March 2006, SHAPE Magazine
Heart of the matter
By Khoo Bee Khim
Think keeping your heart healthy is all about managing cholesterol levels? There's more to it than that.
Breast cancer has long been a woman's biggest fear. But your heart health is something that you should be just as concerned about. After all, women make up 40 per cent of people here afflicted with heart disease. One local study also found that women are one-and-a-half times more likely to die of a heart attack than men.
That's because women seek medical treatment later and may be misdiagnosed by doctors because their symptoms tend to be atypical. Instead of the chest pain that men experience in a heart attack, women usually complain of shortness of breath, general weakness, unusual fatigue, cold sweat, dizziness, back pain or nausea - all of which sound more like an attack of the flu than a heart attack. As Dr Michael Lim, a cardiologist with the Singapore Heart, Stroke and Cancer Centre, says: "Women are under-treated."
More bad news: Women don't do well post-surgery. Female patients are twice as likely as men to die of a by-pass procedure because they have smaller coronary arteries, which makes operating on them more difficult. Even if they survive surgery, nearly half of them find that their quality of life is affected, says Dr Lim.
Tick, tick... boom!
So what puts you at risk? Your age, lifestyle, family history, and get this - whether you're still menstruating or not. Oestrogen, the hormone that controls your menstrual cycle, has a heart-protecting ability. However, once menopause sets in and oestrogen production dips, your risk goes up.
That doesn't mean your periods give full protection against heart disease. Pre-existing conditions such as high blood pressure and diabetes can cancel that out. In fact, diabetic women are twice as likely as men to have artery blockages. "A pre-menopausal woman's hormonal advantage is totally erased if she has diabetes," says Dr Lim. "In fact, her risk is now double that of a man's."
Watch your heart too if you're on birth control pills. You are more prone to developing blood clots (deep vein thrombosis) that can travel in the bloodstream and reach your heart.
Although the presence of other factors such as C-reactive protein (its thought to cause heart disease by increasing inflammation) and the amino acid homocysteine have recently been linked to heart disease, Dr Lim maintains that cholesterol still plays the biggest role in determining your risk. If you have a family history of high cholesterol, you'd be doing yourself a huge favour by passing on that plate of char kway teow.
"Low HDL (good cholesterol) and high triglyceride levels have a more significant effect in causing heart disease in women than men," says Dr Lim. "HDL alone is an independent factor for heart disease, especially in females."
However, keeping your cholesterol levels in check doesn't always cut it. Here are other conditions that could put you at risk when it comes to matters of the heart.
> in your 20s
Congenital heart disease
Do you tire easily or feel breathless often? You may have a hole in your heart. Some cases go undetected till a person is in her 20s. This is because heart murmurs (sounds made by blood moving round the heart) are hard for doctors to pick up. Echocardiography, which uses ultrasonic waves to obtain a picture of the heart's position, motion and internal parts, will be able to confirm this condition.
"If the hole is not big enough to cause a stressful flow of blood in the heart, it doesn't generally need to be closed," says Dr Lim. Such patients are put on life-long medication. However, if a hole needs to be patched up, there are various ways of doing so. "there are clamps called ASD closure devices that spring open to close the hole with a membrane," says Dr Lim. "Every year, 10 to 20 patients undergo this procedure."
Autoimmune diseases
These are cases of mistaken identity gone terribly wrong. Instead of turning against foreign matter entering the body (eg dust, pollen, bacteria, etc), the immune system attacks the very tissues and organs it is supposed to protect. Autoimmune diseases such as lupus and Takayasu's Disease occur for no apparent reason and seem to favour women in their 20s and 30s. In Takayasu's Disease, the blood vessels and arteries get inflamed and thicken. Lupus patients often suffer from inflammation of the muscle and lining of the heart.
They key to managing a heart problem caused by an autoimmune disease is to diagnose the problem and treat it as early as possible, says Dr Lim. But that's easier said than done. Nondescript symptoms such as fever, gradual loss of weight, joint pains and general fatigue allow many sufferers to slip through the diagnostic net. In fact, many women are diagnosed only in their 30s.
Stents may be required to open up blocked arteries in autoimmune disease patients. Often, treating the primary cause of the inflammation is enough to quell the heart problem. While such patients don't usually die from heart disease, internal bleeding caused by immune-system-damaged organs such as the brain, lungs and kidneys often leads to death.
Arrhythmia
That skipped heartbeat or fluttering sensation in your chest is not always romantically induced. Dr Ching Chi Keong, an associate consultant with the cardiology department at the National Heart Centre, says it may be arrhythmia, which is an irregular heartbeat. "It can be rapid, with a rate of more than 100 beats per minute (tachycardia) or a slow heart rate of less than 60 beats per minute (bradycardia)," he says. As a result of the rapid heart rate, the heart does not have enough time to fill with blood and it is unable to effectively pump blood to the rest of the body, explains, Dr Ching.
The causes of arrhythmia vary - from the use of decongestants for colds, inhaled aerosols for asthma, nicotine and caffeine to coronary artery disease, hypertension and high blood pressure. If you are experiencing heart palpitations for no apparent reason, see a doctor.
Treatment depends on the severity and frequency of recurrence. An electric shock delivered to the chest, called an electrical cardioversion, can normalise the heart rhythm. In cases that are life-threatening, an implantable cardioverter-defibrillator (ICD) is placed underneath the skin. "These devices constantly monitor the heart rhythm and deliver energy to the heart muscle to restore a normal rhythm," says Dr Ching.
> from your 30s onwards
Primary pulmonary hypertension
This occurs when blood is pulled to the right side of the heart and has difficulty flowing to the left and out to the rest of the body. The good news: it is a rare condition occurring in one per million. The bad news: women are three times more likely than men to get it, and doctors have no explanation for it.
What they do know is that while primary pulmonary hypertension is generally not genetic, six to 12 per cent of cases are inherited. See a doctor if you have symptoms such as shortness of breath, tiredness, swelling of the legs, palpitations, fainting spells and dizziness when climbing stairs and standing up.
"It is unfortunately a condition where the mortality rate is high," says Dr Lim. "Half the patients die within five years." New drugs are coming into the market but they're expensive. One cost-effective drug is Viagra, says Dr Lim. "Large doses are given to these patients. We don't know how it works exactly but it does. Perhaps Viagra's vessel-dilating ability improves the flow of blood in the heart."
Sudden cardiac arrest
You've heard of fit-for-marathon individuals who suddenly collapse while jogging and die. Why does that happen? Dr Teo Wee Siong, senior consultant at the National heart Centre's cardiology department, blames it on electrical chaos in the heart. "This results in the heart being unable to pump properly. And so, the heart 'freezes' and stops," he says. In 80 per cent of such cases, an area of the heart muscle dies or is permanently damaged because of an inadequate supply of oxygen to that area.
In mature victims, coronary heart disease is to blame. "Older women or women with a strong family history of heart disease should find out whether they may have risk factors such as hypertension, diabetes or hyperlipidemia (high fat level in the bloodstream)," says Dr Teo. "These factors may predispose high-risk women to heart disease, which is still the major cause of sudden cardiac death," he says. In young women, heart abnormalities may be the reason. Adrenaline released during intense physical or athletic activity often acts as a trigger for sudden death when these abnormalities are present.
"The immediate treatment is to shock the patient's heart rate back to the normal rhythm," says Dr Teo. "This must be done within 3 to 5 minutes, and definitely within 10 minutes. The chance of survival is virtually zero beyond 10 minutes.
Myocarditis
Watch that flu. It may have the potential to stop your heart. Myocarditis, or inflammation of the heart muscle, may be suspected if the symptoms appear within 6 weeks of an infection. It is most commonly brought on by viruses such as influenza, herpes, hepatitis and diphtheria, says Dr Lim Chong Hee, senior cardiothoracic surgeon with the department of cardiothoracic surgery at the National Heart Centre.
Reactions to medical treatments such as antibiotics, antihypertensives and radiation therapy, as well as environmental agents such as lead, arsenic and carbon monoxide can also cause myocarditis. Diseases that affect the immune system such as systemic lupus erythematosus (SLE), rheumatoid arthritis, and dermatomyositis are other culprits. Thankfully, it only affects less than one per cent of the population. What is worrying is that the flu-like symptoms, such as fever, muscle aches and fatigue, "tend to mask the sinister problem." says Dr Lim. Treatments are aimed at the complications (high blood pressure, fluid retention, palpitation) that arise rather that he disease itself. These vary from drugs such as calcium channel blockers, diuretics, angiotensin converting enzyme inhibitors to transplantation. |
