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L.J. Rohan

L.J. Rohan

Gerontologist

Susan Lucci’s Heart Attack Scare

People Magazine reported that Erica Kane of Pine Valley* suffered a heart attack in October of 2018. As I read the article, it didn’t surprise me that she never mentioned being tested for heart disease before the heart attack scare. Obviously, her doctor failed to order tests for her which would have revealed the 90% blockage in the main artery leading to her heart, and a 70% blockage in a branch artery even though her doctor knew her father had suffered a heart attack in his early forties.

Looking at this information in black and white, it seems incredulous that her doctor had never ordered a Coronary Calcium Score to help gauge her risk. And, once she had that number, she also needed a Carotid Intima-Media Thickness Test (CIMT) to measure the thickness of the inner two layers of the carotid artery, the artery located at the side of our necks. This simple, and painless, test can let doctors know if there is any thickening in the artery walls long before we might experience any symptoms of a cardiac incident.

If the results of the CIMT are concerning, further tests such as a Doppler Ultrasound, an ultrasound for the blood vessels and the heart to see blood flow through the vessels and heart, a MRI Angiogram or MRA which allows doctors to see inside the blood vessels, or a Cardiac CT Scan, which produces dye-free multiple x-ray images of the heart and blood vessels, will give defining information about the state of our arteries and risk level for a heart attack. Even beginning with a simple stress test, doctors can get an idea of the condition of our hearts and whether some or all of the above tests are needed.

All this begs the question, why didn’t Susan Lucci’s doctor order any of these heart tests, especially with a history of heart disease in her family?

I have some history of heart disease in my family, and since I reached mid-life, my doctor orders both a coronary calcium score and a CIMT every time I have a physical. I don’t want to put Erica’s doctor on the defensive, but even today, women are far less likely to receive the same care and treatment as men when it comes to their health outside of female issues. We are also three times more likely than men to die following a serious heart attack as a result of receiving less equal care and treatment.

In a landmark study done in Sweden over a ten-year period, 2003-2013, involving almost sixty-one thousand women, the researchers found this to be true. I watched my mother languish in a recovery facility, virtually ignored by her (male) physician after undergoing quadruple by-pass surgery. During that stay, she suffered from a host of easily avoidable complications due to basic negligence. I tried to intervene on her behalf, but since I was the baby in the family, no one would listen to me.

The anger I feel as I write these words is almost uncontainable, but the above study, published in the Journal of the American Heart Association in 2017, makes one thing absolutely certain: We must take control of our own health and ASK, or more likely in most cases, DEMAND, that at least once, more if results merit it, we have our coronary calcium scores taken, and for sure, have a CIMT test, especially if heart disease runs in the family or we have any other heart attack scare. If the results are good, the peace of mind is worth it. If the tests show issues, you can do what is necessary so that you will never be like Erica, out shopping one day and then suddenly feel as if an elephant has just sat down on your chest.

To recap, these tests could save your life:

  • Coronary Calcium Score
  • Carotid Intima-Media Thickness Test (CIMT)
  • Doppler Ultrasound
  • MRI Angiogram (MRA) or Cardiac CT Scan

 Until next time….Be Vibrant!

*Susan Lucci is one of the stars of the daytime soap opera, All My Children.

Susan Lucci’s Heart Attack Scare

Since my focus is always retention and prevention, today I will talk about some important tests that will help women avoid a heart attack – a silent or not-so-silent one – and help prevent heart disease. My goal is to keep you well informed, and hopefully, urge you to speak up, and then step up to take control of your heart and your life.

As I mentioned in Women and Heart Disease Part I, over eleven hundred women were surveyed by the Women’s Heart Alliance about their knowledge of and experience with discussing heart disease with their physicians.

Heart Disease Discussions

women and heart disease

While a majority of the women in the survey had a routine physical or wellness exam sometime in the previous twelve months, only 40% of those exams included a heart health assessment, despite 74% of these women having at least one risk factor for heart disease. A tiny number – only 16% – were told by their doctors that they were at risk.

Please take a moment to let that sink in, only 16% were told they were at risk.

To confound me even more, I learned only 22% of primary care physicians, and 42% of cardiologists, felt they were comfortable and prepared to assess cardiovascular risk in women!

The last distressing fact: Only 16% of primary care physicians, and 22% of cardiologists discussed giving their patients life-saving tests I will cover below. They also failed to suggest preventive choices to safeguard a woman’s heart health. This makes my head explode! How can this be true in the twenty-first century, with women being the majority of folks in the U.S. (and around the world)?

The short answer: We seem to care more about how we look, and the medical profession may be reinforcing that idea. A full 63% of the women responding admitted to putting off a doctor’s visit at least some of the time, and 45% of women canceled or postponed an appointment until they lost some weight. (The reasons they gave were difficulty losing weight or finding time to exercise.)

With our primary care physicians spending on average 17.5 minutes with us, we don’t feel safe enough to reveal additional information about any heart symptoms we may be having or call further attention to what might be wrong with us. We are embarrassed to talk to our doctor, family, and friends about heart health because we think it’s tied to solely to our weight, and not a combination of many other important factors—stress level, emotional health, diet choices, sleep, other medications, and dental hygiene. Adding to that burden, many of our doctors are men, and the bias some of them carry about women compels them to discount the importance and risks of heart disease and concentrate primarily on how much a woman weighs.

Heart disease is the number one cause of death for women. It kills twelve times as many women as breast cancer, which gets much more press. Heart disease must be addressed first. Of course, we must also remove the stigma and stereotype of “weight gain equals heart disease.” The good news is that those of us who had our hearts checked by a doctor in the last year were twice as likely to feel comfortable discussing the topic with our family and friends.

Now that all the right cards are in my hand, here are three key tests to ask for the next time you see your physician. Together with ways to prevent heart disease, which I will cover next time, I will lay down my Royal Flush in hearts!

Tests for Heart Disease

A Stress Test

The most familiar of the three, a stress test takes less than an hour and serves as the baseline for understanding the health of your heart. It is done on a treadmill – in sneakers and street clothes – with complete supervision. You set the pace, and no one will ask you to do more than you can.

Coronary Calcium Test

This easy and painless test assesses your level of risk for a heart attack by measuring the amount of calcium deposit(s) in your arteries. This is a coronary CT scan, done with the same equipment as a CT scan.

CIMT: Carotid Intima-Media Thickness Test

Another easy, painless and quick test, a CIMT measures the thickness of the inner two layers of the carotid artery, the artery located at the side of your neck. This test can let doctors know if there is any thickening in the artery walls long before you might experience symptoms of a cardiac incident. This test is a sonogram of the carotid artery in the neck—Gel on the neck, quick scan, off the table in fifteen minutes!

If the results of the CIMT are concerning, your doctor will request further tests such as a Doppler Ultrasound—an ultrasound to watch blood flow through the vessels and heart, a MRI angiogram or MRA—which allows her to see inside your blood vessels, or a Cardiac CT scan—a dye-free, multiple x-ray that provides images of the heart and blood vessels. All of these will give defining information about the state of your arteries and risk level for a heart attack.

I often print out the list and give it to women to take to their routine exams. Knowledge is power and in this case, very possibly life-saving.

I will wrap up my in-depth discussion on women and heart disease next time with the best things we know – this red-hot minute – that will keep our hearts healthy and humming.

Until next time…Be Vibrant!

Women and Heart Disease: The Facts May Surprise You Part II

“Cardiovascular disease is the number one cause of death for men and women in this country,” says Jennifer Haythe, MD, Director of Cardio-Obstetrics, an internist at NYPH/Columbia and co-director of the Women’s Center for Cardiovascular Health at Columbia.”

Before I went back to school, I wouldn’t have known this fact: My first thought, especially for women, would have been cancer, and therein lies a big part of the problem. A 2017 survey conducted by the Women’s Heart Alliance interviewed 1,011 U.S. women aged 25-60 years and collected physician survey data from 200 primary care physicians and 100 cardiologists, as well. The goal of the surveys was “to determine knowledge, attitudes and beliefs regarding heart disease in women.” The results mirrored my own thinking.

Let’s separate the various strands of this knotty problem. First, the researchers found that 45% of women twenty-five to sixty, and 35% percent of women fifty to sixty– that included me—were unaware that heart disease annually kills 500,000 women in the U.S. Add to that, another 15.2 million women, worldwide, who die from the disease every year. Even more surprising– only 13% of Americans know how great a woman’s risk is for developing heart disease. That percentage of awareness falls even more in women with lower levels of education and income, and women of color.

 The next shocking fact: 71% of women almost never discussed heart health with their physicians, assuming their doctors would ask if there were a problem. To further curl your hair, physicians often didn’t or don’t, discuss cardiovascular disease with their female patients because in spending only 17.5 minutes per patient, according to studies, either the patient had a more immediate health issue, or she didn’t fully report her symptoms. This reflects a wholesale lack of interest (or knowledge) in making prevention a priority before a woman experiences symptoms, or worse, has a cardiac incident.

We all have seen someone in a TV show or movie pretending to have a heart attack (usually a man). He clutches his chest, his breath becomes short and shallow, his eyes bug out, and he makes some dramatic yelp as he falls onto the floor, or into a chair, if he’s lucky.

Realistically, heart attacks come in several different flavors and their symptoms vary. Let’s begin with maybe the most dangerous —The Silent Heart Attack.

The symptoms of a silent heart attack can be subtle, and often dismissed as sudden fatigue, nausea, or shortness of breath that occur when exercising or just out and about. Those symptoms disappear when resting, according to cardiologist Suzanne Steinbaum, MD, director of Women’s Heart Health at Lenox Hill Hospital in New York City.

Additionally or differently, especially in women, there might be nontraditional signs like unexplained fatigue, pain or discomfort in the throat, neck, or jaw, or what seems like heartburn — symptoms so mild, they’re barely noticed, or that go completely unnoticed during times of heightened stress.

 The damage from these silent attacks is usually only discovered accidentally while testing a woman’s heart for other reasons. If we have had a silent heart attack, we are 3x more likely to die from heart disease.

One might also experience the following heart attack symptoms:

  • Feeling very full, as though you have eaten a large meal, even if you haven’t eaten recently
  • Followed by feelings of indigestion and a large person sitting on your chest
  • Ribs tightening and becoming short of breath
  • Pain in your right shoulder and arm (not left, as many believe)
  • Pain in the front of your neck and up into your jaw

I suggest you memorize all possible heart attack symptoms. Make a copy and keep it on your phone or pin it on your fridge. I have!

In Part Two of this discussion, I will talk about some empowering choices we can make to keep a heart attack a thing of fiction.

Until next time…Be Vibrant!