Heart/Lung Conditions & Stroke

Stroke

What is a stroke?

A stroke is sometimes called a "brain attack." A stroke can injure the brain like a heart attack can injure the heart. A stroke occurs when part of the brain doesn't get the blood it needs.

There are two types of stroke:

• Ischemic stroke (most common type) -- This type of stroke happens when blood is blocked from getting to the brain. This often happens because the artery is clogged with fatty deposits (atherosclerosis) or a blood clot.
• Hemorrhagic stroke -- This type of stroke happens when a blood vessel in the brain bursts, and blood bleeds into the brain. This type of stroke can be caused by an aneurysm -- a thin or weak spot in an artery that balloons out and can burst.

Both types of stroke can cause brain cells to die. This may cause a person to lose control of their speech, movement, and memory. If you think you are having a stroke, call 911.

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What is a “mini-stroke”?

A “mini-stroke”, also called a transient ischemic attack or (TIA), happens when, for a short time, less blood than normal gets to the brain. You may have some signs of stroke or you may not notice any signs. A “mini-stroke” lasts from a few minutes up to a day. Many people do not even know they have had a stroke. A “mini-stroke” can be a sign of a full stroke to come. If you think you are having a “mini-stroke”, call 911.

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What are the signs of a stroke?

A stroke happens fast. Most people have two or more signs.

The most common signs are:

• Sudden numbness or weakness of face, arm, or leg (mainly on one side of the body)
• Sudden trouble seeing in one or both eyes
• Sudden trouble walking, dizziness, or loss of balance
• Sudden confusion or trouble talking or understanding speech
• Sudden bad headache with no known cause

Women may have unique symptoms:

• Sudden face and arm or leg pain
• Sudden hiccups
• Sudden nausea (feeling sick to your stomach)
• Sudden tiredness
• Sudden chest pain
• Sudden shortness of breath (feeling like you can’t get enough air)
• Sudden pounding or racing heartbeat

If you have any of these symptoms, call 911.

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How is stroke diagnosed?

The doctor will usually start by asking the patient what happened and when the symptoms began. Then the doctor will ask the patient some questions to see if she or he is thinking clearly. The doctor also will test the patient's reflexes to see if she or he may have had any physical damage. This helps the doctor find out which tests are needed.

The doctor may order one or more of the following tests:

• Imaging tests that give a picture of the brain. These include CT (computed tomography) scanning, sometimes called CAT scans and MRI (magnetic resonance imaging) scanning. CT scans are useful for finding out if a stroke is caused by a blockage or by bleeding in the brain.
• Electrical tests, such as EEG (electroencephalogram) and an evoked response test to record the electrical impulses and sensory processes of the brain.
• Blood flow tests, such as Doppler ultrasound tests, to show any changes in the blood flow to the brain.

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What are the effects of stroke?

It depends on the type of stroke, the area of the brain where the stroke occurs, and the extent of brain injury. A mild stroke can cause little or no brain damage.  A major stroke can cause severe brain damage and even death.

A stroke can occur in different parts of the brain. The brain is divided into four main parts: the right hemisphere (or half), the left hemisphere (or half), the cerebellum, and the brain stem.

A stroke in the right half of the brain can cause:

• Problems judging distances — The stroke survivor may misjudge distances and fall or be unable to guide her hands to pick something up.
• Impaired judgment and behavior — The stroke survivor may try to do things that she should not do, such as driving a car.
• Short-term memory loss — The stroke survivor may be able to remember events from 30 years ago, but not what she ate for breakfast that morning.

A stroke in the left half of the brain can cause:

• Speech and language problems — The stroke survivor may have trouble speaking or understanding others.
• Slow and cautious behavior — The stroke survivor may need a lot of help to complete tasks.
• Memory problems — The stroke survivor may not remember what she did ten minutes ago or she may have a hard time learning new things.

A stroke in the cerebellum, or the part of the brain that controls balance and coordination, can cause:

• Abnormal reflexes of the head and upper body
• Balance problems
• Dizziness, nausea (feeling sick to your stomach), and vomiting

Strokes in the brain stem are very harmful because the brain stem controls all our body's functions that we don't have to think about, such as eye movements, breathing, hearing, speech, and swallowing. Since impulses that start in the brain must travel through the brain stem on their way to the arms and legs, patients with a brain stem stroke may also develop paralysis, or not be able to move or feel on one or both sides of the body.

In many cases, a stroke weakens the muscles, making it hard to walk, eat, or dress without help. Some symptoms may improve with time and rehabilitation or therapy.

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Who is at risk for stroke?

It is a myth that stroke occurs only in older adults. A person of any age can have a stroke. But, stroke risk does increase with age. For every 10 years after the age of 55, the risk of stroke doubles, and two-thirds of all strokes occur in people over 65 years old. Stroke also seems to run in some families. Stroke risk doubles for a woman if someone in her immediate family (mom, dad, sister, or brother) has had a stroke.

Compared to white women, African American women have more strokes and have a higher risk of disability and death from stroke. This is partly because more African American women have high blood pressure, a major stroke risk factor. Women who smoke or who have high blood pressure, atrial fibrillation (a kind of irregular heart beat), heart disease, or diabetes are more likely to have a stroke. Hormonal changes with pregnancy, childbirth, and menopause are also linked to an increased risk of stroke.

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How do I prevent a stroke?

Experts think that up to 80% of strokes can be prevented. Some stroke risk factors cannot be controlled, such as age, family history, and ethnicity. But you can reduce your chances of having a stroke by taking these steps:

• Know your blood pressure. Your heart moves blood through your body. If it is hard for your heart to do this, your heart works harder, and your blood pressure will rise. People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years. If you have high blood pressure, your doctor may suggest you make some lifestyle changes, such as eating less salt (DASH Eating Plan) and exercising more. Your doctor may also prescribe medicine to help lower your blood pressure.

• Don't smoke. If you smoke, try to quit. If you are having trouble quitting, there are products and programs that can help:

• Nicotine patches and gums
• Support groups
• Programs to help you stop smoking

Ask your doctor or nurse for help. For more information on quitting, visit Quitting Smoking.

• Get tested for diabetes. People with diabetes have high blood glucose (often called blood sugar). People with high blood sugar often have no symptoms, so have your blood sugar checked regularly. Having diabetes raises your chances of having a stroke. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.

• Get your cholesterol and triglyceride levels tested. Cholesterol is a waxy substance found in all parts of your body. When there is too much cholesterol in your blood, cholesterol can build up on the walls of your arteries. Cholesterol can clog your arteries and keep your brain from getting the blood it needs. This can cause a stroke. Triglycerides are a form of fat in your blood stream. High levels of triglycerides are linked to stroke in some people. People with high blood cholesterol or high blood triglycerides often have no symptoms, so have your blood cholesterol and triglyceride levels checked regularly. If your cholesterol or triglyceride levels are high, talk to your doctor about what you can do to lower them. You may be able to lower your cholesterol and triglyceride levels by eating better and exercising more. Your doctor may prescribe medication to help lower your cholesterol.

• Maintain a healthy weight. Being overweight raises your risk for stroke. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. Make healthy food choices and get plenty of exercise. Each week, aim for at least 2 hours and 30 minutes of moderate-intensity aerobic physical activity, 1 hour and 15 minutes of vigorous-intensity aerobic physical activity, or a combination of moderate and vigorous activity. Start by adding more fruits, vegetables, and whole grains to your diet. Take a brisk walk on your lunch break or take the stairs instead of the elevator.

• If you drink alcohol, limit it to no more than one drink (one 12 ounce beer, one 5 ounce glass of wine, or one 1.5 ounce shot of hard liquor) a day.

• Find healthy ways to cope with stress. Lower your stress level by talking to your friends, exercising, or writing in a journal.

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Should I take a daily aspirin to prevent stroke?

Aspirin may be helpful for women at high risk, such as women who have already had a stroke. Aspirin can have serious side effects and may be harmful when mixed with certain medications. If you're thinking about taking aspirin, talk to your doctor first. If your doctor thinks aspirin is a good choice for you, be sure to take it exactly as your doctor tells you to.

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Does taking birth control pills increase my risk for stroke?

Taking birth control pills is generally safe for young, healthy women. But birth control pills can raise the risk of stroke for some women, especially women over 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke. Talk with your doctor if you have questions about the pill.

If you are taking birth control pills, and you have any of the symptoms listed below, call 911:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

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Does using the birth control patch increase my risk for stroke?

The patch is generally safe for young, healthy women. The patch can raise the risk of stroke for some women, especially women over 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke.

Recent studies show that women who use the patch may be exposed to more estrogen (the female hormone in birth control pills and the patch that keeps users from becoming pregnant) than women who use the birth control pill. Research is underway to see if the risk for blood clots (which can lead to heart attack or stroke) is higher in patch users. Talk with your doctor if you have questions about the patch.

If you are using the birth control patch, and you have any of the symptoms listed below, call 911:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

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How is stroke treated?

Strokes caused by blood clots can be treated with clot-busting drugs such as TPA, or tissue plasminogen activator. TPA must be given within three hours of the start of a stroke to work, and tests must be done first. This is why it is so important for a person having a stroke to get to a hospital fast.

Other medicines are used to treat and to prevent stroke. Anticoagulants, such as warfarin, and antiplatelet agents, such as aspirin, block the blood's ability to clot and can help prevent a stroke in patients with high risk, such as a person who has atrial fibrillation (a kind of irregular heartbeat).

Surgery is sometimes used to treat or prevent stroke. Carotid endarterectomy is a surgery to remove fatty deposits clogging the carotid artery in the neck, which could lead to a stroke. For hemorrhagic stroke, a doctor may perform surgery to place a metal clip at the base of an aneurysm (a thin or weak spot in an artery that balloons out and can burst) or remove abnormal blood vessels.

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What about rehabilitation?

Rehabilitation is a very important part of recovery for many stroke survivors. The effects of stroke may mean that you must change, relearn, or redefine how you live. Stroke rehabilitation is designed to help you return to independent living.

Rehabilitation does not reverse the effects of a stroke. Its goals are to build your strength, capability, and confidence so you can continue your daily activities despite the effects of your stroke. Rehabilitation services may include:

• Physical therapy to restore movement, balance, and coordination
• Occupational therapy to relearn basic skills such as bathing and dressing
• Speech therapy to relearn how to talk

Heart Disease

What is heart disease?

Heart disease includes a number of problems affecting the heart and the blood vessels in the heart. Types of heart disease include:

• Coronary artery disease (CAD) is the most common type and is the leading cause of heart attacks. When you have CAD, your arteries become hard and narrow. Blood has a hard time getting to the heart, so the heart does not get all the blood it needs. CAD can lead to:
  • Angina (an-JEYE-nuh). Angina is chest pain or discomfort that happens when the heart does not get enough blood. It may feel like a pressing or squeezing pain, often in the chest, but sometimes the pain is in the shoulders, arms, neck, jaw, or back. It can also feel like indigestion (upset stomach). Angina is not a heart attack, but having angina means you are more likely to have a heart attack.
  • Heart attack. A heart attack occurs when an artery is severely or completely blocked, and the heart does not get the blood it needs for more than 20 minutes.
• Heart failure occurs when the heart is not able to pump blood through the body as well as it should. This means that other organs, which normally get blood from the heart, do not get enough blood. It does not mean that the heart stops. Signs of heart failure include:
  • Shortness of breath (feeling like you can't get enough air)
  • Swelling in feet, ankles, and legs
  • Extreme tiredness
• Heart arrhythmias (uh-RITH-mee-uhz) are changes in the beat of the heart. Most people have felt dizzy, faint, out of breath or had chest pains at one time. These changes in heartbeat are harmless for most people. As you get older, you are more likely to have arrhythmias. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters and other symptoms such as dizziness or shortness of breath, call 911 right away.

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Do women need to worry about heart disease?

Yes. Among all U.S. women who die each year, one in four dies of heart disease. In 2004, nearly 60 percent more women died of cardiovascular disease (both heart disease and stroke) than from all cancers combined. The older a woman gets, the more likely she is to get heart disease. But women of all ages should be concerned about heart disease. All women should take steps to prevent heart disease.

Both men and women have heart attacks, but more women who have heart attacks die from them. Treatments can limit heart damage but they must be given as soon as possible after a heart attack starts. Ideally, treatment should start within one hour of the first symptoms.

If you think you're having a heart attack, call 911 right away. Tell the operator your symptoms and that you think you're having a heart attack.

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Do women of color need to worry about heart disease?

Yes. African American and Hispanic American/Latina women should be concerned about getting heart disease because they tend to have more risk factors than white women. These risk factors include obesity, lack of physical activity, high blood pressure, and diabetes. If you're a woman of color, take steps to reduce your risk factors.

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What can I do to prevent heart disease?

You can reduce your chances of getting heart disease by taking these steps:

Take action to reduce heart disease risk: Be physically active Don't smoke Eat healthy Maintain a normal weight Know your numbers (blood pressure, cholesterol, and triglycerides)

• Know your blood pressure. Years of high blood pressure can lead to heart disease. People with high blood pressure often have no symptoms, so have your blood pressure checked every 1 to 2 years and get treatment if you need it.
• Don't smoke. If you smoke, try to quit. If you're having trouble quitting, there are products and programs that can help:
  • Nicotine patches and gums
  • Support groups
  • Programs to help you stop smoking
  Ask your doctor or nurse for help. For more information on quitting, visit Quitting Smoking.
• Get tested for diabetes. People with diabetes have high blood glucose (often called blood sugar). People with high blood glucose often have no symptoms, so have your blood glucose checked regularly. Having diabetes raises your chances of getting heart disease. If you have diabetes, your doctor will decide if you need diabetes pills or insulin shots. Your doctor can also help you make a healthy eating and exercise plan.
• Get your cholesterol and triglyceride levels tested. High blood cholesterol (koh-LESS-tur-ol) can clog your arteries and keep your heart from getting the blood it needs. This can cause a heart attack. Triglycerides (treye-GLIH-suh-ryds) are a form of fat in your blood stream. High levels of triglycerides are linked to heart disease in some people. People with high blood cholesterol or high blood triglycerides often have no symptoms, so have both levels checked regularly. If your levels are high, talk to your doctor about what you can do to lower them. You may be able to lower your both levels by eating better and exercising more. Your doctor may prescribe medication to help lower your cholesterol.
• Maintain a healthy weight. Being overweight raises your risk for heart disease. Calculate yourBody Mass Index (BMI) to see if you are at a healthy weight. Healthy food choices and physical activity are important to staying at a healthy weight:
  • Start by adding more fruits, vegetables, and whole grains to your diet.
  • Each week, aim to get at least 2 hours and 30 minutes of moderate physical activity, 1 hour and 15 minutes of vigorous physical activity, or a combination of moderate and vigorous activity.
• If you drink alcohol, limit it to no more than one drink (one 12 ounce beer, one 5 ounce glass of wine, or one 1.5 ounce shot of hard liquor) a day.
• Find healthy ways to cope with stress. Lower your stress level by talking to your friends, exercising, or writing in a journal.

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What does high blood pressure have to do with heart disease?

Blood pressure is the force your blood makes against the walls of your arteries. The pressure is highest when your heart pumps blood into your arteries – when it beats. It is lowest between heart beats, when your heart relaxes. A doctor or nurse will write down your blood pressure as the higher number over the lower number. For instance, you could have a blood pressure of 110/70 (read as "110 over 70"). A blood pressure reading below 120/80 is usually considered normal. Very low blood pressure (lower than 90/60) can sometimes be a cause of concern and should be checked out by a doctor.

High blood pressure, or hypertension, is a blood pressure reading of 140/90 or higher. Years of high blood pressure can damage artery walls, causing them to become stiff and narrow. This includes the arteries carrying blood to the heart. As a result, your heart cannot get the blood it needs to work well. This can cause a heart attack.

A blood pressure reading of 120/80 to 139/89 is considered prehypertension. This means that you don't have high blood pressure now but are likely to develop it in the future.

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How can I lower my blood pressure?

If you have hypertension or prehypertension, you may be able to lower your
blood pressure by:

• losing weight if you are overweight or obese
• getting at least 2 hours and 30 minutes of moderate physical activity or 1 hour and 15 minutes of vigorous activity each week.
• limiting alcohol to one drink per day
• quitting smoking if you smoke
• reducing stress
• following the DASH (Dietary Approaches to Stop Hypertension) Eating Plan, which includes cutting down on salt and sodium and eating healthy foods, such as fruits, vegetables, and low-fat dairy products

If lifestyle changes do not lower your blood pressure, your doctor may prescribe medicine.

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What does high cholesterol have to do with heart disease?

Cholesterol is a waxy substance found in cells in all parts of the body. When there is too much cholesterol in your blood, cholesterol can build up on the walls of your arteries and cause blood clots. Cholesterol can clog your arteries and keep your heart from getting the blood it needs. This can cause a heart attack.

There are two types of cholesterol:

• Low-density lipoprotein (LDL) is often called the "bad" type of cholesterol because it can clog the arteries that carry blood to your heart. For LDL, lower numbers are better.
• High-density lipoprotein (HDL) is known as "good" cholesterol because it takes the bad cholesterol out of your blood and keeps it from building up in your arteries. For HDL, higher numbers are better.

All women age 20 and older should have their blood cholesterol and triglyceride levels checked at least once every 5 years.

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What do my cholesterol and triglyceride numbers mean?

• Total cholesterol level - Lower is better. Less than 200 mg/dL is best.
  

  Total Cholesterol Level	Category
  Less than 200 mg/dL	Desirable
  200 - 239 mg/dL	Borderline high
  240 mg/dL and above	High

    
• LDL (bad) cholesterol - Lower is better. Less than 100 mg/dL is best.
  

  LDL Cholesterol Level	Category
  Less than 100 mg/dL	Optimal
  100-129 mg/dL	Near optimal/above optimal
  130-159 mg/dL	Borderline high
  160-189 mg/dL	High
  190 mg/dL and above	Very high

• HDL (good) cholesterol - Higher is better. More than 60 mg/dL is best.
• Triglyceride levels - Lower is better. Less than 150mg/dL is best.

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How can I lower my cholesterol?

You can lower your cholesterol by taking these steps:

• Maintain a healthy weight. If you are overweight, losing weight can help lower your total cholesterol and LDL ("bad cholesterol") levels. Calculate your Body Mass Index (BMI) to see if you are at a healthy weight. If not, try making small changes like eating an apple instead of potato chips, taking the stairs instead of the elevator, or parking farther away from the entrance to your office, the grocery store, or the mall. (But be sure to park in a safe, well-lit spot.)
• Eat better. Eat foods low in saturated fats, trans fats, and cholesterol.
• Eat more:
  • Fish, poultry (chicken, turkey--breast meat or drumstick is best), and lean meats (round, sirloin, tenderloin). Broil, bake, roast, or poach foods. Remove the fat and skin before eating.
  • Skim (fat-free) or low-fat (1%) milk and cheeses, and low-fat or nonfat yogurt
  • Fruits and vegetables (try for 5 a day)
  • Cereals, breads, rice, and pasta made from whole grains (such as "whole-wheat" or "whole-grain" bread and pasta, rye bread, brown rice, and oatmeal)
• Eat less:
  • Organ meats (liver, kidney, brains)
  • Egg yolks
  • Fats (butter, lard) and oils
  • Packaged and processed foods

There are two diets that may help lower your cholesterol:

• Heart Healthy Diet
• Therapeutic Lifestyles Changes (TLC) Diet

Get moving. Exercise can help lower LDL ("bad cholesterol") and raise HDL ("good cholesterol"). Exercise at a moderate intensity for at least 2 hours and 30 minutes each week, or get 1 hour and 15 minutes of vigorous intensity physical activity each week.

• Take your medicine. If your doctor has prescribed medicine to lower your cholesterol, take it exactly as you have been told to.

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How do I know if I have heart disease?

Heart disease often has no symptoms. But, there are some signs to watch for. Chest or arm pain or discomfort can be a symptom of heart disease and a warning sign of a heart attack. Shortness of breath (feeling like you can't get enough air), dizziness, nausea (feeling sick to your stomach), abnormal heartbeats, or feeling very tired also are signs. Talk with your doctor if you're having any of these symptoms. Tell your doctor that you are concerned about your heart. Your doctor will take a medical history, do a physical exam, and may order tests.

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What are the signs of a heart attack?

For both women and men, the most common sign of a heart attack is:

• Pain or discomfort in the center of the chest. The pain or discomfort can be mild or strong. It can last more than a few minutes, or it can go away and come back.

Other common signs of a heart attack include:

• Pain or discomfort in one or both arms, back, neck, jaw, or stomach
• Shortness of breath (feeling like you can't get enough air). The shortness of breath often occurs before or along with the chest pain or discomfort.
• Nausea (feeling sick to your stomach) or vomiting
• Feeling faint or woozy
• Breaking out in a cold sweat

Women are more likely than men to have these other common signs of a heart attack, particularly shortness of breath, nausea or vomiting, and pain in the back, neck, or jaw. Women are also more likely to have less common signs of a heart attack, including:

• Heartburn
• Loss of appetite
• Feeling tired or weak
• Coughing
• Heart flutters

Sometimes the signs of a heart attack happen suddenly, but they can also develop slowly, over hours, days, and even weeks before a heart attack occurs.

The more heart attack signs that you have, the more likely it is that you are having a heart attack. Also, if you've already had a heart attack, your symptoms may not be the same for another one. Even if you're not sure you're having a heart attack, you should still have it checked out.

If you think you, or someone else, may be having a heart attack, wait no more than a few minutes—five at most—before calling 911.

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One of my family members had a heart attack. Does that mean I'll have one too?

If your dad or brother had a heart attack before age 55, or if your mom or sister had one before age 65, you're more likely to develop heart disease. This does not mean you will have a heart attack. It means you should take extra good care of your heart to keep it healthy.

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Sometimes my heart beats really fast and other times it feels like my heart skips a beat. Am I having a heart attack?

Most people have changes in their heartbeat from time to time. These changes in heartbeat are, for most people, harmless. As you get older, you're more likely to have heartbeats that feel different. Don't panic if you have a few flutters or if your heart races once in a while. If you have flutters and other symptoms such as dizziness or shortness of breath (feeling like you can't get enough air), call 911.

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Should I take a daily aspirin to prevent heart attack?

Aspirin may be helpful for women at high risk, such as women who have already had a heart attack. Aspirin can have serious side effects and may be harmful when mixed with certain medicines. If you're thinking about taking aspirin, talk to your doctor first. If your doctor thinks aspirin is a good choice for you, be sure to take it exactly as your doctor tells you to.

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Does taking birth control pills increase my risk for heart disease?

Taking birth control pills is generally safe for young, healthy women if they do not smoke. But birth control pills can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke. Talk with your doctor if you have questions about the pill.

If you're taking birth control pills, watch for signs of trouble, including:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

If you have any of these symptoms, call 911.

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Does using the birth control patch increase my risk for heart disease?

The patch is generally safe for young, healthy women. The patch can pose heart disease risks for some women, especially women older than 35; women with high blood pressure, diabetes, or high cholesterol; and women who smoke.

Recent studies show that women who use the patch may be exposed to more estrogen than women who use the birth control pill. Estrogen is the female hormone in birth control pills and the patch that keeps you from getting pregnant. Research is underway to see if the risk for blood clots is higher in patch users. Blood clots can lead to heart attack or stroke. Talk with your doctor if you have questions about the patch.

If you're using the patch, watch for signs of trouble, including:

• Eye problems such as blurred or double vision
• Pain in the upper body or arm
• Bad headaches
• Problems breathing
• Spitting up blood
• Swelling or pain in the leg
• Yellowing of the skin or eyes
• Breast lumps
• Unusual (not normal) heavy bleeding from your vagina

If you have any of these symptoms, call 911.

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Does menopausal hormone therapy (MHT) increase a woman's risk for heart disease?

Menopausal hormone therapy (MHT) can help with some symptoms of menopause, including hot flashes, vaginal dryness, mood swings, and bone loss, but there are risks, too. For some women, taking hormones can increase their chances of having a heart attack or stroke. If you decide to use hormones, use them at the lowest dose that helps for the shortest time needed. Talk with your doctor if you have questions about MHT.

Lung Disease

What do healthy lungs do?

Lungs are the organs that allow us to breathe. Lungs provide a huge area (as large as a football field) for oxygen from the air to pass into the bloodstream and carbon dioxide to move out. The cells of our bodies need oxygen in order to work and grow. Our cells also need to get rid of carbon dioxide.

During a normal day, we breathe nearly 25,000 times, and take in (inhale) large amounts of air. The air we take in contains mostly oxygen and nitrogen. But air also has things in it that can hurt our lungs.Bacteria,viruses, tobacco smoke, car exhaust, and other pollutants can be in the air. People with lung disease have difficulty breathing. These breathing problems may prevent the body from getting enough oxygen.

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Is lung disease a common health problem?

Yes. More than 35 million Americans have an ongoing (or chronic) lung disease like asthma or chronic obstructive pulmonary disease (COPD). If all types of lung disease are lumped together it is the number three killer in the United States. It causes 1 in 7 deaths in this country each year.

The term lung disease refers to many disorders affecting the lungs such as:

• Ongoing obstructive lung diseases such as asthma, chronic bronchitis, and emphysema
• Infections like influenza, pneumonia and tuberculosis (TB)
• Lung cancer
• Pulmonary fibrosis and sarcoidosis

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Should women be worried about lung disease?

Yes. The number of women diagnosed with lung disease in the United States is on the rise. The percentage of women dying from lung disease in this country is also increasing.

Here are some other reasons why lung disease is an important health concern for women:

• Lung cancer is the leading cancer killer of women in the United States. It kills more women than breast, ovarian, and cervical cancer combined.
• Deaths from lung cancer among women have risen 150 percent in the last 20 years while deaths among men are decreasing.
• Studies show that women are 1.5 times more likely to develop lung cancer than men.
• About 64,000 women in the United States die every year from chronic obstructive pulmonary disease (COPD).
• Sixty-five percent of people who die from asthma are women.
• More than twice as many women are diagnosed with chronic bronchitis than men every year.

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What types of lung disease are most common in women?

Three of the most common lung diseases in women are asthma, chronic obstructive pulmonary disease (COPD), and lung cancer. Other important but less widespread lung problems that affect women include:

• Pulmonary emboli and pulmonary hypertension -- These conditions affect the blood flow and gas exchange in the lungs.
• Sarcoidosis and pulmonary fibrosis -- People with these diseases have stiffening and scarring in the lungs.
• Influenza (the flu) -- This viral infection can affect the membrane that surrounds the lungs.

This FAQ gives detailed information on asthma, COPD, and lung cancer. For more information on other lung diseases, please visit the web sites of the following organizations:

• National Heart, Lung, and Blood Institute (NHLBI)
• American Lung Association (ALA)
• National Institute of Allergy and Infectious Diseases
• Centers for Disease Control and Prevention

Asthma

Asthma is an ongoing or chronic disease of the airways in the lungs called bronchial tubes. Bronchial tubes carry air in and out of the lungs. In people with asthma, the walls of the airways become swollen (inflamed) and oversensitive. Asthmatic airways overreact to things like viruses, smoke, dust, mold, animal hair, roaches, and pollen. When they react they get narrower. This limits the flow of air into and out of the lungs. Asthma causes wheezing, coughing, tightness in the chest and trouble breathing.

About 20 million Americans have asthma. Women are more likely to have asthma than men. In the United States more than 11 million women had asthma in 2003 compared to 8.2 million men.

The percentage of women, especially young women, diagnosed with asthma continues to the rise in the United States. Researchers are not sure why. But there are several theories.

Many experts think that more contact with indoor and outdoor allergens and pollution plays a role in increasing the rate of asthma. Exposure to house dust mite and cockroach allergens as well as tobacco smoke is linked to an increased risk of asthma.

Chronic Obstructive Pulmonary Disease (COPD)

COPD is a term that describes related diseases: chronic obstructive bronchitis and emphysema. These conditions often occur together. Both diseases limit airflow out of the lungs and make breathing difficult. COPD gets worse with time.

In almost 90% of cases, smoking is the cause of COPD. The single most important thing a person can do to reduce their risk of lung disease is to stop smoking.

COPD is the fourth leading cause of death in the United States. In 2003, more than 7.2 million women had COPD in this country. And more women have died from COPD than men every year since 2000.

In COPD, there is inflammation of the tubes (bronchial tubes) that carry air in and out of the lungs. This ongoing irritation thickens and scars the lining of the bronchial tubes. The irritation also causes the growth of cells that make mucus.

If the airways become thickened enough to restrict air flow to and from the lungs, the condition is called chronic obstructive bronchitis. The excess mucus leads to a constant cough typical of this illness.

But early signs of COPD are often hard to detect. People often decrease their activity level without even realizing it. And some people just assume age or weight gain is the cause of their lack of energy.

In emphysema, the walls between the air sacs (alveoli) are destroyed and the lung tissue is weakened. Normally oxygen from the air goes into the blood through these air sacs. But as the air sacs become damaged, the lung has less surface area. This interferes with the movement of oxygen from the air into the blood. So less oxygen passes into the blood of people with emphysema. Emphysema causes shortness of breath, cough and wheezing (squeaky sound when breathing).

Still, the early signs of emphysema are often very hard to detect. Since 2004, the rate of emphysema in American women has increased by 5 percent. In contrast, the rate in men has decreased by 10 percent. In 2003, approximately 1.4 million women had emphysema.

Lung cancer

Lung cancer is a disease in which abnormal (malignant) lung cells divide without control. These cancerous cells can invade nearby tissues and/or spread to other parts of the body. There are two major kinds of lung cancer: non-small cell lung cancer and small cell lung cancer. Non-small cell lung cancer is the most common kind.

Lung cancer is the leading cancer killer of American women. Lung cancer will kill more than 68,000 women this year. And more and more women are being diagnosed with this disease in the United States. Smoking causes 87% of all cases of lung cancer.

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How would I know if there was something wrong with my lungs?

Early signs of lung disease can be easy to overlook. Often people with early lung disease just say they don't have much energy.

Some common signs of lung disease include:

• trouble breathing
• shortness of breath
• feeling like you're not getting enough air
• a decreased ability to exercise
• a cough that won't go away
• coughing up blood or mucus
• pain or discomfort when breathing in or out

If you have any of these symptoms, call your doctor immediately. She will be able to pinpoint what is wrong with you.

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How can I decrease my chances of lung disease?

Things you can do to reduce your risk of all lung diseases include:

• Stop smoking. If you are a smoker, the single most important thing you can do to stay healthy is stop smoking. Talk to your doctor about the best way to quit. Smoke from all tobacco products (cigarettes, cigars, and pipes) boosts the chances of lung disease.
• Avoid second hand smoke. The best thing you can do to avoid lung disease is to stay away from smoke. If you live or work with people who smoke, ask them to smoke outside. Non-smokers have the right to a smoke-free work place. Keep in mind that cigar and pipe smoke is just as harmful as cigarette smoke.
• Test for radon. Find out if there are high levels of radon gas in your home or workplace. People who work in mines are often exposed to radon. And in some parts of the United States, radon is found in houses. Kits you can buy at most hardware stores can measure the amount of radon gas in your home.
• Steer clear of asbestos. Some jobs expose workers to asbestos. If you work in construction, shipbuilding, asbestos mining or manufacturing, car repair (brake repair), and insulation you should always wear protective clothing including a face mask. Federal law protects people who work with asbestos. Employers who work with asbestos must train their workers about asbestos safety, provide protective gear, and monitor the levels of radon to which workers are exposed.
• Protect yourself from dust and chemical fumes. Working with some chemicals like vinyl chloride and nickel chromates increases the risk of lung cancer. If you spend a lot of time working around dust and chemical fumes, protect yourself. Wear protective clothing including a gas mask and ventilate work areas.
• Eat a healthy diet. Limited research shows that people who eat diets rich in fruits and vegetables have a lower risk of cancer. The American Cancer Society recommends eating 5 to 6 servings of fruits and vegetables every day.
• Ask your doctor about spirometry testing. This test checks how well you can breathe. Some groups recommend routine spirometry testing in at-risk groups. If you're a smoker over the age of 45, are exposed to lung-damaging substances at work, or have other risk factors you should consider spirometry.
• See your doctor right away if you have a cough that won't go away, trouble breathing, pain or discomfort in your chest, or any of the other symptoms described in this FAQ.

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What causes lung disease?

There are many known causes of lung disease. Still, the causes of many lung diseases are still not known. Some known causes of lung disease include:

• Smoking. Smoke from cigarettes, cigars and pipes is the number one cause of lung disease. So the best thing you can do to reduce your risk of lung disease is to stop smoking. If you live or work with a smoker, it is also very important to steer clear of second hand smoke. Ask the person to smoke outdoors.
• Radon gas. Radon gas is the second leading cause of lung cancer. Radon is naturally present in soil and rocks. You can check your home for radon with a kit bought at many hardware stores.
• Asbestos. Asbestos is natural fiber that comes from minerals. The fibers break apart easily into tiny pieces that can float in the air and stick to things. If a person inhales asbestos particles, they can stick to their lungs. Asbestos harms lungs cells which may lead to lung cancer.
• Air Pollution. Recent studies suggest that some air pollutants like car exhaust may contribute to asthma, lung cancer, and other lung disease. But doctors still do not fully understand the link between pollution and lung disease.

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How can I find out if I have asthma?

Asthma can be hard to diagnose. This is because the signs of asthma are similar those of other lung diseases. The signs of COPD, pneumonia, bronchitis, pulmonary embolism, anxiety and heart disease can all be confused for asthma. It is important to note that women are misdiagnosed with asthma when they really have COPD more often than men.

To figure out if asthma is causing your discomfort, the doctor will first ask about your symptoms and health history. She will then do a physical exam.

To confirm the diagnosis, the doctor may run any of the following tests:

• Spirometry: The doctor uses a machine called a spirometer to see how well you breathe. This test measures how much air you can blow out of your lungs. It also records how fast you can exhale it. If these measurements are lower than normal, you may have asthma. But sometimes people with asthma have normal spirometry results.
• Bronchodilator (Brong-ko-di-LA-tor) Reversibility Testing: If your spirometry test is abnormal, your doctor will ask you to inhale a medicine called a bronchodilator. Then the doctor repeats spirometry to measure how this medicine affects your breathing. Bronchodilators relax muscles around the airways making it easier to breathe.
• Challenge Test: If the diagnosis is still unclear after spriometry and bronchodilator reversibility testing, doctors often suggest a challenge test. During this test you will inhale a medicine that narrows the airways in your lungs. After you inhale the medicine, the doctor will do a spirometry test. If you have asthma, the medicine will reduce the amount and speed of the air exhaled.

The doctor may also suggest other tests to make sure another disease is not causing your problems. These include:

• Chest x ray: This allows the doctor to see the condition of your lungs. Chest x rays can help the doctor to see if other lung diseases or infections are causing your symptoms.
• Electrocardiogram: An electrocardiogram is a test that records the electrical activity of the heart. An electrocardiogram allows the doctor to see if heart disease is causing your breathing problems.

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How is asthma treated?

Asthma is a chronic disease that cannot be cured. But medicines and lifestyle changes can help control the symptoms. One way to help relieve asthma is to avoid things in the environment that make symptoms worse. A number of types of medicines are also used to treat asthma. Most work by opening the lung airways and reducing inflammation.

The medicines used to treat asthma fall into two groups: quick-relief and long-term control.

Quick-Relief

Quick relief medicines are used only when needed. They should be taken when symptoms are getting worse to prevent a full-blown asthma attack.  They can also be used to stop attacks once they have started. These medicines relieve symptoms in minutes. Short-acting inhaled bronchodilators (albuterol and pirbuterol) are two commonly used quick relief medicines. They quickly relax tightened muscles around the airways. 

Long-Term Control

Long-term control medicines or controller medicines are taken every day, usually over a long period of time. Over time, these medicines relieve symptoms and prevent asthma attacks in those with mild or moderate persistent asthma.

These medications help control inflammation in the lungs. To be effective, they must be used every day. These medicines are not intended to relieve symptoms immediately. Some may even take a few weeks to have their full effect.

Some long-term control medicines include:

• Cromolyn and nedocromil -- These inhaled medicines keep airways from swelling when a person comes in contact with a trigger.
• Corticosteroids -- These medicines can be inhaled or taken in a pill form. They can prevent and decrease swelling in the airways. Corticosteroids can also decrease the amount of mucus.
• Anti-leukotrienes -- These medicines come in a pill. They open the airways, control swelling and inflammation, and reduce mucus.
• Long-acting beta 2 bronchodilators -- Over time, these inhaled medicines help relieve symptoms. They are often combined with anti-inflammatory medicines

Staying away from triggers, taking your medicine consistently, and regular visits to the doctor will help you take control of asthma.

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I just found out I'm pregnant, should I still take my asthma medicines?

It is very important to call your doctor as soon as you find out you're pregnant. As your doctor will explain, it is extremely important to manage your asthma symptoms when you are pregnant. Taking asthma medicines and avoiding triggers helps make sure the baby gets enough oxygen. Untreated asthma can harm a growing fetus.

Many asthma medicines seem to be safe for use during pregnancy. Inhaled medicines are usually preferred for pregnant women. These medicines are less likely to be passed on to the baby than oral medicines. However, sometimes pregnant women need oral medicines to control symptoms. Talk with your doctor about the safety of asthma medicines during pregnancy. You should also talk to your doctor about getting a flu shot after the first trimester. The flu can be very serious for pregnant women with asthma.

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How do I find out if I have chronic obstructive pulmonary disease (COPD)?

If you smoke, have a cough that won't go away, and shortness of breath see your doctor. To figure out if you have COPD, doctors usually:

• Ask about your family and personal health history.
• Do a physical exam.
• Run some pulmonary function tests.
• Perform spirometry (speh-ROM-eh-tree) testing. During this test, the doctor uses a machine called a spirometer to see how well you breathe. This test measures how much air you can blow out of your lungs (lung volume). It also records how fast you can exhale it.
• Perform bronchodilator (brong-ko-di-LA-tor) reversibility testing. During this test you will inhale a medicine called a bronchodilator. Then the doctor uses a spirometer to measure how this medicine affects your breathing. Bronchodilators relax muscles around the airways making it easier to breathe.

Your doctor may also suggest other tests like chest x rays to make sure something else is not causing your problems. X rays may allow the doctor to see if another lung disease or heart disease is causing your symptoms.

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How is chronic obstructive pulmonary disease (COPD) treated?

The damage to the lungs in COPD cannot be repaired. But treatment can relieve symptoms. The only thing that can slow the progress of the disease is to stop smoking. So if you're a smoker, the single most important thing you can do is stop smoking. This slows down COPD and minimizes future damage to the lungs.

Medicines can also help you feel better. Common medicines used to treat COPD include:

• Bronchodilators. These medicines open up air passages in the lungs.
• Inhaled steroids. These medicines relieve symptoms by reducing inflammation in the lungs.
• Antibiotics. These medicines are used to clear up infections in the lungs.

Sometimes doctors also recommend the following for women with COPD:

• Get a flu shot every year. Influenza (flu) can cause serious problems for people with COPD.
• Get the pneumococcal vaccine. This vaccine reduces the risk of some kinds of pneumonia.
• Pulmonary rehabilitation. Pulmonary rehabilitation is a program that helps people cope physically and mentally with COPD. It can include exercise, training to manage the disease, diet advice and counseling.
• Oxygen therapy. Oxygen therapy helps women with severe COPD. Oxygen is inhaled through a mask or a tube connected to a tank filled with 100% oxygen. This extra oxygen helps them breathe easier, sleep better, and live longer.
• Surgery. Sometimes surgery can help people with severe COPD feel better. Lung transplant surgery is becoming more common for people with severe emphysema. Another procedure called lung volume reduction surgery is also used to treat a small subset of people with severe COPD of the emphysema type. In this surgery, a part of the lung is removed.

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How do I find out if I have lung cancer?

Usually there are no warning signs of early lung cancer. But if there is a sign, it is usually a cough. By the time most women have symptoms, the lung cancer often has advanced to more serious stages.

Symptoms of lung cancer may include:

• a cough that doesn't go away or gets worse
• coughing up blood
• frequent chest pain
• hoarseness or wheezing
• frequent problems with bronchitis or pneumonia
• loss of appetite or weight loss
• exhaustion

If you have any of these problems, call your doctor as soon as possible. The doctor will ask about your personal and family health history, smoking history, and exposure to harmful substances. She will also do a physical exam and may suggest some tests.

Common tests for lung cancer include:

• Chest x rays. Chest x rays allow doctors to "see" abnormal growths in the lungs.
• Computerized tomography scans (CT scans). A growing number of doctors use CT scans to diagnose lung cancer. CT scans are more powerful than standard x rays. CT images can reveal subtle signs of cancer that don't show up on x rays. This boosts the chances of finding cancer in its early, more treatable, stages.
• Biopsy. In this test, the doctor removes a small piece of lung tissue and studies it under a microscope. There are many ways to take a biopsy including:
  • Bronchoscopy is often used to remove lung tissue for a biopsy. Doctors put a special tube called a bronchoscope into the nose or mouth and down through the throat. They can see the lungs and remove a sample of tissue with this tube.
  • Sputum Cytology is another way to do a lung biopsy. In this test, doctors study a sample of mucus that is coughed up. The mucus may contain cancer cells.

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I smoke, should I get tested for lung cancer?

Talk to your doctor. Some doctors suggest testing smokers over 50 years of age for lung cancer. But experts still are not sure if routine testing (screening) saves or prolongs lives.

Testing for cancer before a person has any symptoms is called screening. Screening tends to find cancers early when it is easier to cure and treat. Screening high-risk groups (like smokers) for lung cancer is a controversial issue.

Many studies show that using x rays to screen smokers for lung cancer does not save lives. For this reason, the National Cancer Institute and the U.S. Preventive Services Task Force (USPSTF) do not recommend screening for lung cancer.  It is important to note that the USPSTF does not recommendagainst screening either. More studies are needed to show the exact risks and benefits of screening for lung cancer. Some groups do recommend screening in at-risk groups including smokers over 45 years and people exposed to lung-damaging substances at work.

Computerized tomography scans (CT scans) show promise as a screening tool. The National Cancer Institute is doing an important study called the National Lung Screening Trial (NLST) to answer important questions about routine testing for lung cancer. This study will show if screening with CT scans and/or chest x rays can save lives.

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How is lung cancer treated?

Most lung cancer is hard to treat. The best way to fight lung cancer is to never start smoking or to stop smoking.  If you need help to stop smoking, talk to your doctor. A government website all about quitting smoking can also help you kick the habit.

Lung cancer can be treated in a number of different ways including a combination of surgery, radiation, andchemotherapy. Most of the time treatment does not cure the cancer but stops it from spreading and relieves symptoms. Your specific treatment will depend on:

• kind of lung cancer,
• where the cancer is and if it has spread to other parts of the body,
• your age,
• and overall health.

Radiation therapy uses a machine to aim high-energy x rays at the tumor. This energy kills cancer cells. Radiation therapy can relieve pain and make a person feel better.

Chemotherapy uses medicine to kill cancer cells. Chemotherapy medicines can be injected into a vein or taken as a pill.

Surgery is used to remove tumors.

To find out about research studies on new treatments for lung cancer, visit the website of the National Cancer Institute and click on "clinical trials."