Matters Of The Heart


Pain in the chest, arm, neck and jaw—we all recognize these as signs of a potential heart attack. We know to watch our blood pressure and cholesterol. But not everyone knows that symptoms of a heart attack can look completely different for women than men, and that heart disease is the No. 1 cause of death for American women. Sudden cardiac death is rising among people below 35, well before many of us think of heart disease as a pressing issue. And now, more than ever, experts say stress is contributing to cardiac complications.

Srisha Rao, MC, FACC, is board certified in cardiovascular disease and internal medicine and has practiced cardiology in Ocala for 20 years. Today she treats patients at Cardiovascular Institute of Central Florida, specializing in noninvasive cardiology, which mainly includes diagnostics like stress tests. When patients visit her for the first time, she performs initial testing to reveal key risk factors.

“When I do the risk assessment, some of the most common risk factors in women and men are the numbers for their blood pressure; their BMI, which can be a sign of obesity, which increases risk of chronic disease; family history of heart disease (especially before the age of 55 in men or 65 in women); being postmenopausal and having a history of smoking.”

According to the American Heart Association, heart disease (including coronary heart disease and hypertension) is the No. 1 cause of death in the United States, and about 790,000 people in the United States have heart attacks each year. Rao estimates Ocala has a higher incidence of heart disease than the national average due to the population’s overall older age.

But heart disease and heart attacks don’t just happen after 50.

Age Is Just A Number

Although most deaths due to cardiac arrest occur in older adults or patients with coronary artery disease, cardiac arrest is the leading cause of death for young athletes. How often it occurs is unclear, but experts estimate one in every 50,000 sudden cardiac deaths a year is a young athlete. These deaths typically occur during physical activity, like playing a sport, and more often occurs in males than females.

Although that rate isn’t high, it is concerning because most of these victims seem to be in peak physical condition. However, these deaths are often caused by undiscovered heart defects or abnormalities.

Hypertrophic cardiomyopathy is an inherited condition that causes the walls of the heart to thicken. The thicker muscle tissue throws off the heart’s electrical system, leading to fast or irregular heartbeats (arrhythmias) that can lead to sudden cardiac death. HCM is not normally fatal but does tend to go undetected, and it’s the most common cause of sudden cardiac death in people under 30.

Some people are born with coronary arteries that are connected abnormally, and they can become compressed during exercise, cutting off blood flow to the heart.

Long QT syndrome is an inherited heart rhythm disorder that causes fast, chaotic heartbeats and frequently leads to fainting. Young people with long QT syndrome have an increased risk of sudden death.

Although it’s hard to know if an abnormality has gone undetected in a young adult’s heart, there are three major warning signs that indicate something could be amiss.

  • Unexplained fainting, or syncope, occurring during physical activity
  • Family history of sudden cardiac death in relatives younger than 50
  • Shortness of breath or chest pain (these are also known to indicate asthma)

If your child exhibits any of these warning signs, ask their pediatrician about screening options to ensure they can play their days away safely.

To Each Her Own Symptoms

Most people are familiar with the standard symptoms of a heart attack, but what they don’t know is that heart attacks can present in different ways for women.

“Chest pain and chest discomfort are still the most common symptoms women experience, and if they have pain in the neck, jaw, back or abdomen those are signs as well,” she explains. “Females complain more of back pain, abdominal or gastric discomfort, and shortness of breath, which can signal angina, angina equivalent or coronary artery disease. The older women get, their symptoms are a lot more subtle. It can just seem like unexplained fatigue.”

Rao says women who feel fatigued more easily than they used to should see their primary care physician. They can test for common causes of fatigue, such as thyroid complications, anemia or depression. If women are experiencing a newly diagnosed, unexplained fatigue and a primary care doctor has ruled out other possibilities, this may be cause for concern.

Most women who come to Rao present with some of these symptoms, most commonly some type of pain, and want to find out if it is related to their cardiac health, or they have already had a cardiac event.

Because heart disease is the No. 1 cause of death for women in the United States, Rao emphasizes two things when treating her female patients.

“Prevention and modification. In younger women, I think stress is a big part of the problem, so I always stress that they should take care of themselves. Be compassionate with themselves, and be able to say no.”

And although most people understand that smoking is bad for their health in innumerable ways, Rao says women may not realize the impact it can have on them specifically.

“If a woman is smoking, her risk of heart disease is three times greater than a man who smokes, so if someone with that risk factor is experiencing symptoms, I would not ignore it.”

Change Of Heart: Preventive Measures

So is there any good news about heart disease? Sure is—the steps toward prevention are simple and achievable for everyone. By addressing some of the risk factors of heart disease, such as high cholesterol, high blood pressure and stress, the chances of a cardiac event go down while overall health reaches a new high.

“I have an acronym I tell my patients, which is to take care of the SELF: sleep, exercise, love and food,” says Rao. “Sleep is a big problem because so much blue light sleep deprivation is highly present with today’s generation constantly being disturbed by electronics. Get a good seven to eight hours of solid sleep. It will help negate all the stress hormones in the body.”

After a restorative snooze, exercise is key. As a general rule of thumb, the Department of Health and Human Services recommends a healthy adult get at least 30 minutes of physical activity every day.

“Inactivity is a major risk factor for heart disease,” Rao says, “and research is showing this generation is much more inactive in their 20s and 30s than people were 50 years ago. Your 20s and 30s is a great time to start being active because heart disease can start very early on.”

The L stands for love, and Rao says this is her reminder to patients to engage in activities they are passionate about and spend time decompressing with people they love.

“I do advise the youngsters to go out, have some connections, do things in the community, actually seek out people rather than be on social media. Depression is linked to heart disease, so don’t isolate.”

She says stress is the main cause of Takotsubo cardiomyopathy, more commonly known as broken heart syndrome.

“Broken heart syndrome, which is brought about by stressful situations, usually happens after menopause, but sudden stress can cause a person to experience chest pains and give them symptoms of a heart attack,” says Rao. “It gives credence to the fact that our minds have so much to do with heart health.”

Because of that strong connection between mental and physical health, Rao recommends patients try a few stress relief techniques, such as mindfulness, yoga or tai chi, to find one they are receptive to and can practice for 20 to 30 minutes each day.

“Try to avoid processed foods, especially those high in fructose. The bottom line is not to eat fast food or anything from packages where you can avoid it, and choose good sources of protein like eggs, a lot of greens and fresh foods.”

Of course, some people are born with risk factors they can’t prevent. Those with a family history of heart disease or who may be genetically predisposed to it should alert their primary care physician and be sure to monitor their blood pressure and cholesterol regularly.

“The other risk factors are the same, so those who have family history should maintain a healthy weight, eat a healthy diet and have a good primary care physician. I would probably check their cholesterol more often and more aggressively [and] try to bring their numbers lower with medication if they do have that family history,” says Rao.

All About AEDs

Automatic external defibrillators are designed to save the life of a person experiencing sudden cardiac arrest. The most common cause of SCA is an arrhythmia called ventricular fibrillation. During v-fib, the heart’s lower chambers, called ventricles, quiver rapidly and beat irregularly.

Another type of arrhythmia that can cause SCA is ventricular tachycardia. This is a fast, regular beating of the ventricles that can last for just a few seconds or much longer.

When someone experiences one of these arrhythmias, an electric shock from an AED can restore their heart’s normal rhythm if it is delivered quickly. If a victim of SCA receives a defibrillation within the first minute of onset, their survival rate skyrockets to 90 percent. Thirty to 50 percent of SCA victims would survive if AEDs were used within five minutes.

How do I use one?

Marion CPR Training & Certification offers classes on first aid, CPR and AED usage to save lives. To register, call (352) 653-8821 or visit It is vital to receive formal training on using an AED before attempting to use one.

“I think it’s one of those things that’s good to have in a workplace or school, but if you have them I do think you have to have training. The key is people need to know how to use it,” says Rao.

What do they look like?

AED boxes can be white, red or yellow, and they are labeled with a symbol of a heart and lightning bolt. Most commonly, the front of the box has a glass panel allowing you to see the AED inside. Just like a fire alarm, never open a wall-mounted AED box in a nonemergency. Many are wired into the building’s alarm system and will alert a 911 dispatcher to your location when the door is opened. If there is an emergency situation, always call 911 before using the AED so a dispatcher can get first responders there as soon as possible.

Where are AEDs located?

Take time when visiting new places to look around for an AED. Be aware of where AEDs are located around your school, workplace and frequently visited places, like the gym or grocery store. Much like a fire hydrant, we recognize an AED when we see one, but its location may not fully register in our memories.

In cities and large suburbs, many businesses are starting to keep AEDs on hand. They can usually be found alongside first aid kits. Schools typically have at least one if not more and place them at hallway junctions and high-traffic areas like locker rooms, gyms and cafeterias. Most dental and medical offices have AEDs, as well as many malls, fitness centers, theme parks, sports venues and major transportation terminals like airports. These are often located near water fountains or restroom areas.

Why is this important to know?

Knowing where to find an AED is critical during a sudden cardiac arrest. CPR can save a life, but an AED can read a person’s heart rhythm and determine if an electric shock is needed to restart it or restore it to normal. In most cases, this can assist the heart in beginning to pump again, which can help minimize damage from lack of oxygen and blood flow common to patients who experience this serious cardiac emergency. When CPR is paired with an AED, survival rates increase significantly.

Original Story: Ocala Style Magazine | | By Katie McPherson