Women's Heart Advisor January 2014 Issue

Ask The Doctors: January 2014 Women's Edition

Q. I read that about half of all heart attacks occur in those with “normal” cholesterol. Is this true, and if so, is there a way to assess my overall risk of having a heart attack based on my risk factors?

A. A cholesterol level that is “normal” by U.S. standards may still be high enough to contribute to hardening of the arteries and lead to a heart attack. A study published in the American Heart Journal (January 2009) showed that nearly 75 percent of patients hospitalized for a heart attack in the United States had cholesterol levels that would indicate they were not at high risk for a cardiovascular event.

Cholesterol levels are measured in milligrams (mg) of cholesterol per deciliter (dL) of blood in the United States and some other countries. Although a cholesterol level of less than 200 mg/dL is labeled “desirable,” the optimal cholesterol level is considerably below 150 mg/dL. Your cholesterol level is one of a group of risk factors that predicts risk for heart attack. For this reason, some people with “normal” cholesterol levels (less than 200 mg/dL) can suffer a heart attack. For example, for those who are age 50 with a cholesterol level that is below 200 mg/dL, the 40-year risk for developing a heart attack is about 40 percent for a man and about 20 percent for a woman. For people with cholesterol levels that are high (240 mg/dL or above), the long-term risk of a heart attack increases to approximately 60 percent in men and 40 percent in women.

Q. I am a 50-year-old woman who has had recurring chest pains. My doctor suspects these are angina attacks. How is angina different from a heart attack?

A. Angina is a recurring pain or discomfort in the chest that occurs when some part of the heart does not receive enough blood. Although an episode of angina is not a heart attack, those with angina may have a hard time telling the difference between angina and heart attack symptoms. Angina may feel like pressure or a squeezing pain in your chest. The pain may also occur in your shoulders, arms, neck, jaw or back. Angina may also feel like indigestion, which is a hallmark sign of a heart attack in women. Yet, angina is usually relieved within a few minutes by resting or by taking prescribed medication.
Because the symptoms of angina are similar to a heart attack, it’s important to be seen by your doctor for a complete physical exam to review your risk factors, including whether you have a family history of heart disease. There are several tests your doctor may order to help confirm you have angina, including: electrocardiogram, stress test, echocardiogram, nuclear stress test, chest X-ray, blood tests, coronary angiography, cardiac computerized tomography (CT) scan, and cardiac MRI.

Q. I’ve suffered from occasional panic attacks throughout the last 10 years. I thought my symptoms of sweating, shortness of breath and chest pain were a normal part of these attacks, but my doctor thinks I may have mitral valve prolapse. What is mitral valve prolapse?

A. Mitral valve prolapse is a condition in which the two valve flaps of the heart’s mitral valve don’t close smoothly or evenly. Also known as click-murmur syndrome, Barlow’s syndrome or floppy valve syndrome, mitral valve prolapse includes symptoms such as chest pain, dizziness, fatigue, heart palpitations and shortness of breath. Panic disorder, also called a panic attack, is the most frequently reported psychiatric syndrome associated with mitral valve prolapse syndrome. Panic attacks tend to last no more than 10 minutes, but they often seem to come “out of the blue.” Those who have mitral valve prolapse often experience the same symptoms as those related to a panic attack, including a “racing” heart, chest pains and breathing difficulties. To determine if it’s a panic disorder or mitral valve prolapse causing symptoms of a panic attack, your doctor will recommend an echocardiogram, which uses ultrasound to view the chambers of the heart.

Mitral valve prolapse is fairly common, and most cases are not dangerous, with more women than men diagnosed with the disorder. The good news is that once discovered, symptoms of mitral valve prolapse can be managed through avoiding caffeine, taking a daily, buffered 80 mg aspirin and quitting smoking. Your doctor may also prescribe a beta-blocker medication to help prevent irregular heartbeats or a prescription anticoagulant (blood thinner) to prevent your blood from clotting.

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