Heart attack signs often missed in women
On a family trip to the cinema in August 2012, Claire-Marie Berouche began to feel unwell. At first, she assumed it was indigestion from a sandwich she had eaten before the film.
But for the next six days, she was struck by severe nausea and became convinced she had a tummy bug. "The strange thing was I couldn't vomit - I felt so sick and uncomfortable, with waves of this clammy, horrible feeling," says Claire-Marie, 49, who lives in west London with her husband, Bouchaib, and son, Yousef, 21.
When Bouchaib finally called an ambulance the following Wednesday, the last thing Claire-Marie expected was paramedics to shout out "code blue" after doing an ECG. She had been having repeated mini-heart attacks since Friday night and was in the midst of life-threatening heart failure.
"I still remember sitting in the ambulance in disbelief," Claire-Marie remembers. "I never smoked, barely drank and I'd had none of the symptoms I thought signalled a heart attack: no crushing pain in my chest."
Because women's heart attack symptoms are more subtle than men's, they are more likely to be misdiagnosed. Indeed, 76,000 women die each year from heart and circulatory diseases in the UK - twice as many as breast cancer and a quarter of all female deaths.
Research published in 2012 in the Journal of the American Medical Association found that 42 per cent of women admitted to accident and emergency for heart attacks had no chest pain at all. Another study from January this year, published in the journal Circulation, found that women having a heart attack were more likely to experience less common symptoms, such as the nausea Claire-Marie had, along with vomiting, shortness of breath and back or jaw pain. How can this be?
Putting others first
Women are also less likely to seek help. Claire-Marie had been struck by repeated episodes of "indigestion" since January that year, which her doctors now think were heart attacks. "It happened when I was running for the bus or climbing the stairs at work - probably about 15 or 16 times," says Claire-Marie, a former retail manager. "But I put it down to having wolfed down my breakfast or lunch, thinking, ‘Oh, I must get some Rennie.’ I thought about having it checked out, but I didn't want to let people down by taking time off for something that seemed so small."
"Claire-Marie's story highlights the fact that it's not uncommon for both patients and their doctors to mistake women's heart attacks for indigestion," says Dr Mike Knapton, associate medical director of the BHF. "It's compounded by the fact that women are most often the carer in the family, and their concerns are often more for their children or elderly parents, so they ignore symptoms or put them down to something else."
Swedish researchers found women who survived heart attacks reported delaying going to hospital or seeking help from their doctors, often neglecting their symptoms because of a need to maintain social responsibilities.
Once at accident and emergency, Claire-Marie's doctors, who weren't sure she would make it through the night, admitted her immediately for life-saving surgery in which a "stent" - a small, self-expanding metal tube - was placed in her right coronary artery to restore the blood supply to the heart. Three months later, she was admitted for open-heart surgery.
Claire-Marie had been active, but today she can no longer work and gets breathless and exhausted after standing up and cooking a meal.
"I can't walk out on my own," she says. "I rely on a mobility scooter. I can't climb a flight of stairs, I need a stairlift. I get so angry with myself for not picking up the signs sooner."
Despite being fit, a non-smoker and only a light drinker, Claire-Marie has type 1 diabetes, which increased her risk of developing a heart attack at such a young age (women typically experience heart problems in their fifties and sixties, 10 years later than men do).
Why early diagnosis could change everything
If you get symptoms such as indigestion out of the blue, especially if this is accompanied by pressure or pain in the chest, neck and arms, breathlessness, nausea, sweating and pallor, it's reasonable to call 999, says Dr Knapton. "No one will criticise you for misusing the health service because the sooner you get treatment, the less damage to the heart muscle there will be. This is crucial."
Diagnosis is straightforward and involves an electrocardiogram, which is painless, and a blood test to measure levels of troponin, a protein that can indicate damage to the heart muscle, the most common cause of which is heart attack.
A study published in the British Medical Journal and funded by the British Heart Foundation found a newer, high-sensitivity troponin blood test could be a vital tool in diagnosing heart attacks in women. The research looked at 1,000 men and women admitted to the Royal Infirmary of Edinburgh with chest pain, and found the more sensitive test doubled the diagnoses of heart attack in the female patients.
"This suggests women have a lower threshold of troponin levels for diagnosis of heart attack and that if we keep using the same threshold as used in men, we will keep missing some heart attacks in women," says Dr Knapton.
Researchers are now preparing to carry out a larger clinical trial of 26,000 women to confirm their findings.
A gene for heart disease?
Other research is set to change things even further. Academics at University College London last year published a paper in which they discovered that a particular version of a gene called BCAR1 could increase a woman's risk of heart disease.
They found those with the high-risk version of BCAR1 had a 6.1 per cent increased risk of heart attack or stroke compared with those with the low-risk version, at 2.5 per cent risk.
Men do not seem to be affected by the gene in the same way. If the link is confirmed, gene testing could potentially be used to identify those women at higher risk and target lifestyle advice towards them, says Dr Knapton. "It also means that if we understand the mechanisms by which genes affect the heart, we might be able to develop targets for drugs in the future to combat this."
The signs
If you're experiencing any of these symptoms for the first time, especially if you're over 40, seek help urgently, advises Dr Mark Knapton of the British Heart Foundation. Early diagnosis is crucial to prevent irreversible damage to your heart.
- Chest pain or discomfort - the most recognised symptom of a heart attack, though not always present.
- Pain radiating to the arms, neck, jaw, stomach or back. For some people the pain is severe, but for others just uncomfortable.
- A feeling of indigestion or reflux-type pain - this is often ignored in the hope that it will pass.
- Feeling sick, sweaty, breathless or light-headed with associated chest pain or discomfort.
- A general feeling of being unwell or lethargic if accompanied by chest pain or discomfort.
Do you find that you push niggling health issues to the back of your mind, or are you always on top of your general check-ups? Let us know in the comments below.
Written by Anne Magee. First appeared on Stuff.co.nz.
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