Good call on heart
“General Hospital,” Thursday, Feb. 27, 3 p.m.
The premise: Epiphany Johnson (Sonya Eddy), an obese African American nurse in her late 30s, is suffering from stress due to the death of her son. She suddenly becomes short of breath and falls to the floor, clutching her chest.
Dr. Leo Julian (Dominic Rains) reviews her electrocardiogram and tells her she has “acute ST elevations,” a sign of a heart attack. He recommends PCI (percutaneous coronary intervention) with a “drug eluting stent,” adding that “in this situation, time is muscle” and “every second counts.” He says that she was at greater risk for a heart attack in the first place because of her gender and race.
At first, Epiphany says she’s simply exhausted but, with the doctor’s admonitions, eventually goes through with the heart procedure. She recovers well.
As the current episode ends, she joins a Go Red for Women heart disease survival group whose leader’s stated goal is “to end an epidemic of ignorance and suffering.”
The medical questions: How prevalent is heart disease among women? Among African American women? Are women more likely than men to minimize symptoms? What are ST elevations on an EKG, and is coronary intervention with a drug-coated stent the preferred treatment? Do women suffer the same heart symptoms as men, and is treatment the same? Do stress and grief increase risk?
The reality: Eight million women in the U.S. have heart disease, including 10% of all women ages 45 to 64 and 25% of women older than 65, statistics show. More than 250,000 women die of heart attacks every year, a death toll six times that of breast cancer. And although 38% of women and 25% of men will die within a year of a heart attack, women are less likely than men to receive aspirin and heart medication after a heart attack. Further, they receive only 33% of angioplasties, stents and bypass surgeries.
The risk for African American women is greater. Their age-adjusted rate of heart disease is 72% higher than in white women. Epiphany’s obesity, a condition affecting 38% of black women, raises the danger even higher.
Age isn’t always a protector. “There is a growing amount of heart disease in younger women,” says Dr. Vyshali Rao, chief of cardiology at Huntington Hospital in Pasadena and a spokesperson for the Go Red for Women campaign. This is in part due to increased cigarette smoking in young women at a time when more men are quitting.
Vyshali also thinks -- as the show portrays -- that women are more likely to minimize or excuse their symptoms. “Women show up to hospitals later than men, and some studies show they are referred less often for cardiac procedures.”
The show is also mostly accurate in the details of how a heart attack happens. ST segment elevations (an EKG change consistent with ongoing injury to the heart muscle) are classic signs of heart attacks, and the physician is right to call for acute coronary intervention (in which a catheter is threaded from an artery in the groin up to the tiny arteries that feed the heart), with a likely placement of a tiny stent. This timely procedure has been shown to decrease the death rate from heart attacks.
But Dr. Frederick Feit, director of the Cardiac Catheterization Lab at New York University Medical Center, says that the use of drug-coated stents during treatment for a heart attack is still controversial.
Finally, stress does increase the risk of a serious heart attack.
“The only way we are going to reduce the death rate of heart disease in women is through prevention,” says Nieca Goldberg, a NYU cardiologist and author of “Dr. Nieca Goldberg’s Complete Guide to Women’s Health.” “We must convince young women to make important lifestyle changes.”
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Dr. Marc Siegel is an internist and an associate professor of medicine at New York University’s School of Medicine. In the Unreal World, he explains the medical facts behind the media fiction. He can be reached at marc@doctorsiegel.com.
