Published on February 11, 2009

Women: Listen to Your Heart

Heart disease is your No. 1 killer

Jeanne Stoltz of Bettendorf thought of every excuse in the book to explain away her symptoms of heart attack.

Her nauseous stomach was probably the flu. Her constant shortness of breath was the result of years of smoking, even though she had quit years earlier. Her shoulder ached and pain radiated down her arm but, then again, she had a bad left shoulder.

The 56-year-old had survived an aneurysm four years earlier, and was a frequent sufferer of migraines. Her tolerance for pain already was high. To top it off, she had passed a stress test with flying colors just one year before.

"Unlike many women, I actually had the classic signs of a heart attack. But what did I do? I totally ignored them and, despite my discomfort, went shopping with my daughter that day," Stoltz says. "At that point, heart disease wasn't on my radar."

The year was 2005, and Stoltz was in St. Louis visiting her children for Easter. She went shopping to help her daughter register for baby gifts. That "little case of the flu" wasn't going to stop her from sharing the special milestone with her pregnant daughter.

But the next day, when her symptoms persisted, she finally went to the Emergency Room and learned she had indeed suffered a heart attack. Three days later, she underwent a quintuple bypass to open blockages in her heart.

Dr. Rafat Padaria

Heart attacks in women go unnoticed or unreported, often because their symptoms are more subtle than men’s.

“Women have different symptoms than men,” says female cardiologist Rafat Padaria, M.D., of Cardiovascular Medicine, P.C., and a member of the Genesis Heart Institute. “Women go to the doctor later than men do. They are the nurturers in the family and don’t pay enough attention to their own health. When they finally come to the Emergency Room, they are in the later stages of heart disease.”

Dr. Padaria is passionate about promoting awareness of women and heart disease.  “Scientific data supports that fewer women with heart disease receive angioplasties and bypasses than men. The medical community is working to correct this, but it’s up to the female patients themselves to come in for screenings and stress tests. Women must take control of their heart health.”

Several factors may explain the apparent disparity in treatment of men and women with heart disease, she says.

  • Atypical symptoms -- Women often don’t have the “classic” chest pain that grips the chest and spreads to the shoulders, neck or arms. Instead, they may have atypical chest pain or complain of abdominal pain, difficulty breathing, indigestion, nausea and unexplained fatigue. "A common misdiagnosis in women is that they're having a panic attack," Dr. Padaria says. 
  • Later diagnosis -- Since women tend to have heart attacks later in life than men do, they often have other diseases like arthritis or osteoporosis that can mask heart attack symptoms, Dr. Padaria says. They often are diagnosed at a later age, which explains women's greater mortality after heart attacks.
  • Diagnostic accuracy -- Some diagnostic tests may not be as accurate in women, so the disease process leading to heart attack or stroke isn’t detected until later, Dr. Padaria says.
    For example, the routine exercise stress test can be less accurate in women. Estrogen, depending on the phase of the ovulatory cycle, affects EKG changes, accounting for some of the false-positives in young women. Nuclear stress testing and stress echocardiography are more accurate tests for women.

Stoltz has this bit of advice for women: Don't do what she did and ignore the symptoms.

"Well when I finally went to the Emergency Room with my symptoms, the female doctor said I'd had a heart attack the day before and scolded me for not coming in sooner. She said, 'If you had come to the hospital right away, you would have suffered less heart damage.'"

After open-heart surgery, Stoltz now takes heart disease seriously. She participated in Genesis’ Cardiac Rehabilitation and encourages her own four grown children to pay attention to heart disease. Even though her own mother had a heart attack at age 67, Stolz always assumed she was immune because she led a healthier lifestyle.

"Listen to your body," she says. "I think women have a higher tolerance for pain, and that's really a problem when it comes to seeing a doctor."

Gender differences

Dr. Padaria points to other gender differences between men and women:

  • Women have smaller heart arteries, and their hearts are thicker when they present with heart disease. That can lead to higher complication rates. Women die earlier than men after heart attack.
  • Females with diabetes are at much higher risk for heart disease than their male counterparts. Dr. Padaria says, “There’s a 3-to-7-fold risk of heart disease in women with diabetes compared to a 2-to-3-fold risk for heart disease in men with diabetes.”
  • Research shows that low levels of “good cholesterol” or HDL appear to be a stronger risk factor for women than men. Losing extra weight, quitting smoking and regular physical activity may help boost HDL cholesterol levels.
  • Women who smoke are 2-6 times more likely to suffer a heart attack. Use of birth control pills and smoking compounds the risk.

Dr. Padaria tells women: “Educate yourselves. Learn the signs of a heart attack. Change the risk factors that you can. Stop smoking, lose extra weight, become active, manage diabetes and control your cholesterol and high blood pressure. Make yourself a priority, and make yourself aware. That’s what will save your life.”

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