Science has a long history of bias against women, from medical schools rejecting Elizabeth Blackwell in the 1840s to scientific paradigms of women’s physical inferiority dating back to Galen and Aristotle.
This bias persisted well into the 20th century. For decades, American researchers excluded women from medical studies that set the standard for the detection and treatment of heart disease, instead using men as subjects.
But times are changing.
At Mercy Regional Medical Center, three women cardiologists – Dr. Eugenia Miller, Dr. Susie Kim and Dr. Rachel Chaney – and nurse and clinical nurse practitioner Sheena Carswell are working in a traditionally male-dominated field.
And alongside Go Red For Women, a national campaign spearheaded by the American Heart Association, Mercy’s specialists are bringing attention to a sleeper feminist issue: women’s heart health.
In America, heart attacks kill one in three women. Yet, Miller said, “Most women, just because they listen to the media, all think they are going to die of breast cancer. It’s a significant issue, but there’s been such a big push on that – I think women are much less aware of heart disease.”
Indeed, the ubiquity of breast cancer awareness campaigns and their trademark pink ribbons can obscure the fact heart attacks are the No. 1 killer of American women, killing twice as many women as all types of cancer – including breast cancer.
Chaney said the goal of raising awareness isn’t to make women unduly fearful of heart attacks but to correct the public’s dangerous misconception women are at lesser risk.
When it comes to awareness, there is a lot of work to be done.
Symptoms differ for men, women
Though the data show heart disease is a women’s disease, in pop culture, heart attacks read male.
In Francis Ford Coppola’s “Godfather” trilogy, Vito Corleone – the mafia patriarch – meets his end in a field of flowers. He clutches his heart, apparently in unbearable, sudden pain and drops dead seconds later.
It makes for compelling cinema, and Corleone’s demise at the hands of “the big one” remains the gold standard in film and TV, where heart attacks are near uniformly depicted as dramatic events, killing men instantaneously after a convulsing spasm of pain to the heart. But “the big one” provides the public with very a poor model for understanding heart attack symptoms in women, despite the fact heart attacks are deadlier to women than to men.
While chest pain, pressure or discomfort are the hallmark symptoms of a heart attack, many women don’t experience those symptoms at all.
In a 2012 Journal of American Medicine Association study of 1.1 million people, 42 percent of women admitted to hospitals for heart attacks never experienced chest pain. The study found women were significantly less likely to survive heart attacks than men.
Indeed, women suffering heart attacks are more likely than men to experience shortness of breath, pain in the right arm, nausea or vomiting, sweating, lightheadedness or dizziness and abdominal, neck, jaw, shoulder or upper-back pain.
The problem is it’s easy for a woman who’s dizzy, sweating and nauseous to dismiss her ailments as merely the side effects of flu, indigestion or a panic attack – as opposed to a major, life-threatening medical episode, Carswell said.
“Women are used to multitasking. That symptom of fatigue – you’re always tired because you’ve been doing 10,000 things all your life. So these symptoms are subtle, and women keep rationalizing them and rationalizing them,” she said.
In fact, though about a third of women who have heart attacks never experience chest pain, 71 percent of women report flu-like symptoms for two weeks to a month before having more acute chest discomfort or severe shortness of breath. These milder symptoms are underreported to emergency room staff members, according to the Women’s Heart Foundation.
Though every minute passing after a heart attack is crucial, Miller said women often delay going to the hospital, either because they fail to recognize the urgency of their symptoms or get entrapped in the myriad responsibilities – financial and familial – constituting many’s experience of womanhood in modern American.
“Characteristically, women will present later with symptoms because women had to get dinner on the table and feed the dog before they could come into the hospital. Women will feel those kinds of obligations and put themselves last,” she said.
She said the situation is somewhat ironic, as women make the health-care decisions in most households; and when husbands complain of the same mild symptoms, most women won’t hesitate to send their spouses to the emergency room, whether or not their husbands are willing.
Kim said many women’s lives could be saved if they got to the hospital sooner after having a heart attack.
“Awareness – that’s still the thing that we can improve upon the most. All the time that they spent before they get to the hospital is the most important,” she said.
Ticking time bomb
The heart is a miraculous organ, the hardest working in the human body. From life’s beginning through its end, the heart pumps blood containing oxygen and vital nutrients through a vast, complex system of arteries, on which the survival of all human cells and every other organ depends.
To accomplish this great, continuous task, the heart itself needs blood – blood that’s rich in oxygen – to flow to it incessantly. That blood is delivered via an interweaving network of coronary arteries to the heart’s muscular walls, the myocardium.
A heart attack – a myocardial infarction – occurs when blood flow to the heart muscle is blocked. The lack of oxygen kills tissue, inflicting grave damage to a portion of the heart.
While heart attacks can come on suddenly, Kim said one’s likelihood of suffering one grows steadily over time as plaque builds up in the coronary arteries, causing the arteries to grow narrower and narrower. She pointed to autopsies of young American soldiers who’ve died in car accidents: though in physically fighting shape, at the time of their deaths, coronary plaque already was accruing in their arteries.
Beyond recognizing heart-attack symptoms when they happen in women, the specialists at Mercy said certain factors – age, family history, cholesterol, diabetes and smoking – strongly influence whether someone is at risk of heart disease, regardless of gender.
Prevention often boils down to good-health basics, like diet and exercise, Carswell said.
Kim said what’s going on with a person’s outsides has little to do with what’s going on with a person’s insides. She recently treated a male heart attack patient.
“He was relatively in shape, came here from Texas. But coming to a higher altitude, he was trying all of the ski equipment and did more than he used to do at sea level,” she said. “He had never seen a doctor in 10 years because he considered himself healthy. Even though he was outwardly the picture of health, he was actually prediabetic, and his cholesterol was off a little bit.”
Kim said he might have avoided a heart attack had he “taken it upon himself to manage all of these issues” – a reminder of the value of preventive medicine that both women and men should take to heart.
cmcallister@durangoherald.com
