What you can learn from 36-year-old woman's heart attack
Picture a heart attack survivor, and Jennifer Podkasik of Naperville is not the image that comes to mind.
Imagine how a heart attack happens, and the way Podkasik's struck is not the norm, either.
But what the health-conscious 36-year-old learned since her unexpected ordeal is a good lesson for others like her, doctors say. Heart attacks often show different symptoms in women than in men, and they can happen even to those who are young and otherwise fit and healthy.
"It's so rare and unexpected and it takes you off-course with your life," Podkasik said.
Research on heart attacks in women is building - enough that the American Heart Association released its first scientific statement on the topic this year on the eve of American Heart Month in February. The document suggests more should be done to help women and medical professionals recognize heart attack symptoms and improve aftercare - both physical and mental - for women recovering from attacks, said lead author Dr. Laxmi Mehta, a cardiologist at the Ohio State University Wexner Medical Center.
Heart attacks, she said, kill 53,000 women across the country each year and roughly 6.6 million women are affected by heart disease.
"Deaths from cardiovascular disease are on the decline in both genders, but more women are dying," Mehta said. "In the past we thought young women would be protected because of their estrogen, and that's not necessarily the case."
Women such as Podkasik might think they're safe because of their lifestyle choices - eating a balanced diet, exercising, keeping cholesterol and blood pressure low, not smoking, managing stress.
But the new Heart Association statement says heart attacks occur frequently in women even without a blockage in the coronary artery, which is what usually causes an attack. Women can experience heart attacks because of a spasm in the coronary artery or a spontaneous tear, and doctors say these problems can happen unpredictably.
"You're working out and eating healthy and doing everything you should - and then you have this huge, traumatic event with this organ that keeps your body alive," Podkasik said. "It took almost an entire year to start to feel a new normal."
Surprise heart attack
Podkasik was getting her daughter's hair ready for school about 7:45 the morning of Oct. 20, 2014, when her second strange symptom struck.
"All the sudden I felt like a hot tear in my chest," Podkasik said. "It became very intense, very quick."
It was the first sign she recognized that something was wrong, although she'd been having what she thought was unusual acid reflux, an uncomfortable feeling like a thick bile rising in her chest, for the past few weeks.
Podkasik walked into her kitchen to tell her husband, Curt, what she was feeling. She buckled under the burning pain and Curt suggested it might be a panic attack.
Not prone to anxiety, Podkasik thought it was something else. Breathing remained a struggle. Soon a routine morning driving the couple's three kids to school became a rushed trip to the Edward Hospital emergency room - not by ambulance but with Curt behind the wheel.
In the ER, nurses and doctors ran an electrocardiogram - a test used to gauge heart function - and told Podkasik what was going on. Here she was, mid-thirties, a frequent exerciser and eater of organic food, a mother of four with none of the typical risk factors or storybook symptoms, and she was having a heart attack.
'Silent' symptoms
Podkasik didn't know it, but doctors say she experienced key symptoms that are "atypical," yet occur more often in women than men.
The "Hollywood heart attack" features chest pain or pressure and a dramatic collapse, doctors say. The real-life woman's heart attack can feel quite different, especially if it's a so-called "silent" attack.
"It can be burning, not pressure," Mehta said. "Women can have unusual shortness of breath, back pain, arm pain, dizziness, intense fatigue, indigestion or intense heart burn."
These discomforts don't scream "heart attack!"
"Women tend to under-recognize or deny them," she said.
In fact, women delay treatment of heart attack symptoms much longer than men - a median time of 54 hours instead of 16, according to one study Mehta reviewed.
Podkasik said she's fortunate she didn't wait. She advises all women to take their discomforts seriously.
"I am so thankful that I insisted on going to the hospital," Podkasik said. "If something is serious or your gut is telling you something is wrong, don't waste time."
Four hours after a heart attack begins, muscle damage starts to occur, said Dr. Annabelle Volgman, medical director of the Rush Heart Center for Women in Chicago. And delaying treatment could increase likelihood of death.
"Every minute counts in recognizing the symptoms of a heart attack in women," Volgman said. "There is still a lot of active research into why women have these kinds of symptoms and what are the symptoms that women feel because we don't want to miss them."
Doctors also are pushing paramedics and emergency room nurses to better recognize atypical heart attack symptoms as they respond to 911 calls and prioritize how quickly patients receive care.
Says Mehta: "Education of the nurses on the difference in symptoms is really vital."
Long-term solutions
What happens after a heart attack can be just as challenging as the crisis itself.
Podkasik said every day of her yearlong recovery left her wondering if her heart would give out again.
Doctors handled her case well medically, she said. They eventually determined her attack could have been caused by a spontaneous tear in her coronary artery or because she had a hole in her heart that allowed a clot to pass through and interrupt its regular beating. She has since had surgery to close the hole.
"It came down to the doctors saying we'll never know exactly what caused it, but we know that the odds of you having a second one are extremely rare," she said.
Emotionally, she and Curt both wished for more support, more understanding, more connections to others who have endured similarly shocking heart attacks.
"You need to hear that you're going to be OK," Podkasik said.
The need for reassurance could be even stronger among the young, healthy subset of women who survive heart attacks because they feel confused about why it happened, Mehta said. Science also remains unsure why some women's arteries tear, seemingly out of nowhere, and what can be done to prevent it.
"What's also frustrating for these women is there's no real way to tell when that would occur," Mehta said. "There's a lot of angst with that type of heart attack."
When Volgman gets new patients at Rush she refers them to find a peer group through WomenHeart, a national coalition for women with heart disease.
"It is a very emotional thing, and these women need support," she said.
As doctors provide mental and emotional support for recovering patients, they continue to probe the "why" behind the more unexplainable heart attacks in younger, otherwise healthy women. Volgman said 80 percent of heart attacks can be prevented with lifestyle changes, but the remaining 20 percent occur because of outlying risks that are difficult to spot.
That's why doctors, including Mehta, recommend increasing women's participation in cardiovascular research trials so the best diagnostic and treatment methods can be found.
"In the past 10 years we've ramped up the amount of data we have about women and heart attacks," Mehta said. "But there are still gaps in knowledge that we find."