// by Chloe Emory
Karla Manley remembers soccer coaches in high school telling her parents that she just wasn’t athletic. The fatigue she was experiencing was pure lack of talent and stamina.
What her parents and coaches didn’t know was that she was pushing herself far harder than she ever should have.
In February 2003, then 33 years old, Manley found herself in the hospital for what was supposed to be a sinus surgery, when she was informed that the operation was to be postponed. The doctor had discovered that she had a heart disease.
Although the diagnosis came as a shock to Manley and her family, it saved her life. While her heart condition was congenital, many women with heart diseases suffer the same symptoms that can be easily overlooked.
In fact, until 20 or 30 years ago, heart disease was considered primarily a man’s affliction and researchers focused almost exclusively on male subjects. Women’s cardiac symptoms went largely un-researched.
That, despite the fact that heart disease is the number one killer of women, according to the American Heart Association. It is more deadly for its female victims than all forms of cancer combined.
Today, however, much more is known about women and heart disease and Manley suggests all women should know the signs of impending heart conditions.
“I think a lot of people are just afraid of knowing,” says Manley. So what should women know about heart disease?
First, they should know that the rate of death for cardiac disease has actually increased for women 35 to 50 years old in recent years, according to Mayo Clinic cardiologists. Second, they should know that research over the last decade has shown that women’s symptoms are often very different from men’s.
While men often complain of chest pain as their most frequent symptom, women may instead feel discomfort in the neck, jaw, shoulder, back, or arms as well as experience nausea, vomiting or a feeling similar to indigestion.
Because they’re often more subtle, women’s symptoms can be easily overlooked. Manley, for instance, initially thought her symptoms were attributed to the fact that she was just out of shape.
Locally, Dr. DeLisa Fairweather, director of Translational Cardiovascular Research at Jacksonville’s Mayo Clinic, has focused her research on understanding the differences between men and women when it comes to heart disease.
Fairweather says that the human body’s immune system is regulated differently by sex hormones. Her studies focus on separating her patients into different categories to better understand how hormones play a part in the disease.
Because of the many differences between the genders, Fairweather explains that a treatment that works for men won’t necessarily work for women.
“Disease diagnosis is different; symptoms are different; pathology is different. We need to have a different treatment.”
Mayo Clinic suggests women see a doctor if they are experiencing the following symptoms:
• Neck, jaw, shoulder, upper back or abdominal discomfort
• Shortness of breath
• Right arm pain
• Nausea or vomiting
• Lightheadedness or dizziness
• Unusual fatigue
In going forward with her research, Fairweather says her approach is to change the way patients are treated for the disease. “What we’re really trying to do right out of the gate is going back with data we already have, analyzing it by sex and getting immediate discoveries we can apply to patient care, so we can understand key questions going forward.”
Not only do cardiac patients need to be separated by gender for treatments, women also need to be split up into pre- and post-menopause treatment groups, says Fairweather. This is due to the significant drop in hormones in women after menopause.
Virginia Miller, who leads gender differences research at Mayo Clinic and specializes in how menopause affects a women’s susceptibility to heart disease, says “changes in hormones affect how the heart responds and contracts.”
For example, women battling cardiovascular heart disease do so even more after menopause and during pregnancy.
Dr. Leslie Cooper, chair of the Department of Cardiology at Mayo Clinic, says that, “men are more likely than women to develop myocarditis. When they do, the disease is more severe and the recovery from heart failure less complete.”
Cooper explains that men are more susceptible to heart disease and that their cases are more likely to result in death. “Testosterone and estrogen affect immune cell function and may lead to the changes in heart muscle cells that in turn lead to fatal arrhythmias in males.”
One of the things that most helped Manley recover was exercise, which experts say is also a tremendous help in preventing heart disease. So far, it’s helped her avoid what she believed to be the inevitable: a heart transplant. Nine years after receiving her diagnosis, she underwent surgery at Mayo Clinic where the leaky valve and hole in her heart were fixed successfully.
“At this point, I don’t know for sure if I’ll ever need a heart transplant,” says Manley. “It’s only been three years since I’ve had the surgery, but I feel 100 percent better.”