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This has been a heat-wave summer on both sides of the Atlantic. So whether you are currently in one, or planning to vacation in an unexpectedly hot spot, you should be aware of how high heat affects your heart. Especially, since post-menopausal women often suffer lesser-known cardiovascular attacks known as Myocardial Ischeamic Syndromes [MIS].
How does heat affect the heart?
Our bodies like to hover at around 37C. Activities like walking, running or hiking in 35C+ heat really taxes your body to regulate at this temperature. Your blood vessels dilate to direct blood away from the core to the body’s surface and sweat glands start to release water to evaporate and cool you down.
But if you sweat too much without re-hydrating, this decreases your blood volume causing blood pressure to fall and heart rate to increase making you feel faint or tired. Alternatively, if you are in a very humid environment, sweat has difficulty evaporating in the damp atmosphere. If your body is unable to cool off, it has trouble regulating its core temperature, putting extra stress on your heart.
This is especially important in peri- and post-menopause because many have vascular concerns with hot flashes. But it is also the time when new heart issues begin to present themselves. Some traditional symptoms of heart attack in women could be easily dismissed as hot-weather reactions: feeling light-headed, dizzy or nauseated; excess sweating; and experiencing extreme fatigue or tiredness.
Myocardial Ischeamic Syndromes primarily affect women and yet, most people have never heard of them. In a Yale University study of non-obstructive heart attacks in women and non-white patients, emergency physician and the study’s lead author Dr. Basmah Safdar said, “For a long time, patients with MINOCA were completely disregarded because the prior literature showed they didn’t have a higher risk of dying or recurrent heart attacks, and so they just were not studied.” As if to prove her point, another female cardiologist I spoke to dismissed them as ‘events’ – not heart attacks. When I asked if this was because, “the accepted classification is based on heart attacks as they present in men?”, she sheepishly agreed. Even my own GP, who has been practicing for over 30 years, admitted she hadn’t heard of some MISs. Luckily, as anecdotal evidence mounts, clued-up cardiologists and researchers are championing more research in this area.
Myocardial Ischeamic Syndromes primarily affect women and yet, most people have never heard of them – even my own GP who has been practicing for over 30 years, hadn’t heard of MINOCA. In a Yale University study of non-obstructive heart attacks in women and non-white patients, emergency physician and the study’s lead author Dr. Basmah Safdar said, ‘For a long time, patients with MINOCA were completely disregarded because the prior literature showed they didn’t have a higher risk of dying or recurrent heart attacks, and so they just were not studied.’
As if to prove her point, another female cardiologist I spoke to dismissed MISs as ‘events’ – not heart attacks – specifically because they didn’t fit the classic definition which is based primarily on how white, male patients experience a heart attack. Luckily, as anecdotal evidence mounts, clued-up researchers around the world are amp-ing up research in this area.
What are MISs and what do we know about them?
INOCA
Ischaemia with Non-Obstructive Coronary Arteries is a collection of conditions that falls under the umbrella of MIS. INOCA can result from problems with the heart’s small blood vessels, like a condition called Coronary Microvascular Dysfunction [CMD] which causes Microvascular Angina. They may also be caused by spasms in the coronary arteries like the vasospastic disorder Coronary Artery Spasm [CAS] aka Vasospastic/Variant Angina. You can have INOCA and another heart condition like Coronary Artery Disease at the same time.
MINOCA
Myocardial Infarction with Non-Obstructive Coronary Arteries is at least twice as prevalent in women because they are more likely to have a heart attack without significant obstructions in their main arteries or to experience blockages in smaller arteries. Since smaller blood vessels account for around 90% of women’s coronary ‘tree’, micro-circulation problems can play a role in MINOCA.
A friend with no previous diagnosis of heart problems experienced her MINOCA during a particularly hot, stressful day, “I initially thought it was a severe panic attack or that I was just over-heating, but then I felt numbness in my jaw, a waterfall of sweat and I was unable to catch my breath,” she says. Her attending paramedic, advised a quick blood test in hospital that confirmed it was her heart, not anxiety.
TAKOTSUBO
Also known as Stress Cardiomyopathy and Broken-Heart Syndrome, it is most often triggered by intense emotional or physical stress. ‘Takotsubo’ comes from the Japanese word for an octopus pot trap because the heart’s left ventricle takes on a similar shape, very suddenly swelling, during the attack. This makes the heart’s pumping action less efficient and sometimes fatal. Doctors in Japan noticed it often happened to wives experiencing shock at the death of their partners, thus gaining the nickname ‘Broken Heart Syndrome’. It is more common in post-menopausal women.
One of my colleagues describes her Takotsubo as happening during a time of severe stress, “I just knew it was something serious. I felt the sudden pain across my back and shoulders, became breathless and ended up being blue lit to the hospital,” she says. “They did all the tests under the sun. All were okay except for the Troponin levels.” Troponins are proteins with some specific ones found only in heart muscle. If the heart suffers an attack, these proteins leak into the bloodstream and therefore, can be measured with a blood test. Elevated Troponin levels (above the normal range), generally indicate a heart attack or other conditions such as the MINOCA example above.
SCAD
Spontaneous Coronary Artery Dissection is a tear in the wall of a heart artery that can restrict blood flow. It is a common cause of heart attacks in women under 50, primarily because it often happens in pregnancy, but hormonal fluctuations are thought be involved in cases of 40+ women. It can also be caused by extreme stress or excess exercise stress, especially in high heat.
How do I know if I am at risk?
As always, we advise you speak to your own doctor for personal health advice. High heat can put extra stress on the heart, so if you already suffer from heart risks such as high blood pressure, cholesterol, diabetes, vascular conditions, etc… you need to be extra vigilant. Keep cool, stay hydrated, and have a heart-healthy summer.z
For more information:
British Heart Foundation
INOCA International (A Patient-Medical Partnership)
MINOCA
TAKOTSUBO
SCAD Alliance is an international patient-led info and advocacy group
Heart is an international, peer-reviewed journal from the British Medical Journal and the British Cardiovascular Society.
Alexia Economou is a design and culture journalist, and regular TNMA contributor.
Images Pexels and Unsplash.
Your GP should be your first port of call for concerns about any symptoms that are new, unexplained, unusual for you or getting worse. If you think you need medical help right now, 111 online can advise you what to do next, or call 999 if it’s an emergency, or 911 if you’re based in the US.
This post was published on
thatsnotmyage.com
on August 27, 2025 and written by Alexia Economou.
