When Marcia Pupkin (45) woke up at 3 a.m. with intense pain in her right arm, she never imagined what the diagnosis would end up being. “I felt like my whole arm, from my shoulder to my fingers, was going to explode,” she explains. She was 42 years old and convinced that that night would be the last of her life. Secretary Sonia Duff (72) also did not suspect the final diagnosis when, five years ago, in the middle of the office, she felt short of breath and couldn’t breathe. Her lips turned purple and her colleagues gave her some aspirin to ease a pain that never stopped.
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Marcia and Sonia had a heart attack. Both were lucky, unlike the 10 women who die daily in Chile from this cause. In fact, cardiovascular diseases – which affect the blood vessels that supply the heart and those that carry blood to the brain – are the leading cause of death among Chilean women. “In Chile, 30% of heart attacks occur in women and 70% in men. And when women have a heart attack, they die twice as often as men,” says cardiologist Sonia Kuntsmann from Clínica Las Condes. “Historically, heart diseases have been associated with men, since women are linked to diseases affecting the breasts and reproductive system,” explains Dr. Kuntsmann.
“For every death from breast cancer, there are 10 from cardiovascular diseases,” says cardiologist Mónica Acevedo of the Chilean Society of Cardiology. “Breast cancer impacts more because it affects a younger segment, around 45 years old. In contrast, heart attacks occur with the onset of menopause, between 55 and 60 years,” adds Dr. Acevedo.
The night Marcia Pupkin woke up distressed by pain in her right arm, the first thing she did was take anti-inflammatories, but the pain became increasingly sharp until she asked her husband to take her to the emergency room of a private clinic. The on-duty doctor gave her analgesics intravenously to relieve the pain, but they had no effect. Meanwhile, Marcia had vomited and was referred to a traumatologist. After a scan, she was sent back home with painkillers and a cervical collar for a problem detected in her cervical spine.
The instruction was absolute rest for ten days, during which Marcia worsened. “It hurt a lot, I couldn’t breathe. It was like I was dying,” she recounts. Thinking she had pneumonitis, she consulted a pulmonologist who finally diagnosed a heart attack. A cardiologist ended up performing two coronary bypasses on her.
The fact that women die more than men when having a heart attack has a logical explanation. Since this condition is not associated with women, the diagnosis is much later. “In men, the presentation of a heart attack is clear: they feel chest pain radiating to the left arm and sweating. Within five minutes of these symptoms, they are already in the emergency room,” says Mauricio Fernández, cardiologist at Clínica Alemana.
In contrast, in women, symptoms are varied and they rarely think they are having a heart attack. This happened two years ago to Ximena Montero (65), when her jaws started hurting. “It was intermittent pain. Like labor pains, coming and going. How could I have thought it could be a heart attack!” And for not recognizing the symptoms, a month passed between visits to the gastroenterologist – who thought she had a gallbladder issue – and the neurologist, who said it could be bruxism. Unsatisfied, she made an appointment with a cardiologist. The next day she underwent angioplasty to unblock her arteries.
“Heart attack symptoms in women are not always accompanied by pain. For example, they feel shortness of breath, fatigue, abdominal discomfort, jaw or neck discomfort, vomiting, and chest tightness that causes anxiety. All symptoms that can be confused with diseases of any kind, even panic attacks,” explains Dr. Acevedo.
“Generally, only up to 6 hours after symptoms begin can the heart tissue that is not being supplied be saved. After that, the consequences are severe heart failure or death,” emphasizes Dr. Fernández.
For specialists, the blame is shared. On one hand, women do not know how to recognize their symptoms, and on the other, doctors do not act in time. “It is a matter of educating peers, who generally treat women as exaggerating,” says Dr. Acevedo.
The call is that when these symptoms are present and, above all, if there are risk factors influencing heart disease, insist on having an electrocardiogram to detect any anomaly. “Time gained is heart gained,” concludes Dr. Kuntsmann.
Women debut with heart attacks when menopause arrives, between 55 and 60 years old. Men, on the other hand, have heart attacks 10 years earlier. This gap is because when a woman is of fertile age, her heart is protected thanks to the effect of estrogen, a hormone that protects arteries and blood vessels.
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When ovarian function ceases, during climacteric, the woman stops producing estrogen and, therefore, the protective effect. However, younger women can also suffer heart attacks because risk factors are transversal across all ages.
Years before Marcia Pupkin had a heart attack, she had been diagnosed with diabetes and had a family history of coronary disease. “My mother had two heart attacks at 40 years old and a brother of mine had a heart attack a few years ago,” she says.
Diabetes and genetic history are determining factors for heart attack risk. “Diabetes in a woman is equivalent to a heart attack. If two women have not had a heart attack, the diabetic one is at higher risk because she behaves as if she had already had one,” explains Dr. Rodrigo Macaya, gynecologist at Red Salud of the Catholic University.
Obesity, cholesterol, hypertension, and smoking are also indicators of a possible heart attack. Just like what happened to Carmen Warner (63), who at 49 began to feel profound fatigue, a symptom that her arteries were blocked and she underwent a four-bypass surgery. At that time she was overweight, did not exercise, and ate fried foods and meat almost every day. “My cholesterol was through the roof,” she says. Also, she smoked a pack of cigarettes a day.
According to the cardiovascular study Risk Factor Multiple Evaluation in Latin America, conducted in 2008 on women with an average age of 44 years from seven Latin American cities, in Santiago 43.3% of respondents declared themselves smokers, taking first place in smoking in the region and the dubious honor of second place – after Mexico – in generous waistlines with 87.9 cm, when the recommended maximum to reduce cardiovascular risk is less than 80 cm.
“A wide waist means there is a greater amount of intra-abdominal fat – which accumulates between organs – and that generates diabetes, high cholesterol, hypertension, and arterial inflammation, all factors that influence heart attack risk,” explains Dr. Acevedo. “In ten years, we will see an increase in cardiac events in women. Maybe they won’t die, but there will be a rise in people having heart attacks,” says Dr. Acevedo.
“Some people think that having thin legs and a slightly bulging abdomen means no risk, but the truth is that it is not normal. Women with abdominal fat are more exposed than those with fat accumulated in the hips,” says Dr. Acevedo.
Therefore, keeping risk factors under supervision is crucial to prevent heart diseases. “The combination of hypertension, smoking, and diabetes increases the risk of having a heart attack by 4 times. That is why coronary disease is a disease of risk factors. Keeping it controlled only means changing habits and starting to exercise and eat healthily,” concludes Dr. Kuntsmann.
The problem is not hormone replacement therapy, but its late administration. “There are women who receive this treatment five years after menopause, and it is proven that this increases cardiovascular risk,” says endocrinologist Eugenio Arteaga from the Catholic University. However, when therapy is indicated during the perimenopausal period or up to the first five years, hormones are not harmful. “This period is called the window of opportunity and only here is it advisable to administer therapy. After that, it makes no sense because the woman no longer has symptoms,” adds the specialist.
Also, today there are new forms of administration. For example, the transdermal route, which unlike oral, is not metabolized in the liver. “Oral therapy passes through the liver, stimulating a series of proteins, including those involved in coagulation, which increases cardiovascular risk. The transdermal route enters through a patch on the skin and goes directly to the heart, so there are no risks,” explains Dr. Arteaga.
While in men the signs of a heart attack are clear: chest pain – radiating to the left arm – and sweating, women experience a variety of symptoms that are not always accompanied by pain. Therefore, if risk factors are present, it is important to be alert when one or more of the following symptoms appear: abdominal, dorsal, or jaw pain; shoulder or neck pain; dizziness, nausea, or vomiting; difficulty breathing; fatigue; palpitations; indigestion; brief loss of consciousness; and anxiety due to chest tightness.
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