Coleen was slim and fit – but her daily chocolate habit gave her a heart attack
21:39 GMT, 30 April 2012
Until the heart attack, Coleen Gill had no idea she had several risk factors
Coleen Gill reached for an indigestion pill when she felt a burning sensation spread across the middle of her chest.
‘I’d eaten a miniature Easter egg about an hour and a half before and thought it was repeating on me,’ says Coleen, 59, from Elloughton, East Yorkshire.
‘I’d got into the habit of treating myself to a chocolate bar with a cold drink every afternoon.
'I had a stressful job as a town councillor and often felt tired in the afternoon and in need of an energy boost.’
But despite the indigestion pill, the sensation in her chest didn’t go away and she was also getting hot and sweaty.
She was still feeling unwell by the time her husband Terry, a marketing consultant, got home from work an hour later.
Terry, 59, encouraged her to ring NHS Direct. She expected to be reassured.
‘I was totally shocked when they said they were sending an ambulance right away,’ says Coleen.
When the paramedics arrived, they said Coleen was having a heart attack.
‘They told me not to panic and gave me an aspirin to chew. /04/30/article-2137572-12D9A801000005DC-500_468x570.jpg” width=”468″ height=”570″ alt=”'It's an important message to get across that you don't have to be overweight to be at risk of a heart attack,' said Dr Carl Shakespeare” class=”blkBorder” />
'It's an important message to get across that you don't have to be overweight to be at risk of a heart attack,' said Dr Carl Shakespeare
Worryingly, research shows few women are aware they are at risk of heart disease.
Furthermore, if they do suffer a heart attack, like Coleen, they might not recognise the signs.
Though typically a heart attack causes chest pain, less well-known symptoms include shortness of breath, sweating, nausea, indigestion-type symptoms, a dull ache in the arms, shoulder or back or stomach pain.
Sometimes the patient might just feel dizzy or as if they have flu.
Women are more likely to have these atypical symptoms, says Professor Peter Weissberg, a cardiologist and medical director at the British Heart Foundation.
A recent U.S. study of one million heart attack sufferers between 1994 and 2006 found only 30 per cent of women reported chest pain during a heart attack compared with 42.7 per cent of men.
Furthermore, women under 45 were most likely to experience a heart attack without chest pain, according to the study from the Watson Clinic and Lakeland Regional Medical Centre, Florida.
‘The message is that heart attack symptoms come in all shapes and sizes and you don’t necessarily have the classic crushing central chest pain you see in films and TV soap operas,’ says Professor Weissberg.
The U.S. research found women under 54 without the characteristic chest pain also had a higher death rate than men of a similar age who had no chest pain.
One explanation is that they had waited longer before they sought emergency care.
‘Women are more likely to present later to hospital,’ says Professor Weissberg.
‘This could be due to not recognising the symptoms and not realising they are at risk — heart attacks are still perceived as something that happen to men.’
Dr Carl Shakespeare, a cardiologist at the Queen Elizabeth Hospital, Woolwich, says: ‘Women are protected from heart disease by the hormone oestrogen — but by the age of 45 this protection starts to wear off and other risk factors — such as high blood pressure, raised cholesterol and being overweight — start to cluster.
‘Women, particularly younger ones, can go under the radar and not get diagnosed, especially if they are slim because doctors will assume they eat healthily.
‘It’s an important message to get across that you don’t have to be overweight to be at risk of a heart attack and, though this applies to both sexes, it’s more of an issue for women because they are less likely to be overweight than men.’
Another problem is that women are less likely to get the right diagnosis, as some of the investigations, such as treadmill stress tests (where the heart’s activity is checked while you run), have high false positive rates because women are generally less fit than men.
Meanwhile, angiograms — where doctors look inside your heart using dye and X-rays to identify blockages or damage — tend to reveal fewer problems in women.
This is because women are more likely to experience abnormalities in the smallest blood vessels, while men tend to experience narrowing in the larger arteries.
‘Both are equally serious and can cause heart attacks, but problems in the larger arteries are more likely to be detected and treated,’ says Dr Shakespeare.
‘That’s partly why women who have heart attacks tend to have more advanced disease than men and a higher death rate, with more women than men dying within a year of a heart attack.’
But there is now a more sensitive device, EndoPAT, that can detect the earliest indicators of cardiovascular disease.
Experts believe it might be particularly useful for detecting problems in women.
The EndoPAT measures changes in the endothelial cells, which line the blood vessels. It is fitted to the fingertips and takes less than 15 minutes to do a reading.
Dr Shakespeare, one of the first to use the device (at the private Lister Hospital — it is currently used only in research trials in the NHS), explains that diagnosing problems earlier means doctors can treat them more aggressively.
Until the heart attack, Coleen had no idea she had several risk factors: a high-fat diet, stressful lifestyle and being post-menopausal.
‘It wasn’t just chocolate,’ she says.
‘I also loved butter spread thickly on toast, as well as cream in my coffee, hard cheeses such as cheddar and fatty bacon sandwiches.
‘I made the mistake of believing I didn’t have to worry because I wasn’t overweight.
'It didn’t enter my head to get my cholesterol or blood pressure checked. My GP didn’t suggest it, either.’
When she was taken to hospital, she was connected to a heart monitor and given blood tests that confirmed she’d had a heart attack.
She later had an angiogram, that revealed one of her coronary arteries was slightly damaged, but not enough to warrant surgery.
‘The doctors said my cholesterol reading was exceptionally high.
'When I told them about my love of chocolate and high-fat diet, they said that was probably what caused it.
‘The other risk factor I had was stress — I worked 40 to 50 hours a week, including late nights.
'I visited my elderly mother daily and was worrying about her.
'Looking back, I often felt exhausted, though maybe that was a symptom.
‘But I didn’t have any symptoms you think of with heart attacks, such as tightness in the chest.’
Coleen was prescribed statins to lower cholesterol as well as beta-blockers to reduce blood pressure and aspirin to thin her blood, and told to lower the saturated fat in her diet.
She was also sent on an exercise course for six months.
‘I enjoyed working out — I now teach Zumba classes.
'I’ve overhauled my life and by cutting out cream, butter, fatty meats and biscuits, and exercising more, I’ve got my cholesterol reading down to 4.5, in the normal range, and have been able to stop taking statins.
‘I’ll just have one or two squares of dark chocolate. More than that just isn’t worth the risk.
‘I tell all my female friends to get their cholesterol levels checked — like me, most of them don’t realise they are at risk.’