‘It was impossible that I was having a heart attack’: Why Canadian women’s heart health continues to suffer

Helen Robert was getting ready to walk her dog one Friday morning in May 2015 when an abrupt feeling of dizziness washed over her. When she began to feel light-headed, the 54-year-old called her husband to ask him to re-schedule an appointment at the car dealership she had booked that day.

“I was just talking to him and I started getting chest pains and it got more and more intense by the second,” Robert said. “I can’t even describe the level of pressure I felt – it was nothing I’ve ever felt before.”

Worried, she mentioned what she was feeling to her husband.

“He was like, ‘Do you think maybe you’re having a heart attack?’ And I said, ‘That’s just ridiculous.’”

But the feeling kept getting worse.

“He said, ‘I need you to hang up and I need you to call 9-1-1.’” Robert recalled. “So, I did, but only begrudgingly because it was impossible that I was having a heart attack.”

When paramedics arrived, they hooked Robert up to an ECG. When the test confirmed her heart was in distress, they rushed her to the emergency room.

“I went up to ICU for about a day or so,” she said. “Things started to resolve itself. The chest pain went down but my heart was still in trouble. [Doctors] weren’t sure what to do with me because it seemed like I had had a heart attack but then it was sort of over.”

It wasn’t until five days later when Robert visited the University of Ottawa Heart Institute and an angiogram confirmed her fears: Robert – an otherwise healthy woman – had suffered a SCAD, also known as a spontaneous coronary artery dissection. Essentially, there was a tear in an artery wall and it was blocking the blood flow to her heart.

Robert’s story is all too common – and it’s because women have largely been ignored in heart health research, B.C.-based cardiologist Dr. Jacqueline Saw says.

“Generally, in North America and most developed countries, most of the studies that looked at heart disease primarily involved male subjects and women are typically (only) included in less than 30 per cent of the population being studied in these studies,” she said. “This unfortunately limits our ability to understand the comparative differences between men and women.”

What makes men and women different is rooted in their physiology.

According to the Heart and Stroke Foundation, women’s hearts and arteries are smaller, and plaque tends to build in different ways and the symptoms women experience during a heart attack and mini stroke are not the same as men.

For example, while both men and women can experience chest pain during a heart attack, women may not always and are more likely to experience other less commons symptoms like shortness of breath, nausea, vomiting or arm, back or jaw pain.

Hormones and life events unique to women are also thought to play a role. While women tend to have a lower risk of heart disease prior to menopause because of the presence of estrogen, their risk increases with diabetes and pregnancy. Menopausal women are also at a heightened risk with the development of high cholesterol and high triglyceride levels.

And these shortfalls in research and understanding in medicine are hurting women.

Statistics show that 45 per cent more women than men died of a stroke in Canada last year.

When it comes to SCAD specifically, 90 per cent of cases are women, mostly between the ages of 30 and 60. What causes a SCAD to happen is still unknown, but it’s believed to start with the artery wall weakening.

While researchers and doctors still have a long way to go in understanding women’s heart health, progress is being made, Saw says.

“We’ve certainly come along way in terms of raising awareness in the general public,” Saw said. “Gradually, we’re seeing more research funds that are directed towards looking at and addressing women with heart disease, and that certainly helps in terms of our quest for knowledge to understand more these conditions and how to manage them.”

The areas that still need work, Saw says, are with prevention, diagnosis and treatment – specifically with understanding what medications work best, as men’s heart attacks tend to be more cholesterol-based rather than hormonal, as can be the case for some women.

While Robert has recovered from her SCAD, she remains cautious – that’s because there’s still a 20 per cent chance she may experience a second SCAD event.

To avoid another episode, Robert has had to make a few life changes, like avoiding lifting heavy weights and keeping an eye on her stress levels.

“It’s really made me think about what’s important and made me realize that tomorrow really isn’t a guarantee,” she said. “So, I think a lot of things I was putting off until retirement, I’m not procrastinating as much anymore. If I get an opportunity to do something, I do it.”

Five years later as Robert looks back on what she’s been through, she says the experience has been surreal.

“What I’ve learned since is just that we as women need to pay attention to our bodies,” she said. “We need to recognize that we really are only human and we can only handle so much. If nothing else, this experience has kind of given me the strength to realize that a lot of things I used to think were important are really not that important anymore.”

“It’s been a time of reflection and really sorting out what is important for me and learning to appreciate the things that I have,” she added.

And part of her new outlook on life includes helping other women by raising awareness through the Heart and Stroke Foundation and the University of Ottawa Heart Institute.

“I just want to raise awareness to other women who might not realize that it is possible to have a heart attack, regardless of what they do,” she said.

Robert hopes more women will talk to their doctors about any symptoms or concerns they have about their heart health, as well as consider participating in research.

Canadian women's heart health, by the numbers. Dani-Elle Dubé/OttawaMatters.com