Source: Best Health magazine, January/February 2015
When I was 39, I found out I had a problem with my heart. I remember having a tight, heavy feeling across my chest on Christmas morning. It was so foreign to me, but I just shrugged it off as normal holiday stress.
A few weeks later, after a whirlwind trip to Florida with my family, I started experiencing severe heart-racing episodes three to four times a week. They would knock me off my feet. At the same time, I was getting a lot of headaches and having difficulty walking up and down the stairs. And one morning at work, I had a panic attack standing in line at the cafeteria.
One evening I had the most horrific feeling as I was putting the kids to bed ‘ a sudden, sharp pain in my right shoulder shot all the way down my arm. It felt as though someone had hit me really hard with a baseball bat. An excruciating pain trickled around to my back, and an overwhelming feeling of exhaustion hit me like a Mack truck. But I didn’t call an ambulance.
I told my husband that the pain ‘would go away’ and I’d feel better in the morning. ‘I just need to get some rest,’ I insisted with tears in my eyes. After all, it had been an extremely demanding time at work and I was dealing with a crazy four-hour daily commute. How could it not be stress? Plus, I wasn’t a smoker and I was too young and too healthy to worry about my heart.
Looking back, I should have gone to the hospital right away, but I was in denial. Since the incident I’ve come to realize that everyone is at risk of heart disease or stroke. I was lucky. If it weren’t for my hefty wake-up call, I may not have gone for the necessary tests, which eventually led me to have heart surgery last March.
Why are women in denial about heart disease?
In 2011, more than 33,000 Canadian women died as a result of heart disease and stroke. Compare that to breast cancer, which killed 11,000 Canadian women.
It’s hard to imagine that more women die from strokes than men because women don’t get to the hospital on time. Why is that? Well, for starters, we live in a go-go-go society and women try to do it all at home, work and in their social circles. And, since the typical symptoms can be similar to regular ‘everyday’ female aches and pains, we often dismiss them as normal.
Plus, most people equate heart problems with being a smoker, obesity, high amounts of caffeine and poor eating habits ‘ not healthy females.
‘Historically, heart disease has been believed to be an ‘old gentleman’s disease,” says Matthew Mayer, a senior research specialist at the Heart and Stroke Foundation of Canada. ‘As a result, most of the research from years ago was focused on men and their conditions, so for a lot of people, the idea of heart disease being a ‘man’s disease’ has stuck.’
Slowly, that perception and reality are changing ‘ and that’s key, given the fact that heart disease and stroke is the second leading cause of death in Canadian women today, resulting in 140,000 hospitalizations each year.
What we know about heart disease
Over the past 20 to 30 years, we’ve seen more and more women in the workforce in addition to taking care of the home, which can lead to a high level of physical, mental and emotional stress.
‘Heart disease and stroke build up over time, but sometimes the cues aren’t apparent until something major happens or we are living with it and don’t even know it because we don’t have a simple screening process,’ says Mayer. ‘You can feel healthy one day and be diagnosed with a heart rhythm disorder the next.’
He adds: ‘With the changing family dynamic, women are the gatekeepers of the house and in the workforce, so they’re working two full-time jobs. This leads to less time for personal care. Women really need to stop and ask, ‘Am I treating myself right?”
Part of the problem is that we are a generation that feels invincible or indestructible. We try to do it all and don’t think about the repercussions of our actions. If we feel something unusual in our bodies, we ignore the signs because we don’t have time to wait hours in an emergency room. Instead, we’re thinking about (in no particular order) shopping for groceries, climbing the corporate ladder, picking up the kids from school and carpooling them to their activities and, if there’s time, booking a hair appointment, being a wife and so on.
But this modern-day attitude needs to change. We have learned from research that stroke rates are increasing in young women and smoking rates among women and young professionals remain high. Stress is not going away anytime soon.
What’s being done
Experts are working on new treatments and prevention strategies that are being implemented and put into practice. Research has also become a huge priority, with a lot more female-focused research being conducted. In fact, researchers have found that certain types of stroke are more prevalent in women than men, and unique issues specific to female bodies are being addressed.
Women’s bodies are different, and the research should reflect this. The Heart and Stroke Foundation is helping to recognize these pertinent issues and translating their findings into the programs on the frontlines.
The good news is that healthcare workers and physicians are more aware of the problem today, but doctors can’t be mind readers. We have to be honest with our doctors and forthcoming with information.
‘As patients, we need to stay informed and take responsibility for our own health. If you don’t tell them you smoke or that you’re not exercising enough, they can’t help you or send you for the necessary tests,’ adds Mayer.
Why we ignore the warning signs
Women often disregard the warning signs of heart disease or stroke because they don’t believe there could be anything wrong. We shrug off the symptoms too easily. We also can’t physically see our heart and therefore don’t think about its inner workings until there’s a problem.
We tend to think that strange feelings in our chest, stomach or lower back are either indigestion or heartburn ‘ something we can deal with on our own. But this is how heart problems are often misdiagnosed, because women downplay what is happening.
Tanya Lee, a naturopathic doctor from the Health Centre of Milton in Milton, Ont., says one reason heart disease isn’t on women’s radar is because of the lack of knowledge behind its contributing factors. Lee says women, particularly young women, are not often concerned with their cardiovascular risk because they don’t have high cholesterol.
‘It has been well accepted that cholesterol is the major contributor to heart disease over the past few decades, and this seems to be what the public views as a way to monitor risk, but this is no longer the only known contributing factor,’ says Lee. ‘It’s becoming more and more apparent that inflammation is a major player in the development of heart disease; if your cholesterol levels are fine, you can still be at high risk of developing heart disease if you have a highly inflamed body environment. What contributes to this inflammation? Poor diet, lack of exercise, stress and vitamin deficiencies.’
An example of these possible contributors is low vitamin D, as recent research shows that low levels of vitamin D have been consistently found in those with cardiovascular disease.
Symptoms of a heart attack
Dr. Melissa Hershberg, founder of the U Health Clinic in Toronto, says it’s no surprise men and women view this issue differently. ‘Men tend to experience the classic symptoms we associate with heart attacks: crushing chest pain, often described as an elephant sitting on the chest, that often radiates down the left arm, whereas women tend to present with less intense symptoms, so they go unreported.’
Women can experience an overwhelming fatigue, nausea, shortness of breath, dizziness or chest pain that can be anywhere from left-sided and right-sided to central and abdominal. Sometimes no chest pain is present at all.
Why the difference? ‘Studies confirm that heart disease in women can differ from men because it doesn’t often involve an obvious blockage in one of the big arteries. Instead, plaque develops throughout the smaller arteries to the heart, cutting off blood flow more slowly and resulting in more subtle symptoms,’ explains Dr. Hershberg.
Most experts believe that women need to take responsibility for their own health. Women need to stay on top of modifiable risk factors like blood pressure, cholesterol, blood sugar levels and obesity (especially around the midsection) and stop smoking.
In particular, Dr. Hershberg warns that if you’re having symptoms like shortness of breath, dizziness and fatigue (even if it’s without chest pain), you should speak to your doctor right away. ‘These signs could be presenting symptoms of heart disease without you realizing it. Also, if anyone in your family had a heart attack or stroke before the age of 65, you should definitely mention this to your doctor as this could signal an increased genetic risk.’
However, experts agree, it would be wrong to put the responsibility squarely on the shoulders of women. While healthcare professionals have come a long way from where they were, says Mayer, there is more work to be done across the entire system. ‘We need better tools and therapies to help practitioners diagnose and treat women who are living with heart disease because we have learned that women are different from men when it comes to vascular health.’
‘Research is helping to make these changes, but it takes time and money ‘ something we lack these days. Furthermore, it takes a long time to take something from bench to bedside ‘ research to practice ‘ and that is something that needs to be improved but in a safe and effective way.’
Adds Lee: ‘I don’t think it’s fair for women to take most of the blame for this. The knowledge of health and wellness should come from professionals, and doctors are responsible for keeping up and relaying up-to-date information to their patients.’
Reduce your risk of heart disease and stroke
That said, the best thing a woman can do is learn the warning signs for heart attack and stroke. Feeling under the weather can be a vital indicator. If you think something is wrong, take a moment to stop and listen to your body. Get to a doctor right away and take the necessary tests.
Dr. Hershberg tells her patients that the top five things they can do to reduce their chances of heart disease are to quit smoking, lower your cholesterol, adopt a heart-healthy diet, lower their blood pressure and go for preventive testing if they have risk factors or a family history of heart attack and stroke.
You can also do a free online assessment at heartandstroke.com. It takes about 10 minutes and you’ll learn whether you’re at risk. Tell a friend to do the same. We need to be as aware of heart disease as every other serious disease or issue.