Life-Saving Lessons from Women Heart Attack Survivors

When Cindy DeMarco, 32, woke up from a deep sleep with crushing chest pain, severe upper back pain and shortness of breath, she knew something was seriously wrong. But the young, physically fit marathon runner and Army captain attributed her pain to a running injury. It didn't cross her mind that she might be having a heart attack. She took a painkiller and went about her day but her symptoms worsened. It wasn't until 12 hours later that she checked herself into the emergency room. DeMarco admits that her lack of awareness of heart attack symptoms and the loss of time could have killed her. But it was eventually DeMarco, not the doctors and nurses in the ER, who saved her own life. Her doctor said she probably just pulled a muscle, but she insisted on an electrocardiogram test (EKG), a test that identifies irregularities in heart functioning. The EKG indicated she was having a heart attack.

DeMarco's experience is not uncommon. Too many female heart attack survivors say they didn't recognize their symptoms as heart-related, according to a recent study in the January/February 2003 issue of the journal Women's Health Issues. The study examined the attitudes and experiences of 204 heart attack survivors through a telephone survey. In addition to their own lack of awareness, more than half of these women reported their physicians displayed insensitivity and ignorance when discussing heart disease in women. As a result of the inadequate information and support provided by doctors, more than half of these women said they felt depressed and anxious and had a hard time making the lifestyle changes needed to stay healthy. These findings confirm already existing evidence of a larger problem in the American health care system -- a knowledge-gap surrounding the prevalence of heart disease in women. Despite alarming statistics -- one in two women will eventually die of cardiovascular disease -- it is still considered a men's issue. Warning signs in women, including symptoms of cardiac arrest, often go undetected and untreated.

Women can experience typical heart attack symptoms such as chest pain, arm pain or pressure and shortness of breath, as well as less "classic" signs such as dizziness, nausea, fatigue or jaw pain, upper back pain, shortness of breath and lightheadedness. Women's symptoms are not dramatically different than those of men, but they are sometimes mistaken for menopausal, psychiatric or gastrointestinal problems, according to WomenHeart, a nonprofit organization dedicated to women with heart disease, which funded the study. "Fatigue and nausea are also menopause symptoms so they can be difficult to recognize as heart related," says Nancy Loving, heart attack survivor and executive director of WomenHeart. Attacks are rarely like those dramatic Hollywood chest-grabbing gasps we often see in the movies.

When asked what advice former heart attack survivors would give to other women, "educate yourself and ask questions" was the most cited answer. Women must take a preemptive role when it comes to heart disease. Of the women surveyed who were dissatisfied with some aspect of their health care, 58 percent pointed directly to physician attitudes and communication styles as the culprits. Specifically, they cited physician insensitivity, rudeness, abruptness (feeling "brushed off," Loving explains) and ignorance about heart disease in women -- factors that can intimidate women from asking lifesaving questions. "When you go to one physician and tell him your symptoms and he says you are fine, you are likely to believe him," says Sharonne Hayes, M.D., director of the Mayo Clinic Women's Heart Clinic and coauthor of the study. "If you have someone who minimizes your symptoms, it could be deadly."

Inadequate treatment by physicians can persist throughout a woman's heart attack experience. A January 2003 study of 2,763 postmenopausal women in the Annals of Internal Medicine found that doctors often fail to prescribe women the medications that are known to prevent future heart attacks, such as aspirin, beta blockers and cholesterol-lowering drugs. According to WomenHeart, women also receive less cardiac rehabilitation services and nutrition counseling than men do. When DeMarco was released from the hospital she was not told about cardiac rehab and was forced to research her options on her own. "When I got out, I felt I could drop dead any moment and I was really scared," she says. "I had no idea that there was something out there that I could do to get better." It wasn't until rehab that DeMarco felt her concerns were fully addressed. She found a "wonderful nurse" who talked to her about rehabilitation and, for the first time, the emotional aftereffects of having a heart attack.

Emotions can have a tremendous impact on post heart attack well-being, as they can affect one's ability to get better, the survey suggests. Heart attack survivors often feel scared, alone and depressed. Over one half (57 percent) of the women surveyed said they had suffered a mental illness as a result of heart disease, and Loving says that financial and relationship problems are also common. The lack of social support and treatment for depression can be a barrier to healing. "When depression is left untreated, a woman is not likely to make lifestyle changes," such as changes to exercise and diet regimes, says Hayes. "Depression makes it difficult to recover."

Further studies may help improve outcomes among women, but for now, women heart attack survivors have this advice for all women:

Listen to your body, don't ignore your symptoms and inform yourself about the risks of heart disease.
Find doctors who are attentive, understanding and knowledgeable about heart disease in women -- and listen to their advice.
Educate yourself about the best preventive and diagnostic tests for women, such as exercise nuclear scanning and exercise echocardiograms.
If you've had a heart attack, search out the best rehabilitative care and make sure you are evaluated and treated for depression.

Educating yourself is your best defense, advises DeMarco. "You have to know about the number one killer of women."