Spring 2014
Veronica Sanchez didn’t know she had a problem until she was admitted to the hospital with her second heart attack. The 51-year-old had recently passed her annual check-up, when she woke in the night with chest pressure and nausea. She crawled to the bathroom, and then, watched some television, hoping to feel better. When Sanchez’s left arm went numb, she alerted her husband, who took her to the emergency room. There, she learned that most women don’t wake up during such an episode, and this saved her life.
Heart History
In 2010, Pam Sowa had an accident that required rotator cuff surgery. This revived some unresolved heart history. Nearly 60 years old by then, she’d received conflicting information for decades from doctors about how to handle a congenital heart problem—bicuspid aortic valve. She had only two, instead of the usual three, valves. That diagnosis came during her fourth pregnancy, after she had been treated for a viral infection.
Over the years, Sowa was on and off of medication, suffering episodes of plummeting blood pressure and struggling to catch her breath. Eventually, tests concluded she had developed valvular heart disease and congestive heart failure. Her health failed so rapidly, Sowa was added to the heart transplant list.
As a bridge in 2011, she had a pacemaker and defibrillator implanted, which assured a regular heartbeat with resuscitation, if required. Sowa surprised everyone, however. She improved quickly, and now, spends time playing with her grandchild. She is thankful for every day.
Risks and Symptoms
Sanjay Kunapuli M.D., a DeBakey cardiologist associate at Houston Methodist Willowbrook Hospital, performed Sowa’s surgery. “Her heart function increased from 20 to 51-percent, so Pam was kicked off the transplant list,” says Dr. Kunapuli. Good news, but it has been a long road. Diagnosing women is trickier, because they present atypical symptoms of the disease, especially in crisis. According to Dr. Kunapuli, women may not grab their chest, and more often, exhibit episodes of extreme fatigue. “Over time, they cannot climb a flight of stairs, may have an irregular heartbeat or palpitations and jaw pain,” he says.
Risk factors, such as hormonal imbalances and ethnicity, as well as a first degree relative, who experiences heart trouble before 55 years of age in men and 65 in women, also contribute. Although women have a degree of hormonal protection against heart attack until menopause, they statistically catch up with men after that.
“With higher smoking rates, the numbers of women presenting has increased,” Dr. Kunapuli adds. “Women have smaller arteries than men, so they become blocked faster, and ruptures are mover severe with worse outcomes.”
Waking up to Heart Disease
“I was nervous and confused by the news,” Sanchez says. “My cholesterol was normal, I wasn’t obese, and I didn’t smoke or drink.” Still, she was unaware of the health history of family living outside the country. Sanchez realized, after that fact, that warning signs had been there, like blurred vision and swelling feet. Her heart was so badly damaged that Sanchez needed a heart pump to regain enough strength to undergo further surgery. Three months of cardiac rehabilitation followed.
Sanchez has changed her lifestyle, eating organic, grass-fed proteins and using salt sparingly, seasoning her food with fresh herbs instead. Recognizing that stress is a catalyst for her, she tries to integrate an active, balanced lifestyle.
Atypical Presentation
Interventional cardiologist Dr. Krishnamoorthy Vivekananthan is also associated with Willowbrook Hospital and advises primary prevention for heart health. Irrespective of gender, he recommends checking cholesterol levels regularly, building a lifestyle of good dietary habits and aerobic exercise, controlling hypertension through medication and other measures, strictly controlling diabetic needs, and kicking the habit, if you’re a smoker. “Women don’t present with early symptoms of heart disease,” he says. “They have atypical presentation, so they shouldn’t ignore symptoms, especially if they are in a risk category.” As with men, the most common heart attack symptom in women is chest pain or discomfort. Still, women are more likely than men to experience other common symptoms, particularly shortness of breath, nausea or vomiting, and back or jaw pain.
Advice to Women
Both cardiologists encourage women to learn the warning signs and get proactive when it comes to heart disease. Sowa’s gastrointestinal symptoms—bloating and nausea—masked her failing heart. “Young and old should listen to your body and persevere until you get the answers to your questions,” she suggests.
Sanchez reminds women, “Everything is a priority except ourselves—our kids, our husband, our job, our church, and our neighbors. We dismiss the small things. Then, our bodies have to go through a major event to get our attention.” She respects that heart disease comes with a high price tag. “If you don’t take care of yourself, your quality of life declines, and can include medications or even death.” CFM
Heart Attack Signs in Women
- Persistent or intermittent pressure, squeezing, fullness or pain in the center of your chest.
- Pain or discomfort in one or both arms, the back, neck, jaw, or stomach.
- Shortness of breath, with or without chest discomfort.
- Atypical signs: breaking out in a cold sweat, nausea or lightheadedness.
If you have any of these signs, don’t wait more than five minutes before calling for help. Call 9-1-1 and get to a hospital right away.
www.heart.org