Women: Take it to Heart

"Go Red" and get serious about the No. 1 killer

DAVENPORT, Iowa - It was Saturday morning, and Jill Guenther woke up feeling energetic and refreshed. The feeling wouldn’t last.

"I took a shower and started having this terrible, intermittent shooting pain across the left side of my chest," Guenther, 60, of Davenport says.

Heart attack crossed her mind, but she tried to talk herself out of it. She took some antacids and waited. The pain continued, and feelings of panic set in. To avoid the "commotion" of an ambulance, she called her husband at work and said, ‘I’m having sharp chest pains.’ "

In hindsight, she knows she should have called 911. Instead, her husband rushed home and drove her to Genesis Medical Center’s East Rusholme Street campus. "At least we had the sense to call ahead," she says. "When I got there, it was like a whirlwind. The response time at Genesis was tremendous."

An EKG found a blockage in her heart’s left ventricle. She was rushed to the Genesis Cardiac Catheterization Lab, where blood flow was restored to her heart.

A nagging sensation in her jaw...

That was the lone symptom that led Sally Oosterhuis to discover she needed heart bypass surgery. If she hadn’t read an article in her physician’s office that linked jaw pain to heart disease, she never would have mentioned it during her routine exam.

"I didn’t have jaw pain, but I did have a sensation in my jaw when I was on the treadmill," says Oosterhuis, 66, of Bettendorf. "I’d get to a certain point and notice this little tingle. Or when I took a walk, I’d notice a strange feeling in my jaw. Then it would go away."

Her physician recommended a baseline nuclear stress test, which yielded "extremely abnormal results," she says. Next came the angiogram that gave a grim picture of her heart -- five severely blocked arteries. "I had open-heart surgery the following week," she says. "Fortunately, my blockages were discovered before I had a heart attack and damage to my heart."

Go Red Day

Today, in celebration of the American Heart Association’s "National Wear Red Day," Guenther and Oosterhuis want all women to realize that heart disease is not just for men. It’s the No. 1 killer of women. Despite that, only 13 percent of women view heart diease as a health threat, says the American Heart Association.

"Never say never," says Guenther, who has six stents in her heart and participates in Genesis’ Phase 3 Cardiac Rehabilitation at the Bettendorf YMCA. "I had traditional symptoms, unlike a lot of women, but I never thought I’d have a heart attack. I’ve never been overweight. I didn’t eat a lot of deep-fried foods."

Oosterhuis completed Phase II Cardiac Rehab at the Genesis Heart Institute last September and continues to exercise diligently with her husband six days a week. She has this advice for women: "If you have a sensation or symptom that’s not normal, typical or explainable, pursue it. Mention it. Don’t just ignore it and think, ‘I don’t have time to have a problem.’ Listen to your body and your common sense.

She adds, "For me, the surprise wasn’t that I had heart disease as a woman. The surprise was that I had heart disease despite the fact that I had been exercising and eating properly."

More subtle symptoms

Cardiovascular disease kills more than 480,000 women a year, about one per minute. 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 upon the female patients themselves to come in for screenings and stress tests. It is important for women to take control of their heart health."

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

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.

"One woman just had a pain in her palm," Dr. Padaria says. "She had gone to the Emergency Room multiple times and was told she was having a panic attack. That’s a common misdiagnosis in women."

Brenda Flack, RN, a charge nurse for Genesis’ Phase II Cardiac Rehabilitation, says many female heart patients miss their very vague symptoms. "Sometimes, their only symptom is extreme fatigue or some shortness of breath," Flack says. "Nothing against men, but women are going in all directions and supposed to be able to do it all. They think fatigue is just a normal part of living.

"We encourage people to consider that any pain above the belly button might be heart-related -- until it’s ruled out.’ "

Listen to your heart

Before she retired as a schoolteacher, Jill Guenther remembers how going up and down three flights of steps from her classroom to the cafeteria would leave her a little out of breath. "I was a little winded but I thought, ‘Maybe that’s just old age.’ "

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.

Oosterhuis had a bad back for years. Since her heart surgery, the aches and pains have somewhat subsided, leading her to wonder if some of her back complaints could had been caused by heart disease.

Another problem: 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.

"My mother has heart disease. Her stress test was completely normal, but an angiogram showed she had a 90 percent blockage in the LAD artery," Dr. Padaria says. "She could have had a massive heart attack if it had not been treated promptly with a stent."

Gender differences

Dr. Padaria points to other gender differences:

• 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."

For women with heart disease, Oosterhuis and Guenther also recommend participating in cardiac rehabilitation and having the reassurance of medically supervised exercise.

"Being in a class with other heart patients can be a real motivator," Guenther says.

"When something happens to your heart, it definitely makes you feel like you’re not in control," Oosterhuis says. "The Genesis Cardiac Rehab staff is very professional, competent and comforting. You need to appreciate the education process that they’re giving you; take your heart disease seriously; and learn from other heart patients."

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