Search for tag: "heart attack"

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Mitch: The turning point, a point break, an aha moment. That final moment in time where the status quo has become unsustainable and we know we must finally make a change.

We've all experienced that kind of experience in our lives at one point or another. And when it comes to the turning point in our health, it can be as tame as looking into the mirror at that bit of growing belly fat and changing one's diet to a bit of blood work that leads to changing your activity level. But in some cases, something a little bit more serious can happen. And today, we'll be talking with one of our listeners who just recently experienced one heck of a turning point.

This is "Who Cares about Men's Health," where we aim to give you a little inspiration, motivation, and perhaps a different interpretation of your health. I'm Producer Mitch, and bringing the BS as always is Scot Singpiel.

Scot: Man, I love these turning point stories because I think we all can learn from them. So I look forward to hearing what Robb's is.

Mitch: I know, and it's been a while since we've done one of these, so it's kind of exciting. And bringing the MD to our trio is Dr. Troy Madsen. How are you today, Troy?

Troy: Doing well, Mitch.

Mitch: And joining us today is my friend and listener, Robb. Hey there, Robb. How are you doing today?

Robb: Hey. I'm really good, Mitch. Thank you very much.

Mitch: Now, Robb, before we get into your turning point, I want to get a little bit about you kind of before that, maybe ask how old you are.

Robb: Yeah, I am 51.

Mitch: Great. And what do you do for work?

Robb: I am a marketing director actually, manage an in-house creative agency for the company I work for. Been doing that actually for decades, but a new company starting about two and a half years ago.

Mitch: On a day-to-day, is your work really stressful? Do you end up sitting around a lot? Just trying to figure out how is your health in relationship to your work?

Robb: Yeah, I have always had pretty high-stress jobs, high-stress positions. I've found myself usually working . . . A 40-hour workweek is not a thing for me.

Mitch: It's like vacation.

Robb: Yeah, exactly. I mean, I've always worked 50-plus hours a week. I don't work as long hours or days as I used to maybe 10, 15 years ago, but it's still a 50-, 55-hour week.

Mitch: And here on "Who Cares," we have a thing called the Core Four. It's the four things that if you really have tuned in, you'll have a healthy life. And so I just want to check in. You're a handsome fit guy. You look really good for your age.

Robb: Well, thank you.

Mitch: You're welcome. Because it's an audio medium, I'm trying to draw totally a picture here, right? Okay. So how would you say your activity is day-to-day?

Robb: Before or after?

Mitch: Before. Let's talk before.

Robb: Yeah. So even though, again, I work a lot . . . I enjoy what I do, by the way. But I'd still find time before, in the evenings, to go to the gym, to run. Years ago, I meditated and I practiced yoga, and honestly stopped that about seven years ago. But still tried to stay active. I enjoy hiking during the winter here in Utah. One of the reasons I moved here from Florida seven years ago was for the skiing. So I've always been active from my late teens, early 20s through where I am today. Yeah, I'm very active. Try to do something outside active about five, six days a week.

Mitch: Wow. That's more than I do. And how about your nutrition? What's your diet like? Is it pretty healthy or eating burgers every day?

Robb: Yeah, again, that's something . . . I think pretty healthy. I will say that it's healthier now. But yeah, there were a few years where . . . I was a vegetarian for maybe three to four years. And that was maybe, in terms of nutrition, the healthiest that I've ever been.

But yeah, I still would go out to eat maybe a couple times a week, but I tried to eat at home more often and as many fresh fruits, vegetables as possible. Was it perfect? Absolutely not. But I thought that my diet was pretty decent as well.

Mitch: How about sleep? Get usual, pretty good, eight hours?

Robb: Sleep is almost one thing that I protect somewhat rapidly I think for my sake, but also for other people's sake. If I don't get seven and a half hours of sleep a night . . . I can go lighter from time to time, but I get a little bit nasty, a little bit testy. And I've even had partners in the past and even family members who have expressed beyond envy, even jealousy at how well I sleep. I'm seven and a half to eight hours a night and I sleep soundly also.

Mitch: Ugh.

Robb: Yeah, I know. It's gross.

Mitch: I'm jealous.

Troy: Robb, you're scaring me because I know where this is going. Our listeners don't know yet where this is going, but you sound like a guy who's traditionally been in good shape, very active, eats well, sleeps well. Yeah, you have stress, but everyone has stress with their jobs.

Mitch: Exactly.

Troy: I'm getting nervous just hearing this.

Scot: That's right.

Mitch: Right?

Troy: You're on edge.

Robb: Well, I mean, cholesterol was . . . I don't know about a concern, but my cholesterol has always sat around 200. I remember the first time I had my cholesterol screened when I was in my . . . I think I was 19, maybe 20, and it was like 212 or something when I was young. And it's always been right around that 200 to 220 level. The exception being when I was vegetarian, it was in the high 180s. But it's never been exceptionally low. And that's a little bit of a family history.

Scot: That's just kind of the one thing, huh, Robb? Otherwise healthy, but that cholesterol has been a struggle.

Robb: The cholesterol has been a struggle. And honestly, the past year my primary care doctor and I, we actually meet . . . I do a pretty intense, annual physical, but we still meet on a regular basis throughout the year. And we were working on that and it was probably closer to maybe 230 or so. And I might have gotten around the 210s just by a little bit more focus on diet and exercise, but still, unless I was vegetarian, getting it below 200 has not been possible for me.

Scot: Was that frustrating for you? I mean, you were doing all these things right, and that cholesterol is high like that.

Robb: Yeah. I mean, I even joked . . . I don't even know if rice crackers are still a thing right now, but I'm not going to fall into just eating rice crackers. I did feel like I was taking care of myself with diet and exercise, and at the time, I just really did not want to go on a statin.

Mitch: So I guess what's really frustrating is knowing what's about to happen, when we talk about it, is you seem like such a healthy person. When I hear you talk about "a healthy relationship with my doctor" and "I'm very protective of my sleep," there's legit jealousy where I'm just like, "Why can I not have that?" I'm working towards. It's just like, "Man."

How about Troy? Scot? Anything? I know you guys both know what's about to happen, but any feedback that you're getting from hearing his story?

Troy: I'm curious about your BMI.

Robb: Another previous doctor had commented one point, this was years ago, just how consistent I am stepping on a scale. I am almost always between 174 or 178. I'm 6'1. So relatively lean. And again, physically, I guess I look like I'm in good shape.

But I will tell you smoking nicotine cigarettes probably the past 10 years or so, I picked that up again after stopping when I was in my late 20s. I wasn't a heavy smoker. No more than two packs a week. And even during the past 10 years, there were moments where I quit for two months to even close to a year, but I would start again.

Troy: You're a current smoker?

Robb: I am not now.

Troy: Okay. And again, we'll talk about this turning point, but at the time you were a current smoker at that time?

Robb: Yes.

Troy: So it sounds like your biggest concerns in terms of health were current smoker at that time, and then also sounds like the cholesterol had been a little bit of a struggle. Sounds like the LDL ran on the high side. You were able to get it down a bit on a vegetarian diet, but typically was running high.

Robb: Correct.

Scot: Do you feel like you're getting diagnosed? Because that's exactly what Troy's doing to you right now.

Robb: I'm like, "Who do I direct my co-pay to?"

Troy: Like I said, this is hitting so close to home as I'm hearing your experience and just hearing you're super healthy. You've struggled with cholesterol. These are things we've talked about on the podcast before. I have struggled with cholesterol and I'm not nearly as good as you on the sleep piece of it. That worries me because you were right on it. You're getting sleep consistently and doing well with that and staying very active. And you're 51 years old. You're not old.

Robb: Right.

Scot: But that smoking, man. You probably knew it wasn't good for you. You're doing all the right things otherwise, so why did you do that?

Robb: Absolutely. I think for me it was . . . Yeah, I mentioned moving here, or I think I did, from Florida. I actually moved here for a Ph.D. program in communication at the University of Utah. And few years before that, I had decided to go back to school for a master's in communication when I lived in Florida. And I basically picked it up again after starting school.

Scot: Wow. I just got out of my master's program. Thank goodness I didn't pick up smoking, but I can definitely understand how one could.

Mitch: No, for sure. I definitely picked it back up when I was in my master's program.

Robb: Yeah. And for me, it was a bit of a . . . I don't know. It's a strange thing to say now, but a reward. I would finish some homework, or as a graduate student teaching assistant, I finished some grading, or I just wrote five pages of research or something like that, and it was just a nice, "Let me step outside and enjoy a cigarette."

Troy: Scot, did you have a cigarette equivalent during your master's program?

Scot: Juicy Fruit gum. I chewed it like it was my job. I would put a piece of Juicy Fruit in my mouth and it would . . . Five minutes later, there was another piece following it up. It was just packs and packs and packs.

Mitch: Geez.

Troy: I think we all have that to one degree or another. If we're in a stressful situation, if it's a sugary snack or a soda or cigarette or whatever we find that becomes a rewarding thing that maybe it's not the best thing for our health, but a lot of times it's just coping and getting by.

Mitch: So, Robb, what happened?

Scot: Our audience has just been waiting for this moment.

Troy: "What's going to happen next?"

Scot: "I stubbed my toe and . . ."

Mitch: I stubbed my toe. Yeah.

Robb: Five weeks ago, I out of nowhere had a heart attack. Never saw it coming. I mean, I have no personal history of cardiac disease, and have been searching in my head and have conversations with family and there's no history of cardiac disease on either my mom's or my dad's side of the family either. So it was shocking and surprising to me, as well as to my family and friends.

Troy: What kind of symptoms did you have when you had the heart attack?

Robb: Yeah, so it was Saturday right around noon, and it came on suddenly. I was out running a few errands that morning. I picked up dry cleaning and I was on my way home thinking about, "Am I going to go to the gym?" because I was actually already dressed for the gym. Or maybe grab lunch first.

Brought my dry cleaning in. And there was really, again, no warning, but I felt . . . I only can just describe is what felt like heartburn, which I don't usually get or really ever get, to be honest. But it was also very intense.

And then I would say within . . . I mean, this all happened within minutes, but the next minute brought . . . I had pressure on chest. And then the telltale sign for me was, and it's hard to describe, but my teeth hurt, or maybe more accurately, my gums hurt. I don't know why I did this at the time, but I even went to my bathroom at home and I grabbed one of those floss picks.

Troy: Oh, wow.

Robb: Maybe I just . . . I don't know. There's something in between. I don't know.

Mitch: You started flossing while you were having a heart attack?

Robb: I mean, I didn't know what I was . . . A heart attack doesn't make sense.

Mitch: Okay.

Robb: And then . . .

Troy: That's first time I've heard that.

Robb: I was just trying to ease that pain. And then kind of through my jaw, down both sides of my throat, my neck, and then shoulders, arms, and back. And again, this is all within five minutes. I Googled on my phone symptoms of a heart attack, and it was the jaw pain. Everything else that I just described, I was feeling also, but it was specifically the jaw pain. And when I saw that in particular, that's what kind of confirmed for me that that's what was happening. Even though at the time I still . . . I say confirmed now, but I still didn't want to believe it at the time.

Troy: Did you go to the ER at that point or call an ambulance?

Robb: I did. So I guess answering that directly, I don't want to lie to you guys or your viewers. I did not call an ambulance, but I did get to the ER. I actually drove myself.

Mitch: Oh my god.

Robb: Right? In hindsight, not smart, but again, at the time, even though I kind of checked off all the boxes I was seeing when I did that internet search on what was going on, I still didn't want to believe it. I live 10 minutes maybe from the ER and I just thought, "Well, get in your car, drive. By the time you get there, you're going to feel fine. And you save the ambulance for someone else who actually needs it."

Mitch: Oh my god.

Troy: Sure.

Robb: And when I got there, I did not feel fine.

Troy: Wow.

Scot: Yeah. I can totally relate to that, Robb, because I think I could check all the boxes too, and I'd be like, "Well, I don't want to be a bother." It's so weird how us guys are like that.

Robb: Yeah, I just . . .

Troy: That's true. I would do the same thing, but trust me . . .

Scot: Bad idea?

Troy: No matter what you call the ambulance for, there's someone who has called it for something more minor. So don't feel like you need to reserve it for those who "really need it."

Scot: How long did you have to sit in the waiting room, Robb? Or did they get you right in?

Robb: Fortunately, in my life I haven't visited the emergency room often, but I've always waited a few minutes at least when I do. This time, there was no wait.

Scot: They were taking you seriously, huh?

Robb: Yeah. It's so funny because even walking in, even though I knew, I still was couching my words, like, "I think I might be having . . . I don't know. I have never felt this way." It was hard for me even at the time to say it out loud and to acknowledge that I at least think I'm having a heart attack.

Mitch: I was the exact same way when I had my stroke scare a couple years ago. I walk in, my face is completely paralyzed, and I'm like, "Oh, yeah, so I think maybe I'm having a stroke. I don't know." And again, it wasn't, but there was something very, "Why am I minimizing this? My face isn't moving."

Troy: Yeah. I mean, the good news is triage nurses are well trained and I think they have a lot of experience on both ends of the spectrum, both with people who probably catastrophize things a little bit and then others like yourself who just really downplay it. But they kind of know how to pick out the information they need and it sounds like they were on it and got you right back.

Robb: Yeah.

Troy: And then I guess I'm curious what happened next? Did you have what's called a STEMI, an ST-elevation myocardial infarction, where . . .

Mitch: Oh, yeah, sure. No big.

Troy: Well, you probably knew it if you did, because if you did, they would've had you up in the cardiac catheterization lab within about 10 to 15 minutes.

Robb: No. I was again, admitted, I think very quickly into the ER. I was on a table or bed and hooked up to monitors. I don't remember the specifics, but I do remember my blood pressure being in the 190s over 120 range, and that's never been that way. But yeah, they just were asking me how I was doing.

By that point, honestly, I hate to sound dramatic, but I was writhing in pain. It hurt, and not just my chest, but my body. And I just remember not being able to really sit still. They were talking about the importance of it trying to take deep breaths and trying to calm myself down.

Within a couple hours, the pain started to subside and I started to feel a little better. And I really, to this day, I don't know why, they did give me four baby aspirins. I remember that. And I can't help thinking, because I don't remember getting any other treatment until later that evening, that that must have helped.

Troy: Did they diagnose it based on the blood work?

Robb: So yeah, that was . . . I've learned all kinds of things since then, but I think it's . . . It starts with a T. Troponin, I think.

Troy: Troponin. Uh-huh.

Robb: Yeah. So that's when I learned that your body, I guess, produces this enzyme I think to help try to protect the heart. And that's something that they can test for to see if you may be having a heart attack.

And so they did that, and this was about an hour, maybe an hour and a half in the emergency room. A doctor came in and said that there wasn't any in my blood. By that point, I'm like, "Are you kidding?" I don't want to say I was disappointed, but I was like, "Then what is going on? I've never felt this way." And they did explain to me that it can take three, maybe four hours before it shows up in blood. So they would do another blood draw in a couple hours.

And these numbers don't really mean anything to me and I may not even be remembering correctly, but it was at least . . . it went from zero to above one. And then the next morning, on a Sunday morning . . . And that is when they did the procedure, did a catheter and inserted a stent in my heart. But the next morning it was above nine.

Troy: Wow. That's legit. That's impressive. Yeah.

Mitch: Impressive, huh?

Troy: That's impressive. Yeah. So the blood test, just for reference, a troponin level, like you said, it's a protein that's released into the blood from the heart when there's damage. But exactly like they told you, it can take six hours after a heart attack for that to turn positive.

So for reference, less than 0.03 is normal. And then once it gets above 0.3, then we say you've had a heart attack. There's kind of that gray zone from 0.03 to 0.3. So yours was at 1 after a couple hours and you were at 9 the next morning. That's significant.

Most heart attacks we see where we're just diagnosing it based on the blood work and there's nothing on the EKG that says you need to have a cardiac catheterization done right now, most of those cases we're seeing the troponin levels go up to maybe 0.7 and then maybe it's 1.2, something like that. So what you had definitely . . . that's a sign of pretty significant heart attack and pretty significant damage to release that much troponin into the blood.

Well, hearing your story, just from my perspective as an emergency physician, as someone who sees all the time with chest pain, I'll say what you had was no joke. There's no question that was a legitimate, serious heart attack. And it's so fortunate you went in and didn't just write it off.

Getting aspirin early on is a key. I think that's one take-home. If you do experience symptoms of chest pain and any symptoms of a heart attack, the earlier you take aspirin, the better. That just prevents those platelets and things from clotting around that area where there is some blockage or some narrowing.

And certainly getting into the ER was the thing you needed to do. And you got the treatment you needed, you got on the blood thinner, you had the cardiac catheterization. So it sounds like everything went really well. I'm glad to hear that.

Robb: Thank you. Yeah, you and me both. I mean, I've shared this with people that I have talked to, friends and family, and nobody wants to have a heart attack, right? Certainly, I didn't, and never expected it, but it was kind of right time, right place, the right things happened, that I didn't explain it away even though there was a minute or two I was like, "Eh, maybe I can. It's not that." And maybe driving to the ER myself wasn't the best decision, but I at least got there and I think everything else, again, just kind of fell into place.

Mitch: So, Robb, what do you do now? What's next? What has changed and what are you going to be doing from here on out?

Robb: Yeah. Not to be over the top and dramatic, but in a lot of ways, at least mentally and emotionally, everything has changed. I mean, that started for me in the hospital within an hour or so after the procedure where I just . . . I was still scared for sure, but I felt like I was in amazing care and I felt that I was lucky.

My brother who lives in Pennsylvania was able to come and stay with me for a week. And that was great. We've joked about how . . . We've always been very close. We always bond in different ways when we see each other, but it was a very strange bonding experience this time around.

It's just thinking about and taking stock in life and being appreciative. My cholesterol . . . I mean, I'm on five new medications each day right now: blood pressure, platelet thinner, baby aspirin, and cholesterol. I just had labs done last week and . . . My cholesterol was 220, again, when I was admitted to the hospital when I was having my heart attack. My cholesterol is now 130.

Troy: Oh, wow.

Robb: Yeah. And again, I think the statin has a lot to do with that. However, I'm also in cardiac rehab. I do rehab once a week where I'm on a treadmill hooked up to monitors and they check my blood oxygen, my heart rate, blood pressure a couple times while I'm there, and just my heart rhythm. And that I do mostly for not just physical improvement, but also peace of mind.

I like that people who are much more knowledgeable about all of this than I am are actually checking out my heart on a weekly basis.

But I've also, since my first cardiac rehab appointment, which was the week after I had my heart attack, not to be too geeky, but I have an Apple watch and I have closed all three rings of my apple watch every single day now for 28 days.

Scot: Nice.

Mitch: Good for you.

Robb: I've never done that before. And again, I was an active, pretty fit guy. And I don't think that I'm neurotic about it. There will come a day when I don't, and I'll be fine with that. Not being strenuous with my activity, but just being active.

I did run for the first time on a treadmill at cardiac rehab last week. And that was the first time I jogged. It was just two very easy, slow, smart quarter miles. But I got emotional when I was on the treadmill. And so I'm trying to take care of myself. I mentioned my cholesterol, and again, I'm being active.

I joke with a couple people who had recommended it before, because I was like, "Air fryer? I don't want to get an air fryer at home. I don't want to cook like that." And I got an air fryer and I've been using that.

And so, I mean, my diet is better. And again, the statin I know has helped, but I also was like, "I'm being more active. I'm being smart. I'm eating better. I want some personal credit for that too."

Troy: Yeah, for sure. And you deserve it. I mean, you've made significant changes and very quickly. What about smoking?

Robb: I have not picked up a cigarette since the Saturday morning of my heart attack. And I've got some gum, I've got patches, and I'm to the point now where I'll go a couple days without the patch and I don't think about it. Same thing with the gum.

But I've talked to close friends, my family, my primary doctor. Quitting for me in the past has rarely been hard. I don't get cranky. I don't get irritable. It's easy for me to quit. What's not easy for me is to stay quit, if that makes sense.

Troy: Oh, yeah.

Robb: And so I'm aware of there might come a time a month from now, a year from now, where I'm out and I see somebody with a cigarette, and in the past I would go up and bum one, but I know that the next day I'll buy a pack. I won't put myself in that position again. So yeah, nothing like a heart attack to really commit me anyway to quitting smoking.

And I'm also working on managing my stress level at work more. I've just this week kind of returned more to full time. And my boss, my team at work, my company, they've just been so amazingly encouraging and supportive and understanding, even a little bit more like, "Hey, I'm ready to come back full time," and my boss will say, "No, you're not."

But I'm right at full time, and I'm still working remotely, which again is great to have that flexibility. But just trying to be smarter about how I prepare for a day and even taking walks in the morning, which kind of helps to center me as I start my workday.

Before, I would get up, drink coffee, have a couple cigarettes, and then jump into my car commute or whatever. And so I'm starting my days with a lot less stress, which I'm finding gives me a lot less stress throughout the day. And I feel better at the end of the day, too.

Mitch: Wow. So that is quite the turning point. Troy, anything that you take away from this? I mean, personally, I hear how healthy Robb was and it just is like, "Man, if this can happen to even some of the healthier of us, we've got to . . . I know there are a few things that I need to change on my own to make sure that I don't increase my risk for anything like this."

Troy: Yeah, it really is. And like I said, as I was just hearing all this leading up to it and knowing where this was going, because I knew the title of our session today was "Robb Had A Heart Attack," I was hearing all this and I thought, "Wow, this really hits close to home."

I think we always look for something in our mind to say, "Well, we're okay. We're protected." I feel fortunate that I don't smoke and that's definitely a risk factor for heart disease. We've talked about smoking and we've talked about your experience too, Mitch, with quitting and the changes you've made. And I know some of your wake-up calls and turning points as well.

But yeah, again, Robb, I think you're just fortunate that, like you said, right place at the right time and you got the treatment you needed quickly and got the help you needed.

I think for all of us, we do hope though that that's not our turning point, that it's hopefully prior to that. For me, it was the cholesterol. And I think for others, we've had different experiences of things that have been a wake-up call for us to say, "Hey, I need to make changes now so I'm not having that heart attack or getting to that point."

But having that dramatic of an experience, you've made dramatic changes and it's a credit to you to now have made very significant changes and really be on a track now to prevent that in the future.

Robb: I'm definitely working toward it. Yeah.

Mitch: How about you, Scot?

Scot: I think my big takeaway is my grandma smoked and she lived to be 95, had no ill effect from it, smoked her whole life. And a lot of times we ask ourselves . . . You'll hear somebody even say, "Well, my grandma smoked or my dad smoked, so I'm not worried about it." But you just don't know what's going on inside of you, right? Maybe there's something happening inside that you're not going to be able to get away with that. So it just kind of makes me double down a little bit more on making sure that I'm being consistent.

And again, I think we get into this notion that society pushes that that means we have to go to the gym and be ripped and do workouts like you see on TV for Fitbits and Nike. But it's not. It's just being active and maybe making a small little decision like not having a couple cigarettes in the morning and instead going for a walk and just getting a little bit of activity. You just replaced one thing with another. How much of a difference is that going to make?

Troy: I mean, obviously, hindsight is 20/20, but if you could talk to yourself 10 years ago as a man in his early 40s or even late 30s, what would you say?

Robb: I don't know that I've let myself think of that just yet. I've asked myself all kinds of questions, but I don't know about that one.

Troy: And you don't have to.

Robb: The word that has popped into my head and even some conversations that I've had with others is cavalier. And I think it's easy when you're young or younger, whatever that means because it's all relative, to say, "I can do this and I'll be fine. I can smoke. I'll be fine. I can eat this. I'll be fine." If I'm being honest, over the past 10 years or so of smoking there has been a time or two where I thought, "It's going to probably take something kind of severe for me to actually put these down." Well, that's exactly what happened.

I do wish that I was a lot less cavalier and put it down for other reasons. But here I am, and at the same time, in so many ways, I feel healthier now than I have ever in my life.

Again, even my workouts, they're a lot less "I have to go to the gym" and more "I get to go to the gym" or "I get to go for a walk" instead of "I have to go for a run."

I have phone conversations with my family or dinners with friends or whatever. It's all more meaningful.

So it's really not so much . . . I hate to turn your question around, but not so much what I would've said to my previous self as more as just being grateful for my present and future self, I guess.

Troy: That's great.

Robb: Kind of where I am now and not taking it for granted.

Troy: Yeah, that's great. And for me too, like I said, I think hearing this . . . I don't want this to be all about smoking because we can easily point to that and say, "Well, yeah, you were smoking. You had a heart attack." But I'm thinking to myself, let's say I'm in your shoes down the road, what would I say to myself today?

You're doing a whole lot of things and were doing a whole lot of things a lot better than I am. Like I said, sleep, stress, those are big things I deal with. And so I think for all of us, just hearing your story, it's probably worth considering if we were in your shoes down the road, what would we think today we could change to prevent that?

And again, whether it's stress reduction, whether it's diet, exercise, weight loss, managing our cholesterol, all sorts of things that that can prevent us from being in the ER and being diagnosed with a heart attack and going through that procedure, or potentially something worse and not getting the care we need quickly enough and having things go much worse than your situation.

Scot: Robb, one of the things that really resonated with me is . . . So I'm a fairly healthy guy. I come from fairly healthy people. However, other people in my life, I noticed, started having health issues. And it's cliché when they say, "Don't take your health for granted," or, "Your health is the only thing you have," but yet it is so true.

And I think what I'm hearing from you is kind of how I processed it as well. I was not eating that well. I was not getting the activity I needed to do. I was not doing a lot of things right. And I'm like, "I've been blessed actually with good health. Why am I throwing it away now?" That's just the way I processed it. So that is one of the things that motivated me to start doing some things that are a little bit more positive in my life.

Would you say that's accurate for you, or is it something a little different?

Robb: I would. Absolutely. Thanks for helping me think through that a little bit that way, because I don't know that I would've been able to articulate it that way. But as you were saying that, of course, I'm nodding. I'm like, "Yes, yes, yes."

Again, something about where I am in my life, and maybe it is my age or maybe it is my overall relative good health despite what I've just gone through, that my recovery has surprised me.

I didn't know what to expect, but that I feel as good as I do right now . . . I don't know if I've been given a second chance, but I feel like yes, I have, and I want to appreciate that.

So to a very large extent, this was a wake-up call for me. Again, not glad that it happened, but not too sad about the way that it happened, I guess, and kind of what has helped me change and think about differently in my life.

Mitch: Thank you so much for sharing that story with us. I think a lot of times men, we talk a lot about not sharing or talking about health with one another as often as we maybe should, but we learn from one another and we can kind of get new understandings and learn to be grateful for what we have by talking about what is scary and how we've approached our health.

And I really, really appreciate you joining us and sharing not only an emotional experience that you've gone through, but also the perspective that you've learned from it.

Just hearing you talk about it, seeing you in the hospital, etc., I know it's made me double down on some stuff, and hopefully some listeners will have a similar response. So thank you so much for joining us today, Robb.

Robb: Yeah. I appreciate the opportunity to speak with you guys. This has been great.

In medicine, we were taught that women were protected against heart attacks until they went through menopause, and then our risks caught up with men's risks. But what if we weren't really protected that well?

For many years, our research into the heart attacks has been focused on men. Even on TV and the movies, something awful happens, and a man clutches his chest and keels over. And we find if it's a police or a medical show, that he died of a heart attack. Most of us could have figured that out before the forensic pathologist told us on the TV show because we know what men's heart attacks look like.

In fact, we understood men's heart attacks and the causes, high blood pressure, smoking, eating red meat and fatty foods, and high cholesterol. Doctors really got on men's cases, and since 1960, men have decreased their smoking. And if their cholesterol or blood pressure is high, and their wives drag them into the doctor, the men were on blood pressure medications and cholesterol-lowering drugs. And meat and fatty foods, they're still Super Bowl yummies and fast food, and they're doing better.

Men's rates of heart attacks dropped dramatically. And then we noticed that postmenopausal women caught up with men in the rates of heart attacks at about 60. So we sort of got on it and started a national campaign, like the red dress for heart health, to help women understand their risks and the signs of heart attacks. But we were still thinking about women over 50, at least OB/GYNs were. And now comes a troubling study that shows that the rate of heart attacks in young people, people under 50 are increasing and are increasing more for women. This is worrisome. And it's important to look at the communities where this work was done and see what we can learn.

From 1995 to 2014, the ARIC, A-R-I-C, Community Surveillance Study gathered information on almost 29,000 heart attacks. ARIC stands for Atherosclerosis Risk in Communities. And atherosclerosis is the clogging up of the arteries in the heart that can lead to heart attacks.

The communities that were involved in this study were in four geographic areas in the U.S. -- counties in North Carolina, Maryland, Mississippi, and suburbs of Minneapolis. Some of these counties have Americans at risk for heart attacks based on increased rates of diabetes, smoking, hypertension, obesity, and poverty in African American race. Of those 29,000 heart attacks, over the 20 years, one-third in what they called young people, people 35 to 54. Over those 20 years, the annual rate of young men's heart attacks went down some. But women's rates went up to the point that young women, pre-menopausal women had the same rate of heart attacks as young men. These data are alarming, and they mirror similar data from Canada, suggesting that the incidence of heart attacks in young women is rising.

Well, what are some of the risk factors for these young women? Smoking, high blood pressure, and diabetes very substantially increase the risk in women. And black women had very significantly more heart attacks than white women. Seventy-five percent of the young women with heart attacks had high blood pressure, 36 percent had diabetes. And women who had heart attacks were more likely to have multiple risk factors than men.

Young women who had heart attacks were less likely than young men who had heart attacks to have their cholesterol treated or their blood pressure treated. Young men and young women who had heart attacks had a 10% chance of dying the following year. Young women have some extra risk factors for heart attacks compared to men. They're more likely to have demonstrated risk for diabetes by being diabetic in pregnancy. They're more likely to demonstrate risk of hypertension and vascular disease by having preeclampsia when they were pregnant. And they are more likely to suffer the psychosocial stressors of poverty than men.

This information hurts my heart. These young women were mothers of young children and teens. They were at the most productive times of their lives, and they were also at the most stressful times of their lives. So what do we do with this information as women and as physicians? The risk factors in this study are ones that we all know about, risk for heart health, such as smoking, diabetes, and hypertension. But diabetes and hypertension often don't have physical symptoms.

Unless women are getting regular checkups, getting their blood pressure measured, their cholesterol measured, and their blood sugar checked, they may not know. Women used to go to their OB/GYN or their family doctor, get a Pap smear every year, but now they don't. Many women who used to go regularly for their checkups when they were having babies, don't go anymore. All clinic visits, for one reason or another, will have a blood pressure check, but cholesterol or diabetes checks aren't done so often in young women.

Of course, the big risk of smoking cigarettes in an unbelievable 48 percent of the young women who had heart attacks were cigarette smokers, would be addressed by the clinician, if women admitted to it. See our podcast on lying to your doctor.

So all women and men need access to health care. All the women and men need regular checkups at this very busy time of their lives, 35 to 54. All women and men need to have their blood pressure, high sugar, and high cholesterol managed according to national guidelines. And women need to take their medication.

How we manage the stressors of poverty, the stresses of being a minority are issues that we all need to address as a community and as a state and as a national level. So, ladies, please take care of your heart. And thanks for joining us on "The Seven Domains of Women's Health" on The Scope.

updated: September 5, 2019

originally published: February 7, 2014

Interviewer: You have chest pain, but you don't think it's probably a heart issue, what could that be? Well, we're going to examine that next on The Scope.

Announcer: This is "From the Frontlines with Emergency Room Physician Dr. Troy Madsen" on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health, and Dr. Madsen, sometimes I get this thing on my left side of my chest. I don't think it ever happens on the right, but it feels like there's a lot of pressure in there. It feels like a bubble, like an air bubble maybe. It's difficult for me to take a deep breath. And it'll either just go away, or if I can take a deep enough breath, it feels like it pops. What could that possibly be? I hope I haven't been having heart attacks this whole time.

Dr. Madsen: I hope you haven't. This is a very common question I get in the ER, and I may see over the course of the shift maybe even a couple of people, like yourself, who have this exact same question. So in my mind, of course, I'm thinking, "Okay. I've got to make sure it's nothing serious." So I would ask you about, do you have any risk factors for heart disease, any risk factors for blood clots in your lungs? So those are number one and two I'm thinking about. Have you had any recent surgery or anytime you just haven't been moving a lot where you could have formed a clot that went to your lungs?

But what you're describing doesn't sound much like either of those things. I might do some basic tests to make sure things are okay there. But once we rule out the more serious things, and I start to think about other things that often cause chest pain. And probably one of the most common things is acid reflux. People get acid reflux, acid that's working it's way up from the stomach through the esophagus into that food tube that runs down your chest, and that can oftentimes cause a feeling like maybe a bubble in your chest. Most people describe it as a burning sensation there, maybe a bitter taste in the back of their mouth.

Another thing we see often is something called costochondritis. And that's an inflammation in the cartilage where the ribs come and they meet the sternum. So the breast bone there, where they come together there, that that can get inflamed either from sometimes a viral infection, or just from maybe overuse, or maybe even you've been twisting wrong, and that causes some inflammation that can cause some pain.

Sometimes, you can get what we call pleuritis, where you get inflammation along the lining of the lungs. And that can cause, again, some chest pain in there that sometimes worse when you take a deep breath. But with your symptoms, if I had to say it's anything, I would lean more toward maybe some reflux, that feeling like a bubble in there.

Interviewer: I was thinking that's about as close, but it's not in the center. It's always off to the side, like up in this area. And it tends to be pretty consistent to where it will develop when it develops.

Dr. Madsen: Yeah interesting.

Interviewer: And it freaks my wife out a little bit when I'm like, "Oh, oh." And I try to take that deep breath and I can't, because there's that catch or something there.

Dr. Madsen: And sometimes you can, in your back, you can have some muscle spasm. You've got muscles between your ribs. Sometimes you could get maybe some muscles spasm or some inflammation between the ribs. That could cause, possibly, something that comes and goes like that, especially where it's worse when you take a deep breath. The reality with chest pain is, I tell patients, "Hey, once we've ruled out the bad stuff, it could be any of a number of things. It could be reflux. It could be the costochondritis. It could be some muscle thing, some inflammation there.

There's not a lot I'm going to do differently for these things. Maybe try some acid medications, some stomach medication for the reflux. Try some ibuprofen for some of these other things. And so I wouldn't worry about it. I don't want to tell you that now, I know you are going to have a heart attack just [Inaudible 00:03:36]

Interviewer: Well, I was going to say, this could point probably at this point two things. One, I'm going to pay attention next time and see maybe if I feel that it is acid reflux. Because sometimes just realizing what it could be makes you visualize it differently.

Dr. Madsen: Exactly.

Interviewer: Maybe that is indeed what it is. And then the second thing that I want to do right now is the importance of if you do feel like you are having a heart attack that you should go to the ER. And are there some very specific symptoms of that?

Dr. Madsen: Absolutely, yeah, and that becomes the challenging thing because the reality is if I were to see you in the ER, I'd probably at least do a couple tests. I'd probably do a chest X-ray just to look at your lungs, look at your heart size, make sure everything is normal there. I would do an EKG, just a basic test on your heart, to make sure the electrical activity looks normal, make sure I'm not seeing anything unusual there.

But the biggest things with heart attacks are people describe it as a crushing chest pain, like someone sitting on their chest. They say when they go upstairs or they try to walk, the chest pain is much worse, or they get short of breath. And they feel pain up their neck or down their arm. They feel sweaty, nausea, but it's challenging, because certain groups of patients like women, people with diabetes, sometimes older patients have really unusual symptoms. Some of them may just have some abdominal pain or just shortness of breath.

So it is a little bit of a challenge. If you have risk factors for heart disease, like high blood pressure, or high cholesterol, smoking, family history, these are all things where even just some kind of unusual chest pain like you're describing might be a reason to, if nothing else, at least see your doctor and get things checked out there.

Interviewer: Especially if it doesn't go away right away?

Dr. Madsen: Absolutely, yeah.

Interviewer: What about the pulse? Does the pulse increase if you are having a heart attack, or could the pulse stay at a resting heart rate?

Dr. Madsen: I've seen both. I've seen people come in with heart attacks who do have a high heart rate. I've certainly seen other people who come in and say, "Yeah, I'm having this crushing chest pain." But you look at their heart rate and it's normal.

Interviewer: So just it doesn't really manifest itself in any one way for any certain person, it sounds like? It's very unique. At least it could be.

Dr. Madsen: Yeah, and some people with heart attacks are on medication that slows their heart down so that affects it too when I see those patients.

Interviewer: So when in doubt, go see somebody.

Dr. Madsen: Yeah, chest pain is one of those things . . . it's tough. You want to take it seriously. Ninety-five percent of the time, people we see with chest pain, all the testing is normal, at least 90 percent of the time it is. But that 10 percent or 5 percent, you don't want to mess around with those things.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: June 12, 2018
originally published: May 27, 2016

Interviewer: Heart attack patients are not all the same and that's important to know. We'll talk about that next on The Scope.

Announcer: Examining the latest research and telling you about the latest breakthroughs. The Science and Research Show is on The Scope.

Interviewer: I'm talking to Dr. Rashmee Shah, Assistant Professor of Cardiovascular Medicine at the University of Utah. What did you find?

Dr. Shah: We looked at heart attack patients who had a specific complication called cardiogenic shock. Cardiogenic shock occurs in patients who have very big heart attacks, and the heart muscle becomes so weak that it can't pump blood to the rest of the body. These are the sickest of the heart attack patients. In the last decade, we've gotten a lot better at treating heart attacks using stents, interventions and stents, to open the blocked arteries.

A lot of these patients are now surviving the hospitalization. That means they get hospitalized, get treated for their heart attack and then make it out of the hospital. Since that's happening more frequently, we need to know what happens to these patients after they leave the hospital. Are they going home and resuming their usual life? Or are they disabled and still sick like they were when they were in the hospital?

Interviewer: What did you find amongst these patients? How are they doing when they leave the hospital?

Dr. Shah: In a publication that preceded this one, we found that two-thirds of patients like this will survive the hospitalization and get discharged. We took it up from there. So among these patients who survived the hospitalization, we found that, surprisingly, within a year over half . . . almost 60% of these patients will either die or be rehospitalized.

Interviewer: Oh gosh.

Dr. Shah: Yeah, so not great. The interesting finding was that this risk is really clustered in the immediate, post-hospital period. So within the first 60 days after discharge, this is when these cardiogenic shock patients are the most vulnerable to have an adverse outcome, meaning death or hospitalization.

One interesting finding was that actually all heart attack patients, over 50% die or were rehospitalized within a year. That's all heart attack patients. That was a bit surprising and I think we'll have to delve a little deeper to see what could be driving that and what we can do about it.

Interviewer: That's not common knowledge yet, right, until this paper?

Dr. Shah: Correct.

Interviewer: Do you have any ideas of what's happening within this 60-day period that might put these patients at risk for dying?

Dr. Shah: Yeah. So there are some theories out there about the post-hospital, discharge period. One interesting idea is there's so-called post-hospital syndrome, especially among critically ill patients. Patients with cardiogenic shock are often in intensive care units, they're very sick. What happens is they become debilitated because they don't have adequate nutrition during that period, they're lying in bed, their days and nights gets reversed.

Everything about their daily life has changed and they become really weak. Critically ill patients, not just limited to cardiogenic shock patients, when they get home or when they get discharged to wherever they go, they're still very debilitated. This post-hospital syndrome is one possibility and efforts related to rehabilitation, physical therapy, occupational therapy could address that issue.

The other issue is that cardiogenic shock is a condition in which there's not enough blood getting to other organs of the body so they might have renal failure. They might have had less blood going to their brain, some kind of neurological effect. All those things coming together make patients very debilitated so it could also be a multi-organ issue.

Interviewer: Among patients who have heart attacks, what percentage is represented by this population?

Dr. Shah: The dataset we used is called the Action Registry and it's from the American College of Cardiology. This is the largest registry of heart attack patients in the US. In this population, 5% of heart attack patients will have cardiogenic shock.

Interviewer: You would think that if they have those serious problems, that they would be under a close watch once they're discharged. Do we know if that's happening?

Dr. Shah: Yeah. There are guidelines that encourage one-week follow-up for patients after a heart attack. That happens fairly consistently and it's something we work on aggressively here at the University of Utah. Often, the patients . . . there are standard therapies following heart attacks and these patients might not be able to get some of those therapies because, for example, their kidneys aren't working as well so they can't have the drug that can sort of protect the heart. They could have a follow-up, but that doesn't necessarily mean they eligible or able to get those evidence-based therapies to help the heart heal.

Interviewer: What are the next steps? What do you think this information is telling you about what can be done or what should be done?

Dr. Shah: I think there are many things we can do from here. A couple of things I'm interested in are focusing on the so-called patient recorded outcomes. We measure these very quantitative metrics, "Did the patient die? Did they get hospitalized?" But there's much more to patient wellbeing than just that. We want to know, "Are they able to function? Do they feel like they're short of breath every day?" those sorts of symptoms.

We can only get that by asking the patients and asking every patient, every time. Especially in this population, it'll be interesting to know what their daily life is like because it could be very different than what these somewhat simple metrics imply. I think that's a really important part there for subsequent research.

The other issue I think is important is, "Can we find a way that, while these patients are in the hospital, that we could proactively identify them before they leave the hospital?" That's really useful information for planning subsequent treatments or helping the patients and families understand what to expect when they leave the hospital.

Announcer: Interesting, informative, and all in the name of better health. This is The Scope Health Sciences Radio.

Interviewer: The Super Bowl and heart attacks: is there really a risk? We are going to find out from cardiologist Dr. John Ryan, next on The Scope.

Dr. Ryan, I've seen news stories, I'm sure our listeners have seen news stories, I even did a Google search because the thought of somebody having a heart attack during the Super Bowl seems kind of crazy to me. Really, does this happen? Is it a common thing or a rare thing? But there's some research out there that says that it really is possible. Is that true?

Dr. Ryan: Yeah, so it is a recognized risk, namely that's the Super Bowl and this has been shown in several studies the time of the Super Bowl is a high-risk time for heart attacks or a higher risk time for heart attacks. It's also been shown in the World Cup, in the soccer World Cup, there has also been shown that there is a higher risk of heart attacks around this time. It seems, in particular, in cities hosting the Super Bowl and in the cities whose teams are playing in the Super Bowl it seems to be higher. So when there's an investment in the game, it does seem to be higher as opposed to other cities that either aren't hosting or don't actually actively have a team in the Super Bowl. And this is, again, the same with the World Cup.

However, when you look at the people who have heart attacks during the Super Bowl, they're already at higher risk of having heart attacks. So they are typically folks who have high blood pressure, maybe a history of heart disease, a history of smoking, a history of high cholesterol, and then the stress and circumstances surrounding the Super Bowl event can be a trigger towards that cardiac event.

Interviewer: So if you've been told by your doctor that you are at a high risk of a heart attack and your lifestyle kind of reflects that, would it be the equivalent of going out and trying to run a marathon?

Dr. Ryan: Yeah. That's a good analogy, yeah, that's a good analogy.

Interviewer: Because I don't think that people watching the Super Bowl and having some wings and beer would be like running a long-distance race.

Dr. Ryan: Yeah, that's a good analogy. Again, it's all about you're introducing more stress onto your cardiovascular system and into your life and what are the consequences of that stress. One of those consequences of that stress is an increased risk of having a heart attack. So, a lot of times, it's just about stress management and how you deal with stress as well as you've rightly pointed out, it's risk factor modification.

When you look at heart disease in general, it's all about risk factor modification, eating better, not smoking, not drinking as much alcohol, and not getting dehydrated. And these are all things that happen in or around the time of Super Bowl or college game day or workups. When folks bring this up, I talk about my father, during Ireland rugby games, will sit outside in the garden and then when the game is over, he will come in and ask what the result of the game was. And that's his way of modifying his risk. So it's a matter of modifying your risk. Thanks, Dad.

Interviewer: And, as a result, he's been there for you all these years.

Dr. Ryan: Exactly. Exactly.

Interviewer: So if you're worried that you're going to have a heart attack leading into the Super Bowl, you probably need to take a bigger look at . . .

Dr. Ryan: Figure out your coping mechanisms, figure out your stress, what you do for stress and what you're doing for your risk factor modification with your heart disease.

updated: February 9, 2022
originally published: February 3, 2016

Interviewer: How e-cigarettes affect your heart and it's not in a good way, and it might not be better than smoking after all. We're going to find out more about that next with cardiologist, Dr. John Ryan on The Scope.

Announcer: Health information from expects, supported by research. From University of Utah Health, this is TheScopeRadio.com.

Before we get into the conversation about e-cigarettes and how they affect your heart health, I think it's important that we say that cigarettes and e-cigarettes are linked to many different health problems. But today, we're just focusing on one particular and that's issues related to the heart. So, Dr. Ryan, how do e-cigarettes affect a person's heart health and are the threats real?

Dr. Ryan: I think the threats are real. I think the concerns are legitimate. One particular concern with e-cigarettes is that it's really re-normalizing cigarette smoking, nicotine consumption, and tobacco use within North America. Some of it, the science is uncertain. We are not sure of the long-term effects of e-cigarettes, either on heart or lung disease. And then legitimate concerns get raised because of this chronic exposure to nicotine, chronic and also varying exposure to nicotine. One of the particular issues there seems to be marked variation in how much nicotine is being consumed with each vape.

Interviewer: Because when you get the little vapor things, it tells you how many milligrams per whatever, but that's not regulated so we don't know if that's accurate or not.

Dr. Ryan: Exactly. And the anticipated is .05 is what's often quoted. It can really range up to 15 whereas where your cigarettes would be about two to three. So in that regard, there's variation there that's concerning. Also, some of the physiologic effects that e-cigarettes and nicotine consumption, in general, are concerning, in particular, high blood pressure, fast heart rate, endothelial dysfunction, which is the lining of the blood vessels of the heart, in particular, which can be a trigger for atherosclerosis and coronary artery disease.

And all of these things are affected by the nicotine consumption and, in particular, by the e-cigarette nicotine consumption as well as other chemicals that are in the e-cigarettes. And as you rightly pointed out, the regulation of this is difficult and not as robust as many physicians and scientists would like. And that just raises further concerns.

Interviewer: So you mentioned a lot of different bad things that can happen from e-cigarettes, and it's related to nicotine primarily, the raising your heart rate, the blood pressure, your blood vessels narrowing, high risk of hardening of the arteries. What does that do, then, that causes heart failure or heart attack or stroke?

Dr. Ryan: So a lot of it we don't know, first of all. That specifically raises concerns, but the issues, in particular, that are raised with high blood pressure, with fast heart rates, with narrowing of the blood vessels of the heart, the coronary arteries, as you mentioned, this puts extra strain on the heart. The heart obviously depends on blood flow in order to get oxygen, and in the setting of high blood pressure, fast heart rate, decreased vessel size, you do raise the risk of having a heart attack.

So the essential concern, in particular, is for heart attacks, that the use of nicotine, e-cigarettes, and cigarettes raises your risk of having a heart attack. And also, it's not necessary, and that's where I got back to the normalization of tobacco consumption and nicotine consumption within North America. This is not a necessary thing that we need to do. This distinguishes it from . . . and there's controversy of this as well, but diet consumption, fat consumption, etc. However, we do need to eat. We don't need to smoke and we don't need to vape.

Interviewer: So for sure, we know nicotine causes these negative effects to the heart.

Dr. Ryan: Exactly.

Interviewer: What about the other chemicals, like . . . I've heard the flavoring chemicals. Even if you're getting the dose without the nicotine, they've found that it can cause other diseases.

Dr. Ryan: Yeah, so the flavoring has recently been associated with what's called popcorn lung or bronchiolitis obliterans, which is a form of inflammatory and fibrotic lung disease. The reason this raises concerns is, first of all, lung disease, therefore, puts a strain on your heart. And secondly, if there's chronic inflammation, which we see in the setting of poor air quality and stress, it can result in triggering heart attacks or heart disease. So I think there are two main concerns with the chemicals that you bring up in terms of e-cigarettes.

Interviewer: If you've got a patient that's right in front of you now that smoked e-cigarettes, how would you convince them that they shouldn't? Because a lot of people get enjoyment out of it, or it's an addictive habit that they can't stop. It takes a lot of willpower to quit.

Dr. Ryan: Being sensitive enough in terms of convincing people to do things. Ultimately, I think you have to introduce the risks associated with the disease, the risks associated with the risk factors, and hope that they make an informed, educated decision about their habits. And so I try and present to them the uncertainty about e-cigarettes. I try to present them with some of the concerns that I have about e-cigarettes and nicotine consumption in general. And then, hopefully, when they leave the clinic and when they go home, they're able to access resources themselves and make good decisions themselves and be comfortable with the decisions they're making.

Interviewer: And I think, essentially, it comes down to this is something that you don't have to do to your heart.

Dr. Ryan: Exactly, yeah. You don't have to do it to your heart. You don't have to do it to your lungs.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: January 8, 2019
originally published: January 26, 2016

Interviewer: Did you know that when women have heart attacks the symptoms are different from men? True. You're going to find out more about that next on The Scope.

I was surprised to find out that heart attack symptoms are actually different in men and woman. We're going to learn more about that right now with Dr. John Ryan, he's the director of the Dyspnea Clinic at the University of Utah. Men and woman, heart attack symptoms are different, is that true?

Dr. Ryan: It's true to a certain extent, so the traditional concept we have of heart attacks being the crushing chest pain, hand on your chest, sweating, vomiting and presenting to the emergency department and be found to have a heart attack, is seen more commonly in men, however, part of the issue is is that women also experience these, but tend to ignore them more. So yes, they have the symptoms, but they just tolerate them better or dismiss them as being a heart attack, because many women don't feel that they're predisposed to a heart attack.

Interviewer: So for example if you were to ask somebody what kind of pain you're feeling, one person might say it's a level ten, same amount of pain...

Dr John Ryan: Yes, exactly.

Interviewer: ...number five, women are doing the same thing with these symptoms.

Dr. Ryan: Exactly, yeah, so there's a tendency to dismiss the symptoms, so therefore the symptoms often times need to be more severe or more advanced before woman present with them and then by the time they're more severe and more advanced, they're then different, so instead of having left sided chest pain or pain radiating down the left arm, they now have central chest pain and it's radiating down both arms. So that's what ultimately can make the syndromes different. Also, women often don't feel that they should have heart attacks.

Interviewer: They don't have time.

Dr. Ryan: Not only do they not have time, but it's a problem that men have. And this is a serious misconception because cardiac heart disease is the biggest cause of death of women in the United States.

Interviewer: Which is a surprise to a lot of people.

Dr. Ryan: Surprise to a lot of people and it's an important public awareness issue so therefore when women again, when they get their chest pains, or their symptoms from the heart attack, not only do they tolerate it more than men, but also they dismiss it as being a heart attack, sure, sure, why would I be having a heart attack, I'm a woman.

Interviewer: Sure.

Dr. Ryan: I don't have heart disease.

Interviewer: Why do women dismiss, I mean, what is it about a woman's body that they tolerate it more? Any idea?

Dr. Ryan: Probably a pain threshold issue.

Interviewer: We've heard that before.

Dr. Ryan: Exactly, yeah, women often claim to have a higher pain threshold than men, and that's probably true and in this, and that's a very, that's an advantage, but ultimately that ends up hindering people in terms of presenting when they are having their heart attack. So that's probably the issue.

Interviewer: The symptoms are the same but different, they experience them differently, but at the end of the day, are heart attacks different?

Dr. Ryan: So the heart attacks are still associated with significant morbidity, significant mortality and so in that regard they are just as ominous and just as sinister. And the pains, again, the classical pains that people get or that people are taught, is that the central chest pain or the left sided chest pain, radiating down into the left arm, woman often times don't describe this as pain but will describe it as a pressure or a tightness in the chest, all of which are various adjectives that really impact how you perceive pain and again that reflects how you perceive pain. But ultimately the prognosis is still serious, still ominous, and still needs to be treated, taken very seriously and women need to be aware of the fact that they are as likely to experience cardiovascular events as men.

Interviewer: Is there a take away that you would have?

Dr. Ryan: Although we want to see patients when they're having heart attacks, we want to prevent patients from having heart attacks all together, so the more important aspect would be for women to be proactive in order to preventing events, so doing exercise, eating healthy, having heart smart diets and trying to, staying on top of their blood pressure, cholesterol and so on so that we don't end up seeing them when they've had a heart attack.

updated: February 23, 2022
originally published: February 7, 2014

Interviewer: Is it bad enough to go to the Emergency room, or isn't it? Find out now. This is E.R. or Not on The Scope. Time for another edition of E.R. or Not with Dr. Troy Madsen. This is an interesting one: I'm having pains in my chest. E.R. or not?

Dr. Madsen: And that is always a tough question because chest pain is one of the most common things we see in the E.R., and 95% of the time or more, all the testing we do is negative. But it's very concerning because there's that 5% of the time where it's a heart attack, where it's something really serious and it's something you need to come to the E.R. for.
Risk Factors for Heart Disease

Dr. Madsen: So the big thing I base this on is what are your risk factors for heart disease? Because when we think chest pain we think of the heart. If you're someone who is older, let's say over the age of 55, if you're a smoker, you've got high blood pressure, high cholesterol, diabetes, all these things that increase your risk, absolutely you need to come to the E.R. If you're someone who is 25 years old, who was maybe out running, maybe got a little bit tight, maybe coughing a little bit, there, I'm not so concerned. Maybe it was a little bit of asthma, something like that that just caused some tightness in the chest.

So the big thing in my mind is, what kind of risk factors do you have for heart disease, is it a crushing pain that goes up to your neck? Is it causing you to sweat? Does it go down your arm, you feel nauseated, and all these other things that are signs of a heart attack? All good reasons to come to the E.R.

Interviewer: I've had instances where I feel like there's a gas bubble in my chest and it's hard to breathe in deeply.

Dr. Madsen: Yes.

Interviewer: And eventually if you do breathe in deep enough it kind of pops and goes away.

Dr. Madsen: Yeah.

Interviewer: What's that?

Dr. Madsen: It's probably something that's worked it's way up into your esophagus, maybe a little gas bubble up in there that you're feeling over in your chest. Sometimes a lot of causes of chest pain are maybe not causing symptoms exactly like you had, but maybe some kind of a viral illness that can cause some inflammation along the ribs, or along the lining of the lungs. All those can cause these sort of things that cause chest pain. And they're not really that serious.

Interviewer: Is chest pain for a heart attack on the left side, or can it be on the right side?

Dr. Madsen: It's tough. Sometimes, even in older women, it can be abdominal pain. They can have signs of a heart attack where they're actually having pain down in their abdomen and you're thinking, "Oh, maybe they've just got a little bit of food poisoning or a virus." So it's really tough. So that's why it's usually the left side and it's usually going to cause pain to go up and down your neck and your arm and make you sweat. That's a classic heart attack, but I've seen lots of cases of heart attacks that aren't classic, so that's why in my mind, I think a lot in terms of what are their risks for heart disease, and if they have a lot of risks, I'm going to do more testing on those patients.

Interviewer: And come into the E.R.

Dr. Madsen: Yeah, absolutely.

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