedness.

Burning, irritation below breastbone.
Usually occurs after meals
Gets worse when lying down    
Antacids will often make pain go away.

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