Olga Krasnobay-Oganezov, RN
Assignment #2
Women’s Health and Wellness Across the Lift Continuum
Due Date: 03/11/2018
What do women know about heart disease? Unfortunately, the knowledge about cardiovascular health among female population is very limited and, oftentimes, factually incorrect. These myths, so widely accepted, cloud patients’ judgement and prevent them from taking timely precautionary measures to decrease morbidity and mortality from. One of the myths is that heart disease mostly affects men. In fact, according to Encyclopedia of Heart Diseases, “this is a false notion that cardiovascular disease (CVD) is more common in men than in women (Khan, 2011).” The same source reports that “after age 65, about one in four women have some form of CVD” and that “more than 350,000 women die of a heart attack and more than 120,000 die of a stroke in USA each year (Khan, 2011).” Moreover, according to the statistics, out of all CVD deaths, women show higher numbers than men, 52% to 48%, respectively. However, these statistics come into play when discussing CVD deaths in postmenopausal women after 48 – “most women are protected … up to age 48 because of their hormonal status (Khan, 2011).” Comparative data for myocardial infarction (MI) rates among men and women as they age clearly depicts the increase of incidence in women: “the incidence of heart attack in men and women at ages 35, 40, 50, 65, 70, and 75 is about 100:1, 20:1, 10:1, 5:2, 5:4, and 1:1 (Khan, 2011).” Another misconception has to do with the leading cause of death among women in the US – cancer, breast and uterine in particular, is falsely considered the main cause. According to Boston Scientific Journal, “heart disease is the leading cause of death for women, taking more female lives than all cancers, respiratory diseases and Alzheimer disease combined (Smith, 2015).” Encyclopedia of Heart Diseases states that “notably, breast cancer deaths are about 10% than that of CVD deaths, and deaths from all forms of cancer are less than 50% of CVD deaths (Khan, 2011).” People tend to think that heart disease affects men and women the same way. This understanding is wrong for many reasons. The factors that affect disease characteristics in terms of gender are heart size and strength. Since the size of the right ventricle is an atomically smaller in women, it is more vulnerable to damage. Anatomical weakness is leveraged by the abundance of estrogen in premenopausal women. In the same manner, people believe that CVD is a disease of the old disregarding the fact that it affects all age groups. For “younger women in particular, the combination of birth control pills and smoking boosts heart disease risks by 20 percent (Leuzzi, 2014).” Another myth is that in order to be diagnosed, symptoms have to be present and they are similar among both genders. Sadly, American Heart Association (AHA) claims that “sixty-four percent of women who die suddenly of CVD had no previous symptoms… and … because the symptoms vary greatly between men and women, they are often misunderstood (Smith, 2015).” Moreover, since women’s symptoms like dizziness, indigestion and sleep problems, are very subtle, they can be brushed off or attributed to a number of unrelated conditions. It is falsely believed that men and women with heart disease get the same medical care. According to Boston Scientific Journal, “research shows that among heart patients, women were less likely … to receive medications such as beta blockers, statins, ACE inhibitors, which help prevent further heart problems (Leuzzi, 2014).” One more misconception has to do with the belief that gender differences are accounted for when it comes to heart disease research. In fact, heart care research tends to overlook gender differences focusing mainly on men. Heart clinical trials report “gender-specific results only about 25% of the time (Smith 2015).”
Even though medical community is aware of the fact that heart disease does not manifest the same way in men and women, all the diagnostic tests and treatments guidelines are universal for both sexes. The gap between cardiovascular diagnostic tests and resulting medical treatment exists based on the gender of the patient. Recent research published in Clinical Chemistry and Laboratory Medicine Journal showed that female heart patients experience longer wait time for treatment initiation for the same symptoms as their male counterparts. The reason for this inequality of treatment that creates the gap itself is known as Yentl syndrome. The syndrome represents the different course that heart attacks take in males as opposed to females. The problem itself, however, rose due to the overwhelming concentration of the cardiovascular research on white male participants. Heart disease does not discriminate among genders – treatment practices do. Sadly, with the existing amount and variety of CVD research and the amount of investments into the field, women of all ages are still more likely to die from a heart attack. Womensheart.orgmentions interesting findings of one Israeli study that claims that the CVD death risk for women is 1.7 times higher than for men. Looking at myocardial infarction (MI) example, timely administration of thrombolytic agents increases survival rates. However, according to womensheart.org, for unknown reasons, thrombolytics work better in male patients. While doctors look for more gender specific CVD treatments, nurses can play a role in decreasing this gender gap and saving lives through education. Studies show that women tend to wait too long before seeking medical attention for their heart attack symptoms. According to the American Heart Association (AHA), “about 95% of women notice that something wasn’t right in the weeks before their heart attack (Smith, 2015).” Timely arrival and diagnosis are the first and foremost determinants of how successful the outcome of treatment will be. Nurses should educate female patient on the symptoms of heart attack in women and necessity of emergent medical care shall the symptoms appear.
There are several teaching points that need to be addressed by the nurses during women’s education: risks, warning signs and symptoms. Risk factors can be subdivided into general and specific to gender. General risk factors include a list of common comorbidities: diabetes, obesity, hear failure, history of stroke, and kidney failure. Among gender specific, nurses can mention these risk factors during a teaching session: higher blood pressure during menopause, higher testosterone levels before menopause, autoimmune disorders, depression, smoking, anxiety, and stress. AHA mentions that among heart attack warning signs for women, unusual fatigue, sleep disturbance, shortness of breath, indigestion, anxiety, and racing heart. As it was already mentioned above, the signs are very non-specific, and can be attributed to the number of unrelated conditions. In comparison to warning signs, the symptoms experienced by women during the heart attack, as per AHA, are: chest discomfort, shortness of breath, weakness with difficulty moving, unusual fatigue during and after activities, cold sweat, nausea, dizziness, lightheadedness, week or heavy-feeling arms, and pain in one or both arms, the back, neck and jaw. The characteristic that needs to be emphasized by nurse-educator is the fact that for both males and females the most common heart attack symptom is chest pain; however, women report it significantly less. To clarify the situation, compared to men, women report “diffuse chest discomfort – pressure, squeezing, and fullness – and, perhaps, do not perceive or report them as pain (#9).” Additional women-specific symptoms, as per AHA include: sudden pain that awakens the patient from sleep, sudden pain unrelated to physical exertion, pain specific to the left lower side of the jaw, pain in either arm (no just left like in men), and pain in the lower or upper back that starts in the chest (Khan, 2011).”
What life-style modifications can nurses recommended to female patients? First recommendation would be to quit smoking, according to AHA, tobacco acts like a vasoconstrictive agent that can highly increase women’s chances for development of heart attacks. Healthy eating would be another lifestyle modification. Nutritional recommendations are particularly important and should be well explained by the nurse. The outcome of the teaching about diet modifications would be favoring of fruits, vegetables and whole grains instead of deep-fried fast foods, bakery products, processed snacks by women. Special attention should be paid to the limitation of the saturated fats in beef, butter, cheese and milk and favoring polyunsaturated fats in fish and liquid oils. Significant decrease of alcohol consumption is necessary to keep blood pressure in check and prevent both CVD and CVA. Regular exercising would be is another valuable advice to give – a minimum of 30-60 minutes of daily physical activity is necessary for cardiovascular health. Daily exercising falls under a broader category of prevention from CVD – weight watching. With the reduction of weight, chances for the development of high cholesterol levels, hypertension and insulin resistance – all leading to CVD – become much slimmer. Stress reduction is another invaluable amendment to everyday lives. Stress, unfortunately, triggers most of the other types of unhealthy behaviors like overeating, smoking, and alcohol consumption. Last but not least, nurses should pay tremendous amount of attention and effort to regular health screenings. Adults should be taught to have their blood pressure checked at least every two years and cholesterol about every four to six years. Unfortunately, high blood pressure and elevated cholesterol my not cause symptoms, but they can permanently damage hearts.
Even though contemporary cardiology hasn’t come up with a specific plan for diagnosis and treatment of heart disease in women, decrease in mortality and morbidity can be achieved through thorough nursing education of females of all ages about prevention, risk factors, signs and symptoms and course of action during heart attack. The power of word and pervasion should be embraced and multiplied by thousands of nurses fighting for the same goal of female cardiovascular health.
References:
Common Myths About Heart Disease. Retrieved March 11, 2019, from https://www.goredforwomen.org/en/about-heart-disease-in-women/facts/common-myths-about-heart-disease
Heart disease in women: Gender gap still in need of repair. (2018, August 09). Retrieved from http://www.mysouthernhealth.com/heart-disease-in-women/
Khan, M. G. (2011). Encyclopedia of Heart Diseases. Totowa: Springer. Retrieved from https://onesearch.cuny.edu/primo-explore/fulldisplay?docid=TN_gale_gvrlGVRL6MJZ&context=PC&vid=ny&lang=en_US&search_scope=everything&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,encyclopedia of heart disease&sortby=rank&facet=rtype,include,books&mode=basic.
Leuzzi, C., Sangiorgi, G. M., & Modena, M. G. (2010). Gender-specific aspects in the clinical presentation of cardiovascular disease. Fundamental & Clinical Pharmacology,24(6), 711-717. doi:10.1111/j.1472-8206.2010.00873.x
Smith, G. N. (2015). The Maternal Health Clinic: Improving women’s cardiovascular health. Seminars in Perinatology,39(4), 316-319. doi:10.1053/j.semperi.2015.05.012
