Prominent Kannada film actor-director Vijay Raghavendra’s wife Spandana, 44, was apparently healthy while holidaying with her cousins in Bangkok when she reportedly suffered a heart attack, the family said. Although the family claimed that her blood pressure had plummeted very low, triggering a heart attack, it has again highlighted the increasing risk of heart attacks among middling women, who are over 45. While some triggers, like post-menopausal hormone irregularities, unregulated use of oral contraceptives and smoking have been much discussed in the public domain, unknown ones like stress can make women vulnerable, according to Dr Sunil Dwivedi, Consultant, Cardiology, Manipal Hospital, Bengaluru.
“While factors like menopause, where the protective effect of estrogen wanes as its levels dip, smoking, poor lifestyle management and unregulated use of oral contraceptives can cause heart attacks, we must look at overlooked triggers,” he says.
What is stress cardiomyopathy?
“One of them is stress cardiomyopathy, commonly known as the broken heart syndrome, which manifests in middle-aged women faster than other age groups. A woman’s risk of developing the condition increases five times after the age of 55. This happens when a person experiences sudden acute stress, both emotional and physical, that can rapidly weaken the heart muscle. The reason it suddenly creeps up on the patient is because it may be a gradual degradation following a sudden illness, a traumatic incident, an extreme surprise, unknown fear or the loss of a loved one. Usually the patient is not aware that the stressful incident has been eating them up inside and up to 30 per cent of patients have no identifiable trigger at the time of onset of symptoms,” says Dr Dwivedi. “Sometimes, physical illnesses, severe bleeding in the body and even low blood sugar can build up stress,” he adds.
Explaining the mechanism, Dr Dwivedi says, “Whenever the heart senses stress, the body produces excess adrenaline, which can narrow arteries and impede blood flow to the heart. Sometimes the adrenaline binds itself to the heart cells, causing large amounts of calcium to enter the cells. Estrogen usually neutralises the harmful effects of adrenaline, which is why menopausal women are most at risk. But if detected on time, this condition is completely reversible and the patient can recover easily. So women in this age group should watch out for the frequency of chest pain or shortness of breath in stressful situations and seek medical advice to avoid an emergency.”
What is spontaneous coronary artery dissection?
The second less talked about trigger for sudden heart attacks in middle-aged women is spontaneous coronary artery dissection. “Now this happens because of a tear in a blood vessel of the heart and affects mostly women in their 40s and 50s even if they do not have traditional risk factors like high blood pressure, high cholesterol or diabetes. This is because of fibromuscular dysplasia (FMD), which causes irregular growth of cells in the artery walls, weakening them. This could lead to blockages and aneurysms. It can also cause high blood pressure, stroke and tears in other blood vessels,” says Dr Dwivedi.
What is undefined cardiomyopathy?
Sometimes a heart attack could be the result of undefined cardiomyopathy, which is not caused by genes. This can lead to heart beat problems or arrhythmia, slow down the ability of the heart to pump effectively and accelerate clotting. “Though this is usually associated with a family history, it can happen because of long-term high blood pressure, obesity, long term abuse of alcohol and substances, diabetes, thyroid or excess iron in the body,” says Dr Dwivedi.
He also points out how severe dehydration, when body salts go down, especially potassium and magnesium, can trigger very fatal rhythm disturbances and cause a heart attack.
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“Many women do not experience typical chest pain which makes early diagnosis and treatment difficult. Often due to responsibilities at home and at work, women tend to ignore their own well-being and dismiss mild symptoms as a routine niggle. But women must be aware that they too are vulnerable to heart diseases and should ensure regular check-ups as well as pay attention to any worrisome symptoms that need medical intervention. Peri-menopausal women, especially, are at higher risk,” says Dr Sanjeev Gera, Director & HOD, Cardiology, Fortis, Noida.
One must not ignore heart attack symptoms — aching, heaviness or burning sensation in the chest, pain in one or both arms or left shoulder, throat or jaw, shortness of breath or cold sweat, extreme fatigue and so on, he advises. “Often women do not undergo regular preventive heart check-ups to determine if there are any signs of heart disease. Many a time, patients reach hospitals with heavily blocked arteries that increase their risks like formation of blood clots, which can lead to 100 per cent blockage of coronary arteries, leading to a heart attack,” Dr Gera says.
