Wednesday, July 14, 1999
What women need to know about heart attacks
Doctors working to convince female patients to take symptoms seriously
BY SUE MacDONALD
The Cincinnati Enquirer
Sandy Arnold uses a treadmill to keep in shape.
(Thomas E. Witte photo)
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Sandy Arnold of Milford figured she had a bad case of indigestion one day last November. She downed some Mylanta, took a walk until the pain in her neck and chest went away, and then went to bed.
She was accustomed to feeling tired — who isn't? — and neck pain had been a constant companion for more than nine years.
But the next morning, still feeling fatigued and achy, she went to her doctor and was rushed to Deaconess Hospital for emergency heart bypass surgery. There, doctors told her she was hours away from a major heart attack.
“If I hadn't gone to the doctor because of what had happened to me the night before, I would have been alone in the house ... ” says Ms. Arnold, a Child Focus Inc. family advocate in Clermont County and one of about 435,000 American women to experience a heart attack each year.
Ask women what health problem they worry about, and most identify cancer as their biggest fear. But health advocates point out that heart disease is far more common and deadly than most women think. And the message is important: Compared to men, women recover more slowly from heart attacks and die from them more frequently, according to the American Heart Association.
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SUSPICIOUS SYMPTOMS
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When should women get serious about heart attack symptoms? “Heart disease is always going to be tricky because you can get chest pain from other things — indigestion, hiatal hernias, muscle pulls — and you hate to be running to the emergency room every time,” says Montgomery cardiologist Dr. Roberta Erena. “But you don't want to miss a heart attack, either.” Her golden rule: “If you're having suspicious chest pain that goes on for longer than 15 minutes and you've never had it before, you should have it checked out. Call immediately. If you notice a pattern, particularly where pain is occurring with exertion or pain lingers for months, you'd better get in and have it checked.” And remember that women's heart attack symptoms are often different from men's. Women tend to report more nausea, indigestion, fatigue and pain that affects the chest, neck, jaw, shoulders and upper back.
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“It's a matter of getting women over that thinking that, "Oh, it's nothing,'” says Dr. Roberta Erena, a Montgomery cardiologist. “It's also getting society over the mindset that, "Oh, women don't have heart attacks,' because they do. We see heart attacks in women in their 40s and 50s. Heart disease is the No. 1 killer of women.”
Getting help early
Convincing women of the severity of heart attacks is a difficult task. On the one hand, doctors and health educators encourage women to seek immediate help when symptoms arise, but they don't want women to panic at the slightest aches and pains.
Yet within a year of having a heart attack, 42 percent of women die, compared with 24 percent of men. Six years out, women are more likely than men (33 percent to 21 percent) to have a second heart attack.
Why is it so hard to convince women of the seriousness and prevalence of heart disease?
“Sometimes women try not to panic or worry if they get symptoms,” Dr. Erena says. “Typically, they don't seek help as early as they should.
“Of all the people who don't have chest pain with a heart attack, more of them are women,” she says. “So we have to look out for shoulder heaviness, fatigue, sweating, nausea, shortness of breath — all of those can be symptoms of heart attack even without chest pain.”
Other reasons why women may not seek help immediately:
• They may be accustomed to aches, pains and fatigue, women often disregard their symptoms as temporary.
• They may assume they couldn't be having a heart attack. Women push through their routines for hours or days, using antacids and over-the-counter pain relievers to mask symptoms.
• They may be caught up in hectic, busy lives. They may assume that phantom pains, nausea, breathlessness and fatigue are the results of stress.
• They may be used to worrying about the health of everyone else in their lives, they fail to pay attention to their own bodies, delaying treatment and often worsening the problem.
“I think it's true of a lot of women that they've never accepted any help from anybody,” says Ms. Arnold, who was 58 when she had her heart attack. “It took three people telling me to go to the doctor — my husband, my son and my supervisor at work — before I actually did something about it, and I think a lot of women are like that.”
"I was in shock'
Juanita Popplewell of Springdale can relate.
One September evening while shopping, she experienced weird chest pains and went home. She took a Rolaids, sent her reluctant husband off to a Reds game and lay down. Throughout the night, the pain radiated through shoulders, neck and jaw. At 4 a.m. she fell asleep. The next morning, she went to a regular dental appointment and then drove home. She finally called her doctor because her arms became so weak while driving that she had trouble gripping the steering wheel.
He sent her immediately to the hospital.
“They chewed me out big-time in the emergency room,” remembers Mrs. Popplewell, who was 58 at the time. “They said, "You don't seem to realize that you've had a heart attack and you need surgery.' I was in shock. I still didn't think it was a heart attack because I still felt pretty good. I had my grocery list in my pocket.”
She didn't go shopping, of course. She went into the operating room, where doctors put a stent — a tube-like device — into her blood vessels to keep them open.
“My mother died of heart disease at 78, and all her brothers and sisters had heart problems, too,” says Mrs. Popplewell, 59, retired from Napa. “That should have been a red flag for me, but when you're younger, you kind of shove that into the back of your mind. I ate so many fried foods. I hadn't been in for a checkup for 21/2 years. I didn't smoke, but I had a lot of bad eating habits.”
No longer. She limits fat, gets regular checkups and attends cardiac rehabilitation when she can.
Lifestyles must change
Recovery from a heart attack is the same for men and women — low-fat diet, exercise, control of blood pressure, cholesterol and stress, Dr. Erena says, but women often take longer to recover from a heart attack and heart surgery than men for reasons not fully understood.
That's why it's important for women concerned about heart disease to begin adopting lifestyle patterns in their 20s, 30s and 40s to stay heart-healthy as they age and their risks increase, she says.
That means monitoring high blood pressure, cholesterol, diabetes and fat intake. It means quitting smoking, getting physically active and managing stress.
“We really should be focusing on preventing what might be coming 10 years down the road,” Dr. Erena says.
“Listen to your body,” advises Ms. Arnold, who credits the support of her doctors, husband, children, in-laws, friends and co-workers with helping her through a difficult time. “And positive rehabilitation is really important. It's important that the people who love you take time to be around you and encourage you.
“At age 50, you start evaluating what you've done. It makes your life seem a little more important to think that your family and other people really care.”
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