Women & Heart Disease

Women at risk of ‘silent heart attack’


Special to The Miami Herald

Lois Randall was 50 when she started getting strange pains shooting into her jaw and neck. Although she was a nurse, the Miami resident refused to see a doctor and instead popped aspirin.

She eventually did see a cardiologist, who informed her she had suffered a “silent heart attack.”

Randall, who had just lost her father during a triple bypass operation, left the cardiologist’s office and promptly stuck her head in the sand, where it remained for 12 years — until she suffered a mini-stroke at work one day. At that point, Randall finally got a stress test, which she flunked, and a catheterization.

Doctors at Baptist Hospital refused to let her leave the hospital and she spent the next 14 days there undergoing triple bypass surgery and having holes poked in her heart to stimulate growth. It took three years for Randall to fully recover.

Now 67 and a law firm secretarial and training coordinator, Randall tells female friends not to ignore what could be a heart attack coming in the form of dizziness, jaw pain or even back pain.

“I say, ‘Don’t trivialize anything that doesn’t feel normal for you,’ ” she said. “See a doctor as soon as you can.”

Randall’s story is not unusual. The American Heart Association, doctors and women’s health advocates have been trying to get out the message that heart disease is now the No. 1 killer of women, killing more women than all types of cancer combined.

They are also trying to educate the public — and physicians — that heart attack symptoms can be different for women. While men usually experience the “elephant sitting on your chest” syndrome, women can experience a variety of other symptoms, such as dizziness, nausea, neck and jaw pain, shortness of breath and extreme fatigue.

“Twenty years ago, people didn’t recognize that while there are differences between men and women’s physiology, there are differences with their hearts as well,” said Dr. Jonathan Roberts of Baptist Hospital. “We are trying to raise awareness in the community and with physicians that heart disease in women can be different than heart disease in men.”

For this reason, Baptist Hospital, like many other hospitals, now does a special blood test that detects heart disease as well as an electrocardiogram (EKG) on most women who come to the emergency room with non-specific symptoms, Roberts said.

“It’s become standard,” he said. “Twenty years ago, more women than men were sent home with these non-specific symptoms. Now, we look further.”

The American Heart Assocation has been trying to raise awareness of heart disease and women for a decade, starting its Go Red For Women campaign in 2003. The campaign asks women around the country to wear red every Feb. 1 to draw attention to the issue. According to the association, 627,000 lives have been saved as a result of the campaign and 330 fewer women are dying per day.

In addition to educating women on how to recognize heart attack symptoms, the medical community is also trying to teach women how to prevent heart disease in the first place, by avoiding smoking, a sedentary lifestyle, obesity, an unhealthy diet and excessive stress. The growing obesity crisis in the United States is fueling a rise in diabetes, high cholesterol and heart disease, all of which are starting at alarmingly early ages.

“Before, women would get heart disease or strokes when they were elderly,” said Dr. Claudia Martinez, an assistant professor of medicine at the University of Miami Miller School of Medicine. “Nowadays, women tend to manifest younger, even before menopause.”

Martinez’s youngest female heart attack patient to date: 26.

At Baptist, women under 30 are coming to the emergency room with heart attacks once or twice a month, Roberts said. Additionally, a recent study showed that pregnant women diagnosed with high blood pressure or diabetes are predisposed to heart disease later in life, he said

Research over the last four to five years has shown that some women could benefit from a stress cardiac MRI, yet another test for heart attacks. According to Baptist’s Dr. Stratego Castanes, this test picks up a form of heart disease suffered more commonly by women called microvascular ischemia, which is not typically revealed by stress tests or cardiac catheterization.

“For women, sometimes the first signs of heart disease are in the small vessels that supply the blood to the heart, causing very patchy distribution,” Castanes said. “When you find that, women need to be treated aggressively. But without this test, sometimes women are told they are anxious or crazy and sent home.”

Despite the campaigns, not everyone is paying attention. Like Randall, Lourdes Brezo, a 53-year-old marketing manager, thinks she also had a silent heart attack. Brezo, a lifelong Miamian who recently moved to New York City, had been told to take high blood pressure medicine many years ago but ignored the doctor’s advice. Fast forward to March last year, when Brezo was walking home from church one Sunday and felt her heart racing.

“I had a little pressure on my chest but it wasn’t excruciating or anything,” she said. “It’s like when you go the hair salon and they put the gown on too tight on your neck and you feel like you are choking.”

Brezo ignored the symptoms, put an aspirin under her tongue and went to sleep.

A week later, she started shaking and shivering with cold at work. Brezo popped another aspirin, but her co-workers called paramedics. They took an EKG and determined she had recently suffered a heart attack. Brezo is now under the care of a cardiologist and taking proper medication.

Her advice for women: “Don’t ignore the doctor and don’t ignore your symptoms.”

“I live alone and I could have died in my sleep that night,” she said. “It was the dumbest thing I’ve ever done in my life.”

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