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FirstHealth of the Carolinas
Heart him heart her By Erica Stacy

Even today, in our modern society, gender differences continue to be debated. The arguments have generated books, videotapes and television news shows.

In many ways, the similarities between men and women outnumber the differences. Yet understanding that men and women are not identical—physically or psychologically—is critical, especially when it comes to preventing disease and promoting good health.

It’s not just a man’s disease
True or false: Cancer is the number one health risk for women. You might be surprised at the answer. Most women are.

Heart disease is the number one killer of both men and women across the nation.

For years, however, experts believed that heart disease was not a real problem for women. It seemed primarily to affect men and often presented itself during mid-life. Contrary to that idea, clear and compelling information from the last decade has indicated that more women died from heart disease than men.

“The course of heart disease is the same in men and women,” says Nick Cavros, M.D., a cardiologist with Pinehurst Cardiology Consultants. “The process of the disease does not change, but it often presents very differently. It is rare to have women describe the classic symptoms that are typical for male heart patients. If I see a female patient with risk factors for the disease who describes herself as just not feeling quite right, I immediately take steps to rule out acute heart problems.”

The traditional warning signs of heart disease include chest pain or shortness of breath after physical activity or exertion, intense crushing pressure in the chest or pain that radiates down the right arm. These symptoms, while present in nearly all men with heart disease, are often not noticed in women suffering from the same health problems.

“Women have more vague symptoms that can easily be overlooked or attributed to some other cause,” says Srivani Armbati, M.D., a cardiologist with Pinehurst Medical Clinic.

“They may complain of an unusual weakness or fatigue, nausea, dizziness, cold sweats or sharp pain in unusual locations such as the back, shoulders, arm, neck or abdomen. The symptoms are not necessarily in response to exertion and may actually occur at rest.”

Unfortunately, these symptoms are also common during menopause— which is also when women’s risk increases—as well as among many diseases, including the flu.

No reason for the difference in men and women has been scientifically proven, but some studies focus on the perception of pain as associated with neurotransmission and hormonal changes.

Nick Cavros, M.D.


Srivani Armbati, M.D.


John Krahnert, M.D.

Treatment and outcomes
Treatment for cardiovascular disease may include medication, angioplasty, stents, coronary bypass or some combination.

“There are no differences in the way I manage male and female heart patients,” Dr. Cavros says. “It is essential to be equally aggressive in treating the disease once it has been identified.

According to Dr. Ambati, however, “More women tend to die of a first heart attack than men. They also develop heart failure due to unrecoverable heart damage at a greater rate than their male counterparts.”

Why? The answer is simple. At the time of diagnosis, women are often older and have more widely scattered disease than men. As a result, their treatments may be less aggressive but carry greater risk.

“When we are able to recognize heart disease early, we can treat it more aggressively with better outcomes,” says Dr. Armbati.

In fact, statistics prove that fewer women are referred for invasive procedures even after an accurate diagnosis. If a woman is diagnosed at a later age, she may have other health conditions that rule out surgery. On the other hand, because men’s disease is usually discovered earlier, it is more likely to be effectively managed with stent or balloon procedures.

“Differences in treatment and outcomes may not be simply related to gender,” says John Krahnert, M.D, a cardiothoracic surgeon with Pinehurst Surgical. “Typically, women are smaller than men. Their blood vessels are also smaller. Generally speaking, that makes surgical treatment much more challenging.”

It has been said that the best way to predict the future is to create it. The same is true with managing cardiovascular disease. Heart disease is largely preventable. Stopping tobacco use, maintaining a healthy weight, and managing chronic health problems such as high blood pressure and diabetes are simple steps that significantly reduce risk.

Establishing a relationship with a health care provider or group also offers advantages for both men and women. Aside from the trust and reassurance that such a connection offers, there is also clinical value in monitoring health over time.

“Knowing a person’s history is beneficial as physicians work to diagnose and treat disease,” says Dr. Cavros. “Most of my patients come as referrals from family physicians. The best outcomes are often a result of knowing your own body, becoming aware of the warning signs and staying in close contact with a primary care provider, especially when something doesn’t seem quite right.”

He said

“I would get out of my car and walk across the parking lot to work like I always had, but the pain in my chest increased with every step,” says Gilbert Rall, 55, of Harnett County. “I tried to convince myself that it was just bad heartburn, but I was sure that there was something wrong with my heart.”

Rall works in Environmental Services at FirstHealth and is an active volunteer firefighter. “I am no Charles Atlas,” he laughs, “but I’ve always been active and healthy. When I started to slow down because of the pain, I knew it was time to get checked out.”

Rall wasted no time in making an appointment with a local cardiologist who determined that he had one artery with a 60 percent blockage and another that was completely blocked.

“I have a lot to live for,” says Rall. “I have a wonderful wife, and a 6- year-old granddaughter. Agreeing to bypass surgery was an easy decision.”

Rall had a double bypass on June 19. Just four days later, he was back at home. Just three weeks later, he was ready to resume his usual routine.

“I’ve never had any surgery before so I was a little nervous, but I feel better already,” he says. “I get out and walk, and I am looking forward to getting back to work.”

Through the surgery, Rall found out something unexpected. “Apparently, I had a heart attack without knowing it about five or six years ago,” he says. “My system actually grew its own bypass to accommodate the fully blocked artery.”

What has Rall learned from his experience?

“It can happen to anyone,” he says. “I get regular check-ups. I stay on top of my blood pressure and cholesterol. My stress tests have always been clear. This came on suddenly, but if I had listened to my body a little sooner, I might have avoided surgery. If you have any pain, even if it doesn’t seem like much, get it checked out. That’s the best advice I can give.”


She said

“It’s hard to say exactly when I started having problems with my heart,” says Elizabeth Wild, 64, of Southern Pines. “It was probably a while ago, but it was always masked as something else. At first, I thought I had strained my back. Later, I assumed it was stress. It never crossed my mind that my symptoms could be heart related, never in a hundred years.”

Wild, a native of Canada, relocated to the Sandhills in 2005 after spending several years in Florida. Although she acknowledges that she should exercise more, she has always felt healthy and leads a relatively active life. In fact, she had been looking forward to a cross-country vacation ending with an Alaskan cruise this spring. Instead, she booked a round-trip ticket to a Moore Regional Hospital operating room.

“I was a walking time bomb, and I didn’t even know it,” she says.

Wild had been tired and depressed. When her mother had a stroke in December 2006, she immediately left for Canada. Unfortunately, her mother passed away while she was en route.

“I had been having pain in my back,” she says. “Sometimes it radiated from my abdomen. In the airport, I was short of breath walking from one concourse to another.”

When her sister was visiting in March, Wild learned just how sick she really was. “I was stripping a bed, and I became breathless,” she says. “I had to cough just to try to catch my breath. My sister is a nurse, and when she saw what was happening, she told me I needed to get medical attention right away.”

Wild was admitted to the hospital for a catheterization. David Cowherd, M.D., a cardiologist with Pinehurst Medical Clinic, determined that she needed six bypasses, and John Krahnert, M.D., a cardiothoracic surgeon with Pinehurst Surgical, performed the surgery on March 19. One artery was 75 percent blocked, four were 90 percent blocked, and one was completely blocked.

Wild started to feel better immediately afterward.

“No one would think that I had ever had such a serious surgery,” she says. “I feel great. I am involved in (cardiac) rehab, and it’s like being a new person.”

Looking back, Wild admits that she should have sought help sooner. “I have a family history of heart disease,” she says.

“My father died at 39 and my brother at 37. All of my paternal uncles died before they reached their 50s. My oldest sister has stents, and another sister had a valve replacement and bypass.”

What has she learned from her experience? “Don’t poopoo pain,” she says. “Especially for women, the symptoms for heart disease can be attributed to other things. Know what the warning signs are and pay attention to your body. I waited too long. I was lucky, but I know that it could easily have gone the other way.”