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For women, the symptoms of a heart attack are very different from men.  Dr. Smolens, Director of the Women’s Heart Center at Banner Heart Hospital explains:

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‘Heart Disease’.  With these two words, the lives of millions of women are changed in an instant.

While there is a sense of relief in knowing why your heart hurts, it is impossible to predict how this knowledge will affect your life.

Beyond the questions lie the reality that your life has taken a dramatic turn.  Although chronic by nature, your viewpoint of your condition doesn’t have to be.  It would seem, though, that this is a lesson best learned in retrospect.

20/20

As in ‘hindsight is’.  I’ve always thought this to be a strange saying.  It suggests that looking back is the only way to see if your chosen path was correct.  It makes sense, I guess.  Looking behind is the best vantage point from where to view the road ahead.  Only from this perspective can we know if we’ve made the best use of our knowledge and time.  This is the place where changes can be made and attitudes can be adjusted. 

Panoramic View

If you’ve seen ‘Pride and Prejudice’, you’ll recognize this scene:  She stands on a precipice, wind blowing in her face, clouds float by intermittently shading her closed eyes.  When she opens them, she has made a decision; one that she sees only now; now that she’s found time to stop and see where life has taken her.  Though probably not the best time to mediate as she is standing on a cliff. 

 Stepping Back From The Edge

Taking a moment to meditate on the past year has brought me to some astounding conclusions.  First and most importantly, I’m not alone.  While the numbers already suggest that, it’s the stories we share with one another that count most.  Secondly, the decisions we now make matter absolutely.  Will be chose to learn and share and live our lives or will we waste the time we’ve been given. 

While heart disease may be in your future, how you get there is your choice.

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If asked if the current state of your heart disease is acceptable, how would you answer?

It’s a tough one; I know.  Just yesterday I was asked this very question.  “If, when we first met, your chest pain and quality of life was terrible, 10 being terrible, what number would you assign your quality of life now?” asked my super-hero of a doctor, Dr. Bairey-Merz.

Looking her straight in the face, I responded, “That’s a tough thing to quantify”.

How do you assign a number to the quality of your life?  Of course, I understood the question.  I realized that she needed a figure to determine where I am on my journey.  How else is she to know what to try next. 

Leaning back in my chair, I looked down at my hands and fiddled with my ring.  Slowly raising my eyes, I assigned a number to my life. 

“I estimate my quality of life currently to be a 3”.  Her face relaxed a bit, but I saw no smile.  “About 75% better than when we first met; would you agree?” she asked. 

That’s when it occurred to me.  Her face gave her away.  This was the best it would ever be.

The Best Compared To What?

Every six weeks I visit my wonderful doctors.  With each passing week, however, something very interesting has happened.   My visits with both Dr. Bairey-Merz and the fabulous Dr. Margo Minissian focus more on managing my condition and less on curing me.  ‘Curing me’….  Only now am I beginning to realize how stupid I was to think that I would be cured.  After all, I have Microvascular heart disease.  You can’t operate on the tiny vessels around your heart. 

Why Compare?

I know my life will not be returning to the old ‘normal’.  To be sure, 75% better is better than 0% better.  Even still, the problem isn’t so much in the number assigned to my quality of life as in having to assign a number. 

It’s hard not to compare.  But remember; comparisons do one of two things; they either make you feel bad because others have it better than you or make you feel better because others have it worse than you.  Either way you lose.

So, I will stop comparing my current self to my old self.  I will stop comparing what I could do then to what I can do now.  I’ll stop comparing — period. 

Call it a compromise if you will.  But life is worth living.  Nothing compares to that.

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Having been the rather unwilling participant in four procedures, you might think it odd that I believe angiograms to be necessary.

In the end, however, it was a specific type of angiogram that ultimately confirmed my diagnosis of Coronary Microvascular Disease.  I was given a Coronary Reactivity Test which is an angiography procedure specifically designed to examine the blood vessels in the heart and how they respond to different medications.

Recently, both the Wall Street Journal and NPR posted some very convincing arguments as to why the traditional angiogram is no longer the ‘gold standard’ in heart testing.  And quite frankly, from my experience, I would have to agree.

I had my first angiogram in 2005.  Having been rushed to the ER with chest pains, I was given the full range of testing.  However, when my angiogram came back ‘clear’, I was sent home rather unceremoniously; almost made to feel bad that I put them through the trouble.

My second and third angiograms happened under much the same circumstances.  Continued chest pain, trips to the ER and confounded doctors who could offer no explanation of continued chest pain without clogged arteries.

However, my fourth angiogram was the one that made the difference.  This specialized take on the traditional angiogram proved to be the breakthrough needed to finally diagnose my condition.

How It Affects You

While risk factors for men and women are the same, women tend to have more coronary microvascular disease.  This dysfunction of the small arteries lies in the heart muscle itself and cannot be seen on a traditional angiogram.

Perhaps the problem is not in how often angiograms are ordered, but in the way in which they are administered.

For many women, the road to diagnosis is a long one.  It would be a wonderful thing to leave the cardiologist’s office with a correct diagnosis on your first visit.  Since that’s not going to happen, we must prepare ourselves for the gamut of testing bound to be in our future.

What better way to prepare yourself than to know what your testing options are?

Click here for more information regarding Cedars-Sinai Women’s Heart Center and Coronary Reactivity Testing.

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Why in the world would a person choose to admit herself into a hospital to undergo scary tests on her heart?  What!??!  This doesn’t sound like fun?  Well, you are right there.  It’s not fun.  In fact, it sucks.  But, if the results will one day contribute to the ‘betterment of womankind’, count me in. 

That’s the line my cardiologist used to get me onboard for the first Clinical Study.  I say ‘first’ because, as it stands, I’m currently involved in my third study with the good folks at Cedars-Sinai Women’s Heart Center.

It’s probably the altruistic attitude of my doctor and all those I’ve met there that has prompted me to share what I’ve learned with you all.  But, I digress.  What we will discuss today is two of the major cardiac procedures I underwent when participating in a Study.  But first…

 Why Choose To Participate

Interesting question.  I imagine that for each of us, the answer would be different.  Are there holes in your diagnosis?  If so, are you willing to try new therapies?  Are you near enough to a research hospital that you could participate?  How will this affect you and your family?  The list goes on and on.  Let’s just say, however, for the sake of argument, that you do enlist in a Cardiac Study.  Here is what you can expect from my limited experience.

Testing

You will undergo tests to make sure that you meet the criteria for participation.  Included will be a brief physical exam, a review of your medical history and a blood draw. 

Depending upon the type of  Study you’re involved in, you may have to undergo a Coronary Angiogram.  The link provides all the details; what is done, what you can expect as far as recovery time, etc.

For my second Study, I underwent a Cardiac MRI.  This test is certainly a bit more state of the art.  If you are prone to claustrophobia, there are MRI machines with openings, which help a lot.

I know that ‘womankind’ will certainly benefit from the finding in the Clinical Studies I participated in.  Even now, my symptoms have significantly decreased because of the findings of and adjustments made to my medication.  But, as with anything, its good to know what you’re getting into before you get involved.  Don’t you agree?

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Most times we ladies are on the losing end of this battle.  Does that mean you shouldn’t go to the ER if you experience extreme symptoms?  I won’t even dignify that with a response.  Well; maybe a short response.

I’ve gone to the ER no less than 10 times in the last five years.  Each time I go, I question whether or not I should have gone.  Inevitably, I’m sent home with few answers and worse for the wear.  And yet, if it happens again, I have to go.  So do you.  Here’s why.

It is the job of the ER at your local hospital to make sure you aren’t going to die.  The tests they run are intended to do just that; ensure that you aren’t having a heart attack.  Here’s the burn; Ischemic Heart Disease (IHD) cannot be detected with an EKG.  A chest X-Ray cannot determine IHD.  But what can help you is a blood test, which checks your cardiac enzymes.  This will provide conclusive evidence as to whether or not you’ve had a heart attack.

And that, my friends, is why you must always go to the ER.

Yes, the doctor may think you’re a loony.  So what!  You may be made to feel as if you are a hypochondriac.  Who cares!!  You are experiencing some major symptoms and you’d be a fool not to confirm that it’s not a heart attack.

Keep in mind, too, that they are not there to identify chest pain yet to be diagnosed.  Only regular visits to a good doctor can determine that.  Very specific tests are done to check for IHD; none of which are performed in the ER.  So, if you have experienced symptoms (pressure, dizziness, palpitations, shortness of breath, etc.) go to the ER.  STAT!  Just don’t expect validation of your condition.  

So how can we come away from another 8-hour overnight stint in the ER feeling the victor?

–     Be proactive!  Before another trip to the ER comes, have your treating physician write your condition down (including  which tests are best in the event of an emergency).  Keep this with you at all times and give it to your treating ER physician.

–    Understand that you most probably have more information about your condition than your Emergency Room doctor.  That’s ok.  Share what you know.

–    Realize that you have an obligation to yourself and your family to take your condition seriously. 

–    Last but not least, take it all in stride.  A good sense of humor goes along way.

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