Are You About to Have A Heart Attack? 7 Heart Attack Signs Women -- And Doctors -- Often Miss

Conventional wisdom has it that heart attacks come out of the blue. We're also trained to expect a heart attack to happen a certain way: The victim clutches his chest, writhes in pain, and collapses. But for women, it often doesn't happen that way. Study after study shows heart attacks and heart disease are under-diagnosed in women, with the explanation being that they didn't have symptoms.

 

 

But research shows that's not the case. Women who've had heart attacks realize, looking back, that they experienced significant symptoms -- they just didn't recognize them as such.

 

In a study funded by the National Institutes of Health and published in Circulation: Journal of the American Heart Association, 95 percent of women (that's almost all!) who'd had heart attacks reported experiencing symptoms that were decidedly new or different from their previous experience a month or more before their attacks.

 

Even when a heart attack is occurring, women are often slow to realize what's happening and call a doctor. The reason? Women's heart attack symptoms are different than men's. This failure to recognize heart attack signs in women has led to a grim statistic: Women are more likely to die from sudden cardiac death than men are, and two thirds of women who have a heart attack don't recover completely.

 

To prevent a heart attack from sneaking up on you, watch for these 7 little-known signs of heart attack

  

 

6 Surprising Heart Attack Triggers—And How to Avoid Them

 

Heart attacks often come without warning, and although it's well documented that they're caused by atherosclerosis (plaque buildup on arterial walls), there are certain triggers that can set off a heart attack in people who are at risk. This week, Belgian researchers published a study in The Lancet ranking various heart attack triggers according to their prevalence in people who are already at risk for cardiac problems. Here's a list of some of their more surprising findings, and some ways to protect yourself from heart attack triggers:


#1: Traffic Exposure


Commuters beware: Traffic exposure triggers about 8 percent of heart attacks among those who are vulnerable, according to the study, and it can affect you if you're a driver, a passenger, or even a bicyclist riding along the road. Previous research on the link between traffic and heart attacks has been inconclusive as to whether it's traffic-related pollution, the stress of being in traffic, or some combination of the two that causes heart attacks. But the clear message is that getting stuck in rush-hour jams isn't good for anybody. Save your ticker and ask your boss if you can work from home one day a week. Telecommuters are healthier, past studies have shown, and they even work longer hours while still maintaining a better work-life balance than their colleagues in cubicles.

 

#2: Physical Exertion

Second on the list of heart attack triggers was physical exertion, accounting for just over 6 percent of cases. But they weren't talking about the good kind of exertion that comes from exercise. The study authors noted that people who are sedentary most of the time, and then suddenly engage in heavy-duty physical activity, are most at risk. The best protection against this is at least 150 minutes per week of regular exercise. But if you're already sedentary and need to, say, shovel out four feet of snow from a recent storm, be sure to warm up first, and delay the strenuous activity till later in the morning. Strenuous exercise first thing in the morning is a shock to your system and can up the risk of a heart attack.


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#3: Alcohol and Coffee

These drinks, whether to get you going or calm you down, each contribute 5 percent to total risk of triggering a heart attack. Heavy alcohol intake is the primary villain, although doctors aren't sure how it triggers heart attacks. A few theories are that too much alcohol can increase inflammation and interfere with your body's ability to dissolve blood clots. But keep in mind that one glass of wine or other alcoholic beverage per day can help prevent heart disease because of the beneficial polyphenols in wine and beer. Coffee, on the other hand, seems to work in exactly the opposite way. Most studies linking coffee to heart disease have found that people who drink it less frequently are more prone to heart attacks than people who drink a lot of coffee. So if you drink less than one cup of coffee per day, consider switching to tea to get your caffeine boost.

 

#4: Air Pollution

Smog, vehicle exhaust, and all those tiny particulates emitted by burning woodstoves all combine to form a potent, but silent, killer. Air pollution triggers 4.75 percent of heart attacks among those vulnerable, and even though it's one of the lowest percentages, the authors considered it most concerning because no one can avoid air pollution. For that reason, experts in a new field of medicine called environmental cardiology agree that preventing heart attacks in other ways is more effective than trying to cope on the individual level with air pollution. Minimize stress, treat migraines if you have them, don't eat red meat and salt, and do eat a Mediterranean diet. You'll protect yourself against air pollution and all the other heart attack triggers included in the study.


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#5: Feeling Happy and Feeling Mad

Strong emotions seem to trigger a heart attack even if they're good ones. Anger and negative emotions contribute more to your risk—almost 7 percent—than positive emotions, which contribute just 2.5 percent. "Both intense positive and intense negative emotions can cause stress to the body," says Jeffrey Rossman, PhD, director of Life Management at Canyon Ranch in Lenox, Massachusetts, and a Rodale.com advisor.


All strong emotions increase adrenaline output, heart rate, and the stickiness of red blood cells, which combined can trigger heart attack. But there's a reason you should still try to embrace more positive emotions to ward off heart attacks. "Positive emotions generally result in more balanced heart rhythms than negative emotions, and disrupted heart rhythms are a contributing factor in some heart attacks," Rossman says.


Furthermore, he adds, "Because we tend to resist negative emotions, they produce more muscle tension than positive emotions, including tension in the muscles in the periphery of blood vessels. This blood vessel constriction also makes negative emotions more likely than positive emotions to contribute to heart attacks."


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#6: Sex

Rounding out the top seven heart attack triggers is sex, which increases your chance of heart attack by 2.2 percent, the authors found. All that horizontal activity can raise blood pressure and heart rates, triggering a cardiac event. The various studies looking at the link between sex and heart attacks have all concluded that this risk is still relatively low for healthy people, somewhere around 1 chance in a million. But people already at risk for heart attacks should take it easy. The good news, according to a study in the Journal of the American Medical Association, is that regular exercise can keep you from succumbing to a sex-induced heart attack.

Caring

6 Surprising Heart Attack Triggers—And How to Avoid Them

 

Car owners with a television are 27 percent more likely to suffer heart attacks than people who have neither, according to a global study on physical exercise and heart disease published Wednesday.

More broadly, the study -- covering more than 29,000 people in 52 countries -- showed that working up a light sweat may be the best preventative medicine against heart failure.

Until now, surprisingly little research has focused on how physical exertion at work and play influences the incidence of heart attacks, and even less has directly compared this data across nations at all income levels.

"This study shows that mild to moderate physical activity at work, and any level of activity during leisure time, reduces the risk of heart attacks," said lead researcher Claes Held, a professor at Uppsala University in Sweden.

It also "extends previous findings of the protective effect of leisure-time physical activity ... to low- and middle-income countries."

Held and colleagues poured over data collected from 1999 to 2003 for the so-called Interheart study.

They compared one group of more than 10,000 middle-aged men and women who had had a single heart attack with an even larger cohort with no history of cardiovascular disease.

Pathway through the heart:

 

After depolarization and repolarization occur, the resulting electrical

 impulse travels through the heart along a pathway called the

 conduction system.

Impulses travel out from the SA node and through the internodal

 tracts and Bachmann’s bundle to the AV node. From there,

 they travel through the bundle of His, the bundle branches, and

 lastly to the Purkinje fibers.

 Setting the pace

 The SA node is located in the upper right corner of the right

 atrium, where the superior vena cava joins the atrial tissue mass.

 It’s the heart’s main pacemaker, generating impulses 60 to 100

 times per minute. When initiated, the impulses follow a specific

 path through the heart. They usually can’t flow backward

 because the cells can’t respond to a stimulus immediately after

 depolarization.

 

Bachmann’s bundle of nerves:

 Impulses from the SA node next travel through Bachmann’s bundle,

 tracts of tissue extending from the SA node to the left atrium.

 Impulses are thought to be transmitted throughout the right atrium

 through the anterior, middle, and posterior internodal tracts.

 Whether those tracts actually exist, however, is unclear. Impulse

 transmission through the right and left atria occurs so rapidly that

 the atria contract almost simultaneously.

 

AV: The slow node:

 The AV node, located in the inferior right atrium near the ostium

 of the coronary sinus, is responsible for delaying the impulses that

 reach it. Although the nodal tissue itself has no pacemaker cells,

 the tissue surrounding it (called junctional tissue) contains pacemaker

 cells that can fire at a rate of 40 to 60 times per minute.

 The AV node’s main function is to delay impulses by 0.04 second

 to keep the ventricles from contracting too quickly. This delay

 allows the ventricles to complete their filling phase as the atria

 contract. It also allows the cardiac muscle to stretch to its fullest

 for peak cardiac output.

 

Branch splitting:

 The bundle of His, a tract of tissue extending into the ventricles

 next to the interventricular septum, resumes the rapid conduction

 of the impulse through the ventricles. The bundle eventually divides

 into the right and left bundle branches.

 The right bundle branch extends down the right side of the

 interventricular septum and through the right ventricle. The left

 bundle branch extends down the left side of the interventricular

 septum and through the left ventricle.

 The left bundle branch then splits into two branches, or fasciculi:

 the left anterior fasciculus, which extends through the anterior

 portion of the left ventricle, and the left posterior fasciculus,

 which runs through the lateral and posterior portions of the left

 ventricle. Impulses travel much faster down the left bundle branch

 (which feeds the larger, thicker-walled left ventricle) than the

 right bundle branch (which feeds the smaller, thinner- walled right

 ventricle).

 The difference in the conduction speed allows both ventricles

 to contract simultaneously. The entire network of specialized

 nervous tissue that extends through the ventricles is known as the

 His-Purkinje system.

 

Those perky Purkinje fibers:

 Purkinje fibers extend from the bundle branches into the endocardium,

 deep into the myocardial tissue. These fibers conduct

 impulses rapidly through the muscle to assist in its depolarization

 and contraction.

 Purkinje fibers can also serve as a pacemaker and are able

 to discharge impulses at a rate of 20 to 40 times per minute,

 some times even more slowly. Purkinje fibers usually aren’t activated as a pacemaker

 unless conduction through the bundle of His becomes blocked or

 a higher pacemaker (SA or AV node) doesn’t generate an impulse

Heart Failure Symptoms

In the early stages of heart failure, symptoms may not be noticeable. Often people mistakenly overlook signs of fatigue and shortness of breath, dismissing them as temporary illness or simply as signs of growing older. As heart failure progresses, the symptoms often become more obvious. Everyday activities may be affected; going to the grocery store or walking up a flight of stairs can be exhausting. Eventually, it can become difficult to breathe even when relaxing or lying down.

Because of the heart's inability to effectively pump blood to your organs, such as the kidneys, the lungs and the brain, you may experience a number of symptoms, including:

Shortness of breath (SOB) (dyspnea)

Lack of energy, fatigue

Difficulty breathing while lying flat (orthopnea)

Swelling of the feet, ankles, legs or abdomen (edema, bloating)

Lack of appetite and nausea

Persistent cough or wheezing with white or pink blood-tinged mucus (productive sputum)

Confusion, memory loss or disorientation

Irregular or rapid heartbeat (tachycardia)