Feature

Subtle Danger Signs

In Women, Heart Attacks Can Be Hard to Recognize

Brenda Dively describes herself as someone who rarely gets sick. So in August 2015, when she came down with flu-like symptoms—dizziness, nausea, fatigue and shortness of breath—she brushed it off for days. She even continued going to work at Pollywog Place, the daycare and preschool where she was teaching at the time.

After a week or so, however, Dively still wasn’t feeling any better, and she had a nagging feeling that “something just wasn’t right.” So she decided to seek medical care—a decision that probably saved her life.

“I wasn’t getting better, my blood pressure was low, and I was getting more and more concerned that something serious was wrong,” says Dively, of New Market, who is now center manager for Pollywog Place in Strasburg. “I wasn’t having what I thought were typical heart attack symptoms, but I really felt I needed to get checked out.”

Dively’s husband, Craig, called 911, and she was transported by ambulance to Sentara RMH Medical Center. Diagnostic tests confirmed that Dively was indeed having a heart attack. Her heart ejection fraction, the measure of how much blood the left ventricle pumps out with each contraction, was 15-20 percent—much lower than the normal range of 50-70 percent. In addition, she had diabetic ketoacidosis, a life-threatening complication of diabetes that results from the body’s inability to produce enough insulin, as well as from a buildup of blood acids called ketones.

Dively was admitted to the hospital’s Critical Care Unit, where the medical team worked to stabilize her condition in preparation for a heart catheterization, scheduled for two days later. The night before the procedure, however, Dively went into cardiac arrest. Fortunately, the fast-acting heart care team at Sentara RMH was able to resuscitate her.

“I’m so thankful I went to the hospital when I did, because otherwise I probably would have gone into cardiac arrest at home, and I might not have survived that,” says Dively, who was 47 at the time. “I was definitely in the right place at the right time.”

Dively underwent the catheterization as planned. To give her heart a chance to rest and recover, Nadim Geloo, MD, an interventional cardiologist who has since left Sentara RMH, inserted an Impella® heart pump, a small device that temporarily takes over the job of pumping blood through the body. The device is inserted via catheter through a small incision in the femoral artery, the large artery of the leg.

Once the Impella pump was functioning, Dr. Geloo placed a stent into Dively’s left anterior descending artery—a main pathway for blood—to open up the blockage found during the cath procedure.

“We only use the heart pump when patients need cardiac output support, and/or when the stenting procedure is high-risk,” says Brad Rash, MD, a cardiologist with Sentara Cardiology Specialists who specializes in women’s heart health. “Mrs. Dively’s blockage location was really high-risk, as it was very high up on the artery, which stunned the heart muscle and severely reduced her pumping function. It was quite a dramatic presentation in such a young person.”

Dively was one of the first patients at Sentara RMH to use the Impella device. The pump was removed after 24 hours, and then her own heart went back to work.

“The care I received at Sentara RMH was phenomenal,” says Dively, who since has had the opportunity to tour the Boston facility where Impella devices are made and to meet the people who worked on the device that helped save her life. “I was extremely impressed with how knowledgeable my Sentara RMH caregivers were about cardiac care, and I was so grateful to be able to have access to the Impella heart pump—which may have allowed me to avoid open-heart surgery. We’re so fortunate to have such excellent quality of care and access to medical technology here in our community.”

The Biggest Risk to Women’s Health

Like Dively, many women don’t recognize the signs of a potential heart attack, often dismissing their discomfort as acid reflux, the flu, or just the normal aches and pains that come with aging. While many women do experience the same heart attack symptoms as men—including chest pain or pressure, shortness of breath, or pain in the left arm—they also may experience more subtle signs like fatigue or nausea, according to Dr. Rash. Women also may experience pain in the jaw or abdominal region—or, as in Dively’s case, an uneasy feeling that something isn’t quite right.

Even though heart disease is the leading cause of death for women in the United States, according to the American Heart Association, just one in five women believes she could be at risk for the disease. That’s why it’s critical for women to know the signs of a cardiac event.

“Sometimes women simply feel like something’s wrong, but they can’t put their finger on the cause,” says Dr. Rash. “We don’t know all the reasons why some women experience symptoms that are different from those experienced by men, but women in general need to have a better understanding of the signs of heart disease—that’s key to saving more lives.”

Heeding Heart Symptoms

For Leslie Wagner, her family’s Thanksgiving 2017 celebration was followed by two nights of chest discomfort. Since holiday preparations often can be stressful, Wagner figured she just had heartburn, triggered by a combination of anxiety and indulgence in larger-than-normal portions of rich, fatty foods.

That Sunday, Wagner went to two church services and took a walk. Still experiencing chest pain, she decided to go to the doctor the next day. As she was getting ready for bed, however, she felt a sharp chest pain and had to grab on to something for support. Somewhat alarmed, she checked her blood pressure—which was high—and immediately decided to go to the Sentara RMH Emergency Department (ED).

“The Lord went before me, because even though it was a holiday weekend, and even though the ED was really crowded, the medical team took me in right away,” says Wagner, of Mount Solon, who was 53 at the time. “Less than two hours later, I was diagnosed with a heart attack.”

The next day, Wagner underwent a cardiac catheterization. Interventional cardiologist David McLaughlin, MD, found that she had a 95-99 percent blockage in her left anterior descending artery, and a stent was inserted to open up the artery.

“I can’t say enough praises for the medical team who took care of me,” says Wagner. “From the moment I walked in, there was no delay in my care—even on a holiday weekend. Everyone took my symptoms seriously, and I felt totally safe. I even sent my husband home to get some sleep—that’s how comfortable I felt there.”

A Safety Net for Recovering Heart Patients

Cardiac rehabilitation at Sentara RMH was an important part of the recovery process for Dively and Wagner, both of whom say they have adopted healthier eating and exercise habits since their respective cardiac events.

During each cardiac rehab session, Sentara RMH’s specially trained cardiac team monitors the patient’s heart rhythm and blood pressure during exercise. In addition, the team provides education about heart-healthy behaviors like exercise, proper nutrition and stress management.

“Cardiac rehab has been shown to improve outcomes and decrease mortality rates after a heart attack,” says Dr. McLaughlin. “It’s a good way for us to keep a close eye on our heart attack patients during this critical period, when there’s potential for problems with new medications or changes in blood pressure and heart rate. During cardiac rehab, patients are monitored in a controlled environment by nurses who can keep a check on their symptoms—so rehab really serves as a safety net for patients.”

Since heart patients often deal with fear and uncertainty after an event like a heart attack or coronary arrest, cardiac rehab also can serve as an emotional safety net.

“Every single pain in your chest alarms you,” says Wagner. “Even if it’s indigestion or something insignificant, you worry about it. In cardiac rehab, I was attached to monitors, and the medical professionals there could let me know that my heart wasn’t in any danger. They offered me real encouragement, and that gave me a lot of assurance and comfort during a trying time.”

Do You Know Your Risks?

The risk factors for heart disease that are shared by men and women include:

• High cholesterol

• High blood pressure

• Smoking

• Family history of heart disease

• Diabetes

• Obesity

• Sedentary lifestyle

Risk factors specific to women include:

• History of pre-eclampsia

• History of gestational diabetes

• Early menopause

Take Care of Your Heart!

Almost 80 percent of cardiac events are preventable, according to the American Heart Association. While your primary care doctor or cardiologist can offer a variety of tests to evaluate your risk factors and customize a plan to manage those risks, here are some steps you can take right now:

•    Stop smoking. If you’re having trouble quitting, talk to your doctor about the many options that can help you kick the habit.

•    Reduce stress. Find positive ways to manage stress, including meditation, reading a favorite book, taking a walk or visiting a friend.

•    Get plenty of exercise. The American Heart Association recommends a half-hour of moderate aerobic activity at least five days a week, along with moderate to high-intensity muscle strengthening exercises two days per week.

•    Eat healthy. Try a Mediterranean-style diet, which emphasizes fruits, vegetables and whole grains; nuts and legumes; and olive oil, while limiting meats and sweets.

ProEx for a Healthier You!

Exercise is good medicine for heart patients. Sentara RMH Wellness Center’s Progressive Exercise Program—also known as ProEx—is an eight-week program during which fitness specialists design a customized exercise plan based on each participant’s medical needs and personal fitness goals. ProEx participants have full access to the Wellness Center, including group fitness classes, weights and exercise equipment, during the program.

“Patients who have had a heart attack or other cardiac event are often eager to continue the work they began in cardiac rehab,” says Ali Snook, fitness coordinator at the Wellness Center. “ProEx can help them adapt to a new exercise program that will help them improve their overall health. That can help them gain confidence and peace of mind.”

Patients who complete cardiac rehabilitation at Sentara RMH are eligible to enroll in ProEx at no cost, thanks to funds provided through the RMH Foundation. The fee for other participants is $60. Upon completion of the program, participants may become members of the Wellness Center with a reduced initiation fee.

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