Women: Take Heart

Heart disease is your No. 1 enemy

DAVENPORT, Iowa --   Maggie Van Fossen of Davenport would grab the pink bottle of Pepto Bismol whenever the uncomfortable ache came to her chest. She thought the problem was indigestion.

She found out differently Feb. 25, 2007 when the pressure in her chest increased. Instead of experiencing acid reflux, she was having a heart attack.

She had climbed the 14 steps to her office at home. Brushing off the nagging feeling in her chest, she turned on the computer; discovered she finally had Internet service again; and, ran down the stairs to tell her husband the good news.

“By the time I hit the bottom of the stairs, the pressure had increased in my chest,” she says. “I said to my husband, ‘Guess what? We have Internet service again, and I think I might be having a heart attack.’”

On her way to the hospital, she experienced tingling down both arms and felt like an elephant was sitting on her chest. She was rushed to the Cardiac Catheterization Lab at Genesis Medical Center, Davenport, where an artery that was 99 percent blocked was cleared and then propped open with two stents.

Unlike many women across America, Donna O’Neill of Moline figured that heart disease would catch up to her.

After all, her mother died at age 56 of a massive heart attack. Heart disease killed her brother at age 54. She herself had developed diabetes in her 30s, a strong risk factor for heart disease.

But it was her brother’s death in 1988 that prompted her to begin routine stress tests, which led to an angiogram years later and a diagnosis of heart disease. By the time she reached her late 50s, she had undergone balloon angioplasty and received three stents at Genesis Medical Center, Davenport.

“Because of my family history, I thought ‘This is the beginning.’ I never had any pain in my chest, just maybe some fatigue,” she says.

Since then, she has had angioplasty five times to open clogged arteries. She has outlived her mother and brother and credits being alive today at age 70 to exercise and her participation in the Genesis, Illini Campus and PULSE cardiac rehabilitation programs.

Even so, heart disease has affected her eyesight. She also has peripheral artery disease. “Because of my healthy lifestyle, I’ve lasted 15 years longer than my brother and mother who died in their mid-50s,” O’Neill says.

Wear Red Day for Women

Today, in celebration of the American Heart Association’s National Wear Red Day for women, Van Fossen and O’Neill want to remind women that heart disease is not just a man’s problem. It’s the No. 1 killer of women. One in 2.5 women will die of heart disease or stroke, compared with one in 30 from breast cancer.

“Women have different symptoms than men,” says female cardiologist Rafat Padaria, M.D., of Cardiovascular Medicine, P.C., and a Genesis Heart Institute member. “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 often 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,” she says. “The medical community is working to correct this, but it’s up to female patients to come in for screenings and stress tests and take control of their heart health.”

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

• 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 have a greater tendency to have atypical chest pain or to complain of abdominal pain, difficulty breathing,  indigestion, nausea and unexplained fatigue. “A common misdiagnosis in women is that they’re having a panic attack,” she 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, she says. They often are diagnosed at a later age, which explains women’s greater mortality after heart attacks.
• Diagnostic test 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, with more serious consequences, 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. In contrast, single-vessel heart disease, which is more common in women than in men, may not be picked up on a routine exercise stress test. Nuclear stress testing and stress echocardiography are more accurate tests for women.

Several months before her heart attack, Van Fossen had gone to the Emergency Room, worried about the on-and-off again ache in her chest. After an EKG and blood work, she was told she wasn’t having a heart attack; the problem was likely acid reflux.

“I had the family history,” explains Van Fossen, 62. “My mother had a stroke and recovered. She later died of a massive heart attack while she was fighting lung cancer. Nevertheless, I had let myself become overweight and I wasn’t exercising.”

A year after her heart attack, she is active in Phase IV Genesis Cardiac Rehabilitation at the Bettendorf Family YMCA; has lost more than 30 pounds; and, is faithful about eating right and accomplishing 6-7 hours of exercise each week.

“It’s a blessing in disguise, because it helped me turn my lifestyle around,” Van Fossen says. “On the night of my heart attack, my cardiologist talked to me about the importance of diet and exercise. I remember saying, ‘You’ll never have to tell me that again.’ “

Gender differences

Dr. Padaria points to other 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.

Low levels of “good cholesterol” or HDL appear to be a stronger risk factor for women than men. Lose extra weight, quit smoking and get regular physical activity to help boost HDL cholesterol levels, she says.

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, Van Fossen and O’Neill also recommend participating in cardiac rehabilitation and having the reassurance of medically supervised exercise.

O’Neill and her husband, who has had a heart attack, exercise at the Genesis PULSE Program at the Two Rivers YMCA in Moline. The couple exercises three times a week with others who are at risk or who have heart disease.

“It’s comforting to know that the program is medically supervised and that staff is monitoring your pulse and blood pressure,” she says. “They caught my high blood pressure, so now I’m on medication. It’s a great place to receive motivation and support from people who are going through what you are.”

Van Fossen adds, “After my heart attack, I went into a stage of sadness that I hadn’t taken better care of myself. I worried that every pain I felt was another heart attack. Cardiac Rehab was absolutely the best therapy I could have had. It was a wonderful support group. The nurses and exercise therapists would push me to try to reach the next level, but I always felt safe.”

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