Former talk-show host Rosie O'Donnell recently became one of the 195,000 Americans each year who experiences a heart attack and does not know it. O'Donnell, age 50 at the time of her attack, reportedly did not realize what was happening to her when she became nauseated and started to feel clammy, two of the subtle, often-missed heart attack symptoms that are frequently experienced by women. Other "atypical" heart attack symptoms in women include back or jaw pain, extreme fatigue, dizziness and light-headedness.)

An even more insidious risk: It's common for women and men to fail to tell their doctors about elusive heart disease symptoms that often precede a heart attack. If recognized, these symptoms often can be effectively treated to stop a heart attack before it occurs.

What Gets Missed

Most people do not realize just how important it is to report new symptoms during a doctor visit. With heart disease, in particular, there can be such a wide range of mild and/or fleeting changes in the heart, that the way you describe any possible abnormality to your doctor can mean the difference between an accurate diagnosis and a missed one. That's why you always should be sure to include details whenever you tell your physician about a symptom.

Examples: Don't just say that you're short of breath-do you feel this way all the time or just when you're climbing stairs? And don't just say that you've noticed changes in your heartbeat–is it too fast, too slow, fluttery, irregular, etc.?

Other important symptoms that should be discussed…

  • Intermittent chest pain. The majority of heart attacks are preceded by the development of atherosclerosis, accumulations of fatty deposits in the arteries that inhibit the normal flow of blood and oxygen. When these deposits restrict blood flow to the heart, the result can be myocardial ischemia, a condition that typically causes chest pain due to a lack of oxygen.

Main symptom: Sharp chest pains or pressure that can last anywhere from a few seconds to about five minutes. This type of chest pain, known as angina, usually occurs during physical exertion, such as climbing stairs or working in the yard. It also can occur during cold weather, which causes blood vessels to constrict, or during stressful situations, which can increase demands on the heart and cause it to beat faster.

Exceptions: Angina isn't always painful, and you won't necessarily feel it in your chest. Patients with myocardial ischemia affecting the base of the heart might have abdominal discomfort instead of chest pain. (Some people mistake it for heartburn.) People with diabetes who have nerve damage, or those with a high pain threshold, might have no pain at all.

My advice: Suspect angina when you have chest and/or abdominal pain that occurs only during physical exertion. Rest if you experience pain in these areas. The pain should go away within five minutes if angina is the cause. In this case, call your doctor promptly to make an appointment. Call 911 if the pain isn't gone after five minutes.

  • Shortness of breath (dyspnea). It is one of the main symptoms of heart disease, yet patients don't always mention it because they attribute it to other factors, such as smoking, advancing age and/or a lack of exercise.

Important: Shortness of breath can be caused by atypical angina. These angina patients do not experience pain as the main symptom. They are more likely to have episodes of breathlessness, weakness, fatigue and/or sweating. This is particularly common in older adults and those with diabetes.

My advice: To distinguish "normal" shortness of breath from a heart-related condition, ask yourself whether the dyspnea is out of proportion to what you're doing.

Don't Let Unemployment Hurt Your Heart

People who were jobless because they had been fired, laid off or quit a job earlier in life had a 35% higher risk for heart attack after age 50 than people who remained employed. Multiple job losses posed as much of a threat to heart health as smoking, high blood pressure and diabetes. Talk to your doctor about heart-health strategies, such as reducing stress.

For example, people do not normally get winded from unloading the dishwasher or walking to the mailbox. If you do and you haven't been diagnosed with a condition to explain it, such as lung disease-see your doctor. Also, any change in your tolerance for exercise could indicate a heart problem. If you experience unexplained shortness of breath or a significant change in your tolerance for exercise, see your doctor as soon as possible.

Call 911 if you have severe shortness of breath that comes on suddenly, especially if it's accompanied by chest pain, fainting or nausea-these could be signs of heart attack or pulmonary embolism.

  • Palpitations. Everyone has occasional changes in the heart's pumping rhythm. You might notice that your heartbeat is rapid, pounding or fluttering, particularly during exercise or when you're stressed. The heart is probably still pumping blood effectively, but you'll want to talk to your doctor anyway.

The risk: Heart palpitations can indicate that you have arrhythmias, problems with the heart's electrical systems. A heartbeat that's too rapid (tachycardia), too slow (bradycardia) or irregular (atrial fibrillation, among others) can be life-threatening.

Example: Atrial fibrillation is common in older adults. The heart usually regains its normal rhythm within a few seconds, but not always. There's an increased risk for stroke if the irregular heartbeat continues for more than 24 hours.

My advice: Call 911 immediately if palpitations are accompanied by other symptoms, such as fainting, heavy sweating or extreme anxiety-all of which can signal a heart attack or an impending one. If you have palpitations without other symptoms, make an appointment to see your doctor as soon as possible.

  • Leg pain. It's normal to experience occasional charley horses," cramps in the muscles in your legs. It's not normal to have frequent pain in a foot, calf, thigh or buttock when you're walking or doing other activities. Leg pain that develops during exertion is often a sign of peripheral artery disease, a form of atherosclerosis that occurs in arteries in the leg. Patients with peripheral artery disease have a high risk of having (or developing) cardiovascular disease.

My advice: If you notice aching, cramping or pain in one or both legs during physical activity, see your doctor. Peripheral artery disease also can cause a sensation of "burning," tingling or numbness in the legs and/or feet. These symptoms indicate that the leg isn't getting enough oxygen-rich blood-and there's a good chance that your heart arteries are also at risk. With advanced peripheral artery disease, the symptoms occur even at rest.

  • Hair loss on the legs/feet. Sedentary patients with peripheral artery disease might not notice leg pain or cramps. However, they might have other "silent" symptoms that indicate impaired circulation, including hair loss on the legs and/or feet.

My advice: See your physician as soon as possible if you notice hair loss on the legs or feet or one of the other possible signs of peripheral artery disease-one leg/foot that is colder than the other...sores that are slow to heal.. a "shine" to the skin...or thick, slow-growing toenails. The symptoms may occur in both legs, but patients often report that only one leg is affected.

When To Call 911…

Severe chest pain (often described as "crushing pain) is the heart attack symptom that everyone knows about-and fears. You most likely are having a heart attack if you have severe, unexplained chest pain that lasts longer than 20 minutes. But do not wait that long before getting help.

Call 911 even if your chest pain has lasted just a few minutes or if you do not have chest pain but are experiencing other symptoms that could indicate a heart attack, such as unexplained nausea, breaking out in a cold sweat, dizziness, shortness of breath or extreme anxiety accompanied by a feeling of impending doom.

Emergency personnel may advise you to chew aspirin while you wait for help to arrive, so always keep a bottle of aspirin handy.

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