Who is going to get heart disease? The common answer is “men, of course.”
And, indeed, men are at higher risk in their mid-40’s to mid-50’s, according to Leslie L. Davis, RN, MSN, ANP-C, a cardiology nurse practitioner and doctoral student at UNC-Chapel Hill School of Nursing. Davis, who gave a continuing education presentation to a group of 35 Carolina SON alumni this past week in Charlotte, cautioned that as women get older, more of us are having heart attacks. In fact, women who reach the age of 55 have a higher risk than men! “If you live long enough, you’re going to have heart disease,” she said. The alumni gathering and presentation was hosted by the Levine Children’s Hospital at Carolinas Medical Center.
The leading cause of death for both men and women is heart disease. In the United States, heart disease has been the number one killer since 1900. Citing Center for Heart Disease 2002 data, Davis noted that heart disease was the cause of 356,000 deaths for American women. The cause of death from the next four major diseases was 274,000 combined. Stroke caused 100,000 deaths. Lung cancer caused 68,000 deaths. Chronic obstructive pulmonary disease caused 64,000 deaths, and breast cancer caused 42,000 deaths.
“We do well decreasing death rates for men,” said Davis, “But we’re not doing enough for women.” Davis, the Jane Winningham Smith Doctoral Scholar in Cardiovascular Nursing, is focusing her doctoral research on how to help women reduce heart attacks.
Davis went on to explain that there are two types of heart disease. The first is known as Stable Angina. It presents a predictable pattern of symptoms after a person has had a coronary artery disease diagnosis. Stable angina is associated with mild symptoms associated with physical exertion, weather extremes or emotional stress. People know they are having symptoms or can predict when symptoms will occur, and know that rest, a nitroglycerine tablet or aspirin will relieve the symptoms. If rest and nitroglycerine are not getting rid of symptoms, you’re probably having a heart attack.
Acute Coronary Syndrome is a new terminology that explains a less predictable pattern. Symptoms are more frequent or lasts longer, are progressive, more intense, occur at rest or abruptly awakens a patient from sleep. Acute Coronary Syndrome is more likely to occur with a new diagnosis or is a change of pattern from stable angina. The symptoms are strong enough to wake them up and include extreme tiredness, nausea and occur even at rest. If symptoms occur between the belly and the nose, Davis says we should be highly suspicious that it could be heart disease.
How do you find out if you’ve had a heart attack? The fastest test is an EKG. But, blood work will be what identifies heart attack for most women. Davis advises patients to ask for an EKG within 10 minutes after being admitted to a hospital, so that therapies or surgery to open the blood vessel can be ordered immediately. Unfortunately, it can take an average of one to two hours after an admission before an EKG is ordered, and sometimes, that can be too late. It takes about eight hours for results to come back from the laboratory after blood has been evaluated.
What To Look For: Symptoms of Heart Disease
Ischemic pain, pain caused by the narrowing of the coronary arteries, includes pressure, tightness, crushing and squeezing. It happens throughout the chest and is not localized to any particular area. Up to 33 percent of those with acute MI (myocardial infarction or heart attack) have silent ischemia. Angina is the term for the pain caused by ischemia. One-quarter to one-third of men and women never had any chest pain before a heart attack. They had other symptoms. Davis continues to explain that we need to be aware that something is different in our bodies. Do we note unusual fatigue, feelings of impending doom, anxiety, lightheadedness? Are we experiencing palpitations, profuse perspiration, nausea and vomiting?
If you get admitted to the Emergency Department, what do you say that will get you an EKG immediately? Davis tells her audience to say, “I have chest pains. I think I’m having a heart attack.”
The take home message is clear. Women and men may not have chest pain to be having a heart attack. Up to 37 percent of women who had heart attacks did not have chest pain. Davis explains that women have chest pain and a lot of other symptoms. It’s important to recognize what’s happening with your body, to get help immediately, call 9-1-1 and take two-to-four low dose aspirin while you are making the call. Aspirin, she says, can stop 20 percent of heart attacks. A low dose is 162 mg to 325 mg.
Davis tells her audience of nurses that we assume that people will recognize symptoms, but they don’t. It is an average of three hours from the time that symptoms occur to when people finally decide to call for help, and it has been this way for 30 years.
“When you’re having a heart attack you want to get an EKG fast and then get immediate treatment. The time of treatment is inversely related to mortality and morbidity,” she says. “Every half hour you wait decreases your chances for survival, and surprisingly, women more likely to wait to call for help than men.”
Why do women delay? They are more likely to have atypical symptoms and vague warning signs. There is a mismatch of expected vs. actual symptoms. Women think we are supposed to have the Hollywood heart attack, and we don’t. We believe we are invulnerable to heart disease. We are socially ingrained to take care of others and put our own needs aside. The older we are the less likely we are to go to the hospital quickly. African Americans are less likely to go to the hospital than their white counterparts. If women ask a spouse or family member to take them to the hospital, it will most likely take longer. If you need to get to the hospital quickly, ask a stranger!
Davis observes that because there are competing demands of women’s time, because women are trying to “do it all” and wearing lots of hats, so to speak, that women push the symptoms back and postpone addressing them. There is a subset of women who know they have symptoms and just don’t take the time to deal with them. She says that when women do go in for medical help, they are more likely to be misunderstood and misdiagnosed. Typically, women have single vessel disease while men have multiple vessel disease. The tests are not designed for women who need medical imaging. Because women have vague symptoms and are not having the traditional MI, they don’t get cathed.
Prevention and managing risk factors:
- Lower blood pressure
- Lower total cholesterol, LDL and raise HDL
- Stop smoking
- Manage diabetes
- Weight loss
- Increase physical activity (30-45 minutes daily)
Davis says that current mass public education is not working. Men and women have to deal with their thoughts, feelings and emotions. She is conducting a study that includes how to eliminate pre-hospital delay, educate people in hospital after they have had their first heart attack to talk about symptoms, how does it feel, rewards of seeking treatment, negative outcomes of denial and who makes decisions if the patient can’t.
Resources:
www.med-decisions.com to determine heart attack risk
Questions? lldavis@email.unc.edu
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