Women slowly becoming more aware of silent killer

FRESNO -- Vicki Westburg made excuses for being tired and short of breath. She blamed long, stressful days on her job as a special education administrator for a weariness she couldn't shake. And she thought her labored breathing was due to asthma.

When she woke gasping for breath on New Year's Eve a year ago and her husband rushed her to the hospital, Westburg, 48, of Fresno suspected an asthma attack.

Instead, she was stunned: Tests showed congestive heart failure. "The left side of my heart was just not functioning," she said.

Westburg is among 8 million women nationwide and more than 85,000 in San Joaquin Valley diagnosed with heart disease -- and that doesn't include many others who don't even realize they have it.

Heart disease is the No. 1 killer of women in the United States, claiming the lives of more women each year than men. But in doctors' offices across the country, heart disease in women often goes undiagnosed. Their symptoms don't mirror those seen in men, and women tend not to recognize the warning signs, doctors say.

Like a lot of women, Westburg ignored her symptoms and kept working.

"I'll get better," she remembers thinking. "I'll get better."

We expect men to die of heart disease. But it has been killing more women nationwide than men each year since 1984, and the gender gap shows no signs of going away.

The number of women who die from breast cancer and all other forms of cancer combined doesn't equal the death toll from cardiovascular disease, including heart attacks and strokes, according to the American Heart Association.

This year, an estimated 490,000 women nationwide will die of heart disease.

In the valley, women have some of the highest heart-disease death rates in California. The latest figures available from the state show that in 2005, heart disease killed 2,803 women in the San Joaquin Valley and 24,702 statewide.

Doctors say several factors appear to be at play in the valley, including air pollution that can trigger heart attacks and elevated levels of obesity and diabetes, which are risk factors for heart disease that can be controlled.

Eleven percent of valley women 40 and older have been diagnosed with heart disease, according to a 2005 statewide health survey. That rate is among the highest for women in California.

And even more valley women almost certainly have the disease but don't know it.

Nearly half of women who have a heart attack had never been diagnosed with heart problems, according to a June 2006 program brief on women's cardiovascular health by the federal Agency for Healthcare Research and Quality.

The agency cited a review of medical records of 150 Minnesota women who suffered heart attacks between 1996 and 2001.

The women had made 8,732 visits to doctors and had 457 hospitalizations in the 10 years before their first heart attacks, the report said. Doctors diagnosed only 52 percent with heart disease before they had heart attacks.

Westburg knew something was wrong. Her 50- to 60-hour workweeks as manager of special education services and programs at the Fresno Unified School District had never bothered her, but she found herself leaving meetings early to lie down in her office.

She could barely walk a flight of stairs. She had to ask her secretary to drive her to meetings that were only two blocks away.

Westburg now recognizes her symptoms were those of heart disease. At the time, she said, "I kept thinking it was just overwork -- stress. All the things that women say to ourselves."

But even doctors were puzzled by her symptoms. There was little reason to suspect serious heart problems. She was overweight and had a rapid heartbeat, but other than that, she didn't have risk factors -- high blood pressure, high cholesterol or a family history of heart disease. She never smoked.

After her January 2007 trip to the emergency room, she had a triple bypass to clear arteries and surgery to repair a damaged heart valve.

Westburg took a medical retirement from the school district, where she worked for 23 years in various positions. Now she spends long hours in bed. When she ventures out of her northwest Fresno home for a walk, she uses a motorized scooter.

"I'll have to have a transplant at some point," she said.

If Westburg had complained of chest pains, her heart problems might have been caught earlier, family members said.

But the possibility of heart disease never came up, said Westburg's sister, Louanne Kruse, 50, of Fresno. "If she'd just said she couldn't breathe -- 'it feels like an elephant sitting on my chest' -- that might have triggered something," Kruse said.

Women's symptoms don't make it easy for doctors to detect heart disease.

In men, chest pain or pain in the arm or jaw are classic signs of coronary artery disease, which can lead to a heart attack when an artery is blocked. In women, those signs may not be present.

Even when women with coronary artery disease exercise, "they may not get the typical chest pain," said Dr. John Telles, a Fresno cardiologist.