Top 10 most-read Heart Sisters posts from 2021

by Carolyn Thomas    ♥   @HeartSisters  

Looking back on what I wrote about here during 2021 was a reminder to me that, in the world of women’s heart health, I seem to be all over the map. And I rarely write about regular heart stuff like cholesterol or drugs or heart-healthy recipes (because people above my pay grade write far more efficiently elsewhere about those things!)  Here, for example, are the Top 10 most-read Heart Sisters articles during this past year:

The weirdest stuff I’ve learned about women’s heart disease:  This article, written for Heart Month in February 2021,   offered some of the weirdest examples of the weird cardiology gender gap. My personal favourite:  the National Emergency Medical Services Information System study which reported that,  if you’re a female heart patient being transported to the Emergency Department in an ambulance after calling 911 for help, you are less likely than male patients to receive recommended cardiac treatments en route (even aspirin!) – and also significantly less likely to have the ambulance sirens or flashing lights turned on.   This post also included the weirdest heart attack symptoms I’ve heard so far,  and some of the weirdest things that cardiologsts have said out lout to their female heart patients.

♥  Heart disease: decades in the making:  Also from February 2021 was this reminder that heart disease rarely strikes   out of the blue, but may in fact take 20-30 years to actually show up.  This fact is a shock to most audiences in my Heart-Smart Women presentations.  In other words, I didn’t have a heart attack because I ate a piece of bacon or had a stressful day at work. I had a heart attack because something – likely decades earlier – had damaged the delicate endothelial cells lining my coronary arteries.   This post explains why.

  My year of living COVIDlyI barely made it to mid-March this year before I had to start writing about our COVID pandemic again, as I’d frequently done last year.  This particular post looked back to the day when it hit home for me:  March 9, 2020. That’s when my sister Bev (who lives in Italy) reported that Italy was suddenly in nationwide lockdown because the country’s COVID-19 count there had exploded  from under 10 cases to over 9,000 within weeks. On the same day, we here in Canada recorded our first confirmed COVID death. From there, life for all of us became a dizzying decline – for those who became sick, the families and friends who grieved for those who had died alone, the overwhelmed healthcare professionals who cared for the sickest, the people who lost their jobs or their homes.  Yet in the midst of this surreal chaos, life somehow went on – my son Ben and daughter-in-law Paula announced, for example, they were expecting their long-awaited first baby (and our darling Zachary David Dunn was born this past spring).

  Heart FAILURE vs. Heart FUNCTION:  As part of my relentless one-patient campaign to convince the medical profession to stop telling heart patients out loud that they have heart FAILURE,  in April 2021, I wrote about a new editorial in the Journal of the American College of Cardiology that suddenly offered patients a glimmer of hope in getting that hurtful name changed. Cardiologists Dr. Anuradha Lala and Dr. Robert Wentz (who is also the journal’s editor-in-chief) wrote: “Few words in the English language universally invoke the negative emotions of fear and disappointment as does the word ‘failure’.”  My own wonky heart skipped a beat when I read that.  (See also, from September 2019: Would You Drive Your Car if Your Brakes Were Failing?

  How could YOU – of all people! – have a heart attack?  This post from late May included some brilliant quotes from  Dr. Wayne Sotile’s very useful book Heart Illness and Intimacy: How Caring Relationships Aid Recovery.. He talks about the “family scramble” that can happen when somebody in that family is diagnosed with heart disease.  And few things can heighten the family scramble, he claims, like the “wrong” family member getting sick. There were also several heart-wrenching reader comments in response to this post, confirming what I’ve observed so many times: sharing stories with others in the same boat can make us feel less alone. 

♥  This is your heart in hot weather:  In June 2021, British Columbia suffered a week-long record-breaking heat wave that resulted in the tragic deaths of over 600 people. Meteorologists called this unprecedented weather event a “heat dome”.  The heat was unlike anything we’d ever experienced. And because few homes here have air conditioning, and few if any of us expected that this freakish heat dome was potentially fatal, our provincial death toll was staggering. In mid-heat dome, I reposted a 2012 article about how hot weather hurts our hearts, and what we can all do to prevent heat stroke. 

Did you underestimate your cardiac risk?   I’ve been writing about Harvard researcher Dr. Catherine Kreatsoulas for several years because her expertise involves a unique area of linguistics: specifically, how women talk to Emergency Department staff during their heart attacks.  Right up my alley.  In her latest study, she found that women are significantly more likely than men to underestimate our own risk of heart disease – which is why we pay less attention to cardiac symptoms, which is why we delay seeking urgent medical attention, and which is why female heart patients have poorer outcomes than our male counterparts do.

 How I used to describe SCAD. And what I’ve learned since.    I’d never heard of Spontaneous Coronary Artery Dissection (SCAD) before I went to Mayo Clinic to attend their annual WomenHeart Science & Leadership patient advocacy training in 2008, five months after my own heart attack. SCAD was described at that time as a tear in the lining of a coronary artery wall, creating a torn flap that blocks blood flow through that artery to the heart muscle – thus causing a heart attack. Many physicians over the years have dismissed cardiac symptoms in young, healthy-looking SCAD patients who don’t fit the “old fat white guy” profile, a reality that has resulted in up to 80 per cent of SCADs likely being missed.  But in August 2021, cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic and a prominent SCAD researcher, moved the goal posts. She explained that she now believes most SCAD patients do not actually have a flap from a torn artery, but a bleed or a split called an intramural hematoma.

  New chest pain guideline: “atypical” is OUT!  The big news in the cardiology world in September 2021 was the release of the long-awaited first-ever Guidelines for the Evaluation and Diagnosis of Chest Pain for physicians and their patients in the U.S. We have long known that female heart patients are significantly more likely to be misdiagnosed compared to our male counterparts. These new guidelines remind us that chest pain is the most commonly reported cardiac symptom – for both women and men – and spell out this gender gap. For example, in the guidelines’ section called “A Focus On the Uniqueness of Chest Pain in Women” – you will you read this:

“Women who present with chest pain are at risk for under-diagnosis, and potential cardiac causes should always be considered.  It is recommended to obtain a history that emphasizes accompanying symptoms that are more common in women with Acute Coronary Syndrome.”

  When patient ’empowerment’ means doing the heavy lifting:    This was the article I almost didn’t write. That’s because the new Patients As Advocates document appears at first blush to be addressing the problem of women’s cardiac misdiagnoses. But this document points directly at you heart patients out there, implying that if you are not “part of the solution” to diagnostic error in medicine, then you’re clearly part of the problem. This is patently wrong-headed, as I explained in this December post. It’s disturbing to observe this public pivot away from educating the ones actually doing the misdiagnosing (while they’re using diagnostic tools that have for decades been designed and researched on white middle-aged men). Instead, women themselves are now being asked to do the heavy lifting that isn’t being adequately done by the medical profession.

Illustration: Virin, Pixabay

See the complete list of all published posts this past year (as well as links at the bottom of the page to 900+ archived posts dating back to 2009).

As always, I appreciate so much those of you who read my posts, and especially those who comment in response to what they read here – that’s over 14,500 comments so far!  I know from my behind-the-scenes WordPress stats crew that most of my readers are from the U.S. (five times more than the second place U.K.)  Canadians were in third place, followed by Australia, India, South Africa, Ireland, New Zealand, Philippines, and Singapore.

Wherever you live, I hope that 2022 will be a better year for all women living with heart disease, and for those who research, diagnose, treat and support us.  Please take care, and stay safe. . .

NOTE FROM CAROLYN:   You’ll find many more wide-ranging topics like those mentioned here in my book, A Woman’s Guide to Living with Heart Disease” (Johns Hopkins University, 2017). You can ask for it at your local library or favourite bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (and use their code HTWN to save 30% off the list price when you order).


Q:   What topics on living with heart disease are most useful to you?

12 thoughts on “Top 10 most-read Heart Sisters posts from 2021

  1. Hi Carolyn
    I am really interested in your blog and papers. I am reading your book. It is brilliant.

    I was diagnosed with Atrial Fibrillation and then following echocardiogram moderate to severe Left Ventricle Systolic Dysfunction in July 2021.

    I am 57 now. I am really interested in trying to raise awareness of the symptoms of Heart Failure. I feel my AF and HF was missed for quite a while , disguised by asthma.

    I am also trying to close the gap in service for cardiac rehab in my area. I can’t access it. I live on a small Island on the West of Scotland.

    I am on the patient forum for the European Society of Cardiology and I am on the Committee of the European Heart Rhythmn Association as a patient. Also a patient Educator for Pumping Marvellous.

    I would be delighted to work on any projects you think I can be of help with.

    Liked by 1 person

    1. Hello Sharon – thank you so much for your kind words about my book. I’m glad you found it! I too live on an island (off the west coast of Canada).

      Cardiac rehab in isolated or rural areas is a pervasive problem everywhere (and during early COVID isolation closures, even the best-funded programs in big urban centres basically shut down). Some rehab programs were able to survive online (which also addresses some of the current shortcomings of in-person classes (which are generally scheduled for the convenience of paid staff, not for patients!) Dr. Scott Lear at Simon Fraser University has published studies on virtual cardiac rehab you might be interested in reading. Personally, as much as I loved attending 2 months of my own in-person rehab, I suspect that virtual cardiac rehab might realistically become the way of the future.

      I’m glad your AF and HF were finally correctly diagnosed. People with more than one medical issue seem to be confusing to diagnosticians – so your asthma likely looked to be the obvious one to lock onto.

      I’m very impressed by the volunteer roles you have taken on since you were diagnosed! Each of the organizations you mentioned is a worthwhile resource for heart patients, and now you will be a resource for other patients like you.

      I have a feeling that you might also be interested in checking out HeartLife Foundation, a patient-driven charity based in Canada whose mission is “to transform the quality of life for people living with heart failure by engaging, educating, and empowering a global community to create lasting solutions and build healthier lives.”

      Good luck to you, Sharon – take care, and stay safe. . . ♥


  2. My sister is diabetic and sugar levels were never stable.
    Shocking news for us when we received a call one morning that she suffered a heart attack.
    Some points here match..
    Fear and anxiety about her children,
    Financial fears,
    She was feeling uncomfortable at 4am and was taken to hospital,
    Emergency took an ECG and said all is normal,
    By 5 a.m. she suffered seizures, vomiting, and a heart attack.
    She was administered an injection but we have no clue what it was.
    Instantaneous death. She was 49.


  3. My sister has diabetes, and sugar levels were never stable.
    Shocking news for us when we received a call one morning that she suffered a heart attack.
    Some points here match:
    – Fear and anxiety about her children
    – Financial fears
    – She was feeling uncomfortable at 4am and was taken to hospital
    – Emergency took an ECG and said all is “normal”
    By 5 a.m. she suffered fits, vomiting, and a heart attack.
    She was administered an injection, but we have no clue what it was.

    Liked by 1 person

    1. Hello Shirley – your sister’s heart attack must have been dreadful news for your family to hear. It’s not uncommon for families to have more questions than answers about such outcomes – particularly early on when everything seems overwhelming.

      It’s also not uncommon – unfortunately! – for women’s diagnostic tests to appear “normal” even when they are not, given that virtually all research on cardiac testing for decades has been done on (white middle-aged) men.

      Take care, stay safe. . .


  4. I enjoy the wide variety of topics you cover and admire your advocacy for all of us.

    After reading your year end summary, I must recall the google search that lead me to your blog – and the article that got me to follow you regularly: It was your article on fatigue.

    It was the first time I felt like someone understood the indescribable feelings of deep profound fatigue that were continually dismissed by PCPs and cardiologists alike. It has taken me years to finally get my cardiologist to understand that despite all the studies to the contrary, exercise makes me feel worse, not better.

    Liked by 2 people

    1. Hello Jill – your doctors are, sadly, not alone! I now caution women not to tell their doctors “I’m so tired!” because I know what the predictable shrugged response will likely be (spoken or unspoken): “Yeah, right, EVERYBODY is tired!”

      But INSTEAD describe it in functional ways: “This fatigue is so bad that I can no longer _______” (insert a basic activity of daily living that you’re just too tired to do anymore). One of my readers told me that her reports of crushing fatigue were basically dismissed until one day she said to her doctor: “I’m so tired that I can no longer lift my laundry basket!” She wasn’t a doctor, but even she knew that the sudden inability to lift a laundry basket is NOT normal!

      I hope you are doing better these days. Happy New Year to you, take care, and stay safe. . . ♥

      Liked by 1 person

      1. Thank You – Happy New Year to you too! Recently I had to deal with “. . .yes doctor I am always a bit tired but this is MORE tired than usual” Getting short of breath making my bed or walking to my car is NOT my usual tiredness. Turns out my Hgb was down to 10 and ferritin had dropped from 100 after IV iron infusions in July to 14 this week.

        So off on a diagnostic journey once again . . . LOL
        Life is definitely interesting.

        Liked by 1 person

  5. First and most important, thank you for your incredibly effective efforts and constant attention to all aspects of women’s heart disease.

    Second: I hope to hear more about Coronary Microvascular Dysfunction. Its effects can be subtle, manifesting in ways that can elude cardiologists.

    Recognition of Coronary Microvascular Dysfunction as a major threat to women is only very slowly dawning. Thus, it needs your help!

    Liked by 2 people

    1. Thank you Sandra for your kind words, and especially for the reminder of how elusive the diagnosis of Coronary Microvascular Dysfunction can be. Our healthcare system is basically set up to identify the most obvious medical culprits (so in cardiology, that can mean confirming a large blockage in a large coronary artery – e.g. the widow maker heart attack). No large blockage = no problem! At least, that’s how it has been for far too long. I’m happy to see that newer studies are being shared – even the new Chest Pain Guidelines include a section on non-obstructive coronary artery disease.

      I too share this diagnosis (correctly diagnosed a few months after my own widow maker heart attack in 2008). I’d never even heard of it before then. But I knew that my ongoing painful symptoms were just not “normal”. When I was re-admitted to the hospital for a second trip to the cath lab (the doctors suspected “stent failure”, a lovely term), the interventional cardiologist doing my procedure happily pronounced that my Left Anterior Descending Coronary Artery (where the new stent lived) was “clean as a whistle”. And he wrote – with a flourish! – NON-CARDIAC on my chart. As if that should reassure me.

      But if my debilitating chest pain was NON-CARDIAC, what WAS causing it? It took a while to get it right, but amazingly luckily for me (especially at that time), the pain specialist that my cardiologist referred me to at our Regional Pain Clinic had spent a one-year fellowship in Sweden studying Inoperable Coronary Microvascular Disease – a world expert in non-obstructive heart disease, right here in my town! But not all women are so lucky.

      You are so right – this non-obstructive diagnosis is indeed elusive. Thanks so much for your comment. Take care, stay safe. . . ♥

      Liked by 1 person

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