Health & Fitness

Heartburn may not be your problem. It could be a heart attack, especially for women

Cristina Totorica-Gil exercises at Tropical Park in Miami on Saturday, Feb. 16, 2019. Totorica had a heart attack in March 2017 when she was 46 while doing push-ups in her garage. She stopped to catch her breath when she felt chest pains and a numbing in her left arm. She called 911 and was treated at the ER.
Cristina Totorica-Gil exercises at Tropical Park in Miami on Saturday, Feb. 16, 2019. Totorica had a heart attack in March 2017 when she was 46 while doing push-ups in her garage. She stopped to catch her breath when she felt chest pains and a numbing in her left arm. She called 911 and was treated at the ER. adiaz@miamiherald.com

A heart attack caught Elaine Bloom unaware.

Bloom had no chest pain, no numbness, “nothing that would be considered symptoms,‘’ she said. A former Florida state representative turned healthcare executive, Bloom had heartburn. She attributed that to the tamoxifen she was taking following breast cancer surgery.

When told she had a heart attack, Bloom remembered thinking, “I don’t have time for this.”

That tendency to ignore pain can lead to women not getting treated quickly, which can be a fatal decision. According to a report by Harvard Medical School, women tended to wait three times longer than men to seek treatment for a heart attack.

Yet heart attacks have grown increasingly deadly for women as for men. In fact, coronary heart disease is the single biggest killer of men — and women — in the United States. And while surveys show that women worry more about getting breast cancer, heart disease kills six times as many women a year, according to a Harvard Medical School report detailing women’s risk for heart disease.

Women often have different symptoms than men do. The American Heart Association reports women’s chest pains may be less severe or even non-existent. Women’s symptoms can include nausea, heartburn, shortness of breath, sweating, unusual fatigue, light-headedness and discomfort in the neck, jaw, shoulder, upper back or abdomen.

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Technologist Sue Olsen gives Kristin Stanley-Motzner an electrocardiogram at The Total Heart Center at Memorial Regional Hospital. Stanley-Motzner had chest pains shortly after she had delivered her baby son. She was 31 and was diagnosed with postpartum cardiomyopathy, a rare condition that often affects Hispanic and black women. She is Nicaraguan. On Christmas Day 2018, she received a heart transplant at Memorial Hospital. Now, her heart is expected to function fully for the next 15 to 20 years. CHARLES TRAINOR JR ctrainor@miamiherald.com

Kristin Stanley-Motzner thought she was “having a panic attack.”

That, not the chest pains, was why she had her husband drive her to the hospital in Colorado, where they were living at the time.

“I just had a baby,” Motzner recalled. “Once you go through that pain 48 hours earlier, this pain is nothing,” Motzner said of her heart attack. “Even at the hospital, I was still thinking I was just having an anxiety attack.”

Then 31, she was diagnosed with post-partum cardiomyopathy, a disease so rare she was only the second case the hospital had seen.

“It happens more to Hispanics and blacks,” said Motzner, who despite her surname, is “100 percent Nicaraguan.”

She has since moved to Lantana to follow her doctor, who now works for Memorial Healthcare System in Broward County.

Dr. Daniel Benhayon Lanes, Motzner’s doctor and a cardiac-electro physiologist with Memorial, said symptoms typically “start right after giving birth” with the heart weakening dramatically. The condition can occur up to six months post-partum.

While Motzner’s case is rare, cases like Bloom’s aren’t.

Bloom was 79 when she had her heart attack. A woman has her first heart attack, on average, at 72, according to the Harvard report. (For men, it’s 65.)

“I’m a very, very lucky woman,” said Bloom, who as CEO of Miami-based Plaza Health Network, a network of rehab and long-term care centers, bought telemetry equipment for Plaza’s six facilities so nurses could give patients bedside EKGs when they complained of chest pains.

Bloom described the device as a 5- or 6-inch-wide belt with 12 leads built into it that is worn under a woman’s bosom or around a man’s midriff.

The EKG readings are then transmitted to a cardiologist, who can read the results immediately.

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Jose Francisco is given a reading by the heart telemetry machine, Feb. 6, 2019. Elaine Bloom, CEO of Plaza Health Systems, decided to add telemetry machines so that EKGs could be given to patients in bed. The machine wound up detecting Bloom’s heart attack, in real time. CHARLES TRAINOR JR. ctrainor@miamiherald.com

One Friday, a nurse practitioner named Julio asked Bloom how she was. She said since he was wearing the white coat, she mentioned her heartburn.

He suggested she try a different antacid and then call him on Monday.

On Monday afternoon, he called her at her office. When she said she still had heartburn, Julio begged her “to go downstairs and let the nurse do this EKG. “

“While the EKG is in progress, the nurse gets called by the cardiologist at ‘the other end of the cloud’ as well as by Julio, who says, ‘Quick, call 911. She’s in the middle of a heart attack,’” Bloom said.

Bloom was whisked to the ER, where she was treated in the hospital’s heart catheter lab to unclog her blocked artery.

Looking back to that Monday morning, Bloom said she had “sort of low energy, but I’d been working very hard.’’

“That’s one of the main problems,” said Dr. Sandra Chaparro, a cardiologist and heart failure physician with UHealth Miami. “The patient underestimates the symptoms and they don’t get evaluated in time.”

With women, it’s often not the typical chest pain that radiates down the arm. It can be “something like fatigue, weakness, lack of energy,” Chaparro said.

The heart attack sometimes goes undiagnosed and the woman “gets to the hospital way too late,” she added. “It’s a very small window in terms of minutes. If we can open the blood vessel as soon as the patient hits the ER, we can triage,” Chaparro said, getting oxygen and blood flowing back to the heart.

She and others advise patients to always call 911 because an EKG can be administered in the ambulance, and the patient usually will be treated as soon as she arrives at the hospital.

“The treatment can make a big difference,” she said, adding that if not enough oxygen reaches the heart muscle, “the patient will eventually have heart failure and end up with a chronic disease “

One woman who did call in time was Cristina Totorica-Gil, the assistant principal at Miami’s Charles R. Hadley Elementary. She had her first heart attack two years ago when she was 46.

“Honestly, I had had a bad chest pain a week earlier and ignored it. The following Saturday I was in my garage doing push-ups and stopped to catch my breath,” Totorica-Gil recalled.

She was having chest pains and felt a numbing in her left arm.

“I called 911. I kept asking, ‘Am I having a heart attack?’”

She didn’t want to go to the ER but “knowing those are classic symptoms,” she agreed. “I had a blood clot. I called rescue at 10:55. By 12:15 I’m already out of the cath lab at Baptist Hospital.”

“I had very minimal damage, all due to speedy treatment and me making the decision to call 911.

“When I start to stress out, I tell myself it isn’t worth it. I have a 14-year-old son,” she said.

“Stress is bad for the heart,” said Benhayon, the Memorial physician. “In the past, women were somewhat protected” from heart attacks. “As we become equal, the healthcare risks” equalize. Now the [heart attack] rates are similar, not the case 50 years ago.

“Typically men have heart attacks younger. As soon as women reach menopause, their risk becomes almost equal to the one that men have,” Benhayon said.

In the case of the patient who had a heart attack after giving birth, there’s a risk of the heart not recovering fully.

With post-partum cardiomyopathy, “roughly 50 percent [of the hearts] get better, another 25 percent function at half strength and 25 percent will continue to decline,” Benhayon said.

The disease is not due to a clogged artery but inflammation that leads to the heart weakening. Despite multiple interventions, Motzner’s heart kept worsening.

“It got to the point her heart needed a replacement and that’s what she got very successfully in late December,” Benhayon said.

“She will have a great life,” the doctor predicted. “The heart should be functioning for 15 to 20 years. By that time she will be in her 60s. Hopefully by then we may have an Apple-made robotic heart,” Benhayon said.

Last year, when Motzner asked her son what he wanted for Christmas, he replied, “I want my mom to have a heart for Christmas.”

Said Motzner: “I got my wish on Christmas Day. It was definitely a Christmas miracle.”

Heart attack symptoms in women

Uncomfortable pressure, squeezing, fullness or pain in the center of your chest, which lasts more than a few minutes, or goes away and returns.

Pain or discomfort in one or both arms, the back, neck, jaw or stomach.

Shortness of breath with or without chest discomfort.

Breaking out in a cold sweat, nausea or light-headedness.

Women are more likely than men to experience shortness of breath, nausea/vomiting and back or jaw pain.



Source: American Heart Association

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