Continued from last week…
In the days following my terrifying visit to emergency, I booked an appointment with my doctor and tried to figure out what might have caused my apparent heart attack. My primary suspicion was the condition of my blood and hemoglobin. I’ve been severely anemic for some time now. When this was first discovered a few years ago, my doctor told me my hemoglobin level was so low that, had I been in hospital, a transfusion of red blood cells would have been considered imperative (the normal level is between 12-16 Hg, mine was 6 Hg). Amazingly, my body had somehow learned to function at the low level, but being so severely anemic, I was constantly tired, forced to nap several times a day, feeling run down, as well as having trouble focusing and functioning normally.
Since that time, I’ve been trying to monitor the anemia and keep my iron levels up, but it’s a constant battle, particularly since stress prevents your body from replenishing itself and interferes with the immune system. In discussions with my doctor and based on everything I could research, it seems fairly clear that the main culprit was a combination of anemia and stress. Anemia has been implicated in many serious diseases, although researchers are only beginning to understand the role of anemia in heart failure (Anemia Lifeline). With severe anemia, a low level of hemoglobin (i.e., the substance in red blood cells that transports oxygen) causes the heart to work harder to get oxygen to all parts of the body. Under stress, the heart’s need for oxygen increases. When the heart is unable to pump oxygenated blood strongly throughout the body, the body responds with symptoms like those I experienced, including chest pain and shortness of breath. Many studies have found anemia to be common in anywhere from 17% to 48% of people with heart failure. Another study showed a connection between anemia and heart attacks with 43% of people admitted to the hospital after suffering a heart attack also suffered from anemia. Another study found that people with anemia were 41% more likely to have a heart attack or die of heart disease within 6 years (cited in National Anemia Action Council).
This is a matter of serious concern, not just for myself, but for everyone. Women in particular should be concerned, since heart disease and stroke are now among the leading causes of death for Canadian women (Canada Public Health). Recent research has indicated that women show heart attack symptoms differently than men. Men usually describe a heart attack as a crushing, squeezing chest pain, whereas women will describe a vague discomfort in the chest that doesn’t disappear with rest. Women may simply experience fatigue or extreme shortness of breath. Symptoms of heart disease in women are often overlooked, making early detection and awareness particularly important. Women tend to be older when diagnosed and also tend to have other health complications. Doctors also tend to misdiagnose heart disease in women, since 50 percent have no visible risk factors and don’t display classic symptoms. Younger women, in particular, are often thought to be too young for heart trouble, which is a fallacy (Heart & Stroke Foundation).
Other research suggests that, for both men and women, a heart attack can include a wide range of vague, non-specific symptoms above and beyond the classic “elephant on the chest” type of experience. One account described a 42-year-old man who complained of extreme tiredness as he went to sleep in his armchair. Hours later, he had a heart attack and died. A doctor recounted a similar heart attack experience, marked by weariness with no pain. Nonspecific symptoms of this nature can include overwhelming fatigue; dizziness; breaking out in a cold, drenching sweat; an attack of nausea and vomiting; or a sudden onset of breathlessness. Many of these symptoms are related to a sudden decrease in the heart’s ability to pump blood, leading to a circulation drop-off that quickly saps energy (Donahue, 2005).
What causes a heart attack? Most people are aware of the primary causes, such as arterial blockage, heart disease, high blood pressure, and extreme stress. Congestive heart failure can be the result of gradual weakening of the heart’s ability to pump, leading to symptoms such as shortness of breath, swollen ankles and legs, tiredness or loss of energy (Heart and Stroke Foundation – Congestive).
Although extreme stress is thought to bring on an attack in some situations, the role of cumulative stress is often overlooked, although the Canadian Heart and Stroke Foundation now lists depression as a heart condition that places people at risk. The effects of emotional or physical stress on the heart have been shown to be intensified by poor health. Some recent research indicates that stress can reduce estrogen levels earlier in life, placing younger women at increased risk for heart disease (Wake Forest University Baptist Medical Center, 2000, September). There are also indications that low estrogen levels during a woman’s menstrual cycle can also place her at higher risk for sudden serious heart disease (American Heart Association, 2000, November (Heart attack statstics).
Traumatic situations can stun the heart, sending it into life-threatening spasms. Researchers from the John Hopkins School of Medicine reported that “a broken heart is not just folklore,” stating that “a traumatic breakup, death of a loved one, or even the shock of a surprise party” can flood the body with stress hormones that stun the heart and send it into sudden, life-threatening heart spasms in people who are otherwise healthy” (Edmonton Journal, 2005; Washington Post, 2005). This phenomenon, termed stress cardiomyopathy, occurs when emotional stress stimulates the adrenal glands and nerves to produce stress hormones including adrenaline. These hormones shock the heart and reduce its ability to pump, causing chest pain and other symptoms similar to a heart attack. This stunning does not kill the heart muscle like a typical heart attack does, but leaves the heart helpless and temporarily dysfunctional, similar to a heart attack. Women appear to be more vulnerable to this condition, and researchers speculate that it may be related to hormones or the way women respond to stress (Sharkey, et. al., 2005).
Although most people do survive a heart attack, this is dependent on getting emergency help as quickly as possible. On average, most Canadians wait almost five hours before deciding to get help, yet half of all heart attack deaths occur within two hours after the beginning of the attack (Heart & Stroke Foundation, Statistics). Hospital wait-times also factor in, with some statistics showing that women experience even longer emergency department wait-times than men (Tu, 2005).
What are some of the warning signs of a traditional heart attack?
“¢ A sudden discomfort or pain that does not go away with rest, usually in the chest, neck, jaw, shoulder, arms or back;
“¢ Pain may be more vague in women, and it may be more like a heaviness, tightness, pressure, squeezing or burning;
“¢ Shortness of breath;
“¢ Nausea, vomiting, indigestion;
“¢ Cool, clammy skin; and
“¢ Fear, anxiety, and denial.
(Heart and Stroke Foundation)
In my own case, I experienced almost all of the above, including extreme anxiety and denial.
The heart does try to repair itself after an attack, but its ability to do so depends on the level of damage. While it is essential to know the signs of a heart attack and seek medical help quickly, prevention is even more important. The three key factors are diet, exercise, and stress reduction. Diet and exercise are two areas that are relatively easy to improve on. One of my daughters gave me a yoga book and DVD, and I’ve been trying to build up my ability to perform these low-impact stretch exercises. I’m also walking every day now that the weather is better, and making a conscious effort to watch my diet and include heart-healthy foods. I’m keeping a close eye on iron levels in my blood, and I’m continuing to follow up with other tests.
Stress, however, is not quite so easy to deal with. One researcher acknowledges that it is impossible to completely remove emotional stress, but suggests that we “control inappropriate emotional displays and keep negative feelings in check” (Steptoe, 2005). Good counsel, and I do try to stay cool and put a positive spin on things. I’ve tried to adjust my viewpoint of work and school. I worry less about being available to others. Rather than making myself guilty if I’m late completing a report or responding to an email, I try to relax and not be overly concerned if I don’t get to it until the next day, or even the next week. It will get done eventually! I’ve tried to stop obsessing over getting top marks. Instead of staying up all night to meet a deadline, I’ve handed in assignments late and taken my punishment (i.e., loss of marks) with relatively good grace. I’ve also tried to take time to just relax, meditate, sit and think. I watch the occasional movie and read books. For a long time I hadn’t even listened to music, too stressed and rushed to even put a CD into the player. Now I try to make music and creativity a part of my daily life, doing things I enjoy like sewing, playing piano, and writing. When my grandson comes to visit, I put everything else aside and play with him.
It seems likely that what I experienced was some form of stress cardiomyopathy, combined with a panic attack. It was not brought on by sudden stress, but rather by a combination of cumulative stress and severe anemia, exacerbated by generally poor physical condition and a particularly stressful few weeks prior. Fortunately, I’ve been told I don’t have permanent heart damage, but my doctor and I are monitoring things closely. In the weeks following my attack, I had several dizzy spells and other worrisome manifestations, but thus far I’ve remained generally healthy. The sheer terror of the experience, knowing what it felt like to believe death is imminent, is something I never want to endure again.
American Heart Association (2000, November 24). Low estrogen linked to heart attack in premenopausal women. Science Daily. Retrieved April 20, 2005, from http://www.sciencedaily.com/releases/2000/11/001120072723.htm
Anemia Lifeline. Anemia and serious diseases. Retrieved April 20, 2005, from http://www.anemia.com/anemia/anemiaheart.html
Canada Public Health (2002, November 22). Heart Disease and Stroke in Canada, 1997. Retrieved April 27 from http://www.phac-aspc.gc.ca/publicat/hdsc97/s02_e.html
Donahue, Dr. P. (2005, February 17). Heart attack signs not always apparent. Edmonton Journal.
Edmonton Journal (2005, February 10). Flood of hormones can shock a healthy heart into helplessness: Researchers link sudden stress with dangerous malfunction.
Heart and Stroke Foundation – Congestive (2002, October 11). Heart Conditions – Congestive Heart Failure. Retrieved Alfil 27 from http://ww2.heartandstroke.ca/Page.asp?PageID=1613&ContentID=18795&ContentTypeID=1
Heart and Stroke Foundation – Statistics (2002, October 11). Heart Conditions – Congestive Heart Failure. Retrieved Alfil 27 from http://ww2.heartandstroke.ca/Page.asp?PageID=1613&ContentID=18795&ContentTypeID=1
National Anemia Action Council. Anemia and heart disease. Retrieved April 20, 2005, from http://www.anemia.org/patients/educationsheets/heart_disease.pdf
Sharkey, S. et al (2005). Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation, 111: 472-479. Retrieved April 20, 2005, from http://circ.ahajournals.org/cgi/content/abstract/111/4/472
Steptoe, A. (2005, March/April). Physical, emotional stress trigger heart attack. Psychosomatic Medicine.
Tu, J. (2005, March 2005). Heart attack victims wait too long for treatment. Cited in the Edmonton Journal.
Wake Forest University Baptist Medical Center (2000, September 25). Stress could increase risk of heart disease in women. Science Daily. Retrieved April 20, 2005, from http://www.sciencedaily.com/releases/2000/09/000921073532.htm
Washington Post (2005, February 10). Broken heart can kill you.