Heart diesease is increasing a condition affecting Irish women, writes Anne Dempsey
In March 2001 when she felt pain in her chest and right arm Catherine Dempsey went immediately to her GP.
"I had been having pains in my right arm on and off for about a year which I thought was tension, but when I felt chest pain, I took action. However, the doctor said the left arm only should cause concern. My father suffered from heart disease but they said that wasn't particularly relevant either and just asked questions about my mother's side of the family. My blood pressure was slightly up but they still felt I had nothing to worry about."
She was placed on a blood pressure monitor for 24 hours, subsequently given the all clear and prescribed medication for muscle pain.
"At first I was very relieved and wanted to believe but they were right. But over the next week, the pain got worse, so bad that I couldn't walk the 100 yards from car to work. I started taking aspirin as a precaution because I thought it would be good for my heart, though I don't recommend self-medication in general. When I returned to the doctor I saw someone different, who again seemed to want to reassure me."
Catherine (48), from Enniscorthy, Co Wexford has three children aged 21, 14 and 12. She is the family breadwinner and works in the Department of Social Welfare. She had lost two stone with Weight Watchers in 2000 and was fit. Now the constant pain was incapacitating.
"I felt like my father looked when in pain, I just knew something was wrong, I got a third professional opinion including an ECG which was normal.
"But two days later, the pain was so bad, I went to Wexford General Hospital myself. They diagnosed angina, confirmed my father's history was relevant as was the pain in my right arm. I learnt I had had a slight heart attack that morning which given the pain I wasn't surprised."
Catherine was stabilised and underwent a medical procedure to clear a blocked artery. Her homecoming instructions were to take things easy but she felt exhausted anyway without knowing why.
She feels her real salvation was a 14-week outpatient cardiac rehabilitation programme at Wexford Hospital.
"I can't praise it enough. We met twice a week for exercise and seminars. Each was excellent.
"For example, as a result of "Know your tablets" lecture, I was able to identify my severe fatigue as a side effect from medication which I then had changed.
"I learnt about risk factors - family history, diet, lifestyle and how much each contributes. We learnt that stopping smoking was the most effective way of lowering your risk. If you stop the day after a heart attack, your risk of another is reduced by up to 70 per cent. I would like smokers to hear that. We learnt about stress, relaxation, diet and how to read food labels when shopping."
Today three years later Catherine is well and exercises regularly.
"I walk for up to 90 minutes four or five times a week, usually with my sister. We were told in rehabilitation to find a pace that leaves you breathless but not speechless, and we're certainly not speechless.
"Walking the talk in this way is de-stressing. At the beginning, I became a bit allergic to stress and worried about becoming stressed.
"Now I've learnt not to ignore it but to take it more in my stride. I did join a gym and while that fell by the wayside due to work pressure , I intend to join again to get in shape for summer.
"Looking back, I am annoyed that I wasn't taken seriously when I first went to the doctor and saw three different GPs on four visits without a correct diagnosis.
"I would say to women, listen to yourself. If you are not happy with the diagnosis, be assertive and don't worry about feeling a nuisance. I accept that it may be more difficult to diagnose symptoms in women, but for that very reason,
"GPs should listen to women themselves, and be open to the possibility what we describe could be related to heart problems, particularly with a family history on either side."
If you were asked to imagine a typical heart attack candidate, you would probably picture a high-flying stressed out man. But you would be only half right.
Women suffer from heart disease too - in every increasing numbers. This month an EU conference in Brussels, The Future of Cardiovascular Disease in Europe, heard that cardiovascular health in women has improved less because female rates of smoking has increased.
In fact, while most Irish women dread a diagnosis of breast cancer, they are 10 times more likely to die of heart disease, the single most common cause of death with more than 4,200 fatalities each year.
A recent paper on Women and Cardiovascular Health by the Women's Health Council concluded that heart attacks and strokes kill as many women as all cancers combined.
The male image of heart disease - which both women and their doctors may have imbibed - has harmed women in a number of ways.
Iif a woman comes to her GP complaining of vague chest pains and is referred to a cardiologist, the diagnostic ECG stress test is less accurate for women than for men.
"Symptoms can be more difficult to diagnose in women. Men are more likely to present with so-called classic symptoms such as chest heaviness which radiates to their upper arm. A woman's symptoms are often vague and diffuse. She may have pain in her side and back, and/or suffer from nausea and vomiting," says Dr Vincent Maher, medical director of the Irish Heart Foundation.
"We need to raise more awareness among women so that they would go to their doctors earlier, understand their own level of risk for stroke or heart attack and recognise the signs and symptoms. For example, if you experience chest discomfort as a result of exercise which resolves after rest, and have a strong family history of heart disease on either side, you should attend the doctor. Women who smoke, have high cholesterol or blood pressure must heed symptoms more attentively. From a positive point of view, small changes in lifestyle today can make a big difference in the long term.
"We in Irish Heart Foundation are continually trying to raise this awareness among the public and professionals alike through articles and peer lectures. We need to address the whole issue of how women's medical symptoms differ from men's, and to evaluate diagnostic techniques so that women are given an equal opportunity of receiving a correct diagnosis. There is a lot of work still to be done."
For more information contact the Irish Heart Foundation, 4 Clyde Road, Dublin 4, telephone 01-6695001 LowCall 1850 364 364
www.irishheart.ie