Self-Care With Dr. Shermaine: “Heart Disease: Signs, Symptoms, Treatments and Tips”

Heart Disease is the No. 1 Killer of U.S. men and women, accounting for 40% of all U.S. deaths! That's more than all forms of Cancer combined! Why is Heart Disease so Deadly? One reason is that many people are slow to seek help when symptoms arise. Yes, someone gripped by sudden chest pain probably knows to call 911. But heart symptoms aren't always intense or obvious, and they vary from person to person and according to gender. Because it can be hard to make sense of heart symptoms, doctors warn against ignoring possible warning signs, toughing them out, waiting to see if they go away, or being quick to blame them on heartburn, muscle soreness, or other less serious, non-cardiac causes. That's especially true for men and people over 65, as well as for people with other cardiac risk factors, such as high cholesterol or blood pressure, obesity, smoking, diabetes, or a family history of Heart Disease.

"The more risk factors you have, the higher the likelihood that a symptom means something is going on with your heart," says David Frid, MD, a cardiologist at the Cleveland Clinic. "People often don't want to admit that they're old enough or sick enough to have heart trouble. Putting off treatment for other medical problems might not be so bad, but a serious heart problem can mean sudden death. It's better to go in and get it evaluated than to be dead."

Here are a dozen symptoms that may signal heart trouble:

1. ANXIETY: Heart Attack can cause intense anxiety or a fear of death. Heart attack survivors often talk about having experienced a sense of "impending doom."

2. CHEST DISCOMFORT: Pain in the chest is the classic symptom of a Heart Attack, and "the No. 1 symptom that we typically look for," says Jean C. McSweeney, PhD, RN, Associate Dean for research at the University of Arkansas for Medical Sciences College of Nursing in Little Rock and a pioneer in research on heart symptoms in women. But not all Heart Attacks cause chest pain, and chest pain can stem from ailments that have nothing to do with the heart. Heart-related chest pain is often centered under the breastbone, perhaps a little to the left of center. The pain has been likened to "an elephant sitting on the chest," but it can also be an uncomfortable sensation of pressure, squeezing, or fullness. "It's not unusual for women to describe the pain as a minor ache," McSweeney says. "Some women say the pain wasn't bad enough even to take a Tylenol." Women, more so than men, can also experience a burning sensation in their chest, rather than a pressure or pain. "Sometimes people make the mistake of thinking that the pain comes from a stomach problem," says Nieca Goldberg, MD, Clinical Associate Professor of medicine at the NYU Langone Medical Center in New York City and another expert on women's heart symptoms.

3. COUGH: Persistent coughing or wheezing can be a symptom of heart failure -- a result of fluid accumulation in the lungs. In some cases, people with heart failure cough up bloody phlegm.

4. DIZZINESS: Heart Attacks can cause lightheadedness and loss of consciousness. So can potentially dangerous heart rhythm abnormalities known as Arrhythmias.

5. FATIGUE: Especially among women, unusual fatigue can occur during a Heart Attack as well as in the days and weeks leading up to one. And feeling tired all the time may be a symptom of heart failure. Of course, you can also feel tired or fatigued for other reasons. How can you tell heart-related fatigue from other types of fatigue? "If you don't feel well and all the wind is knocked out of your sails, don't try to figure it out on the Internet or from a book," says Goldberg. "Wasting time is dangerous."

6. NAUSEA OR LACK OF APPETITE: It's not uncommon for people to feel sick to their stomach or throw up during a Heart Attack. And abdominal swelling associated with heart failure can interfere with appetite.

7. PAIN IN OTHER PARTS OF THE BODY: In many Heart Attacks, pain begins in the chest and spreads to the shoulders, arms, elbows, back, neck, jaw, or abdomen. But sometimes there is no chest pain -- just pain in these other body areas. The pain might come and go. Men having a Heart Attack often feel pain in the left arm. In women, the pain is more likely to be felt in both arms, or between the shoulder blades.

8. RAPID OR IRREGULAR PULSE: Doctors say that there's nothing worrisome about an occasional skipped heartbeat. But a rapid or irregular pulse -- especially when accompanied by weakness, dizziness, or shortness of breath -- can be evidence of a Heart Attack, heart failure, or an arrhythmia. Left untreated, some arrhythmias can lead to stroke, heart failure, or sudden death.

9. SHORTNESS OF BREATH: People who feel winded at rest or with minimal exertion might have a pulmonary condition like asthma or chronic obstructive pulmonary disease (COPD). But breathlessness could also indicate a Heart Attack or heart failure. "Sometimes people having a Heart Attack don't have chest pressure or pain but feel extremely short of breath," Goldberg says. "It's like they've just run a marathon when they haven't even moved." During a Heart Attack, shortness of breath often accompanies chest discomfort, but it can also occur before or without chest discomfort.

10. SWEATING: Breaking out in a cold sweat is a common symptom of Heart Attack. "You might just be sitting in a chair when all of a sudden you are really sweating like you had just worked out," Frid says.

11. SWELLING: Heart failure can cause fluid to accumulate in the body. This can cause swelling (often in the feet, ankles, legs, or abdomen) as well as sudden weight gain and sometimes a loss of appetite.

12. WEAKNESS: In the days leading up to a Heart Attack, as well as during one, some people experience severe, unexplained weakness. "One woman told me it felt like she couldn't hold a piece of paper between her fingers," McSweeney says.

However, the BEST Advice of all: TALK TO YOUR DOCTOR CONSISTENTLY!

By David Freeman
WebMD Feature

Reviewed by Robert J. Bryg, MD

TIPS FOR AVOIDING HEART DISEASE:

SIMPLE STEPS TO LOWER CHOLESTEROL: Has your doctor said you have high cholesterol? Then you know you need to change your diet and lifestyle to lower cholesterol and your risk of heart disease. Even if your doctor prescribed a cholesterol drug to bring levels down, you'll still need to change your diet and become more active for cardiovascular health. These simple tips can help you keep cholesterol levels in check.

CHOLESTEROL, GOOD AND BAD: Your body needs a small amount of cholesterol to function properly. But we may get too much saturated fat and cholesterol in our diet -- and both raise levels of LDL "bad" cholesterol. LDL cholesterol can cause plaque to build up in arteries, leading to heart disease. HDL "good" cholesterol, on the other hand, helps clear bad cholesterol from your blood. You want to lower LDL cholesterol and raise HDL cholesterol, starting with your diet.

PORTION CONTROL: Lend a Hand: Most Americans eat super-sized meals, with portions that are twice the size recommended for good health. That can contribute to weight gain and high cholesterol. Here's an easy way to practice portion control for a meal: Use your hand. One serving of meat or fish is about what fits in the palm of your hand. One serving of fresh fruit is about the size of your fist. And a serving of cooked vegetables, rice, or pasta should fit in your cupped hand.

SERVE UP THE HEART-HEALTHY FOOD: Load your plate with fruits and vegetables -- five to nine servings a day -- to help lower LDL "bad" cholesterol. Antioxidants in these foods may provide the benefit. Or it may be that when we eat more fruits and veggies, we eat less fatty foods. Either way, you'll also help lower blood pressure and maintain a healthy weight. Foods enriched with plant sterols, such as some margarine spreads, yogurts, and other foods, can also help lower LDL cholesterol.

FOR HEART HEALTH, LOOK TO THE SEA: A heart-healthy diet has fish on the menu twice a week. Why? Fish is low in saturated fat and high in healthy omega-3 fatty acids. Omega-3 fatty acids help lower levels of triglycerides, a type of fat in the blood. They may also help lower cholesterol, slowing the growth of plaque in arteries. Go for fatty fish, such as salmon, tuna, trout, and sardines. Just don't drop the filets in the deep fryer -- you'll negate the health benefits.

START YOUR DAY WITH WHOLE GRAINS: A bowl of oatmeal or whole-grain cereal has benefits that last all day. The fiber and complex carbohydrates in whole grains help you feel fuller for longer, so you'll be less tempted to overeat at lunch. They also help reduce LDL "bad" cholesterol and can be an important part of your weight loss strategy. Other examples of whole grains include wild rice, popcorn, brown rice, barley, and whole-wheat flour.

GO NUTS FOR CARDIOVASCULAR HEALTH: Need a snack? A handful of nuts is a tasty treat that helps in lowering cholesterol. Nuts are high in monounsaturated fat, which lowers LDL "bad" cholesterol while leaving HDL "good" cholesterol intact. Several studies show that people who eat about an ounce of nuts a day have lower risk of heart disease. Nuts are high in fat and calories, so only eat a handful. And make sure they're not covered in sugar or chocolate.

UNSATURATED FATS PROTECT THE HEART: We all need a little fat in our diet -- about 25% to 35% of our daily calories. But the type of fat matters. Unsaturated fats -- like those found in canola, olive, and safflower oils -- help lower LDL "bad" cholesterol levels and may help raise HDL "good" cholesterol. Saturated fats -- like those found in butter and palm oil -- and trans fats raise LDL cholesterol. Even good fats have calories, so eat in moderation.

MORE BEANS, FEWER POTATOES: You need carbohydrates for energy, but some do your body more good than others. Whole grains, such as brown rice or quinoa, whole-wheat pasta, and beans have more fiber and raise sugar levels less. These help lower cholesterol and keep you feeling full longer. Other carbs, like those found in white bread, white potatoes, white rice, and pastries, boost blood sugar levels more quickly, leading you to feel hungry sooner, and may increase risk for overeating.

MOVE IT!: Even 30 minutes of physical activity five days a week (20 minutes three times a week for vigorous exercise, such as jogging) can help lower LDL cholesterol and raise HDL cholesterol -- although more exercise is even better. It also helps you maintain an ideal weight, reducing your chance of developing clogged arteries. You don't have to exercise for 30 minutes straight -- you can break it up into 10-minute increments.

WALK IT OFF: If you're not used to exercising -- or hate the thought of going to a gym -- just go for a walk. It's easy, healthy, and all you need is a good pair of shoes. Aerobic or cardiovascular exercise such as walking lowers risk of stroke and heart disease, helps you lose weight, and keeps bones strong. If you're just starting out, try a 10-minute walk and gradually build up from there.

WORK OUT WITHOUT GOING TO THE GYM: If exercise sounds like a dirty word to you, here's some good news: You can boost your heart health by incorporating physical activity into your day. Any kind of cardiovascular activity counts -- gardening, dancing, or taking the stairs instead of the elevator. Even housework can qualify as exercise -- as long as you're doing serious cleaning that gets your heart rate up and not just light dusting.

TAKE CHARGE OF YOUR HEALTH: If you have high cholesterol, you and your doctor may be using a number of strategies to lower cholesterol levels. You may be working on your diet, losing weight, exercising more, and maybe taking cholesterol drugs. There are other actions you can take, too, to make sure you stay on the right track.

WHAT TO DO WHEN EATING OUT: If you're eating healthy food at home to keep cholesterol in check, don't blow it when you eat out. Restaurant food can be loaded with saturated fat, calories, and sodium. Even healthy choices may come in super-size portions. Try these tips to stay on track:

Choose broiled, baked, steamed, and grilled foods -- not fried.
Get sauces on the side.
Practice portion control by asking for half your meal to be boxed up before it’s brought out.

LOOK FOR HIDDEN TRAPS: A close look at nutrition labels is essential for a low-cholesterol, heart-healthy diet. Try these tips:

Check serving sizes. The nutrition info may look good, but does the package contain two servings instead of one?
If it says "whole grain," read the ingredients. Whole wheat or whole grain should be the first one.
A food with "0 grams cholesterol" could still raise your LDL cholesterol. Saturated fat is the other culprit to watch for.

DON'T STRESS OUT: Chronic stress can raise blood pressure, adding to your risk of atherosclerosis, which occurs when plaque from cholesterol builds up in arteries. And research shows that for some people, stress might directly increase cholesterol levels. Reduce your stress levels with relaxation exercises, meditation, or biofeedback. Focus on your breathing and take deep, refreshing breaths. It's a simple stress-buster you can do anywhere.

WHEN LOSING MEANS WINNING: Losing weight is one of the best things you can do to fight cardiovascular disease. Being obese increases the risk of high cholesterol, high blood pressure, and type 2 diabetes. These all affect the lining of your arteries, making them more prone to collect plaque from cholesterol. Losing weight -- especially belly fat, which is linked to hardening of the arteries -- helps raise HDL "good" cholesterol and reduce LDL "bad" cholesterol.

FOLLOW YOUR DOCTOR'S ADVICE: Managing your cholesterol is a lifelong process. See your doctor regularly to keep tabs on your health. Follow your doctor's recommendations on diet, exercise, and medication. Working together, you and your doctor can lower your cholesterol levels and keep your heart going strong.

SURPRISING THINGS THAT HURT YOUR HEART:

GET THE HEART FACTS: You know that a bad diet and too little exercise can hurt your ticker. But there are lots of sneaky sources of heart disease that you may not be aware of. Here are some you need to know about, and heart-smart steps to help you keep healthy.

DENTAL PROBLEMS: Need extra motivation to brush and floss every day? People with gum disease are more likely to have heart disease, too. The connection isn’t clear, but some experts think bacteria from your gums may move into your bloodstream, leading to inflammation of the blood vessels and other heart problems. See your dentist every 6 months for checkups. Make an appointment right away if you spot redness or soreness on your gums, or changes in your teeth.

SHIFT WORK: Working at night or irregular hours raises your risk of a heart attack, according to a recent study from Western University in Canada. Researchers say shift work has a bad impact on the body's circadian rhythm (a.k.a. your "internal clock"), and they think that harms your heart. So if you don't work regular day hours, take extra steps to lower your risk of heart disease: Get exercise, eat a balanced diet, and see your doctor for regular checkups.

TRAFFIC DELAYS: Anyone who’s ever been stuck in bumper-to-bumper traffic will tell you it's stressful. That may be why research links spending a single hour in traffic to higher odds of having a heart attack. High noise levels -- like the kind you hear on a freeway -- are also linked to heart disease. If you can’t avoid traveling during rush hour, squash stress by listening to relaxing music. Or share the ride and chat with your fellow passenger.

EARLY MENOPAUSE: If you’re a woman and you go into menopause before you turn 46, your odds of having a heart attack or stroke may be twice as high as those who go through it later. A drop in estrogen, a hormone with ticker-friendly effects, may play a role. Ask your doctor to test you for heart disease risk factors (like high cholesterol).

SNORING: If your partner says you regularly snore or you sound like you’re gasping for air while sleeping, see your doctor. You might have a serious condition called apnea. It can happen when your airway is partially blocked and it causes you to have pauses in your breathing. The disorder is linked to high blood pressure, an irregular heartbeat, strokes, and heart failure. Treatments can help you breathe easier and lower your risk for heart disease, too.

HEPATITIS C: If you have this liver infection, you’re more likely to have low cholesterol and low blood pressure than people who don't have the disease. But even so, you still have a higher risk of heart disease. Researchers think hep C may cause inflammation of the body’s cells and tissues, including those in the heart. Work closely with your doctor to keep tabs on any heart symptoms.

NOT GETTING GOOD SLEEP: When you routinely get less than 6 hours of shut-eye a night, you raise your risk of higher blood pressure and cholesterol. It increases the odds you’ll become obese and get diabetes, too (both of which can hurt your heart). That doesn’t mean you should sleep your way through the day. When you spend more than 9 hours horizontal on a regular basis, it raises your odds of getting diabetes and having a stroke -- major risk factors for heart disease. Baby your brain, body, and heart -- aim for 7 to 9 hours of slumber a night.

AN UNHAPPY MARRIAGE: A good match makes your heart happy and healthy. Older adults who are content in their unions have a lower risk of heart disease than those who aren’t, according to a recent study from Michigan State University. The likely cause? Stress. When you’re stressed, you’re more likely to make bad diet choices and do other things that can hurt your ticker, like drink too much alcohol. What’s more, stress hormones may have a negative effect on the heart. So consider seeing a couples’ therapist or clergy member together if your marriage isn't a happy one.

LONELINESS: When you spend time with loved ones, it thwarts stress and helps you stay active. Lonely folks may be more likely to have heart disease. If you’re not near family or close friends, get connected by helping someone in need, or adopt a dog or cat. Volunteers and dog owners might enjoy better heart health and live longer, too.

BELLY FAT: Any extra weight is hard on your heart, but the kind around your midsection is especially dangerous. It may trigger your body to make hormones and other chemicals that can raise blood pressure and have a bad effect on your blood vessels and cholesterol levels. If you’re a woman and your waist is more than 35 inches around, or 40 inches if you’re a man, talk to your doctor about a diet and exercise plan. Research shows that yoga and short bursts of high-intensity exercise are great ways to whittle your middle.

TOO MUCH TUBE TIME: Couch potatoes, stand up! People who park themselves in front of the television a lot are more likely to get heart problems than those who limit their TV time. Every hour you spend watching TV on a daily basis may increase your risk by almost 20%. Sitting is the most likely culprit; it’s linked to problems like high blood pressure. Until researchers know how and why TV and heart trouble are connected, try to limit your time in front of the tube.

TOO MUCH EXERCISE ALL AT ONCE: Exercise is great for your heart. But if you’re out of shape or only work out occasionally, start slowly and build your endurance. When you exercise too long or too hard, it may put you at risk for heart attack and other problems, research shows. Not sure what’s safe for you? Start with a gentle exercise like walking. If you have a high risk of heart disease, talk to your doctor, and consider using a heart monitor while working out.

Reviewed by James Beckerman, MD, FACC

SOURCES:
American Academy of Cardiology: “Study Bolsters Link Between Heart Disease, Excessive Sitting” American Heart Association: “Sleep Apnea and Heart Disease, Stroke.” Boutcher, S., Journal of Obesity, November 2010. Butt, A., Clinical Infectious Diseases, [NO MONTH] 2009. The Cleveland Clinic: “Oral Health and Cardiovascular Disease.” Dahabreh, I.J., JAMA, March 2010. Dunstan, DW., Circulation, January 2010. Nieca Goldberg, M.D., medical director of the Joan H. Tisch Center for Women’s Health at New York University in New York City. Grandner, M., Sleep Medicine, January 2014. Halonen, J., European Heart Journal, June 2015. Harvard Medical School: “Belly Fat Can Signal an Unhealthy Heart,” “Why Having a Pet is Good For Your Health,” “Volunteering May Be Good for Your Body and Mind.” Lee, J.A., Menopause, April 2012. Liu, H., Journal of Health and Social Behavior, December 2014.

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