The heart wants what it wants, but what we want are some answers about it. In honor of American Heart Month, we chatted with Nicole Harkin, MD, FACC (she/her), cardiologist and founder of Whole Heart Cardiology, to get to the bottom of our blood pumping questions. (Which she does on TikTok, too.)

Before we get to that, let’s hear a bit about Dr. Harkin’s background: “I’m the first doctor in my family! Originally, I thought I was going to go into infectious disease, but after doing volunteer work abroad, I realized how widespread and prevalent cardiovascular disease is globally. So, I decided to marry my interests in prevention and cardiology and became a preventive cardiologist. More recently, I established my own practice in San Francisco dedicated to the optimization of heart health with precision and lifestyle medicine.”

Now, let’s get to the 🫀 of the matter.

Why is it crucial for women to take care of their heart health?
Heart disease is the #1 cause of death in women globally. It’s responsible for more deaths than all cancers combined, and shockingly, is also the top cause of death in new moms.

So, while it’s something we only think might affect us when we get older, it actually starts when we are in our 20s and 30s. In fact, 45% of all women over the age of 20 already have some form of heart disease. It’s truly never too early to take preventive measures—with the good news that 80% of heart disease is preventable!

What sort of cardiovascular diseases affect women in particular?
The most common type of heart disease is coronary artery disease. This is when cholesterol builds up in our arteries and can cause blockages or heart attacks. There’s also atrial fibrillation—a common rhythm issue—and heart failure which is when the heart pump function isn’t as strong as it should be.

While coronary artery disease is the most common cause of heart disease, women are more likely than men to have other causes of heart disease that cause chest pain. One of these causes is microvascular dysfunction, a disorder of the small arteries of the heart rather than the large ones as in more “typical” coronary artery disease. Another is spontaneous coronary artery dissection, which is when the walls of the heart arteries separate and can cause impairment of blood flow and heart attack.

What sort of symptoms should we look out for when it comes to heart problems?
While women often have the classic symptom of chest pain when they are having a heart attack, they’re more likely than men to have atypical symptoms. Almost as commonly as chest pain (which may be crushing, pressure, or tightness), women will experience something else such as shortness of breath, extreme fatigue with walking, nausea/vomiting, extreme anxiety, back pain, or jaw pain. Women are also more likely to have symptoms brought on by stress or in their sleep.

How do we know if the burning sensation in our chest is heartburn or something more serious?
It can be difficult to distinguish between heartburn and heart disease. First of all, as I tell my patients, if it’s new and concerning, it’s better to go get checked out and be told it’s just reflux then ignore something potentially serious. Women in general often present later in their heart attack than men because they mistakenly think their symptoms can’t be due to a heart attack. That said, heartburn symptoms most classically will occur shortly after eating a meal and respond to over-the-counter antacid medications, while heart disease won’t.

Can you also tell us about POTS and how that relates to someone’s cardiovascular health?
POTS, or postural orthostatic tachycardia syndrome, is a type of orthostatic intolerance—which means feeling unwell in an upright position—that typically affects women. Heart rate goes up significantly when standing, but blood pressure remains stable. The symptoms are usually palpitations, nausea, dizziness/lightheadedness, or shortness of breath. Often it occurs after a viral infection, like Covid, surgery, or other prolonged bed rest. While not necessarily life threatening, it can cause significant symptoms that dramatically impact someone’s ability to go about their day-to-day life.

Speaking of Covid, studies have now linked Long Covid to cardiovascular complications. What’s your advice to those who are worried about these valid concerns?
Long Covid describes a constellation of symptoms that last 4 or more weeks after Covid and are frustratingly common. Symptoms range from fatigue, brain fog, chest pain, shortness of breath, palpitations, and exercise intolerance. The cause is still poorly understood, and may actually represent many different conditions, with POTS being one of them. Regardless, if you’re experiencing any of these symptoms, especially those you’re concerned are cardiac-related, it’s important to seek care and have proper testing conducted. Other than Long Covid, Covid can also cause cardiac complications like myocarditis (heart inflammation), arrhythmias, microvascular disease, and other heart problems.

What’s the most important thing you want us to remember about our heart health?
Whether you’re 20, 30, 40, 50, or beyond, it’s always a good time to think about your heart health. Some of the best preventive measures are eating a diet rich in diverse plant foods, exercising at least 150 minutes a week, getting adequate sleep, and working on stress management. It’s also super important to know your family’s heart health history, and get regular check-ups to ensure things like your blood pressure, cholesterol, and such are at goal.