Heart attacks can and do occur in young women. Unfortunately, this patient population has several strikes against it during a heart attack.

First, heart attacks are rare in young women. Symptoms that would normally draw attention may thus be overlooked. For example, a doctor may not place a heart attack high on the list of possible diagnoses in a woman with shortness breath and atypical chest discomfort. The same symptoms in an elderly male patient often prompt a heart attack as the leading diagnosis.

A second problem with diagnosis is that heart attacks in women are often associated with atypical symptoms. Women under 55 often expect a chest pressure as the only symptoms on a heart attack. Instead, symptoms can include shortness of breath, fatigue, nausea, or sweating. A delay in treatment because the heart attack symptoms are unusual can be life threatening.

An important part of the physical examination for a cardiologist is listening to your neck. A stethoscope can detect vibration (bruit) in the neck’s arteries (carotids). The bruit is caused by blockages in these critical arteries supplying the brain and turbulence in blood flow.

Blockages in the carotid arteries are formed in a similar process as those in the coronary arteries. Those with abnormal cholesterol levels, diabetes, and high blood pressure are more likely to develop both a heart condition and carotid artery disease and a stroke. It’s not surprising that carotid artery bruits and heart attacks occur in the same people.

A study of over 17,000 people, published in Lancet, indicates that those with a carotid bruit are twice as likely to have a heart attack as those without.

If a bruit is heard, further testing, such as an ultrasound of the neck, is needed. Additionally, you may need to start taking aspirin. As with any medical decision, talk to your doctor before initiating, stopping, or changing treatment.

Low thyroid function may put women at risk of a heart attack. A study published in the Archives of Internal Medicine evaluated over 17,000 women with no signs of heart disease. Those with low thyroid hormone levels but no physical signs of thyroid disease were at a 69 percent higher risk of a heart attack, possibly due to a rise in blood pressure and abnormal cholesterol levels.

Similar findings were not noted in men.

It is not clear if treatment with synthetic thyroid hormone could prevent heart disease. More studies need to be done to better understand the connection between thyroid levels and heart disease.

The longer a coronary artery is blocked the more heart muscle dies. Early diagnosis of a heart attack is thus critical. A phrase often heard among cardiologists is “time is muscle”.

Currently electrocardiograms (ECGs) and blood tests are used to diagnose heart attacks. Unfortunately, ECGs are not always accurate and blood tests can take up to eight hours to become abnormal after a heart attack starts.

A new way to diagnose a heart attack within fifteen minutes may come from your saliva. Researchers at the University of Texas at Austin recently developed a technique to use several drops of saliva on a specially designed micro-chip. An abnormal test result can not only diagnose a heart attack but also predict your risk of having one in the future.

LabNow, Inc is developing this exciting new technology.

Bystander cardiac pulmonary resuscitation (CPR ) doubles the chance of survival from a cardiac arrest. The American Heart Association recently issued new guidelines on performing CPR.

Traditionally, those who provide CPR were instructed to give both chest compressions and breaths in a 15:2 ratio. The newer guidelines advise giving significantly more chest compressions relative to breaths (30:2). It turns out that the time spent interrupting compressions to give breaths may be better spent giving more compressions.

The new guidelines advise giving 30 compressions instead of 15 for every two breaths.

By giving more chest compressions, a grater amount blood flow is delivered to the heart muscle. If the heart should recover after a cardiac arrest the extra blood flow provides energy and allows for restoration of normal contraction. Conversely, if compressions are interrupted, the recovering heart may not be able to pump once restarted.

An article in Circulation recommends that bystanders who witness a person’s sudden collapse give compressions in the center of the chest after calling emergency medical services (EMS). The chest compressions should be hard and fast pushing motions without interruption. The article stresses that ventilation is still advisable if possible. However, chest compression alone is acceptable for those unable or unwilling to provide breathing assistance (ventilation).

It’s important to note that rescue breathing is especially critical in some cases. For example, if the cause of cardiac arrest is predominantly due to a breathing, or respiratory, problem such as drowning or choking. Additionally, the new guidelines do not apply to situations in which a person’s collapse is not witnessed and to children with cardiac arrest.

One goal of the new guidelines is to reassure bystanders, who may hesitate to provide mouth-to-mouth breathing to a stranger, that CPR alone is acceptable.

USA Today reports that since 2006 the number of balloon and stent procedures, also known as angioplasty and stenting, has been on the decline in the United States by up to 15 percent. Although the exact cause is not clear, decreasing smoking rates and greater use of medications such as aspirin and statins are likely contributing. Additionally, recent media reports about the controversial use of stenting may be affecting doctors’ decisions.

Look for more information on trends in cardiac procedures from the upcoming meeting American College of Cardiology meeting in Chicago.

A recent study compared the risks of the balloon and stent procedure in those over the age of 80 and those less than 80. No significant difference was found.

Modern medicine has prolonged and improved the quality life for many. More and more in my practice age is just a number. I’ve treated a vibrant 93 year old tennis player with heart failure and more energy than three normal people. I’ve also treated a 45 year old with a heart so weak he could barely get off the couch. I make a point to consciously acknowledge a patient’s age but not to make clinical decisions based on it alone. If a procedure is warranted, age alone is not reason to delay or cancel.

The relationship between alcohol consumption and heart attacks continues to evolve. A recent article in the American Journal of Medicine indicates that those who currently do not consume alcohol may benefit from starting.

The medical records of nearly 8000 middle aged non-drinkers revealed that those who started drinking a “moderate” amount of alcohol (one drink per day or fewer for women and two drinks per day or fewer for men ) had 68% fewer heart attacks in the next few years. Of note, those who drank only wine had the most benefit. Drinkers of beer, liquor and mixed drinks had only a 21% improvement.

It may be that the improved HDL cholesterol levels in drinkers contributed to the decreased heart disease. Importantly, those who started drinking did not have increased blood pressure as has previously been suggested.

Death rate from heart disease did not improve in the drinkers; only, “hear health” did. Specifically, less chest pain and fewer heart attacks occurred in those who started drinking alcohol.

The benefits of alcohol must be weighed against the risks of its use. Alcohol can worsen liver and heart function, especially in those with already weakened systems. For some, limiting alcohol to moderate use may be difficult and complete abstinence is best.

The American Heart Association currently does not recommend people start drinking to prevent heart disease. Based on this new data and other studies suggesting alcohol prevents heart attacks, it may be time to reconsider the use of moderate alcohol, especially wine, in middle aged people at risk for heart attacks.

John Ritter died in September 2003 of a tear to his aorta (aortic dissection). A phone message left by Mr. Ritter, shortly before his death to his wife, Amy Yasbeck, was recently played during a wrongful death court case. In this message he complained of feeling nauseous as if he had food poisoning, and chest pains. He then passed out.

When Mr. Ritter arrived at a local hospital, based on the above complaints and a family history of heart disease, he was treated for a heart attack. Unfortunately the true cause of his symptoms was an aortic dissection, a tear of the large artery leading out of the heart.

Distinguishing heart attack symptoms from those of an aortic dissection is often difficult. A heart attack often causes increasing pressure-like sensation behind the breast bone, occasionally radiating to the left arm or jaw. An aortic dissection, on the other hand, is often sudden and described as a tearing sensation radiating to the back. Significant overlap in symptoms does exist, and one diagnosis can seem to be the other.

An x-ray or CAT scan image of the chest can help differentiate a heart attack from an aortic dissection. It’s however impractical to perform CAT scans on everyone who comes to the hospital with chest or back pain symptoms. This would be extremely expensive and an unnecessary radiation exposure for many patients. The diagnosis and treatment for both conditions depends largely on the clinical skills of emergency room doctors and cardiologists.

It’s important for patients to be as precise as possible when describing their symptoms. Not all chest discomfort comes from the heart, other causes must also be considered.

Heparin is a medication commonly used to prevent blood clots during a heart a attack. Much of the Heparin used in the United States is made by Baxter International, which, in turn, buys its supplies from a Chinese manufacturer. The Food and Drug Administration reported last week that 21 deaths resulted from the use of heparin from Baxter. It’s unclear how exactly the medication contributed to the deaths; an allergic reaction is suspected. It is also possible that those who died were already seriously ill and would have died whether or not heparin was used.

Heparin and enoxaparin (Lovenox) are blood thinners critical in the treatment of heart attacks and during balloon and stent procedures. They prevent blood clots from forming inside a coronary artery.

Baxter International responded to the reported deaths by recalling nearly all of its heparin products. Another supplier, APP Pharmaceuticals, should be able to meet the demand for this life-saving drug.

Read more about drugs used in treating a heart attack.