Triple bypass surgeries save newly-wed woman

When young newlywed 32-year-old Zahra Mahroon went to RAK Hospital emergency complaining of severe upper backache and shortness of breath, little did she and her family members knew that she was suffering from life threatening coronary artery disease putting her at a great risk of an impending heart attack or may be death.

After carefully studying her case and understanding the family history, she was found to be a high risk patient with diabetes and history of premature coronary artery disease as her mother suffered with it in her 40s. Based on the symptoms and results of diagnostic tests, bypass surgery was performed to treat severe blockages in three of Zahra's arteries.

Although heart disease is often thought of as a problem for men, more women than men die of heart disease. Around 8.6 million women die of heart disease annually, accounting for a third of all deaths of women worldwide. The greatest challenge is that the heart disease symptoms in women are unique, subtle and very different from men. 71 per cent of women experience early warning signs of heart attack with sudden onset of extreme weakness that feels like  flu - often with no chest pain at all.

“Heart disease or heart attack symptoms in women are so atypical that it becomes difficult to recognise. These are more subtle than the obvious crushing chest pain often associated with heart attacks, may be because women tend to have blockages not only in their main arteries, but also in the smaller arteries that supply blood to the heart — a condition called small vessel heart disease or microvascular disease. Women are more likely than men to have heart attack symptoms unrelated to chest pain, which include: Neck, shoulder, upper back or abdominal discomfort, shortness of breath, nausea or vomiting, sweating, lightheadedness or dizziness or unusual fatigue”, said Dr. Ajay Kumar Kanojia, Director Cardiac Services, RAK Hospital, Ras Al Khaimah.

“In Zahra’s case as well, she had actually experienced backache and shortness of breath couple of times earlier too, which she treated with analgesics and felt better, but this time the pain was severe, rushing her to emergency. Women indeed tend to show up in emergency rooms after much heart damage has already occurred and physicians are slower to recognise the presence of heart attacks in women because ‘characteristic’ patterns of chest pain and EKG changes are less frequently present”, said Dr Kanojia who did initial assessment and performed the coronary angiography on Zahra.

“It is well known that diabetes and smoking are strong predictors of heart problems in both genders, but the risk is two to four-fold greater in women. Diabetes in women is frequently associated with heart attack, heart failure and death. When sudden heart problems occur in women, they have multiple risk factors and coexisting illnesses and the rate of in-hospital death is always substantially greater than men, even after procedures to remove the blockages in the blood vessels of the heart. Women and men therefore differ in how they present, how they are evaluated and the chances of success from treatment,” added Dr Kanojia.

Young, courageous and smiling, Zahra Marhoon Abdulla Saeed Ruwaihi shares her experience and requests all women to be extra careful about their health, fitness and advises regular checkups for them.

She said: “I am so thankful to Allah for having given me this second life, I got married just eight months back and was looking forward to spending a beautiful life with my husband but my condition presented a difficult challenge. Going through such a major surgery was not an easy task but am very thankful to the highly skilled, encouraging and understanding team of doctors at RAK Hospital who provided me the much needed support and confidence. Specially Dr. Arun Goyal who performed such an excellent surgery that I was feeling great within two days of the surgery and was discharged on the fifth day. My husband and my family also stood by me at every step of the journey.  On doctor’s advice I have now made lifestyle changes to keep myself healthy and fit. Honestly I feel on top of the world”.

Unpredictability of diagnostic tests in women with coronary artery disease:

The standard 12 lead ECG and exercise electrocardiogram (TMT) testing is the most commonly used of the non-invasive tests for the assessment of blockages of vessels in the heart. However both resting 12 lead and exercise ECG testing has higher false positives in women. Several factors may influence exercise testing responses in women. A negative test has better diagnostic value than a positive test.

Heart disease risk factors for women:

Heart disease is the leading cause of deaths in the UAE, and cardiovascular problems account for 22 per cent of deaths in the country. Although the traditional risk factors for coronary artery disease — such as high cholesterol, diabetes, high blood pressure and obesity — affect women and men, other factors may play a bigger role in the development of heart disease in women. For example:

•     Metabolic syndrome — a combination of fat around your abdomen, high blood pressure, high blood sugar and high triglycerides — has a greater impact on women than on men.

•     Mental stress and depression affect women's hearts more than men's. Depression makes it difficult to maintain a healthy lifestyle and follow recommended treatment, so talk to your doctor if you're having symptoms of depression. Sudden excessive emotional stress can also lead to 'Broken Heart Syndrome'.

•     Smoking is a greater risk factor for heart disease in women than in men.

What can women do to reduce their risk of heart disease?

There are several lifestyle changes you can make to reduce your risk of heart disease:

•     Exercise 30 to 60 minutes a day on most days of the week.

•     Maintain a healthy weight.

•     Quit or don't start smoking.

•     Eat a diet that's low in saturated fat, cholesterol and salt.

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