Archive | September, 2010

A foreshortened future

27 Sep

Cardiac psychologist and heart attack survivor Dr. Stephen Parker recently described a symptom of Post Traumatic Stress Disorder that rang a bell for him after his own cardiac event. The PTSD symptom is called “a sense of a foreshortened future“. In other words, after a traumatic event – in this case, a heart attack – the patient “does not expect to have a career, marriage, children, or a normal life span.” Dr. Steve tells his own story of this symptom in his Heartcurrents blog:

“Three months after the heart attack, I went to Home Depot to buy something for the house. I walked inside, saw the plethora of nice things to make a nice house, and started feeling extremely depressed.

“What was the point? I knew I was going to die within a short time.   (more…)

Say what? Do patients really hear what doctors tell them?

23 Sep


When I had a heart attack two years ago, I was taken immediately from the E.R. to the O.R. for emergency treatment, including cardiac catheterization and a stainless steel stent implanted in my left anterior descending coronary artery that turned out to be 99% blocked.

But, overwhelmed and terrified, I knew nothing of what was about to happen to me, even though I have a vague memory of the cardiologist explaining something to me before I was taken upstairs. I don’t think I was even capable of comprehension at the time. What I learned much later was that my tiny  stent may help a newly-opened artery to stay open.

But a new study now suggests heart patients believe that stents have far greater benefits than they actually do, the Boston Globe reports.  (more…)

Long distance running: safe for women’s hearts?

19 Sep

Eighteen years ago, when my YWCA running group completed our very first half-marathon event, we all crossed the finish line together holding hands. And weeping! Tear-streaked race number bibs are how you can the spot first-time distance racers.

There was interesting news for distance runners last month from the European Society of Cardiology meetings in Stockholm: distance runners appear to develop some transient heart changes during races, but overall these activities don’t seem to mean long-term cardiac harm for the vast majority of runners.

But there do seem to be some gender differences in heart changes, particularly among black women.   (more…)

The heart patient’s chronic lament: “Excuse me. I’m sorry. I don’t mean to be a bother…”

15 Sep

Two weeks before being hospitalized with a heart attack, I was sent home from the Emergency Department of that same hospital with an acid reflux misdiagnosis, despite presenting with textbook heart attack symptoms like chest pain and pain radiating down my left arm.  At that first visit, I left for home feeling embarrassed and apologetic because I’d just wasted five hours of their valuable time. I felt so embarrassed, in fact, that I even sent the staff in Emergency a sheepish little thank you note the following day apologizing once again for making a fuss over nothing.

Not making a fuss is a valued trait for many of us strong women, but this tendency can cause disastrous cardiac outcomes if it makes us reluctant to demand immediate medical attention when we need it most.

Consider this compelling example shared with the online community of WomenHeart: The National Coalition of Women With Heart Disease. It was written by a 49-year old American heart attack survivor from New Mexico. Like me, you too may also be able to relate to her tales of chronic apology:

“It dawned on me today how many times I said I was sorry on Thursday when I had to go to the hospital to have a cardiac angiogram done.

“The first time was when I phoned the doctor, even though he had told me to call right away if I had any more chest pains and I had already waited three days before calling. But still, I apologized for bothering him.

“When he told me to go to the ER, my 15-year old daughter was in the car with me. I apologized to her.

“I then had to go get my husband at work so that he could drive me the rest of the way to hospital. He was getting lunch for everyone at the office for a very important meeting, so I apologized to him, too.  (more…)

What is causing my chest pain?

11 Sep

First of all, I think even using the word “pain” to describe a common heart attack symptom may be misleading for many women.

It’s important to remember that up to 40% of women experience no chest symptoms at all during a heart attack. And since my own heart attack, I have met countless women who describe their chest symptoms not as pain, but in one of these ways:

  • pressure
  • squeezing
  • choking
  • numbness
  • tightness
  • heaviness
  • fullness
  • burning

These symptoms – called angina pectoris -  can appear not only in the chest area, but also in the neck, throat, or upper abdomen, and can be associated with discomfort in the jaw, shoulders, head, or both left or right arms.

Cardiologist Dr. Richard Fogoros reminds us that “these symptoms can last from less than a second to days or weeks, can occur frequently or rarely, and can occur sporadically or predictably. With such a broad definition, you can see why the term ‘chest pain’ is in itself of little help to doctors.”  

It’s also important to remember that there are some heart attacks that are accompanied by extremely atypical symptoms. When I was at Mayo Clinic after my own heart attack, I met two women there whose only symptoms in mid-heart attack had been a persistent cough and numbness in the lower lip respectively. For more on the wide variety of actual heart attack symptoms in women, read How Does It Really Feel To Have A Heart Attack? Women Survivors Tell Their Stories

Angina can also occur in the absence of any coronary artery disease. Up to 30% of people with angina with a heart valve problem called aortic stenosis, which can cause decreased blood flow to the coronary arteries from the heart, can have angina. People with severe anemia may have angina because their blood doesn’t carry enough oxygen. People with thickened heart muscles need more oxygen and can have angina when they don’t get enough.

When it comes to chest pain, Dr. Fogoros adds that it’s important to keep in mind that chest pain is merely a symptom, not a diagnosis. And because it can be a symptom of anything from a catastrophic to a trivial medical problem, when a person experiences chest pain it’s important to try to characterize that pain as rapidly as possible as being either completely benign or possibly significant.

He offers the following list of the more common causes of chest pain:

  • angina due to coronary artery disease
  • angina due to coronary artery spasm (Prinzmetal’s Angina)
  • angina due to coronary microvascular disease (sometimes referred to as Coronary Syndrome X)
  • heart attack
  • heartburn (acid reflux)
  • benign chest wall pain
  • costochondritis, an inflammation of the cartilage that connects a rib to the breastbone
  • anxiety or panic disorder
  • asthma, bronchitis, pneumonia, pleuritis
  • mitral valve prolapse
  • pericarditis
  • recent chest trauma
  • peptic ulcer
  • aortic dissection
  • Thoracic Outlet Syndrome *

Let’s look at the condition on this list called benign chest wall pain as an example. In young, healthy people presenting with chest pain, this diagnosis is particularly common according to Dr. Fogoros. He believes that doctors do not understand this condition very well, and consequently neither do their patients.

“Because this condition is completely harmless, the lack of understanding on the part of patients as to what is causing the pain often leads to months or years of needless worry or anxiety.”

Read specific details about each condition that may cause chest pain in the original article from Dr. Richard Fogoros.

See also:



“I’m not depressed!” – and other ways we deny the stigma of mental illness after a heart attack

7 Sep

“This is the most thorough review article I have seen on psychological interventions after heart events,” writes cardiac psychologist Dr. Stephen Parker about a recent UK study on heart patients. And he should know. Dr. Steve is also a heart attack survivor himself who has explored his own profound experiences with the depression and anxiety that commonly accompany any cardiac event.

The study, reported in the British Journal of Cardiology in July 2010, followed over 400 London heart patients for two years – of whom at least half showed symptoms of anxiety or depression when first interviewed.  But the study authors described their participants in this way:

“Many of these heart patients were reluctant to accept a diagnosis of anxiety or depression and expressed reservations to the clinical psychologist by rejecting the term ‘depression’ for describing their problems, or by expressing negative views about attending a mental health service for treatment.”

In fact, these ‘negative views’ associated with the stigma of having mental health problems were so strong that all psychological interventions studied were provided to heart patients as part of a scheduled Cardiac Rehabilitation program at St. Thomas’s Hospital in London instead of at a mental health facility.   (more…)

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