State of the heart

Susie Burrow Nichols was suddenly jolted awake one morning in October 2005 due to shortness of breath, pain radiating down both arms, and tingling teeth. She sought medical help and ultimately underwent tests inside the heart catheterization lab at Leesburg Regional Medical Center. A grim discovery was made.

The 27-year-old had suffered a major heart attack and required quadruple bypass surgery.

Although she had experienced symptoms for nearly 16 months, the diagnosis was shocking. After all, she had previously been diagnosed with a less severe problem. Plus, she had always been an active woman who maintained a healthy weight. And like many people, she visualized a heart attack as an elderly man clutching his chest and dropping to the ground.

“I could not believe that someone my age could actually be having a heart attack,” she says. “Although my dad’s parents died of heart-related issues, I never imagined I would be dealing with heart problems at such a young age.”

Today, Susie is 35 and resides in Eustis with her husband, Ray, and 6-year-old adopted son, Tyler. She speaks straight from her heart when urging other women to take cardiovascular disease seriously.

“Nobody should assume that their age or gender makes them immune to heart disease,” she says. “The only risk factor I had was a family history of heart disease. I did not smoke, I was never obese, and I never battled high cholesterol. If heart disease can happen to me, it can happen to anyone.”

Unfortunately, that message oftentimes falls on deaf ears. Simply put, many women do not consider heart disease to be a major problem. That was apparent in a 2003 study of 1,000 women conducted by the American Heart Association (AHA). Only 13 percent believed their greatest health threat was heart disease or stroke.

However, statistics provide a glaring gap between perception and reality. Heart disease is the leading killer of women and is more deadly than all forms of cancer combined. According to the American Heart Association, 1 in every 3 American women dies from heart disease or stroke. In comparison, only 1 in 31 American women dies from breast cancer each year.

To compound problems, it appears that women and men do not receive equal treatment when it comes to heart disease because some doctors may not take a woman’s complaints seriously. This was evidenced by research conducted by the Agency for Healthcare Research and Quality, which concluded that women with heart problems are not diagnosed or treated as aggressively as men are.

“In quite a few cases, women with coronary artery disease may have no chest pain whatsoever and therefore they are misdiagnosed because doctors commonly associate heart attacks with crushing chest pain,” says Dr. Joseph Sahab, a cardiologist with Leesburg-based Florida Heart and Vascular Multi-Specialty Group. “Another problem is that women are more prone to experience chest pain not related to the heart. So when a woman with cardiovascular disease goes to a doctor’s office and complains of chest pain, doctors may assume it is something else.”

According to the National Coalition for Women with Heart Disease, women “only receive 33 percent of angioplasties, stents and bypass surgeries; 28 percent of implantable defibrillators; and 36 percent of open-heart surgeries.” In addition, females comprise only 24 percent of participants in all heart-related studies. These statistics could possibly explain why more women than men have died of heart disease each year since 1984.

Despite the prevailing attitude that heart disease is a man’s disease, heart attack victims like Susie understand that it is an equal opportunity killer. That’s why she remains frustrated about being misdiagnosed after experiencing her first symptoms during a hiking trip to Washington and Oregon in June 2004.

”I was going up a mountain and my chest starting feeling uncomfortable. At one point I sat on a bench to rest. My blood flow was already lacking.”

After returning from vacation, Susie resumed her

Dr. Joseph Sahab, a local cardiologist, answered common questions pertaining to women and cardiovascular disease.

Q: What are the risk factors for women developing cardiovascular disease?

A: They are essentially the same for women as for men— smoking, high blood pressure, cholesterol, obesity, and a family history of heart disease.

Q: What ages are women at greatest risk for heart disease?

A: After menopause, a woman’s risk is the same as a man’s risk because their estrogen levels are now lower. Estrogen helps prevent plaque formation.

Q: What specific symptoms do women experience prior to an actual heart attack?

A: One week before the heart attack, they may feel shortness of breath, fatigue, insomnia, dizziness, and indigestion. They may also have cold sweats and cold, clammy skin.

Q: Why do female heart attack victims typically suffer worse outcomes than their male counterparts?

A: I cannot say for certain, but one explanation is that women have smaller coronary arteries than men. Because of the smaller coronary arteries, a woman’s body may not develop natural bypasses around the blockage.

Q: How does hormone replacement therapy affect a woman’s heart?

A: Recent studies have showed that it does not reduce the incidence of cardiovascular disease or increase the risk.

Although Susie was unable to give natural birth following her heart attack, she and her husband, Ray, adopted a beautiful baby boy in July 2007. They named him Tyler. “There is nothing like being a mom,” she says. “I cannot even remember what life was like before we had Tyler. He is such a joy to be around. One good thing about adopting Tyler is that I did not pass on my bad genes to him and I don’t have to worry about him going through everything I did.” daily walks. One morning, however, she failed to make it past the neighbor’s driveway because the uncomfortable feeling she experienced on vacation returned. “I had discomfort in my chest and I was short of breath,” she says. “I turned around and went back inside my house. At that point I knew I needed to see a doctor.”

Susie was examined by a family doctor and diagnosed with costochondritis, an inflammation of the chest wall that causes chest pain. For the next 16 months, she made monthly visits to her doctor to monitor the condition. Her symptoms worsened during this time. She began having increased chest pain, felt achy in both arms, gained weight due to water retention, struggled to fight off sinus infections, and experienced debilitating shortness of breath.

“For two weeks I would wake up with chest pain and shortness of breath. I would sit on the edge of the bed so I could calm myself down and recuperate.”

Still, her family doctor stuck to the original diagnosis. It wasn’t until she called him one morning complaining of “tingling teeth” and an “elephant on my chest” that he admitted her to the hospital. By then, she had already suffered a heart attack.

To this day, Susie wonders whether things could have turned out differently had she been accurately diagnosed. Even though stents would have been ineffective due to the location of her blockages, a proper diagnosis could have allowed her to undergo bypass surgery before suffering a heart attack.

“There’s always the possibility that they could’ve prevented the heart attack with medication,” she says. “Heart attacks are bad because they leave behind damage to your heart. Fortunately, my quality of life has not been diminished, and I’m grateful for that. Still, I went through a phase where I was very angry about being misdiagnosed. I feel that way not just for myself, but for all women who are misdiagnosed.”

While she could not change the past, Susie moved forward in her life by implementing important lifestyle changes. She walks for an hour three times a week and eliminated red meat, sugar, and processed food from her diet. She strongly encourages other women to take their cardiovascular health to heart.

“You know your body better than anyone. If something does not feel right and you are unsure what is going on, do not stop until you receive answers. I also tell women that they should receive regular screening. Women spend so much time taking care of others. We need to remember to take care of ourselves.”

For women, suffering a heart attack can pack an emotional punch. That was certainly the case for Kim Bitting, a resident of Leesburg who had a heart attack in September 2006 at age 38. She felt like a shell of her former self and dealt with depression for an entire year.

“It was very hard on me emotionally. I was a wife and mother and for a while, could not take care of the people I loved the way I used to. I was afraid to do much because I thought any activity might trigger another heart attack. To make matters worse, I did not know anyone my age who had suffered a heart attack, so I really did not know where to turn. That was very difficult because having support from people who understand what you’re going through is vitally important.”