Women's heart health

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Dr. Nieca Goldberg
Wednesday, November 24, 2010; 12:30 PM

heart health, women, heart disease

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New York, N.Y.: Do women feel pain differently than do men and, if so, does this affect how they may feel some painful warning signs of heart attacks?

Dr. Nieca Goldberg: Men and women do experience pain differently. Studies have shown that women have higher tolerance to pain. Heart attack symptoms can differ in men and women. Both men and women may experience chest pressure, a squeezing or pressure on the cest as though an elephant is sitting on the chest. Sometimes the heart attack symtom is severe shortness of breath, extreme fatigue, pressure in the upper back.Nieca Goldberg MD

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Heart Health for women: What role does stress play in heart issues. Sometimes I find myself worrying about worry?

Dr. Nieca Goldberg: Stress increases heart rate and blood pressure. It also raises levels of cortisol that leads to increased blood sugar. Although Stress is not considered as strong a risk factor as smoking, diabetes or high cholesterol. People who are stressed do not exercise regularly , sometimes smoke and eat an unhealthy diet.This is continuing research on the role of heart disease and stress. Relaxation exericises and aerobic exercise, reduces stress.

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Symptoms: I have read that the symptoms of a heart attack are different for a woman than for a man. Exactly what sudden conditions should cause concern?

Dr. Nieca Goldberg: The sudden onset of chest pressure ,shortness of breath, fainting, extreme exhaustion, a rapid and irregular pulse where you feel you are going to faint.

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one key thing?: Hey! Is there one key thing that everyone should do to improve heart health: 3 servings of whole grains a day, for example, or exercise most days, or something else? Also, I have read that salt is over-rated as a problem for most people. Thoughts? Thanks.

Dr. Nieca Goldberg: Salt is not overated, we all can do with a little less. The people who need to be concerned are those with high Blood pressure, kidney problems and heart failure.

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Tako-Tsubo Syndrome: Several years ago, after being under a great deal of stress, I felt very ill in the night. I had chest pains which went into neck and down left arm, nausea and diarrhea, at one point I was too weak to get out of my chair. I did not want to go to the ER in the middle of the night so my husband helped me back to bed. The next day I still felt terrible so he called the squad. They and the doctors at the ER said I had not had a heart attack. The squad paramedics were trying to jolly me along with "oh probably indigestion" or hyperventilation or panic attack -- NONE of which I have ever had in my life. I specifically asked my husband in the night how I was breathing and he said I was just breathing normally and quietly. I did not feel any sense of panic, although I knew something was very wrong. I later read about Tako-Tsubo Syndrome and wondered if this might have been what happened to me. Is it possible to test for this after the fact or is it so transient that once it's over, any evidence of it happening is gone? And what are the odds of it happening again? Does an incidence of TTS make a heart attack more likely? I am 57.

Dr. Nieca Goldberg: The diagnosis has to made at the time of symptoms. Sounds like you had 911 symptoms and it is best to call 911 and go to the hospital.

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Should I worry?: I am in my mid-50s, and on my mother's side of the family everyone died of heart disease, usually at about 70 but my first cousin died at age 45. My BP is good .. about 108 over 80, but last year my total cholesterol was 205, up from five years ago when it was about 160. My doctor said it was a function of aging. I'm not so sure. I try to be good ... moderate walking pace for 90 minutes a day, but I will chow down on the junk food in the office and am 10 pounds overweight (well maybe 15 ...). Should I be concerned, and if so, do I need more of a medical checkup than just blood test, or should I chill and focus on diet/exercise?

Dr. Nieca Goldberg: High cholesterol is a combination of what you inherit from your family and what you eat. Cholesterol goes up as we get old because of less activity and people are so busy they eat fast food on the run. The good news is that you want to make changes. I suggest you go to the doctor and have a lipid panel where you not only get your total cholesterol, but also levels of the good (HDL) and bad(LDL) cholesterol and triglcerides. It is also a good idea to get your glucose tested and blood pressure. You should have an ECG. Since you have a family history your doctor will advise you on further testing.

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Florida freakout: I'm a woman, 52, 5-9", 175, normal blood pressure & cholesterol @ 123. I swim 5 days a week. No smoking, no rx., no health issues at all. I used to feel great. I am so stressed out about our possible foreclosure that I am panicked most days, for hours. Year two of this with no end in sight. Is my heart health @ risk, based on this sustained very high stress?

Dr. Nieca Goldberg: It seems from your blood pressure and cholesterol your heart is handling this well. Keep up your exercise and healthy lifestyle as that is helping you prevent heart disease.Take careNieca Goldberg MD

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Low cholesterol: Can low cholesterol have a negative impact on the heart as well? My cholesterol was 120 the last time I had it checked, which is well below the baseline minimum.

Dr. Nieca Goldberg: Low cholesterol does not increse heart disease risk.

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Virginia: Do you believe long term use of birth control affects women's hearts?

Dr. Nieca Goldberg: Birth control pills can raise cholesterol and blood pressure. That is why it is important to get a check up before going on birth control pills. Birth control pills increase risk for blood clots in the legs and lungs. As for heart attack risk on birth control pills it is highest in women over 35 who smoke.

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When to start statins?: I'm 35, active, and thin, but like many in my family, I have very high cholesterol (200+ LDL). I've seen some recommendations that suggest I should start taking statins now, but I also hear that pre-menapausal women are at very low risk of heart attacks, so it seems strange to start taking drugs more than a decade before they are needed. I know you can't give specific recommendations, but what kind of questions should I ask when thinking about this?

Dr. Nieca Goldberg: Without meeting you I cannot comment on your specific care. There are things to consider before statin therapy is started .1. Is there a family history of high cholesterol>2. Is there anything else causing the increse in cholesteol such as an underactive thyroid gland, are you taking birth cintrol pills high in progestin or prednisone as these can increase LDL cholesterol3. Risk is not only based on age, but other risk factors such as family history,smoking or diabetes.4. Suggest having this discussion with your doctor.

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Krill Oil?: Do you have any thoughts on the advantage of taking Krill oil (or fish oil for that matter) capsules?

Dr. Nieca Goldberg: No advantage

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New York, N.Y.: Are there significant differences between the survival rates of women and men when having a heart attack, and do these rates vary at different stages of a heart attack?

Dr. Nieca Goldberg: In the first month after a heart attack women have a higher risk of dying compared to men.Although heart attacks are less common in women under 50. Women are 50% more likely to die compare to a man of the same age.This is why we we to educate young women on how they can prevent their first heart attack.


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