By Laura Williamson, American Heart Association News | Contributor

Among many teenage girls, hearts are a communications staple. Heart emojis punctuate their texts, heart hands frame their selfies on social media.

But rare is the girl who thinks about her heart as the critical organ it is, the epicenter of the circulatory system, supplying blood with oxygen to the body to keep things working smoothly.

While good heart health may be a given for most young girls, adolescent health experts say there’s still plenty that teenage girls should know about taking care of their ticker.

Here are five things to get them started:

Good – or bad – heart health begins now

Habits and lifestyle behaviors established in adolescence – such as staying physically active and eating a healthy diet, or not – can put a person on a path toward good or bad cardiovascular health, say experts like pediatric cardiologist Dr. Teresa Lee.

“Starting early is always the best,” said Lee, who also is an assistant professor of pediatrics at Columbia University Medical Center in New York. “You want to try to prevent cardiovascular disease, as opposed to having to treat it later. The choices and the habits developed in early childhood and adolescence really determine health and well-being for years to come.”

Studies have shown that atherosclerosis, the hardening of the arteries due to plaque buildup, can begin to develop as early as adolescence. Hardened, or narrowed, arteries block blood flow and can lead to heart attacks, strokes or other problems later in life. 

An unhealthy diet, smoking, a sedentary lifestyle, obesity and being overweight can contribute to high cholesterol, a major risk factor for atherosclerosis, heart disease and stroke.

According to American Heart Association statistics teens and adolescents can exhibit a wide range of cardiovascular risk factors, including elevated blood pressure, use of tobacco products, high cholesterol, physical inactivity, obesity and an unhealthy diet.

“The rapid weight gain some teens have due to diets high in junk food and low physical activity levels really sets them up for challenges with weight for the rest of their lives, which absolutely affects their hearts,” said Dr. Judith Simms-Cendan, director of the division of pediatric adolescent gynecology at the University of Miami’s Miller School of Medicine. “Teens who are really sedentary also often have poor sleep patterns, and that can affect their heart health as well.”

The AHA encourages young people to follow the same healthy behaviors known to maintain good heart health in adults: staying physically active, eating a diet high in fiber, fruits and vegetables and low in fat, maintaining a healthy weight, getting a good night’s sleep and not smoking or using tobacco products, including electronic cigarettes.

Organized sports, dance teams or exercise classes are good places to start, Simms-Cendan said.

“Participating in sports, regardless of whether you are a competitive athlete, can set you up for a better cardiac future,” she said.

Listen to your heart

While most teens will have healthy hearts, it’s important to notice signs or symptoms that something could be amiss – and speak to someone about it, Lee said.

For example, “if there’s ever something you were able to do that all of a sudden you are unable to do,” that could signal a problem, she said. “You are your best predictor of when things are off.”

Ceirra Zeager* of Ephrata, Pennsylvania, thought her heart was fine until she collapsed while getting dressed the day after her first high school dance.

“Heart disease doesn’t care how old you are,” said Zeager, who was 14 when she had a heart attack, caused by a hole in her heart she was unaware she had. “I was otherwise healthy, but the pain I was feeling was indescribable.”

Zeager, now 23, volunteers with the AHA’s Go Red for Women campaign. She said teenage girls shouldn’t hesitate to ask health care professionals questions about their heart and to listen to their hearts. “You can hear irregular heartbeats,” also called arrhythmias, she said. “Teens should learn what that means. It’s basic information that’s good to know.”

Irregular heart rhythms occur for many reasons and may not be cause for alarm, but they should be checked out. Zeager said the hole in her heart caused a murmur that could have been detected with a stethoscope. “I wish I would have known to ask,” she said.

Other teens can also be a good gauge of something being amiss, Lee said.

“If you notice that, compared to your peers, you are not able to do things as well, especially physical activity, and if there’s a worsening over time,” it’s probably something to discuss with your parents or health care team, she said.

Even if all seems well, “there’s never a wrong time” to ask questions about heart health, Lee said. Wellness visits are a great time to talk about ways to promote good cardiovascular health and address any risk factors.

Pregnancy can affect your heart 

“Pregnancy is a big stress for anybody, and it’s a big stress especially on the heart,” Lee said.

Pregnant teens can be at high risk for preeclampsia, a condition that can cause very high blood pressure.

Pregnancy can be especially problematic if a teen has an underlying congenital heart defect or cardiovascular risk factors, such as high blood pressure or obesity, which can lead to pregnancy complications.

“Some forms of contraception are safer for girls with underlying cardiac conditions,” Simms-Cendan said. Birth control options with progestin are safer options, she said.

While contraceptive pills that contain estrogen may be safer for healthy girls, those with underlying heart issues and risk factors, such as uncontrolled high blood pressure, should avoid them, Simms-Cendan said. “In those girls, they may increase blood pressure and other complications.”

“A lot of the girls with the highest risk of unplanned pregnancy affecting their heart are not receiving contraceptive counseling,” Simms-Cendan said. “A real gap in care is making sure if you have underlying heart disease and are considering being sexually active, there is safe birth control you can take. If you do become pregnant, immediately seek prenatal care.”

Some things may feel like heart problems, but aren’t

A rapid heartbeat could be a sign of heart trouble, but it might not be, Simms-Cendan said. It could be a sign of anxiety, which has increased in prevalence among teens and adolescents since the start of the COVID-19 pandemic in 2020.

“When teens have anxiety, their heart races,” she said. “This feels frightening, but if their heart is healthy, they are not in danger.”

However, it should still be checked out, she said. And if it’s anxiety, it should be treated.

Mental health issues can affect every system in the body, Simms-Cendan said, including the heart. “They affect your energy level and the desire to exercise. If you’re depressed, you don’t feel like moving much. Teens who are depressed may also use sleep as an escape. They might spend all day in bed.”

Parents can play an important role

Talking to teenagers about heart health can be challenging for parents. But if they want their kids to practice healthy habits, the first thing they should do is lead by example, Lee and Simms-Cendan said.

“Teenagers are not always receptive to hearing advice or critiques about eating or sleeping habits from the adults in their life,” Lee said. “Honestly, I think one of the best things parents can do is mirror a healthy lifestyle and healthy choices.”

“You can’t talk to a teen about doing things if you’re not doing them yourself,” Simms-Cendan said. “If you have a child struggling with weight, telling them to not drink soda or eat junk if you have it in your house is not going to work.

“If you are concerned about their weight or blood pressure or diabetes and you want them to become healthier, you have to walk the walk,” she said. “Keep the unhealthy food out of the house.”

Simms-Cendan suggested parents take their teenagers with them when they go grocery shopping so they can select healthy foods that they like. Going on walks together is another way to model healthy behavior, she said.

“Ask them to go for walks but understand that sometimes they’d rather listen to music than talk. Let them keep their headphones,” she said. And if they don’t want to do that? “Ask them what they would like to do to get healthy.”

HEALTH CARE DISCLAIMER: This site and its services do not constitute the practice of medical advice, diagnosis or treatment. Always talk to your health care provider for diagnosis and treatment, including your specific medical needs. If you have or suspect that you have a medical problem or condition, please contact a qualified health care professional immediately. If you are in the United States and experiencing a medical emergency, call 911 or call for emergency medical help immediately.

* Ceirra Zeager now works to spread awareness about heart health among teenage girls and young women. (American Heart Association)