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“An extraordinary work that reveals the secrets of the heart and the keys to a heart-healthy life.


– Robert O. Bonow, MD, Past President, American Heart Association

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How You Can Prevent and Reverse Heart Disease
With Natural and Conventional Strategies

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9780470678459.indb 6 30/11/10 4:17 PM
“Acomprehensiveandwell-writtenguidethat’seasytounderstand.
It’samust-readforwomenofallageslookingtotakechargeoftheir
hearthealth.”
— LeslieBeck,registereddietitian,Globe and Mailcolumnist,andbest-selling
authorofThe Complete Nutrition Guide for Women

“Amasterfulsummaryofallweneedtoknowabouttheleadingkiller
ofwomen,heartdisease.Thisbookshouldberequiredreadingforall
healthconsciouswomenandthepeople wholovethem.”
— HenryBlack,MD,PastPresidentoftheAmericanSocietyofHypertension,
ProfessorofMedicineatNewYorkUniversity

“W hatawonderful,easytounderstand,comprehensiveguidefor
livinghealthfully!Theauthorsbeautifullyexplaintheimportance
oftakingcareofourmostvitalorgan.”
— KimColes,actorandtelevisionhost

“Ifyouhaveaheartandcareaboutawomanwhohasaheart,youmust
havethisbookandshareitwitheveryoneyouknow.”
— JesseDylan,award-winninghealthjournalist,authorandradiohostof
The Good Life

“Amazinglythorough!Writtenfromwomen’sheartsforwomen’shearts.
Thisisabookaboutbeingaware,anditisamustforeverywoman’s
self-carelibrary.”
— BarbaraGoodman,editorialdirectorofCanadian Health & Lifestylemagazine

“Theauthorspresentthoughtfulandpracticaladvicethatcaptures
whateverywomanneedstoknowaboutherheartandhowtokeep
ithealthy.”
— AliceK.Jacobs,MD,ProfessorofMedicine,BostonUniversitySchool
ofMedicine

“Interesting,provocativeandempowering.Thisbookisacalltoaction
forwomentoaddressournumberonehealththreat.”
— FannyKiefer,televisionhostofStudio 4

“Neverbeforehastherebeensogreataneedtoeducateourworldon
women’sheartdisease.Saving Women’s Heartswillsavelivesand
protectfamiliesfromunnecessarydevastationandloss.”
— DanielleLin,certifiednutritionistandradiohostofThe Danielle Lin Show

9780470678459.indb 1 30/11/10 4:17 PM


“Thisbooktrulyempowerswomen.Itcutsthroughallthemisinfor-
mationandsupplieswhatisscientificallyvalidinanunderstandable,
interestingform.Iwillrecommendittomypatientsandviewers.”
— MaryAnnMalloy,MD,cardiologistandcontributortoNBCChicago

“Amust-readforwomenofallages.Theauthorsprovidevaluableguid-
anceonhowtoreduceyourriskofheartdisease.Thisbookandits
strategiescouldreallysaveyourlife.”
— LynnMartin,radiohostonAM800CKLW

“Saving Women’s Heartsisathorough,practical,scientificallybased


booktoempowerwomentoconquerheartdisease.Thebestpartis
thatittakessomuchinformationandmakesiteasytounderstand.”
— JenniferH.Mieres,MD,FACC,FAHA,AssociateProfessorof Medicine,
NorthShore-LIJSchoolofMedicine,co-authorofHeart Smart For Black
Women and Latinas

“Thisbookislikehavingaheart-to-heartwithadoctorwhoisalso
yourbestfriend.Itgivespractical,real-lifeadviceaboutheartdisease
andhowtopreventit.”
— AphroditeSalas,journalist

“Trulythebestbookonthesubject.Itfocusesontheperson,thesoul,
andtheimportanceofhearthealth.Otherbookshavefocusedonquick
fixesandnotappliedanemotionalsidetogettinghealthy.Thisbook
takesaveryfemaleapproachtoaverychallengingissue.”
— LesleeShaw,PhD,FACC,FAHA,FASNC,ProfessorofMedicine,
EmoryUniversity

“Imagineabookthatcombinesthebestinconventional,natural,and
complementaryapproaches.Imagineabookthathonorspurescience
andtheincredibleadvancesinmedicaltechnologybutalsowhole-
heartedlyacceptsthebrillianceofnature’sofferings.You’reholding
thatbook!Don’tletitgo.Itmaysaveyourlife.”
— BryceWylde,HD,RNC,authorofThe Antioxidant Prescription,television
hostofWylde on Health

9780470678459.indb 2 30/11/10 4:17 PM


SAVING
WOMEN’S
HEARTS
How You Can Prevent and Reverse Heart Disease
With Natural and Conventional Strategies

MARTHA GULATI MD, MS, FACC, FAHA


SHERRY TORKOS BSc Phm

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Copyright © 2011 by Martha Gulati and Sherry Torkos

All rights reserved. No part of this work covered by the copyright herein may be
reproduced or used in any form or by any means—graphic, electronic, or mechanic-
al without the prior written permission of the publisher. Any request for photocopy-
ing, recording, taping, or information storage and retrieval systems of any part of
this book shall be directed in writing to Canadian Copyright Licensing Agency
(Access Copyright). For an Access Copyright license, visit www.accesscopyright.ca
or call toll free 1-800-893-5777.

Care has been taken to trace ownership of copyright material contained in this book.
publisher will gladly receive any information that will enable them to rectify any
reference or credit line in subsequent editions.

publication contains the opinions and ideas of its author(s) and is designed to
provide useful advice in regard to the subject matter covered. author(s) and pub-
lisher are not engaged in rendering medical, therapeutic, or other services in this
publication. publication is not intended to provide a basis for action in particu-
lar circumstances without consideration by a competent professional. author(s)
and publisher expressly disclaim any responsibility for any liability, loss, or risk, per-
sonal or otherwise, which is incurred as a consequence, directly or indirectly, of the
use and application of any of the contents of this book.

Library and Archives Canada Cataloguing in Publication


Gulati, Martha, 1969–
Saving women’s hearts : how you can prevent and reverse heart disease with nat-
ural and conventional strategies / Martha Gulati, Sherry Torkos.

Includes bibliographical references and index.


ISBN 978-0-470-67845-9
978-0-470-67846-6 (e-PDF), 978-0-47067848-0 (Mobi), 978-0-47067847-3 (ePub)

1. Heart diseases in women—Popular works. 2. Heart—Diseases—Prevention—3.


Women—Diseases—Prevention—Popular works. I. Torkos, Sherry II. Title.

RC682.G84 2011 616.1’205082 C2010-906240-X

Production Credits
Cover design: Diana Sullada
Interior design and typesetting: Mike Chan
Author photos: Danny Clark Photography (M.G.)
and Precious LaPlante Photography (S.T.)
Printer: Solisco Tri-Graphic Printing Ltd.

Editorial Credits
Managing Editor: Alison Maclean
Production Editor: Lindsay Humphreys
Editorial Assistant: Katie Wolsley

John Wiley & Sons Canada, Ltd.


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To the two women whose hearts I care about the
most — Patricia Gulati-Conti and Natasha Conti.

To my teacher, who was the first to make me aware that


women’s hearts were special, Dr. Leonard Sternberg.

In memory of my mentor, who made it possible for me to do


research on women’s hearts, Dr. Morton Arnsdorf.

To my father, who has cheered me on in every step and


is essential to my heart.

And in memory of my mother, who taught me how to use my heart.


M.G.

To my parents, who inspire me with their boundless energy and


passion for life. You have led by example and taught me from an early
age how to live a heart-healthy lifestyle.

To my husband Rick and baby Phoenix, I love you with all my heart.
S.T.

We dedicate this book to all the women we love and to all our
patients who have entrusted us to help them save their hearts.
M.G.&S.T.

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Acknowledgments

Iwouldliketofirstacknowledgemybrother,JustinGulati.Hopefully
heforgivesmefornotdedicatingthebooktohimbuthehasbeenmy
biggestadvocateandwasthefirstpersontotellmeIshouldwritea
bookonthistopic.Thankyouforallyourgreatideas(particularlythe
survey!),editingsuggestions,andbeingmygreatestfan.Ialsomust
thankmysisterPatriciaGulati.ThankyouforwalkingaroundSouth-
ernFloridamakingrandomwomenfilloutmysurvey!Iamsorryyou
couldn’tgivethemtheanswersonthespot,butitwasyourfriends
andcontactsthathelpeduslearnwhatwomenneededtoknowand
helpedusshapethebook.Sothankyoutoallofthewomenwhotook
thesurvey,too.Myfatherhasalwaysbeenmybiggestfanandwillbe
forcingbothwomenand mentoreadthisbook,becauseheismydad.
Thanksforyourunconditionallove.Iwouldalsoliketoacknowledge
theconstantsupportandfeedbackfrommyfriendsandfamilyaswe

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a c k n o w l e d g m e n t s   ix

wrotethebook.ThankyoutoGarethGwynforyourlove,patience,and
foralwaysbeingonmyside(evenwhenImaybewrong!).Imustalso
thankChristinePauley-Kultgen.Withoutyouasmyfriend,Iwould
havenevermetyourmomwhois“beingforcedtoexercisemoreevery
timeanewsetofguidelinescomesout.”Inaddition,withoutyou,my
vocabularywouldbeincomplete.
IwouldparticularlyliketothankthePeggyShure-Snyderfamily,
theNancyandLarryGlickfamily,andtheSallyandBillSoterfamily
forsupportingmyworkandmyresearchonwomen.
Iamalsogratefulforthesupportandshapingofmycareerfrom
thefollowingpeople:Drs.LeonardSternberg,ArthurRubenstein,
MortonArnsdorf,JefferyLieden,HenryBlack,NoelBairey-Merz,
LesleeShaw,JenniferMieres,RobertBonow,NeilStone,TomRyan,
WilliamAbraham,andNanetteWenger.
ToallmypatientswhoIhavehadthehonoroftakingcareof,please
knowthisbookwasshapedbythequestionsyouaskedandthethingsI
learnedfromyou.Youcontinuetobemyinspirationandmydailyjoy.
ThankstotheWileyteamforhelpinguswiththebookandbe-
lievinginouridea,particularlyLeahFairbankforbeingthebestad-
vocateforusandgettingourbookofftheground.Thankyoualsoto
ourlawyerandfamilyfriend,Mr.JohnBurns,forthelegalguidance.
Lastly,Imustthankmyco-author,SherryTorkos,whohasbeena
friendsincethefirstdayinuniversityfreshmanyearwherewefound
wewereinthesamecalculusandphysicsclasses.Oneofuslovedthe
classes,onedidnot,sowewereabitlikeprotonsandelectrons,don’t
youthink?Ourstrengthscontinuetocomplementeachother,even
ourcareerpaths.Youroptimism,patience,andpassionarealwaysan
inspirationtome.Yourabilitytoworkonthisbookduringacrazyyear
endingwithBabyPhoenixwasastresstestofitsown.Youpassedwith
flyingcolors,dearfriend.Youarepartofmyheartforlife.

MarthaGulati

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x  s a v i n g  w o m e n ’ s  h e a r t s

TherearemanypeopleIwouldliketothankfortheirhelpandsup-
portwiththisbook.
TomyhusbandRickandmyfamily:thankyouforyourencourage-
ment,patience,andunderstandingofmycommitmenttothisproject
andallthelonghoursrequiredtoseeitthrough.
Tomycoauthor,Martha:Iamsogratefulfortheopportunity
toworkwithyouonthisbook.Iadmireyourvastknowledgeand
expertiseandyourdedicationtoresearchandtheadvancementofour
understandingofheartdiseaseandwomen.Ialsovalueyourfriend-
ship.Wehavehadmanyfuntimestogether.Fromthedayswhenwe
werestudyingsciencetogetheratMcMasterUniversityandthrough
themanytwistsandturnsourliveshavetaken,youhavealwaysbeen
atruefriend.
TotheteamatWiley:LeahFairbank,AlisonMaclean,Lindsay
Humphreys,andthesalesandmarketingteams,thanksforallyour
helpandsupportwiththisbook.
Finally,Iwouldliketothankyou,thereader,foryourinterestand
fortakingthetimetoreadthisbook.Isincerelyhopethatthisinfor-
mationempowersyoutotakecareofyourheart.

SherryTorkos

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Introduction
Heart Disease in Women
Wherever you go, go with all your heart.
—Confucius

Whyshouldyoucareaboutyourheart?Whydoesyourheartmatter
at any age? Well, heart disease is the number-one killer of women.
Mostwomenthinkcancer(particularlybreastcancer)shouldbetheir
number-one health concern, but the facts are the facts. One out of three
womenwilldevelopheartdiseaseinherlifetime.1Andwearemore
likely to die of heart disease as adults than we are to die from the next
sixleadingcausesofdeath.Butheartdiseaseisthesinglemostprevent-
able cause of death, which means we can change the odds of getting
thisdiseasethatclaimstoomanywomen’sliveseveryyear.
Given the statistics, all of us must think about our hearts, take
careofourhearts,watchourhearts,andknowourhearts.Itisnever
too late or too early to start and to make changes to reduce your risk
ofheartdisease.Allwomenneedtobeproactiveaboutknowingtheir
risks for heart disease and working to reduce those risks.

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2  s a v i n g  w o m e n ’ s  h e a r t s

Youmayaskyourselfwhythisbookshouldmattertoyou,espe-
ciallyifyoudon’thaveheartdiseaseordon’tidentifyyourselfasbeing
atriskforheartdisease.Thetruthis,mostwomendonotrecognize
themselvesasbeingatriskforheartdisease.Womenarelesslikelythan
mentorecognizesymptomsofaheartattack,whichareoftendifferent
forwomenthantheyareformen,andlesslikelytocallanambulance
or9-1-1whentheyarehavingsymptomsofanattack.2Asaresult,
wewomenaremorelikelytodelaygettingcarewhenwearehavinga
heartattack.Andnotonlydoheartattacksinwomenfrequentlygo
unnoticedbythewomenthemselvesbuttheyareoftenunrecognized
bytheirdoctors.Evenafteraheartattackisdiagnosed,womenare
lesslikelytoleavethehospitalwiththestandardmedications(asper
nationalguidelinesforanyonewithaheartattack,regardlessofgender)
thathaveproventosavelives.Thisultimatelyleadstohigherdeath
ratesforwomen,andparticularlyyoungerwomen,whichisverycon-
cerning.3Weneedtochangethis.Althoughtheriskforawomantoget
heartdiseaseinherlifetimeisoneinthree,itwillsoonbeoneintwoif
thetrendskeepgoinginthedirectionweareseeing.Thatmeansthat
theoddsofyougettingheartdiseasearethesameasgettingheadsin
acointoss—notgreatoddsforanywoman.
Tohelpstackthoseoddsinyourfavor,wedecidedtowritethis
book,inwhichwegiveyouinformationthatyoucanincorporateinto
yourdailylifetoreduceyourriskofheartdiseaseandstroke.We
comeatthistopicfromdifferentangles.Oneofusisapharmacist,
withtraininginbothconventionalandcomplementarymedicine.
Oneofusisacardiologistspecializingincardiacdiseasepreven-
tioninwomenandwhodoesresearchonheartdiseasepreventionin
women.But,firstandforemost,we are both women.Wearepassion-
ateaboutthisissueandhaveourownpersonalreasonsforwanting
toreduceheartdiseasein women:webothhavefamilyhistoriesthat
predisposeustodevelopingheartdisease.We’vechosentodevote
ourselvestolearningasmuchaspossibleaboutourheartsandhow
toprotectthem,sothatwecantakecareofourheartsandhelpother
women,likeyou,dothesame.
Whileweweredoingourrespectiveschoolingandtraining,we
werebothshockedtodiscoverhowlittlewasknownaboutwomenand
heartdisease.Andwearenottalkingaboutsolongago—thiswasthe
mid-1990s.Naively,wethoughtthatmostofmedicinewaswellstudied,
andthat,inparticular,thenumber-onekillerofwomenshouldbe!But

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heartdiseaseinwomen  3

toouramazement,wefoundthatwomenwereroutinelyexcludedfrom
mostofthemajorcardiologytrials.Sothemedicinewewerepracticing
tookforgrantedthatwomenarethesameasmen—thattheywould
presentinthesamewayandrespondtomedicationsinthesameway,
thattheirdiseasepatternsforheartdiseasewouldbeidenticaltomen,
andthatthetestsusedtodiagnoseheartdiseasewouldworkequally
aswellinwomenasmen,eveniftheywerenottestedorvalidatedin
women.Butthesewereassumptions,notfacts.Andthefactisthis:until
the1990s,fewwomenwereevenincludedinlargecardiologytrials,
sowereallydidnotknowverymuchaboutwomenandheartdisease.
Itisamazingthatthemedicalfielddidnotrecognizethisforsuch
alongtime.Heartdiseasewaskillingwomenacrosstheglobe.Women
hadworseoutcomesafteraheartattack,worseoutcomesafterunder-
goingheartsurgery,andsince1984morewomenweredyingfrom
heartdiseasethanmen.Dr.NanetteWenger,acardiologistfromEm-
oryUniversityandtheformerchiefofGradyHospitalinAtlantawho
reallyledthemovementforcardiacresearchinwomen,saiditbest:“The
[medical]communityhasviewedwomen’shealthalmostwitha‘bikini’
approach,lookingessentiallyatthebreastandreproductivesystem,
andalmostignoringtherestofthewomanaspartofwomen’shealth.”4
Whenwespokeofwomen’shealth,weweretalkingaboutfertility
andreproductivehealth,breastcancer,andovariandisease.Butnot
theheart.Thegoodnewsforallwomenisthatwehavecomesucha
longwaysincethen.Wehavemadehugestridesinthelast15ormore
years.TheU.S.governmentmandatedthatwomenbeincludedinall
newclinicaltrials,andthelargeststudyofwomenandhormonereplace-
menttherapy(theU.S.-basedWomen’sHealthInitiative)wasstarted
asaresultofthatmandate.Wenowhaveevidence-basedguidelines
forheartdiseasepreventioninwomen.Wearestudyingtheeffectsof
medicationsonwomen,aswellasthesideeffects,anddetermining
theappropriatedosingforwomen.BecauseoftheNationalInstitutes
ofHealthmandate,wehavemoretrialsthatincludebothwomenand
men,andweareabletocomparegenderdifferencesinheartdisease.We
aretrackinghowwellwomendoafteraheartattackandaftercoronary
bypasssurgery.Andsince2001,wehaveseenadeclineinmortality
inwomenfromheartdisease.5Sowearedefinitelymakingprogress;
butwearenowhereclosetohavingalltheanswersorcompletingall
thetrialsthatwilltellusforcertainwhatmethodsofpreventionand
treatmentworkbestforwomenandheartdisease.

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4  s a v i n g  w o m e n ’ s  h e a r t s

Despitetheinclusionofwomeninheartstudiesandthelike,
heartdiseaseisstillconsideredtobea“man’sdisease.”Womenneed
tobeawarethatitis,however,anequalopportunityaggressor.Itjust
announcesitselfabout10yearsearlierinmen,butonceitaffects
women,itisawholelottougher:Morewomenthanmendieofheart
diseaseeachyear.Womenaremorelikelytodiefromaheartattack
thanaman.Morewomenthanmendiewithinoneyearofhavinga
heartattack.Twiceasmanywomenthanmenendupdisabledasa
resultofheartdisease.
Wearewritingthisbooktoguideyouthroughtoday’sbestevi-
denceofwhatwillhelpyousaveyourheart.Wewantwomentorecog-
nizethattheyareatriskforheartdiseaseandthatitisthenumber-one
killerofwomen.Wewanttopresentyouwiththetoolstodoeverything
youcantopreventgettingheartdisease.Andforthosewomenwith
heartdisease,wewanttohelpprotectyoufromanyfutureproblems
andequipyouwiththetoolstomaintainthehealthiestheartpossible.
Wewantallwomentobeawareofthesymptomsofheartdiseaseand
toknowwhattodowhenyouthinkyoumaybehavingaheartattack.
Inthisbookwewilltellyouaboutthemostrecentstudiesonwomen
andheartdiseaseprevention,sothatyoucanmakeinformeddecisions
abouthowtokeepyouandyourhearthealthy.Wewantyou toknow
whatkindofhearttestingandscreeningyouneed,andwhattoexpect
whenyougettestsdone.Wewillpresentyouwithevidence-basedtreat-
mentoptions,regardlessofwhetherwearediscussingconventional
Westernmedicationsorcomplementarymedicines.Wewantallwomen
tofeelempoweredtounderstandtheirheartssotheycanhavefrank,
informeddiscussionswiththeirhealthcareprovidersaboutwhatneeds
tobedonefortheirownindividualhearts.

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The Heart Questions
Survey of What Women Know
About Their Hearts

Beforewedecidedtowritethisbook,weperformedasurveytofindout
whatwomenknowabouttheirhealthandtheirhearts.Thissurveyis
copiedbelow.Whydon’tyougoaheadandtakeitnow?We’lldiscuss
theresultsinthefinalchapter.

Pompano Beach Heart Survey

1. Whatisyournumber-onehealthconcern?
A. Breastcancer
B. Cervicalcancer
C. Lungdisease
D. Heartdisease
E. Mentalillness
F. Other

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6  s a v i n g  w o m e n ’ s  h e a r t s

2. Whatisthenumber-onekillerofwomen?
A. Breastcancer
B. Cervicalcancer
C. Lungcancer
D. Heartdisease
E. Suicide

3. Haveyoueverbeenscreenedforheartdisease?
A. Yes
B. No

4. Doyouthinkyouareatriskforheartdisease?
A. Yes
B. No

5. Whatisthelifetimeriskofheartdisease?
A. Oneinthreewomenwilldevelopheartdiseaseintheirlifetime.
B. Onein100womenwilldevelopheartdiseaseintheirlifetime.
C. Onein1000womenwilldevelopheartdiseaseintheirlifetime.
D. Onein10,000womenwilldevelopheartdiseaseintheir
lifetime.

6. Whichsupplementisrecommendedforheartdiseaseprevention?
A. Folicacid
B. VitaminE
C. VitaminC
D. Fishoil(omega-3)
E. Beta-carotene

7. Whatisnormalbloodpressure?
A. Lessthan100/70
B. Lessthan120/80
C. Lessthan135/85
D. Lessthan140/90

8. Whatisnormalbodymassindex(BMI)?
A. <25kg/m2
B. <30kg/m2
C. <35kg/m2
D. Iamunawareofwhatthebodymassindexis.

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theheartquestions  7

9. W
 hichsupplementshouldallwomentakedailytopreventheart
disease?
A. Aspirin(81mg)
B. Aspirin(325mg)
C. Folate
D. Noneoftheabove
E. Alloftheabove

10.Whichofthefollowingareriskfactorsforheartdiseaseinwomen?
A. Tobaccouse
B. Physicalinactivity
C. Familyhistoryofheartdisease
D. Alloftheabove
E. Noneoftheabove

11. Atwhatageshouldwomenbescreenedforheartdisease?
A. Age60andabove
B. Age50andabove
C. Age40andabove
D. Age30andabove
E. Age20andabove

12.Afterawomanundertheageof60hasaheartattack,sheismore
likelytosurvivecomparedtoamanofthesameagewhohasaheart
attack.
A. Yes
B. No

13.Doeshormonereplacementtherapyprotectwomenagainstheart
disease?
A. Yes
B. No

14.Howinformedaboutheartdiseasedoyoufeelyouare?
A. Poorlyinformed
B. Moderatelyinformed
C. Highlyinformed

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Chapter 1
Affairs of a Woman’s Heart
And now here is my secret, a very simple secret;
it is only with the heart that one can see rightly,
what is essential is invisible to the eye.
—AntoinedeSaintExupery

Think of your heart as a muscle. No, wait, let’s use an analogy, one that
allwomencanrelateto.Thinkofyourheartasyourfavoritepairof
shoes. Whether you love them for their comfort or for their style, they
areyourfavoriteshoesandyouwonderifyoucouldeverreplacethem
if they wore out. You know which shoes we are talking about — the
onesyouwishyou’dhadtheforesighttobuymultiplepairsof.Soyou
treat those shoes with great care and love, because you want them to
lastforever.Wearingtherightpairofshoescanmakeyoufeelamaz-
ing, like you can conquer all your problems and, well, just deal a little
betterwithlifeingeneral.
The same can be said for a healthy heart. But unlike a pair of shoes,
theheartishiddenfromview,soyoudon’tthinkaboutitallthetime.
You may not even think about it at all when it is working well. And
whenit’snotworkingwell,youmaybecomemorefamiliarwithit,but
by then it may be too late.
Rememberthatweeachgetoneheartandoneheartonly,soit’s
imperative that we treat it well. So let’s start thinking about our hearts

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affairsofawoman’sheart  9

everytimeweputonapairofshoes,which,formostofus,isatleast
onceaday.
Inthischapter,weintroduceyoutotheheartandallitsparts.We
describehowtheheartfunctionsnormallyandwhatcangowrongin
theheart.

What Is Your Heart?


Theheartisamuscle.Quiteanamazingmuscle,infact.Itstwosides
arenotexactlythesame,butsimilar,andtheyworkinunison.One
sidecannotworkwithouttheother.Thetopchambersontheleftand
rightsidesarecalledtheatria.Thebottomchambers(againoneon
therightside,oneontheleft)arecalledtheventricles.Youcanseethe
differentpartsoftheheartinthediagrambelow.

Anatomy of Your Heart

Aorta

© 2010 Nucleus Medical Media, all rights reserved. www.nucleusinc.com

Theatriaandventriclesworkincoordination.Whentheventricles
relaxandfillwithblood,theatriacontract;andwhentheatriarelax
andfill,theventriclescontractandpumpthebloodforward—tothe
aortaontheleftsideandtothepulmonary arteriesontherightside.
Theaortaisthelargestarteryinthebody,originatingattheexitofthe

9780470678459.indb 9 30/11/10 4:17 PM


10  s a v i n g  w o m e n ’ s  h e a r t s

heart,andfromtheaorta,alltheotherarteriesbranchofftoprovide
bloodtoalltheorgansandtissuesinthebody.Th  epulmonaryarteries
carrythevenousbloodfromtherightsideofthehearttothelungsto
getoxygenandreturnthisbloodtotheleftsideoftheheartthrough
thepulmonaryveins.
Th eventriclesaretherealpowerhousesoftheheart,particularly
theleftventricle.Ifyoulookattheventricles,youwillseethethick
musclethatmakesupthischamber.Inanormalheart,theleftven-
tricleismoremuscularthantheright.Nonetheless,bothventricles
handlethesamevolumeofblood,sotherightsideoftheheartisjust
asimportantastheleftside.
Th eleftandrightsidesoftheheartareseparate,meaningtheydo
notexchangeanyblooddirectlyacrosstheatriaorventricles.Ifthey
dotransferbloodbetweenanyofthesechambers,thereislikelyahole
intheheartandthisisabnormal.Normally,theheartkeepstheven-
ousblood(bloodthathasbeendepletedofitsoxygen)fromtheright
sideoftheheartseparatefromtheoxygenatedbloodintheleftside
oftheheart.

Did you know . . .


The heart beats approximately
♥ 70 beats a minute
♥ 10,000 beats a day
♥ 38 million beats a year
♥ 2.5 billion times over 70 years

Th eatriafi llwithbloodfromthevenoussystemsthatemptyon


bothsidesoftheheart,buttherightsideoftheheartgetsthebloodthat
hashadmostofitsoxygenextractedandisreturningfromthebody.
Th erightsideoftheheartpumpsthebloodthroughthepulmonary
arterytogetoxygenfromthelungs,anditreturnsthebloodtotheleft
sideoftheheartthroughthepulmonary veins,wherethebloodisnow
richwithoxygen.Th  eleftsideoftheheartpumpsthebloodthrough
theaorta.Th  isblood,nowrichinoxygen,goestoallofthearteriesin
thebody,includingthosethatsupplytheheartmuscle.

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Youcanunderstandhowiftheheartcan’twork,meaningifit
can’tpumpbloodtothebody,therestofthebodycan’twork.Weneed
ourheartstofunction,otherwisealltheotherorgansofthebodywill
failtogetbloodand,therefore,theoxygentheyneedtodotheirjobs.
Ultimatelythiswillcausealltheorganstoshutdownandstopwork-
ing.Thisiswhytheheartisthemostimportantorganinthebody.
Withoutaworkingheart,wecannotlive.

The Coronary Arteries


Thecoronaryarteriesprovidethebloodsupplytotheheart.These
arteriesgettheirbloodsupplyeverytimetheheartbeats.Eachtime
theleftventriclepumpsbloodforwardthroughtheaorta,thecoron-
aryarteriesfillandprovidethemuscleoftheheartwithoxygen-rich
bloodsothattheheartcanwork.

What Can Go Wrong with the Heart Arteries?


Theheartmusclerequiresaconstantsupplyofoxygentofunction
andthisoxygencomesthroughtheheartarteries.Iftheheartarter-
iesareblocked,andthusthebloodflowtotheheartmuscleisblocked
orseverelyreduced,oxygenwillnotgettotheheartmuscleandthe
musclecanbedamaged.Thisiswhatoccurswhensomeonehasaheart
attack —alsoknownasamyocardial infarctionor,ifyouwatchtele-
visionmedicaldramas,an“MI.”(Wediscussheartattacksinmorede-
tailinChapter6.)Amyocardialinfarction isthemostcommoncause
ofheartdiseaseinwomen,sowereallywantyoutounderstandexactly
howthisoccursandhowyoucanpreventitandtreatit.
Thecoronaryarteriescanbecomeblockedovertimeduetoagrad-
ualbuildupofplaque,madeupprimarilyofcholesterol.Thisprocessis
knownasatherosclerosis.Ifthecholesterolplaquerupturesorbreaks
inresponsetostress,abloodclotcanformandblockthearterycom-
pletely,preventingbloodfromflowingforwardtotheareabeyondthe
blockage.Sincetheheartmusclepasttheblockageisdependenton
thatarteryforitsoxygensupply,ablockageinbloodflowwilldamage
it.Thisconditionoftheheartmusclenotreceivingenoughoxygento
functionproperlyisknownasischemia.Ifthebloodflowisnotquickly
restored,thataffectedareaoftheheartmusclemaydie(infarct).
Lesscommonproblemswiththecoronaryarteriesmaybethe
resultofbirthdefectsintheheartarteryanatomy,forexample,con-
genitalabnormalitiesinthepositionsofthecoronaryarteries.Such

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anabnormalitymayrequiresurgicalcorrectionifthearteryposition
resultsincompressionoftheartery,whichwouldultimatelyleadto
ischemia,evenwhenthereisnoplaquebuildup.Vasospasm,wherethe
heartarterycontractsandreducesthebloodflowtotheheartmuscle,
isanotherproblem.

The Heart Valves


Theheart’sfourvalveskeepthebloodflowingintheappropriatedir-
ection.Thesevalvesaremadeupofleaflets (triangular-like flaps).The
heartvalvesopenandclosewithintheheartcycle,allowingtheblood
toflowinonedirectiononly:forward.Whenthevalvesareworking
normallytheyopenandclosefullyandatappropriatetimeswhenthe
heartcontracts.Theheartvalvesbetweentheatriaandventriclesare
knownasthetricuspid valveandmitral valve,ontherightandleftside
oftheheart,respectively;thevalvebetweentherightventricleandthe
pulmonaryarteryisthepulmonic valve;andthevalvebetweentheleft
ventricleandtheaortaiscalledtheaortic valve.Refertothediagram
oftheheartonpage9toseethepositionoftheheartvalves.

What Can Go Wrong with Heart Valves?


Twothingscanpotentiallygowrongwithheartvalves.First,theycan
leakandallowbloodtoflowbackwards.Thisisknownasregurgitation
andcanoccurwithanyofthefourvalves.Second,thevalvescanbecome
tightandnarrow,makingitdifficultforbloodtoflowforward.Thisis
knownasstenosis,andit,too,canaffectanyofthefourvalves.Inaddi-
tion,morethanonevalvecanbeaffectedbythesamediseaseprocess,
andapersoncanhavealeakyvalveandtightvalveatthesametime.
Regurgitationandstenosismaybecausedbycongenitalvalveprob-
lems(thatis,youarebornwiththem),infectionsoftheheartvalves,
rheumaticfeveraffectingtheheartvalves,damagetoaheartvalveor
itsstructureafteraheartattackorafterdevelopingheartfailure,or
valvediseasefromagingwherethereiscalcificationonthevalves.
Symptomsareimportantsignals,butchangestotheheartcanoccur
evenwithoutsymptoms.Ifthevalveisnotrepairedorreplaced,more
damagetotheheartmayoccur,dependingonhowmuchthedisease
processaffectstheheartvalves’abilitytoopenorclose(orboth)prop-
erly.Heartfunctioncanstartdecliningasaresultofthevalveproblem
and,ifleftuntreated,maybeirreversible.

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a f f a i r s  o f  a  w o m a n ’ s  h e a r t   13

The Heart Ventricles


Th
 eventriclesoftheheartareinchargeofpumpingthenutrient-rich
bloodtothebodyanditsorgans,providingadequatenourishmentand
oxygentoalltheorganssothattheycanfunctionnormally.

What Can Go Wrong with the Heart Ventricles?


Whentheventriclesoftheheartarenotworkingnormally,theheart
cannotpumpbloodaseffectivelyasitshould.Whenourheartcan-
notmeetthebody’sdemands,wearesaidtohaveheart failure.Even
thoughthetermmayimplythattheheartcan’tworkatall,itcan—
justnotaswellasahealthyheart.Th  ereisaremarkablespectrumof
severityofthisdisease.Somepeoplewithheartfailurehavenosymp-
tomsatall,whileothersaresolimitedbytheirheartfailurethatthe
simpleactofmovingabouttheirhomecanbediffi cult.Heartfailure
canoccurevenwhentheheartfunctionappearsnormalbuttheheart
cannotrelaxnormally;thisisknownasdiastolic heart failureandis
commoninwomen.
Heartfailurecanresultfromseveralcauses,includingaheartattack
orcoronary artery disease(whereoneormoreofthecoronaryarter-
iesisnarrowed),hypertension,valvedisorders,chemotherapydrugs,
alcohol,orinfectionsordiseaseprocessesthataffecttheheartmuscle.

Each year, 267,000 U.S. women die from heart attacks, which kill six times
as many women as breast cancer. Another 31, 837 women die each year
of congestive heart failure, representing 62.6% of all heart failure deaths.

The Electrical System of the Heart


Whatisreallyfascinatingabouttheheartisthatithasitsownelectrical
systemthatrespondstoyourbody’sdemandsandrequirements,tell-
ingtheheartwhentobeatfasterorslower,dependingonhowactive
youare.Ifyousuddenlybreakintoarun,yourheartknows:yourheart
ratepicksup.Whenyoustoprunning,itknowsitcansafelyandgrad-
uallyslowdown.Whenyousleep,thebody’sdemandsforbloodand
oxygenlessen,sotheheartslowsdownitsrateevenfurtherfromyour
restingheartrateofyourwakinghours.
Itisthesinoatrial node(SAnodeorsinusnode)locatedintheright
atriumthatusuallycontrolstheheartrate.Whenworkingproperly,
theSAnodegeneratesanelectricalsignalthatthenmovesfromthe

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rightatriumtotheleftatriumandontotheatrioventricular node(AV
node),wherethroughaspecializedconductionsystem(His-Purkinje
system)theelectricalimpulseistransferredtotheventricles.Itisthis
electricalimpulsethatcausesthehearttopump.Ifitisdisruptedany-
wherealongthispathway,theheartrhythmmaybeaffected,aswellas
thenormalfunctioningoftheheart.
Ifforsomereasonthesinoatrialnodefails,manyotherplacesin
theheartcantakeover.Basically,everycellthatmakesuptheheart
muscleiscapableofsendingachargeorsignaltohelpkeeptheheart
beating.Whichpartofthehearttakescontroldeterminestheheartrate.

What Can Go Wrong with the Heart’s Electrical System?


Arrhythmias,irregularorabnormalheartbeats,arequitecommonand
canrangefrominconsequentialtolife-threatening.Arrhythmiasare
morecommonasweage.Wediscussinmoredetailthedifferentrhythm
disorderslater,butbriefly,yourheartcanbeattooquickly(tachycardia),
tooslowly(bradycardia),ortooearly(eitherpremature atrial contrac-
tionsorPACs,orpremature ventricular contractionsorPVCs),which
canfeellikeaskippedbeat.Arrhythmiascanberegularorirregular.
Somearrhythmiasmayoccurunnoticed—youonlylearnaboutthem
throughadoctor’sexamorwhenanelectrocardiogramisperformed.
Somearrhythmiasrequirenotreatmentatall,somerequiremedications,
somerequireapacemakertoregulatetheheartrate,andsomerequire
immediatedefibrillationtoshockthehearttobringaboutamorestable
rhythm.Somearrhythmiasrequireanimplanteddefibrillatorthatwill
shocktheheartwhenitdetectsthatadangerousarrhythmiaisoccurring.
Cardiac arrest,whentheheartstopsworking,isthemostdan-
gerousofallarrhythmias.Usuallythisoccursbecauseofventricular
fibrillation,whentheventricleshaveelectricalactivitybutitistoo
fastfortheventriclestoeffectivelypumpblood,andsobloodcircula-
tionceases.Thismaybeaconsequenceofaheartattack,butthereare
othercausesaswell.

The Pericardium
Thepericardiumisathin-membranesacsurroundingtheheart.As
wellascontainingtheheart,itcontainstherootsofthegreat vessels
(theaorta,pulmonaryartery,pulmonaryvein,andthevenacava).The
pericardiumhastwolayers—likeasacwithinasac—separatedbya
spaceknownasthepericardial space,whichisfilledwithathinamount
oflubricant,thepericardial fluid.

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What Can Go Wrong with the Pericardium?


Pericarditis,orinflammationofthepericardium,canoccuraftera
certaintypeofinfection.Itcanalsooccurafteraheartattack,after
heartsurgery,orafterradiationtreatmenttothechestarea.Italsocan
resultfromcancerinorgansneartheheart(thelungs,thebreast,the
bloodsystem).Pericarditismayoccuraftercertaintraumaorinjuries
tothechestarea.Itisseen,too,withautoimmunedisorders(likelupus
orrheumatoidarthritis)orinpersonswithkidneyfailure.Rarely,this
canoccurwithexposuretotoxicfumes.Whenpericarditisispresent,
apersonwilloftenexperiencechestpainthatcanbesharpandcan
getworsewhenchangingpositionorwhentakingdeepbreaths.This
inflammationcanresultinanincreaseintheamountofpericardial
fluid,knownasapericardial effusion.
Pericardialeffusioncanalsoresultwithoutpericarditisinthose
withheartfailure,kidneyfailure,certaincancers(particularlybreast
andlungcancer),orbecauseofhypothyroidism.Itmaybeseenin
peopleafterheartsurgeryorafterchestinjuriesortrauma,whereblood
accumulatesinthepericardialspace.Iftheamountoffluidcollected
inthepericardiumbecomessolargethatitaffectstheabilityofthe
hearttofunction,theresultispericardial tamponade,whichislife-
threatening.Iftamponadeisdiagnosed,thefluidinthisspaceneeds
toberemovedasquicklyaspossible.

The Circulatory System


Thebloodfromtheheartisdeliveredtothebodythroughthearterial
systemthatstartsattheaorta,thearterythatsitsjustabovetheheartto
whichtheventriclepumpsblood.Theaortaisthelargestarteryinthe
body.Fromthislargevesselthatgoesuptowardthetopofthebodyand
thenarchesdownward,numerousarteriesbranchofftoevensmaller
arterioles,creatingacapillary bedthatbringstheoxygenandnutrients
toalltheorgans,muscles,andtissuesinthebody.Whentheheartis
includedinthiscirculatory system,itisknownasthecardiovascular
system.Thecardiovascularsystemincludestheheart,thecoronary
arteries,andtheentirearterialsystemofthebody.

What Can Go Wrong with the Circulation?


Astrokeoccurswhenthereisdiseaseinthearteriestothebrain,causing
areductioninthebloodsupplytothebrain.Strokeisthethirdleading
causeofdeathandcanoccuratanyage,althoughmost(three-quarters

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16  s a v i n g  w o m e n ’ s  h e a r t s

ofallstrokes)occurinpeopleovertheageof65.Th  erearetwotypesof
stroke.Th  emostcommontypeofstrokeisanischemic stroke, which
accountsfor87%ofallstrokes.Anischemicstrokeoccurswhena
bloodclot(thrombus)blocksthebloodflowinanarterytoanareaof
thebrain.Th  isisoftentheresultofplaquebuildupinthearteries,or
atherosclerosis,thesamediseasethatcanoccurintheheartarteries,
asdescribedearlier.Th  isiswhyheartdiseaseandischemicstrokeare
oftendiscussedtogether:Althoughtheorgansaffectedaredifferent,
thediseasesaretheresultofthesameprocessandthesameriskfac-
tors.Anothercauseofischemicstrokeisabloodclotthathasformed
elsewhere(usuallyintheheart)andlodgesinanarterythatsupplies
thebrain.Itcandevelopintheheartasaresultofatrialfibrillation
becausetheheartcannotpumpeffi cientlyandbloodpoolsintheatria,
creatingaclot.Aclotmayalsoforminwomenwhousehormonalcon-
traceptivesandwhosmoke,whichcanresultinastroke.
Th eothertypeofstrokeisahemorrhagic stroke.Here,too,the
bloodtothebraintissueisreduced,butthisisaresultofanartery
tothebrainburstingorrupturing,causingableedaroundthebrain
tissue.Th  isislesscommonandisnotaresultofatherosclerosis,but
ratheritiscausedbyanabnormalityofthebloodvesselinthebrain.
Th esebloodvesselscanbeaggravatedbyhighbloodpressure,butrisk
factorsresponsibleforcoronaryarterydiseaseandischemicstrokedo
notcauseahemorrhagicstroke.

The facts about women and stroke


♥ Stroke is the third leading cause of death in women, following heart
disease and cancer.
♥ Every year, stroke kills twice as many women as breast cancer.
♥ The risk of a stroke in women doubles each decade after the age
of 55.
♥ Every year in the United States, about 55,000 more women than
men have a stroke, and women are more likely to die from a stroke
than men.
♥ A smoker has double the risk of having an ischemic stroke than a
nonsmoker.
♥ Physical activity is associated with a lower risk of stroke.

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a f f a i r s  o f  a  w o m a n ’ s  h e a r t   17

Peripheral vascular disease,alsoknownasperipheral arterial dis-


ease(PAD),istheresultofprogressiveplaqueformationinthearteries
(narrowingofthearteries)inthecirculationsystemoutsideofthebrain
andtheheart.Itisaresultofatherosclerosis,thesamediseaseprocess
responsiblefordiseaseoftheheartandbrainarteries.Riskfactorsthat
causeheartdiseaseandstrokecanalsocausePAD,butthereisgreater
riskofPADinwomenwhosmokeorwhoarediabetic.IfthePADis
severe,therecanbeacompleteblockageofbloodflowtothearteries,
andifbloodflowisnotrestored,thelimbaffected(mostoftentheleg)
willneedtobeamputated.
An aortic aneurysmiswhenanareaoftheaortaisdilatedorbul-
gingout.Itoftenoccursasaresultofatherosclerosisintheaorta(which
isnodifferentfromtheatherosclerosisseenelsewhereinanyartery),
butcanalsobeseeninpersonswithMarfanSyndromeandsomeother
disorderswherethearterywallsareabnormal.Ananeurysmisaweak
wallinthatareaoftheaortaandisathighriskofrupturing,causing
thebloodtospilloutoftheaorta.Itisalsoathighriskofdissecting
ortearing,causinganaortic dissection.Th  isiswheretheinnerlining
ofthearterysplitsandbloodflowsintotheliningoftheartery.Both
canoccuranywherealongtheaorta,buttheconditionismostdanger-
ouswhenitappearsinthepartoftheaortacomingofftheheart(the
ascending aorta).Itisparticularlydangeroussinceitmaybepresent
withoutanysymptoms.Interestingly,aorticdissectionsappeartooccur
morefrequentlyinmenthanwomen.

Aortic aneurysms and aortic dissections


♥ The larger the aortic aneurysm, the more likely it is to burst.
♥ Some aortic aneurysms (based on size) do not require emergent
treatment but are followed with imaging over time to check if they
are enlarging.
♥ The symptom of an acute aortic dissection is sudden chest pain.
♥ If they are detected, aortic aneurysms and aortic dissections can
be successfully treated.

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The Heart of the Matter


Theheartandthecardiovascularsystemhavecomplexandamazing
structures.Everyheartbeatkeepsusalive.Werelyonourheartsto
functionnormally,soweneedtobeawareofthem,takecarethem,
andmakesuretocheckthemonaregularbasis.Somethingsthatcan
gowrongintheheartareapparentonlywhentheydogowrong.But
otherproblemsaredeceptivelyquiet—untilitistoolate.Soevery
womanneedstoknowherheartandhowtoprotectit.Rememberour
advice:thinkaboutyourhearteverytimeyouputonyourshoes.And
treatyourheartlikeyourfavoritepairofshoes—loveit,careforit,and
doeverythingyoucantoprotectit.Next,weguideyouonjusthowto
protectyourheartandkeepithealthy,sokeepreading.

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