Health: Heart Signs


One of the keys to surviving a heart attack or stroke is recognizing that you are having one.

If you’re of a certain age, you’ve undoubtedly had that twinge of worry: Is that a gurgle of indigestion, or a chest pain? Is this sudden headache something minor, or something to worry about? What people tend to do is either rush to the emergency room, only to leave red-faced a few hours later, or pass off their symptoms as nothing to worry about and delay getting the treatment they need.

So, how do you really know if you’re having a heart attack or stroke?

“It’s really tough,” admits Steven Rose, M.D., chief of cardiology for Kaiser South Sacramento, “because indigestion or spasms of the esophagus can produce the same symptoms as a heart attack.” And similarly, every headache, every slight sense of vertigo, isn’t necessarily a stroke.

In order to tackle this tough issue, we talked with local experts and offer their advice here—for recognizing a cardiac event and preventing one in the first place.

Safe, Not Sorry

Remember TV’s Fred Sanford, that wily junkyard codger from the 1970s? He’d manipulate his grown son, you’ll recall, by clutching his chest, stumbling around and saying, “This is it—it’s the big one. I’m coming to you, Elizabeth.”

Granted, some heart attacks do present themselves in true Hollywood fashion. “If you have ‘an elephant sitting on your chest’ and shortness of breath, chew an aspirin and go to the ER,” says Michael Ingram, M.D., associate medical director of Sutter Heart & Vascular Institute. (Aspirin acts as an anti-clotting agent; chewing it gets it into your system faster than simply swallowing it.)

But sometimes, symptoms can be subtler, particularly for women. “Research has shown women having a heart attack more commonly have . . . sweating, breathlessness and fatigue,” says Amparo C. Villablanca, M.D., director of the Women’s Cardiovascular Medicine Program at UC Davis. “And when asked, they don’t characterize the chest pain as pain, but as ‘discomfort.’ Oftentimes, they don’t feel these symptoms are ‘bad enough’ [to see a doctor].”

Experts agree: It’s better to be safe than sorry. You should seek medical attention “if you’re concerned, if you have a family history [of heart disease], if you’re diabetic, if you smoke—and you’re experiencing dizziness and shortness of breath,” says Ingram.

Rose concurs, adding, “If a symptom lasts more than five minutes, particularly if it wakes you up, chew an aspirin and call 911.” He also suggests people pay attention to any psychological sense of dread or worry—it often accompanies a major life-
threatening event.

This is true for strokes, too, although stroke symptoms are usually more clear-cut: sudden headache, loss of vision or motor skills (particularly on one side), trouble with your coordination or speech. But the advice remains the same: Don’t mess around. Chew that aspirin and get to the hospital.

“Stroke is the No. 3 killer after heart disease and cancer,” says M. Asim Mahmood, M.D., regional director of neurovascular medicine for Mercy Healthcare. “And it’s the No. 2 killer for women. It’s historically more common in men, but women are more likely to die.” And, if given within three hours after the start of symptoms, a clot-busting drug called tissue plasminogen activator can reduce long-term disability for the most common type of stroke. So every second counts.

It’s also important to know that older folks aren’t the only ones vulnerable to stroke. “The most important risk factor is age,” says Mahmood. “After age 55, the risk of stroke doubles every decade. . . . But it can happen when people are younger.” Especially, he warns, if they have untreated or poorly controlled high blood pressure. “It’s easily the most significant modifiable risk factor,” he says. “It’s estimated if we could control blood pressure to recommended levels in the general population, we’d reduce the incidence of stroke by 40 percent.”

An Ounce of Prevention

To a cardiologist, a heart attack is a tragedy—made even more frustrating by the fact that it could, in nearly all cases, have been prevented. “If you have heart disease, it can end in three ways: You drop dead, you have a heart attack or you have heart catheterization,” says Ingram. “It’s so critical—this is curable stuff.”

It’s also diagnosable stuff—before the big one hits. You should “know your numbers,” according to Villablanca: your cholesterol levels, your blood pressure, your blood sugar and whether these numbers are normal. Other important tests that can give an accurate picture of your current cardiac health, Ingram suggests, include calcium scores, CT scanning, treadmill and nuclear testing—particularly if you have family history or significant risk factors.

Then there’s the issue of preventing heart disease altogether, which is not as pie in the sky as it sounds. A recent poll by the American Heart Association and the National Institutes of Health shows cardiovascular knowledge is up among women, says Villablanca. Forty percent of those polled know heart disease is the No. 1 killer of Americans and can accurately identify the risk factors. (This figure is double what it was several years ago.) However, “it isn’t clear how pertinent they think this is to themselves,” she cautions. “They may know high cholesterol is a risk factor but not know what their own cholesterol level is.”

On the other hand, a new study at Kaiser shows its Healthy Heart prevention program—with its focus on smoking cessation and controlling blood pressure, cholesterol and weight—is having a significant effect. “It’s a systemwide effort,” says Rose. “And the result has been a 30 percent drop in cardiovascular mortality for all the Northern California centers. That’s pretty dramatic.”

In fact, it’s these types of permanent lifestyle choices that can have the most preventative impact, say experts. “It’s not the steak and potato every now and then that’s the problem,” says Ingram, “but those bad choices we make on a regular basis.” In addition, he suggests taking a baby aspirin every day. “That’s a no-brainer,” he says, with virtually no downside. He also advises patients to see their dentists regularly. “The dirtiest place in the human body is the mouth,” he says, adding there is evidence that inflammation increases the risks of cardiovascular disease, and people with untreated periodontal disease have higher rates of inflammation.

The bottom line? Be pro-active: Know your risk factors, do what you can to mitigate them, and keep yourself in good overall health. Most importantly, don’t think it can’t happen to you. “None of us,” says Ingram, “is immune to this disease.”

Heart Attack Warning Signs

• Chest discomfort that lasts more than a few minutes or goes away and comes back
• Discomfort in other areas of the upper body: one or both arms, back, jaw, neck or stomach
• Shortness of breath, with or without chest discomfort
• Breaking out in a cold sweat, nausea or lightheadedness

Stroke Warning Signs

• Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
• Sudden confusion, trouble speaking or understanding
• Sudden trouble seeing out of one or both eyes
• Sudden trouble walking, dizziness, loss of balance or coordination
• Sudden, severe headache with no known cause

Source: American Heart Association

CPR Smarts

What, you may wonder, should you do if someone you love, or even just the guy next to you on light rail, keels over from cardiac arrest? Why, do CPR, of course.

CPR, or cardiopulmonary resuscitation, has been around for hundreds of years—at least. (Indeed, there is a scenario in the Old Testament that seems to describe an attempt at CPR. Medical articles from the 19th century and Boy Scouts manuals from the early 20th century give versions of it as well.)

For the past 50 years, CPR has included chest compressions and artificial respiration—or breathing into the person’s lungs. But this past March, the American Heart Association and the European Resuscitation Council reversed this advice, endorsing chest compressions alone as a more effective way to maintain oxygenated blood flow to major organs until the heart starts beating again.

Many professionals including physicians, nurses and teachers must be certified in CPR, but anyone can be trained in this life-saving technique. For local classes, contact the American Red Cross Sacramento Sierra Chapter by calling (916) 368-3131 or logging on to

A Broken Heart

At 52, Linda Souza was tired—all the time. “I’d get up at 6 a.m. after eight hours of sleep, take a shower and be just exhausted getting dressed,” says the real estate administrator and mother of two. “That didn’t seem right.” Throughout the past 10 years, she’d also had episodes of fainting and nausea, accompanied by shortness of breath and sweating.

But heart disease wasn’t on anyone’s mind. “I was a smoker for 33 years,” Souzasays, a habit she was struggling to break, and her lung capacity had her worried. “I kept chasing my [doctor], but he’d check my lungs and insist they sounded fine.”

Online at work one day, however, Souza found a study in the Bay Area that focused on early detection of lung cancer. Still convinced this could be her problem, she applied and was accepted. At the initial screening, during a CT scan of her upper body, doctors discovered a significant heart problem: stenosis of the aortic valve, which has a life expectancy, if left untreated, of about five years. Since no one could say how long she’d had this problem, time obviously was of the essence. “My life expectancy was decreasing every day,” she says. Back at Sutter Medical Center in Sacramento, she was booked for surgery before the week was out.

After an artificial valve replaced her damaged one this past May, Souza is, for all intents and purposes, cured. “But this was a fluke: If they hadn’t caught it, something disastrous would have happened to me very soon,” she says. “I likely wouldn’t be here.”

Souza now feels strongly about women and heart disease. “You know, being a woman, raising kids and telling them, ‘You’re going to be fine; it’s nothing,’ going through menopause—it’s easy to [ignore] symptoms,” she says. “So you really, really need to pay attention to your body, because heart symptoms can be very minor, very sporadic. And if you honestly know something is wrong, insist on getting the treatment you need.”