“Time is muscle.” That was the mantra I learned in my fellowship training. What it means is: The longer a heart attack victim has to wait before being treated, the greater the potential damage to the heart muscle. To me, as a young doctor on call in the hospital overnight, it meant that the longer it took me to get out of the on-call room bed, get to the patient in the ER, evaluate and treat, the greater the chance that the patient’s heart could be scarred for life. Talk about pressure! I used to sit up all night and wait even if things got quiet, just in case someone came in with a heart attack. Some doctors nap when they are on call, but I would sit with a huge cup filled with ice, then ½ water and ½ apple juice that I would find unused on patient food carts. I would alternate drinking that apple juice with cups of coffee all night long. I had jelly beans in my lab coat pocket for quick energy, and I would chew packs and packs of gum throughout my shift until morning came and the new team arrived. To me, this was my only option. Time is muscle, and I wasn’t going to have anyone’s heart muscle destroyed unnecessarily on my watch!
This vigilance, no matter how crazy it might have looked to my colleagues, paid off on multiple occasions. Women often came into the ER with shortness of breath, nausea, vomiting, sweating and chest discomfort, and I needed to make sure I evaluated them in time. Although their symptoms were often atypical (although not, as it turns out, atypical for women), many of these women were indeed having heart attacks. We were learning then, and women’s symptoms were often misdiagnosed as being something other than heart disease. Statistics show that within the first month after suffering a heart attack, women are twice as likely to die. Within the first year after a heart attack, they are 50% more likely to die. The more I learned, the more shocked I became. I felt that I needed to do everything I could to help change these stats. It was devastating—and it became my life’s work.
But that was a long time ago—about 20 years ago, in fact. Surely things have changed. It’s a whole new century with 20 more years of research and technological progress. Surely by now, we have moved beyond these statistics—doctors must easily recognize a heart attack in a woman. Patients who suffer heart attacks must have a much better chance of post-event survival. Right?
Studies show otherwise. On those front lines, where EMTs in the field and doctors in the ER see heart attack victims all the time, it is still all too common that cardiac care for women gets unnecessarily delayed due to misdiagnosis or ignorance of the esoteric nature of symptoms in women. And that means more heart muscle damage. More subsequent risk of death. Time is muscle.
In her Wall Street Journal essay, I Had No Idea I Was Having a Heart Attack, Robin Oliveira, a retired nurse, describes the challenging and often typical scenario of a woman suffering a heart attack: the symptoms that don’t seem obviously heart-related (nausea, vomiting, extreme fatigue, shoulder and back pain)…the lack of urgency and immediate diagnosis on the part of EMTs and ER doctors…and the reality of the neglect that women suffer all too often when they have a heart attack or heart disease. The author relates her own worrisome family history of heart attacks—her mother died of a heart attack at 53, and her father died of a heart attack at 62. Even though she took cholesterol-lowering medication and was a medical professional, she did develop heart disease and she did have a heart attack.
Yet even women with a family history of heart disease are still, frustratingly, misdiagnosed, resulting in treatment delays. What are we to do about this problem? Do we have options? Do we have any power?
Fortunately, we do. The reality is that for Ms. Oliveira and other women like her (and for all women), heart disease doesn’t just appear out of nowhere. There are signs and there are warnings. The scary part is that we don’t always see them and can’t always feel them. The only way to catch them is to be proactive and brave in assessing your own personal heart truth. If a doctor or an EMT may not recognize your heart issues, then the simple fact is that it may be up to you.
I had a patient tell me the other day that she thought I had a scary job. Recalling those fellowship days in my early career, I used to think so too! But now I know that there is a predictable process by which heart disease develops, and understanding it can help to prevent those scary moments from happening. Today, instead of staying up all night popping jellybeans and chewing gum to stay awake, I spend my energy getting out this one message: There are ways to protect yourself! Heart disease almost always develops not just due to a possible genetic susceptibility but because of lifestyle factors. It all goes back to basics:
- Get tests to understand your cholesterol level, blood pressure, blood sugar and a coronary artery calcium score (a screening test for plaque in the arteries). Tell your doctor you want to establish a baseline so you can best monitor your own health.
- Stop smoking. (That goes without saying…)
- Exercise regularly—at least 3-5 days a week—and get your heart rate up!
- Get to a healthy weight.
- Manage your stress.
- Eat a heart-healthy diet full of vegetables, fruits, whole grains and healthy fats
- If you need medication to lower your risk factors, don’t dismiss this option! It could save your life.
- If you think something is wrong, seek medical attention immediately. Don’t make excuses.
- Take your health seriously. Be proactive. Let your voice be heard and advocate for yourself.
- Don’t put yourself on the bottom of the list. Make your health a priority.
Although it would be nice if doctors caught every heart attack within seconds, the truth is that you, who might actually need care and help someday, may have to demand it. Although Ms. Oliveira needed help and care and didn’t get it as quickly as she should have, she was lucky enough to receive medical attention within the time frame necessary, without dying and without having muscle damage. Not every woman is so lucky.
Bottom line: For now, at least, this one is on us, ladies. It’s in our laps, in our hands and, yes, in our hearts. We need to be the force that drives this story. We need to be more in charge of our health. We need to demand care and attention, and we need to take advantage of the many known preventive strategies available to us. We need to ask for tests that can detect disease before it gets too advanced. We need to take medication if we need it, eat a diet that works for us and is nutritionally complete, exercise to keep our hearts strong, get to a healthy weight where we feel good and our heart isn’t unnecessarily burdened—in other words, know and manage our risk factors and get regular and routine follow-up.
Today, my job isn’t nearly as scary as it used to be, but the landscape for women is just as scary as it was 20 year ago. I know that with aggressive prevention, we could get this disease under control. I can’t speak for the many clinical care teams taking care of women’s hearts across the country and the world. Each team and each scenario has its challenges. But the simple fact is that time is muscle, and that is something every woman should understand. Let’s stop depending on a system that is not yet quite adequate and tackle this disease on our own time. Let’s take charge of our own health. Let’s demand early prevention and early detection. Let’s prevent this story from happening to any woman ever again. When that happens, my job won’t be scary at all.
Click here to buy Dr. Suzanne Steinbaum’s book, Dr. Suzanne Steinbaum’s Heart Book: Every Woman’s Guide to a Heart-Healthy Life