In her usual ten-minute walk to the Tube station, Rachel Boothroyd suddenly experienced crushing pains in her chest, throat and down her arms. ‘It felt as if an elephant was sitting on my chest,’ says the lawyer.
Rachel, then 37, had no reason to suspect anything serious. She was slim, ate healthily, exercised and didn’t smoke or have a family history of heart disease.
Admittedly, for the previous two months she hadn’t been exercising as much as usual after a bout of chicken pox and virus, so she assumed the pain was a sign she wasn’t fit.
But over the next few months, whenever she exercised the pain returned, becoming increasingly so intense it reduced her to tears.
‘I remember I was walking one day about seven weeks after the pains started and my chest felt excruciating. I couldn’t breathe and I was sweating profusely,’ she says.
After a few months of putting up with the chest pains, Rachel saw her GP, who could tell from ‘looking at her’ that her heart was fine. But because she had private medical insurance, she was referred to a cardiologist as a precaution.
Rachel was stunned when tests showed she had coronary heart disease — where plaque builds up inside the arteries, restricting blood flow to the heart.
One of her main arteries was 99 per cent blocked and the cardiologist — who had also initially reassured her there would be nothing wrong — said she could have had a massive, probably fatal, heart attack within days.
That day she underwent surgery to have a stent (a tiny metal tube) inserted into the artery to hold it open. This relieved the pain instantly (which was a result of the heart muscle being starved of oxygen).
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‘The diagnosis was a complete shock because as a woman I’d always believed I wasn’t at risk,’ says Rachel.
‘I was also frustrated my GP hadn’t realised and there was no sense of urgency about seeing a cardiologist. If I’d been an overweight, older man, then an ambulance would have been called straightaway.’
There are many women — and even some GPs — who regard heart disease as a man’s problem. But according to newly published figures, in the UK there are 710,000 women aged 16 to 44 living with cardiac illness, compared with 570,000 men of the same age.
Coronary heart disease kills three times as many women as breast cancer. It’s the single biggest cause of death of both sexes, with more than 30,500 women and 40,000 men dying from heart disease every year.
Despite this, the British Heart Foundation says women are more likely to ignore symptoms of a heart attack and not seek help.
‘Women are just as vulnerable as men to heart disease, but often refuse to recognise their risk,’ says Dr Jane Flint, consultant cardiologist to the charity.
‘Women in their middle years are under great pressure looking after elderly parents and children so don’t put themselves first.’
There is also the general perception it’s a man’s illness — the stereotypical picture of the heart disease patient as an overweight, middle-aged man who smokes still endures.
Recovery: Rachel's experience has transformed her outlook, but she is mindful of the risksWhile it is true that being overweight and a smoker are risk factors, there are other, perhaps less well-known, factors, including lack of exercise, a family history of heart disease and stress.
Stress triggers the production of the hormones cortisol and adrenaline, which make the blood thicken and more likely to clot.
They also inflame the lining of the arteries — this produces a thick, slimy deposit in the arteries, which, over many years, can combine with cholesterol, fat and calcium to form plaque, says Dr Rajay Narain, a research cardiologist at St George’s Hospital, London. Inflammation can also make the lining of the arteries narrower, so reducing blood flow.Often it’s a combination of factors that leads to a heart attack.
‘Rachel’s chest pain was a typical symptom, but she was a fit, young woman with no apparent risk factors. However, she was stressed in her job,’ says Dr Flint.
When the pains started, Rachel was a partner at a busy law firm. She was working on a major deal and so put off seeing a doctor.
‘I tried adapting my life around the pains, such as getting the bus to avoid walking,’ says Rachel, now 44, who has a three-year-old son, Oscar.
The chest pain (or angina) is a typical symptom of heart disease and is usually triggered by stress or exertion. Typically, it is felt behind the breast bone and radiates through the jaw on the left side and in the left arm — the same side of the body as the heart.
Symptoms tend to last for a few minutes, but if the pain remains 20 minutes after using angina treatment (such as a nitrate spray or indigestion medicine), the patient is probably suffering a heart attack.
But angina pain is not always severe and some people may experience it as a slight tightness in the chest, tingling and numbness in the hands and fingers, or pain in the jaw and neck.
‘Some people may just get breathless, so it’s important to investigate any reduced exercise tolerance,’ says Dr Flint.
Indeed, a recent U.S. study involving 1.4 million patients found 10 per cent more women than men didn’t experience chest pain with a heart attack — the difference was greatest in women under 55.
Younger women sufferers may get shortness of breath, which isn’t painful so doesn’t demand immediate attention, or dizziness or palpitations. The concern is that women in their 20s, 30s or early 40s who complain of chest pains are often, like Rachel, not taken seriously by their GPs.
‘It’s a myth that coronary heart disease doesn’t happen to younger patients,’ says Dr Narain. ‘GPs should assess risk factors, which are present in up to 95 per cent of heart disease cases.’
But though Rachel had been saved from a heart attack, it wasn’t all plain sailing because doctors are unused to treating pre-menopausal women for heart disease.
For a year after the stent was fitted, she was prescribed drugs to stop her blood clotting, but these caused heavy periods and she developed anaemia from blood loss.
The deficiency meant she was too weak to fight off coughs and colds, then the antibiotics she was taking caused antibiotic-induced Clostridium difficile and she ended up in hospital.
There, doctors discovered Rachel’s iron levels were a third of what they should have been and she needed a blood transfusion.
‘No one thought I might need different treatment because I’m a young woman. I wasn’t advised to take iron tablets, which would have helped,’ she says. Rachel now takes aspirin (to thin the blood) and statins (to reduce calcium and cholesterol in the arteries) and her health has been fine since.
But the experience has transformed her outlook.
‘I couldn’t stop crying for months. I struggled to make sense of life after nearly dying,’ she says. ‘Eventually, it gave me courage to make changes. I left my job two years later and began running workshops for new lawyers.’
Rachel also moved from London to York. She says she is much less stressed, though she is mindful of the risks.
‘I still panic if I feel pressure in my heart. Every so often I have an electrocardiogram to check my heart for piece of mind.’
Rachel wants women to take cardiac illness seriously.
‘Struggling through pain can be part of female culture and we often don’t listen to our bodies. You wouldn’t ignore a lump in your breast, so don’t ignore signs of heart disease.’
The British Heart Foundation Women’s Room is designed for women living with heart disease. Visit bhf.org.uk/women
