"I didn't really pause too much or nothing went off in my head," Kalish recalled.
angiogram (a diagnostic procedure to visualize the blood vessels supplying her heart), she was shocked by what the test discovered. She had a significant blockage in a major blood vessel requiring angioplasty, a procedure to improve flow through the vessel. Three stents were then placed in her artery to hold it open.
After her angioplasty, Kalish educated herself about heart disease, which is the No. 1 killer of women in the United States and the leading cause of disability. Despite the danger, research shows many women don't recognize the signs. To help raise awareness, the U.S. Department of Health and Human Services Office on Women's Health this month kicked off the Make the Call. Don't Miss a Beat campaign. The goal is to educate women about the warning signs of heart attack and encourage them to call 911.
"I think this is one of the most important campaigns I've ever worked on," said campaign director Suzanne Haynes, who has a doctoral degree in epidemiology and is the senior science adviser in the Office on Women's Health. "I know that we can save women's lives and men's lives with this campaign."
The classic presentation of a heart attack is chest pain or chest pressure with shortness of breath that may radiate to the arms or another part of the upper body like the neck, jaw, back or upper stomach. However, women are more likely to have atypical symptoms, said Dr. James Galloway, a cardiologist and acting administrator for the U.S. Department of Health and Human Services for Region 5, which includes Illinois.
Women also are likely to miss at least some heart attack warning signs, according to a February 2010 study.Published in the American Heart Association's journal Circulation: Cardiovascular Quality and Outcomes, the study found that only 56 percent of 2,300 women surveyed recognized some typical symptoms of a heart attack such as chest pain, neck, shoulder and arm pain. Fewer were aware of other possible signs such as shortness of breath (29 percent), chest tightness (17 percent), nausea (15 percent) and fatigue (7 percent).
Having only one of the symptoms could mean a heart attack, Haynes said, and that symptom could be something as unusual as wrist pain or breaking out in a cold sweat. (The sweating can be distinguished from that caused by menopause because there is no hot sensation associated with it, she said.)
It may be hard for women to know whether a vague symptom such as arm pain is a sign of a heart attack, so Haynes encourages women to think about whether the symptom is unusual or not. Women who have survived heart attacks often describe the symptoms as profound and persistent, she said.
When asked what they would do if they believed they were having a heart attack, only 53 percent of women surveyed said that they would call 911. But 79 percent did say they would call for somebody else.
Not calling 911 "delays your entrance to the hospital, which delays the immediacy of care, which causes heart muscle damage, which can lead to heart failure and death and a larger heart attack," Galloway said. People who call 911 also benefit because emergency medical personnel might also administer oxygen to them in the ambulance, Galloway said.
"If there is a trickle of blood getting through that blockage, increasing the oxygenation may help," Galloway said. Also if something happens en route to the hospital, "You're in medical care already so if, God forbid, your heart goes into an unstable rhythm, they can shock you out of it."
A number of reasons might prevent a woman from calling 911, including costs and caretaking responsibilities, Haynes said.
After her angioplasty, Kalish, learned she had borderline high cholesterol, although she had always eaten well and exercised. It became more clear that her strong family history of heart disease was a major factor in her case.
"Family history in general is a very important aspect of our assessment of risk," Galloway said, adding that women with such as family history should see a doctor to make sure other factors aren't increasing their risk of heart attack, such as inherited conditions.
In 2009, Kalish did suffer a heart attack. But she knew the warning signs and got to a hospital quickly and had another angioplasty. Because of Kalish's fast response, her heart attack was mild.
"I knew time was muscle," Kalish said, referring to the fact that the longer it takes to get care, the more damage can occur, "and I recognized the symptoms and I knew I was in distress."