In case you haven’t heard
Or, even if you have…
by Jill Becker, MD., MA.
The symptoms women experience when having a heart attack or angina are not what you’d expect. For that reason, it’s important to be aware…Save the life of your mom, wife, partner, sister, friend, daughter or yourself!
I just received a call from my cousin. A 65-year-old, post-menopausal woman who has smoked cigarettes for as long as I can remember (but who has now quit!), she started our conversation with “You’re never going to believe what happened to me.” She then went on to describe a bout with “queasiness” which had occurred about a week earlier. I said, “You need to get your heart checked out.” I think she was a bit surprised. Most people don’t think of heart problem when they hear queasiness or even nausea. Instead we are programmed to think of left-sided chest pain, shortness of breath and sweating as the typical symptoms for a cardiac event. The reason for this is because those symptoms are fairly typical – for men! Women, however, do not necessarily experience heart attacks in the same manner. Instead there is a whole host of unusual symptoms. One of the most common, however, is the feeling of nausea.
I remember reading a story about a woman, recently, who told her husband she felt sick to her stomach. She wanted to go to bed to see if she would feel better in the morning. Her husband, thankfully, knew that women can experience cardiac problems in this manner. He insisted on taking her to the hospital where she was found to be having a full-blown heart attack.
What, then, is a heart attack? The heart itself made up of muscle tissue (the myocardium) that is separated into four sections or chambers. Electrical impulses travel throughout the heart telling it when and how to squeeze each part. A heart attack, or myocardial infarction, occurs when the blood vessels of the heart become occluded or plugged up and are unable to deliver oxygen rich blood to the tissue of the heart. When this happens, and if it is not rapidly reversed, the portion of the heart that is without oxygen can die (become infarcted).
Why does this matter? Dead heart muscle can’t pump properly. Sometimes a section of the heart can’t squeeze completely (think of the juice left behind in a partially squeezed lemon) and tissues of the body don’t receive the oxygen-rich blood they need to operate correctly. Sometimes the electrical impulses, themselves, get interrupted (think of a broken wire and the inability of electricity to get from the outlet to an appliance) and the impulse can’t get to the tissue where it will tell the heart what to do. In both cases, the heart can’t do what it is meant to do and parts of the body will die.
Back to the story about my cousin…For a couple of days she had been feeling tired. She attributed this to burning the candle at both ends and the feeling of fatigue that often comes at the end of a work day. When I asked my cousin if I could write about her story, she asked that I make clear the fact that both of her “non-symptoms were easily explainable and that they often occur same time.” My cousin felt she might have been coming down with a virus. When she felt no improvement, however, during the hour and a half that she sat and thought about it, she realized a sense of “I just don’t feel good.” She says she wasn’t anxious about it but that she did want to feel better. It was then that she called a friend who brought her to the emergency department at a local hospital.
Upon her arrival at the hospital, my cousin asked the triage nurse if she would be given a baby aspirin to chew (something she had heard was done with heart patients). The nurse told her that she couldn’t have anything until she was evaluated by a doctor. By this point my cousin was certain something was wrong so she decided to report feeling chest pain (something she did not experience until later). Once she reported this the triage staff began to take her seriously and placed her on a cardiac monitor. My cousin was in the middle of a full-blown heart attack which required the placement of three stents (kind of like strong-walled straws) to allow blood to flow through the heart vessels and to where it needed to go.
Luckily my cousin was very aware of her own body and she felt confident enough to advocate for the treatment she needed. Many women, however, do not. After spending a few days in the cardiac care unit, my cousin is now recovering at home. Her ongoing care will be provided by several specialists and specialties. Included in her cardiac care program will be medical management, nutrition counseling as well as education surrounding stress management.
Why am I writing about this? My medical training is in Women’s Health. I also have a masters’ degree in Counseling Psychology with a concentration in Expressive Arts Therapy. As soon as my cousin and I hung up the phone I knew I wanted to write and inform (or remind) people that women can experience heart problems very differently than do men. As stated in the American Heart Association Scientific Statement (Circulation. 2016;133:00-00. DOI: 10.1161/CIR.0000000000000351.), “Cardiovascular disease is the leading cause of mortality in American women. Since 1984, the annual cardiovascular disease mortality rate has remained greater for women than men.” Also from that article is the following (non-exhaustive) table:
The entire AHA Scientific Statement is worth the read. In addition to the above table, I want to make note of the following as stated on page 6: “Men and women share similar risk factors for CHD [coronary heart disease], certain risk factors are more potent in women. These include tobacco abuse, type 2 DM [diabetes mellitus], depression, and other psychosocial risk factors. The INTERHEART study data identified 9 potentially modifiable risk factors (smoking, hypertension, DM, waist- to-hip ratio, dietary patterns, physical activity, alcohol consumption, plasma apolipoproteins, and psychosocial factors) that account for 96% of the population-attributable risk of MI in women.”
What this means is that when it comes to our risk for heart attacks, there are many things women can’t control – BUT – there are many things we can! The first order of business, in my opinion, is to make certain we have educated ourselves.