Despite the unnerving sense that something was desperately wrong, my grandma left the emergency room with more questions than she came in with.
“She was told she had a cold in her chest,” my mom tells me. “She knew there was more to the story; the symptoms she had were totally foreign to her.” As it turned out, Grandma Marlene—who was, at the time, in her early 50s—was experiencing a heart attack. Had she not returned to the ER later that night to demand further observation, she may not have survived.
Her story isn’t a unique one, unfortunately. Being told to just “go home and rest” is a refrain far more commonly said by health care professionals to women than to men. In this particular instance, it’s because women’s heart health research trails so many years behind the curve (35, count them!). But that isn’t to the fault of any one group or individual, says Kristine Fortman, CEO of the Minneapolis Heart Institute Foundation (MHIF).
“As women, we present differently, we respond differently,” she says. “Even if we’re having similar symptoms [as men], we describe them differently like, ‘Yeah, I’m a little uncomfortable, but I was doing a lot of work around the house.’ We come up with all of these other excuses or rationales, but part of that is also because our physicians haven’t really talked to us about our cardio health.”
Not Just A Man’s Disease
Back in the early ‘80s, the American Heart Association (AHA) ran an ad campaign that pervaded our TV screens for years: “If your husband had a heart attack in bed tonight, would you know what to do?” Meanwhile, women were suffering from heart disease in silence.
“Women were banned from NIH and FDA clinical trials [in the early ‘60s] and that’s because of—and with all good intents and purposes—there was controversy around a drug called Thalidomide that pregnant women with morning sickness were trialing,” Fortman explains. Tragically, the trials either resulted in miscarriages or the surviving babies experienced a low quality of life: underdeveloped limbs, eyes, ears, and internal organs. In fact, of the 100,000 babies affected by the drug, only 3,000 are still alive today. This led to greater drug regulation in many countries—which also led to the exemption of “child-bearing women” (read: ages 12 to 50) in clinical trials.
“The Clinton Administration turned all of that around and actually required that women be included in medical trials,” she says. “Since then, we’ve come so far in cardio care in terms of prevention, diagnostics, and treatment—it’s amazing. But so much of that is all based on men.”
OB/GYN + Primary Care: Bridging the Gap
Research shows that between 1999 and 2008, about 81 percent of women’s preventive health visits were made to an OB/GYN; the rest involved a primary care doctor. But primary care docs are nearly two and a half times more likely than OB/GYNS to address more comprehensive care issues, like cardio health. Fortman says that for their part, MHIF is playing a role in engendering partnerships between local OB departments and local cardiologists through the rollout of educational sessions and materials.
“We’re trying to change the groundwork and also help women know their own risk. Allina Health is the largest health system in Minnesota, and we’re at Abbott Northwestern, the flagship hospital—the highest patient population with the highest complex cases. This is a great place to enact change,” she says.
Can a Broken Heart Be Repaired?
Our hearts are collectively feeling heavy these days. We’re missing our friends, family, colleagues … old routines. Spontaneity—excitement! Life looks exorbitantly different these days for all of us. And that’s stressful. While we all know that surging stress hormones have the ability to impact the immune system, mounting stress can also be a matter of life or death for some.
New research shows that older women are at a greater risk of developing broken heart syndrome, otherwise known as takotsubo cardiomyopathy. It’s most commonly associated with the death of a loved one, but cases are seeing a stress-related uptick during the pandemic.
“In the early hours, takotsubo and heart attacks share many similarities in presentation, including chest pain and breathlessness,” says Dr. Scott Sharkey, chief medical officer of MHIF. “Even experienced physicians can be challenged in distinguishing between the two.” While heart attacks are often caused by a blocked coronary artery, an X-ray in a takotsubo patient reveals an unusual shape of the left ventricle (the pumping chamber).
The good news is, takotsubo is considered a temporary heart condition. Timely recognition and supportive therapy can reverse takotsubo, where heart function gradually improves over the course of several days. Adds Sharkey, “A minority of patients are susceptible to recurrences.”
When Healthy Young Women Have Heart Attacks
While an exceedingly rare condition, spontaneous coronary artery dissection (SCAD) causes up to 35 percent of heart attacks in women under the age of 50. And, most surprisingly, many of whom are otherwise considered healthy by most standards. While SCAD has been shrouded in mystery since its 2010 emergence (into the mainstream, at least), Fortman says that it’s been quietly making positive gains in the research world.
“We have a registry developed [including thorough demographic info and patient-centered outcomes], and we’re proactively informing women so they understand what this is and what the symptoms are,” Fortman says. “We don’t want them to say ‘Oh, that couldn’t be me, I’m a healthy 20, 30, 40something.’”
MHIF and its partnering organizations are doing their part to educate women, cardiologists, and ER physicians alike on how to recognize SCAD when it strikes. While the diagnostics are making strides, the tricky part that researchers, scientists, and the healthcare world at large are having to contend with is the other side of the coin: how can this subgroup of healthy women prevent this sometimes-deadly condition?
“While it’s a scary diagnosis, these women can make a full recovery. Right now, it’s like the rule of elimination—we’re learning how NOT to treat it. We know we can’t put a coronary stent in, like we do for men,” he says. “So often it’s time and recovery and treatment and lifestyle for these women going forward. An important minority, however, had a major heart attack or second SCAD event which highlights the importance of further research.”
Fortman says that the common denominator in SCAD symptoms is feeling “disbelief, like you’re taken by surprise,” not the hallmark breathlessness and chest pain associated with heart attacks. “When these women get seen, their doctors aren’t directly launching into treating their symptoms as a heart attack,” she says. “We’re trying to fix this.”
Know Your Risk
Being at risk for a heart-related event comes down to a variety of factors. “A portion of it is genetics,” says Fortman. “The other portion is: did you undergo cancer treatment? Are you going through menopause? Are you experiencing depression? What was your pregnancy history—did you have preeclampsia, or deliver a preterm baby? All of those things can put you at a heightened risk.” We can reduce our risk by a whopping 80 percent just by being active, eating our greens, abstaining from smoking, avoiding added sugars, etc., etc.
The keys to a healthy lifestyle aren’t anything we haven’t heard before but what does come as a bit of a shock is just how much our psychological state can influence heart health and other conditions that used to be intrinsically tied to external factors.
“Mental health can contribute up to 30 percent of your overall heart risk,” she says. “That can be everything from social isolation to stress and severe depression.” Data shows the power of a five to 10 minute practice of gratitude or mindfulness can physically alter the neuroplasticity of our brain. Teaching our brains to be more optimistic can help lower blood pressure and our fight-or-flight response.
“For the last three years, we’ve done this event in August specifically designed to connect women together,” says Fortman. “We know our mental health helps our physical health, so we corral about 300 women together to talk about our hearts amongst a panel of cardiologists.” While big-person events are no longer a thing at the moment, MIHF pivoted to mailing boxes to past women attendees with contents that included a playlist of songs, inspirational perspectives, recipes, and an online marketplace.
What we consider a “full life”—being a mother, a professional climbing the corporate ladder, a loyal friend, partner, daughter—and keeping these expectations on ourselves in the midst of a centennial pandemic (!) is just piling on additional health risks. “We have to take a pause and look after our own health, our own hearts,” adds Fortman. “We’ve frankly done a poor job of that, and this is a special time in history. All of these responsibilities are driving women out of the workforce. With outside societal support missing from the equation, it’s shining a light on how unsupported moms are right now.”
“Encourage the women in your life to talk about their hearts. What do you do to unwind? What do you do to relax? How have you improved exercise in your life? And mindfully keep the conversation going.”