A few months ago, Savita Rana, 58, woke up with cold sweat, feeling uncomfortable and anxious at 2 am. Her heart was racing; she had chest pain and was feeling faint. “I felt nauseous, my stomach rumbled as if I had diarrhoea. I wondered if I had an anxiety attack but that was the first signal that everything was not right with my heart,” she says.Savita’s daughter Swati, a psychologist, decided to check her blood pressure afterwards and found it to be normal. “I assumed she had an anxiety attack since she was under a lot of stress being my father’s primary caregiver. He was recovering from a brain stroke and kidney disease. Focussing on him, we ignored her condition till her symptoms showed up again, luckily at the hospital while visiting our father,” says Swati. Tests showed she had had a heart attack. Her heart was working only at 30 per cent capacity. The doctors immediately took her in for an angiography and angioplasty (an imaging process to check blood vessels for blockage, then putting a stent or a mesh to widen and hold up the arteries and restore blood flow). While she was recuperating in the ICU, the family found out that she was diabetic too. She had never got herself tested. Now Savita has a very disciplined lifestyle, particularly diet, which her family has internalised. She has eliminated sugar, reduced her salt intake and ghee and is exercising every day.GAS OR HEART ATTACK: A CONFUSION THAT UPS YOUR RISKWhile most people think heart attack is not common among women — the hormone estrogen is known to protect the heart — it is now on the rise, even among pre-menopausal women under the age of 40.Dr Naveen Bhamri, director and head of interventional cardiology at Max Hospital, Shalimar Bagh, Delhi, says, “The gap between the genders is closing. Every month, I perform five angioplasties in women under 40 and around 15 in women under 50.” He says while classical risk factors such as obesity, hypertension and diabetes remain, there are more risk factors that are equalising the field. “People are living with a lot of stress — everybody is in the pressure cooker. People have either started overdoing exercise or not at all. Add to that screen time which disturbs circadian rhythms. Lack of sleep is a risk factor,” he says. The most problematic risk factor is the tendency of most women to dismiss their condition as indigestion. “No matter what the discomfort in the abdomen and chest, go to a hospital and get a clean bill of health rather than leaving everything to personal assumption,” he adds.After menopause, a drop in estrogen levels increases heart disease risk by altering blood vessels and promoting plaque buildup. Besides, women are more likely than men to have heart attacks that don’t involve severe blockage of main arteries but rather in the smaller coronary arteries, where smaller plaques dislodge easily, causing the blood to clot over the tear. This is a less understood condition that can lead to worse outcomes.HIGH BLOOD PRESSURE A SILENT KILLERThirty-eight-year-old Sonali (name changed) has had a long day, travelling more than 250 km from her home in Himachal Pradesh to reach the OPD of the Department of Cardiology, PGI Chandigarh, for a review with Prof Dr Rajesh Vijayvergiya, an interventional cardiologist. She has been his patient since 2023, after an emergency angioplasty in October that year. “I am very nervous during these review visits, having had two major setbacks in 2022 and 2023,” shares Sonali, here with her husband, a school teacher who has been her pillar of strength and support.Story continues below this adIn June 2022, Sonali had an excruciating headache, vomiting and fainting spells, for which she was referred to PGI. She had a ruptured aneurysm, a condition where a weak spot in one of the brain arteries bursts, leading to bleeding. She underwent emergency brain surgery and went home after two weeks. “I had high blood pressure, was a little overweight and prone to stress and overthinking. I did not really have an exercise routine as I was busy with my twin daughters, household chores and my work at the beauty salon,” says Sonali, who decided to take a break from her work, hoping the relaxed pace would keep her fit.But within a year of recovery, in October 2023, she felt a shooting pain in her chest and left shoulder while going grocery-shopping with her husband. She dismissed it as muscular pain but fainted on returning home. She was rushed to the emergency department of a nearby hospital, where an ECG was not very conclusive. So she was given certain medicines, a blood thinner and discharged. In the days that followed, Sonali felt tired, breathless while walking, and one day, while putting clothes into the washing machine, she experienced unbearable pain, again in her chest and left shoulder. She could not breathe properly. “I was rushed to the hospital and an angiography revealed that there was 95 per cent blockage in one of the arteries supplying blood to the heart. We then came to PGI, where a stent was put in to open it up. Ever since the procedure and cardiac rehabilitation with exercises, I have not experienced chest pain or breathlessness,” she says. “Yoga, pranayama and daily walks are an integral part of my routine life, now. I pray and meditate to stay calm. Our meals are cooked fresh at home and we have omitted processed food from our diets,” she adds.HIDDEN RISK FACTORS IN PRE-MENOPAUSAL WOMENSonali’s story highlights a bigger concern – women and heart disease. “One in five Indian women between 15 and 49 years has untreated hypertension. Cardiovascular disease is the leading cause of death among women globally, surpassing even breast cancer. Yet, symptoms in women are often misdiagnosed. Nausea, fatigue and shortness of breath are frequently mistaken for symptoms of gastric issues. Hormonal changes, depression and unregulated cosmetic hormone treatments may elevate cardiac risk, and early detection and awareness are critical,” says Dr Vijayvergiya.A study done at the department by Dr Vijayvergiya shows that pre-menopausal young women below 40 are also being diagnosed with coronary artery disease, with the doctors seeing up to five young women patients in the cardiology clinic every month. Risk factors like diabetes, hypertension and obesity play a role, and early diagnosis with investigations, including blood biomarkers, he says, is important.Story continues below this ad“Lifestyle factors like stress, sleep deprivation, smoking, uncontrolled hypertension and undiagnosed diabetes contribute to cardiac vulnerability, even in the young and seemingly healthy individuals. Processed food, late-night work, excessive screen time and unregulated exercise regimes can create cumulative stress on the heart. Supplement misuse, sedentary behaviour and chronic mental strain disrupt heart rhythm and promote inflammation, weakening the heart’s ability to recover and increasing the risk of sudden cardiac death,” says Dr Vijayvergiya.He even draws up a checklist. “Before a sudden cardiac arrest, the body often sends subtle warnings like dizziness or fainting. There could be an acute onset of shortness of breath, chest discomfort or tightness at rest or during exertion and heart palpitations. These signs are frequently dismissed as stress or exertion. However, they may indicate serious heart issues,” says Dr Vijayvergiya.In fact, Sonali’s brain aneurysm, he says, was also because of her high, untreated blood pressure and stress. Any delay for such medical emergencies can be catastrophic to an individual if timely treatment is not provided.