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Are You at Risk for a Heart Attack?

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Understanding a Woman's Heart

Beyond misinformation and miscommunication, inadequate diagnostics may also undermine young women's heart health, say experts. At 29, Tara Jacques had been seeing a cardiologist regularly and had a cardiac stress test to measure her heart's reaction to physical exertion -- which she passed. Nonetheless, she went on to have a heart attack. "I had three blocked arteries," she recalls. "Why didn't the test show that?"

It may be because women develop a different type of heart disease than men, says Dr. Steinbaum. "We're just now beginning to understand that microvascular disease, which strikes the heart's small arteries, is a significant problem in women, more so than in men," she says. While men may develop a single large plaque that clearly blocks an artery, in women the thickening is more diffuse and affects the entire inner, or endothelial, lining. "It narrows and stiffens the vessel throughout, so it's hard to pick up with conventional testing," explains Dr. Steinbaum. A calcium score test may help diagnose this problem. And if a seemingly fit woman is having trouble climbing a flight of stairs, it may indicate significant blockage. "It's the smaller arterioles -- the ones involved in microvascular disease -- that contract or relax in order to direct blood flow to working muscles," says C. Noel Bairey Merz, MD, director of the Women's Heart Center at Cedars-Sinai Medical Center in Los Angeles. "When the arteries become stiff, they lose the ability to increase blood flow and pump oxygen to the heart during exertion." If plaque is also present, the combination is a classic recipe for an attack.

Additionally, notes Dr. Goldberg, "the connection between the reproductive organs and heart health has been under-recognized." Unpredictable menstrual cycles may be due to obesity, which is a risk factor that can increase your chances of developing heart trouble. "If you have abnormal periods, your body may be producing less estrogen, a hormone that helps to keep coronary vessels elastic," explains Dr. Goldberg. "Stiff arteries are more susceptible to heart disease and heart attack."

Pregnancy can also be a trigger, since it leads to increased blood clotting, which ups heart-attack risk. In her second trimester, Julie Venables, 40, started having chest pain and difficulty breathing. She had to spend the last two months of her pregnancy hospitalized and was eventually diagnosed with mitral-valve stenosis, a narrowing of one of the valves in the heart that affects three times more women than men. Doctors believe that Venables probably developed the disease during an earlier bout of rheumatic fever, but it didn't cause problems until her heart was forced to help nourish an additional life. Other pregnancy complications, such as high blood pressure, preeclampsia (high blood pressure and swelling), eclampsia (high blood pressure with seizures or coma), and gestational diabetes, can also make you more vulnerable to future cardiac issues. "Doctors used to tell women that these conditions were pregnancy-specific and resolved once you gave birth," says Dr. Goldberg. "New research shows that they can have an impact years after the pregnancy and can increase your risk for early heart disease."

"If there's anything that I could tell women out there, it would be, 'Don't let anyone talk you out of your symptoms,'" says Roach. "In hindsight, I wish that I had pushed a little bit harder. I should have told my doctor, 'Okay, so the test came back clear -- I still need to get to the bottom of my symptoms,'" she says. "If I had only done that, then I wouldn't be sitting here telling you the story of my heart breaking -- literally."

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