Confusing symptoms raise the stakes for heart attacks in women

Wednesday, March 23, 2011 | 4:44 p.m. CDT; updated 4:12 p.m. CDT, Thursday, March 24, 2011
Janet Schisser, left, and Sharon Roulier walk together on the track at the Columbia Activity and Recreation Center on Tuesday. The two try to work out at least three times a week together. Their routine has changed since they started taking yoga classes.

COLUMBIA — For Sharon Roulier, the biggest challenge of Sept. 1, 2005, was supposed to be breaking in her new golf shoes during a round with her husband.

But then, on that beautiful fall morning, she felt what she describes as an irritating pain in the middle of her chest. Not severe — more uncomfortable. When an upset stomach and nausea followed, she called her regular doctor, who advised her to be checked out in an emergency room near her home in Loveland, Colo.


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“I felt really silly,” said Roulier, who was then 62. “I couldn’t believe we were going to the ER ..., but it was just uncomfortable and persistent enough that we went anyway.”

Often, the symptoms of a heart attack for women don’t match up with those of men. Chest pain is one of the least common symptoms. Women are more likely to report jaw pain, fatigue and nausea. Many times a woman having a heart attack will be sent home from the hospital with a misdiagnosis of indigestion or stress.

“It takes a pretty savvy staff to recognize that the presenting complaint may not be the actual problem,” said Virginia Huxley, a biomedical research scientist with a doctorate in biophysics who works at University Hospital.

According to WomenHeart, more women than men die of heart disease each year. Women are also less likely to receive appropriate treatment, often because of vague and confusing symptoms.

Because Roulier had consistently healthy blood pressure and was at a healthy weight, her doctors told her that her heart was something she should never have to worry about, despite her family history.

“My dad was the one with heart disease in the family," Roulier said. "I thought it was mainly a guy’s problem.”

Quite the opposite. Heart disease is now the leading cause of death in American women — a very real problem. Roulier found that out the hard way in the emergency room where she was told her heart was in serious distress and she needed an emergency cardiac procedure.

On the ride to another hospital for the procedure, Roulier remembers thinking, “Aren’t we overreacting here?” She still couldn't believe what was happening.

She soon learned that she had three major blockages in her arteries and one of them was 95 percent blocked. Doctors quickly cleared the arteries and installed three stents. Her husband went home, and she fell asleep, assured that all was well. 

Because of complications that arose from a hospital error, she awoke hours later to the "crushing" pain of a life-threatening heart attack as deadly clots formed around the newly placed stents — a problem that went undetected by the ICU monitors. A frantic scene unfolded around her as doctors scrambled to keep her alive. She remembers being wheeled to another room as loud voices instructed her to breathe while she said a hasty goodbye to her husband, asking him to tell their two sons she loved them. 

Doctors and nurses managed to get the situation under control. Roulier survived full cardiac arrest and ultimately lost 20 percent of her heart function.

She went about her daily activities for years feeling — and assuming she was — healthy. She was stunned to learn how sick she actually was. 

“You think you’d know what people look like when they’re about to die,” she said.

But with heart attacks in women, recognizing that someone is about to die can be very tricky.  

A multi-faceted problem

Fundamental physiological differences between men and women make heart attacks difficult to identify.

For a long time, there was little research or statistics on heart disease that related specifically to women. In "Sex and the cardiovascular system: the intriguing tale of how women and men regulate cardiovascular function differently," Huxley wrote that part of the reason is hormonal changes that occur during the menstrual cycle make women tricky to study. Men provide a "cleaner model" because their hormones are more constant, making research less expensive and less time consuming. So men were the only focus of cardiovascular research, and data gathered from them was applied to everybody.

Then there were the misconceptions— women were protected against heart disease and there were no significant differences between women and men other than physical size, Huxley said. 

That has changed over the past 10 years as differences in the physiology of men and women have gained recognition. Researchers now understand that methods traditionally used to study men are not as effective on women. 

Huxley's study concludes that it is important to know the differences and the reasons for them in order to design effective research methods, and ultimately, appropriate treatment. 

Heart disease in women usually affects smaller vessels of the heart. In men, it is the larger vessels and arteries.

"It's twigs as opposed to branches," Huxley said.

Because large vessels are affected in men, their bodies' reactions are more profound and much more easily detectable. A heart attack feels like a heart attack. For women, a heart attack might mimic the effects of stress, exhaustion or indigestion — especially when there's no chest pain. 

And then, when women notice possible symptoms, sociological and psychological factors can prevent them from receiving the treatment they need. It gets down to women's tendencies to not put themselves first.

Huxley has observed in her research that many women tend to deny or discount the thought that something serious is happening and put off calling their physician. 

According to Huxley, studies show women will take their male partner's health problems very seriously. Women will take men to their rehabilitation programs and doctors' appointments, but the reverse doesn’t tend to happen. Left to their own devices, women will put off driving themselves to the doctor to find out what's going on.

Many times when women do seek medical attention, they are turned away without a serious diagnosis, making them feel stupid and reinforcing the notion that "it's not a big deal."

Roulier, who moved to Columbia in 2007, now spends much of her time sharing her story and volunteering for WomenHeart. She has noticed the tendency to downplay heart problems in many women she has talked to over the years. 

"Many women feel unsupported and embarrassed when their symptoms are not taken seriously," Roulier said. She regularly advises women to push past those feelings and take charge of their heart health. 

What women can do

Both Roulier and Huxley emphasize the importance of being aware and proactive when it comes to heart health. In many cases, heart attacks are preventable.

“It’s best to avoid being in an emergency situation like I was,” Roulier said. She said she wishes she had talked more directly to her doctor to better understand her risk factors, her symptoms and relevant tests that could have led to earlier detection and treatment.

Huxley advises women to be fully aware of their family history and to have a good relationship with their doctors so they feel comfortable consulting them about symptoms that appear to be minor, she said. It can be as simple as saying "I don't feel right" and trusting that the doctor will pay attention and listen, Huxley said.

The American Heart Association's Go Red For Women website has heart healthy tips and exercise suggestions for women as young as their early 20s, showing that it's never to soon to take potentially life-saving preventive measures. 

"I have lost 20 percent of my heart, but the rest is strong," said Roulier who now exercises regularly; she walks, uses a rowing machine, lifts weights and does yoga. She makes it a point to exercise for at least a half-hour every day. 

"You can't figure out how to work exercise into your day. You have to work your day around exercise. It's not optional," she said. 

The power of denial

Roulier is keenly aware of how dangerous denial can be. It set in during and after her heart attack. How could someone who had recently been hiking and golfing have massive blockages in her heart? How could someone who wasn't overweight and had excellent blood pressure have a heart attack?

In the years she's spent volunteering, she has encountered many women who can relate to the natural doubts and skepticism about heart disease and its symptoms. She's been trained through WomenHeart to better educate women about the dangers of heart disease.

And still, she's not immune to denial.

Two weeks ago, when her husband was complaining of minor chest pains, Roulier found herself resisting the realization that he was indeed on the verge of a heart attack. There was just no way the man she described as “Iron Man fit” could have a heart problem.

But she was reminded of her own experience and the advice she has given countless women to not ignore their bodies' warning signs. She gave her husband two aspirin and took him to the emergency room. Still, she couldn’t help but think: “They’ll probably laugh at us.”

There was no laughter, but the couple was almost sent home with a diagnosis of indigestion. Then one doctor ordered an electrocardiogram, "just in case." The same doctor returned in a rush, saying her husband was experiencing a full heart attack. Roulier's first reaction was to laugh; he had to be joking. 

Her husband had a blood clot, but because doctors got to it in time there was no damage to the heart. He is expected to make a full recovery. 

With both her own heart attack and her husband's, Roulier noticed her tendency to want to ignore the problems.

"We often think that when people simply have the right information, they will make the right choice," Roulier said.

But it's more than that. She made a point to explain that it's not just about recognizing the situation — it's accepting it. 

“If you respond, a heart attack does not need to drastically change your life or leave you damaged," she said, "Going to the ER to check out symptoms literally saved both our lives."

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