CHANGE OF HEART

Until she had a ministroke at 31, writer Amanda Scriver had no idea that heart disease and stroke is one of the leading causes of death for Canadian women—and risk factors, symptoms and even treatment might vary by age.

HEART HEALTH DICTIONARY

ATHEROSCLEROSIS: When arteries narrow and harden due to plaque buildup.

CARDIOMYOPATHY:

Diseases of the heart muscle, which cause it to become enlarged, thick or rigid.

CARDIOVASCULAR

DISEASE: A broad term for problems with the heart and blood vessels, often due to atherosclerosis. These conditions can lead to heart attack, angina or stroke.

HEART ATTACK: Also known as a myocardial infarction, these attacks happen when the flow of blood to a section of the heart is blocked, preventing the muscle from getting oxygen.

HIGH BLOOD PRESSURE:

Also called hypertension, this is when the long-term force of blood against artery walls is elevated, requiring the heart to work harder, which may eventually lead to heart disease.

MICROVASCULAR ANGINA:

A disease of the small coronary artery blood vessels. Many angiograms do not view the small blood vessels, so this can be difficult to diagnose.

SPONTANEOUS CORONARY ARTERY DISSECTION:

A tear in the coronary artery wall. Physical or emotional stress appears to play a role. Most cases (around 70 percent) occur in women under 50—and a third of those are pregnant or postpartum women.

STROKE: When the blood supply to a portion of the brain is interrupted. This can happen when a blood vessel carrying oxygen and nutrients to the brain either bursts or is blocked. IT WAS DEC. 13, 2014. I was getting ready to go out for dinner when suddenly everything went wrong. I lost coordination, almost like I was drunk. I went numb, as if the local anesthetic that dentists use had been applied to half of my body. My arm went limp, I could barely walk and, out of the blue, I got a raging migraine.

At 31 years old, I was in the midst of a transient ischemic attack, often called a ministroke, but I had no idea.

It wasn’t until the next day, when I was feeling only slightly better, that I realized something was really wrong. I didn’t want to wait for an appointment with my family doctor, so I called

Telehealth Ontario, the provincial service that connects callers to a registered nurse via telephone. In the very back of my mind, I wondered if I’d had a stroke—but I was too young, or so

I thought. But when I described my symptoms, it became clear that I wasn’t too young. In fact, the nurse who took my call was worried enough to send paramedics to my house. Soon, I was in the back of an ambulance, rushing through Toronto’s busy streets on the way to the hospital.

Luckily, my stroke was mild, and, in July 2015, Irmine MacKenzie also went to the hospital

I underwent surgery to have a patent foramen immediately. It’s been 35 years since the ovale closure device inserted to close the hole in New Waterford, N.S., resident lost the use of my heart. But, to this day, I’m still shocked at her left arm and leg after suffering a stroke how little I knew about the risks associated with caused by carotid artery stenosis, narrowing of stroke and heart disease, or just how common the arteries that carry blood from the heart to they are. As I soon learned, about 1.6 million the brain. She was 61 years old and, having just

Canadians—557,000 of them women over the finished eating breakfast with her husband, John, age of 24—report having cardiovascular disease. she headed to the kitchen to tackle the dishes.

And, according to a study looking at factors Suddenly, plates started dropping from her and behaviours affecting cardiovascular health hands, shattering as they hit the floor. published in 2013 in the Canadian Medical After a six-week hospital stay and a three-

Association Journal, fewer than one in 10 adult month stint in a rehabilitation program in

Canadians were in ideal cardiovascular health Halifax, she eventually learned to walk again. from 2003 to 2011, which means 90 percent of Her ability to manage quite well over the past us are making choices that are increasing our three decades is clearly a testament to her grit— risk for a cardiovascular event. In fact, heart and maybe some kind words from a stranger. disease and stroke is one of the leading causes “I won’t ever forget the ambulance driver who of death for Canadian women, and most of us took me to the rehabilitation centre,” she says. have at least one risk factor. “He told me, ‘We’re taking you by stretcher now,

It’s a club that I didn’t particularly want to be but you’ll be walking out of there with a cane.’ ” a part of, but having joined, I began wondering Sure enough, that’s exactly what she did. what other women’s experiences had been like. It has now been two years since I suffered my

Unlike me, when Victoria resident Carolyn transient ischemic attack, and I feel like I’m still

Thomas started having a range of symptoms— learning about heart health. I now understand crushing chest pain, nausea, weakness, sweating the importance of cardiac rehabilitation, for one and a persistent ache down her left arm—on her thing. When I had my stroke, I didn’t know this 58th birthday, she immediately thought it could kind of program existed—my cardiologist didn’t be a heart attack and went straight to the ER. refer me to one, but having access to dedicated

But when she got there and told the doctor on professionals in a safe, encouraging environment duty about her symptoms, he said it was just could have helped me navigate the health-care acid reflux. “I remember exactly what he said,” system and guided me toward healthier choices. she recalls. “ ‘You’re in the right demographic One thing I found myself, Carolyn and Irmine for acid reflux. Go home and call your family echoing is how, as women, we must advocate for doctor for a prescription for antacids.’ ” ourselves in the health-care system, ensuring that

Embarrassed and apologetic, she did just that. our voices are heard and our health is looked after.

But her symptoms persisted for two more We need to put ourselves first, without shame or weeks. She eventually went back to the hospital, guilt. As Dr. Paula Harvey, director of the cardioand this time, she was told she was suffering vascular research program at Women’s College from what was actually one of the most serious Hospital in Toronto, says, “It comes back to edutypes of heart attacks—a complete blockage cation and partnership with your health provider. of her left anterior descending artery, which Don’t be afraid to ask questions and be informed.” is often referred to as the widow-maker.

Since then, she has recovered, but it’s far from FIND 21 THINGS YOU CAN DO TO full—she had to retire early and continues to IMPROVE YOUR HEART HEALTH AT see a specialist at her regional pain clinic. canadian living.com/hearthealth.

Nearly two-thirds of all heart attacks and strokes occur in Canadians 65 or older, but younger Canadians are increasingly at risk. Here’s what you need to know at every age.

IN YOUR 20S & 30S

YOUNG PEOPLE with heart-health issues are part of a growing minority. A study published in 2012 out of the University of Cincinnati College of Medicine found that, over a period of 12 years, strokes among people aged 20 to 54 made up an increasingly greater proportion of strokes across all age groups, growing from about 13 percent in 1993–94 to 19 percent in 2005.

Closer to home, the Heart and Stroke Foundation says several studies predict that the rate of strokes among younger adults will double in the next 15 years. The main reason? According to Dr. Tara Sedlak, a cardiologist at Vancouver General Hospital and clinical assistant professor at The University of British Columbia, it comes down to lifestyle—high stress levels, poor eating habits, lack of exercise and smoking. Research bears this out: The University of Cincinnati study suggested that a rise in lifestyle-related risk factors (such as diabetes, obesity and high cholesterol) may contribute to a higher incidence of stroke.

But there is a way to turn the tide: As with other age groups, simple changes such as exercising regularly, quitting smoking and eating healthily could see the rates of cardiovascular disease—and, more specifically, stroke—decrease, says Dr. Paula Harvey, director of the cardiovascular research program at Women’s College Hospital in Toronto. WOMEN OVER 65 have the most strokes of all age groups, but they still have fewer strokes than men the same age. However, a Danish study published in the Journal of the American Heart Association in 2015 found that, after 60, women tend to have more serious strokes than men—and they’re more likely to survive, which can have serious repercussions on quality of life.

John Sawdon, the public education and special projects director of the Cardiac Health Foundation of Canada, explains that cardiac rehabilitation programs, which are free with a referral from your doctor, are the perfect next step for recovering cardiac patients of all ages, but they’re particularly important for older Canadians, who tend to live more sedentary lives. These programs are supervised by a cardiologist and, after an assessment, are tailored by your cardiac rehab team, which usually includes nurses, physical therapists, kinesiologists and social workers. They can provide exercise training, education on heart-healthy living and stress counselling—all of which can contribute to the health and well-being of people who have heart problems. And they’re effective, too: “Research has shown that those completing cardiac rehab live seven years longer than control groups,” says Sawdon. It also “reduces incidence of another heart attack by 50 percent.”

NINETY PERCENT OF ADULT CANADIANS have at least one risk factor for cardiovascular disease. But while factors such as obesity, hypertension, alcohol abuse, family history and ethnicity increase everyone’s risk, regardless of gender, the following three are particularly relevant to women.

IN YOUR 40S & 50S

CARDIOVASCULAR DISEASE is less common among younger women, in part because of their higher estrogen levels; the hormone offers some protection to the arteries. But as women approach menopause and their estrogen levels drop, the incidence of stroke and heart attack increases.

Unfortunately, broad knowledge of their increased risk may not protect perimenopausal women from misdiagnosis. According to research by the Canadian Medical Protective Association, which provides advice, legal assistance and risk-management education to 95,000 Canadian physicians, doctors are missing the signs of stroke in patients nearly 10 percent of the time, largely because symptoms are often nonspecific—patients often complained of headache, dizziness, nausea and vomiting.

And women, who have historically been less inclined to advocate for themselves, are particularly at risk. Research out of the University of Leeds in England showed that, between April 2004 and March 2013, 198,534 heart attack patients at National Health Service hospitals in England and Wales were initially misdiagnosed—and most of them were women. During that time, women suffering a heart attack were 50 percent more likely to be misdiagnosed compared to men.

It might be difficult to challenge doctors who tell you nothing’s wrong, but Dr. Sedlak encourages women to listen to their bodies and to be firm with health-care providers about what they’re experiencing. “If you feel there is a real problem, be persistent,” she says.

IN YOUR 60S & BEYOND

WHAT’S YOUR RISK?

SMOKING

While we all know that smoking is seriously unhealthy, it can be especially damaging to women’s cardiovascular health. Smoking when taking the oral contraceptive pill can drastically increase the risk of heart attack and stroke. But quitting can cut your risk within a year.

DIABETES

According to the Canadian Diabetes Association, people with diabetes are at a very high risk of developing cardiovascular disease. In fact, “they may develop heart disease 10 to 15 years earlier than individuals without diabetes.”

MENTAL ILLNESS AND STRESS

“Women have a higher frequency of stress-induced heart disease, and women’s hearts are affected by stress and depression more than men’s,” says Dr. David Fitchett, a cardiologist at St. Michael’s Hospital in Toronto and associate professor of medicine at the University of Toronto.