From The Oregonian Newspaper
By DON COLBURN
Posted February 27, 2008
After a walk one January morning, Brandy Coleman returned to her Oregon City home with back pain, a queasy stomach and cold sweats. She took two aspirin and rested, but the pain hung around and prompted her to call the hospital.
The nurse on the line told Coleman she might be having a heart attack and dispatched an ambulance.
"I was not at all thinking heart attack," recalls Coleman, who was 47, athletic and fit, with no known heart problems. She took the aspirin only because she thought she had twisted her back while yanking a heavy gate.
Tests in the emergency room found no evidence of a heart attack, and Coleman says doctors sent her home with a pain-reliever prescription and told her to call her physician. Over the next few weeks, she bounced from specialist to specialist – one theory held that the pain came from her esophagus – before finally seeing a cardiologist.
A treadmill test led to an angiogram that found five blocked arteries to her heart. A month after her initial symptoms, Coleman had quintuple bypass surgery to restore blood flow to her heart.
"Nobody could confirm I had a heart attack," she says. Her doctors called it "a heart episode." Either way, she knows she's lucky. Many people with that degree of coronary blockage do have a heart attack, and many of those don't survive.
Coleman is convinced that another factor kept doctors from promptly diagnosing her life-threatening heart condition: her gender. Because she didn't fit the widespread but misleading stereotype of a heart attack patient – middle-aged, overweight male – she was more likely to be sent home with a prescription and a hunch that her chest pain might be mere heartburn.
"If I hadn't been a woman, they would have done something about it," Coleman says. "I got the brushoff."
Hospitals are better about this than they were 12 years ago, "but we're still not there yet," says Coleman, who now lives in Scotts Mills and works as a volunteer for the American Heart Association, helping to alert women to the dangers of undiagnosed heart disease.
Heart disease is the nation's No. 1 killer of women as well as men. More women than men die of heart disease, and six times as many women die of heart disease as of breast cancer.
The urgency of those numbers grows further in light of a report last week that only one in four Americans knows all the warning signs of a heart attack and what to do first. Researchers from the national Centers for Disease Control and Prevention surveyed 72,000 people in 13 states (not including Oregon) and the District of Columbia.
Women are more knowledgeable than men about the warning signs and the urgency of calling for help, but the CDC found gaps in awareness throughout the population.
Most – but not all – heart attacks start with a crushing "weight" on the chest. But the word "pain" is subjective and can be a misnomer, says Dr. Suzanne Hall, medical director of the women's cardiovascular program at the Providence Heart and Vascular Institute.
Hall has treated patients whose first heart attack symptoms were an aching jaw or elbow pain or severe indigestion or discomfort between the shoulder blades. "We're all built a little different," she says.
Anyone who "feels really bad and doesn't know why" should call for help, says Hall, who also is in private practice at Columbia Cardiology Associates. A saying among cardiologists goes, "Time is muscle" – as in heart muscle damaged by the loss of blood supply during a heart attack.
"Call 9-1-1, take an aspirin," Hall says, "and while you wait for the ambulance unlock your front door and lie down."
When Hall started her cardiology practice in 1984, the heart association pamphlet on dietary prevention of heart disease was titled "The Way to a Man's Heart." Not coincidentally, she says, that was the last year when more men than women died of cardiovascular disease.
"Yet even nowadays," Hall says, "a 47-year-old woman is going to garner less suspicion of heart disease – despite all our messages."
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