Heart to heart: A Q&A with a Yale cardiologist

Icons: An apple, a heart, an active person.

February is American Heart Month and the ideal time to put a spotlight on heart health. In light of the fact that heart disease is the leading cause of death for both men and women in the United States, YaleNews spoke to cardiologist and assistant professor at Yale School of Medicine Dr. Joseph Brennan, who provided insights about common heart-related medical conditions and what we all need to know about them.

Most people are familiar with chest pain as a symptom of heart attack. What are other signs?

There can be a whole set of other signs. Chest discomfort is the most common. Most people don’t describe it as pain, but as chest pressure or unusual chest discomfort. Other signs include nausea, vomiting, profuse sweating, neck discomfort, arm discomfort or heaviness, and back discomfort.

How are the symptoms different for women?

Women can present with non-specific symptoms. They say, “I don’t feel well.” “Something is wrong, I’m short of breath.” Those kinds of symptoms. An ER physician has to be suspicious and say, “This is a woman. She might be having a heart attack.”

If you suspect you are having a heart attack, what should you do — or ask others to do?

If you think there is a precipitating event, like snow shoveling, stop. Go inside to someplace warm. Ask for help. Some individuals will drive themselves to the ER department — that is not a good thing to do. Instead, sit down, rest, and relax. Call 911. If you have a history of heart disease, such as bypass or stenting, you probably have nitroglycerin available. Also, use aspirin unless you have an aspirin sensitivity. Chew four baby aspirin if you suspect a heart attack.

How would you know that you are at risk for heart attack?  What are the risk factors?

Dr. Joseph Brennan (photo by Jerry Domian)

If there is a family history of someone having a cardiac event at a young age, under 50, you are at increased risk. If you are a smoker, diabetic, or if you have documented high blood pressure or high cholesterol, those factors significantly increase your risk.

The other risk is a sedentary lifestyle. Individuals who are sedentary have a significantly increased risk of heart attack precipitated by activity. It’s linked to the degree of activity. For someone who exercises once a week or not at all, the risk is higher than someone who exercises four times a week.

What steps can we all take to prevent or lower the risk of heart attack?

Obviously, exercise regularly. Be careful with your weight. Obesity is associated with a sedentary lifestyle. Treat the risk factors. If you have high blood pressure or diabetes, make sure the condition is treated aggressively. If you smoke, stop smoking. You can’t change your genes but you can modify every other risk factor.

In winter, there’s a risk for heart attack related to shoveling snow. What’s the connection?

There are studies that looked at geographic areas. Who gets a lot of snow? New England, the Upper Midwest. They’ve also looked at the timing of heart attacks. During the 1978 blizzard, there was an increase in heart attacks. It’s thought to be related to a number of factors. We go out in the morning and shovel snow. That is the time of day that people are at the highest risk for heart attack. And that is thought to be related to a rise in blood pressure and to an increase in blood viscosity and platelets being more likely to aggregate (stick together) in the morning.

Then there is the type of exercise. When you shovel show, you’re using your arms and lifting heavy, often wet, snow — things you may not be used to doing. Lifting heavy snow is very taxing to the heart, causing a marked rise in heart rate and blood pressure. In studies researchers have put young men on treadmills and compared it to shoveling snow, and showed that snow shoveling after two minutes led to the same heart rate increase as very vigorous treadmill activity. The risk of dying of heart attacks with shoveling snow is much greater in males. It’s reported to be three times greater in males than in females.

View a video of Dr. Brennan discussing the dangers involved with shoveling snow.

How can people remove snow safely? 

Take your time and don’t overdo it. Shovel light loads, then stop and rest. Don’t be compulsive. And warm up. The exposure to cold air is also a precipitant. It may cause constriction of the heart arteries. Cover up by putting a scarf over your mouth.

There’s another common heart condition called stress cardiomyopathy, also known as broken heart syndrome. What is that and what do people need to know about it?

It’s very common. Unlike heart attacks, stress cardiomyopathy occurs predominantly in women. And it can be related to emotional as well as physical stress. It’s been reported after the sudden loss of a loved one, financial difficulties, an argument, even a surprise party. It’s common. It may present just as a heart attack would — chest discomfort, shortness of breath. Call 911 and go to the ER via 911.

(Illustration via Shutterstock)

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Ziba Kashef: ziba.kashef@yale.edu, 203-436-9317