The (Not So) Tell-Tale Heart
The heart has its reasons of which reason knows nothing. –Blaise Pascal
A few years ago, a colleague of mine developed chest pain while going through a marriage break-up. Although he did not have a heart history, as a middle-aged male he was given a cardiac work-up, including a catheterization. A vessel was nicked during the procedure and were it not for an astute nurse at 4:00 a.m., he might have bled out internally. The irony is had he been female, he likely would have received the correct diagnosis: an anxiety attack.
According to the American Heart Association (AHA), every 40 seconds someone in the US will have a myocardial infarction (MI), with up to 75 percent of heart attacks occurring at home. Cardiovascular disease remains the leading cause of death in the US, accounting for more deaths annually than all cancers and chronic lung disease combined.
The AHA monitors eight essential lifestyle factors as a barometer of overall cardiovascular health. One is smoking, which is the leading cause of premature death and the third leading cause of years lived with a disability.
Several interrelated lifestyle factors also impact heart health, including inactivity, nutrition, cholesterol, diabetes, and obesity. The numbers are not good. Between 2000 and 2018, obesity among men increased from 27 percent to 43 percent; for women, from 33 percent to 42 percent. Poor nutrition plays a part in the obesity epidemic, with diet also affecting cholesterol and sugar levels.
According to the Centers for Disease Control and Prevention (CDC), approximately two of five Americans have high cholesterol, a risk factor for both heart disease and stroke. While the numbers of those with high cholesterol have declined, up to 40 percent are unaware they have it. More concerning, about seven percent of children now have been diagnosed with high cholesterol.
The prevalence of diabetes in the US has nearly tripled in the past three decades. As of 2022, the CDC estimates 37 million Americans have diabetes.
Adequate sleep and blood pressure management impact heart health as well. The National Sleep Foundation recommends seven to nine hours of quality sleep per night yet reports only about 20 percent of Americans achieve that goal consistently. Key disruptors include electronic devices: the Foundation estimates 89 percent of adults and 75 percent of children have at least one electronic device in their bedrooms.
Hypertension is another critical risk factor for heart disease and one rampant in the US. Close to half of American adults live with high blood pressure, yet only 25 percent are believed to have adequate management.
All these essential heart health metrics can be improved with physical activity. Unfortunately, fewer than one in three adults get the appropriate amount of exercise to stay healthy, per the CDC. Results worsen by region. Only 16 percent of adults outside urban areas and 22 percent in the South meet national physical fitness metrics. Less than one quarter of children younger than 18 participate in daily, 60-minute exercise sessions and only 51 percent of high school students attend weekly physical education classes.
Emotions can also impact heart function. First identified in Japan in 1991, Takotsubo syndrome (TTS)—or broken-heart syndrome—presents as a classic MI, linked to a sudden or severe emotional event. In many cases, the condition is temporary and the heart returns to normal baseline function. Not always, however, and clinicians need to treat the event as a physiological heart attack. While not well understood, a preponderance of TTS cases occurs in post-menopausal women, suggesting a hormonal link.
Over 90 percent of both men and women report the classic symptom of chest pain when having an MI. However, other key discriminators in how women and men present have resulted in MI now being diagnosed with sex as a factor. For example, women more often than men are also likely to report radiating pain in the left arm and back, palpitations, and nausea. In addition, a specific chemical marker increases the likelihood of an MI in women by close to 30 percent. This may be critical in younger women with a cardiac history who often present without classic chest pain, but with the associated heartburn, nausea, dizziness, and shoulder pain. These women historically have been misdiagnosed, only to return later in more critical condition.
A recent AHA study highlights a potential increase in MI risks among individuals who identify as transgender. After adjusting for common cardiovascular risk factors, the study indicates transgender men—born biologically female—had about four times the rate of MIs as cisgender women. Transgender men also had more than twice the rate of heart attacks as cisgender men. Transgender women—born biologically male—had more than twice the rate of MIs as cisgender women. While the authors cautioned against suppositions yet, they surmised hormones may play a part, as with TTS.
The heart has its reasons for skipping a beat. The key is knowing when that funny feeling is just Cupid’s aim or the Grim Reaper knocking. ▼
Sharon A. Morgan is a retired advanced practice nurse with over 30 years of clinical and healthcare policy background.