By Shauna Mazenes
Elana Trainoff didn't think it was possible to have a heart attack at age 40.
That is, until she was rushed to the hospital with shortness of breath and chest pain. Doctors discovered she had a STEMI — one of the most fatal types of heart attacks. She had total blockage in one artery; two others were 65 per cent blocked. She was taken into emergency surgery.
"I had this instinctive feeling that something was seriously wrong," says Elana, now 50, who was saved at UHN's Peter Munk Cardiac Centre (PMCC). "It was a very traumatic and scary experience."
February is Heart Month and the 10th anniversary of Elana's life-saving procedure. She wants women to know their risks, prevention strategies — and most importantly — that they're not alone.
"I didn't know if I was going to live 10 years, but I did. And now, I'm stable and thriving," she says. "I've made a lot of changes in my life since then, and I want other women to know that they can, too."
According to Professor Sherry Grace, Director of Research in the Cardiovascular Rehabilitation & Prevention Program at PMCC, what happened to Elana is becoming increasingly common. While heart disease has traditionally been viewed as an older man's condition, they're seeing more young women diagnosed.
"It's being recognized in the research literature that something's going on, because a lot more 40-year-old women are getting acute coronary syndrome than in previous years," says Professor Grace, who is also a Senior Scientist at UHN's KITE Research Institute and a professor in the Department of Medicine at the University of Toronto.
She says increased rates of heart risk factors in young women, such as stress and mental illness, as well as delayed diagnosis and sex-related biological differences, can all impact the disease pathway and health outcomes.
There's been an effort to increase the number of women being recruited into heart research, including at UHN — to better understand how symptoms and treatment outcomes may differ compared to men.
For Elana, the first indication of a problem was shortness of breath and heartburn. Despite what may have seemed like minor discomfort, she knew something was wrong.
But her vitals were normal when she arrived at the hospital. Doctors initially thought it might be indigestion — a common symptom of a heart attack in women. It wasn't until she experienced crushing chest pain that she got an electrocardiogram and it was determined what was happening.
"I want to remind women if you feel these concerning symptoms, go to the hospital," she says. "Advocate for yourself if you know something is wrong."
Professor Grace echoes this sentiment. The lack of research historically has resulted in a care gap in women's heart health — women are more likely to have their symptoms misattributed, to not be tested or to receive inadequate care.
"It's very typical for women to also present with symptoms other than chest pain," says Professor Grace. "That's why we want to encourage women to speak up for themselves, and to be aware of the unconscious bias that they're more likely to have their symptoms dismissed."
This is, in part, why heart and stroke are the leading causes of death amongst women worldwide.
"Physicians report feeling less confident treating heart issues in women," she says.
Elana struggled with her mental health after the procedure. Not only did she feel lost and alone, but overwhelmed by all the lifestyle adjustments she had to make.
One of the most important parts of her recovery was seeing a cardiac psychiatrist at UHN. She says she needed to learn how to care about herself enough to make positive changes in her life.
"I had to wake up every morning and think: I'm going to make good choices for myself today," she says.
Professor Grace says Elana is not alone. One in five people suffer with depression after a heart attack, a number that's higher in women than it is in men.
It's also more common, she says, to see people suffering with feelings of shame after being diagnosed with heart disease as opposed to a condition such as cancer, even though the risk factors are the same.
Professor Grace says for these reasons and more, women's awareness of cardiac rehab programs is low, even though they have much to gain from participating.
Cardiac rehab aims to help patients recover from a heart issue by leading a healthier lifestyle. It promotes things such as stress management, exercise and awareness.
"Women need to be better informed about their risks and given psychosocial support," Professor Grace says. "That's why UHN is trying to promote women's heart health clinics and increase access to heart doctors who understand and know how to treat women's heart issues."
Professor Grace's research has guided the refinement of a woman-focused cardiac rehab program at UHN, which opened in 2005. The program addresses women-specific issues that can influence heart disease and consider socio-economic barriers that can impact access to care. This includes mental health challenges, care-giving demands, transportation difficulties and work-related priorities.
Since joining cardiac rehab, Elana has adopted a lifestyle that supports her needs. She quit smoking, limits her alcohol intake and exercises as best as she can. She also follows a heart, diabetes and anemia-friendly diet that isn't too restrictive.
"Don't ignore these metabolic, chronic conditions that can lead to heart problems," says Elana, who started showing signs of blood sugar and cholesterol issues in her 20s but chose to look the other way.
"And, don't discount your family history, even if you're young."
Both of her parents had heart issues as well.
But Elana says it doesn't stop there. There's a dire need for more women in research and more funding towards women's heart health.
She's committed much of her time towards raising awareness, advocating and reminding women that they're not alone if they find themselves in the same position she was.
"If there's anything I want women to know, it that there's a light at the end of the tunnel," she says. "I was in a dark, lonely place.
"But 10 years later, I'm healthy and I'm happy, and you can be, too."
