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On a sunny day in Bellevue, Washington, in June 2011, I had just finished a physical training class when I felt a strange sensation of intense muscle fatigue in my whole body. I started to sweat. The top of my left arm ached, a deep pain next to the bone. I raised myself to take the air quickly. I became nauseated. A fist was pressing against my spine through my chest. I was 56 years old, I am an exercise enthusiast, a non-smoker and a retired nurse in cardiac care. And yet, I did not know that I had a heart attack.
I did not feel anything I had imagined. It turns out that it's hard to recognize a heart attack the moment it happens. What I did not understand until much later was that a plaque had broken in the right coronary artery and caused a clot to form, thus depriving my heart – and my brain – of oxygen. I knew something was wrong, but not what, and it was hard to think clearly. Was it serious? It just seemed weird. I should have asked for help, but I was heading to the parking garage instead.
There, my symptoms eased as quickly as they arrived. I had recently stopped taking a prescription medication for heartburn and I concluded that I had a rebound indigestion. I called my husband, a doctor, and asked him to run to the store to do grocery shopping for dinner. I told him that I felt bad for a few minutes. Stopping this medicine was difficult, I say. If that's what a heart attack feels like, I added, it really hurts. I became aware of it, I did not shoot any alarms, I gave no indication of my suffering.
On the way back, my symptoms came back in strength. Now I had to merge on a main highway, then on a second, and navigate the traffic at rush hour. I lay on the steering wheel, beating myself for air. My sight is narrowed. Instead of shooting on the side, I left, taken by a desire to go home. The clarity of the judgment was evaporated, a dangerous symptom of lack of oxygen.
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Women with heart attacks take an average of 30 minutes longer than men to get to the hospital.
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Why did my symptoms subside and then relapse? Most likely, the blood had temporarily bypassed the clot, restoring the flow through the damaged tissue, flooding my heart muscle with oxygen. But then the clot is formed again. This occurs frequently during heart attacks, which adds to the confusion that many patients experience when symptoms disappear and then reappear.
At home, my neighbor, also a doctor, checked his mailbox. Can you help me, I asked? I have big problems. I rolled another 50 feet into my driveway and handed him my keys and cell phone through the open window of my car. I sank quickly, desperate for air, soaked in cold sweat. My arm hurt. The nausea was overwhelming. My neighbor tells me that my skin has become gray. I heard sirens. "They are coming," he assured me.
Arrived firefighters are the first to evaluate through the window of my car. "Slow down your breathing," they shouted. "Stop hyperventilating. You must answer our questions. But I could not answer. I was trying to surface depths too deep to speak. They ignored my neighbor, who urged them to treat me as if I had a heart attack. "Answer our questions," they shouted again. I felt myself escaping. A medical truck appeared. "Stop breathing so hard," they shouted. These useless guidelines lasted for some time. Firefighters and doctors have not recognized that one of the main symptoms of a woman suffering from a heart attack is extreme shortness of breath.
A plethora of recent research shows that women have different cardiac symptoms than men. According to a 2016 statement from the American Heart Association, published in the journal Circulation, women are less likely than men to experience chest pain. More of them have symptoms like mine: shortness of breath; muscle weakness and fatigue; abundant and cold perspiration; atypical chest pain (or pain in the arm, jaw and back) and indigestion. When medical providers and patients do not recognize these symptoms, the consequences can be fatal.
Signs of danger for women
Women often have one or more symptoms of heart attack unrelated to chest pain. The Mayo Clinic summarizes these things:
- Pain in the neck, jaw, shoulder, upper back or abdomen
- breathlessness
- Pain in one or both arms
- Nausea or vomiting
- Sweat
- Dizziness or vertigo
- Unusual tiredness
The latest comprehensive study on the subject, a study conducted in 2017 by the American College of Cardiology, shows that women are twice as likely as men to die within 30 days of having a heart attack. After a year, they are still 50% more likely. Why? One of the factors is that women are older on average when they have seizures and are more likely to have associated diseases such as diabetes.
However, according to a study published in the 2017 Journal of the American Heart Association, the key problem is that women with heart attacks take an average of 30 minutes longer than men to get to the hospital . Like me, they are more likely to misinterpret or erase symptoms. A 2018 Swiss study published in the European Heart Journal showed that women with heart attacks wait an average of 37 minutes longer to contact medical authorities.
When my symptoms suddenly subsided in front of the doctors – the clot broke up and let more oxygen in – they led me to their van to get what they called a "superficial" electrocardiograph. But walking is a dangerous thing for someone with a heart attack. In another moment, my symptoms broke out again. The doctor was speechless while reading the EKG. He started taking oxygen, placed two infusion tubes and injected morphine. My neighbor appeared with a baby aspirin. As the truck returned to the same road I had just negotiated, my heart began to beat at an irregular pace. "Atrial fibrillation," the doctor murmured. The right coronary artery, I said to myself. A heart attack, definitely.
The emergency room was fuzzy: a team of seven or eight people, a chest x-ray, another electrocardiogram, more morphine, oxygen. My husband arrived in his own car. "I love you," I tell him as they chased me away. "Tell the kids that I love them." I thought maybe it was the last time I saw him.
Fortunately, the cardiologist was able to clean the clot and place a stent in my artery. I recovered in the cardiac care unit without complications and three subsequent stress echocardiograms showed no damage. I had reached the hospital within two hours required to save the heart muscle, one of the key factors in survival and recovery. J & # 39; lived.
My parents did not do it. My big risk factor, which I'd spent all my life trying to alleviate, was that I was the descendant of generations of deceased young people with cardiovascular disease: my mother at age 53, my father at 62, my maternal grandmother, 40 years old. A high cholesterol level prevailed in our family, for which I took Lipitor. But it's difficult to counter genetics, even though I tried.
Cardiovascular disease remains the leading cause of death for both women and men, and women experience slightly more than half of fatal heart attacks. Morbidity and mortality rates from attacks are decreasing for both sexes, but women are dying in a higher proportion than men. And as stated in a 2016 National Institutes of Health circular, among women under 55 – and I was close, at 56 – women's mortality has not decreased.
Three months after this experience, I had a series of conversations with the County Emergency Services, Medic One, to encourage them to commit to retraining firefighters and doctors who had mismanaged my treatment. The gender gap in cardiac care, from first contact with physicians or first responders to hospitalization, has improved in recent years, but persists. Despite the awareness, women still arrive at the hospital more slowly than men. Time is everything in a heart attack. Women must recognize the signs of danger, even when in doubt, and get the immediate help we need.
-Mrs. Oliveira is the author of three novels, including the most recent, "Winter Sisters," published in pocket earlier this month by Penguin Books.
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