Hayder Hashim, MD, Interventional Cardiologist

MedStar Health Research Institute is leading a global effort to understand better coronary microvascular dysfunction with a worldwide patient data registry.   Through a first-of-its-kind free global registry and advanced testing technology, MedStar Health Research Institute is revolutionizing the medical understanding of coronary microvascular dysfunction (CMD)—a diagnosis given when other causes of chest pain have been ruled out.  The Coroventis CoroFlow Cardiovascular system is an advanced diagnostic technology that allows us to diagnose CMD more definitively. Pairing this not-yet-widely-available technology with our CMD registry (CMDR), which has been online for close to 1 year, is already changing our understanding of this tricky condition. CMD is a non-obstructive disease that causes malfunction of the small blood vessels that supply the heart. Decreased blood flow can cause symptoms similar to heart attack, such as chest pain, shortness of breath, and fatigue. Over time, it can increase the risk of major cardiovascular adverse events. Historically, CMD has been difficult to diagnose. While standard tests like coronary angiography look for blockages in the heart’s large arteries, 50% of patients with chest pain do not have significant blockages  as defined by <50% narrowing. Studies estimate that 4 million people in the U.S. might have CMD, and about 70% are women—many of whom are dismissed from the emergency room with a diagnosis of heartburn or anxiety because their large arteries are clear. Our research will hopefully help clinicians identify more patients with CMD before tragedy strikes. Related reading: Melanie’s Story: How Determination and Advanced Technology Found the Cause of Her Heart Attack. With the CoroFlow system, confidently diagnosing CMD and providing timely treatment is now possible. The rapid expansion of our knowledge offers an opportunity to collaborate with providers around the world to learn more about: Different types of CMD How do these types present in patients Other types of evaluation and noninvasive testing Prospective data, including how patients treated for CMD fare in the long run We created the CMDR, a collaborative global registry funded by MHRI, to collect encrypted data from patients who are tested for CMD, including: Baseline characteristics Comorbidities Medications Chest pain severity Noninvasive cardiovascular testing Coronary anatomy based on angiography Physiologic measurements Postprocedural outcomes The registry currently contains data from 253 MedStar Washington Hospital Center and MedStar Southern Maryland Hospital Center patients. Seven institutions are in the process of joining the registry, and another 21 are interested, including hospitals from many U.S. states, Italy, Hungary, Egypt, and Brazil. Our team’s first paper based on CMDR data was published in summer 2023 in the American Journal of Cardiology. Early data shed light on characteristics of CMD, including: About one-third of patients suspected of having CMD were confirmed to have the condition after testing with the CoroFlow system. The CoroFlow system is safe. There were no testing complications among patients in the CMDR.  CMD-positive patients tend to have a lower body mass index than CMD-negative patients. Ten more manuscripts in various stages of publishing investigate the diagnosis process, mental health impacts of CMD, potential associated factors such as chemotherapy and excess fat, and relevance of EKG abnormalities.  Thanks to our research and advocacy, the U.S. Centers for Disease Control and Prevention recently assigned an ICD-10 code to CMD. These codes establish medical necessity for payment of healthcare services so insurers can cover treatment, which will also lead to more data to support the need for more research.  For too long, we’ve told patients what their chest pain doesn’t mean. Now, we can provide an accurate diagnosis, and we’re leading the world in creating a new understanding about CMD to benefit future generations.

Melanie McCauley is a tenacious person, and she’s a perfect spokesperson for self-advocacy in heart care. When she had an uncommon type of heart attack in November 2021, she saw several cardiologists who couldn’t pinpoint the cause or suggest a treatment to keep her chest pain symptoms at bay. Unwilling to take “I don’t know” for an answer, Melanie came to see me after getting a referral to the MedStar Heart and Vascular Institute at MedStar Washington Hospital Center. Using the Coroventis CoroFlow Cardiovascular System, a diagnostic tool that’s only available at a handful of U.S. heart centers, our team found the cause of Melanie’s symptoms: coronary microvascular dysfunction (CMD). This condition involves blockages in small blood vessels of the heart that are too tiny to be seen on standard imaging but are large enough to cause a heart attack. About half of patients with chest pain, including Melanie, do not have blockages in their large coronary arteries. Sometimes these patients are dismissed from the emergency room with a diagnosis of heartburn or anxiety—when they’re actually having a heart attack. Once known as “Cardiac syndrome X”, CMD occurs more often in women, especially younger women, than men. Risk factors include diabetes, high blood pressure, and high cholesterol.  Once we pinpointed the cause of Melanie’s symptoms, we prescribed a treatment that has helped control her symptoms and improve her quality of life. In honor of American Heart Month, I invited Melanie to share her story. By Melanie McCauley I was 44 when I had a heart attack. Before that, I didn’t really have any heart problems. My blood pressure was a bit high, but I was on medication for that. So, when I started to feel some unusual tightness in my chest while watching my husband’s bowling tournament, I excused myself to the restroom—the thought of a heart attack didn’t cross my mind, and I didn’t want to alarm him. I thought maybe I was having indigestion, but then I felt a strange sensation in my arm, and I got very warm and nauseous. I went out to the car and cranked up the air conditioning. Even though it was November, the cold air made me feel a little better.                                             That’s when I checked the symptoms of a heart attack on my phone. Other than shortness of breath, I had every single one. Chest pain, nausea, arm pain, back pain. I texted my husband and said, “I think I might be having a heart attack.”    He left his tournament right away and insisted we go to the nearest hospital. I argued a bit—I didn’t have time for this. Ladies, you know what I mean. My mind was busy with plans for hosting Thanksgiving dinner and a gender reveal party coming up for our first grandchild.      At a hospital near the bowling center, the provider team immediately brought me back to check my heart. My EKG and blood pressure were normal, but my troponin level indicated I was having a cardiac event. Troponin is a protein that is released when the heart muscle gets damaged. The more troponin, the more damage. I had plenty to indicate a heart attack.   When they gave me nitroglycerin, my symptoms went away immediately. Nitroglycerin, a medicine called a nitrate, helps the blood vessels relax and boosts the oxygen supply in the blood while reducing its workload.   I said, “Great! I can go home and start cooking Thanksgiving dinner.” But the nurse chuckled kindly and said I’d need to stay for a while. If I had been well, the nitroglycerin wouldn’t have done anything. So, feeling a little better wasn’t entirely good news.  I spent three days in the hospital getting every test you can imagine: echocardiograms, angiograms, blood tests, everything. It all came back normal. Every provider I saw was kind, but no one could explain what was wrong. One cardiologist after another said, “We don’t know what happened. You’re a medical anomaly. We can’t explain it.”  They thought it could be anxiety or stress and suggested that I try to relax. That’s a tough assignment when you have chest pain, and it felt dismissive. I was frustrated. I didn’t want to go home without an answer. I worried that it could happen again and that the next time might be worse. So, when I was sent home, I followed up with my cardiologist.  The hospital had given me a medication to help keep my vascular system open, and it caused terrible migraines. After five weeks of severe headaches—and no relief of the pain and tightness in my chest—I told my doctor my quality of life was suffering and I needed to try something else.  My cardiologist knew I needed advanced care, and she referred me to Dr. Hashim at the MedStar Heart and Vascular Institute. She said I fit the criteria for CMD, and that Dr. Hashim could perform a special test to find a diagnosis.  I reached out to Dr. Hashim’s coordinator because I was nervous about having another invasive test. Dr. Hashim is a specialist, and he’s very busy—but I said I’d like to speak to him, and he made time to give me a call. I asked Dr. Hashim a million questions, and he very patiently answered every one. He calmed my nerves about the test and explained the procedure in detail. Using the Coroventis CoroFlow Cardiovascular System, he would insert a thin, flexible tube into a blood vessel in my wrist. Then he’d use a specialized instrument to check the blood flow of the large blood vessels in the front of my heart and the small vessels in the back to determine if there were blockages. Related reading: Coronary Microvascular Dysfunction: New Diagnostic Tools Offer Quick Answers and Treatment. During the CMD test, Dr. Hashim found that the tiny blood vessels behind my heart were blocked. He diagnosed me with CMD, and we developed a treatment plan to help me get back to living my life. Honestly, I don’t know if I’d be here today if I hadn’t gotten that referral to Dr. Hashim. I’m confident I would have had another cardiac event—I was so miserable I couldn’t even sleep. Now, I’m on the right medications and I feel like myself again. Today I’m doing great. I have a remote job, so I can work from home and have flexibility to go to my follow-up appointments. My husband and I set up a home gym, and we encourage each other to exercise regularly. I’ve never been much of a gym rat, but we have a lot of fun motivating each other.  I have so many important reasons to prioritize my health. I want my family, especially my granddaughter, to understand that it’s important to stay on top of your own health. Women, we know our bodies best—how things are supposed to feel and when something’s not right. If one doctor can’t find anything, go see another until you can get answers. There are incredible doctors out there with the right tools and dedication to figure out what’s going on. Don’t take “I don’t know” for an answer.  I’ve been so fortunate to have a wonderful team of cardiologists working together for me at MedStar Washington Hospital Center. They communicate, they collaborate, and they’re so responsive. I love my team, and I’m in a good place. I encourage other women to make time for self-care. If you’re not well, you can’t take care of anyone else—and Thanksgiving dinner can wait.

How does the heart work? Your heart is a lot like your house, complete with a framework, plumbing, and an electrical system. It has one mission: to keep blood moving. The framework is provided by the heart muscle itself. The coronary arteries function as the external plumbing, supplying the heart muscle with oxygen-rich blood. The heart’s internal plumbing—its four chambers—squeeze and relax in precise sequence, controlled by the electrical system, the nerves that regulate heartbeat. A disturbance at any point in this well-choreographed process might impede the blood’s movement and create cardiovascular disease. For instance: Over time, plaque can become deposited on the walls of arteries, narrowing the pipeline and reducing blood flow. When the narrowing blocks a coronary artery, cells within the heart muscle can die, a condition known as heart attack. A narrowing can cause angina—pain or pressure in the chest; more severe blockage can lead to more extensive muscle damage—heart attack. Things can also go wrong in the internal plumbing, the chambers and valves. Some problems result from physical defects in the heart structure, often congenital—something we’re born with. These may include defective valves or deviations in the heart wall, both of which can prevent the heart from filling and emptying normally. Electrical problems can cause arrhythmia, an unstable heart rhythm. The worst case is cardiac arrest, when the heart is unable to pump a life-sustaining volume of blood. Other electrical problems include irregular heartbeat, when the heart beats too fast or too slow; and fibrillation. Disease can also directly affect the heart muscle. A common example is heart failure, defining a heart that is in a weakened state. As the pump weakens, some blood is left behind with every heartbeat. This blood backs up and congests the circulatory system, triggering palpitations, shortness of breath, even potential organ failure. Inflammatory or infiltrative conditions—such as cardiac sarcoidosis and cardiac amyloidosis—can hijack normal cardiac muscle cells, replacing them with diseased tissue. Infection in the heart can cause endocarditis, a life-threatening inflammation of the inner surfaces of the heart and valves. As we age, to some extent, all of us have a greater risk of heart disease. But each person’s actual risk is unique, a product of their own inherited and acquired factors. A person at low-risk has few or no existing risks and avoids them by pursuing healthy habits. A person at average risk perhaps has a few unmodifiable risks and some lifestyle risks. A person at high-risk may have unmodifiable risks and also eat poorly, have high blood pressure, not exercise, not see the doctor, and use tobacco. These factors can culminate in a serious health event. We can’t control genetic makeup, family history, age, sex, or race—all of which can contribute to our personal level of risk. But we can delay the onset of disease and/or reduce the severity of illness by concentrating on risk factors for coronary heart disease that we can control, such as blood pressure, diabetes, inactivity, weight, smoking, and stress. Blood Pressure: High blood pressure makes the heart work harder. Uncontrolled hypertension can weaken blood vessels and accelerate the deposit of plaque. That increases the risk of coronary artery disease, stroke, and peripheral artery disease. Treating high blood pressure can be a challenge since it presents no symptoms. Checking blood pressure regularly, reducing salt in the diet, and taking any medications your doctor has prescribed are keys to success. Diabetes: Uncontrolled diabetes causes blood vessel damage, and peripheral artery disease can result in loss of vision or limbs. It also puts a patient at higher risk for stroke and heart attack. Type 2 diabetes can often be prevented with weight control and healthy eating. Once a patient has been diagnosed, however, it’s very important to keep it under control with a doctor’s help. Weight and Exercise: Excess weight makes the heart work harder to distribute blood over a larger body mass, potentially leading to heart failure. It often results from inactivity and poor diet, accelerating the buildup of plaque and increasing the risk for type 2 diabetes. Controlling weight is about burning the calories we consume, but most Americans eat far more than they burn. Managing weight isn’t easy, but exercise can make a big difference. Exercise strengthens your heart and burns more of the calories you consume. It can also serve as a useful sentinel for cardiovascular problems. People who exercise regularly are more likely to notice when they suddenly can’t complete their normal routine or feel chest pain or shortness of breath walking up a hill they climb daily. The American Heart Association recommends at least 150 minutes of moderate exercise each week for adults—that’s 30 minutes per day, for at least five days. If more Americans follow this guideline, we will see drastic reductions in cardiovascular disease. Tobacco: Even if you eat right and exercise, smoking significantly increases your risk of heart disease. Tobacco acts very aggressively in the cardiovascular system. Like high blood pressure, it accelerates the growth of plaque. It calcifies the arteries, making them rigid and less flexible. It also hinders interventional treatments—stiffened arteries can resist expansion from catheterization and stents. Alcohol: Alcohol in moderation may have a limited protective effect. While science has yet to prove a direct link between alcohol and heart health, we do see an association between red wine and reduced risk of death from heart disease. Antioxidants in red wine may improve cholesterol. Assuming that you exercise, avoid tobacco, and adopt other healthy habits, I recommend four ounces of red wine per day for women, eight ounces for men. Keep in mind that higher levels of alcohol consumption can alter liver function, increasing cholesterol levels. And excessive drinking can actually cause heart failure, a condition known as alcohol-induced cardiomyopathy. Dental Neglect: When dental issues are present, bacteria in the mouth can enter the bloodstream and collect in the heart, causing endocarditis or valve problems. We also know that inflammation from poor dental hygiene can make plaque and coronary artery disease more aggressive. Everyone should have a dental exam at least twice per year. A traumatic physical or emotional event can cause stress cardiomyopathy, also called takotsubo cardiomyopathy or broken heart syndrome. Stress cardiomyopathy behaves very much like a heart attack, but without ischemic muscle loss. Fortunately, most patients recover without long-term damage. Stress is part of life, especially during a global pandemic. But chronic, persistent, daily stress can take a slow and dangerous toll. You can’t change your basic personality, but you can change how you respond to stress. It’s important to de-stress in a way that works well for you: meditation, yoga, listening to music, chatting with friends. This is where exercise can also provide amazing benefits. Going for a walk, run, bike ride or swim can help off-load the negativity of the day. When it comes to cardiovascular disease, any symptom must be taken seriously, including chest pain, tightness, or heaviness; shortness of breath; nausea; dizziness; or pain in the jaw, neck, or left arm. If you experience any of these indicators, don’t try home remedies or procrastinate—it’s time to seek emergency care. Even if you suspect it’s just indigestion, it’s safer to be examined by a medical professional, especially if you have pre-existing risk factors. This is particularly vital advice for women, whose symptoms are often less specific than men’s and could potentially also include discomfort through the shoulders, shortness of breath, chills, profound fatigue, or sudden dizziness. MedStar Heart & Vascular Institute is a national leader in the research, diagnosis, and treatment of cardiovascular disease. Our experts are well equipped with the knowledge and technology to offer the outstanding level of heart and vascular care that patients in our region deserve.

Recent advances in diagnostic technology are providing answers for patients with the mysterious heart condition “chest pain syndrome X”—a frustratingly common condition that we used to know little about. As many as 50% of patients with chest pain do not have blockages in their large coronary arteries—are usually called coronary artery disease and can explain chest pain. Thanks to new technology, we can now identify, name, and treat this disease: coronary microvascular dysfunction (CMD). For many years, we have known and realized that the small arteries (microcirculation) of the heart muscle is responsible for approximately 80% of its circulation. These small arteries dilate (relax) and respond to changes similarly to how large arteries do. Therefore, they can lead to symptoms that could occur during daily activities, times of mental stress, or physical activity. Symptoms of CMD can include: Chest pain Discomfort in the left arm, jaw, neck, back or abdomen Fatigue Shortness of breath Trouble sleeping CMD may or may not be caused by plaque obstructing the vessels. It can result in spasms and decreased blood flow to the heart, which can lead to heart attack and heart failure over time. Everyone with chest pain should seek medical care—symptoms of CMD and heart attack can be similar. Studies estimate that 3 to 4 million people in the United States have CMD, and that 60-75% of them are women. CMD is more common in young women. Because CMD has been difficult to diagnose, patients often endure in recurring visits to the cardiologist or emergency room in search of answers. This results in frustration and a high economic burden for both patients and caregivers.  With this new technology, we’re leading the way to understanding that CMD is not a disease of narrowing but a disease of resistance—reduced blood flow to the heart. More importantly, we can now precisely give patients a clear diagnosis—and a straighter path from symptoms to effective treatment.  For decades, doctors have used a device called a Doppler wire to help understand and measure the rate of blood flow in coronary arteries without the ability to measure the actual resistance in the microvascular circulation. With this new technology—and as the only center in the region with this type of technology—we are using a device with pressure and temperature sensors to measure flow across the coronary arteries and, most importantly, resistance in the microcirculation. With tools we know are safe, and measurements we know are reliable, we can quickly give many patients an accurate reason for their chest pain. For others, we can effectively rule out heart-related causes for their discomfort.  For patients who have been struggling to understand their symptoms, just putting a name to that pain can be a significant relief. A 2017 CorMica trial published in the Journal of the American College of Cardiology found that patients who were diagnosed with CMD using the new technology showed notable improvements in their chest pain and quality of life compared to patients who were not given a diagnosis, even though they received the same treatment.  That said, MedStar Health offers proven, effective treatments for CMD. CMD is a disease of the coronary arteries, but unlike other heart problems treatment does not involve heart surgery or stents. Treatment will be based on your overall health and heart disease risk factors Medications: Patients with no sign of structural blockages of the arteries can take calcium channel blockers to lower blood pressure or long-acting nitrates to help prevent chest pain. Patients who have plaque or obstructions may need alpha receptor beta blockers or other drugs to improve cholesterol, lower blood pressure, prevent blood clots, and help the blood vessels relax. Lifestyle changes: Making heart-healthy changes to movement and eating habits can benefit heart and vascular health. For example: Building and maintaining an exercise routine Creating nutritious eating habits Managing stress Quitting smoking At MedStar Health, we’re experts in the new diagnostic technology, and we’re breaking ground to help bring more patients answers. We’re contributing data to a large health registry working to understand the impact of this diagnostic procedure. What’s more, we’re taking part in a major clinical trial called the Heart Attack Research Program (HARP), working with medical centers around the country to better understand CMD. As part of our work, I am a group leader in North America Microvascular Network, a group of 50 interventional and general cardiologists from the U.S. and Canada. I am leading an effort to have this condition be recognized by the Centers for Disease Control and Prevention (CDC) and be granted an ICD-10 code for more streamlined care management.  MedStar Washington Hospital Center has the capacity and robust cardiac imaging program to provide care and search for all types of chest pain. If you are referred to us, we will work with your local cardiologist to create a clear care plan you both are comfortable with. For patients with undiagnosed chest pain, we know that seeking an explanation for health problems can be frustrating. If you’re looking for answers, don’t give up. We can help.

Feeling stress or strain on your heart these days? Here’s a sobering fact: Anxiety about the novel coronavirus is causing people in our community to avoid seeking medical help for their heart issues. So-called “COVID phobia” is delaying treatment and causing needless suffering. Since the pandemic began, the number of patients going to emergency rooms for heart attack and stroke has plummeted. If you have chest discomfort or other warning signs of a heart attack, don’t delay! Come to the ER. At MedStar Washington Hospital Center, we’re well equipped both to safeguard you from the virus and to give you cardiac care that could save your life or protect you from long-term injury. During the pandemic, as always, it’s critical not to dismiss warning signs of a potential medical issue—like the crushing pain of a heart attack. Your condition may become even worse if you don’t get appropriate medical care when needed or neglect your planned therapy, preventative treatment, or screenings. At the Hospital Center, we are, of course, trying to prevent patients of all types from exposure to this new virus. But at the same time, our mission is to avoid a potential increase in deaths from other serious or chronic conditions. My patients often describe their heart attack pain as an elephant sitting on their chest. Pain might also travel down the left arm, or up to your neck or jaw. Other symptoms include: Shortness of breath A sense of impending doom Vomiting Sweating profusely even if not exerting physically Women may experience different and more vague symptoms: Pain in the upper part of the abdomen right below the ribs Indigestion And studies show that the novel coronavirus itself can impact the heart. It can imitate certain heart attack symptoms, such as difficulty breathing, shortness of breath, abnormal EKGs, and severe inflammation of the heart muscle (myocarditis) among others. Only a proper medical examination can determine whether you’re experiencing a heart attack, virus symptoms, or some other issue. For some patients, that characteristic crushing pain may very well subside. But this doesn’t mean you tackled death and won. This is just the body saying, “I tried everything I could to alarm you. I gave you pain, nausea, shortness of breath. I give up.” The damage remains, and most likely you will eventually suffer from a chronic, hard-to-treat illness. Ignoring symptoms of heart disease can lead to death of the heart muscle. Traditionally, our patients arrive from Maryland, Washington, D.C., and Virginia by ambulance or helicopter. The emergency medical service crew sends the EKG ahead, so we’re ready to work on patients as soon as they arrive. Because we can treat them within 50–60 minutes of onset, many heart attack victims are able to sit up shortly after treatment. They text, they call their family—even though they just suffered a heart attack! Unfortunately, these days many heart attack victims are staying home, wary of COVID-19. They opt to treat themselves with aspirin and wait for the pain to go away. After 24 hours, they don't feel pain anymore, but they will grow sicker over time. For example, before this new virus, we saw maybe one or two cases a year of ventricular septal defect (VSD), a hole between the chambers of the heart typically caused by delayed treatment. But in the last three weeks alone, we’ve already treated three patients with VSD. Some patients who are chronically ill with heart disease also try to stay home and self-treat. Unfortunately, without regular medical attention, their illness can progress to the point where it's too late to help them. Here’s an analogy: When 80% of your house is on fire, the house is already beyond help, even though 50 fire trucks might arrive to put out the flames. The minute you see the fire is the time to summon help, and extinguish it while damage is still minimal. In the same way, ignoring warning signs because of virus phobia can eventually make a weakened heart muscle difficult to salvage. Even if we can help you, you could be permanently injured or ill for the rest of your life. That’s what we want to prevent. Time is of the essence. As we cardiologists say, time is muscle. Make the phone call. Come to the ER if you have symptoms. Don’t wait for symptoms to improve—call 911 or have a telehealth visit with your doctor. Describe what you’re experiencing and get their advice. Throughout MedStar Washington Hospital Center, we have developed new pathways and protocols to create a safe environment for you during this pandemic. We have the right personal protective equipment to keep you safe while we treat you. The minute you enter the Hospital Center, you will wear a mask. If you don't have one, we'll give you one. We take your temperature. If no fever is recorded, you will be guided to admissions or registration. Seating in our waiting areas is separated by six feet or more. There is enough staff to receive you and work to treat you quickly. If you’re going to the cardiac catheterization lab, a concierge associate will escort you. They’ll operate the elevator and help you arrive at the lab without contacting quarantined areas or hallways. As we adapt to life with the coronavirus, I am conducting more telehealth visits. I sit with my patients virtually, face-to-face, review their symptoms, discuss their medications, review their chart, and discuss their treatment plan. They don’t have to worry about the new virus. And if we determine they do need medical attention right away, they know what to expect when they get here. If you’re nervous about coming in to the hospital, but have some health concerns, speak with a medical professional. Schedule a telehealth visit. Mammograms, colonoscopies, and screening for cancer are still essential to detect life-threatening conditions. Maintaining your health to avoid future medical issues is as essential as getting your groceries or prescription medications. COVID-19 is just one illness that we face today. But other illnesses still require our attention. It’s worth repeating: if you think you’re having a heart attack, stroke, or other medical emergency, call 911 and come to the ER. For less urgent matters, schedule an appointment with your doctor. Let us give you the treatment you need when you need it.

There are a number of symptoms that might be warning signs of a heart attack—from radiating chest pain to something as subtle as dizziness or lightheadedness. The symptoms can even vary from men to women, too. Women often have heart attack symptoms that are different from men’s symptoms, and women often overlook these symptoms because they don’t want to overreact. A patient can be experiencing alarming upper belly pain, but they don’t want to call an ambulance, go to the emergency room, and then find out their pain was only indigestion. Don’t ignore your body. Know what signs of a heart attack women should watch for and whether you’re at risk for a heart attack so you can get help fast if you need it. Related reading: Why do more women than men die after heart attacks? Women are more likely to have a silent heart attack, or one that doesn’t show any apparent symptoms. They’re also more likely to die after their first heart attack because they don’t want to overreact to symptoms. Women rarely feel the classic crushing pain in the chest that appears for men who have heart attacks. Instead, women’s symptoms often are more subtle and may include: Chest discomfort or fullness Blackouts or fainting Breathlessness during activities or waking up breathless at night Chronic fatigue after routine activities Dizziness that can indicate irregular heartbeats, or arrhythmias Swelling, particularly of the lower legs and ankles Palpitations, rapid heartbeats that may cause pain or difficulty breathing Nausea or vomiting, unrelated to diet, indigestion, or abdominal pain Sweating Some patients say they feel an impending sense of doom. They feel as if they will die if they don’t seek help. In women with diabetes, the symptoms are a bit different. They can experience chest pain when they’re going down the stairs to laundry or going up the stairs to put their kids to bed. If the pain creeps up on you and then gradually dissipates, this usually is an indication of coronary artery disease. You most likely have a blockage in a blood vessel that supplies blood to the heart that needs to be taken care of. Patients also can feel pain in the middle of their chest that travels to their back. Some people even have chest pain on their right side, away from the heart. If your symptoms aren’t going away and they’re alarming you, don’t take the chance. Call 9-1-1 and take that ambulance ride. It’s even more important to seek medical help for possible symptoms of a heart attack if you have risk factors for heart disease, such as: A family history of heart disease Diabetes High blood pressure (hypertension) High cholesterol (hypercholesterolemia) Diabetes can lead to serious cardiovascular issues, particularly in women. A woman’s risk for heart disease increases after menopause because estrogen levels decline. Before menopause, estrogen can protect against some of the problems related to high cholesterol, a common factor in heart disease. Lifestyle choices such as smoking, an unhealthy diet, and not exercising can lead to heart disease. Women should have their blood pressure, cholesterol, glucose, and body mass index checked by their doctor. Monitoring those numbers can help you stay healthy. They should also learn about their family history and discuss all these issues with a doctor. We know that coronary artery disease can manifest suddenly and become a heart attack. Women should take these symptoms seriously and not take the chance. They should seek medical help. It’s better to be safe than sorry. Request an Appointment