Used by permission of "Today’s Omaha Woman"

Omahan Dana Schwarz had recently celebrated her 40^th birthday, and that seemed to explain why she was feeling more tired these days. Of course, who in her position wouldn’t be? Not only had she hit the big 4-0, she was the single parent of a teenage son, a full-time nurse and college student.

Heart disease was the furthest thing from Schwarz’s mind. That was a man’s disease – something women didn’t need to worry about. But actually, Schwarz knew better. She was a cardiac nurse who knew the real and startling facts about women and heart disease. She knew heart disease is the No. 1 killer of women in the United States and the leading cause of long-term disability. In fact, more women die of cardiovascular disease than all the forms of cancer combined. Almost one in every two women will die of heart disease, stroke or other cardiovascular disease.

But, Schwarz reasoned, she was active. And besides, she didn’t have time to be sick. Looking back, Schwarz admits she was in denial. She had many of the risk factors, including a strong family history of heart disease, with both parents dying of heart disease at early ages. She also smoked, had high cholesterol and high stress.

Besides fatigue, Schwarz began experiencing other symptoms. At night, she would sometimes awaken to a feeling of nausea and chest burn that radiated up to her throat. But she continued to come up with other reasons for her symptoms. Then one night, she woke up faint, nauseated and doubled over in pain. "The pain was 10 over 10," she says. "It was the worst I had ever felt. I looked in the mirror and I was as pale as a ghost. I couldn’t deny it anymore. I knew I must be having a heart attack."

Schwarz’s son called 911 and she was taken to the nearest hospital.

Unfortunately, even health care professionals are sometimes reluctant to diagnose women with heart disease, so for the nest twelve hours, Schwarz was treated for heartburn. She was eventually taken to the catheterization lab where it was discovered that one of her blood vessels was 70 percent blocked and another completely blocked. She was treated with clot clearing medication, and angioplasty was performed. To open the vessels and two stents were then placed to keep the vessels open. Schwarz was told she had suffered an extensive heart attack.

While the misconception about women and heart disease still exists among much of the general public, it is improving among health care providers, says Monique Kusler, M.D. a Nebraska Health System cardiologist at the University of Nebraska Medical Center. Kusler runs a clinic that sees mostly women, because she believes there is not enough focus on women and heart disease. "Not only is there less awareness about women and heart disease, but women are harder to diagnose for a number of reasons," she says.

"One of the differences with women," Kusler says, "is that symptoms usually start showing up about ten years later than in men. This is usually during a woman’s 50s or post-menopausal years, when she begins experiencing a diminishing supply of estrogen. Estrogen provides a beneficial effect on the arteries. When estrogen production slows down, women lose that protective effect," Even so, Kusler adds, women in their 30s and 40s still experience heart attacks.

Another problem with diagnosing women with heart disease is that their symptoms often differ from those of men, Kusler says. Most people are familiar with the more common symptoms of heart attack experienced by men, which include anxiety, shortness of breath, cold sweats, nausea and vomiting, abdominal pain and heart burn.

As a result, many women fail to seek medical attention for their symptoms, resulting in accumulative heart damage over time, Kusler says. When they do finally seek help, their physical health is much worse, and they often have other complications as a result of their untreated heart condition, reducing their chances of survival.

Accumulative damage occurs when women experience a series of small heart attacks that are never treated. Heart attacks in general result from plaque build-up in the coronary arteries. The plaque breaks apart and blocks blood supply to the heart muscle. If untreated, this part of the muscle dies. With immediate treatment, however, the artery can be opened and blood flow reestablished, preventing permanent damage.

"Another problem," Kusler says, "is that women are procrastinators. We don’t take care of ourselves. That has to change. Women need to start taking their health more seriously and become more knowledgeable about heart disease."

What else can women do? Know their family history and other risk factors for heart disease. These include:

As women reach their menopausal and post-menopausal years, they should consider estrogen replacement as a preventative measure, according to Kusler. "An estrogen-progesterone combination can help relieve the symptoms of menopause, protect against osteoporosis and help prevent heart disease. Major studies that are looking at the benefits of estrogen in preventing heart disease are ongoing."

Women should also take a half an aspirin a day starting at age 40. "The bottom line is, heart disease is a growing problem among women in our society," Kusler says. "Since 1987, more women have died of heart disease each year than men. But we can help curb this trend if we take a more proactive role in our own health.