A retired cardiac-care nurse didn’t recognize her own symptoms which are different for women. Neither did the first res-ponders. It’s a problem that can have fatal consequences.
On a sunny day in Bellevue, Wash., in June 2011, I had just completed a workout class when I experienced a bizarre sensation of intense, full-body muscle fatigue. I broke into a bone-chilling sweat. My upper left arm throbbed, a deep ache next to the bone. I was heaving for air at a rapid clip. I grew nauseated. A fist was pressing through my chest to my spine. I was 56 years old, an exercise enthusiast, a nonsmoker and a retired cardiac-care nurse. And yet I had no idea that I was having a heart attack.
It felt nothing like I’d imagined. It turns out that it’s hard to recognize a heart attack as it happens. What I didn’t understand until much later was that a deposit of plaque had ruptured in my right coronary artery and caused a clot to form, depriving my heart-and brain-of oxygen. I knew something was wrong., but-not what, and it was difficult to think clearly. Was it serious? It just seemed weird. I should have asked for help, but in-stead I headed to the parking garage.
There my symptoms eased as swiftly as they’d arrived. I had recently stopped taking a prescription medication for heartburn, and I concluded that I had suffered re-bound indigestion. I called my husband, a physician, and asked him to run to the store to get groceries for dinner. I told him that I’d felt bad for a few minutes. Stopping that drug was rough, I said. If that’s what a heart attack feels like, I added, it sure does hurt. I made light of it, raised no alarm, gave no indication of my suffering.
On the way home, my symptoms returned in force. Now I had to merge onto a major highway, then a second, and navigate through rush-hour traffic. I draped myself over the steering wheel, fighting for air. My eyesight narrowed. Instead of pulling to the side, I drove on, gripped by a primal urge to reach home. Clarity of judgment had evaporated, a dangerous symptom of lack of oxygen.
Why had my symptoms eased and then recurred? Most likely, blood had temporarily found its way around the clot, restoring the flow through the damaged tissue, flooding my heart muscle with oxygen. But then the clot formed again. This frequently happens in heart attacks, adding to the confusion that many patients feel as symptoms subside and then reappear.
At home, my neighbor, also a physician, was checking his mailbox. Can you help me, I asked? I’m in terrible trouble. I drove 50 more feet to my driveway and handed him my keys and cellphone through my open car window. I was sinking fast, desperate for air, drenched in cold sweat. My arm ached. The nausea was overwhelming. My neighbor tells me that my skin turned gray. I heard sirens. ”They’re coming,” he assured me.
The firefighters who arrived first assessed me through my car window. “Slow your breathing down,” they shouted at me. “Stop hyperventilating. You have to answer our questions.” But I couldn’t recover. I was trying to surface from depths too deep to talk. They ignored my neighbor, who was urging them to treat me as if I were having a heart at-tack. “Answer our questions,” they shouted again. I felt my-self slipping away. A medic van appeared “Stop breathing so hard,” they yelled. These unhelpful directives went on for some time. The firefighters and medics failed to recognize that one of the major symptoms of a woman suffering a heart attack is extreme shortness of breath.
A plethora of recent research shows that women dis-play different cardiac symptoms from men. According to a 2016 statement from the American Heart Association, published in the journal Circulation, women are less likely than men to feel crushing chest pain. More of them exhibit symptoms like mine-shortness of breath; muscle weakness and fatigue; profuse, cold sweating; atypical chest pain (or arm, jaw and back pain) and indigestion. When medical providers and patients fail to recognize· these symptoms, the consequences can be fatal.
The most recent comprehensive research on foe subject, a 2017 study by the American College of Cardiology, shows that women are twice as likely as men to die within 30 days of a heart attack. After a year, they are still 50% more likely. Why? One factor is that women are older, on aver-age, when they have attacks and are more likely to have associated diseases such as diabetes.
But a key issue, according to a study published in 2017 in the Journal of the American Heart Association, is that women suffering heart attacks take an average of 30 minutes longer than men to reach a hospital. Like me, they are more likely to misinterpret or write off their symptoms’. A 2018 Swiss study in the European Heart Journal showed that women suffering heart attacks wait an average of 37 minutes longer to contact medical officials.
When my symptoms suddenly eased in front of the medics-the clot, breaking again, had allowed more oxygen through-they walked me to their van to get what they called a “perfunctory” EKG. But walking is a dangerous thing for someone having a heart attack. In another moment, my symptoms erupted again. The medic gaped as he read the EKG. He started oxygen, placed two IV tubes and in-fused morphine. My neighbor appeared with a baby aspirin. As the van raced back down the same highway I had just negotiated, my heart broke into an irregular rhythm. “Atrial fibrillation,” the medic muttered. The right coronary artery, I told myself. A heart attack, definitely.
The emergency room was a blur-a team of seven or eight people, a chest X-ray, another EKG, more morphine, oxygen. My husband arrived in his own car. ”I love you,” I told him as they wheeled me away. “Tell the children I love them.” I thought it might be the last time I ever saw him.
Luckily, the cardiologist was able to clean out the clot and place a stent in my artery. I recovered in the cardiac-care unit without complications, and three subsequent stress echocardiograms showed no damage. I had reached the hospital within the requisite two hours to save heart muscle, one of the key factors in survival and recovery. I lived.
My parents hadn’t. My great risk factor, which I had spent a lifetime trying to mitigate, was that I was the descendant of generations of people who had died young of cardiovascular disease: my mother at 53, my father at 62, my maternal grandmother in her 40s. High cholesterol ran in our family, for which I took Lipitor. But it’s difficult to counteract genetics, much as I had tried.
Cardiovascular disease remains the leading cause of death in women as well as mett,afld -women suffer just-over half of all fatal heart attacks. Rates of morbidity and mortality from attacks are decreasing for both sexes, but women die at a higher ratio than men. And as reported in
a 2016 circular by the National Institutes of Health in women younger than 55-and I was close, at age 56 female mortality hasn’t declined.
For three months after the experience, I had a series of conversations with the county’s Medic One emergency services to spur them to commit to retraining the firefighters and medics who had mishandled my treatment. The long-standing gender gap in cardiac care, from the time of first contact with physicians or first res-ponders to arrival at the hospital, has improved in recent years, but it persists. De-spite strides in awareness, women still arrive at the hospital more slowly than men. Time is everything in a heart at-tack. Women must recognize the danger signs, even amid doubt, and get the immediate help we need.