“It’s 2 a.m. and I think I’m having a heart attack”

7 Feb

by Carolyn Thomas    @HeartSisters

“It’s 2 a.m. and I think I might be having a heart attack. Right now I have a tight chest and pain in my left arm and in my elbow that comes and goes; early this week, I was having pain in my left and right legs. What should I do?”

“I’m sitting in bed and have been up for hours. For four days, I have been having upper right back pain up to the neck. I cannot turn my head left. Tonight I have pain in my elbow and a tingling all the way down my right arm and to my fingers. I’m only 29 and a healthy weight. I need some answers. Do I need to go to the ER?”

“I have most of these symptoms.  My mom thinks I’m fine. I really think she doesn’t understand. I can be heading to a heart attack any day soon. And I’m only 14, almost 15 in a couple of days.”

These represent just a tiny sampling of the symptom questions that my blog readers often send me. My response to each of these is virtually always some variation of this statement:   Continue reading

Finally. An official scientific statement on heart attacks in women.

31 Jan

“Sucks to be female. Better luck next life!”

You’re unlikely to spot this succinct summary within the pages of the new official scientific statement on women’s heart attacks from the American Heart Association, but that’s basically the message.(1)  That pithy summary, by the way, was originally quoted here from Laura Haywood-Cory, who at age 40 survived a heart attack caused by Spontaneous Coronary Artery Dissection.  (See also: Cardiac Gender Bias: We Need Less TALK and More WALK.
 .
The AHA statement, published this week in the journal Circulation to a flutter of media interest, basically confirms what I’ve been writing and speaking about for the past eight years: if you’re a woman having a heart attack, you’re more likely to be underdiagnosed – and then undertreated even when appropriately diagnosed – compared to our male counterparts.   So my question this week (as a woman who was sent home from the ER in mid-heart attack with a misdiagnosis of acid reflux) is this:  if Laura and I and countless other women who’ve survived a heart attack have long ago reported on this “news”, why has it taken 92 years for the American Heart Association to produce its first ever scientific statement on myocardial infarction in female patients?  But don’t get me wrong – I’m always relieved to see any attempt from any major heart organization that helps to spread the word, so I’m running the full AHA news release for you here:  

Continue reading

Depressed? Who, me? Myths and facts about depression after a heart attack

24 Jan

fake-smile

by Carolyn Thomas    @HeartSisters

I have a friend who has a friend who’s been depressed, off and on, for years. During that time, my friend and I have done our fair share of eye-rolling whenever the subject of this person’s depression came up. We wondered why she just couldn’t pull up her socks and quit all this self-absorbed moping around.

Neither my friend nor I had ever had one nanosecond of actually experiencing clinical depression ourselves – which, of course, didn’t stop us from passing judgement.  Continue reading

Why don’t we listen to doctors’ heart-healthy advice?

17 Jan

change lifestyle cartoon cathy thorne

by Carolyn Thomas  @HeartSisters

Imagine that your daughter is preparing for a ski race. It’s five minutes before the start of the race. You want to give her some meaningful advice. Which one of these two messages are you going to use?

1. “Honey, remember to do XYZ – it will help you avoid falling!”
2. “Honey, remember to do XYZ – it will make you faster and you’ll have more fun!”

Austrian physician Dr. Franz Wiesbauer, writing to his fellow doctors in a Medcrunch article called Why Your Health Message Does Not Work, has asked this question many times. His conclusions?  Continue reading

Heart attack: is it a clogged pipe or a popped pimple?

10 Jan

by Carolyn Thomas      @HeartSisters

decisionsWhen my little sister Bev was booked to have her tonsils removed at age six, our family doctor declared that I must have mine out at the same time – not because there was anything at all wrong with them, but because I was already 12 years old and, for some inexplicable reason, I still had my tonsils intact!  (Back then, kids with tonsils were apparently an endangered species. As New York ear/nose/throat specialist Dr. Steven Park described the historical take on tonsils: “In the 50s to 70s, it was a given that if you had tonsils, they were removed.”)

On our designated procedure date, Bev and I were admitted to the pediatric ward at St. Catharines’ Hotel Dieu Hospital together.  I remember this experience vividly because the archaic rule at the Hotel Dieu back then was that all pediatric patients had to wear diapers overnight.  DIAPERS! As a humiliated almost-teenager, I pleaded with my mother to convince the ward nurses that I most certainly did NOT need to wear diapers at my mature age! But rules were rules, and I somehow managed to survive both an unwarranted surgical procedure and its associated diaper humiliation.

It turns out I wasn’t the only person questioning the wisdom of taking out a perfectly fine pair of tonsils based on flimsy if any medical evidence.  Decades later, many researchers – including in this U.K. study published in the journal Archives of Disease in Childhood (1) – blamed not only the physicians who recommended the routine surgical removal of tonsils (and often adenoid glands at the same time) to treat childhood sore throat, but also “parental enthusiasm” as the factors influencing an entire generation of higher-than-necessary rates of surgery.

“Despite the enthusiasm with which tonsillectomy is offered and sought, there is little evidence of efficacy.”

I like this tonsil analogy to illustrate how medical attitudes, no matter how pervasive, can indeed change over time as our physicians rethink the status quo in order to embrace evidence-based medicine.

In other words, just because we’ve been doing this for a long time, is there any evidence that it’s actually what needs to be done? 
Continue reading

What if I’d had my heart attack decades earlier?

3 Jan

by Carolyn Thomas  @HeartSisters

“When I first became a GP in England well over 30 years ago, the early diagnosis of myocardial infarction (heart attack) was a matter of slight importance, since there was no intervention which made any difference to survival.

“You tried to reach patients in their homes quickly to relieve their pain with heroin, but only sent them to hospital if their pain was not controlled, or they were going into shock.  Studies at the time indicated that patients with heart attacks survived better at home, where they were less likely to be killed with injections of lidocaine.”

Quite a difference, according to Dr. Richard Lehman, writing this in the British Medical Journal, compared to modern cardiac care options like clot-busting thrombolytic drugs or invasive coronary angioplasty procedures that are now routinely available to patients presenting with heart attack symptoms these days. (Unless, of course, you happen to be a woman in your 50s presenting to the E.R in mid-heart attack, in which case, as reported in the New England Journal of Medicine, you are seven times more likely to be misdiagnosed and sent home compared to your male counterparts with the same symptoms).(1)  But I digress . . .      Continue reading

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