[Music] [Music] don't use the word heart-attack they just said you're having an event the leading cause of death and women is heart disease it's greater than both respiratory disease and all cancer combined why aren't we checking our hearts at 35 and 41 and four will die of cardiovascular disease he told me to take some aspirin and to go how poor a job have we been doing in the past that case the diagnosis get in these patients you know I was pretty fit I didn't present as a heart attack Kennedy when is the professionalism going to kind of kick in here all the early research on heart disease was done in men women are under diagnosed in mid heart attack compared to men and were under treated even when appropriately diagnosed [Music] definitely birthless today my own symptoms the symptoms leading up to it were were missed I'm just looking to that to educate so that we don't miss things in the future because too many people are dying too young far too young and they just don't need to work for good life for that reason because I have a platform where I can get to people and they they listen to try to do a full 15 I won't talk to you while you do 15 fight that fight that's what I mean by fight that fight at least I'm doing something I feel like I'm doing something down you have to hold for the four count doctors nurses and people in general I can do something to still gotta get wd-40 for that one squeak-squeak squeak-squeak-squeak and i was typing away and i felt kind of a cramp in my right arm which can be pretty normal but then it literally felt like a physical wave that I could have traced as it went up my shoulder I was 33 but I'm going some this is weird I've never felt anything like this and then I feel like I'm in a Monty Python sketch cuz on the television comes the Heart and Stroke Foundation ad with a list of symptoms barely able to point at the television I'm like that that I have oh and it was suddenly like boom I just felt like immediate like a pain on my chest and intense radiating pain on my neck and my jaw going down my arm chest pain shortness of breath nausea sweating and pain down my left arm which even I'm not a doctor but even I know pain down your left arm is not a sign of indigestion so that was my first introduction to getting misdiagnosed 2/3 of research has historically been done on men it's a system issue the Heart and Stroke Foundation released the misunderstood report in February of 2018 it was the first report in Canada to publicly acknowledge that our health care system is ill-equipped to diagnose and treat women with heart disease the misunderstood reports that have highlighted that women are sort of our you know under-researched they're under diagnosed so I think that that report was incredibly helpful in terms of really really focusing on what we do know about heart disease and women and what we don't know and where our needs are women have a greater proportion of atypical symptoms than men sometimes they are presenting with classic symptoms but either the patient or the healthcare practitioners have it in their mind that 42 year-old woman couldn't possibly be having heart attacks so this must be an anxiety attack given they have a history of anxiety chain of care are the assessments and treatments performed by paramedics and nurses and doctors breakdown of communication can really occur at any stage if paramedics aren't recognizing heart disease symptoms then women may not be receiving appropriate follow-up testing women can have heart attack even young women can have heart attack while two-thirds of men will have the classic Hollywood heart attack women will have that only 1/3 of the time clutching your chest women are 2/3 of the time more likely to have stomach indigestion shortness of breath cold sweats or radiating pains into their jaw or their arm it will often not be detected on traditional diagnostics the woman then told there's nothing wrong with her or that she should seek some noncardiac here for her symptoms I had gone to the doctor maybe I'd say five times over the course of a month with different little symptoms only to be sent away to take aspirin or it's a flu or you know this was diagnosed as tendinitis actually this one he told me I had tendinitis from from playing baseball all of those years the first words the day I walked into that clinic or please give me nitro it's my heart and I said no we have to hook you up to a monitor to see but I knew it was my heart because my heart would started doing flip-flops and just something wasn't right they're not sure if I had three small heart attacks or one large one when I had the open heart surgery in May 18 28 teen so the paramedics that well other we're driving down one of them just kind of said I think you're having an anxiety attack his perception was that we should just leave it and wait a year my husband and I knew that something was wrong and so we pushed she said let's just do an echocardiogram just to be sure she said it can be an indication of heart disease and she said I can't imagine you have heart disease but let's just rule it out the week before my heart attack happened I had been through fairly rigorous medical testing to prepare myself for a knee replacement surgery and I had passed all of the exams with flying colors after he left a nurse from emerge came in to talk to me and she said she told me very sternly you'll have to stop asking questions of the doctor he is a very good doctor and he does not like to be questioned when my symptoms returned which of course they did there was no way I was going back to emergency and make another fuss over nothing the major arteries of the heart are on the outside of the heart so if this is the heart muscle these would be the arteries that are sitting on the heart and providing blood flow through smaller branches that penetrate into the heart muscle these would be the micro vessels of the heart micro vascular disease is three times more common in women than males and that women who have micro vascular disease have much higher risk of suffering a heart attack or even a death as a result of heart disease we first became aware of this in 1984 when we saw more women dying every year of cardiovascular disease physicians are increasingly starting to recognize this it's a bit of the me2 in medicine blood work measures a protein called troponin that's released into the bloodstream when heart tissue dies the problem is the reference range of what's considered normal is based on a male heart not a female heart which is smaller than a man's earned so a woman can be having a heart attack but her blood results will come back normal as we learn more and more and more about women we recognize that that models different in the early years we sort of just said well that's an atypical presentation I think we now have a critical mass of data suggests it's not atypical it's typical for women we absolutely need to clear up the language to say there's typical male presentations there's typical female presentations there's absolutely overlap between those those two things but there are things that are going to be unique to the male experience and unique to the female experience perhaps the use of the term atypical is not appropriate and will change in the forthcoming years you know we're socialized to take care of other people to put other people's needs ahead of our own if a man or a child is sick they get to be sick women don't we put things off you know cuz the kids got to get here or we've got this function to do or we but this you know we have got to get the house clean or we're out our job and there's deadlines to meet and we're not paying attention to ourselves when our body is yelling at us [Music] he's my world he's the apple of my eye he's probably the biggest driving force of why I've done what I've done and I'll do what I do next to the heart disease you know trying to fight for my life to be longer so I can be here for him [Music] oh boy she was a big presence she was loud she was proud she loved glamour she loved diamonds everybody loved barb she could be a hard-ass she could be hard and stubborn but she had the softest heart you could ever come across Barbara actually texted me it was two o'clock in the morning one night my sister Barbara and she said her exact words were Heather am I going to die I'm scared please tell me the truth what didn't reply got up I got dressed and I flew across the street here to the hospital and I said these exact words to her I said this is it's hard for me sorry I said you're not gonna get any better burp we know this I said I don't know if you have three weeks six weeks six months nobody knows I said but I do know that we fight the fight and we fight the fight to the bitter end and we leave with love and hope in our heart and I have a picture of her and I pump and fists in the hospital bed and I've got it in black and white up in my office at work and I look at that every time I struggling and think I can't get through something I look at that picture and in my head I'm gonna fight the fight no she was a good person she really was and it was sad to see her go through this it was sad to see the vibrant strong hard-ass woman turned into somebody who couldn't even do up her housecoat I had three arteries that were plucked when was a hundred percent one was eighty and ninety in a strand and the Widowmaker which is your main artery was 70 percent and then they brought pictures of the scans to me and demonstrated that I had five major blockages like over ninety percent blockages you have a weak heart in layman's terms your pump is really weak and you need to get to a cardiologist and they said it quite quickly the second time I went back to emerge I could tell right away just by the looks on everyone's faces that something was very different than it was the first time two weeks earlier this time for example they called in a cardiologist he said mrs. Thomas I can tell from looking at your diagnostic test that you have significant heart disease SCAD itself is caused when the interior wall of the artery tears and instead of the blood going in between that tissue it goes in between the terror and the outer of the wall so it creates a blockage and you have a heart attack last heart attack I had in 2017 was that I had three arteries dissected at that particular time and according to them that is considered a very rare event they used to think that SCAD was extremely rare but what they're discovering now is that it's under-diagnosed 50 years of clinical and scientific research on heart disease has been largely with a male model we are beginning to understand the other causes of heart attacks in the women that are highly relevant to women up to 50% of women presenting with chest pain do not have blockages in the major blood vessels feeding their heart muscle but 50% of women do have evidence of abnormal micro vascular disease the traditional cardiovascular risk factors include type 2 diabetes or type 1 diabetes high blood pressure high cholesterol smoking and having a family history of heart disease or stroke and then there are sex specific risk factors particularly for women related to reproduction hypertension during a pregnancy preeclampsia a baby that's too large or too small and then finally diabetes that's brought on by the pregnancy there are so many other risk factors that affect women they go beyond pregnancy related risk factors but unfortunately many healthcare professionals still don't know what they're and if we're not bringing up some of these major issues in women's heart health at these various CMEs and conferences and whatnot it doesn't get brought up again and if it's not in there in their mind to go look it up specifically they might may not be even aware of micro vascular disease or dissection of an artery called SCAD or a vasospasm of an artery you know that that that women that treat women in the emergency room are more likely to recognize heart disease and treat it more effectively once we actually do do these tests say and we do find that yes they've had a heart attack the ECG is abnormal a lot of times women are actually treated differently after a heart attack women tend to not have the same type of investigations that a man might have similarly they're not sent home on the same medications the same life-saving medications that we know prevent another heart attack recently I was just at the American Heart Association meeting and I listen to a panel of experts talking about models that could be used to study heart disease and at the end of the session I got up and asked the question my question was I had I heard nothing about sex representation in these models and these were you know esteemed colleagues and experts in the field and so I think I was struck I thought I thought we were making progress but I'm not sure that we are I don't know if you can see that my sister Lorna I believe was misdiagnosed she was in the hospital the night before she died with a heart rate over 200 nobody's heart rate is over 200 for no reason there's a reason for that and it wasn't going down and they never kept her in my sister Ann Miller passed away in 2011 of end-stage heart disease is just a horrible thing to watch okay I can't even describe it to you properly she was in heart failure and it was just a slow process from then on my sister Sheila died in between Ann and Barbara she was 61 the heart was just too weak for any kind of treatments at all a month after my surgery my brother Gordon passed away massive heart attack what o'clock to them to the heart so that's five of them gone there's only three left and all three of us have heart disease and all three of us hang on to every day like you know we're checking with each other making sure are you okay how you feeling today it's we live in fear my son lives in constant fear that his mom's not gonna he's gonna wake up and not have a mother tomorrow I made sure that I had power of attorney in place that I had personal directive in place I wrote a letter to my husband to my son and to my in-laws telling them how special they were and to thank them for being kind I mean I'm having heart attacks like I want to die I went directly from the ER to the o.r essentially and I had a stent implanted in a what doctors still call the Widowmaker my heart rate got up to 255 beats a minute and then I got shocked and then Here I am and so I asked my cardiologist I said so what would happen if I didn't have that he said hopefully somebody would had started CPR on you I said but he wouldn't come out into that on your own hello just one sec Marion please actually this is no no this is good this is my doctor calling me with my results hi Marion sorry actually the day before I went for the second blood test I took a lace I took it upon myself to take a lasix and that helped so my breathing's a little better why am i is it still showing I'm in heart failure somewhat better but I still struggle for breath a little bit here and there like if I talk a lot or come upstairs no never the first two heart attacks I was on it for six weeks and that was it I've never been on the plavix soon okay Marion okay thanks bye bye so I'm in severe heart failure which is not good but just treat it with meds and just keep doing what I do all right there's just no other option he's got to keep doing what I do I don't know what's causing it because I feel good for the most part I don't but I haven't felt my strength has not been there since the surgery so it definitely takes a toll on you you know and when I do this it just like I said it validates what's happened to my family and it just it just keeps me going because I truly from the bottom of my heart I don't want anybody to go through this it's too much sorry okay enough of that bite the bullet huh would it be lovely if before every person leaving the hospital on discharge would be told this is something that's very common post cardiac depression what they call situational depression a situation has happened that is so traumatic for the human brain and the human body that you need some help getting through this it's common it's treatable and it's usually temporary and all it takes us for someone to look at me and like so what's going on with you and I'm just like and I just crying like oh my gosh that's you know even if I would have an emotional moment I could take a breath and suck it up and I've learned the hard way that I can't really do that anymore I wasn't advised that this was gonna be something I needed to deal with mentally and I would say this to people everybody else's life went back to normal right once the the shock for my family and people that I work with once that kind of died down it was like everybody else's life went back to normal except me this is like forever now you've read the stats once you start getting a progressive heart failure there's a five year life span all right so it's I got a lot to do in five years puts added pressure on you and you don't want to live thinking that way but it's always gonna be here right it's but you're not gonna let it affect your daily life or how you roll with people or I have to accept it and make the best of the moments that I have here with the people that I love and that love me because it breaks my heart to think of the day that I can't be there I will be a little bit much more aggressive next time I think it's critical that we have all levels of health care providers and scientists and policy makers involved where lives would be lost if we had sex specific protocols as for do you start getting mammograms you should also go in and get an echocardiogram so much work that needs to be done what you feel is real and important and you should never feel afraid about communicating that state I think I'm having a heart attack it's going to open up the system to appropriate diagnostics and interventions the minute you feel it go to a clinic go to a doctor go to a hospital and get it - I had to listen to my doctor and my heart trust in what your body is telling me and then do exactly what you would do if it were your daughter or your mom or your sister or your friend you need to be as smart as your doctor you know when something is just not right fight the fight validate the rest of my family's death that's how I want to spend the rest of my life dedicated to making sure that people don't get it or if they do have it they prolong their life [Music] [Music] you you