By Mehmet Oz and Michael Roizen

As a woman, you may feel that a heart attack is not the greatest risk you face. But the threat is very real, especially in the years leading up to and following menopause, when hormonal changes can open the door to heart disease. Knowing the symptoms that women often experience during the early stages of cardiac troubles, as well as your risk factors for cardiovascular disease, can significantly increase your chances of survival.

Cardiovascular disease (CVD) is the leading killer of women in America, accounting for over one-third of all deaths. That’s more than the combined death rates from breast, ovarian, and cervical cancers.

Heart Attack Warnings Can Be Subtle

Studies on cardiac events in women reveal that many women may experience prodromal — or early — symptoms of cardiac distress in the days, weeks, or even months leading up to a heart attack. Unfortunately, many of these signs may be dismissed as nothing out of the ordinary — by both women and their doctors. The most common early warning signs include:

Unusual fatigue — Fatigue is a common complaint and one that may indicate that you’re simply missing out on sleep, fighting a virus, overextending yourself, or experiencing a side effect to medication. But unusual or extreme fatigue may also be a warning sign of heart disease. In one study, more than 70% of the women surveyed experienced marked fatigue in the days or weeks prior to their heart attacks.

Sleep disturbances — Although it’s not unusual to feel tired due to a lack of sleep or a particularly demanding week or month, you should take special notice of any unusual or prolonged disturbance in your sleep patterns. A recent study revealed that almost half of the women who had recently suffered a heart attack also experienced sleep disturbances in the days or weeks leading up to their attacks.

Shortness of breath during normal daily activities, indigestion, and anxiety may also be early warning signs of cardiac distress in women.

So how do you know if your symptoms are serious? Getting into the habit of noting your typical aches and pains and your normal reactions to foods and activities may help you recognize when something is truly amiss. Also, remember that if you have risk factors for heart disease, you should be especially vigilant about monitoring how you feel. If you experience worrisome or unusual changes in your energy level, comfort, or sleep habits, you should discuss your concerns with your healthcare provider, particularly if you have heart disease risk factors, such as high blood pressure, high cholesterol, obesity, diabetes, a smoking habit, or a sedentary lifestyle.

Acute Symptoms in Women

Although chest pain is considered to be one of the classic signs of a heart attack in both women and men, the sudden, violent chest convulsions portrayed on TV or in movies may not be experienced by all women.

Fortunately, we now know of several more moderate signals a woman’s body sends to alert her that she is having a heart attack.

Severe chest pain may occur during a heart attack, but women also report pain or discomfort in other areas of the body before or during a heart attack. Pressure, tightness, aching, or burning in your upper back, neck, shoulders, and arms, or even in the jaw or throat can be signs of heart distress. Women have also described the discomfort as a sharpness, a fullness, or a tingling.

Shortness of breath, fatigue, stomach pain, cold sweats, dizziness, indigestion, or nausea also may occur during the acute phase of a heart attack.

Learning about the many different acute symptoms of heart attack can help ensure that you seek emergency care when you need it. Keep in mind that not all of these symptoms occur in every attack, and some symptoms may go away and then return.

Reduce Your Risk of Heart Attack

As a woman, after 40, your risk for coronary heart disease (CHD) starts to rise as your body stops producing estrogen naturally and your cholesterol levels increase. Although taking estrogen through hormone replacement therapy was initially thought to protect against CHD, clinical trials have found that it does not offer cardiac protection and may increase the risk of heart disease and ovarian and breast cancers.

So what can you do to protect your heart and reduce your risk of heart attack? Plenty.Controlling your cholesterol, blood pressure, and weight can greatly reduce your risk of heart attack.

Start with these seven steps:

1.                        Check your blood pressure regularly. If it’s high, and you are prescribed medication, take it exactly as directed, even if you feel fine.

2.                        Stop smoking, if you smoke ask your doctor for help.

3.                        Eat plenty of fresh fruits and vegetables, whole-grains, and low-fat dairy to get your daily dose of calcium, potassium, and magnesium.

4.                        Choose healthful unsaturated fats instead of saturated fat

5.                        Reduce stress levels at home and at work.

6.                        Limit your alcohol intake to no more than one glass per day.

7.                        Get 30 minutes of exercise every day, and keep your weight within healthy limits.

Don’t Ignore How You Feel

Research shows that women tend to ignore signs of illness or attribute their symptoms of cardiac distress to something else. If you are feeling unusual fatigue or pain and discomfort, don’t dismiss it. The fact that warning signs may occur as much as 1 month before an attack gives you valuable time to seek medical care that may save your life.

Heart Check

Get to know how your heart really works — and what it may be trying to tell you — with these tips


When you feel your own pulse pressing upward to your skin, what do you picture going on inside your body? Most of us picture the heart beating like a drum or like a ball being squeezed. But the heart really twists or wrings blood out like wringing water from a town, more than thumps. After that, it’s on to the rest of the body.

See, your heart is like the main hub in a subway system, the place through which all trains must travel. Your arteries and veins are the tracks and tunnels, which transport passengers (blood) to stations throughout your body.

Now, what happens if there’s a break in the tracks, or some kind of obstruction won’t let the trains get through? In the case of the subway, you’d have some pretty irate customers. And in your body, if the blockage goes on long enough, it could shut down vital organs. Yep, we’re talking total system failure.

To get a better idea of how things can go wrong, let’s take a look inside.

Aging Arteries

When your arteries are clear and uninjured, blood can easily flow through them. But several things can throw a wrench into this process, such as:

  • Nicks: Factors you can largely control, such as high blood sugar, high blood pressure, cigarette smoking, and high homocysteine, can nick the smooth inner layer of the arteries.
  • Clogs: When a nick forms, your body rushes to repair the wound with cholesterol. And in its zeal to heal, it slaps on the bad stuff (LDL cholesterol) like too much plaster over a hole. This triggers inflammation, which signals white cells to invade the area.
  • Clots: The resulting plaque becomes irritated and ruptures, which prompts a blood clot to form. And if the clot suddenly closes off the artery — Boom! It can cause a heart attack, a stroke, impotence, and memory loss.


About half of people with coronary artery disease also develop electrical problems. The effect is irregular heartbeats, like atrial fibrillation. The miracle of today’s medicine is that people prone to irregular rhythms can get an implant put into their chest that shocks the heart back to regular beats.

Leaky Plumbing

Heart valves keep blood from leaking backward into the chambers it has just left. The most common valve problem is mitral valve prolapse, in which the valve between the left atrium and left ventricle doesn’t slam shut fully. The faulty process irritates the nerves in the atrium, which in turn can cause palpitations and sweating. The condition can be treated with medicine, but most people end up outgrowing it.

Taking Control

The good news is that you don’t have to sit around and wait for stuff to go wrong inside your heart and arteries. There are things you can do right now to halt unnecessary aging and wear and tear.


7-Step Action Plan for a Healthy Heart


Check out this simple healthy-heart plan


When it comes to the health of your heart, what you do and what you don’t do can truly make a difference. That’s because lifestyle choices — like smoking, poor diet, and lack of exercise — can be far more dangerous than hereditary factors.

Here’s a step-by-step plan that will help you make smart choices and help get your ticker in top form.

Action 1: Pump Your Heart

For optimal health, you’ll need to do enough physical activity to burn between 3,500 and 6,500 calories a week (or roughly 500 to 950 a day). Most of that calorie loss comes from everyday tasks, but science shows that you’ll also need about 60 minutes a week of stamina training — cardiovascular exercise that gets your heart rate up and makes you breathe harder. Here’s what to do:

Action 2: Know Your Numbers


We’re talking the big three — cholesterol, blood pressure, and blood sugar — plus, two more you should probably know: homocysteine and C-reactive protein. Consider these numbers a stock ticker for your ticker. They tell you how you’re doing, and when you need to do more. When you have them measured, make sure your doctor also tells you what your goal levels should be and what you can do to get there. Getting more active, losing weight, and making smart food choices can help get these numbers in a healthy range.

Action 3: Get Happy


There are lots of reasons to be happy, including your heart health. Negative emotions like anger and hostility can raise blood pressure. People with depression are four times more likely to have a heart attack. And while we don’t understand how emotional stress causes physical stress, we do know there’s a powerful connection. To get yourself in a better mind-set, adopt a more positive outlook and manage daily stressors..

Action 4: Eat Your Heart Out


When making out your grocery list, follow this simple rule of thumb: opt for foods with healthful fats, fiber, and good-for-you nutrients like flavonoids, vitamins, and minerals. And nix the salty, sugary, sat-fat-laden, or processed stuff..

Action 5: Learn from Your Relatives


Even though you have a lot of control over your own heart-healthy destiny, a family history of heart disease does raise your risk significantly. So, along with talking to your doctor about a schedule of heart screenings, talk about your family health history, too. And if Mom, Dad, or a sibling developed heart disease, you’ll want to be extra vigilant about screenings and about adopting heart-smart habits.

Action 6: Pop Some Pills


Certain nutrients, supplements, and occasional medications can work preventive wonders for your heart. Here are the YOU Docs’ top picks:

  • Aspirin: Taking aspirin regularly may reduce the incidence of heart attack by making blood platelets less sticky and decreasing arterial inflammation. But it only makes sense for men over the age of 35 and women over the age of 40. And even then, check with your doctor first, because aspirin can have side effects like stomach irritation and bleeding. Here’s more on the benefits.
  • A multivitamin: Your multivitamin is chock-full of heart-healthy micronutrients, like magnesium, calcium, and vitamins D, C, E, and A..
  • Folate: This B vitamin lowers homocysteine to healthy levels. Since folate from food is only partially absorbed by your body, take a 400-microgram (folic acid) supplement. But make sure you’re getting enough B6 and B12, too, because folate can mask a deficiency in these vitamins.

Action 7: Schedule Sleep

If you don’t snooze 6 to 8 hours a night, you increase arterial aging and raise your risk of a heart attack. Inadequate sleep will also cause you to release less serotonin (the feel-good hormone) in your brain. The result: You may seek out other, less healthful ways to feel good, like noshing on sugary foods or tipping too many martinis..

Peace of Mind for Your Heart


Sometimes, the first signs of heart trouble are chest pain and shortness of breath. Sometimes, the first sign is a life-threatening heart attack or even sudden death. You’ve heard of people who are seemingly at the peak of life, relatively young, and fit, who are suddenly rushed to an emergency procedure such as heart bypass surgery.

What Can You Do for Peace of Mind?


Here are three steps you can take — and chances are you need not go beyond the first one:

1. Find out about your risk. First, take the Framingham Risk Assessment (scroll down for the link) to determine your risk of having a heart attack in the next 10 years. Chances are that you’ll do much better than average.

Cholesterol levels by themselves say very little. If you do not know your blood pressure or blood test values, call your doctor’s office.

You should get to know these values and what they mean.

If you experience symptoms of heart trouble or if you are concerned that you may have heart disease, skip the assessment and see your doctor right away.


Symptoms of Heart Trouble


Go to the hospital right away if you have:

  • Chest discomfort
  • Shortness of breath
  • Discomfort or pain in the upper body
  • Cold sweats, nausea, or light-headedness

2. If you are at elevated risk, consider talking to your doctor about screening options that are appropriate for your pattern of risk factors, including tests of blood lipids that predict heart disease and non-invasive cardiac imaging.

Recent research has given your doctor new tools to accurately determine what, if any, further diagnostic tests or treatments you might need. For example, traditional screening and diagnostic tests are complemented by new blood test measures such as Lp(a) lipoprotein, C-reactive protein, and plasma homocysteine. Even more on the cutting edge of science are two tests that can be quite predictive: apoB/apoA1 ratio; and Lp PLA2. Calcium deposits in coronary arteries can now be visualized with noninvasive tests. Results from these tests can help determine what preventive measures or treatments would be best for you or if any further diagnostic tests are needed.

3. If the results from the above tests suggest that you may have heart disease, your doctor may suggest that you undergo further testing such as a thallium stress test or cardiac catheterization to determine the extent of the disease.


The Good News


The good news is that coronary heart disease can be treated, and heart attacks can be prevented. There now are appropriate diagnostic measures and interventions to move you toward lower risk no matter what the stage of development. You have it in your power to avoid joining the roughly 300,000 people who suffer heart attacks each year before they have a chance to get a diagnosis. But it’s up to you to take the first step.


Go to the websites, below, to take the Cleveland Clinic Risk Assessment Test

Test Your 10-year Risk of Having a Heart Attack



Foods Your Heart Loves


If you think heart-healthy eating means bland, boring food, your taste buds are in for a shock. With a few smart and simple substitutions, you won’t even miss the unhealthy fats, salt, and extra calories making your heart old before its time. In fact, you can still eat some of the old standards if you modify them — and you’ll have new, delicious options to choose from as well.

Six Must-Eat Foods

To help prevent high cholesterol, high blood pressure, inflammation, and arterial aging, eat these delicious foods for your heart’s sake:

1. Strawberries — and just about any other colorful fruit or veggie you can find. Why? Because fruits and vegetables like red grapes, cranberries, oranges, plums, and tomatoes are bursting with flavonoids — antioxidants that help quell inflammation. And that’s a good thing, because inflammation is one of the many processes involved in heart disease. Eat them fresh — sliced or whole. What could be easier? Aim for 2 1/2 cups of vegetables and 2 cups of fruit a day. The highest antioxidant fruit on the planet is

the acai (pronounced “ah-sigh-EE”) berry, and it may beat every other fruit or vegetable by a mile. Case in point: The freeze-dried berry has 30 times the disease-arresting anthocyanins of red grapes.These berries are so nutritious, writes John La Puma, MD, author of ChefMD’s Big Book of Culinary Medicine, that they may help lower bad cholesterol, inhibit inflammation, and fight off arthritis. They may even have cancer-fighting powers. In a lab study, acai berry extract killed between 45 and 86 percent of a sample of human leukemia cells. The antioxidant quotient is reason enough to eat this fruit, but acai berries are also chock-full of B vitamins, magnesium, copper, zinc, phosphorus, and sulfur. In South America, acai berries are pureed and served warm as a sauce or soup. Check your local health-food store for acai juice, smoothies, and other products containing this berry nutritious fruit.


2. Rye bread — and any other grain product made from whole grains. Whole-grain breads and cereals, brown rice, quinoa, flaxseeds, and whole soybeans are full of heart-protective fiber and magnesium that can help keep your cholesterol and blood pressure in a healthy range. Try for six or more daily servings of whole grains..

3. Avocado — and other healthy vegetable-based fats. Use mashed avocado, olive oil, and nut butters in place of unhealthful fats. Mashed avocado makes a good sandwich spread if you mix it with a little salsa. And olive oil is a great butter substitute when you’re sauteing veggies. Use nut butters and peanut butter in place of butter and cream cheese. Substitutions like these are delicious ways to bring down “bad” LDL cholesterol and boost the “good” HDL kind. Just remember to limit portion size as you would with any other oils or fats.

4. Salmon — and other fish rich in omega-3 fatty acids. A strong body of research shows that eating fish (as long as it’s not fried) helps lower your risk of heart attack, stroke, arrhythmia, high triglycerides, arterial plaque buildup, and inflammation in your arteries. Opt for three portions per week of oily fish rich in heart-healthy omega-3 fatty acids.

5. Nuts — yep, not only do they make healthy nut butters, but they make a great snack, too. And eating nuts regularly can cut your risk of heart disease by 20% to 60%. Almonds, pistachios, and especially walnuts are loaded with heart-friendly fats and are a great source of vegetable protein. Just stick to one handful per day to keep your calorie count down.

6. Dark chocolate — see, you don’t have to avoid sweets entirely. In fact, a little dark chocolate every day is good for your heart..

Heart Cutbacks

As you add more heart-healthy items to your daily menu, you also need to curb the foods that age your heart. That means minimizing unhealthy saturated and trans fats, salt, and sugar. But as you can see by the list above, there’s no reason to be dismayed when you’ve got options like apple wedges with peanut butter, low-fat yogurt with raisins, crusty whole-grain breads, fresh berries, olives, veggies with hummus, savory salmon, and even a bit of dark chocolate now and then.