This article was published in the Summer 2014 print issue of Carilion Clinic Living.
Nausea. Extreme fatigue. Profuse sweating. Shortness of breath.
These were among the symptoms that brought Angela Gillespie and Sandi Clemmer to Carilion Roanoke Memorial Hospital’s emergency room on separate occasions.
“I knew something was very wrong, but I had no idea what,” Gillespie, then 49, recalls. Clemmer, a retired elementary school principal, says her symptoms escalated so rapidly, “I didn’t even have time to think about what it might be.”
Both women were stunned when they learned what was happening: Their hearts were failing.
Cardiologist Joseph Austin, M.D., medical director of cardiac rehabilitation at Carilion Clinic, often hears similar accounts from his female patients. “Women don’t always present like men do. People think of crushing chest pain as a primary symptom of a heart attack or heart disease, but women are more likely to experience nausea, profuse sweating, and fatigue, perhaps accompanied by pain in the upper back.”
Cardiovascular disease is the No. 1 killer of women in the United States. “More women die from heart disease than from all types of cancer combined,” Dr. Austin emphasizes. “This isn’t a new phenomenon. For almost 30 years, more women have been dying of heart disease than men. Yet for some reason, it is often still thought of as a man’s disease.”
DeEtta Ray Compton, D.N.P., F.N.P., B.C., is co-director of the Heart Failure Clinic at Carilion Clinic’s cardiology practice in Christiansburg. “Women often write off their symptoms as something else,” she says. “If they experience severe fatigue, they tend to rationalize it—‘I’m a mother, I work a full-time job, I’m taking care of my elderly parents, of course I’m tired.’
“They may report pain in the arm or shoulder blade, or a burning sensation in the throat, but they don’t typically experience the ‘elephant sitting on my chest’ feeling that men more often have.”
‘I Had No Risk Factors’
Angela Gillespie, of Roanoke, began a routine August day in 2011. She had been feeling nauseated and tired but went out to mow her lawn. “I began sweating profusely, even though it wasn’t a hot day. I thought I was going to pass out.”
She stopped mowing and went inside. “I felt tired the rest of the evening. The next morning, as I was getting ready to walk my dog, I collapsed.”
Gillespie was able to call 911 and was taken to the emergency room, where initial tests showed that she was anemic due to a bleeding stomach ulcer. Anemia can cause shortness of breath, fatigue, and dizziness, which fit her symptoms. However, the attending physician, Carilion Chief of Cardiology David Sane, M.D., also ordered an echocardiogram to look at her heart.
The echocardiogram showed a con-genital abnormality of her aortic valve, which regulates blood flow in the body’s largest artery. More alarmingly, the image detected an aneurysm near her aorta that could rupture and quickly cause death.
“I’ve been active all of my life. I had no symptoms, no risk factors, and no family history of heart problems. Never in a million years would I have thought that this is the way I was going to die,” Gillespie says.
Before she could have surgery, Gillespie had to wait for the bleeding ulcer to heal. “Those were the darkest two months of my life. I was afraid if I lifted anything or sneezed, the aneurysm would rupture,” she says.
Gillespie underwent open-heart surgery and was outfitted with an artificial, metal valve. “This valve will outlast me, but I do have to take blood thinners for the rest of my life,” she says.
A Stressful Year
In March 2013, Sandi Clemmer’s routine annual mammogram detected breast cancer, and she immediately underwent a lumpectomy and six weeks of radiation. In early October, Clemmer, of Roanoke, had difficulty breathing and was treated for multiple blood clots in both lungs.
About three weeks later, she developed a pain in her left side, which she describes as “like a bubble under my rib cage. It was severe enough that I went to my doctor.” All of her vital signs were normal and tests showed nothing unusual. She headed home, thinking she might have pulled a muscle.
That night she awoke with arms “that felt like cinder blocks. I couldn’t move them. I began sweating profusely and then I got violently ill. My husband called 911.”
Paramedics checked her vital statistics and saw no indications of problems. They thought she might have a severe case of the flu and transported her to the emergency room. Soon after, when she was hooked up to an EKG machine, she received the prognosis: “You’re having a heart attack.”
Clemmer was immediately taken for a scan which showed one artery in her heart was 99 percent blocked and a second was 90 percent blocked. Within an hour, she was undergoing cardiac catheterization to treat the largest blockage. The second blockage was treated the next day.
Higher Mortality Rate
Women are more likely than men not to survive their first heart attack. Dr. Austin attributes this to multiple factors. “Women tend to develop heart disease later in life, so they’re likely to have other medical issues and not be as healthy,” he says. “Also, women often wait longer to seek medical attention.”
Other reasons are based sheerly on biology. Women’s arteries tend to be smaller than men’s and can become blocked with plaque more easily. Also, “women’s risk of coronary artery disease increases dramatically after menopause,” Dr. Austin explains. “Female hormones have a protective effect that disappears as women age.”
Furthermore, Compton points out that some of the symptoms of menopause mimic those of a heart attack. “Fatigue, hot flashes, and night sweats are all common complaints of women going through menopause, but they can also be signs of heart problems,” she notes. “Women often dismiss heart symptoms as menopause-related, stress, or even panic attacks.”
The first step women can take in reducing their risk of having a heart attack is to educate themselves. Dr. Austin’s succinct advice is, “Know the risk factors and know if you have those risk factors. Know your family medical history. Seek medical attention if you have symptoms, and take steps to lessen any of the risk factors that can be modified.”
Primary risk factors include high blood pressure; high cholesterol (especially when paired with low levels of HDL); smoking; lack of exercise; obesity; diabetes; age 50+ and/or post-menopausal; and history of heart problems in parents or siblings.
Prior medical conditions can also be risk factors. For example, women who’ve undergone treatment for breast cancer are at a higher risk of developing heart disease. Radiation can cause hardening of the arteries and blood clots, and common chemotherapy drugs such as Herceptin (trastuzumab) and anthracycline can increase the risk of heart problems. HPV (human papilloma virus), better known for causing genital warts and most types of cervical cancer, is also linked to a higher rate of future heart disease.
“People are enamored of technology, but one of the best diagnostic techniques is direct communication,” Dr. Austin says. “I pay close attention to family history and the patient’s medical history, and listen carefully to how my patients describe their symptoms.”
He also advises people to “be alert to changes in exercise capacity. That means that if suddenly you find yourself getting out of breath or fatigued going up a flight of stairs or carrying groceries—activities that hadn’t affected you before—you should see your doctor. Another warning sign is upper-back pain or arm pain triggered by exertion that goes away with rest.”
Living with Heart Disease
After their release from the hospital, both Gillespie and Clemmer went to cardiac rehabilitation. “Participants wear a heart monitor while exercising, which made me feel very safe,” Clemmer says. “I was with a small group of patients who’d gone through the same thing so they became a support group.”
Gillespie is candid in saying, “Recovery was not easy. There are lots of emotional issues and depression. I couldn’t sleep, had anxiety, couldn’t take care of my pets, and couldn’t drive for eight weeks. I can’t speak enough about the whole heart care team and the tremendous support they provided.”
Clemmer continues a medically prescribed exercise regimen three times a week at Roanoke Athletic Club, a Carilion affiliate. “The FIT Rx program is wonderful. Cardiac nurses are there to check your blood pressure and heart rate, answer questions, and address concerns.
“It’s really made a big difference. My lifestyle is now healthier due to better food choices and a daily exercise routine.”
At the Heart Failure Clinic, Compton devotes much of her time to patient education. “Little changes will bring about big changes,” she says. “I’m a realist. I know people aren’t going to completely change their lifestyles, but I work with them on taking tiny steps: substitute grilled chicken or fish for a hamburger; smoke one less cigarette each day; take the stairs instead of the elevator; take your blood pressure medication; check your blood sugar. As patients reach these small goals, they feel a sense of accomplishment.
“Some risk factors aren’t modifiable—such as age, family history, and ethnic origin—but others are within your control— blood pressure, cholesterol, alcohol and tobacco use, and exercise.”
Gillespie is fully back to her former, active lifestyle and is able to laugh about “the ticks and clicks” her artificial valve makes. “It’s no big deal, and this is what’s keeping me alive. Your heart is an incredible machine. But you’ve got to take care of it.”