With SMH Cardiologist Chippy Nalluri, MD
Welcome to “Ask an Expert,” a Q&A series with Sarasota Memorial’s team of doctors, nurses and other health experts, where you can get thorough answers to your health and wellness queries from a local source you can trust. Have a question that you’d like to “Ask an Expert”? Email it to AskAnExpert@smh.com.
Q: How does women's heart disease differ from heart disease in men?
Women tend to present with heart disease later in life than men — typically, about 10 years later. So, when a woman presents with her first heart attack, not only is she typically older but she likely has more or greater comorbidities, meaning she's been a diabetic for longer, had high blood pressure for longer, has been battling high cholesterol, etc. She could have other diseases, such as kidney disease, for longer. Because of that, the heart attack isn’t just a heart attack; there likely are more complications because she has other diseases or health challenges that are in full-swing. Women tend to have a greater risk of heart failure and arrhythmia than having just a heart attack.
Q: What heart disease symptoms should women should look for?
We used to emphasize the difference between the symptoms a woman feels versus what a man feels, but what we are finding now is that women more often have the same typical symptoms of heart disease: pressure in the center of the chest, pain or discomfort that radiates into her arms, up her neck, through the back. She can break out into a sweat, get lightheaded or dizzy, or have similar symptoms. These symptoms might be brought on with exertion, however, what we're finding is that women tend to have these symptoms at rest. It can wake them up from sleep, or it could be precipitated by an intense emotion such as emotional stress.
Q: What factors increase the risk of developing heart disease? What can be done to reduce the risk?
The contributing factors for heart disease that we commonly see include smoking, diabetes, high blood pressure, high cholesterol, certain inflammatory diseases, having chronic kidney disease, and importantly, poor physical activity, poor function and poor nutrition.
Fortunately, 90 percent of heart disease can be prevented with changing modifiable risk factors. This means you could stop smoking, or if you have diabetes, you could make lifestyle changes that can dramatically improve or even resolve the disease. Blood pressure and cholesterol can be controlled through diet, physical activity and stress management.
When we talk about what can we do to reduce the risk, there are actually four key areas that should be addressed.
- Food. Nutrition is extremely important, not just for managing heart disease risk, but to reduce the risk of other diseases — what we call diseases of affluence or the modern man; these are namely diseases stemming from an inactive lifestyle, reliance on convenience foods, etc.
- Physical activity. Getting enough exercise and physical activity are fundamentally important to reducing all traditional risk factors for heart disease.
- Stress management. Doing something that reduces your level of stress throughout the day is important. We are finding that stress is an underlying cause for many diseases.
- To have love. We are finding that having love and social connection are exceptionally important to wellness.
When you put these four modifiable things together in a person's life, you can dramatically reduce heart disease and many other chronic illnesses.
Q: When should a patient consider minimally invasive surgery instead of a traditional open-heart procedure?
With minimally invasive surgery, the incision is anywhere from 2 to 4 inches in size, versus the traditional median sternotomy, or cutting the breastbone, which is anywhere from 6 to 10 inches in length. There is a faster recovery and less pain. So, you can return to normal activity quicker, and for young women especially we consider this option for cosmetic reasons.
For a patient to have minimally invasive surgery, they must meet specific criteria. Generally, it’s recommended when a patient needs a very complex surgery or a re-do surgery — like an isolated mitral valve surgery, two valve surgeries, a tricuspid valve surgery or aortic valve surgery.
Q: Can you recommend any resources for women's heart health information?
The American Heart Association and the US Centers for Disease Control are common sources for heart health info, and I personally love two websites: The Physician's Committee for Responsible Medicine and NutritionFacts.org; these are great resources for anybody.
With decades of experience, Sarasota Cardiologist Chippy Nalluri, MD, is board certified in cardiovascular diseases and nuclear cardiology. She is specialty trained in all aspects of non-invasive cardiology, but has a passion for helping women manage heart disease.