You’ve educated yourself on the signs and symptoms of a heart attack in women. You are experiencing signs and symptoms. Now, what do you do?
CALL 911. Tell the dispatcher you are experiencing signs and symptoms of a heart attack. An ambulance will be sent to transport you to the closest hospital with emergency cardiac care facilities. DO NOT drive yourself or ask a friend or neighbor to drive you to the hospital. Aside from the ability to treat and resuscitate should your condition worsen, professional emergency personnel know the proper facilities to take patients. The closest hospital may have no capability of caring for acute coronary problems and being taken there only causes further life-threatening delays while transfer to the right place is arranged. The extra 15 minutes in the ambulance to a more distant hospital could save hours of waiting for proper care.
Chew and swallow with water one regular full-strength aspirin as soon as possible. The aspirin will prevent further blood clotting.
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Be your own health advocate. Insist that the hospital staff takes your complaint seriously, does not make you wait, and gives you a thorough cardiac evaluation including an electrocardiogram (EKG) or echocardiogram and a blood test to check your cardiac enzyme levels.
DO NOT DELAY – TIME IS HEART MUSCLE. The earlier you receive treatment, the better the likelihood that damage to your heart muscle will be kept to a minimum.
Questions for your Doctor
Be prepared to speak with your doctor by writing your questions down and bringing the list with you to your appointment. When the doctor answers your questions, be sure to write down his/her responses. If things are not clear, to ask for clarification! Use the lists below as a guide:
Treatment, Medication and Surgical Procedures
About Treatment Options:
- What is the recommended treatment? Are there other choices?
- What are the chances the treatment will work?
- What are the expected results? When will I see them?
- What are the risks?
- What are the benefits?
- Are there any side effects? What can be done about them?
- Is the treatment painful? How can the pain be controlled?
- What happens if I choose to have no treatment at all?
- How much does the treatment cost? Will my health insurance pay for it?
About Prescription Medication:
- What is the name of the medication you have prescribed for me and what is it supposed to do?
- When and for how long should I take the medication? Can I get these directions in writing?
- What should I do if I miss taking this medication?
- How long will I have to take this medication? When can I stop taking it?
- Are there foods, drinks (especially alcohol), other medications, or activities I should avoid while taking this medication?
- Are there common side effects to this medication? What should I do if they occur?
- Will this medication interact with other medications I am currently taking? If so, what can I do to lessen any negative effects?
- How can I learn more about this medication?
About Surgical Procedures:
- Do I really need this surgery? Is there some other way to treat my condition?
- What will happen if I wait until later to have surgery? Or never have it at all?
- How often does this type of surgery help my problem? How much does it help it?
- Where will the surgery be performed?
- Which surgeon will be operating on me?
- What kind of experience does s/he have with this kind of procedure?
- What complications or side effects might I have?
- What kind of pain might I have? How will it be treated?
- How long will it take me to recover?
- Will I need help at home? What kind of help and for how long?
- How much does the surgery cost? Will my health insurance pay for it?
Testing and Diagnosis
- What is this test and why are you recommending it?
- What information will this test provide? Are there other ways to obtain the information?
- How will the test results affect my care?
- How accurate is the test? Has it been proven safe and reliable in women?
- How should I prepare for the test? When can I eat before and after it?
- Who will perform the test? Where will it be conducted? How often has that person/lab performed the test during the past year?
- What dangers or risks are associated with this test?
- Will I be awake during the test? Will it hurt or be uncomfortable?
- How long will the test last? When can I go home?
- Will there be any pain or side effects after the test?
- How and when will I receive the test results?
- How much will the test cost me?
- What is the technical name of my disease or condition, and what does it mean in plain English?
- Will I need any additional tests?
- What lifestyles changes will I need to make to improve my health?
- Is there a chance that someone else in my family might get the same condition?
- Will I need special help at home for my condition?
- Is there any treatment?
- What are my treatment options?
- How soon do I need to make a decision about treatment?
- What are the benefits and risks associated with my treatment options?
- Is there a clinical trial (research study) that is right for me?
- What organizations and resources do you recommend for support and information?
Roadmap to a Diagnosis
It’s important to know that no one diagnostic test can determine your risk of heart disease; often several tests are required. As your own health advocate, know the reasons and risks of each test, and don’t be reluctant to ask your healthcare provider or technician questions.
When looking for clues about your heart health, your healthcare provider will probably start with blood tests. These tests often reveal risks for coronary artery and other heart disease and sometimes provide warnings for heart failure. Blood testing often requires fasting beforehand so be sure to check with your healthcare provider.
Blood profiles test for abnormal levels of:
- Fats (lipids) in your blood.
- Low-density lipoprotein (LDL) – the “bad” cholesterol – that causes the accumulation of plaque in your arteries.
- High-density lipoprotein (HDL) – the “good” cholesterol – helps clear your arteries of LDL.
- Triglycerides, another type of fat, that raise your risk of heart disease.
- Blood sugar (glucose) to detect the presence of diabetes and glucose intolerance (pre-diabetes).
- C-reactive protein to determine inflammation in your body. This test is given only to individuals who are at risk for heart disease and may be used with other blood tests to assess risk factors for heart disease.
- Complete blood count, thyroid studies, arterial blood gases.
A chest X-ray is a basic diagnostic tool that shows the size and structure of the heart and lungs. It can detect heart failure and reveal abnormalities in your heart, lungs and major blood vessels. Chest X-rays are simple, inexpensive and painless. Because this test exposes you to a small amount of radiation, let your healthcare provider know if you might be pregnant.
Calcium is usually contained in the fatty deposits, or plaques, that build up in arteries, making it an important predictor of coronary artery disease. Computed tomography is used to measure calcium in and around arteries.
Two CT scans are particularly effective:
Electron beam computed tomography (EBCT) is an ultra-fast CT scan that takes high-resolution, three-dimensional pictures of the heart as it is beating. Electron beams scan your heart as you lie on a special scanning table and progress through a doughnut-shaped scanner.
CT coronary angiography (CTA) involves an injection of a contrast dye into your arm to enhance the quality of the CT images. Coronary CTA helps measure the narrowing of coronary arteries and diagnose coronary blockages.
Also known as an angiogram, coronary catheterization tracks blood flow through your coronary arteries. A long, thin tube, or catheter, is inserted through your arm or leg artery and threaded into your coronary arteries. A dye is then injected through the catheter to highlight on an X-ray machine your blood flow in and around the heart. Because it is invasive and usually performed in a hospital, the procedure is recommended for women with severe symptoms, who do not respond to treatment or whose non-invasive tests are inconclusive.
An echocardiogram uses sound waves (ultrasound) to generate images of your heart and help your healthcare provider assess your heart’s pumping strength and detect damage to the heart chamber, valve problems and heart defects. Electrodes are placed on your chest and a wand (sound-wave transducer) is moved around your chest to pick up electrical activity. This test is simple and non-invasive, however, it does require fasting and medication restrictions beforehand.
An electrocardiogram (EKG or ECG) measures your heart’s electrical activity by placing small electrodes with adhesive pads to the skin of your chest, arms and legs. The test takes only a few minutes and is simple, safe and painless. An EKG measures your heart rhythm (fast, slow or irregular), detects inadequate blood flow to the heart, and identifies heart abnormalities, such as enlarged chambers or a heart defect. It can also confirm a heart attack, past or present.
Magnetic Resonance Imaging (MRI)
Magnetic resonance imaging is a testing technique that uses magnetic and radio-frequency waves to look at your heart throughout its blood pumping cycle. Clear, three-dimensional images help determine the structure and function of the heart, lungs, major blood vessels and area around the heart and detect blood vessel plaques and blockages as well as damage from heart attack or heart disease. The test is non-invasive, but requires you to lie on a table that moves through a magnet-shaped chamber. Electrodes are placed on your body for monitoring purposes and often an intravenous (IV) line is inserted into your arm to inject a dye to enhance the images.
Symptoms and evidence of coronary artery disease and other heart ailments often appear when the heart is working harder. Several diagnostic tests are designed to assess heart function and determine blood flow while “under stress”:
Exercise stress tests monitor your heart while you are walking on a treadmill or pedaling a stationary bike. How long you exercise, your blood pressure, your EKG and how you feel when you exert yourself are observed and recorded during the test.
Pharmacologic stress tests use a drug to reproduce the effects of exercise on the heart. This is a safe alternative for women who are not able to perform the required level of exercise due to older age, arthritis or excess weight.
Nuclear imaging, also called myocardial perfusion imaging (MPI), uses a small amount of a radioactive substance to produce images of the heart. A liquid “tracer” is injected into your bloodstream and monitored while you are at rest and during stress. Blood flow to your heart is measured to determine damage to the heart muscle or blood flow problems. Since this test exposes you to a very small amount of radiation, tell your healthcare provider if you think you might be pregnant.