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Senior Circles

Know the warning signs of heart attack and stroke

By Pat Farmer, paf1@patuxent.com 410-332-6653

February 15, 2012

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February is American Heart Month. I couldn't let this month go by without researching and writing about heart disease. The warning signs of heart attack and stroke always bear repeating.

The first paragraph of the Presidential Proclamation for American Heart Month, 2012 should have an impact on us all. It states, "Every year, heart disease takes the lives of over half a million Americans, and it remains the leading cause of death in the United States.

This devastating epidemic leaves no one untouched; its victims are fathers and daughters, grandparents, siblings, cherished friends and community members across our country. This month, we remember the steps each of us can take to reduce the risk of heart disease and recommit to better heart health for all Americans."

The bottom line is that in the United States heart disease is the leading cause of death for men according to the Center for Disease Control and for women according to the American Heart Association. It is within the will power of each of us to improve our heart health by changing our lifestyles to include exercise and healthy eating, so that we can help prevent the damaging, and often fatal affects of heart disease from happening to us.

We often hear that women have different warning signs for a heart attack than men. Men often think of "a heavy, crushing elephant on your chest" pain as the only symptom of a heart attack. Men need to know the other symptoms of a heart attack: discomfort or pain in other areas, such as one or both arms, the neck, jaw, back or stomach; shortness of breath, lightheadedness, nausea or sweating; and abdominal discomfort that may feel like indigestion.

WomenHeart, The National Coalition for Women with Heart Disease, http://www.womenheart.org, has put out a bookmark with the warning signs for women. Among them are: chest discomfort, pain, squeezing, burning or mild to severe pressure in the center of your chest that lasts more than a few minutes or comes and goes; upper body discomfort in one or both arms, back, neck, jaw or stomach; Shortness of breath, with or without chest discomfort; dizziness, lightheadedness or fainting, nausea and vomiting, cold sweats; and feelings of anxiety, fatigue, or weakness – unexplained or on exertion.

These heart attack symptoms for men and women seem very similar to me. However, there is more information that gives more specific signs of heart attack in women.

In an AARP Bulletin, "Am I Having a Heart Attack," Feb, 11, 2011, the author Elizabeth Agnvall points out that according to the search engine Google, "heart attack signs" is among the most commonly searched subjects online and the number of searches for the term increased by 90 percent in the last five years. People are searching online because "it's not always easy to tell whether you're having a heart attack – even doctors have a tough time knowing without tests."

In support of this comment, a while back while at a medical appointment, my doctor told me that he had a female patient who came to him with what he thought were flu-like symptoms and that night she died from a heart attack. I wondered why he was telling me this. Did it make him feel better to tell someone else about it? At the time I thought it was a strange thing to tell me but in hindsight, he probably just wanted to make me aware of this symptom of a heart attack in women.

In the AARP Bulletin, Agnall states that women have a higher risk of dying from a heart attack than men do, partly because women often don't realize they're having a heart attack and partly because they delay getting help. "Women are less likely than men to have the typical 'Hollywood heart attack'," said cardiologist Dr. Sharonne Hayes, the director of the Mayo Clinic's Women's Heart Clinic in Rochester, Minn. "Chest pain was not the main symptom in about 46 percent of women who had a heart attack, studies show."

Agnall lists the heart attack symptoms that are more likely in women as: Pain in the arm (especially left arm), back, neck, abdomen or shoulder blades: Jaw pain; nausea and vomiting; and overwhelming and unusual fatigue.

In an article titled "Women's Heart Attack Symptoms Different from Men's by Robert Langley, he states that research by the National Institutes of Health indicates that women often experience new or different symptoms as long as a month or more before experiencing heart attacks. "Among the 515 women studied, 95 percent said they knew their symptoms were new or different a month or more before experiencing their heart attack. The symptoms most commonly reported were unusual fatigue (70.6 percent), sleep disturbance (47.8 percent) and shortness of breath (42.1 percent).

According to the WomenHeart bookmark, If you think you are having a heart attack, call 911 within five minutes of the start of symptoms. Tell the operator you think you are having a heart attack. Even if your symptoms stop completely in less than five minutes, call your doctor. Do not drive yourself or let family or fiends drive you to the hospital. Emergency personnel can begin treating you on the way in an ambulance. Chew and swallow one regular full-strength aspirin with water as soon as possible to prevent blood clotting. Once at the hospital make it clear that you are having symptoms of a heart attack. Ask for a complete cardiac evaluation, including an electrocardiogram and a cardiac enzyme blood test. If you are waiting too long, tell them again that you are experiencing heart attack symptoms.

At the top of the American Heart Association's website is this quote: "Heart disease is the No. 1 killer of women. The facts are clear. More women die of heart disease than all forms of cancer combined." This is a very sobering statistic to me. The American Heart Association works to reduce deaths caused by heart disease and stroke, by building healthier lives, free of cardiovascular disease and stroke.

Howard County General Hospital has a card available on stroke. It says, "Stroke is an emergency, so every minute counts. Act F.A.S.T.," which stands for Face, Arms, Speech and Time. These are ways to tell if a person has had a stroke. Face: Ask the person to smile to see if one side of the face droops. Arms: Ask the person to raise both arms to see if one arm drifts downward. Ask if one arm is weak or numb. Speech: Ask the person to repeat a simple sentence to see if speech is slurred. Time: Call 911 or go to the closest hospital immediately if the person shows any of these signs.

My friend, Jackie Roberson, agreed to talk to me about her stroke experience. She was just 55 when she had her stroke Feb. 6, 1996. Jackie and her husband, Stan, were visiting their daughter in Florida, when she developed flu symptoms and a very high fever. They decided to leave early and drive back home to their home in Howard County. Jackie even did the driving.

During the next week, the fever would not go away. Because she was keeping Stan up at night, she moved to another bedroom and the next morning Stan found her on the floor. He called an ambulance and it was in the emergency room that she had the stroke. The left side of her body, hand and leg were affected. She could walk within a short period of time and was able to talk some and write. But the fever persisted.

She spent a month at the University of Maryland Hospital in Neurology and the fever continued. One of her doctors believed he knew what was wrong but couldn't prove it without a brain biopsy, which was very risky. Her husband made the difficult decision to allow the brain biopsy.

From the brain tissue, the doctor proved his diagnosis. It was herpes encephalitis, a rare but severe viral infection of the central nervous system, and he then knew how to treat it. The doctor told Jackie that only one percent survives herpes encephalitis and that is what caused her stroke. She then went to Kernan Hospital for rehabilitation, including physical, occupational and speech therapy, for another month and didn't return home until April.

Jackie is convinced that she survived this disease and subsequent stroke because of an "awful lot of prayers." She said that people were praying for her all over the world.

Against the wishes of her doctor and her husband, who both thought she wasn't ready, Jackie went back to work that October. She was there three or four days and became extremely frustrated and emotionally upset when she couldn't remember her password. She had to leave work and later retired.

For the next year, she battled a deep depression. When I asked her if she took any medication, she said she didn't because she considered it a sign of weakness. Finally her general practitioner sent her to a neurologist. She told him about the depression and he thought it was being caused by her concern about having more seizures. She didn't even know that she had had a seizure in the emergency room.

She said that it was a 'horrible year.' She finally had to admit to herself that she couldn't do it. She looked at herself as a failure and felt that she had let her coworkers down. Her "best laid plans" to work until she was age 70, so that all her children could get through college, were dashed. Her saving grace was medication (for anti-seizure and herpes) the neurologist gave her. She said, " After just three days, it was like a black cloud was lifted."

In 2005, her husband Stan, then age 77, had a stroke. He had been complaining of a headache and she found him on the floor with a gash on his forehead. The EMTs came and when in the emergency room, the doctor told Jackie that Stan was blind. He lost the sight in the left hemispheres of both eyes. He also couldn't use his left hand. His blood pressure would drop and he would fall. In spite of seven months of intense therapy, Stan never came back from that stroke.

He would insist that he wanted to drive but the doctor said he couldn't. He didn't want to lose that vestige of independence and continued to say, "I want to drive."

Jackie said that she understood Stan's frustrations because she had been there herself. People would say to her "Why do you go to the nursing home every day to see Stan?" She remembered how he stuck by her for those two horrible years after the herpes encephalitis, stroke and depression and she was committed to do the same for him.

I hope this symptom information and these real life examples will spur you on to take action to improve your heart health. Don't be sedentary — get up and move!