Photographs by J.A. Lewis
Dr. Sandra Weiss, a cardiologist with Christiana Care Health System works with a patient.
Rita Murphy was in the middle of a Zumba class when she began to have trouble breathing. “It felt like a steel band around my chest,” says Murphy, a retired St. Mark’s High School teacher who now lives in Lewes. “I thought I had pulled a muscle, or that it was just because it was August, and it was hot and we were outside.” The pain dissipated, but never went away completely. Nevertheless, Murphy, who was 64 at the time, ignored it. She had never had any health problems, she reasoned. She was exercising five times a week, and she felt she was in better shape than she’d been in years.
That September, Murphy and her husband flew to San Francisco for an anniversary trip. While there, she again had trouble breathing. This time, she attributed the problem to the steep hills, the heaviness of the camera she was carrying and other reasons. “There are a lot of things that you will tell yourself mistakenly in order to dismiss what’s going on,” she says. “You rationalize that this isn’t happening. Unfortunately, that can be a deadly combination.”
In Murphy’s case, it nearly was. She finally went to her general practitioner in October about her breathing issues. She was diagnosed and treated for pneumonia and pleurisy. When the problem didn’t go away, she had an echocardiogram. Finally, the mystery was solved, but the news wasn’t good. Those episodes she’d had in August and September? They were heart attacks. And now she was in heart failure.
A coronary angioplasty—surgery in which a stent was implanted in her artery to restore blood flow—saved Murphy’s life. But the damage to her heart from those two earlier episodes was so bad that she needed another surgery, this time to receive an implantable cardioverter-defibrillator (ICD) because any irregular heartbeat could be deadly to her.
Unfortunately, women all too often mistake their heart attack symptoms for something else. That’s partly because some women experience symptoms that differ from those classically attributed to a heart attack. Instead of acute chest pain, pain in the left arm, sweating, nausea and shortness of breath, they might experience a feeling in the chest “not described as pressure or heaviness, just a ‘different’ kind of feeling,” says Dr. Heather Raff of Cardiovascular Consultants of Southern Delaware. “Some present more with abdominal symptoms like nausea or upper abdominal pain. Some people just present with shortness of breath. Some people just describe an overall uneasiness. They know something is wrong, and they don’t know what it is,” she says.
“Women tend to present with more arm, neck, jaw and back discomfort rather than the classic sternal, crushing, gripping chest discomfort that men tend to present with,” says Dr. Sandra Weiss, a cardiologist with Christiana Care Health System’s Center for Heart & Vascular Health. “The typical warning signs that people see—the animations that people see of the typical heart attack—are distinct from what women experience.” As a result, they can, like Murphy, dismiss their symptoms as muscular-skeletal or gastrointestinal issues.
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Because many women do not recognize their symptoms as a heart attack, they tend to seek help later than men. “Women tend to sit at home for longer periods of time before seeking medical attention,” says Weiss. “By the time that they arrive at a medical facility, they may have been in the throes of a heart attack for several hours, and the longer you wait, the more irreparable damage that is made.”
And as a result, women are more likely to die from a heart attack than men are. According to the Women’s Heart Foundation, 42 percent of women who have heart attacks die within one year, compared with 24 percent of men. They are also more likely to be disabled with heart failure within six years of a heart attack.
It’s not just the nontraditional symptoms that keep women from seeking help, Raff says. “What delays them more is that they think they’re less likely to have heart disease because they’re a woman.” But the truth is heart disease is the No. 1 killer of women, accounting for one-quarter of all deaths in women, according to the Centers for Disease Control and Prevention (CDC). When you combine heart disease and stroke, the rate increases to one in three.
Mamie Hodge, 43, could have been one of those statistics. “I had no idea I was even having a heart attack,” she says. “I had no pain in the arm; nothing like what they say. I just felt sick to my stomach,” says the North East, Md., resident. She was rushed to the hospital after collapsing at her home. “Next thing I knew, I woke up in Christiana Hospital eight days later,” she says. Hodge had gone into congestive heart failure. She was 41 when it happened. Two stents and a defibrillator later, she’s back on her feet but, fearful of another episode, she refuses to drive.
Prior to her heart attack, Hodge never considered it a possibility that she was even at risk. After all, she was young, her weight was good, and her blood pressure was always 120 over 80. But Hodges had other risk factors for heart disease: undiagnosed high cholesterol, smoking, diabetes and a family history of heart disease. Women with diabetes have double the risk of heart disease than nondiabetic women, but Hodge wasn’t aware of that statistic.
Since 2003, when the first National Wear Red Day (the first Friday in February) was held to raise awareness about women and heart disease, great strides have been made in making the medical community and the public more aware that heart disease is a woman’s problem as much as a man’s. But, particularly among the public, there’s still a long way to go. As recently as 2012, only 56 percent of women recognized that heart disease was the No. 1 killer of women. There’s still the perception, Weiss says, “that women can’t have heart attacks and that women don’t die of heart failure.”
According to the CDC, high blood pressure, high LDL (bad) cholesterol and smoking are the key risk factors for heart disease, and nearly half of all Americans—women as well as men—have at least one of these risk factors.
The Importance of Screenings
Despite the very serious risk of heart disease, women tend to be much more aware—and fearful of—the risk of developing cancer, particularly breast cancer. Yet one in 31 American women dies from breast cancer each year compared with the one in three who die from cardiovascular disease (heart disease and stroke), according to the Heart Foundation.
That’s why it’s so important to be screened.
The most basic of those screenings include blood pressure checks and blood tests for cholesterol counts at least every three years, Raff says. In addition, a physical exam should always include a check of height and weight and the calculation of body mass index to determine if you are overweight. And if you are overweight, you should be screened for diabetes through a fasting or non-fasting blood test.
“Just because you’re young doesn’t mean you don’t have high cholesterol,” Hodge warns. “Just because you’re not overweight doesn’t mean you don’t have high cholesterol.” She urges women to get checked.
Another risk factor is rheumatological disorders such as rheumatoid arthritis, lupus and connective tissue disorders, Raff adds. These diseases can increase your risk of heart disease because they cause inflammation, which can narrow the arteries, making it more difficult for blood to pass through them.
Depending on your age and risk factors, a doctor might prescribe additional tests for heart disease. These can include an electrocardiogram (EKG), which can often be done in a primary care doctor’s office, as well as a stress test, typically done in a cardiologist’s office. The stress test can be enhanced further with ultrasound or nuclear imaging, both of which help to detect blockages in the arteries.
Even these tests can miss heart disease. The stress test, for example, only detects evidence of significant heart disease, meaning blockages of 70 percent or greater.
It’s becoming more common to perform CT scans of the coronary arteries, which are newer types of tests for heart disease. There are two such scans: a CT scan with a calcium score and a more sophisticated CT scan with angiography, in which a person is given dye through an IV that highlights the arteries on the scan, making it easier to detect heart disease and plaque in the arteries.
Women who are at risk of heart disease may need to be on preventive medications, depending on their risk factors. These would include medicines to lower blood pressure and cholesterol. In some cases, it is recommended that women take a daily aspirin to guard against heart disease. However, because of the potential side effects of aspirin, a woman should consult her doctor before beginning an aspirin regimen.
Most importantly, says Weiss, “women have to take ownership of their own cardiovascular risk and recognize that sedentary lifestyles and obesity, which have become epidemic in the United States, probably contribute more [to heart disease risk] than any specific number does.” Every woman should be engaging regularly in cardiovascular activity,” she adds.
The good news, according to the American Heart Association, is that 80 percent of cases of cardiovascular disease—among women and men—are preventable through lifestyle changes. That means eating right and controlling your weight, engaging in regular exercise, controlling your cholesterol and blood pressure, and not smoking.
Murphy has an active lifestyle again, traveling with her husband, spending time with her grandchildren and volunteering at Beebe Healthcare’s cardiac rehabilitation program. She’s acutely aware of how lucky she is—and she wants to warn other women not to make the same mistakes she did.
A heart attack, she warns, “is not like Hollywood. If you’re waiting to clutch your chest and fall to the ground—that’s not going to happen in most cases. You know your own body. Listen to what’s going on.”
Indicators for heart disease
The most common risk factors:
- High cholesterol
- High blood pressure
- Family history of heart disease, particularly of early heart disease
- Metabolic syndrome (a combination of fat around the abdomen, high blood pressure, high blood sugar and high triglycerides)
- Lack of physical activity (women as a group tend to be less active than men)