Now that it\’s still early in the New Year, many of you (me too) are determined to change your current lifestyle to one that is healthier. And the first move you may make toward that goal is to get to the gym/personal trainer/dance class/yoga or Pilates instructor or to the exercise equipment store. But hold it just a second – isn\’t there something important you\’re forgetting?

In last month\’s column, Part I concerning your heart, I mentioned that if you haven\’t recently or ever had a physical exam, an EKG, and other cardiac tests your Healthcare provider thinks are necessary – you need to. The issue I didn\’t mention in that column was that of age. And the reason I didn\’t mention it was because I assumed that if you were reading this newsletter, then you were a member of this wonderful organization, and thus are a Baby Boomer and the “right” age to need the above-mentioned medical studies.

To be more specific, most physicians recommend that you have a baseline EKG around the age of 40, earlier if you have a significant family history of coronary heart disease (CHD) or other of the risk factors. If you\’re like me, you sometimes fall into the following trap when thinking about such recommendations, “I\’m not old enough to need that yet.” That\’s great if you do think that, as it means you\’re feeling energetic and young. But you definitely are old enough. So, if you haven\’t already, learn about your family history – especially about any first degree relatives with heart disease, and the age at which the signs of it first occurred. Then schedule that visit with your health care provider, preferably before you start fresh with a new exercise program.

Another reason for thinking you can put off an evaluation of your heart may be that you don\’t have any symptoms. What symptoms do you think heart disease causes? The most common answer will probably be chest pain, or a tightness, pressure, or squeezing sensation on the left side of your upper chest going to your jaw or down your left arm, occurring when doing an extremely strenuous activity. Or perhaps you\’ll say, chest discomfort accompanied by sweating, nausea, dizziness or palpitations. You\’d be right if you mentioned any of the above symptoms as classic for CHD. The important word in that last sentence is classic, or typical. But as you now know from last month\’s column, CHD in women is often misdiagnosed or overlooked because symptoms of this disease in women are often not typical. Put another way, symptoms of CHD in women are often not the same as those which are typical for men. Yes, women can have those “typical” symptoms, but oftentimes they do not.

What are some of the other symptoms of CHD in women? Upper abdominal pressure or discomfort, new onset back pain, or if you have back disease, back pain different from your usual, lower chest discomfort or burning, and unusual fatigue. Other symptoms of CHD that women (and sometimes men too) have include dizziness, nausea, new or unusual shortness of breath during everyday activities, chest discomfort or shortness of breath at rest. In addition, diabetics or very elderly people may get no symptoms at all, and still have severe CHD.

Many of you may have had some of the above symptoms once or briefly in the past, with no ill aftereffects. The important distinction is, that no matter which of the above symptoms you are experiencing, if it is recurring or lasting for more than just a few minutes, is new or different than your usual aches and pains, and doesn\’t go away like it routinely does with your usual remedy – whether that is taking an antacid like Maalox or sitting or lying down – then you must take it seriously.

What should you do if you experience the above sensations? If the symptom is persisting – no matter what you do to try to relieve it – for longer than a few minutes, that may indicate that you\’re having a heart attack.. What you do in this case is simple: you should call “911”. More specifically, the best time to get medical treatment is within six hours of the onset of the first symptoms of a heart attack. Many women say they feel stupid calling 911 or going to the ER because their symptoms are (choose one or more): 1) probably nothing 2) just a routine panic attack 3) caused by boring old indigestion 4) due to a pulled muscle from your earlier tennis game, or 5) due to a sore ribcage from coughing excessively.

Do NOT think like this. If you\’re right, and the symptoms are indicative of a simple and benign process, and you have gone to the ER and gotten evaluated, then what have you lost? Nothing. In other words, you found out that you were not having a heart attack.

But, if the symptoms are in fact due to a diseased heart, getting over your embarrassment and going to the ER may just save your life.

If your symptoms are recurring with activity and disappearing when you cease that activity, that may be a sign of angina, or heart disease, but not necessarily an immediate heart attack. In this case, you should see your provider as soon as possible. And if you\’re simply concerned about a new symptom or symptoms, then see your provider anyway.

The above discussion refers solely to coronary heart disease (CHD). There are other types of heart disease that women can get, though they are less common, and in many cases much less serious. These include: pericarditis – inflammation of the sac surrounding the heart, myocarditis – inflammation of the heart muscle itself, endocarditis – inflammation/infection of the heart valves and the lining of the heart, and arrhythmias – disruption in the heart\’s electrical conduction system leading to abnormal heart rhythm. All of these can be differentiated from CHD by a physical examination with appropriate tests. Equally as important, the other types of heart disease do not have the well- described risk factors which are preventable and/or modifiable.

The risk factors for CHD, as well as recommendations for how to change those factors which are modifiable, were listed in last month\’s column. The specifics of those suggestions are summarized here:

1) Find out about your family history – this includes knowing which relatives have heart disease and at what age they were first symptomatic, as well as which relatives have diabetes.

2) Have a complete health evaluation by your provider, especially to learn if you have high blood pressure, diabetes, or abnormal lipid levels (types of cholesterol, and triglycerides) or an abnormal EKG.

3) Correct any of those abnormalities listed in #2 – for instance, you may need to take a blood pressure medication or a lipid-lowering medication or a prescription to control your glucose.

4) Stop smoking now!

5) Start/continue a regular regimen of aerobic exercise- 3 hrs of walking per week, or about 30 minutes daily, has been shown in studies to reduce a woman\’s risk of a heart attack by 35%! You should not limit your type of exercise to aerobics only – do add in strengthening and flexibility/balance exercises as well.

6) Start/continue to eat a “heart healthy” diet – the best example of this is a Mediterranean-style diet which is rich in vegetables, whole grains, fish, and avoids processed foods, meats, saturated fats, and simple carbohydrates; based on what you eat, find out if you should take any nutritional supplements – vitamin and non-vitamin, including a daily aspirin.

7) Maintain an optimum body weight – find out what your body-mass index (BMI) is. The BMI is more accurate than weight alone.

8) Assess and try to reduce the stress in your life – for that stress which is unavoidable, learn better coping mechanisms in order to avoid suppressed anger and hostility, both risk factors for a heart attack, as is depression. Seek help if you think you have a depression, or if you\’re unable to cope with your anger and hostility.

9) Get in touch with your body in order to recognize new, or changing, symptoms – DO NOT BE EMBARASSED TO HAVE THE SYMPTOMS EVALUATED!

10) Remember – Once you\’ve reached Menopause, heart disease is not inevitable; you may control the development of heart disease by managing your risk factors. So in the words of the Nike advertisements, just DO IT!

Janet Horn, M.D. Physician