Secrets of a Woman's Heart

What you don't know could cost you your life.

by JoBeth McDaniel

March 1, 2005

Melissa Padgett of Newnan was driving home one Sunday when she first noticed a minor achiness, like a pulled muscle. The next morning, the 31-year-old secretary awoke with a crushing chest pain and knew right away something was terribly wrong.

Her husband rushed her to the emergency room where doctors ran an EKG test. It came back normal, so they sent her home. That Wednesday, she was feeling better and almost didn't keep an appointment with her doctor. He ran a second EKG test, which showed a possible irregularity. So she drove herself and her six-year-old son to a nearby hospital for a blood enzyme test.

The results showed she had suffered a heart attack. Within minutes, Padgett was flat on her back in an ambulance, headed for emergency heart surgery at Crawford-Long hospital. Over the next two days, she had two open-heart surgeries for a quadruple bypass. Her right main artery was 100% blocked, her left main was clogged 70%. She and her doctors knew she was very lucky to be alive.

"You always think it can't happen to you," she says now, four years later.

Unfortunately, heart problems have become more prevalent in young women, possibly because of increased rates of smoking and obesity, says Dr. Randy Martin, a cardiologist at Emory University Hospital. About 9,000 women younger than 45 have heart attacks each year in the U.S.

Another reason may be that women think of heart attacks as a problem of older males, so they often ignore symptoms and delay seeking medical attention. When women do seek help, doctors treating them are more likely to misdiagnose serious problems because women's heart attack symptoms look different from the classic signs we've all been taught to watch for.

Women's pain may wake them from sleep, or occur during stressful times, says Martin: "Women are more likely to have jaw, neck and back pain, or even pain in the stomach. Women may have no pain, just nausea, fatigue and shortness of breath. They may think they have the flu."

According to a national survey by the American College of Emergency Physicians, only 37% of women would call a doctor and only 10% would call 911 or visit an emergency room if they were experiencing flu-like symptoms. Nearly 80% would wait 24 hours to see if the symptoms subsided -inaction which could be deadly in women at high risk for a heart attack.

Just the thought of heart surgery can be frightening enough to scare some women away from getting help if they suspect a heart problem. The good news: surgical techniques have improved dramatically in th epast few years, minimizing the risks, the scars and the recovery time. Go to www.allaboutmyheart.com for more information. (See sidebar below.)

Indeed, busy working women, who are under a lot of stress, often put medical checkups far down their to-do lists. Yet, the lifestyle of many working women - meals on the run, long hours, little exercise, travel and stress both at work and home - can land them in the high risk category. (For more information, go to: www.acep.org/takeittoheart)

Padgett was overweight and had high cholesterol, but did not smoke, or have diabetes or high blood pressure, which are key risk factors for women. She now looks back on the months before her heart attack, and recalls how tired she felt, day to day. Just walking up stairs made her short of breath. Sometimes her chest hurt, but she disregarded her discomfort.

"I just thought I was out of shape," says Padgett. "Women deal with so much more pain that we just live with it and let it go longer, until it's really bad. [We think] we've still got to get everything done; we've got to take care of these kids." Even as she was being hooked up to machines in the ambulance, she was trying to call her daughter's babysitter on her cell phone, and worried about her son, who was happily spinning the ambulance's radio dials.

Padgett's family has a history of heart disease, an important risk factor. Years ago, Padgett's aunt had a heart attack at age 28. Her own cholesterol was an extremely high 451 before her heart attack.

As Padgett learned, certain heart tests, such as EKGs, can be less effective on women. Studies also show that some treatments, such as angioplasty, may not be as successful with women as with men.

Dr. Martin says heart disease is actually more disabling, and more fatal, in women than in men: "Women are slower to be diagnosed, and once diagnosed, historically, they have worse outcomes than men."

It all adds up to sobering statistics: cardiovascular disease (CVD) kills one of every three women in the U.S. Each year, 500,000 women die from CVD, making it twice as deadly as all cancers combined, the cause of death for 250,000 women each year.

Risk factors are the same for men and women. However, smoking has more serious consequences for women, as does diabetes, says Dr. Martin, who is also president of the American Society of Echocardiography. "Abnormal blood sugar is a very significant risk factor for women, more than men," says Dr. Martin. "If HDL ("good" cholesterol) levels are low, and triglycerides are elevated, that's a much worse sign for women than for men."

To assess their risk, women should know and monitor their cholesterol and their fasting blood sugar levels, says Martin.

An apple shape, with more weight around the abdomen, increases a woman's risk for diabetes and heart problems. An overweight woman needs to ask for a hemoglobin HgA1C test to see if she is diabetic or pre-diabetic, says Martin. A woman with multiple risk factors for heart disease should have a blood test for C-reactive protein. If she also has chest pains, an echocardiogram, which shows an image of the heart, is generally a better diagnosis tool than an EKG.

The good news: When caught early, most heart disease can be treated successfully with a modified diet, exercise and medication, says Dr. Martin.

Padgett is now on aspirin and statins, which keep her cholesterol down to a low total of 161. "The medicine and the technology keep improving so much," she says. "The year after my surgeries, I had to take 14 huge horse pills. Now it's just four small pills." Diet and exercise can help lower cholesterol, but family history of high cholesterol can have as much or more bearing on a person's numbers - as Padgett soon learned.

Shortly after her surgeries, Padgett made sure her family members - and even her young children - were tested for risk factors. To her shock, her son, then age six, had a total cholesterol of 351; he was immediately prescribed statins, which have kept his cholesterol low for the past four years.

Her daughter, only three years old at the time, had a whopping 355 total cholesterol. Carly, now age eight, will soon start on the statin medication - a step her mom hopes will protect her from heart troubles for the rest of her life.

Heart Attack Symptoms
Women
  Pain while resting/sleeping or during stressful period
  Flu-like symptoms (nausea, fatigue)
  Pain in jaw, neck, back or stomach

Men
  Pain during exercise or exertion
  Sudden gripping pain
  Pain in chest/arm

More female Hispanic Americans die from heart disease and stroke than cancer, diabetes and accidents combined. Heart disease and stroke accounted for 33.1% of total deaths in 2000.

New Advances
Last year, Marianne Wilder, a 25-year-old teacher, went for a routine physical. She was a 50-mile per week jogger, brimming with good health.

Her doctor found a slight heart murmur. "No big deal," she assured Wilder, but referred her to a cardiologist, just to be safe. The cardiologist also thought it was a normal murmur, but chose to look at it closer with an echocardiogram.
 
The image was shocking: Wilder had a hole the size of a quarter in her fist-sized heart, which had been there her whole life. Had the hole in her heart gone undetected and untreated, it could have caused severe problems later in life, especially during pregnancy.

Though Wilder had no symptoms, the chambers of her weakened heart were already enlarged from the extra effort: "They asked me if I passed out often, or if my hands and feet got cold, or if I had a hard time breathing. I never noticed anything. I felt great."

Surgery was quickly scheduled with Dr. Douglas A. Murphy, chief of cardiac surgery at Saint Joseph's Hospital of Atlanta. Murphy is one of the pioneers of less invasive heart surgeries, including the "port access" heart surgery. Unlike traditional open-heart surgery, in which the patient's entire chest area is literally split open wide, port access surgery uses small openings between the ribs to access the heart. The surgery is more precise, and safer overall, with a much faster recovery.

Wilder checked in on a Friday morning, and was back home by Sunday evening. Her mom and fiancé helped out, and in a few days, she could walk unassisted. Within six weeks, she resumed jogging.

"I'm 100% fixed," she says proudly. A year later, she has only three small scars underneath her arm, and a scar on her hip. She'll need to check in with a cardiologist from time to time, and be monitored during any pregnancies - but for now, she stays busy working and planning her wedding - and being very grateful for her healthy, patched-up heart.- J.B.M.

Do Your Numbers Add Up?
If your numbers fall in these ranges, your heart is likely in good shape:
TOTAL CHOLESTEROL   below 200
HDL ("good" cholesterol)   50+*
LDL ("bad" cholesterol)   below 100
TRIGLYCERIDES   below 150
* in a menstruating female

Cut The Risks
1. Stop smoking. Smokers are twice as likely to have heart disease than non-smokers.
2. Exercise. Sedentary folks are twice as likely to have a heart attack than those who exercise regularly.
3. Eat heart-healthy. Staying lean and eating nutritious foods cuts your risk.

Who's At Risk?
- Many major risk factors for heart disease, such as smoking, obesity, physical inactivity, high blood pressure, and high cholesterol, can be controlled with diet and medications. Other risk factors: age, diabetes, and family history of heart disease.
- Women with diabetes are two to three times more likely to have a heart attack than a woman without diabetes.
- African American women are 72% more likely to suffer from heart disease than white women.

From Sister to Sister: Everyone Has A Heart Foundation, Inc. (sistertosister.org)

Ditch The To Do, Take Care Of You
Congratulations, you are taking time for yourself by reading this magazine, but chances are you're still a woman with too much to do. Do you literally have to remind yourself to breathe while plowing through your stressful workday? Do you have a husband, child, parent, co-worker or pet - all of whom come before you on your daily to-do list? Do you rarely treat yourself to four-day weekends, back rubs and laughing out loud episodes?
 
If you answered yes to one or all three, stop right now. This exercise will be short and painless: chunk the guilt, take a deep breath, and make a promise to yourself to follow a few guidelines from Pamela Allardice's book Make Time: The survival guide for women with too much to do.

GET THINGS DONE: Prioritize with three goals daily, and set deadlines expecting quality not perfection. This strategy will shorten your to-do list.

TO YOUR HEALTH: Nourish your body with whole foods and the occasional treat. Take it from Mae West: "I never worry about diets. The only carrots that interest me are the number you get in a diamond." 

NO TIME FOR EXERCISE? Don't wait for next year's New Years party to shake it. Break out the broom (or your man), and let your body feel the music tonight!

HER HAVEN: Use fine linens - plush bath towels wash away stress and soft sheets encourage deeper sleep.

F IS FOR FINANCES: Hire a good financial advisor, and schedule a lunch meeting with her next week. Period.

SPIRIT: Remember telling yourself to breathe? Here's your chance. Just be and breathe. 

F IS ALSO FOR FUN! Find a reason to laugh out loud daily. And then, plan a date with your best girlfriend or male friend. Choose to make time for you, and don't take life so seriously. Now, go on with your beautiful self! - Caroline Correl