A Woman's Heart

Center of Excellence in Women's Health

Supports Efforts to Improve Cardiac Health

Heart disease is the Number One killer of women, nationally and in North Dakota.

Statewide, it is estimated that, each day, three women die of cardiovascular disease, defined as heart attack and stroke.  One in every three women will die from cardiovascular disease.   

"It's very serious," said Elizabeth Burns, M.D., M.A., professor of family and community medicine and director of the National Center of Excellence (CoE) in Women's Health Region VIII Demonstration Project, Grand Forks.

She stresses the need for everyone to be aware of women's heart disease and is working "to increase the awareness at the consumer level and the physician level."

Men and women are more different than previously understood and, when it comes to heart disease, "there are differences in symptoms and in (patient) presentation," Burns explains.  With women, physicians "tend to think it's something else" such as a gastrointestinal problem like reflux disease or a pulmonary problem -- "although I think that's changing."

In order to address this tendency in health care, "we need to make sure that we have more primary care physicians," she says, and "we need to make sure that there are enough primary care physicians out there who know the differences."

Different symptoms, different structure     

In the past, biomedical research has focused almost exclusively on men.  Health professionals have practiced on the pervasive assumption that knowledge gained from this research could be applied to women.              

"When women have cardiac disease, they may have different

symptoms," Burns asserts.  "When they're having pain, it may be in a different location.  The doctor may need to do different kinds of tests" to determine the correct diagnosis.

According to Susan Farkas, M.D., cardiologist with MeritCare Heart Center, Fargo, a woman's heart has smaller arteries and when it is not functioning properly there is more potential for spasm.

Research has found that, in women with heart disease, "the vessels are remodeled," Farkas says, instead of a single lesion such as occurs in men, women are more likely to have multiple little lesions.  And, because the size of the vessel is smaller, it is not possible to stent as well."

Women experience "worse outcomes from bypass surgery or heart attack," she says, "and have a higher mortality rate" from cardiovascular disease.

Unfortunately they sometimes ignore their symptoms, or they may "present with less pain and more with fatigue and generalized symptoms such as nausea or a very atypical discomfort in the chest," she says. 

"But they also can present with typical symptoms such as crushing chest pain or a feeling of heaviness in the chest."                   

Teaming up to raise awareness

With Burns' leadership, the CoE has tackled the issues of women's health, including cardiac health, on multiple levels and in multiple venues.  Last fall, for instance, the CoE sponsored the first North Dakota Women's Health Connection in Grand Forks to encourage women to take a more proactive role in their own health care.  The event featured endocrinologist and geriatrician Saralyn Mark, M.D., assistant clinical professor of medicine and obstetrics at Yale University School of Medicine and consultant to NASA, who spoke on women's heart health. 

The CoE also has partnered with the state chapter of the American Heart Association in support of its "North Dakota Goes Red" campaign designed to raise public awareness of heart disease in women.

"Partnerships like these help us by providing more opportunities to reach a larger audience of women and their families, and convince them to join the movement and to love their hearts," according to Joan Enderle, director of the Go Red for Women campaign, Jamestown.     

"We want to encourage them to learn their risk factors and ways to reduce those factors in order to improve their health."  

The state Go Red for Women campaign also aims to reach health professionals who take care of these women, Enderle says, noting that cardiovascular disease takes more North Dakota women's lives than the next four causes of death combined.               

"Raising awareness at the consumer level and the physician level is key," Burns says, "and we're here to help." 

In the clinical realm, the CoE sponsored Michael Brown, M.D. '82, clinical assistant professor of obstetrics-gynecology and director of the CoE clinical component, and Cindy Anderson, Ph.D. (Physiology '03), assistant professor of family and community nursing, both of Grand Forks, to attend training using "Heart Truth" materials in Washington, D.C.  The training is aimed at increasing physician awareness of women's heart disease.

The goal is to "bring people in, get them trained, so they can go out" and educate other health professionals about new advances in knowledge of women's heart disease, Burns says.

As director of the CoE educational component, Rosanne McBride, Ph.D. (Psychology '95), clinical psychologist and assistant professor of family and community medicine, Grand Forks, analyzes patient "paper" cases used in teaching medical students "to ensure that, if there's a gender difference in presentation of diseases or in any diseases found more often in women, that aspects of gender-based medicine are included," Burns said.

"We have a good number of cardiac cases," McBride says, in which "we can bring out the fact that there are differences." 

Medical students can learn to compare differences in biological functions, development and pharmacological response in males and females, she says, and learn about conditions that are more common, more serious or have interventions that are different in women.

McBride uses guidelines from the Association of Professors of Gynecology and Obstetrics to assess "what we're currently teaching and identify any gaps concerning women's health education.   

"There is so much communication among faculty and students about curriculum issues and so many opportunities to integrate changes into our patient-centered curricular structure," she says, "any gaps can be relatively quickly addressed."

"Our Office of Medical Education works very hard to consistently refine cases and our curriculum so it can be better and better all the time," she says.  "Women's health education is one example of this."

-Pamela D. Knudson

return to top