Women Are Not Small Men: Life-Saving Strategies for Preventing and Healing Heart Disease in Women

Overview

One out of every two women will die of heart disease. It is the single greatest health risk for women today -- more than stroke and all cancers combined. In the course of her work as founder and chief of the Women's Heart Program at New York's Lenox Hill Hospital, Dr. Goldberg has come to a startling realization: Women experience heart disease in a fundamentally different way than men do. The physiology of a woman's heart attack is not the same as a man's, the symptoms of heart disease and signs of impending ...
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Overview

One out of every two women will die of heart disease. It is the single greatest health risk for women today -- more than stroke and all cancers combined. In the course of her work as founder and chief of the Women's Heart Program at New York's Lenox Hill Hospital, Dr. Goldberg has come to a startling realization: Women experience heart disease in a fundamentally different way than men do. The physiology of a woman's heart attack is not the same as a man's, the symptoms of heart disease and signs of impending heart attack differ for women, and once heart disease has been recognized, women often do not get the treatment and medications they require. Now here are detailed, age-specific programs that give women the facts and the guidance they need to recognize, treat, and prevent heart disease.
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Editorial Reviews

Publishers Weekly
Goldberg, chief of cardiac rehabilitation at the Women's Heart Program at Lenox Hill Hospital in New York, believes that misinformation about heart health is keeping women from getting appropriate cardiac care. Women, on their own or because doctors belittle their symptoms, often ignore the warning signs of heart disease, imagining that that they're too young or simply the wrong gender to be having a heart attack. In this comprehensive guide to cardiac health, Goldberg uses numerous case studies to show how women think they're suffering from fatigue or stress or are simply overweight when in fact they're showing signs of cardiac obstruction. Goldberg encourages women of all ages to be proactive in managing heart disease with simple strategies including stress reduction, physical activity, healthier eating and quitting smoking. Included is a simple quiz to determine readers' risk level for heart problems. All relevant related conditions, including diabetes and menopause, are discussed so that readers can assess their options regarding medication and lifestyle changes. Women of all backgrounds will find the material things helpful to read both before and after visiting their own physician, and Goldberg's realistic approach will also appeal to readers. Though she urges women to recognize the potential for serious heart problems, Goldberg knows that few people will transform their behavior instantly. This is an excellent addition to the women's health shelf. (Feb.) Copyright 2001 Cahners Business Information.
Library Journal
American Heart Association spokeswoman Goldberg warns that heart disease is a woman's greatest threat, since one out of every two will die of it. She stresses that women must be proactive in their own health since many physicians don't recognize that women's heart disease is different from men's; she also details what they should know about personal risk factors and physical warning signs. Goldberg highlights the necessary information that can help women recognize heart disease symptoms and successfully negotiate the often-patronizing medical environment. Her prevention program includes use of the Mediterranean diet, moderate exercise, and stress and weight management. Specific cardiac problems are described briefly with signs and symptoms, risk factors, questions for the doctor, diagnostic tests, other possible diagnoses, and an action plan for treatment. Medications, heart attack survival, and surgery are concisely discussed. Focused primarily on prevention, this lucid, sympathetic, and eminently readable volume is on par with the excellent, updated edition of Fredric Pashkow's The Woman's Heart Book (LJ 1/01). Highly recommended for consumer health collections. Janet M. Schneider, James A. Haley Veterans' Hosp., Tampa, FL Copyright 2001 Cahners Business Information.
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Product Details

  • ISBN-13: 9780345440983
  • Publisher: Random House Publishing Group
  • Publication date: 2/1/2002
  • Edition description: 1ST
  • Pages: 480
  • Product dimensions: 6.44 (w) x 9.44 (h) x 1.52 (d)

Read an Excerpt

Women’s Hearts Are Different

As a woman and a cardiologist, I’ve written this book to help you improve the health of the most important muscle in your body—your heart. Knowing that heart disease has taken over the lives of 8 million women in the United States, I want to show you how taking care of yourself today will help you to have a stronger heart and a healthier life for years to come. You can prevent a heart attack from happening to you—even if it runs in your family—by following the Women’s Healthy Heart Program that I present in this book. If you’ve had a heart attack already, this program will show how to keep it from happening again. I have designed this unique cardiac prevention and treatment program specifically for women.

Until very recently, no book like this could have been written, because all the knowledge, research, and treatments concerning heart disease were based on findings in men. For too many years, the medical establishment was ignorant of women’s unique needs and physiology and looked upon women as simply “small men.”

But women are not small men. It is now understood that our physiology is very different from that of men, especially when it comes to heart disease. Our hearts are proportionately smaller, and when we develop the first signs and symptoms of heart disease, we are usually ten years older than men. Consequently, to be effective, heart disease prevention and treatment programs for women must be different from those for men.

If you’re like most women, you probably have a Pap smear every year and, especially if you’re over forty, a mammogram every year ortwo. I’m sure you’ve heard all the scare stories about breast and cervical cancer, and you know that these two simple tests can reduce your risk for them. But you may not realize that heart ailments disable and kill more women than all cancers combined.

Five years ago I established the Women’s Heart Program at Lenox Hill Hospital in New York City to deal with that reality. Now that baby boomer women are entering menopause—the heart disease years—by the millions, I want to spread the word that heart disease is a woman’s greatest health threat.

I’m not interested only in the condition of your heart; I want to help you become healthier as a whole person: healthier in your mind and entire body as well. That means you need to learn better ways to deal with stress, which takes a toll on your overall health and can set you up for heart disease as well as high blood pressure. As a woman working almost exclusively with female patients for over a decade, I know that we often tend to put off seeing to our own health needs in favor of seeing to the needs of those close to us. In this book, I’ll help you figure out some ways you can make time to take care of yourself, which will help you have a stronger heart and a healthier life in general. You’ll also learn to recognize unhealthy behaviors and replace them with healthy ones.

Perhaps you’ve already been diagnosed with heart disease, and you’re feeling overwhelmed and frightened. This book is for you too. I’ll tell you about the latest research on how to keep your disease under control and even—in some cases of high cholesterol—reverse its course. And if you’ve already had a heart attack, this book is for you too because following my program step by step can make your heart healthier and reduce your risk of further heart damage.

Sometimes it’s hard for women to relate to heart disease unless they’re already suffering from it. It’s a silent and initially a painless killer, doing its dirty work in secret and over time. Heart disease can start early in life, even before the age of twenty. In its earliest stages, you can’t see it or feel it—it has no symptoms.

Sometimes physicians have difficulty conceptualizing coronary artery disease in women too, even though they have been to medical school and seen the life-threatening waxy buildup of cholesterol on the insides of the coronary arteries—the atherosclerosis that lies at the root of heart disease. When I was training during the 1980s, doctors didn’t even believe women got heart disease. In fact, when I was a resident, anytime we saw a woman with chest pain, a familiar symptom of heart attack, everyone said, “Oh, this is so unusual!” In my first month of internship, I examined a thirty-eight-year-old woman who worked at the hospital and was suddenly having chest pain. At first no one believed me when I said that she was having a heart attack. Yet she smoked two packs of cigarettes a day, and everyone knew that smoking put men at risk for heart disease. Even though heart disease was right there in front of them, the doctors couldn’t see it in a woman!

Doctors now know that heart disease is so deadly for women that their chances of dying from it are one in two. That means basically that either you or your best girlfriend is likely to die of a heart attack, stroke, or related heart problem. By contrast, the odds of getting breast cancer during the course of your life are approximately one in eight, and your chances of dying from it are one in twenty-five.

The younger a woman is, the less likely she is to have symptoms of heart disease. Until the age of fifty-five, men are much more likely than women to develop symptoms. But after menopause a woman’s risk goes up sharply. In fact, if you don’t take steps to reduce the risk, your chances of having a heart attack after you reach sixty are as great as a man’s.

In over a decade’s practice helping women patients, I have learned a lot, and now through this book I want to help as many women as I can to recognize the prevalence of heart disease and to teach them how to be proactive in preventing it. I want you to see how improving the health of your heart will improve the health of your entire body. I want you to be able to recognize the signs and symptoms of heart disease and to know what to do if you should become affected. I want to show you how to demand the proper treatments if and when you need them. Above all, I want to keep you from ending up like a patient I will call Teresa.

At forty-seven, Teresa was a successful hospital administrator. She was a single mom and active in her church. Although she smoked, was overweight, and was often short of breath, she believed these habits and discomforts were due to her stressful job. One evening after a delicious restaurant meal, Teresa experienced a burning sensation in the lower part of her chest. The pain became so worrisome that she called her doctor, who assured her that it was just indigestion. “Take some Maalox,” he advised. “And Teresa, next time don’t eat so much.”

The following day Teresa went to work, but the burning never stopped. When she finished work at the end of the day, she paged one of my colleagues, a cardiologist. He recognized from her symptoms that she needed to get to the coronary care unit. There she was given medications. I spoke with Teresa the next morning; her blood tests showed that she had not had a heart attack. But it was clear to me that she was at high risk and that anxiety alone was not the cause of her symptoms. In the past few months, she said, four doctors had told her to take a vacation or sign up for a yoga class to relieve her symptoms. I ordered a stress test to evaluate her heart, which, given Teresa’s health history, should have been done days or even months earlier. (In a stress test, as the patient walks on a treadmill at a slightly increasing speed and elevation, her heart is monitored and its rhythm is recorded.)

Later that day, while Teresa was on the treadmill for her stress test, she got the burning feeling again, and the test had to be stopped. This is usually an indication that the patient has an obstruction in her coronary arteries, the blood vessels that supply the heart. Yet when I reported my findings to Teresa’s doctor, he couldn’t believe she had heart disease. “After all, she’s a woman,” he said to me. But Teresa did have heart disease; her stress test as well as other cardiac tests showed that one of the major arteries supplying her heart muscle had a near-total blockage. That was what had made her short of breath, a common symptom of heart disease in women. Teresa’s specific heart disease was coronary artery disease, one of the first steps on the road to a heart attack.

Had her doctors been negligent? Maybe not—like many doctors, they simply didn’t recognize Teresa’s specifically female signs of heart attack. Except for her weight and smoking habit, Teresa had always been relatively healthy. She had never experienced the “classic warning signs” of heart disease; nor had her heart attack appeared to be a classic (that is, male) heart attack.

Women Have Different Symptoms from Men

Teresa didn’t experience the “classic” signs and symptoms of heart disease, precisely because she is a woman. The guidelines upon which her doctor relied had been developed from clinical experience only with men. In short, Teresa’s doctors treated her as a “small man.” And because her heart disease did not conform to the male norm, it wasn’t recognized for what it was.

Heart disease has too often been characterized by the stereotypical image of the middle-aged businessman turning red or pale, sweating, and clutching his chest. But for women, the picture is often very different. For women, the symptoms of heart disease or an incipient heart attack may resemble indigestion (as in Teresa’s case), or backache, or a vague feeling of malaise. Twelve years ago, during my cardiology fellowship, different women who had had heart attacks told me this same story over and over: “I noticed that I felt breathless even during my usual activities.” “Occasionally I’d feel a pressure in my upper abdomen, and there would be numbness in my jaw.” “I’d get a strange numbness in my arm.”

For other women, heart disease first shows up as unusual fatigue, dizziness, or palpitations. One patient, a relatively young woman in her mid-forties, experienced back pain whenever she walked up the hills in her Bronx neighborhood. Not until she went to a hospital in the middle of having a heart attack did she learn that her back pain had actually been the sign of that impending heart attack.

Because fatigue, shortness of breath, back pain, and the like were not known to be “classic” signs of heart attack, no doctors thought to test or treat these women for heart disease. Even today many women go from doctor to doctor knowing that something is wrong but being told that the problem is “just” their “nerves,” fatigue, indigestion, or stress. But these problems are female symptoms of heart disease. Attention must be paid!

How did this life-threatening situation come about, and what can women do about it? Above all, we have to educate ourselves about the risks and learn how to protect ourselves and get the best care, if and when we need to see a doctor. This book is my attempt to help you with that education.

Prevention, diagnosis, and treatment of heart disease in women have all lagged behind that in men for a very long time. Until recently, as I mentioned, all clinical research on heart disease was based on studies conducted only on men: the commonly accepted symptoms, the risk factor evaluations, the types and dosages of medications, the surgical treatments, and the rehabilitation recommendations were all based on what was found to be true for men. As a medical student, I was taught that all medical care is based on what was normal for a 165-pound man. This particularly annoyed me, since I am a five-foot-one-and-a-half-inch, hundred-pound woman. How could a drug dosage for someone who weighed sixty-five pounds more than I did be correct for me? How could that drug act the same in my smaller female body? For too long, most researchers have assumed that women’s reactions were exactly like those of men, except on a smaller scale.

My firsthand clinical and research experience underscores the important fact that women’s heart disease is in fact very different from men’s. I first became interested in this issue in 1990, when I began my own career as a full-time academic cardiologist at SUNY’s Health Science Center in Brooklyn, where I ran the Heart Exercise and Imaging Laboratory. There I could not help but notice that fewer women than men were even referred for stress testing. Perhaps the reason was that stress tests tend to produce a higher rate of false positives for women than for men—that is, they more often indicate the presence of heart disease when none is actually present. As a result, many doctors avoided referring women for stress tests at all, even when it was the best option for helping them diagnose what was wrong. Later, improved techniques for stress-testing women, such as stress echocardiography (the use of ultrasound to visualize the heart during exercise), became available, yet even then women were still greatly underreferred. Today more women are referred for stress-testing than ever before, but they are less likely to be referred for follow-up tests if the results confirm a problem.1 This is particularly true for minority women, who often have to insist on further testing to uncover the particular form of heart disease they have.

Copyright 2002 by Nieca Goldberg, M.D.
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Table of Contents

Acknowledgments xix
Part I Understanding Your Heart 1
Chapter 1 Women's Hearts Are Different 3
Women Have Different Symptoms from Men 7
The Women's Heart Program at Lenox Hill Hospital 13
Your Personal Heart Consultation 16
Assess Your Risk for Heart Attack 16
Chapter 2 Women's Symptoms of Heart Attack 22
Are Women at Higher Risk for Heart Attack Today? 25
The Anatomy of a Heart Attack 26
Sudden Cardiac Death 33
Understanding Your Symptoms 34
Coronary Artery Disease and Women 37
Other Serious Causes of Chest Pain 42
Pulmonary Embolism 44
Be Smart! See Your Doctor 46
Chapter 3 Are You at Risk? 48
Understanding Your Risk Factors 49
Common Risk Factors for Women Under Forty 52
Common Risk Factors for Women Forty to Fifty 62
Common Risk Factors for Women Over Fifty 67
Special Considerations for Women of Color 69
Emerging Risk Factors 70
Control Your Risk Factors 76
Chapter 4 The Hormone Connection 77
Understanding the Hormone-Heart Connection 79
Hormone Replacement Therapy 82
Should You Take HRT? 85
Alternatives to HRT 91
Other Medications for Menopausal Symptoms 97
Your Personal HRT Evaluation 97
Your Best Bet at Menopause: Change Your Lifestyle 101
Chapter 5 The Truth about Stress, Emotions, and Your Heart 102
Are You All Stressed Up with No Place to Go? 103
Lack of Control Adds to Stress 106
How Stress Affects Your Heart 107
Managing Anger and Stress 112
Panic Attacks May Mimic Heart Disease Symptoms 113
Depression May Be a Risk Factor 114
The Importance of Social Support 115
Behavioral Interventions 122
Part II Examining Your Heart 123
Chapter 6 Your Guide to the Symptoms and Diagnoses of Cardiovascular Disease 125
A Powerful Pump 126
Heart Rhythm Problems 130
Blood Vessel Diseases 138
Valvular Heart Disease 147
Heart Muscle Diseases 160
Chapter 7 The Women's Healthy Heart Checkup 165
Guidelines for Choosing the Best Doctor 166
Be Your Own Health Advocate 170
Your Checkup Appointment 173
Checking Your Heart Rhythm 181
Checking Heart Muscle Function Noninvasively 184
Checking for Coronary Artery Disease Noninvasively 187
Checking for Blood Vessel Problems 195
Where Do You Go from Here? 196
Part III The Women's Healthy Heart Program 199
Chapter 8 Your Commitment 201
A Mountain of Excuses 203
Facing Reality 204
Making the Commitment to Change 209
The Five Stages of Change 211
Maintaining the Commitment 213
Chapter 9 Your Exercise Prescription 219
Aerobic Exercise Is the Foundation 220
Resistance Training Strengthens Your Body 220
Benefits of Exercise 222
No Matter What Your Age, Move Around More to Protect Your Heart 223
Overcoming Common Barriers to Exercise 226
How to Exercise 229
Your Exercise Prescription 235
Measurable Healthy Heart Results from Exercise 251
Four Tips to Exercise Safely 253
Give It Time 255
Watch for Burnout 255
Chapter 10 Your Healthy Heart Eating Plan 257
The Mediterranean-Style Diet 259
Lose Weight and Stay at Your Desired Weight 262
Heart-Boosting Weight-Loss Tips for Women 271
Choose Foods High in Antioxidants 275
Choose Foods with Heart Smart B Vitamins 279
Choose Foods with Flavonoids 284
Choose Foods with Phytochemicals 286
Choose Whole Grains 289
Choose Healthy Fats 289
Watch Your Intake of Sodium 296
Limit Your Alcohol Intake 300
Heart Healthy Eating Plan Recap 300
Chapter 11 Nonvitamin Supplements and Heart Disease 302
Separating Fact from Fiction 304
Commonly Used Supplements for Heart Disease 306
Herbs to Avoid 309
The Bottom Line on Supplements 314
Chapter 12 Your Stress Reduction Program 317
Relaxation Response 318
Deep Abdominal Breathing 319
Progressive Muscle Relaxation 320
Visualization 321
Meditation 322
Yoga 323
Aromatherapy 323
Music Therapy 324
Prayer 324
Finding the Right Stress Reduction Therapy 325
When Counseling May Help 327
Chapter 13 Your Stop Smoking Program 329
But It Feels So Good! 330
Common Misconceptions About Stopping Cigarettes 331
Your Stop Smoking Program 334
What If You Relapse? 341
Part IV Medical Treatments for Cardiovascular Disease 343
Chapter 14 Medications That Can Save Your Life 345
Combine Medications with Lifestyle Changes 347
My Philosophy of Prescribing Medication 348
Common Medications for Treating High Blood Pressure 350
Common Medications for Treating Coronary Artery Disease 354
Common Medications for Lowering Cholesterol 360
Drug Combinations 364
Arrhythmias 365
Congestive Heart Failure (CHF) 368
Other Medications 369
Chapter 15 The Heart Attack Survival Guide 372
Heart Attack: How to Respond 374
Other Serious Causes of Chest Discomfort 378
After the Heart Attack 379
Cardiac Rehabilitation: A Lifelong Process 380
Chapter 16 Heart Surgery and Procedures 392
Coronary Angiography 393
Coronary Angioplasty 396
Making the Surgery Decision 400
Choosing a Surgeon 402
Coronary Artery Bypass Surgery 402
Valve Surgery 405
Surgery to Treat Arrhythmia 407
Other Issues Important to Women Facing Heart Surgery 409
Chapter 17 The Future of Women and Heart Disease 411
Resources 415
Notes 417
Glossary 429
Index 437
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