By Virginia Miller Crittenden
“In January 2004, I started having shortness of breath when I’d go up the steps,” says Carolyn Maupin, who was in her mid-50s when the symptoms began. “I had just had a checkup and all my num-bers were good—blood pressure, cholesterol. I had no chest pain, but I started getting these feelings that would come up in the back of my neck and down my shoulder. I thought it was a pulled muscle.” It never occurred to Carolyn that her symptoms were heart-related.
Women’s heart symptoms often differ from the “classic” symptoms men exhibit, such as chest pain, UAB Heart Health Center cardiologist Alan Gertler, M.D. explains, so they often are overlooked or even misdiagnosed. “The fact is, heart disease is the number-one killer of women, leading to more deaths than cancer, lung disease, pneumonia/influenza, diabetes and accidents combined,” Dr. Gertler says.
Although she didn’t have very painful symptoms, it turned out that Carolyn had life-threatening coronary artery disease, with 99 percent blockage in one artery. In this interview with ehealth, Carolyn Maupin recounts her experience with the diagnosis of heart disease, and Dr. Gertler explains how she is being successfully treated.
Coronary heart disease occurs when coronary artery walls become lined with fatty deposits, narrowing the arteries and restricting the flow of blood and oxygen to the heart muscle.
99 percent blockage in one artery
Carolyn: “My EKG was normal, but my internist sent me to Dr. Gertler for a stress test. I never, never once thought about my heart. Not once.”
Dr. Gertler: “When I first saw Carolyn, her primary complaint was shortness of breath, which is a common symptom in women. Changes on the EKG during the stress test indicated that her heart muscle was not getting enough blood flow. So we scheduled a heart catheterization.”
Carolyn: “Just a couple of days after scheduling the catheterization, I didn’t feel well when I got up one morning. But I ignored it and ran my errands.
“When I got home, I lay down and I had a stabbing feeling in the middle of my back. It hurt, and I was scared. My husband, Joe, told me to call the doctor. When I called Dr. Gertler, he said, ‘Get to the emergency room right now.’”
Dr. Gertler: “Pain between the shoulder blades is not that unusual in someone having angina or a heart attack. Pain that originates from the heart can manifest itself anywhere from the upper part of the abdomen to the jaw—pain can be referred to different areas.”
Carolyn: “I was admitted to the hospital that day, and UAB interventional cardiologist Dr. Raed Aqel, who specializes in opening blockages in and outside of the heart, started the catheterization procedure.”
In a coronary arteriogram, or heart catheterization, a tiny tube is inserted in an artery in the leg or arm, then threaded into the coronary artery where dye is injected, enabling the physician to see whether the blood is moving through the vessels as it should, or if there is a narrowing or blockage in the vessels.
Carolyn: “They explained what they would do, and as I watched the monitor, I could see the dye going through my veins. In a few minutes, I heard Dr. Aqel say, ‘Get a balloon and a stent right now. We’ve got a 99-percent-blocked artery.’”
Dr. Gertler: “The stent’s main purpose is to prop open the artery to keep it from closing down again.”
Carolyn: “Later that day, the nurse said if I’d had a heart attack, it would have been very serious. So I was really blessed to be there.”
“I’ll tell everybody to go to UAB”
Carolyn: “I’ve heard so many things about UAB—especially related to the heart. And let me tell you, with the treatment I got, I would go no place else. I’ll tell everybody. I told my husband, Joe, ‘Just go home. I’m fine—everybody’s taking care of me here.’ I really felt that if anything happened, they’d be right there to help me. And that’s a good feeling.”
On the road to recovery
Carolyn: “Sitting around the table at UAB’s cardiac rehab, I started looking at all the women—you think you’ll see a lot of men, but there are a lot of women there.
“I had six weeks of cardiac rehab after the procedure. I saw a dietitian, and learned a lot of things about exercise.
The idea is to get on an exercise routine.”
Dr. Gertler: “I think cardiac rehab really helps patients who have gone through what Carolyn has. They educate patients about the disease process, and patients have the emotional support of others who have gone through the same thing. And during exercise, blood pressure and heart rate are carefully monitored.”
Carolyn: “Joe and I bought bicycles and have done a lot of riding. I’ve also changed a lot of my eating habits and started exercising. I feel wonderful. Now we’re traveling and doing a lot of home remodeling—redoing floors and going up and down ladders. Dr. Gertler says that’s good exercise!”
Looking Forward
Carolyn: “It’s been over two years now and I’m fine. I had another stress test in January 2006 and everything looks good.”
Dr. Gertler: “Carolyn’s prognosis is very good; for one thing, the disease was only in one vessel. Tests indicate that the stent is staying open and blood is circulating well within the artery. Carolyn will probably need to stay on Plavix®, a medication that decreases the risk of a clot forming, and continue to take cholesterol-lowering medication.”
Know the warning signs
Carolyn: “Before I was diagnosed, I knew nothing about taking precautions for heart disease. I’d been healthy all my life, and I certainly didn’t know heart disease was the number-one killer.”
Dr. Gertler: “Women should know their risk factors. In addition to her elevated cholesterol, Carolyn’s post-menopausal status was a risk factor. Around age 55 to 60, the incidence of heart attack starts rising in women. Ten years after menopause, women’s rate of death by heart disease begins to equal that of men.”
Carolyn: “I’d tell women to know what the symptoms are and don’t ignore them. It doesn’t have to be a pain in your chest; mine wasn’t. In fact, most women do not have chest pains. I just had a stabbing in my back and shortness of breath.”
Dr. Gertler: “Women’s symptoms are so different from those of men. A recent study by the American Heart Association asked women who have had a heart attack what symptoms they experienced more than one month before the attack. The number-one symptom was unusual fatigue, then sleep disturbance, shortness of breath, indigestion and anxiety, in that order. Chest pain was last—only about 30 percent experienced it. This study shows very clearly how early symptoms are different for women.
“Therefore if a woman has any risk factors for a heart attack, she should see a doctor at the onset of any one of these symptoms.”
Carolyn: “My biggest message to women is don’t ignore it—don’t put it off—I did and it almost cost me my life.”
To read more about other women who have been treated for heart disease at UAB, visit uabhealth.org/womensheart. To schedule an appointment with a cardiologist at the UAB Heart Health Center at The Kirklin Clinic® at Acton Road or at The Kirklin Clinic® in the UAB Medical Center District, call UAB HealthFinder at (205) 934-9999 or 1-800-UAB-8816.