Heart Disease Kills More Women than All the Forms of Cancer Combined

I had just turned 30 and I taught a fitness class that morning and I was experiencing a STEMI heart attack.

Three stents were placed in my heart. I then went into cardiac arrest and I needed multiple rounds of CPR and shocks. They told my husband I needed to be lifelighted to a different hospital.

Thank you so much. Oh, I love this idea of the healing power of resilience and I want to hear how we can actually tap into that. I want to know how you define resilience.

It's a great question and when I was researching the book Oprah, a lot of the psychologists have different definitions of what resilience is. Yes.

And so for me it was important to come up with my own based on my experience as a physician, as a human, as a journalist. And so I love the concept of resilience being the idea that you never ever go back backwards back to who you were. So

And I like to frame it in the idea that you bounce forward to something new. I use the analogy in the book of Michelangelo who says that he carved the marble until he set the angel free. And so this concept that we are the marble and we are the angel, constantly evolving and being shaped by what happens to us in life, but that what happens to us can not pause us and freeze us in time and paralyze us. We can actually grow and move forward and create a beautiful life, a life where we can thrive and grow and suck all the meaning and joy out of every single day. And that is my hope for my patients, for people who read the book, is to say no matter what life throws our way, no matter what challenges, we can bounce forward. We have that skill.

That's exactly right. And the book is really meant for anyone going through any challenge because at some point in time we will all go through something whether as you said it is a divorce, a loss, a death, or a disappointment.

And you know, I see this in my patients when I walk in the room and they have had a stroke and they can't move the right side of their arm or they've had a heart attack and they have heart failure and they look at me and they wonder, 'When am I going to be myself again?' This is what they ask me. And I tell them, 'You will never ever be yourself again.' But you can be

We won't be that self.

That can still have quality of life and meaning. That's what people want, Oprah. They want to still be able to enjoy every day, to see the sunset, to call their best friend, to really, as I said, take all the pure enjoyment out of every single day they can have.

So, cardiovascular disease is a broad term and it encompasses things like heart attack, electrical problems like atrial fibrillation. It encompasses heart failure, valve disease, stroke. So, it's all of these things under this big umbrella term. And as you said in the opening, it is the leading cause of death for women in this country. One out of every three women, Oprah, are dying from cardiovascular disease. These are our sisters, our friends, our mothers, our colleagues. And I think it just has not become personal enough for people. I think that there is a lack of awareness. And what I would hope that every listener would do right now is to close their eyes and picture the faces of the women that they love, because these are women that we're going to lose, that are not going to have the birthdays with us, that are not going to go to the graduations, we're not going to be able to be at their weddings. So all of those moments in life with the women that we love, they can be gone in a heartbeat.

Absolutely. So by far and away the most common symptom in women of a heart attack will be chest pain or pressure. Okay. So, first of all, that's important to know. But it doesn't have to be the type of very sharp, strong chest pain that makes you fall out of your chair. It can be a sensation like my bra is just on too tight. I feel something heavy or pressure or tightness or squeezing here. It can also look like jaw pain or neck pain or shoulder pain.

Stomach pain. And then when we think outside of the chest pain, there are other symptoms that women can have like shortness of breath, right? I'm a little bit winded when I go up the stairs or up a hill or when I'm walking fast. It can be fatigue, which is another one.

I can't exercise as much as I used to. I'm nauseous. I'm breaking out into a cold sweat. I'm dizzy. I'm feeling my heart skipping or fluttering or racing. Any or all of these symptoms I always tell women it's really important to pay attention to because you may be told that it's acid reflux. You may be told it's all in your head or it's anxiety. And I always say it's so important to rule out.

So many women and it's missed. And the problem is when those heart cells die or those brain cells die, you can't get them back. But if you can catch cardiovascular disease or heart disease early with preventive measures, we can prevent the actual events.

You have to listen to your body and listen to yourself and you need to find a doctor that listens to you. And if that means getting a second opinion or a third opinion, that's what you have to do. I see a lot of women who come to me and say, 'I was blown off by the last doctor I saw. I was told that it was all in my head.' You have to advocate and push and fight for your health, and you have to trust your body.

So I think it's first of all important for women to understand that we have risk factors Oprah at every point in our life starting as early as 11 or 12 years old. If you had early periods or irregular periods you are at increased risk of cardiovascular disease. That's at as an 11 or 12 year old. Then we think about what happens to women in their 20s and 30s. There are female specific risk.

If you had early periods which of course most women don't know. When you think about your 20s and 30s, you may have heard about high blood pressure and diabetes. But let's talk about female specific risk factors there. And those would include polycystic ovarian syndrome, inflammatory bowel disease like Crohn's or ulcerative colitis, migraine, autoimmune conditions like lupus, rheumatoid arthritis, and even psoriasis, a skin condition, and then pregnancy. So what happens during pregnancy is a marker of future risk. So if you have had preeclampsia, eclampsia, gestational diabetes, a baby that was born early, miscarriages, a baby that was small for gestational age, these are markers of future risk of cardiovascular disease. And unfortunately, most women don't get told this while they're pregnant and they don't get connected to a cardiologist after to make sure that they know how to manage that risk. We think about in a woman's 30s, 40s, 50s, breast cancer for example and the treatments they might receive like radiation or chemotherapy that can damage the heart.

So if you have had one of those things that I mentioned, yes, you are at increased risk of cardiovascular disease. And then we think about early menopause and menopause. So this whole arc of a woman's life matters in terms of figuring out her cardiovascular risk.

Hi. Thank you for having me.

Yes. In 2022, I was a 29-year-old special education teacher. I lived a very busy life. I was also working at a tech startup on the side. Wellness was very important to me. So, I was also a fitness instructor on top of that. So, like many women, juggling a lot of competing priorities that would be very stressful. In May, I started to experience pain between my shoulder blades. It was on and off at first and then it eventually radiated to my chest.

Yep. In between my shoulder blades. So, turning around right back here. And then eventually it did radiate to my chest but

To the point where it was very dull like it wasn't 'I'm having a heart attack' feeling. So when I had gone to the doctor because I am otherwise healthy and no traditional risk factors I was told that it was likely attributed to my anxiety that I'd already had and acid reflux which I had never experienced before. Even though I did know something was wrong. In August, the symptoms were much worse. I was exhausted constantly, feeling very weak. And August 22nd, I had gone to the emergency room because by that point, I also experienced jaw pain.

Yeah. Yeah.

At that point, I had just turned 30 and I taught a fitness class that morning, so I did not fit the picture of someone having a heart attack. So I was not immediately taken back. By the time I was taken back, I had already had a 100% blocked heart. The entire left side of my heart was shut down and I was experiencing a STEMI heart attack.

I was immediately rushed to the cath lab. Three stents were placed in my heart. I then went into cardiac arrest and I needed multiple rounds of CPR and shocks. At that point, they told my husband I needed to be lifelighted to a different hospital that has ECMO, which is the highest form of life support. It essentially acts as your heart and lungs when your body needs to rest. So, at that point, I truly believe there is.

Yes. There's definitely a mind-body component I think that came into play at that point because ECMO gets a pretty bad rap. People don't come off ECMO. It's usually a last stitch effort. And my ability to come off ECMO, I do believe it's when my mind-body connection kind of came into play. I did spend a month in the ICU though. The cause of my heart attack was SCAD, which stands for spontaneous coronary artery dissection. Essentially, it's a spontaneous tear in your artery wall. If it's caught early, it's often managed by medications and then it can heal on its own. In my case, it was not caught early enough.

Absolutely.

Yes.

And I now live with heart failure. And so my biggest thing, I am more intentional with my life than I ever have been at this point. I, you know, I'm intentional with my time, who I give my energy to now. And I give myself permission to say no and set boundaries. And my hope is that women who are listening because we are in a society where we are constantly being pushed, women could give themselves permission to slow down, listen to their bodies, advocate for themselves because it is really challenging when after the fact you have to grieve a version of yourself. You were talking about it before that you think that you just want to get back to normal. And for that first year it was about survival for me. It was grieving a version of myself that I had lost and learning how to trust my body again and managing that fear. So I think for me it was over time just really redefining what strength and resilience means in my life.

Yeah.

I definitely have. I feel better now. Even though I have heart failure, I feel better now. Like I'm stronger now than I was pre-heart. And I think that is because I'm so intentional with again how I spend my time and who it's with and for the decisions I make for myself. I'm truly putting myself first and I didn't before.

I do. I do. Dr. Narula, from a cardiovascular perspective, how do chronic stress, constant busyness, and just the pressure for women to constantly keep it all together affect their heart health? And what do you wish more women understood about that connection?

First of all, I'm so happy that you're okay. And second of all, I hope everyone sees this is the face of cardiovascular disease is what I'm talking about. It looks like all of us. I think you said a couple other things which I think are really important to point out before I get to stress which is that women we say in cardiology have been understudied, underdiagnosed and undertreated. So we know that women come to the emergency room with chest pain, they will wait longer than men. They are less likely to receive guideline directed medical therapy and treatments. This is a problem. So we need to work on it from the medical establishment side. And then I think what you mentioned about stress is so critical. And to be honest, that was really the impetus in so many ways for writing this book was to recognize how much of a threat stress is to all of us in our daily lives. And we don't talk about stress. We say it's this amorphous thing that's really bad, but it really truly has an impact on our body. The mind-body connection that you've talked about. So stress was designed to help us survive. We have a stress response that's innate that's built in so that when we see a predator, for example, in the wild, if we're an animal, we have our heart rate go up, our blood pressure goes up, we turn off all functions that are not necessary, like digestion and reproduction. The issue is that we're meant to then turn it off once we've escaped something that's chasing us. We're meant to turn it off. In our daily lives, we are turning on our stress response all the time, every minute, for all kinds of little insults. I got a bill in the mail that I didn't want to see. I may be in trouble with my job. Something happened with my child. And that constant chronic stress is damaging everywhere. But to our cardiovascular system, we turn on hormones like epinephrine and norepinephrine. We turn on hormones like cortisol that increases inflammation. And we have studies that show that stress will increase the ability of a plaque that may be stable in your arteries to rupture. It will increase arrhythmias. It increases blood pressure. It increases your risk of having not only SCAD, spontaneous coronary dissection that is one of the risk factors but also stress induced heart attacks. There's actually a phenomenon of a stress induced heart attack. So stress is something that we all have to do a better job navigating. And that is why I wanted to write the book about the resilient response that I talk about which is to say yes we have this stress response but we also have the power to get back to homeostasis to turn it off to dial it down by activating the resilience that we have inside of us.

Oh yes. I don't like to be told no for things.

And grief is not linear. So you at one point think you are proving them wrong and then of course you have a bad day.

And I think you talked a lot about this at the beginning where you again you grieve the old version of yourself because you want to get back to that person but they no longer exist. So for me, being told no was that I couldn't be who I was. And I didn't know for the longest time what the point was. And I think there's a mental health component to this that you have to make the decision to figure out what you want to do and who you want to be moving forward. And I'm still a fitness instructor. I teach something completely different now.

To move forward and decide what I was going to be after this because being 30 years old and knowing that I had the rest of my life, I didn't want to live it in fear and that first year was truly that and it was very challenging.

I fought them on my medications for a while because I wasn't taking any prior to that.

And now I take my little pill pack everywhere with me. And I think with a little bit of, you know, with the acceptance part of it, I talked about it a lot. I talked a lot about a lot of my struggles and I think that actually helped me.

Talk about the dark parts. Yeah.

Absolutely. I fought it for two and a half years because I'm 3 years out now. And strangely enough, the moment that I reached acceptance was when I realized that because I was trying to constantly improve my heart, improve my heart's function, your ejection fraction.

And it hit me when I realized that I couldn't, you know, have children. And that moment I was like, 'Okay, well then if I can't have children and my heart I'm focused on it not becoming worse, what is my life now?' And

That acceptance piece was right there. I learned that very lesson. I wrote about it in the book when I was in medical school and I lost vision in part of my eye and it was the same story and it was my mother sending me the serenity prayer. God grant me the...

Before. Correct. And her words really changed my ability to accept that. You know, listening to the serenity prayer helped me to walk through my own diagnosis and that's how I know how important it is to accept.