Heart Attack Warning Signs More Likely To Be Missed Or Ignored By Women

Many women under age 55 are not seeking timely treatment for heart attack because they expect the warning signs and their reaction to follow a Hollywood script - tightening in chest, shortness of breath, clutching the chest while dropping to one knee.

That is finding of researchers who presented their study at American Heart Association's 9th Scientific Forum on Quality of Care and Outcomes Research ( QCOR ) in Cardiovascular Disease and Stroke.

Researchers studied 30 women who had suffered a heart attack ( average age 48 ) . The young women were allowed to talk about their experiences in great detail, using their own words to describe their recognition of symptoms, their initial actions ( or lack of action ) , and their reasons for not seeking prompt care.

" We found that most failed to connect their symptoms with a heart condition, commonly misattributing them to fatigue, indigestion, stress or overexertion, " said Judith Lichtman, Ph. D. , lead author of the study and associate professor of epidemiology and public health at the Yale School of Medicine in New Haven, Conn.

Researchers conducted in-depth telephone interviews with the women within seven days of their hospital discharges for heart attacks between October 2006 and May 2007. The interviews explored women's initial recognition and response to symptoms, their healthcare beliefs and their acute healthcare experiences. Lichtman said interviews lasted roughly 30 to 40 minutes, and more open-ended format allowed the young women to describe their experiences in detail.

" The stories they told were incredibly rich in detail, " Lichtman said. " We learned that many of these women had no idea that they were at risk for heart disease and were unaware that their symptoms could be connected with a heart problem, citing lack of good examples in the public media to help them recognize atypical symptoms, or realize that someone their age could even be at risk for a heart problem. We also learned much more about their experiences with healthcare system in terms of preventive care and care they received during acute presentation. "

Lichtman noted many of women were surprised that their actual symptoms differed from the 'Hollywood heart attack' that they would have expected. " They wish that they had known that symptoms such as neck and shoulder pain, abdominal discomfort that was easy to mistake for indigestion, or unusual fatigue could signal a heart problem, " she said. " They often said that TV does not show examples of symptoms they experienced. If they knew, they would have responded to symptoms sooner. "

The participants described a complex internal dialogue as they decided when to engage healthcare system and identified an array of factors that contributed to delays, ranging from:

• Uncertainty

• Preference to self-medicate

• Perceived negative treatment by healthcare providers

• Competing time/family demands

• Individual beliefs and behaviors to health system failures

• Seeking corroboration of symptoms and deferring responsibility to engage healthcare system

" While this was certainly not the experience for all women, repeated stories of being triaged to less urgent care initially for what were thought to be non-cardiac conditions suggest that additional work is needed to help young women, their families and healthcare providers recognize that young women with heart disease may present with typical and atypical symptoms, " Lichtman said. " There are large gaps in our understanding of symptoms young women experience or reasons they delay seeking prompt care. It is important to help young women recognize that they can be at risk for heart disease despite the fact that we often associate heart disease with older patients.

" Although young women represent less than 5 percent of all patients with heart disease, this is significant because it still translates to 16, 000 deaths and about 40, 000 hospitalizations annually - a number that rivals breast cancer in this age group. Because heart disease is less common at this younger age, current media campaigns and prevention messages do not appear to be reaching this group. "

This study builds on findings from a prior pilot study of 24 women ( age 55 and younger ) presented at 2007 QCOR meeting. In that study researchers found that more than half of women who experienced heart attack symptoms delayed seeking care for more than an hour.

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The Fannie E. Rippel Foundation funded current study. The prior pilot study was funded by the American Heart Association Heritage Affiliate.

Co-authors are: Emi Watanabe, M. P. H. ; Norrina Allen, M. P. H. ; Brian Garavalia, Ph. D. ; Linda Garavalia, Ph. D. ; Carole Decker R. N. , Ph. D. ; John Spertus, M. D. , M. P. H. ; Harlan M. Krumholz, M. D. , S. M. ; and Leslie Curry, Ph. D. , M. P. H.

Heart disease is #1 killer of women and claims more than 460, 000 women's lives per year - that is about one death per minute. Because heart disease is largely preventable, the American Heart Association's Go Red For Women movement urges women to take action and reduce their personal risk. Visit GoRedForWomen. org to take Go Red Heart CheckUp and receive a 10-year risk assessment and personalized action plan.

Statements and conclusions of abstract authors presented at American Heart Association/American Stroke Association scientific meetings are solely those of abstract authors and don't necessarily reflect association policy or position. The association makes no representation or warranty as to their accuracy or reliability.

NR08-1054 ( QCOR 08/Lichtman ) Abstract 197

Source: Karen Astle American Heart Association

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Avandia and our health.

uses of Avandia

Avandia is an anti-diabetic drug ( thiazolidinedione-type, also called " glitazones " ) used with a proper diet and exercise program to control high blood sugar in patients with type 2 diabetes ( non-insulin-dependent diabetes ) . Avandia works by helping to restore your body's proper response to insulin, thereby lowering your blood sugar. Effectively controlling high blood sugar helps prevent heart disease, strokes, kidney disease, blindness, and circulation problems, as well as sexual function problems ( impotence ) .

Avandia is used either alone or in combination with other anti-diabetic medications ( e. g. , metformin, sulfonylureas, insulin ) .

how to use of Avandia

Read Patient Information Leaflet available from your pharmacist before you start taking Avandia and each time you get a refill. If we have any questions, consult your doctor or pharmacist.

Take Avandia by mouth, with or without food, usually once or twice daily, or as directed by your doctor. Dosage is based on your medical condition, response to therapy, and if we are taking other anti-diabetic drugs.

Use Avandia regularly in order to get the most benefit from it. Remember to use it at the same time ( s ) each day. Monitor blood glucose levels on a regular basis.

It may take up to 2 to 3 months before full benefit of Avandia takes effect.

Take all other medications for diabetes as directed by your doctor.

side effects of Avandia

See also Warning section.

Headache or cough may occur while use Avandia. If any of these effects persist or worsen, notify your doctor or pharmacist promptly.

Remember that your doctor has prescribed Avandia because he or she has judged that benefit to you is greater than risk of side effects. Many people using Avandia do not have serious side effects.

Tell your doctor immediately if any of these unlikely but serious side effects occur:

Tell your doctor immediately if any of these highly unlikely but very serious side effects occur:

Avandia usually does not cause low blood sugar ( hypoglycemia ) , but this effect may occur while use Avandia if we don't consume enough calories ( from food, juices, fruit, etc. ) . The symptoms include chills, cold sweat, dizziness, drowsiness, shaking, rapid heart rate, weakness, headache, fainting, tingling of hands or feet, or hunger. It's a good habit to carry glucose tablets or gel to treat low blood sugar. If we are in a situation where we don't have these reliable forms of glucose, eat a quick source of sugar such as table sugar, honey, or candy, or drink a glass of orange juice or non-diet soda to quickly raise your blood sugar level. Tell your doctor immediately about the reaction. To help prevent hypoglycemia, eat meals on a regular schedule and don't skip meals.

Symptoms of high blood sugar ( hyperglycemia ) include thirst, increased urination, confusion, drowsiness, flushing, rapid breathing, or fruity breath odor. If these symptoms occur, tell your doctor immediately. Your medication dosage may need to be increased.

A serious allergic reaction to Avandia is unlikely, but seek immediate medical attention if it occurs. Symptoms of a serious allergic reaction include:

This isn't a complete list of possible side effects. If we notice other effects not listed above, contact your doctor or pharmacist.

precautions of Avandia

Before taking Avandia, tell your doctor or pharmacist if you're allergic to it; or to other " glitazones " such as pioglitazone; or if we have any other allergies.

Promptly talk with your doctor or pharmacist about benefits and possible risks of Avandia, even if we have been taking it for awhile, especially if you have heart problems. Don't stop taking it unless directed to do so.

Avandia shouldn't be used if we have certain medical conditions. Before using this medicine, consult your doctor or pharmacist if we have:

Before using Avandia, tell your doctor or pharmacist your medical history, especially of:

We may experience blurred vision, dizziness, or drowsiness due to extremely low or high blood sugar levels; use caution engaging in activities requiring alertness such as driving or using machinery.

Limit alcohol while taking Avandia because it can increase risk of your blood sugar getting too low ( hypoglycemia ) .

During times of stress, such as fever, infection, injury or surgery, it may be more difficult to control your blood sugar. Consult your doctor, as additional medication may be required.

Avandia may increase risk of bone fracture ( upper arm, hand, foot ) in female patients. To lower the chance of getting injured, use caution when doing activities such as contact sports.

Avandia can cause changes in menstrual cycle ( ovulation ) in women with certain fertility problems. Consult your doctor or pharmacist about the use of reliable birth control while taking this medication.

Avandia should be used only when clearly needed during pregnancy. Discuss risks and benefits with your doctor. Your doctor may substitute insulin for Avandia during your pregnancy. Follow all instructions carefully.

It is unknown if Avandia passes into breast milk. Breast-feeding while using Avandia is not recommended. Consult your doctor before breast-feeding.

interactions of Avandia

Your healthcare professionals ( e. g. , doctor or pharmacist ) may already be aware of any possible drug interactions and may be monitoring we for it. Don't start, stop or change dosage of any medicine before checking with them first.

Before using Avandia, tell your doctor or pharmacist of all prescription and nonprescription/herbal products we may use, especially of:

Beta-blocker medications ( e. g. , metoprolol, propranolol, glaucoma eye drops such as timolol ) may prevent fast/pounding heartbeat you'd usually feel when your blood sugar level falls too low ( hypoglycemia ) . Other symptoms of low blood sugar such as dizziness, hunger, or sweating are unaffected by these drugs.

This document doesn't contain all possible interactions. Therefore, before using Avandia, tell your doctor or pharmacist of all products we use. Keep a list of all your medications with you, and share list with your doctor and pharmacist.

overdose of Avandia

If overdose of Avandia is suspected, contact your local poison control center or emergency room immediately. US residents can call US national poison hotline at 1-800-222-1222. Canadian residents should call their local poison control center directly.

notes of Avandia

Don't share Avandia with others.

It's recommended you attend a diabetes education program to understand diabetes and all important aspects of its treatment including meals/diet, exercise, personal hygiene, medications and getting regular eye, foot and medical exams.

Lifestyle changes that help promote healthy bones include increasing weight-bearing exercise, eating well-balanced meals containing adequate calcium and vitamin D, stopping smoking, and limiting alcohol. Consult your doctor to see if we need to take calcium/vitamin D supplements and discuss lifestyle changes that might benefit you.

Keep all medical appointments. Laboratory and/or medical tests ( e. g. , liver and kidney function tests, fasting blood glucose, hemoglobin A1c, complete blood counts, blood cholesterol levels ) will be performed to monitor for side effects and response to therapy. Regularly check your blood or urine for sugar, as directed by your doctor or pharmacist.

missed dose of Avandia

If we miss a dose Avandia, use it as soon as we remember. If it is near time of next dose, skip missed dose and resume your usual dosing schedule. Do not double dose of Avandia to catch up.

storage of Avandia

Store Avandia at room temperature at 77 degrees F ( 25 degrees C ) away from light and moisture. Brief storage between 59-86 degrees F ( 15-30 degrees C ) is permitted. Don't store Avandia in the bathroom. Keep all medicines away from children and pets.

Properly discard Avandia when it's expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

warning of Avandia

Avandia may infrequently cause or worsen a certain heart problem ( congestive heart failure ) . Tell your doctor immediately if we notice any symptoms of heart failure, including: swelling of hands/feet, unusual/sudden weight gain, trouble breathing, or unusual tiredness.

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