Knowing the Difference and Getting Treatment Early Could Save Your Life
story by CHERYL ROGERS portrait by LUIS BETANCOURT
When it comes to women and heart disease, it’s not one size fits all. Breast pain, shoulder or neck pain, arm pain, back pain, stomach or jaw pain, and even pain in your fingers can be a warning sign. If you’re looking for chest pain like men have, you may not get the help you need.
Knowing that was critical when Shelly Lyvers’ mom Elsie was suffering from breast pain some 20 years ago. A mammogram had been ordered, but Lyvers demanded an electrocardiogram.
“Sure enough, she was having a heart attack,” recalls Lyvers, now a cardiovascular service line director at Heart of Florida Regional Medical Center in Davenport. “She ended up getting a stent.”
“With women, you need to have a high index of suspicion,” warns Lyvers, a Registered Nurse with a master’s degree in Science and Nursing. Any change in the normal body capability, such as extreme fatigue, nausea/vomiting, or unexplainable shortness of breath and a cold sweat, can be the tipoff, adds Ruth Clifford, an advanced registered nurse practitioner who works with heart patients at Winter Haven Hospital, part of the not-for-profit BayCare Health System.
BROKEN HEART SYNDROME
Another interesting thing to note: women are more likely than men to be diagnosed with broken heart syndrome, a stress-induced cardiomyopathy that looks just like a heart attack— until medical practitioners take a look at the arteries. The disease is fairly rare and generally occurs in women more than 50.
“We can see that their coronaries are clean, or there’s not enough plaque to be causing the problem,” Lyvers says. “The good news is, most often this is reversible.”
“We think it may be some kind of chest hormone release that’s causing a stunning of the muscle of the heart,” Clifford explains. “It’s not super common, but it’s not uncommon.”
An alternative name, takotsubo cardiomyopathy, was chosen because it describes the odd shape of the left ventricle of the heart, which looks like a clay vase the Japanese use to catch octopus. “For a clinician, it’s just mind-blowing to see that,” Lyvers says. “The shape of the ventricle is very interesting.”
Broken heart syndrome can occur in response to a major stressor such as loss of a spouse or child, financial disaster, divorce or other major trauma. Patients often describe themselves as broken-hearted, Clifford notes, adding one patient said she started having chest pain after telling her boss she felt heartbroken.
Whether it’s broken heart syndrome or heart failure, the medication is similar: diuretics, an ace inhibitor to make it easier for the heart to function and a beta blocker to strengthen the heart, Lyvers points out. In the case of broken heart syndrome, the body usually recovers in a month or two— and the medication is no longer needed, according to Lyvers.
Regular heart attacks may be treated with stents, with the goal of limiting heart damage. “If a patient is having a heart attack, we want to intervene and save that heart muscle,” Clifford explains. The goal now is to do stents in less than 60 minutes, if possible. “The quicker we can open the artery the better,” she adds.
When there are blockages in multiple vessels, the patient may be a candidate for bypass surgery to restore blood flow.
In Polk County, 711 women died of heart disease in 2016, compared to 819 men, according to the Florida Department of Health, Bureau of Vital Statistics data. The age-adjusted county rate was 138.6 per 100,000 for women and 200 for men, up from the state rate of 117.1 for women and 191 for men.