Women's awareness of atypical symptoms must increase
Published: February 16, 2009

Heart Disease Is A Ticking Time Bomb for Women

VIRGINIA DIAZ | Hernando Today correspondent

A woman goes to her doctor for a check up. She says she feels tired all the time and has trouble sleeping. Her stomach has been bothering her and she's been getting pains in her legs. Although she doesn't feel right, she's not thinking heart disease. But she should be.

Heart disease kills more women than breast cancer, but surprisingly, women don't perceive it as the bigger threat and know little about how it's symptoms make them feel.

"I've seen women come in with flu-like symptoms, says Oak Hill Hospital Director of Cardiovascular Services Samantha Wood, RN, BSN CCRN. "We continue further and there's no complaint of chest pain. They just say they don't' feel good or they feel rundown."

"For men you don't need to be a rocket scientist to realize the typical presentation," says Dr. Adel Eldin of Brooksville Cardiology. "There's chest pain in the middle of the chest or throat, or it goes to the neck or jaw or arms. They become short of breath and break out in a sweat."

Eldin has been treating patients with coronary disease for 11 years. He has been involved in clinical trials and has authored several papers. He specializes in diagnosing and treating cardiac and vascular disease as well as managing its risk factors.

"For women, it could be very atypical," explains Eldin. He says his women patients often describe symptoms like chronic fatigue, shortness of breathe with exertion and there are other signs. "I can't sleep in bed, I have to sit in a chair or my heart flutters once in awhile," are complaints Eldin says women report.

Leading Cause Of Death

Heart disease is the number one cause of death for women in the United States. Though the danger goes up with age, one out of eight women 45 to 64 are at risk and women are four to six times more likely to die from heart disease than breast cancer. The cost in dollars and cents reflects that. Heart disease and stroke care's estimated cost is $448.5 billion a year compared to $15 billion for breast cancer. Just as shocking is that, according to the American Heart Association, only 13 percent of women see heart disease and stroke as their greatest health threat.

The unusual symptoms women often experience make it harder to diagnose them. The average woman's lack of knowledge and an unwillingness to act leads to late diagnosis and treatment.

"They (women) are presenting later, with more damage," says Wood. "Time is muscle. So the more time they did not seek assistance is more muscle they lost. The blood supply is cut off. If you can re-instate that blood supply and get it circulating again, you won't loose that muscle."

The National Institutes of Health conducted one of the first studies to look at women's experience with heart attacks and how it differs from men's. Their research showed fewer than 30 percent of the participating women reported having chest pain or discomfort prior to their heart attacks and 43 percent said they had no chest pain at all.

"I had a friend of mine who had a massive MI (myocardial infarction) and she had trouble swallowing," Wood told Hernando Today.

Karen Gidden of the Hernando County Health Department's Heart Healthy Hernando program told a similar story about a co-worker's mother. "She was in her late 60s and had been complaining of nausea, stomach pain and shortness of breath. When she finally went to the doctor she found out she had already had a mild heart attack."

Unfortunately what these women experienced are not exceptions to the rule. "This is just the way they present," explains Eldin. "Some people say it's almost like a different disease."

Putting The Clues Together

Heart disease doesn't happen overnight. It takes years to develop. Fatty deposits collect on the lining of blood vessels and plaque builds up causing arteries to narrow limiting the free flow of blood. Blood flow can also be blocked when weak spots develop in the gelatinous layer that keeps plaque from breaking free from arterial walls and forming clots.

A heart attack can come on suddenly and dramatically which is often the case with men. But it can also come on slowly, almost silently. When a woman reports generalized symptoms that are less typical in men, a primary care physician may not immediately suspect heart disease any more than the patient does. Checking for risk factors is the first step in the diagnosis process.

"If they have some of the common ones like high blood pressure, high cholesterol, diabetes, smoking, family history of heart disease, sedentary lifestyle, obesity - if one or more of these is present, you go on," says Eldin, who this year became a member of Hernando County's Health Care Advisory Board.

He also notes, "Women tend to have smaller sized arteries than men. They will tend to have more diabetes and hypertension and women unfortunately have more incidence of smoking which will tend to cause a spasm of the coronary arteries."

Another factor that could interfere with diagnosis, says Eldin is that breast tissue overlies the front of the heart where the coronary artery is located making it more difficult to spot a clot or a weak spot in the gelatinous layer that keeps plaque contained.

Even the results from standard stress tests for heart disease can be misleading. Explains Eldin, a stress test/EKG is more likely to show abnormal or false positive changes in women. "Some EKG changes in men are very, very specific. For women you have to look specifically to identify the areas where the EKG stress test cannot do it alone." Tests that involve nuclear imaging and a relatively new technique called CT angio imaging, says Eldin, allow doctors to get a clearer picture of what's going on inside the arteries and allow them to pinpoint weak areas.

Same Disease - Different Experience

Susan Larberg, 58, and her husband Dennis, 66, live in Spring Lake. Both have coronary artery disease and both are patients of Eldin's.

Susan Larberg's problems started three years before her husbands. His symptoms were pretty straightforward.

"I was getting tired quickly. I'd go to the bathroom and come back huffing and puffing," remembers Larberg, who spent 15 years as a judicial officer in Hernando County after retiring from a 20 year career as a New York City police officer.

"I had a 77 percent blockage in one artery and 40 percent in another one. Larberg was given medication-releasing stents in 2003. But even following the rules didn't prevent another problem for Larberg. He has developed a triple aortic aneurism in his leg. He will have surgery for it but had he not been aware of how he feels and kept up with check ups, it might have gone unnoticed. He's confident about the outcome. "I'm not too worried."

For Susan Larberg, the road was not as direct.

"I was definitely in denial," says Larberg. She admits she was overweight and leading a sedentary lifestyle. She wanted to do something about it so she began to do regular exercise. "I started speed walking around my property and I wasn't getting any better. I felt worse than I felt before. Heavy breathing, a heaviness in my chest, I though it was because I was very unfit and overweight." She never connected how she was feeling with heart disease.

After three weeks of symptoms, Larberg went to the Oak Hill Hospital emergency room where Eldin treated her. She had been walking around with 2 clots. She was given stents but every 3 months for a year she needed a new one.

Two years after her initial diagnosis, Larberg collapsed while visiting a flea market with her husband. "I thought I was going to die. I made my peace with God."

Larberg had double bypass surgery and with medication and lifestyle changes, she is living comfortably. But she has to work at it. "It's easy to say, it's difficult to do. I watch what I eat. I exercise three times a week. I used to think doing the housework and gardening was enough, but it isn't."

Despite all she went through, Larberg is one of the lucky ones. She received treatment before she had a heart attack and to this day has not experienced one.

Still A Gender Gap

A study published in the medical journal Circulation at the end of January showed that women were 52 percent more likely than men to be delayed in g))etting to a hospital for treatment for heart trouble although researchers could not explain why.

Circulation also published a recent study of United States hospitals in December that women hospitalized for heart attack don't get the treatment they need.

Even though women survived mild to moderate heart attacks about as well as men once they were in a hospital, the study's raw numbers showed that 10 percent of the women were more likely to die from severe heart attacks compared to 6 percent of the men.

The researchers also said that women were less likely to get recommended medicines like aspirin within 24 hours and were less likely to get treatment to restore blood flow or it wasn't given quickly enough.

Studies like these, though disturbing, help to get the word out to women, and their families that heart disease is as big a risk for them as it is for men. They also remind health care providers of the importance of recognizing the signs.

Wood says she believes things are improving. "It really has been in the last five years that we have made a lot of strides in making sure that we identify women. Plus, you have to understand that we can't identify them if they don't present to us. The longer they wait because of that atypical symptom, it's going to be harder to treat."

Excuses And Misconceptions

There are many reasons for a woman to not take heart health seriously. They'll say they're too busy with family responsibilities or they don't want to be a "bother."

Another common reason is a lack of knowledge about the signs and symptoms of trouble. They tend to think crushing chest pain is the only sign of an impending heart attack or they think it can only happen to men or old people.

Wood advises women to step up to the plate when it comes to recognizing there could be a problem.

"Be your own patient advocate. Be the advocate for women's health."

It's important to remember that heart disease is preventable and women can beat the ever-growing odds against them by following the heart healthy guidelines set out by American Heart Association, the National Institutes of Health and many other health care organizations.

"I tell people to address all the risk factors," says Eldin. "If you're smoking, stop. If it's high blood pressure, control it. If it's diabetes, control it. If it's lipids, control it. If it's lack of activity, do something."

The changes don't have to be drastic. Healthcare professionals advise setting reasonable, attainable goals. You are what you eat and a sensible diet that includes heart healthy foods combined with exercise is where to start.

Lori Ann Ness Dennison, Director of Education and Clinical Nursing at Brooksville Regional Hospital is passionate about getting the word out to women about heart health. At a seminar on women and heart disease held last week at the hospital, Dennison who struggles herself with weight, cholesterol, blood pressure and diabetes speaks from personal experience. She told the attendees "If you have medication, take it. It's not doing you any good sitting in the bottle. If you are on coumadin treatment, get your blood tested as ordered by your health care provider." And, she repeatedly said, "Know your numbers. Your blood pressure, your HDL (good cholesterol) and LDL (bad cholesterol)."

If you would like more information on heart disease there are several organizations that can help. Here are a few of them.

National Institutes of Health:

The American Heart Association: www.americanheart.org
The National Coalition for Women with Heart Disease: www.womenheart.org


Virginia Diaz writes regularly for the Hernando Today Health Today section.