Q&As

What Women Need To Know About Heart Disease

A heart attack can look very different for a woman than it does a man. As a national heart disease spokesperson, Shalini Suryanarayana wants women to know the warning signs.

When it comes to maintaining a healthy lifestyle, Shalini Suryanarayana does everything considered right. She eats a vegetarian diet, drinks alcohol only on occasion, doesn’t smoke, maintains an average weight, keeps active, and exercises regularly. In 2012 she was running a couple of miles every day, in training for a team event to raise money for breast cancer.

But when she was struck by a cardiac event that same year at the age of 47, the University of Vermont program director got many things wrong.

“I just wasn’t thinking very straight,” Suryanarayana says.

Heart disease is the leading cause of death in both men and women in the U.S., accounting for approximately one in four deaths nationwide. It can affect people of all ages and ethnicities and can strike with no warning and none of the associated risk factors like smoking, obesity, diabetes, high blood pressure, or depression.

But unlike the chest-clutching pain and squeezing sensation commonly associated with heart attack and cardiac events, symptoms in women can be much more subtle and diverse, sometimes manifesting as a shortness of breath, indigestion, back or jaw pain, fatigue, nausea, sweating, lightheadedness — all common symptoms a woman might easily attribute to more mundane conditions like menstruation, menopause, the flu, or just everyday stress.

In fact, to say a cardiac event “struck” would be an overstatement in many cases. Despite the life-threatening ramifications, cardiac events in women like Suryanarayana can more closely resemble a series of sudden but trivial discomforts.

Shalini and her dog, Budderball.

Despite the life-threatening ramifications, cardiac events in women can more closely resemble a series of sudden but trivial discomforts.

Consider Suryanarayana’s description of events. While out walking her Boston Terrier, Budderball, one day, she says, “I felt a little pressure on my chest, which made it feel like it was a little harder to breathe. But not a huge problem. It would come for a few seconds, and then be gone. Then later it happened again. The only time I had experienced that kind of shortness of breath is when I had an allergic reaction to a medication, so I thought I must be having an allergic reaction to something. I wasn’t worried about it. I just thought, Oh, I’ll go to the doctor sometime next week.”

“But then the next morning, first thing in the morning when I opened my eyes, I woke up experiencing that same shortness of breath and pressure on the chest.”

What Suryanarayana didn’t know at the time was that her heart was struggling to pump blood through an artery that was more than 90-percent blocked. She estimates she experienced, and subsequently dismissed, symptoms for a good 18 hours. But, she admits, “it might have been more than that. Because my symptoms were so mild, I might not have even noticed it.”

Despite a long family history of heart disease, it took the prodding of two loved ones that next morning to persuade Suryanarayana to go to the ER. “I was like, ‘No, I have to do a presentation for work, and I’m supposed to leave in two hours,’” she says. But rather than inconvenience anyone, she insisted on driving herself.

“My poor brother. He was frantically trying to give me a ride, but I wouldn’t wait for him,” she says. “That was a terrible, terrible decision. I put a lot of people at risk if something had happened to me on the way.”

Suryanarayana’s doubts and absence of urgency toward the situation continued unabated at the hospital. Because the pressure she was experiencing inside her chest didn’t hurt per se, she was reluctant — despite the insistence of her brother, who is also a doctor — to term the feeling “pain.”

“I get there, and I’m checking in like normal, and they’re asking me about my symptoms,” she says, “and I said, ‘I guess some people might call them chest pains.’”

They’re asking me about my symptoms, and I said, ‘I guess some people might call them chest pains.’

“I’d barely said the words ‘chest pains,’ and boom! Everybody flew into action. They had people just swirling all around me. And thank God they did.”

Surgeons placed a stent to reopen the artery that had been blocked to allow Suryanarayana’s blood flow to return to normal. “Had I made a different choice at any point in the line, had there not been an experienced person in the ER, my story could’ve been very different,” she says.

Suryanarayana and Budderball have since appeared in local and national heart disease awareness campaigns, and Suryanarayana served as an American Heart Association 2016 Go Red for Women spokesperson, sharing her experiences and encouraging women around the country to take a proactive approach to their heart health through regular Well-Woman Visit check-ups. (Sadly Budderball passed away this past December.)

Now a Go Red for Women ambassador, Suryanarayana here discusses with Folks the crucial role genetics plays in one’s health story, how women in particular can balance vigilance with paranoia with conditions like heart disease, and how sharing her story on a national scale helped her overcome the embarrassment she’d originally felt about her condition.

“Had I made a different choice at any point in the line, had there not been an experienced person in the ER, my story could’ve been very different.”

 

Your mother is one of the first women in your immediate family to live past the age of 45. Is that where a family predilection for heart disease lies?

You know, I don’t know too many of the details. I just know that the women in my mom’s family — several of the people closest to her —all died at about the same time. I remember when I was young when my mom’s birthday — that birthday — came up, she cried a lot. She lost her mother at that age and her sister at that age. It was a powerful day for her. That really stuck with me.

Years later, when I passed 45, it clicked. I remembered that. Not long after that, I had to get the stent. So it really did seem like that [age] was a marker.

Was there any particular culprit that you knew of that affected the women in your family that way?

It’s straight-out genetics. And it turns out it’s not just the women in my mom’s family. Pretty much 100% of the men have had cardiovascular issues. Diabetes and heart disease is just rampant on my mom’s side of the family.

By the time it hit my brother and me, we were both pretty young. But in both our cases, they caught it early and did something proactive. After that our health was actually better than it had been prior. I didn’t have tissue damage because I didn’t actually have a heart attack — I had what’s called a “cardiac event.” It’s sort of the precursor. So once the stent was in, that blood flow was much better. A few months after my event [and stent placement], they measured my ejection fraction [the percentage of blood pumping out of the heart], and it was the same as someone who had never had any issue. We’ve all got something, and in a way I’m lucky because I found out what my something is.

The hours leading up to getting a stent — how you dismissed your symptoms, how you had to be talked into going to the ER, how you kept insisting to the ER staff you were having an allergic reaction — it brings up a larger issue with women’s health. With the laundry list of symptoms that accompany, say, menstruation alone, women get so accustomed to feeling poorly and having to just ignore health issues and work through pain on a regular basis.

Exactly! And some of the other symptoms with heart disease, like lower back pain — women would rarely associate that with a heart problem. And an upset stomach. That could be anything. It’s different for everybody, so unfortunately there’s not a silver bullet or a magic checklist. For me personally, that shortness of breath feeling. I had none of the pain in my left arm like you hear for men. None of those really popular and well-known signs.

With the laundry list of symptoms that accompany menstruation alone, women get so accustomed to having to just ignore health issues…

So with heart disease and the way it manifests, how much do you think relates to how subtle heart attack or cardiac event symptoms can be for women, and how much to how women are accustomed and conditioned to having to just suck it up when it comes to illness?

I don’t know how much of one or the other, but I do know there’s not a woman I know who doesn’t have a pretty high tolerance for all kinds of inconvenient pain and issues for whatever reason, whether they’re trying to take care of their family or their job or whatever. I imagine that is a big driver for why women don’t hit the Pause button and try to figure out what’s going on with themselves. This notion of self-care, I think women struggle with that. We deserve better.

Now I’m so different, though, having had that event. I am so quick to drop everything now and check it out. I’ve not had anything serious since then. But I’ve also learned to get very comfortable with the idea that if it’s nothing, that’s cool. Much better to go to the doctor and find out I was mistaken and it’s nothing, than to not go and to find out I was mistaken and it’s something. I learned the lesson of picking your mistakes wisely.

So with such common heart disease symptoms, how is a woman supposed to tell the difference between warning signs and the usual being-alive issues that happen as a matter of course? How do you balance well-informed caution with outright paranoia?

One thing is knowing your family history, trying to figure out what you might be genetically predisposed to. So if you find out you do have a family history, then you know any of these kinds of symptoms you’ve got to take seriously. Then secondly, it’s being attentive enough to your body, really taking the time to know your body. So that upset stomach that you have? If you can’t attribute it to something you ate, or you don’t have upset stomachs frequently, make a mental note that that’s the first sign. Then that should heighten your vigilance to note any other symptoms. Because it’s usually that combination that would confirm [a diagnosis]. It’s either an extreme version of any one of these [issues] or a combination of them that should set off the red flags.

If you could go back now and talk to yourself back when you were having the cardiac symptoms, what would you tell yourself?

I would’ve taken it a lot more seriously. I really thought I could outrun my genetics just by being careful in all these other ways [like diet and exercise]. I didn’t really understand what that meant, how your body can be wired so that, no matter what you do, certain things might still happen. And I would’ve let someone drive me!

I really thought I could outrun my genetics just by being careful in all these other ways [like diet and exercise].

It can be difficult for people to talk about their health conditions, even among loved ones and friends. Why did you decide to go public the way that you have with yours?

Well, I really didn’t want to. In fact, when they first asked me about it, I thanked them and politely declined. I was in the hospital recovering from the procedure, getting ready to check out, and [the vice president of the hospital] said, “We’ve heard you have a really good attitude. We’re doing this billboard campaign for heart health.”

 

They said, to date, all the photographs and the billboards had been of older, overweight, white males. He said, “We really want to showcase that heart disease can affect anyone. It would be helpful to have a woman, a person of color, someone who looks younger.” And I said no. I was kind of embarrassed. I felt like, I have this thing that’s wrong with me. Why would I want to broadcast it to the world?

So my brother — he knows me pretty well — he said, “What if you get some woman to go get her heart checked out because she sees that poster and says, ‘Wow, that could be me’?” And I thought, He’s right. It’s really not about me. I shouldn’t get all weirded out and embarrassed about my own situation. Maybe it would help somebody else. So I called that guy back and said, “I’ll do it. But I’m embarrassed about this photo shoot idea, and I have this really cute dog, so if I could bring my dog with me…”

Before you became an American Heart Association Go Red for Women spokesperson and ambassador, was public speaking something you were interested in or comfortable with?

I love speaking extemporaneously. In my work I often have to do presentations, so I was very comfortable with the idea of talking. [But] I’m much more nervous about my speaking engagements for the Heart Association than I am about others. With heart disease, I’m knowledgeable about my own situation, but I don’t feel like an expert in a global sense. I try really hard to make it clear to people that I’m not a medical person, and it’s different for everyone.

This notion of self-care, I think women struggle with that. We deserve better.

And I have to say — I started out by not wanting to speak or to let this be known that I have this issue. [But] after my first two presentations, it was so cathartic. It was like therapy for me to be able to talk about it. Every speech I gave, every time I talked about it, I got more and more comfortable. My first perception was that there is something wrong with me, and as time went on, I realized there is absolutely nothing wrong with me. We all have things. The human body works a certain way, and some things work better in some people than others. It’s not something that you can control in and of itself. Once you know about it, you can do your best to shape the way it progresses. By making good choices, I very likely bought myself a lot of time, and, I think, because my body was stronger, I was able to handle the procedure and recover quickly. But that helped me so much, having accepted that role and learning to talk about it with people. It made me feel much more comfortable with my own situation and with trying to help other people not feel embarrassed or shy about their situation.