Cindy Bruce was preparing to meet a friend for coffee the morning of Sept. 7, 2018 when she began to suspect she was having an anxiety attack.
At 61, Bruce was very active, followed a healthy diet, had no underlying health issues, didn’t smoke, and wasn’t on any medication. Although the “weird sensation” in the area around her chest wasn’t painful, it was unfamiliar.
When the Halifax resident began feeling a bit nauseous, she assumed it was something minor that would soon pass. She met her friend and started to “pick up” a little bit, something she attributed to the caffeine.
That afternoon she and her husband drove to their place on the North Shore. While having dinner with friends, Bruce was overcome with extreme fatigue. She went to bed early but was unable to get comfortable.
Despite her exhaustion, she found herself tossing and turning all night.
“It was as though I had to do a chest stretch or a yoga chest-opening or something, but nothing I did resolved the discomfort,” she recalled in an interview.
“It wasn’t getting worse, but it wasn’t getting better either.”
‘A complete and utter shock’
The next morning, Bruce called a neighbour who was also a physician. After showing up and asking a few questions, he told her husband to immediately drive her to the Colchester East Hants Health Centre in Truro.
That was where Bruce learned that she’d suffered a heart attack.
“The doctor comes in and says, ‘Well, Mrs. Bruce, you’ve had a heart attack within the last 12 hours.’ I’m just like, ‘What? What is going on?’ I have to tell you, at the time I was 61. Good diet. No issues with cholesterol. Not overweight. Never smoked,” Bruce said.
“No family history of heart disease or any other kind of disease, for that matter. I’m physically active. I golf, I play tennis, I do yoga. I’m an active person and not on any medication, so this was a complete and utter shock.”
Bruce spent the night in hospital in Truro before being transferred to Halifax for more tests. She’d had a SCAD (spontaneous coronary artery dissection) heart attack. It was in a small enough artery that a stent wouldn’t help, so it was expected to heal naturally.
Within three months of her release from the cardiac care unit where she spent just under one week, Bruce started cardiac rehab.
“I honestly didn’t think I needed it, but I’m really glad I did it because the confidence in my body was not there anymore. I couldn’t trust my body,” she said.
“It gave me the trust back that I could get my heart rate up safely, that my blood pressure wasn’t going to do weird things, that I was OK to go back and be active again.”
Not a ‘Hollywood’ heart attack
Bruce, a retired optometrist, is now a volunteer with the Heart and Stroke Foundation of Nova Scotia.
She’s passionate about sharing her story to help highlight how heart attacks differ for women and to encourage participation in Monday’s Wear Red Canada campaign.
“That image of dropping to the floor? I didn’t. So I say that I didn’t have the Hollywood heart attack,” Bruce said.
“Have full awareness that a healthy appearing person can be having a heart attack and go tell your friends, your sisters, your mother, your daughters, your grandchildren. Tell them that women can have heart attacks that don’t look like that. They can look like this.”
First launched in Halifax in 2018, the Wear Red initiative has since become a nationwide annual event held every Feb. 13 to raise awareness of women’s heart health.
About 50% of women get turned away
Heart disease is the number one killer of women globally and the leading cause of hospitalization and premature death for women in Canada.
And it’s on the rise.
While cardiovascular diseases affect one in three women globally, messaging on the Wear Red Canada website notes that women are “under-studied, under-diagnosed, under-treated, and under-aware when it comes to their cardiovascular health.”
“The statistics do show that about 50% of women get misdiagnosed on their first presentation. So they get turned away,” Dr. Sharon Mulvagh said in an interview.
“Women themselves need to know that the symptoms can be different so they need to get things checked out. But moreover, they have to be persistent and be their own advocate when they go to interact with health care providers because they (health care providers) may not know.”
Mulvagh, a cardiologist, Dalhousie University professor of medicine, and co-director of the Women’s Heart Health Clinic, spearheaded the Wear Red initiative and its inaugural Halifax launch in 2018. It became national in scope in 2019 and is held annually the day before Valentine’s Day.
While a prominent heart attack symptom for men tends to be crushing chest pain or chest pressure, Mulvagh said that single presentation is much less likely to occur in women.
Women are more likely to present with three or more symptoms in addition to chest pain.
Harder to differentiate the symptoms
Those symptoms include pain, pressure, tightness or burning in the chest, and pain in the back, neck, right arm or jaw. Shortness of breath, nausea, and sweating are also frequently reported symptoms.
Women may also experience profound fatigue, sleep problems, dizziness or lightheadedness as well as a fast or irregular heartbeat.
“It’s harder to differentiate the symptoms is really the problem, and so that means that the person who is listening to the symptoms, to the woman presenting, they have to be tuned into this,” Mulvagh said.
“If they’re just listening to the story as if they were listening to a man…but the woman’s saying, ‘Yeah, there was some chest discomfort, but I really have this aching in my upper back,’ they’re going to go, ‘Oh, maybe it’s musculoskeletal, maybe we’ll just send you for an X-ray in a week.’”
Mulvagh said most women know if they’re experiencing something really different and serious. That’s why she encourages them to advocate for themselves to get that messaging across.
“I have even counseled women to say if you have any kind of chest discomfort or you think at all in your mind that this could be a heart attack, just say I have chest pain,” she said. “Leave it at that and then you’ll get the proper evaluation.”
‘Dissed for many, many years’
Women not only experience heart attacks differently than men, but can have different types of heart disease. Pregnancy complications, an earlier onset of menopause, and systemic inflammatory and autoimmune disorders all lead to a greater heart disease risk in women.
In addition, women have three times greater risk of a heart attack due to cigarette smoking compared to men who smoke. Women living with diabetes are also three times more likely to die from heart disease compared to men with diabetes.
“They (women) have been basically dissed for many, many years, despite the fact of there being evidence. But it didn’t fit with what we were taught is the point, because it’s finding new evidence,” Mulvagh said.
“And you find new evidence, but then you have to find the knowledge and be able to do the research to explain why this is happening.”
Two-thirds of research focused on men
That has been a struggle, since Mulvagh said two-thirds of cardiovascular research is focused on men, with women being “relatively neglected.”
“We’re making a lot of inroads in education, both continuing medical education for existing practitioners,” Mulvagh said.
“But also we have a whole curriculum that we’ve developed to be adopted in medical schools and in residency training so that our medical trainees and nursing and, you know, across the board.”
Although there’s still a way to go, Mulvagh said there is momentum and things are moving in the right direction.
“There’s actually a lot of research dollars that are being earmarked and research programs that are being developed, as well as clinical programs that are in the process of being developed focusing on women and heart disease,” she said.
“That is totally new. It was never on the horizon.”
An estimated 80% to 90% of heart disease risk factors are preventable, a statistic Mulvagh describes as “powerfully sobering.” She said the “preventable stuff” includes maintaining a healthy diet, regular exercise, not smoking, managing stress, and limiting alcohol intake.
She also recommends women keep tabs on a few important numbers — those include blood pressure, cholesterol, blood sugar, and weight.
“On this day, I want (people) to be aware that men and women are equally at risk for cardiovascular disease and that there are certain circumstances where women are more at risk,” Mulvagh said.
“And women may not have the same symptoms or the same underlying causes for heart disease, so we need more education and more research.”
‘I was lucky’
Four and a half years after her SCAD heart attack, Bruce sometimes thinks about the tiny voice that surfaced in the back of her mind that day. She recalls wondering briefly if she was having a heart attack.
But she quickly dismissed it as “baloney,” believing she was too healthy.
“I wish I’d known how mild symptoms can appear and still be a serious health crisis, and I think if that had been in my mind, I would have just gotten myself to the hospital that morning and had it checked out,” Bruce said.
“I was lucky. Totally lucky that it wasn’t worse, that it didn’t get worse, and that I had no lasting damage from it.”
This year’s Wear Red Canada Day event in Nova Scotia is being held in-person at the Halifax Infirmary’s Summer Street lobby and the RBC Theater from 11am until 1pm.
It’s also being live-streamed here beginning at noon.
“Knowledge is power, and it will save lives,” Bruce said.
“The more we can gain knowledge, the less we’re going to have deaths and complications from heart attack and stroke.”