Heart disease is the No. 1 leading cause of death for American women, accounting for one out of every five female deaths. Yet women are less likely to recognize heart disease symptoms and often chalk them up them to less life-threatening conditions like acid reflux, the flu or normal aging. Adding to the danger, bystanders are less likely to come to the aid of female heart attack victims than they are to aid males who appear to be having a heart attack.
“Women in general tend to disregard their symptoms because they are so busy taking care of everyone else,” said Dr. Laura Sullivan, a board-certified cardiologist at Cleveland Clinic Indian River Hospital. “And their symptoms are generally more subtle than the typical elephant on the chest pain that we see in men.
“There are two basic ways for chest pains to express themselves in women. The first is through symptoms that are noticed when engaging in physical activity but go away with rest. This might include discomfort in the chest, shortness of breath, dizziness, indigestion, unusual fatigue and a significant reduction in your tolerance for exercise. These could be early signs of heart blockage.”
According to ClevelandClinic.org, many women have these early warning signs hours, weeks or even months prior to a heart attack. Women often don’t seek care until the symptoms persist but it is very important to get help as soon as you notice any unusual symptoms so you have a chance of preventing a heart attack.
“The second way is with a sudden heart attack that occurs when a blood clot ruptures the heart artery,” Dr. Sullivan continued. “The pain and pressure in the chest and left breast is intense. In women it often feels like the world’s worst heartburn and can be associated with nausea and sweating or any pain that radiates from the chest up to the neck or jaw or down the shoulder and arm. Women often feel like their bra is crushing their chest and they have a sense of impending doom. These symptoms mirror those of a panic attack, which is why women need to be evaluated [immediately] to make sure it’s not a heart event.”
According to heart.org, the first thing you should do if you are experience any of these symptoms is to call 911. The 911 operator may recommend that you take an aspirin if he or she can make sure that you don’t have an allergy to aspirin or a condition that makes it risky. If the 911 operator doesn’t talk to you about taking an aspirin, the emergency technicians will give you one if it’s right for you.
“It’s so important to take an ambulance to the hospital because the EMTs will call the hospital and set the care in motion needed to receive a potential heart attack patient,” Dr. Sullivan implored. “There have been many cases of women walking into the emergency room with chest discomfort and shortness of breath and it does not get recognized. They get triaged with an EKG but that doesn’t always show a heart attack and women are prone to be left in the emergency room and not receive immediate care. The ambulance puts you in front of the line.”
Statistics also show that women are less likely to receive CPR or a lifesaving shock with a defibrillator from a bystander in the event of an out of hospital cardiac arrest, often due to unfounded fears and misconceptions.
A recent survey from the American Heart Association (AHA) determined that men receive cardiopulmonary resuscitation (CPR) from a bystander 45 percent of the time while women receive bystander CPR in only 39 percent of the cases. As a result, men have a higher survival rate.
The AHA surveyed 520 non-healthcare providers and found that potential rescuers would react differently based on the gender of the victim. Men were most likely to refrain from performing CPR on a woman in public for fear of being accused of sexual assault or touching a woman inappropriately. Women rescuers feared they might cause physical injury or harm to the cardiac arrest victim. Both genders perceived that cardiac arrest occurs primarily in males or that women may act more dramatically than men in medical crises.
“There are concerns about touching a woman’s breast and in order to use a defibrillator you have to pull the woman’s bra up to the neck and place a pad on either side of the chest. You may even have to move the breast out of the way,” Dr. Sullivan said. “But immediate CPR is critical to survival and should be administered as quickly as possible.”
It’s important to note that laws in most jurisdictions protect bystanders who treat cardiac arrest victims in good faith, so if you know how to administer CPR, do so as quickly as possible without fear of repercussions. If a defibrillator is available and you know how to use it, do so.
Traditional risk factors for heart disease like high blood pressure, obesity, high cholesterol, smoking and family history affect women and men alike. Women, however, face other unique risks making it more likely for them to have multiple risks at the same time.
Women are more prone to depression and more likely to experience psychosocial stress, meaning their stress comes from work, home, money problems and major life events. Women make up about 80 percent of people diagnosed with autoimmune diseases such as rheumatoid arthritis and lupus, which increase their risk for heart attack. And, of course, pregnancy complications like preeclampsia and gestational diabetes compound the risks, as does menopause, which causes estrogen levels to drop, resulting in a higher risk of blood clots, plaque in the arteries and high cholesterol.
“The best way for women to prevent heart disease is to manage stress, eat healthy, sleep well and get plenty of exercise,” Dr. Sullivan concluded. “People don’t realize how powerful movement is. I tell my patients that ‘walking is life – sitting is death.’ Moving is the key.
“Women should spend a minimum of 150 minutes a week doing moderate exercise, such as walking briskly, biking or swimming, or a minimum of 75 minutes a week vigorously exercising – running, rowing or power biking – to reduce the risk of heart attack.”
Dr. Sullivan earned her medical degree at the University of Nevada School of Medicine and completed her internal medicine residency at the University of Tennessee, Knoxville Graduate School of Medicine.
She completed her Cardiology Fellowship at St. Vincent Hospitals & Health Services in Indiana.
Prior to joining Cleveland Clinic Indian River Hospital, Dr. Laura Sullivan served as director of the echocardiography lab at Renown Institute for Heart & Vascular Health in Nevada. She can be reached at Cleveland Clinic Indian River Hospital Health and Wellness Center, 3450 11th Court, Vero Beach, 772-778-8687.
