Women, Menopause, and Heart Disease: Chest Discomfort
Little time goes by for me without a request for cardiology consultation that involves a female, aged 35 to 60 who is having “problems that may be cardiac”. Invariably the idea that the symptoms are not related to menopause, either because the patient reports that the symptoms had ended some time ago, the periods were continuing, or that the doctor had done a blood test that showed that it wasn’t menopause leads to further investigation.
As a male physician in a brief column I won’t belabor the many irritating symptoms that are recognized by women the world over and have been memorialized in magazines and books by well known people that have suffered the same changes and renamed them “power surges”.
So how does a doctor go about helping a woman find out which symptoms she should worry about? Just the same way the doctor goes about diagnosing every other process in the body. We ask questions. You can ask the same questions of yourself. The answers can help shed a light on whether or not you should seek further medical help.
With respect to chest discomfort: We like to know if it is just an unusual awareness, squeezing or heaviness or pain, sharp or dull, constant or inconstant (waxes and wanes), localized (in one spot) or diffuse (all over). We will want to know if the discomfort “travels” anywhere, does it go to the back, belly, shoulder, neck (front or back), arm or forearm (one or both). Next we will ask whether you can bring on the discomfort yourself (emotionally, by eating or after meals, by changing positions, or by physical activities such as vacuuming, washing windows, walking or running up and down the stairs). We will want to know how long the problem has been occurring, and the frequency with which it occurs.
We also like to know the company that this chest discomfort keeps. Just like children, the more “bad actors” in the crowd, the more the risk of a problem. Cold sweat or a hot flash (not worrisome)? Do you fell weak or as if you are going to pass out when you get the chest discomfort, or have you actually passed out? Shortness of breath? Palpitations (the unnatural sensation that your heart is racing out of control though you aren’t doing anything) and if so are they regular (like the fast ticking of runaway clock, less worrisome) or irregular (no real rhythm, like a first piano recital)?
And a bit more about your own risk about getting into trouble is needed to help us decide what the likelihood is that you (as an individual) are more likely to have a serious problem. You are at higher risk of a problem if you have high blood pressure (more so if it is not controlled), diabetes (more so if not well controlled), high cholesterol (again more so if not adequately treated), smoke, are taking female hormones, have a personal history of blood clots, or a family history of any first degree relative (grandparents, parents, brothers and sisters) who had coronary artery disease, stroke or heart attack before age 60.
How does the doctor interpret this and how should you? The physician often has experience with many similar complaints. For the most part, brief, infrequent, unaccompanied discomforts that cannot be brought on by heavy exertion and are accompanied only by hot flashes and palpitations are quite benign and require little more than reassurance. But if the chest discomfort is accompanied by its friends shortness of breath, passing out, irregular heart rhythm and accompanying pains in the arm, jaw or front of the neck, and you are at higher risk because of elements of your history than you had better scurry over to the phone now and speak with your doctor about further evaluation.