Friday, February 15, 2002

Heart disease - Women need to wake up to its symptoms

By Peggy O'Farrell
The Cincinnati Enquirer

        Mary Grace Maltry thought she had food poisoning or a virus when she called for an ambulance a month ago. The nausea was so severe she hadn't been able to sleep for several hours.

        Barbara J. Cole went to the hospital because she was having trouble catching her breath for the second day in a row. She had no idea what was wrong.

        Lydia Snyder was on her way to choir practice, and convinced herself the pressure in her chest was indigestion.

        All three women were diagnosed in the emergency room with heart disease.

        The leading killer of American women is heart disease, but few know the symptoms because they and their doctors are so focused on breast cancer prevention and gynecology, experts say.

        Heart medicine advocates are beating the drum this month because it is American Heart Month. Their push is to make people more aware of the symptoms of heart disease in women, which are different from men's symptoms.

        Considering the statistics, there's no disputing the push has merit:

        Cardiovascular disease — which includes all forms of heart disease and stroke — is the number one cause of death for women and men. About 6 million women and an equal number of men have a history of heart disease and/or angina.

        But heart disease takes a harder toll on women:

        • In 1998, women accounted for more than half the deaths from cardiovascular disease.

        • Half of the 440,000 women who suffer heart attacks every year die.

        • Within six years of a recognized heart attack, three of 10 women will be disabled by heart failure, compared to one of five men. The same rates hold true for second heart attacks. Women are more likely to have them than men.

        • First heart attacks are more likely to kill women than men — four out of 10 women who have had heart attacks die within one year, compared to one out of four men.

        • Women are nearly twice as likely to die after heart bypass surgery than men.

Stomach pain

[photo] Mary Grace Maltry works out on her exercise bike.
(Dick Swaim photo)
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        Mary Grace Maltry was getting ready to go to her health club shortly after noon on Jan. 14 in her Delhi Township home when a pain in her stomach became unbearable. Thinking she had food poisoning — or a flare-up of a virus she had been fighting for nearly a month — she called an ambulance.

        The 71-year-old woman couldn't believe it when an emergency room doctor at Good Samaritan Hospital told her she had a heart attack. Her late husband, Francis, had suffered two heart attacks and undergone a triple bypass. She didn't have his symptoms.

        Mrs. Maltry is one of the 8 million American women living with cardiovascular disease. One of every two women will die of heart disease or stroke, compared to 1 in 27 who will die of breast cancer.

        Women are less likely to get preventive care and treatment for heart disease and more likely to die from it. Now, experts say, it's time for women and their doctors to learn that heart disease is an equal-opportunity killer.

        If experience counts for anything, some would argue Mrs. Maltry should have known she was having a heart attack: Her father and two of her brothers died of heart disease, and two of her sisters had suffered heart attacks.

        Plus, she helped take care of her late husband after his heart attacks and surgery. (He died of lung cancer in 1998.)

        But Mrs. Maltry never connected intense nausea and fatigue with heart disease: She thought the chest and arm pain her husband had complained of were the warning signs to watch for.

        “It was altogether different from what my husband had,” she says. “He had the pain in the chest and the arms and he knew to go to the hospital. I didn't have the pain in the arms or in the chest.”

        There are many reasons why women's outcomes for cardiovascular disease are so much worse than men's, experts say. But it comes down to this: Neither women nor their physicians look for the signs and symptoms of heart disease — which are different in women than in men.

        Women are usually older — postmenopausal, in fact — when heart disease is discovered, so by the time a woman is treated for heart disease — usually after a heart attack or other incident — she's older, sicker and less likely to make a full recovery.

Short of breath

[photo] Barbara J. Cole had trouble catching her breath.
(Brandi Stafford photo)
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        Barbara J. Cole was getting ready to go to church on a Sunday morning when she realized she was having trouble catching her breath.

        The 67-year-old College Hill woman pushed the thought of it aside and went on to Christ Our Redeemer AME Church downtown where she is the music minister. When she still couldn't breathe the next day, she drove herself to the Mercy Franciscan emergency room. A doctor there told her heart was failing.

        “They said my heart was damaged, and my heart was 10 to 20, and the normal rate is 60 to 80,” Dr. Cole says. She was diagnosed with congestive heart failure.

        Dr. Cole also has a family history of heart disease: She lost her father and two brothers to it. But when she got her physical every year, her heart checked out fine, she says.

        In 1998, she was diagnosed with colon cancer. After beating it, she learned she had diabetes — one of the strongest risk factors for developing heart disease.

        “Of course, the doctor said it (heart disease) must have been developing for several years,” she says.

        Dr. Cole expected she'd have to battle breast cancer or ovarian cancer or some more obviously “female” disease.

        Nancy Loving, a heart attack survivor and the executive director of the National Coalition for Women with Heart Disease, says the emphasis on what she calls “bikini medicine” is to blame for the lack of awareness about women's heart disease risks.

        “It's all breast cancer or the reproductive organs,” she says. “The definition of women's health needs to be re-thought, especially with the aging of the baby boomers.”

    • Uncomfortable pressure, fullness, squeezing or pain in the center of the chest that lasts more than a few minutes, or goes away and comes back.
    • Pain that spreads to the shoulders, neck or arms.
    • Chest discomfort with lightheadedness, fainting, sweating, nausea or shortness of breath.
    • Atypical chest pain, stomach or abdominal pain.
    • Nausea or dizziness (without chest pain).
    • Shortness of breath and difficulty breathing (without chest pain).
;     • Unexplained anxiety, weakness or fatigue.
    • Palpitations, cold sweat or paleneness.
    Source: The American Heart Association
    To learn more about heart disease in women, check out these Web sites:
    •, the Web site for the National Coalition for Women with Heart Disease
    •, the Web site for the American Heart Association's “Take Wellness to Heart” campaign, a national heart health education campaign geared toward women
        A 2001 survey by the American Heart Association found that only one out of 10 women considered heart disease their most serious health threat, and that 38 percent of physicians talk to their female patients about heart disease.

        Ms. Loving says a two-step solution is needed to reduce women's heart disease deaths. First, physicians have to learn more about heart disease symptoms and warning signs and they have to begin looking for those signs earlier. And women themselves have to take the initiative to talk to their doctors about heart disease and to make sure their heart health is checked every time they get a physical.

        Local doctors agree.

        “We don't talk to women about heart disease a lot in the health-care media,” says Dr. Tom Ivey, the Christ Hospital heart surgeon who performed Mrs. Maltry's bypass surgery.

        Many women suffering heart attacks experience nausea, fatigue and dizziness.

        When younger women show up at the emergency room with those symptoms, “they're often dismissed as having anxiety attacks,” says Dr. Dan Glassman, a cardiologist with the Ohio Heart Health Center.

        Women and their doctors may also dismiss those symptoms as fatigue or menopause, says Dr. Lynne Wagoner, director of the heart failure and transplant program at the University of Cincinnati.


        Mrs. Snyder, who once worked in a hospital transcribing EKG reports, suspected the discomfort she felt one evening nine years ago might be a heart attack. But she wasn't sure.

[photo] Lydia Snyder thought her heart attack was indigestion.
(Ernest Coleman photo)
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        “I convinced myself it was job-related stress,” says the 69-year-old Mount Healthy woman.

        She decided to head to choir practice at Mount Healthy Christian Church. She climbed the stairs to the practice room and when she got there, out of breath and feeling sicker by the minute, she told her friends, “Don't look now, but I think I'm having a heart attack.” They drove her to Providence Hospital (now Mercy Franciscan-Mount Airy).

        The suspicions she had ignored were correct: She'd had a heart attack. The next day, Dr. Glassman told her one of her arteries was partially blocked, and she underwent an angioplasty to clear it.

        Mrs. Snyder admits she should have known — her chest pains weren't indigestion.

        Most of the risk factors for heart disease are the same for men and women: genetics, poor diet, lack of exercise, smoking and other lifestyle factors.

        But women face an additional risk that adds to the toll heart disease takes: Menopause.

        The hormone estrogen helps protect against some forms of cardiovascular disease. When a woman enters menopause, that protection stops — that's why women begin showing serious signs of heart disease about 10 years later than men. By that time, they've also had time to develop other complications, such as diabetes, that aggravate their heart disease and increase their chances for death and disability from heart disease, experts say.

        “We see a lot of women, especially with diabetes, that have pretty advanced coronary disease and complications from that by the time they present (their other disease is discovered),” Dr. Ivey says. “It's something that's been going on for quite a while.”

        And there are practical issues at work, Dr. Wagoner says. Women's arteries are smaller than men's, and that's a complicating factor during angioplasties and arterial grafts in bypass surgery. Some manufacturers have begun making smaller balloons for use in women's angioplasties, she says, and that will make a difference.

        Drug testing is also an issue. It's only been in recent years that pharmaceutical manufacturers have been required to include women in all large-scale drug trials. Some medications work well for women; some don't. Doctors don't always know why, Dr. Wagoner says, but the recent emphasis on researching women's health issues may find some of those answers.

        Looking for signs and symptoms of heart disease earlier would mean women would get more angioplasties, beta blockers, ACE inhibitors and other proven therapies, experts say.

        “Women have to take the initiative and, just as they're vigilant about breast self-exams and Pap smears, they have to be the owners of their heart health,” Ms. Loving says. “They can't outsource this kind of concern, and that's extremely difficult, because we're socialized to take care of everyone else first.”


        Mrs. Snyder was doing fine until a year ago when “a little episode” sent her back to the hospital with chest pain. This time, she had to have a stent inserted in the same artery that was blocked nine years ago.

        “I went to the hospital in an ambulance this time,” she says.

        She feels fine now. Semi-retired, she works three days a week processing insurance forms in a doctor's office, and she still sings in the church choir.

        Dr. Cole's medication makes her feel “some better,” she says, and sheto receive a pacemaker on Valentine's Day. “Everyone keeps telling me I'm going to feel so much better,” she says.

        Mostly, she's tired all the time. She's taught music for 30 years — voice and piano by the Suzuki method to private students — and she's the minister of music at Christ Our Redeemer AME Church downtown.

        With all the health problems she's had in the last few years, she's been forced to slow down, and space the lessons more throughout the week. But she's still teaching and ministering, so she's doing fine, she says.

        Mrs. Maltry is looking forward to getting back to the gym. Before her heart attack, she went three days a week to a warm water exercise class that helped ease the arthritis in her knee. Now, she's riding her husband's old exercise bicycle a few minutes every day, until her doctor clears her to begin a regular cardiac rehabilitation program.

        “I feel very good,” she says. “I'm still a little leery when I lay down at night because you hear these creaking sounds in your chest, which the doctor says is the wiring holding the ribcage together. But I feel great.”



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