Waking Women to Heart Care: Unique Symptoms Mask Danger of Americans' Greatest Health Risk

Judith Mitchell's odd pain began with the simple effort of clicking on the vacuum to handle an everyday chore she has repeated for decades. "Every time I started to do it," she says, "I'd get a pain in my face."

As Mrs. Mitchell's husband Andrew drove her across town to the Huntington Urgent Care Center affiliated with St. Vincent's Medical Center in Bridgeport, she tried to convince herself it was just sinuses acting up. But deep down she knew this was different, and her doctors confirmed that feeling. They carefully noted the symptoms, took EKG tests, prescribed aspirin therapy, and kept her moving toward a more rigorous review by a cardiologist.

The nagging feeling that she shouldn't ignore this unusual pain was the spark that put her in the hands of the experts at St. Vincent's Regional Heart and Vascular Center. Her prompt action powered her toward treatment and recovery.

The heart-care team at St. Vincent's say Mrs. Mitchell's early-warning action could be repeated daily by women everywhere, but only if women are made aware of their unique symptoms that may signal cardiovascular problems.

A new initiative at St. Vincent's is attempting to raise that awareness.

Fighting our biggest killer

"Women are a special group," says Dr. Jose Missri, new medical director of the Regional Heart and Vascular Center. "We need to make women aware that their symptoms may be different than men, so we can be sure women will get their heart-related conditions treated early."

Although people may think heart disease is primarily a problem for men, "it is the number one killer of women," he says.

More than 32 million American women have some type of cardiovascular disease, according to sobering statistics by the American Heart Association. One in two women die of heart disease.

Dr. Missri is leading the nationally recognized St. Vincent's heart center into an expanded role for women's heart care in southern Connecticut. "Our formal program for women will emphasize prevention, detection and treatment," he explains.

Such a special approach is necessary in part because of how a woman's body changes at menopause.

"The risk of heart disease almost doubles once women are beyond the protection of hormones, particularly estrogen," says Dr. Kathleen Harper, an osteopathic physician and cardiologist at St. Vincent's. When menopause occurs, that hormone production drops steeply, causing many risk factors for heart disease. One major change is an elevated cholesterol level.

During childbearing years, hormones protect women from the buildup of fatty tissue in the blood known as cholesterol. The two types of cholesterol lipoproteins, low density and high density, act differently in the arteries. It's the low-density lipoproteins (LDL) that attach themselves to arterial walls, eventually blocking blood flow. When the hormonal shield drops, cholesterol -- especially the LDL -- often rises.

Cholesterol, age and gender are three of eight major risk factors of heart disease, and apply to both men and women. To fully understand your risk, you also need to consider family history, blood pressure, tobacco use, diabetes and weight. Efforts at detecting heart disease have primarily been addressed to men, however, because the risk occurs earlier in their lives.

Mrs. Mitchell might have been on the alert a bit more than many women. Heart disease runs in her family, and for 25 years she has been taking medication to control high blood pressure. With hindsight, she can see that other risk factors were present. Still, she admits, "my problem-solving is usually putting it on a back burner and saying it couldn't happen to me."

The result is that she was living with undiagnosed diabetes, only discovered when she was tested for her cardiovascular problem.

Symptoms creep up on women

The message to know your heart disease risk factors and symptoms is necessary, but for women there's an educational twist: women's symptoms may not point to the heart.

That trick of nature didn't fool Judith Mitchell, but many women are unaware of the unique symptoms. When she relates her incident to friends, they often expect her to describe pain in her heart. "When I tell them it was in my face, they're totally surprised. The reaction of most of them is, they would've gone to a dentist."

Many women may have described these symptoms to friends: shortness of breath, feeling dizzy or weak, indigestion in the upper abdomen, nausea, sweating, fatigue. Even the direct pains women could compare to the typical male symptom of chest pain -- pain in the breast, arm, jaw or back -- might be tossed off as the aches of aging.

Some physicians might not identify these symptoms as readily as Mrs. Mitchell's doctors did, also concluding that these are simply byproducts of getting older.

Women should start by taking care of themselves as much as they do their families, says Dr. Harper, and letting their doctors know that they want to be checked. Many men chart their blood pressure number and know when it goes up, but women should follow that number too, as well as their cholesterol, an overlooked key indicator.

"We know our bank PIN number and our Social Security number," she says, "but some of the more critical numbers people should be aware of are blood pressure and cholesterol numbers. That's what will help us identify and address the risk factors."

"Stress, diet, lack of activity, certain life stressors can all impact a sudden change in the numbers up or down, and those changes in a negative direction contribute to coronary disease," Dr. Harper explains.

For patients like Judith Mitchell, the quick diagnosis and compassionate care she found at St. Vincent's has turned around her attitude toward getting health care. "Normally I would have a pit in my stomach even going into a hospital," she says, "but I get such a good feeling just walking in the door."

Doctors might advise that part of what she's feeling is extra oxygen. With severe blockage removed from two arteries, she describes immediately feeling lighter and more energetic. "I feel very hopeful," she says. She has not smoked since the July day she went to the medical center, and now she is working with the heart center's nationally certified cardiac rehab program on exercise and diet.

"I feel like I'm starting all over again at 61, with the energy I had 25 years ago. It's really amazing."

And she credits the St. Vincent's team with the "uplifting feeling" she gets now walking into the hospital for rehab. "I'm just thankful that it was caught before it did damage to my heart."