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chest pain

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Summer is often a time to enjoy the beach, barbecue or to simply catch up on outdoor chores. But with increased activity and heat, the summer sun can also be a trigger for chest pain, or angina. For those who have coronary artery disease, or at risk for developing the disease, those hazy, hot and humid days can be potentially life-threatening. With approximately 9 million patients in the U.S. having symptoms, angina is a serious condition occurring when there is reduced blood flow to the heart and can serve as a precursor to a future heart attack.

Robert Pyo, MD, Director, Interventional Cardiology and Medical Director, Structural Heart, at Stony Brook Heart Institute, offers some tips for protecting your heart during the summer heat.

Your Heart in the Heat

Sweating is one of the ways your body rids itself of excess heat. But as temperatures and humidity climbs, there’s so much water vapor in the air that sweating (evaporation) becomes increasingly difficult and your heart, in trying to cool your body down, winds up working overtime.

Further attempting to shed heat, your body reroutes blood flow from the warmer environment of your internal organs to the cooler surface of your skin, causing your heart to beat faster and pump harder and putting significantly more strain on not just your heart but on your lungs, kidneys and cardiovascular system. The higher the uptick in heat and humidity, the greater the burden on your heart and the greater the risk. In fact, on a hot day your heart may have to circulate two to four times as much blood each minute as it does on a cool day.

Beating the Heat and Protecting Your Heart 

Some easy but effective strategies for staying heart-safe this summer:

  • Keep cool. Stay indoors or in the shade as much as possible during peak sun hours of 10 a.m. to 4 p.m. Chilled air is the best way to cope with the heat. Cold compresses applied to your ‘pulse points’ — the areas where your veins are closest to your skin’s surface, including wrists, neck, temples and armpits — can assist in cooling down. Extreme exertion, whether in hot weather or not, can bring on angina.

  • Stay hydrated. Hydration helps the heart to more easily pump blood. Drink water before, during and after going outside in hot weather. Avoid caffeine and alcohol as both of these may increase dehydration. And, be mindful of sports drinks that may contain high amounts of caffeine and/or salt as they have the potential to place stress on the heart.

  • Eat water-rich foods. You get about 20 percent of your water from the foods you eat. A hot weather diet that emphasizes cold soups, salads and fruits can both satisfy hunger and provide extra fluid.

  • Protect your skin. Sunburn affects your body’s ability to cool down and increases dehydration. Wear a wide-brimmed hat, wraparound sunglasses, and lightweight, light-colored, loose-fitting clothing. Apply plenty of broad-spectrum or UVA/UVB protection sunscreen with SPF 30 or higher to all exposed skin 30 minutes before going out. Reapply every couple of hours.

Who’s At Risk for Heat-Induced Chest Pain? 

While anyone’s health can be at risk in extreme heat, soaring temperatures and humidity are particularly stressful for those who already have a weakened heart. In addition to individuals with cardiovascular disease, hot weather precautions are especially important if you’re an older adult, are overweight, have a history of high blood pressure, high cholesterol, diabetes, lung or kidney disease or stroke. Medications such as diuretics (water pills), beta blockers, antidepressants, antihistamines and decongestants may also make you more vulnerable to the heat. It is important to talk with your doctor to fully understand your individual risk factors and take precautions.

“If you’re experiencing chest pain symptoms, the Stony Brook Chest Pain Center is where you want to be,” says Dr. Pyo. “Our dedicated heart care specialists and state-of-the-art advances in critical protocols are a powerful combination that can save critical treatment time when it matters most.”

Making Every Minute Count 

The key to avoiding damage to your heart, is getting treated as quickly as possible. Angina is often the first symptom of heart disease, but in addition to chest pain, discomfort can also occur in such easy-to-ignore places as your shoulders, arms, neck, jaw, abdomen or back. Angina may even appear to be indigestion.

Although for some people their chest pain symptoms might be ongoing but stable for years, for others, there are no red flags at all — allowing blood flow to eventually become completely blocked and a heart attack to occur out of seemingly nowhere.

Don’t take chances with chest pain. If you or a loved one experience any red flag symptoms, don’t wait; call 9-1-1 and get help.

To see a Stony Brook chest pain specialist, call the Chest Pain Center at Stony Brook Heart Institute at (631) 44-HEART (444-3278).

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Chest pain remains the most common symptom in both men and women 

By David Dunaief, M.D.

Dr. David Dunaief

When we refer to heart disease, it is an umbrella term; heart attacks are one component. 

Fortunately, the incidence of heart attacks has decreased over the last several decades, as have deaths from heart attacks. However, there are still 790,000 heart attacks every year, and almost three-quarters of these are first heart attacks (1).

If you think someone is having a heart attack, call 911 as quickly as possible and have the patient chew an adult aspirin (325 mg) or four baby aspirins. While the Food and Drug Administration does not recommend aspirin for primary prevention of a heart attack, the use of aspirin here is for treatment of a potential heart attack, not prevention.

Heart attack symptoms

The main symptom is chest pain, which most people don’t have trouble recognizing. However, there are a number of other, more subtle, symptoms such as discomfort or pain in the jaw, neck, back, arms and epigastric, or upper abdominal areas. Others include nausea, shortness of breath, sweating, light-headedness and tachycardia (racing heart rate). One problem is that less than one-third of people know these other major symptoms (2). About 10 percent of patients present with atypical symptoms — without chest pain — according to one study (3).

It is not only difficult for the patient but also for the medical community, especially the emergency room, to determine who is having a heart attack. Fortunately, approximately 80 to 85 percent of chest pain sufferers are not having a heart attack. More likely, they have indigestion, reflux or other non-life-threatening ailments.

There has been a raging debate about whether men and women have different symptoms when it comes to heart attacks. Several studies speak to this topic.

Men vs. women

There is data showing that, although men have heart attacks more commonly, women are more likely to die from a heart attack (4). In a Swedish prospective (forward-looking) study, after having a heart attack, a significantly greater number of women died in hospital or near-term when compared to men. The women received reperfusion therapy, artery opening treatment that consisted of medications or invasive procedures, less often than the men.

However, recurrent heart attacks occurred at the same rate, regardless of sex. Both men and women had similar findings on an electrocardiogram; they both had what we call ST elevations. This was a study involving approximately 54,000 heart attack patients, with one-third of them being women.

One theory about why women are treated less aggressively when first presenting in the ER is that they have different and more subtle symptoms — even chest pain symptoms may be different. Women’s symptoms may include pain in the lower portion of the chest or upper portion of the abdomen, and they may have significantly less severe pain that could radiate or spread to the arms. But, is this true? Not according to several studies.

In one observational study, results showed that, though there were some subtle differences in chest pain, on the whole, when men and women presented with this main symptom, it was of a similar nature (5). There were 34 chest pain characteristic questions used to determine if a difference existed. These included location, quality or type of pain and duration. Of these, there was some small amount of divergence: The duration was shorter for a man (2 to 30 minutes), and pain subsided more for men than for women. The study included approximately 2,500 patients, all of whom had chest pain. The authors concluded that determination of heart attacks with chest pain symptoms should not factor in the sex of patients.

This trial involved an older population; patients were a median age of 70 for women and 59 for men, with more men having had a prior heart attack. The population difference was a conspicuous weakness of an otherwise solid study, since age and previous heart attack history are important factors.

In the GENESIS-PRAXY study, another observational study, but with a younger population, the median age of both men and women was 49. Results showed that chest pain remained the most prevalent presenting symptom in both men and women (6). However, of the patients who presented without distinct chest pain and with less specific EKG findings (non-ST elevations), significantly more were women than men. Those who did not have chest pain symptoms may have had some of the following symptoms: back discomfort, weakness, discomfort or pain in the throat, neck, right arm and/or shoulder, flushing, nausea, vomiting and headache.

If the patients did not have chest pain, regardless of sex, the symptoms were diffuse and nonspecific. The researchers were looking at acute coronary syndrome, which encompasses heart attacks. In this case, independent risk factors for disease not related to chest pain included both tachycardia (rapid heart rate) and being female. The authors concluded that there need to be better ways to calibrate non-chest pain symptoms.

Some studies imply that as much as 35 percent of patients do not present with chest pain as their primary complaint (7).

Let’s summarize

So what have we learned about heart attack symptoms? The simplest lessons are that most patients have chest pain, and that both men and women have similar types of chest pain. However, this is where the simplicity stops and the complexity begins. The percentage of patients who present without chest pain seems to vary significantly depending on the study — ranging from less than 10 percent to 35 percent.

Non-chest pain heart attacks have a bevy of diffuse symptoms, including obscure pain, nausea, shortness of breath and light-headedness. This is seen in both men and women, although it occurs more often in women. When it comes to heart attacks, suspicion should be based on the same symptoms for both sexes. Therefore, know the symptoms, for it may be your life or a loved one’s that depends on it.

References:

(1) cdc.gov. (2) MMWR. 2008;57:175–179. (3) Chest. 2004;126:461-469. (4) Int J Cardiol. 2013;168:1041-1047. (5) JAMA Intern Med. 2014 Feb. 1;174:241-249. (6) JAMA Intern Med. 2013;173:1863-1871. (7) JAMA. 2012;307:813-822.

Dr. David Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management. Visit www.medicalcompassmd.com.