"My Bra Feels Tight" - What Women Need To Know About Heart Attacks

By Tereza Hubkova, M.D.

"Bra feeling tight" or other vague discomfort in the chest, neck, or throat can be a symptom of heart attack in women. Nausea, burning, feeling flushed, lightheaded, short of breath, weak, or unusually tired can also signal heart attack—which is twice as fatal in women than their male counterparts.

Chest pain can be absent in as many as 43% of women having a heart attack. Because of this, women do not always seek timely help, and when they do, may be misdiagnosed. Women who will develop a heart attack often have more diffuse cholesterol plaques within the small arteries of the heart, which may be harder to diagnose as well as more difficult to treat.

Risk Factors for Heart Attacks in Women

• Age over 55,
• Family history (close blood male relatives with heart disease before age 55 or female relatives under age 65),
• Low HDL cholesterol,
• Total cholesterol over 265 mg/dl in younger women,
• Diabetes or pre-diabetes,
• Smoking,
• High blood pressure,
• Previous heart disease or its equivalent (e.g., stroke, peripheral arterial disease),
• Pre-eclampsia during pregnancy,
• Obesity,
• Sedentary lifestyle,
• Chronic kidney disease,
• Migraines, and
• Stress, isolation, and possibly depression

Additional markers of increased risk may be early menopause, low bone density, microalbumin (a type of protein) in the urine, elevated blood level of homocysteine or fibrinogen.

To Lower Risk of a Heart Attack

I encourage women to:

• Eat a healthy diet (i.e., Mediterranean diet with whole grains, nuts, seeds, fresh fruits and vegetables, organic poultry, fish low in mercury, olive oil, and at least 25 grams of fiber per day),
• Exercise at least 150 minutes per week at a moderate intensity, more if you need to lose weight,
• Maintain optimal weight (body composition is a better way to determine your optimal weight then Body Mass Index),
• Not smoke,
• Maintain a healthy work-life balance,
• Learn how to best deal with stress,
• Get enough quality sleep, and
• Treat any other risk factors accordingly.

Aspirin is no longer recommended to lower risk of heart attack, unless your risk is felt to be higher than the risk of ulcers, bleeding, and other possible complications of aspirin.

Statins may lower the risk of a heart attack in women with inflammation (i.e., elevated C-Reactive Protein or CRP) with or without high cholesterol, or are otherwise felt to be at high risk. If you take a statin, don't then slack on your diet and exercise (as many people do), and watch for possible side effects, including increased blood sugar, muscle aches, or cognitive decline.

Multiple studies have demonstrated a lower risk of heart disease in women using hormone replacement within ten years of menopause (or between the ages of 50 and 59). While not the right choice for every woman, I recommend women discuss this option, including all its pros and cons, with their trusted physicians.

Now excuse me, I need to get my 30 minutes of exercise for today... see you later.

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