The health news of late had been focusing on new research that the symptoms of heart attack are different for women than for men. For years, it had been a one-size-fits-all warning: chest gripping, crushing heart pain and aching left arm–heart attack! Except that women’s angina they now said was not like that at all. For women, it could just be an aching neck or overwhelming fatigue or nausea or–.
I’m thinking all this as I’m standing by the coldcase of sirloin and chopped beef wondering whether this funny feeling, this new-to-me sense of fullness in my chest is my version of a heart attack. I move out of the meat department and down the cereal aisle, trying to ignore the myriad thoughts racing through my mind: Yes. No. It is. It isn’t. I’m being silly. I’m being proactive.
But now, now I’m aware that my arm does ache and I’m having trouble breathing. I feel as if I can’t get enough air in. And I’m starting to feel lightheaded, and kind of cold, clammy actually. And tingly. I’m definitely starting to feel tingly.
Should I go to the ER? Yes–I might be having a heart attack and they’ll save my life. No–you’ll just end up sitting in the waiting room for hours feeling foolish. Yes, no, yes, no. Finally I arrive at a compromise. I’ll go to my doctor’s office, which is only a short drive away. I leave my half-loaded cart in the cereal aisle–.
The doctor does an EKG, pronounces my heart healthy and I return to Raley’s to finish shopping, feeling foolish.
The same thing happened again several years later, on Christmas Day. But this time Dennis is with me and he, who lived through the days of my ruptured cerebral aneurysm, drives me to ER. There I spend about 4 hours having every kind of test imaginable and am told, again, that my heart seems fine. This time, I not only feel foolish, I’m out $3000 because the ER doesn’t take my insurance. (Thank you, Kaiser Permanente).
My story is a classic example of that adage, “a little learning is dangerous.” The National Heart Lung and Blood Institute’s (NHLBI) education program, The Heart Truth®, has done an excellent job in alerting women to their cardiac vulnerability, but the symptoms of angina they list are, to my overactive imagination, too general.
Nausea, back pain, jaw pain, sweating, shortness of breath and inordinate fatigue–these are facts of life in many women’s day-to-day physical being. Is there any way to know when these symptoms should be seen as indicators of heart attack? Is there any way to know when it’s time to call the doctor–or just put your feet up with a cup of tea.
I put those questions on this, the ten year anniversary of The Heart Truth® program, to Nakela L. Cook, M.D., M.P.H., F.A.C.C., a medical officer in the Clinical Applications and Prevention Branch in the Division of Cardiovascular Sciences at the NHLBI. While agreeing that the symptoms of angina can be similar to those of anxiety, she offered this advice about when it should be taken more seriously:
- when the symptoms are different from what you’ve felt before
- when they’re stronger, more intense
- do they last longer or do they go away and then return
- are they associated with physical activity
- do they come together in a constellation
Bottom line, however, according to Dr. Cook is that often physicians can’t tell whether someone is having a heart attack either. “There are other conditions in addition to anxiety attacks that can present similarly to heart disease,” she said. “So what we are trying to do with the physical workup is to rule in or rule out all other conditions. We have to play it safe, take the symptoms seriously and find out what is really going on.”
The Heart Truth® campaign has been successful, Dr. Cook added, in that 54% of us now know that cardiac disease is the leading killer of women. Those women are more likely now to take positive action such as losing weight and eating healthier. However, the campaign’s work is not over by a long shot. “Women are just not as good about getting help for themselves as they are for those they’re taking care of. You have to be the empowered individual in your life in order to have a good outcome for yourself and your family.”
Women of color are at particular risk, according to Dr. Cook. They have a greater burden of risk factors such as high blood pressure, obesity and diabetes than white women. In addition, “women of color often don’t receive the same treatment as the standard of care so the outcomes for them are not as good.”
For all women, however, the gender disparity in cardiovascular disease is the reason why more of us will die of heart disease than from all forms of cancer combined. Now that’s a scary statistic–but it’s one that we as individuals can do something about. How’s your heart health?