Nurse Sharon Hipkins of Laurel, Md. suffered a heart attack on February 3, 1997. She still remembers the events vividly. At age 47 with no history of heart problems, Hipkins had a tight chest with pain radiating out to her elbows and jaw.
Thinking it was a bad asthma attack, Hipkins used her Proventil. She'd been short of breath that fall, and had called her local internist. He thought the symptoms indicated asthma, too. Her doctor cautioned her to visit a hospital, though, to be safe. Alone in her house that night, Hipkins drove to Laurel Regional Hospital and called a friend by cell phone as she drove, for precaution. "You can ask 911 to pick me up from the road if I pass out," she told her friend.
At the hospital, an electrocardiogram (EKG), which measures the heart's electricity output) identified Hipkins' heart attack in time for TPA (an anti-clotting agent used for heart attacks and strokes) to work. The doctors gave it to her immediately.
In the hospital, doctors also noticed Hipkins' cholesterol levels. Her unusually low HDL level, the doctors told her, is a risk factor for heart attacks in women all by itself. It was an education for Hipkins, who is a medical professional. "I was overwhelmed," she says. "I just needed to be a patient, not a nurse who understood medicine. I needed help and information like anybody in this situation would."
Hipkins was lucky. Many women with the same symptoms would have been sent home with a prescription for tranquilizers.
The Facts on Women and Heart Disease
Heart disease is the number one killer of women. In fact, some 250,000 women die each year of heart disease. And black women are 69 percent more likely than white women to suffer heart disease and heart attacks, as well as more likely to die of a heart attack before menopause. All women are more likely to die from their first full-blown heart attack than are men.
So why do we think of heart disease as a man's problem? Maybe that's because until a few years ago, doctors didn't realize that women were suffering a heart attack when they came to hospital emergency rooms complaining of nausea, dizziness, fatigue, and general disorientation.
Men vs. Women
The Differences between Men and Women
Dr. Elizabeth Ross, of the Washington Hospital Center in DC, in her 1999 book "Healing the Female Heart" explained the gender differences in the causes and symptoms of heart attacks.
First, Ross explains, the female hormone estrogen significantly affects the female heart, protecting the entire female cardiovascular system from the kind of wear that men experience by the time they are 40, and in some cases even younger.
Your natural estrogen maintains a proper ratio between the "good" HDL (high-density lipoproteins) cholesterol and the "bad" LDL (low-density lipoproteins) cholesterol, and decreases fibrinogen (a protein involved in the blood's clotting system, which influences how viscous, or sticky, your blood is), among other heart-healthy jobs. That's the good news.
But that benefit stops after menopause, and a woman's lifetime risk of developing cardiovascular disease is two out of three. The risk increases if you are 20 percent or more overweight and carry that weight in your mid-section. More women die each year from heart disease than all cancers put together.
When we talk about heart disease or cardiovascular disease, we're usually talking about coronary artery disease, or atherosclerosis, where there is a narrowing of one or more of the arteries that supply blood to the heart. That narrowing is caused by the formation of plaque, which is a thick, waxy substance made up of cholesterol, smooth muscle cells, and platelets, and inflammation.
Coronary artery disease in women is generally associated with elevated serum cholesterol levels, elevated LDL levels, low HDL levels, high triglyceride levels, and hypertension (high blood pressure). Impaired tolerance to glucose, or insulin resistance, also increases a woman's risk of coronary disease. Risk factors for heart disease unique to women include, pregnancy, having had both ovaries removed, and premature menopause.
In addition, the parts of a woman's heart are generally smaller and more fragile than analogous parts in men's hearts (by about 50 to 100 grams), and women experience different symptoms during a heart attack.
Heart Attack Symptoms
Common Symptoms of Heart Attack in Women
The symptoms of heart attack in women are significantly different from those in men. These are the most common:
- Anxiety, an unexplained sense that "something is wrong"
- Confusion, reduced levels of alertness
- Fatigue that makes no sense
- Gripping sensation in the chest
- Jaw pain that can extend to the throat
- Lightheadedness, nausea or profuse sweating
- Pain in the upper abdomen or back
- Pressure in the chest
- Shortness of Breath
- Spreading pain
- Throat pain (twinge, ache, soreness)
- Weak pulse
"Emergency rooms too often discharge women experiencing throat and or jaw pain, reduced levels of alertness, and thready (weak) pulses," Dr. Ross writes. "These are symptoms of heart diseases and in some cases, heart attacks. Women are too often told that their problems are stress-related, heat-related, or a ploy for attention. Correlating symptoms in men, such as chest pain that radiates to the left arm or shortness of breath, would be immediately recognized as indicators of medical problems. Women in cardiac distress are given tranquilizers, and men are admitted to the cardiology units of their nearest hospital."
Dr. Christine Legato of Columbia University Hospital in New York City agrees. "One of five women does not experience the characteristic symptom of a heart attack typical for men: crushing chest pain. Women experience pain in their upper abdomen or back, nausea and profuse sweating, and shortness of breath. They are often sent from emergency rooms with Valium for anxiety and Mylanta for indigestion, their heart problems being overlooked by an unsuspecting and uninformed medical staff.
"Since Richard Steingart wrote his 1988 paper (in the "Annals of Internal Medicine") about how some cardiologists are more likely to dismiss cardiac symptoms more frequently in women than in men, the cardiovascular community has responded positively to the information about women and their experience with heart disease. The paper stimulated a period of intensive research into how women experience coronary artery disease. It has been a slow but rewarding process to educate primary care physicians about the new information."
Preventing and Treating Heart Problems
Does the New Information Work in Practice?
Hipkins was properly given cardiac catheterization, a test to find out how well her blood vessels work and then was sent home from the hospital despite continued chest pain. Although she was taking her newly prescribed Nitrostat, Hipkins still suffered pains in her arm and chest and could not walk more than a block.
She went for a second opinion. That doctor evaluated her symptoms and accused Hipkins of having problems "in her head." But what Hipkins was experiencing was angina, a serious medical condition that causes significant pain.
Angina pectoris is caused by an insufficient supply of oxygen to the heart muscle, usually after exercise or stress. Angina usually precedes a heart attack and is almost always due to atherosclerosis. But there is another kind of angina, called Prinzmetal's variant angina, which is not related to plaque build-up on the coronary arteries. Instead, it is caused by a spasm of a coronary artery and may occur at rest, or at odd times during the day or night, and is more common in women under age 50.
Angina can be detected with an angiogram, an exercise stress test, or an echocardiogram (a non-invasive, ultrasound exam that measures the size and function of the heart). Angina may be treated with drugs, an angioplasty (a surgical procedure where a very small balloon is inserted into a blocked artery to increase its diameter), or artery bypass surgery.
Hipkins had now been in cardiac rehabilitation for eight weeks, was missing work, and in desperation, visited Dr. Elizabeth Ross at Washington Hospital Center in DC. It was two years before Dr. Ross would publish her book about women and heart attacks.
Hipkins recalls that Ross said to her, "We don't understand all the dynamics of heart attacks and angina in women at this time."
In tears, Hipkins returned to her own doctor. She had no job, no sex life, and chest pain when she drove her car. Her doctor experimented with medication in the hope that he would find the right combination to restore her quality of life.
On her own, Hipkins tried acupuncture, and found she could then take long walks. She discontinued her medications after a year out of concern for eventual liver damage, but continues her acupuncture treatments, and is now an acupuncture practitioner.