Women are living longer than ever before, so it is imperative that they maintain good health to enjoy their lives, their family and friends. Heart disease is well-recognised in men, but largely ignored in women. This can be dangerous as women lose the protective effects of their female hormones once they reach menopause. On average, the risk of heart disease is delayed by 10 years in a woman compared to a man. In addition, a woman’s experience of heart symptoms is usually different from that of a man’s. The textbooks have a bias towards the male experience of heart symptoms, such as chest pain. In heart disease, chest pain is due to narrowed or blocked blood vessels in the heart, leading to insufficient blood and oxygen reaching the heart muscle. This results in heart pain, and if severe, can result in a heart attack, which is always life-threatening. Men with heart pain (also known as “angina”) usually feel a severe central chest discomfort like an elephant sitting on the chest. However, women may not have the same sensation. They may feel sharp pain which feels like a muscle strain, or stomachache which feels like indigestion. This is often brushed aside as minor ailments as they feel they cannot afford to interrupt their busy schedules. In reality, they cannot afford to ignore any symptoms as the next time may be too late. There are accurate ways to diagnose heart disease nowadays, including non-invasive methods using ultrasound (which has no radiation). Heart disease that is not diagnosed or treated is like a time-bomb ticking away. Even if one survives from a heart attack, one may be left with heart failure.
Heart Failure is a problem which is becoming an epidemic worldwide and also in Singapore. The number of hospital admissions for all conditions in Singapore has been rising at 5% every year. However, Heart Failure admissions have been rising at 10% for the last few years. Heart Failure is a condition where the heart muscle is weakened, and cannot pump enough blood to the vital organs such as the brain, the kidneys, the liver, and muscles. The usual symptoms are difficulty breathing, decreased stamina when exercising, leg or abdominal swelling, and waking up at night feeling breathless. The most common cause is a previous heart attack, but there are other causes such as viral infections, diabetes, and hypertension. As the population ages, and in particular, as more women live longer, the occurrence of heart failure is rising exponentially. In older women with heart failure, the conventional tests used to diagnose heart failure may not be conclusive. This is because the type of Heart Failure they have is different – it is due to stiffening of the heart muscle. The heart can still pump blood out, but it is too stiff to fully relax. Relaxation of the heart is important to refill the heart with enough blood before the next contraction pumps blood to the body. A special ultrasound assessment of the heart as well as blood tests and sometimes a Right Heart Study is required to diagnose it accurately.
Palpitations are a common symptom that women face in Singapore. It may simply be due to anxiety and stress from our fast-paced lifestyle. It could also be due to excessive intake of coffee, tea, soft drinks, and energy drinks, which all contain substances which temporarily maintain alertness and energy but can cause the heart to beat too fast. Hormonal imbalance can also result in palpitations when the body produces too much thyroid hormone. Please do seek medical attention if you have palpitations, weight loss, irritability and/or bulging eyes. As women get older, the risk of high blood pressure (hypertension), heart disease and heart failure rises. In addition, the risk of Atrial Fibrillation rises. Atrial Fibrillation is a condition where the upper chambers of the heart no longer contract in a coordinated fashion with the lower chambers of the heart. Instead, the normal electrical signals controlling the heartbeat become chaotic, and result in the upper chambers shivering and shuddering. This results in an irregular, racing heartbeat, causing palpitations. Uncontrolled, this may lead to dizziness, fainting, heart attack, heart failure and even death. But one of the worst complications is stroke. As the heart no longer contracts properly, blood within the heart chambers can stagnate and solidify, forming clots. If a clot is pumped out into the brain, this will cause an immediate stroke. The brain is the most sensitive organ in the body. If blood supply is stopped, the brain cells start to die within minutes. Any brain damage is permanent. Brain damage due to interrupted blood supply is called a stroke. Minor symptoms include numbness and weakness on one side of the body, difficulty speaking or chewing food, and sometimes visual problems. Severe symptoms include paralysis of one side of the body and inability to speak. Fortunately, diagnosis of Atrial Fibrillation is easy, and there are many effective medications to prevent stroke nowadays.
Younger women commonly have iron deficiency due to menstrual blood loss. Older women may also have iron deficiency, but due to other reasons, such as inadequate diet, chronic disease, and specific diseases such as gastric ulcers or diverticular disease which lead to gastrointestinal bleeding. Recent studies show that having a normal blood count may mask low iron levels. Iron is required for blood production, but is also important in many of the body’s metabolic needs. In people with Heart Failure (Weak Heart), normal blood count, but low iron levels, restoring the iron level to normal dramatically improves their exercise capacity and quality of life. Absorption of iron from food and iron tablets is a slow process and it may take weeks to months for adequate replacement. Newer forms of intravenous iron are now available which are well-tolerated and allow a woman to replenish her iron level fully in 1 or 2 treatments, freeing her to return to an active and fulfilling life again.
When in doubt or if you suspect that you may be experiencing some of the symptoms mentioned here, always consult your doctor and let him help you take care of your heart.
Dr Daniel Yeo