Women and Heart Attacks

[janne]

Hi, thank you for taking my question.  I posted earlier this month after I had a heart attack a few weeks ago so I won't go into all of my history again.

Are there  causes of heart attacks other than the typical type from a blocked artery or the unusual variant/Prinzmetal angina? Some sort of chemical imbalance?? An allergy to something?? Angio showed arteries and stents are clear and I don't seem to have typical Prinzmetal angina (although docs are leaning towards this).

I had a stress echo in Jan. and it was very good.  Could I be forming some clots somehow that are causing my problems? (I'm on novasen and plavix and the docs are happy with how thin my blood is).  

What does an ST depression of .3 (3??)in 4 of the leads  on an ecg mean?  

I have taken your suggestion and I'm looking for a preventive cardiologist.  Is that the same as a non-invasive cardiologist?

Now having had 2 heart attacks in less than 2 years, with no risk factors, I'm thinking it has to be something very rare causing this.  The first MI was from a blockage (yet, I don't have high cholesterol or a family hx).  But no one can figure out why I had the recent MI.  I'm a 41 yr old female and I'm feeling like a ticking time bomb.  My symptoms are not getting better and I'm getting really frustrated.  I am to return to school this Fall so I'd like to figure this out soon. I don't have a lot of money to travel, but thought I could try and do some of my own research.  There has to be an answer somewhere.   Have you ever heard of a case like mine?

Thank you so much again.  Janne

[Angie7]

I am so sorry to hear about your two heart attacks. I am wondering about your medication "novasen". I had been taking naproxen 500 for about six days and thought I was going to expire. I became extremely weak, depressed, feeling like passing out, and had extreme malaise. There have been suggestions of heart attacks associated with naproxen(NSAIDS). I think novasen is the same drug.
Three  weeks ago, I went to the ER with chest pains-palipations. Because my stress nuclear test indicated I had an old heart attack, I had an angiogram.The angiogram thankfully showed no blockage.However, two weeks later my cardiologist told me that I never had a heart attack because  the nuclear stress  test nuclear was a false positive.
Meanwhile, I feel sicker today, then when I originally went to the ER. I developed palpitations this week again,when I stopped taking Naproxen. Now I have new twinges of short heart heart pains and extreme fatigue  that I think were caused by the angiogram. I use to feel a "stick in the chest" that began on  the third day after the angiogram. Thankfully today that feeling is almost gone.

[karie]

Please give me your educated opinion?
Heart disease has taken the women in our family and I have been living a very heart healthy diet for years and see a EP yearly for review.
My primary concern has been the increase of symptoms with pvc's,pac's shown on holter and at 36. I was told that my last echocardiogram looked great, Heart murmurs are still present since birth and rated on intensity. I was told to stop pre-medication before all dental work, bleeding gums and this was due to the echo's results 2 years ago. If a patient has symptoms, dental issues and heart murmurs, is that not as great a risk as the result of a echocardiogram and neck ultrsound. Just want to do all I can and respect educated opinions. Appreciate your time

[Carolina03]

Janne,

For what it's worth, my sister's baby had an MI while in vitro, (not surviving). My sister's healthy in all respects, taking good care of herself, so the event was unexpected to say the least. Her OB-GYN ordered all kinds of bloodwork after the late miscarriage, including tests for hypercoagulable disorders. She tested positive for Factor V Leiden. After seeing a hematologist for a further work-up, she now takes Coumadin.

I hope this helps, and that you're coping with the anxiety.

Best,

Carolina

[Cleveland Clinic]

If you are on hormone replacement therapy it could potentially increase your risk of thrombosis.  There are different formulations available. I would discuss this with your doc.

good luck

[janne]

Sorry, I forgot to ask if it's possible it could have something to do with chemical changes from a hysterectomy I had 5 years ago (I have 1 ovary left and I'm not on HRT)?  It's just a guess, but I thought I'd ask.  They say women are different when it comes to MI's and I wondered if it may be something chemical.
Thanks. Janne

[Cleveland Clinic]

Janne,

A heart attack is caused by the blockage of a coronary blood vessel that results in limiitation of the blood supply to the cardiac muscle.  This blockage can result from a blood clot forming in the artery, spasm of the arteries, or an increased demand of the heart muscle for blood that is not able to be provided such as when blockages are present.  The end result is irreversible death of the cardiac muscle.

Are there causes of heart attacks other than the typical type from a blocked artery or the unusual variant/Prinzmetal angina?

See above.  The cardiac enzymes can be elevated from other processes such as myocarditis. But if you had the frank onset of chest pain, with your history this is most likely an MI.  Imbalances in the blood components that can form clots can occur in some.  If you are having recurrent events and all of your other risk factors are controlled (great cholesterol, diet, fitness, blood pressure, right medications) then I would think about looking for some of the other rarer risk factors such as LP(a) and homocystiene.  With the exception of homocysteine these are generally not modifiable do I usually only look at these if everything else is normal.

I had a stress echo in Jan. and it was very good. Could I be forming some clots somehow that are causing my problems? (I'm on novasen and plavix and the docs are happy with how thin my blood is).

Im not familiar with your case. Some people can have recurrent events on medication. This is currently probably the best regimen unless you have evidence of clots elsewhere.


What does an ST depression of .3 (3??)in 4 of the leads on an ecg mean?

These are changes on the ecg that happen in response to stress and could indicate ischemia.  It is not always reliable, especially in women, and depends on the morphology and what leads the changes are in.

I have taken your suggestion and I'm looking for a preventive cardiologist. Is that the same as a non-invasive cardiologist?

No. A non-invasive cardiologist is a cardiologist that doesnt perform procedures. A preventive cardiologist specifically is trained to examine all of your possible risk factors for heart disease and try to minimize them. All cardiologist to some extent play this role, but in your case it may be good to see someone who specializes in this field.

Have you ever heard of a case like mine?

Yes. Often.  Ive seen MIs in women as young as 29 and in men even younger. I think you are on the right medications and with close followup should hopefully be able to minimize your risk fo future evens despite the fact you've had 2 in conjunction. I wouldnt give up at this point and continue to do the things you enjoy.

good luck