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The Healthy Heart Handbooks for Women, Major Risk Factors

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	Women Who Have Heart Disease

If you have heart disease, it is extremely important to take steps to control your condition. this section explains the symptoms of heart disease, tests you may need, warning signs of a heart attack, and how to get emergency care.

Symptoms of Heart Disease

The first noticeable symptoms of coronary heart disease may be angina, which is a periodic pain or discomfort in the chest that is caused by reduced blood flow to the heart. This pain usually occurs behind the breastbone and may travel down your left arm or up your neck, or be a squeezing, pressing sensation that does not change with breathing. It is typically caused and worsened by exercise and eased by rest. The pain usually lasts 2 to 5 minutes.

Some women get a less typical angina. The chest pain may last longer, occur in a location other than behind the breastbone, or not be worsened by physical activity and eased by rest. Some women have shortness of breath or indigestion.

If you have any of these symptoms, you should contact your doctor. With treatment, the outlook is good. Without treatment, however, the symptoms may recur and worsen, and even lead to a heart attack.

DIAGNOSTIC TESTS

In most cases, you will need to have some tets to find out for sure whether you hace coronary heart disease, and also to find out how severe your condition is. If your doctor does not mention tests, be sure to ask him or her whether tests could be helpful. (See " You and Your doctor: A Healthy Partnership") To get complete information about your condition, you may need more than one test. Most of them are done outside the body and are painless. The most common tests are as follows:

*An electrocardiogram (ECG or EKG) makes a graph of the heart's electrical activity as it beats. This test can show abnormal heartbeats, heart muscle damage, blood flow problems in the coronary arteries, and heart enlargement.

*Stress test (or treadmill test or exercise ECG) records the heart's electrical activity during exercise, usually on a treadmill or exercise bicycle. Some older women may not be able to exercise due to arthritis or another condition. In such cases, a stress test can be done without exercise by using a medicine that increases blood flow to the heart muscle and shows if there are any problems in that flow.

*Echocardiography changes sound waves into pictures that show the heart's size, shape, and movement. The sound waves also can be used to see how much blood is pumped out by the heart when it contracts.

*A nuclear scan shows the working of the heart muscle as blood flows through the heart. A small amount of radioactive material is injected into a vein, usually in the arm, and a camera then records how much is taken up by the heart muscle.

*Coronary angiography (or angiogram or arteriography) shows an x-ray of blood flow problems and blockages in the coronary arteries. A thin, flexible tube, or catheter, is threaded through an artery of an arm or leg up into the heart. A fluid is then injected into the tube, allowing the heart and blood vessels to be filmed as the heart pumps. The picture is called an angiogram or arteriogram.

You and Your Doctor: a Healthy Partnership

If you have coronary heart disease, it is especially important to take an active role in your health care. That means giving as much information as you can about your condition to your physician, as well as making sure you understand all treatment decisions and procedures. Following are some tips to help ensure good, clear communication between you and your doctor:

* Be prepared. Before your office visit, make a list of your symptoms, past treatments, and any concerns or questions you may have. Also, bring a list of all medicines you are now taking.

* Be open. During the office visit, briefly describe each of your synptoms, including when each started, how often it happens, and if it has been getting worse. Also tell your doctor about any causes of stress in your life, such as taking care of a sick family member, or a difficult job situation.

* Ask questions. If you don't understand something your doctor says, ask for an explanation. Be sure you fully understand how to take any medication -- when to take it; how much to take; what to do if you forget a dose; what other medicine, food, or activity to avoid while taking it; and what side effects may occur. It may help to write down your doctor's instructions.

* Bring a support person. If you are worried about understanding what the doctor says, or if you have trouble hearing, bring a friend or relatrive with you to the physician's office. You may want to ask that person to write down the doctor's instructions for you.

* Speak up. If something bothers you, say so. Your doctor needs to know if a treatment is working or not, or if you are having trouble following his or her instructions. In some cases, simply getting more information from your physician may solve a problem. In other cases, your doctor may be able to recommend a different treatment or approach that works better for you.

* Ask about tests. If your physician recommends a diagnostic test, ask why you need it and what you will find out from it. Also ask what the test involves and how to get ready for it, and whether you will need help getting home afterward. Also, be sure to find out if the test has any risks or side effects. Remember that your doctor only recommends a test. The decision to take it is yours.

* Inquire about procedures. If your doctor recommends a special procedure, ask about its benefits and risks. Find out what kind of doctor will do the procedure and whether you will need a referral. Also ask if you will need to be hospitalized and for how long, what kind of pain or discomfort you may feel, and what the recovery period will involve. Just as with tests, the decision to have any medical procedure is up to you.

Heart Disease Medications

A healthy lifestyle will improve your heart's condition. But you may need medication too, especally if you have chest pain, or if you have high blood pressure or high blood cholesterol that was not lowered enough with lifestyle changes.

The following list will introduce you to some of the medications used to treat heart disease and its risk factors:

* Aspirin -- helps prevent heart attacks when taken regularly in a low dose on a doctor's orders.

* Digitalis -- makes the heart contract harder and is used when the heart's pumping function has been weakened; it also slows some fast heart rhythms.

* Angiotensin converting enzyme (ACE) inhibitor -- stops production of a chemical that makes blood vessels narrow and is used for high blood pressure and heart muscle that has been damaged.

* Beta-blocker -- reduces how hard the heart must work and is used for high blood pressure, chest pain, and to prevent a repeat heart attack.

* Nitrate (including nitroglycerine ) -- relaxes blood vessels and alleviates chest pain.

* Calcium-channel blocker (CCB) -- relaxes blood vessels; used for high blood pressure and chest pain.

* Diuretic -- decreases fluid in the body and is used for high blood pressure.

* Blood cholesterol-lowering agents -- HMG CoA reductase inhibitors (or "statins"), nicotinic acid, bile acid sequestrants, fibric acid derivatives, an probucol.

Warning Signs of a Heart Attack

If you have heart disease, you should know the symptoms of a heart attack so that you can get immediate medical help. Not all heart attacks begin with sudden, crushing chest pain, the way they are so often shown in the movies and on TV. Instead, the most common warning signal are:

* Pain of discomfort in the center of the chest that lasts more than a few minutes, or goes away and comes back.

* Pain that spreads from the chest to the arm, neck, or jaw.

* Chest discomfort with sweating, shortness of breath, tiredness, or upset stomach. These last three symptoms are particularly common in women.

Immediate Self-Help

If you experience heart attack symptoms and are taking nitroglycerin medication, take one nitroglycerin tablet as soon as you feel discomfort, a second tablet if the discomfort does not go away in 5 minutes, and a third tablet after 5 more minutes if you are still experiencing symptoms.

In addition, you should chew one adult-strength (325 mg) uncoated aspirin. Whether or not you have been prescribed nitroglycerin, you should take one aspirin. If the symptoms stop, call your doctor immediately for further advice. If symptoms continue, dial 9-1-1.

Getting Emergency Care -- A Must

If the above medications do not relieve your discomfort within 15 minutes, get to the hospital fast. Be sure you know the phone number to call for emergency transportation. This is the best way to get to the hospital if you could be having a heart attack. In many areas, the emergency number will be 9-1-1; in other areas, it will be a 7-digit emergency number. (For more information on what to do in case of a heart attack, see "Steps for Survival")

Medical science now offers treatments that can stop heart attacks in their tracks if the treatments are given very quickly after the attack begins. These new treatments include "clot-dissolving" drugs or coronary angioplasty (aslo called balloon angioplasty) to reopen the clogged blood vessel that has cut off the oxygen supply to the heart. These treatments save lives and reduce damage to the heart muscle -- but only if they are given immediately.

New research shows that clot-dissolving medicine also can be used to treat a stroke. But once again, it must be used quickly in order to be effective. That means if you have stroke symptoms, you should get emergency help immediately. Warning signs for stroke include weakness or numbness in the face, arm, hand, leg, or foot; sudden blurred vision; difficulty speaking; and sudden dizziness or loss of coordination.

Steps for Survival

WHAT TO DO IF YOU MIGHT BE HAVING A HEART ATTACK

Nobody plans to have a heart attack. But just as many people have a plan to follow in case of fire, it is a good idea to have a plan to deal with a possible heart attack. Knowing what to do can save your life. Fill out this form and make several copies of it. Keep one copy near a phone at home, another at work, and a third copy in your purse.

WHAT TO DO AHEAD OF TIME

1. Discuss heart attack symptoms and what you plan to do in case of a heart attack with your doctor, family, coworkers, and friends. Tell others howthey can help you if you have symptoms (for example, help you with your medication or call 9-1-1 for you).

2. Make a list of all your medications and how often you take each one. This list would be valuable information to the emergency department doctor or nurse.

Medication _______________ How much/how often? _____________

3. Know the location of the nearest 24-hour emergency department.

* At home, the closest emergency department is ____________________

* At work, the closest emergency department is ____________________

4. Know who should be notified in case of emergency.

Notify ________________ at these phone numbers:

Home _______________ Office __________________

WHAT TO DO IF YOU HAVE HEART ATTACK SYMPTOMS

1. What you may feel: Chest pain or discomfort, left arm pain, pain radiating to your neck or jaw, sweating, shortness of breath, upset stomach, tiredness.

2. Take medication right away.

* Chew one adult-strength (325 mg) tablet of uncoated aspirin.

* If you have been prescribed nitroglycerin, place one tablet under your tongue immediately. Take a second tablet if the discomfort doesn't stop in 5 minutes. Take a third tablet after 5 more minutes if the discomfort still hasn't gone away. If the symptoms do stop, call your doctor at this phone number: _______________

3. Call for emergency transportation if symptoms continue for more than 15 minutes.

* At home, the emergency phone number is ____________________

* At work, the emergency phone number is ____________________

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