“I had a tightness in my chest and I was short of breath,” Jenkins recalls. “Breathing treatments with the nebulizer would give me some relief.”
Jenkins’ heart condition was not confirmed until 2001 when emergency personnel took her to Sinai Hospital because she was suffering a heart attack. Heart disease is the number one cause of death among women in the United States, killing more than 500,000 women every year. It affects one in nine women over the age of 45, and one in three postmenopausal women.
In the weeks just before Jenkins’ visit to Sinai ER-7, she recalls extreme fatigue and a sudden weight gain. On the day of the heart attack, she remembers feeling nauseated with a pain in her stomach that felt like indigestion.
“The pain moved from my stomach up to my chest,” she adds. “It was like no other pain I’ve ever had—it took my breath away.”
These symptoms are not ones we commonly associate with heart trouble, says Jenkins’ cardiologist, Ramona Gelzer Bell, M.D., of Northwest Hospital Center.
“Women may have symptoms that are different than men,” Gelzer Bell says. “ Shortness of breath, nausea, fatigue, sweating, light-headedness, and palpitations—the heart seems to be racing—are other symptoms.” They may also experience back pain, jaw pain or excessive burping.
These subtle signs are often overlooked or attributed to other causes. “Sometimes heart disease is misdiagnosed as anxiety or indigestion,” says Barbara Kircher, M.D., of Northwest Hospital, who co-directs LifeBridge Health’s Women’s Heart Program with Sinai cardiologist Stacy Fisher, M.D.
Many women perceive heart disease as a man’s disease or as a disease of older women. For these and many other reasons, Fisher adds, “women present with heart disease nine years later than men, on average.” And when she does present to the doctor, a woman’s heart condition can be much more diffuse than that of a man. This is because a woman’s vessels, in general, are smaller, and multiple risk markers such as smoking and diabetes often play a role, Fisher explains.
Smaller vessels, in turn, make interventional treatments such as angioplasty more complex in women, an d the death rate for women after their first heart attack about twice what it is for men.
“Physicians now recognize heart disease is not just a man’s disease,” Kircher adds.
Just as the symptoms are different, accurate diagnosis of heart disease in women may also be more challenging, says Gelzer Bell. Diagnosis may include any or all of the following assessments: fasting lipid profile, electrocardiogram, stress test, chest X-ray, echocardiogram, nuclear imaging and cardiac catheterization. In addition, says Fisher, physicians may conduct a highly sensitive C-reactive protein test of the blood to detect inflammation, an indicator of coronary artery disease, and a coronary calcium score to determine the presence of arterial plaque.
Though women may exhibit different symptoms and are sometimes more challenging to diagnose, the risk factors for heart disease for both men and women are the same, doctors say. People who have hypertension, who have high “bad” cholesterol or low “good” cholesterol, who smoke or drink alcohol in excess, who are obese or sedentary, or who have diabetes, all run a greater risk of developing heart trouble. Family history is also important, though generally only if a parent or sibling suffered a heart attack before the age of 55.
Hormones also play a role, says Gelzer Bell. Women who have been using hormone therapy because they thought it would protect them against heart disease should talk with their doctors about discontinuing the therapy. A recent clinical trial* in post-menopausal women indicates that hormone therapy, particularly estrogen in combination with progestin, in postmenopausal women may increase risk for heart attack and stroke and is not protective.
Treatment for women’s heart disease is as aggressive as it is for men, says Kircher. Medication, diet and lifestyle changes coupled with an exercise program, like the cardiac rehabilitation program offered at LifeBridge Health & Fitness, have all played a role in helping heart patients like Rosetta Jenkins see that there is life after a heart attack.
“Women have so much on their plates,” Jenkins says, “that we may have trivialized our pain in the past.” Women have to be their own biggest advocates in order to get a proper diagnosis and proper treatment for heart disease.
*The Women’s Health Initiative, a multiyear, federally funded study, reports that combination (estrogen plus progestin) hormone replacement therapy may increase the risk for heart disease. For more information go to http://www.whi.org/findings/summary_chd.php.
Heart Screenings:
The key to her heart
LifeBridge Health’s Women’s Heart Program screenings are designed for women 40 years old or older, or for any woman with a family history of heart disease. Screenings identify cardiovascular risk factors, and potential health issues that could affect overall heart health. A heart risk assessment, cholesterol testing, blood pressure readings, and height/weight, and body fat analysis are also conducted. LifeBridge Health cardiologists Stacy Fisher and Barbara Kircher are available to review screenings, answer questions or offer recommendations for follow-up tests.
“Everyone should discuss their cardiac risk with their doctor,” Fisher says.
Heart screenings for women are just one of the many health tests available for free or low cost through LifeBridge Health. Some of these programs include screenings for diabetes, osteoporosis, high blood pressure, vision problems and much more. For more information on upcoming screenings in your area, call 410-601-WELL (9355) or go to www.lifebridgehealth.org/calendar
For information about LifeBridge Health & Fitness’ cardiac rehabilitation program, call 410-484-6800.
Related Links:
Sinai Hospital
Sinai ER-7
Northwest Hospital
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