Physician looks at heart disease discrepancies


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Photo by Firas Sattar |

Dr. Sheldon J. Kukafka speaks at the Robert Wood Johnson University Hospital’s annual “Matters of the Heart,” yesterday about cardiac disease affecting young people.


According to Dr. Marianne Legato, physicians have misdiagnosed heart disease in women for decades and are still doing so today.

“Matters of the Heart” is an annual event that began six years ago to celebrate survivors of heart disease and hosts speakers to discuss topics of technologies in the field at the Robert Wood Johnson University Hospital, said Kathleen Johnson, coordinator at the hospital.

The keynote speaker this year, Legato, director of the Foundation for Gender-Specific Medicine, addressed the history of women’s cardiac disease and how physicians still misdiagnose them.

Heart disease is harder to detect in women than in men, as men tend to have identifiable obstruction of the arteries while women have arterial spasm, which are not detected using traditional methods, Legato said.

She said women are still less likely to receive the appropriate barrage of medicine following a heart attack, and 15 percent of women having a heart attack have symptoms of nausea, indigestion, sweating and breathlessness.

Legato said she has seen physicians giving women Valium for their nerves instead of treating them for a heart attack. Some physicians still believe women are more likely to have anxiety or hysteria issues than men.

“Women were undertreated for decades,” she said.

One in two women will die of coronary artery disease, making heart disease a more serious threat to women than cancer, she said.

Twenty-four percent of deaths in women are caused by coronary artery disease, 40 percent of those events are fatal, and more women die of coronary artery disease than men each year, Legato said.

Cardiac disease can be anything from high blood pressure to problems requiring open-heart surgery, Johnson said.

But unlike popular belief, cardiac disease is not just a disease for old people, said Dr. Sheldon Kukafka, an invasive cardiologist at RWJUH.

“I’ve seen patients in their late 20s with heart problems,” he said.

He said he sees cardiomyopathy — a weakening of the heart caused by alcohol and stimulants such as cocaine in young people, which stems from translating the American Heart Association’s drink sizes into the typical college party.

The association recommends up to one beverage per day for women and two per day for men, specifically 12 ounces of beer and 4 ounces of wine in one serving, he said.

The heart is a pump made of specialized muscles that supply blood to the body while coronary arteries supply the heart itself with blood, Kukafka said. If the coronary arteries become clogged or blocked, the affected heart muscle does not receive enough nutrients and begins to die.

Risk factors for heart disease include things that can be adjusted, such as smoking, dietary and exercise habits, but also includes factors such as family history, he said.

Smoking makes a person two to four times more likely to develop coronary heart disease and two to three times more likely to die, he said.

Women who smoke are affected more than men, he said.

Family history is a vague term, Kukafka said, but simply means a person is at increased risk for developing heart disease if an immediate family member has cardiovascular disease.

He said a bigger problem is diagnosing heart disease because women develop atypical symptoms of heart attack, such as shortness of breath while men complain of chest pain.

“There’s decades and decades of literature that don’t include women,” he said. “The symptoms can be misleading if you’re not paying attention to that.”

Where severe coronary artery blockages used to require open heart surgery, a new technology approved by the FDA in 2011 allows blockages to be solved using catheters, she said.

The procedure, called Transcatheter Aortic Valve Replacement, uses a replacement valve to substitute faulty aortic valves, said Donna Prete, clinical coordinator of cardiovascular services at RWJUH.

The new procedure provides a solution to high-risk patients who are unable to have open-heart surgeries, Prete said.

Prete said women do not go for treatment or consultation on heart health when symptoms start and instead wait until the problem is more severe.

It is unfortunate because women’s symptoms are not the typical description of heart disease, which makes many women disregard or mistake them as other disorders, Prete said.

RWJUH educates the public on proper diet and exercise, as well as public health screenings on the symptoms and preventions of heart disease, she said.

Legato said historically, scientists only researched men and treated women as smaller men to protect them from the risks of clinical investigation. It led to a one-sided view of how heart disease affected people.

Legato said a journalist approached her and asked for help researching the different manifestations of heart disease among men and women.

She published her first book, “The Female Heart: The Truth About Women and Heart Disease,” six months later and has since found that the way other organ systems work differ based on sex, she said.

Legato said she found that stress takes a higher toll on women than men and that women who had already had a heart attack were more likely to have another within a year if they lived in an unhappy domestic situation.

Marital stress raises a woman’s risk of heart attack by 300 percent, she said.

“There is no question that emotional support and feelings of closeness are more important to women,” she said.

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