February was American Heart month but perhaps we physicians should think about how heart disease can have various manifestations, especially in women and ethnic minorities. Heart disease affects more than 6 million American women, and another 37 million women are at risk for developing heart disease. It is the number one killer of women and is responsible for 1 in three deaths in women annually.
At the end of 2015, I had the pleasure of visiting with my patient, Lidia M. She is a vibrant 42 year old Latina who requested augmentation with saline breast implants in 2004. Her motives were personal: “I want my breasts to be proportionate to my hips”. Her surgery was uneventful. Her results were consonant with her objectives and she was pleased to avail herself of my offer of annual visits. We did not meet again until 2011, when she presented with a history of left sided chest pain. I started with the usual History and Physical. The pain wasn’t correlated with exercise and could occur sporadically, without any clear provocation. Her health status hadn’t changed and her exercise tolerance wasn’t materially different. She had sought advice from a heart specialist who informed her that it was probably related to some occupational stress she had been experiencing and also because the “implant” was sitting on her heart.
We discussed why this analysis was implausible and I encouraged her to seek another opinion. Four years intervened. Lidia’s demeanor was recognizable for her same delightful, inquisitive nature but she had now turned activist. Impressed by my recommendation, she consulted with another Cardiologist who took her seriously. He listened to the constellation of symptoms, formulated a list of possibilities, ordered appropriate studies and made a timely diagnosis. The origin of her pain was not musculoskeletal, capsular contracture or psychogenic but rather congenital. Lidia’s chest pain was due to anomalous origin of the right coronary artery, a condition which can result in angina pectoris, myocardial infarction and sudden death, in the absence of atherosclerotic heart disease. Treatment is controversial but may include medical treatment with Beta blockers or surgical revascularization. Lidia opted for the latter and proudly displayed her median sternotomy scar.
She fervently believes that this was a 2nd chance for her and she’s definitely taken her mission seriously, sharing her story so that other women may live. She is a spokeswoman for the American Heart Association, serving to educate her sisters.
- Hispanic women are likely to develop heart disease 10 years earlier than Caucasian women.
- Cardiovascular diseases are the leading cause of death for Hispanic women, killing nearly 21,000 annually.
- Only 34% of Hispanic women know that heart disease is their greatest health risk.
- Hispanic women are least likely to have a usual source of health medical care and only 1 in 8 say that their doctor has ever discussed their risk for heart disease.