By Dr. Tom Gross
Marin Independent Journal (California)
Copyright 2007 Marin Independent Journal, a MediaNews Group publication
All Rights Reserved
Editor’s note: Gross is the emergency medical services director for the Novato Fire Protection District.
It is said that you cannot teach an old dog new tricks. That may not be true, because I know plenty of old dogs who are still learning new tricks every day. But what about the converse? Can an old dog learn new tricks and at the same time unlearn the old tricks? This problem is much tougher — to stop doing something that you have always done.
If you ask any medical provider to describe the typical heart attack patient, you’ll often hear that the typical patient is a male. Traditionally, this would have been correct or, at least, demographic data would have supported that conclusion.
Medical studies, starting with the famous Framingham study now running continuously for more than 50 years, have concluded that men are at higher risk than women. Is this true or is this conclusion based upon the possibility that we are underdiagnosing heart disease in women?
More recently, medical research has discovered that women are at much higher risk for heart disease than was previously thought.
For several decades, the medical profession has taught that the typical symptoms are heart disease include chest pain, either under the sternum or in the left lower chest, or chest pressure, often described as “an elephant sitting on the chest.” We learned that cardiac chest pain, as opposed to chest pain from other sources, is most often associated with other symptoms, which include diaphoresis (sweating), shortness of breath, nausea, dizziness and the classical symptom that every male in his 50s knows to watch for, a radiation of pain down the left arm.
However, it may be that women experience slightly different associated symptoms than men. Are hot flashes, often casually written off as a sign of menopause, really just that or are they symptoms of a more serious illness?
It may be that we have to unlearn the classic signs of heart disease and expand our knowledge to include symptoms that may be more common in women than in men.
As we all know, partially because I mention it just about every week, tobacco use is associated with very high risk for heart disease. A recent study demonstrated that, as a result of efforts to improve public awareness of the risks of tobacco use, the overall rates of tobacco use are going down. However, these rates are going down much faster in men than they are in women. Is it related to the mistaken belief that when people quit smoking, one of the first inevitable results is weight gain? Or is it related to something else?
It has been shown that women are counseled about heart disease much less frequently than men. One study by the American Heart Association showed that clinicians are missing opportunities to help women lower their risk for heart disease. I cannot see that this is deliberate. It is a matter of education. We all think of the typical heart disease patient as a male. We all have to change the way we think. We have to unlearn our conventional wisdom that the cardiac patient is predominately male.
The big news for women and men is that much of this illness is preventable. We just have to be aware of it.