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// by Chloe Emory
Karla Manley remembers soccer coaches in high school telling her parents that she just
wasnt athletic. The fatigue she was experiencing was pure lack of talent and stamina.

What her parents and coaches didnt know was that she was pushing herself far harder tha
she ever should have.
In February 2003, then 33 years old, Manley found herself in the hospital for what was
supposed to be a sinus surgery, when she was informed that the operation was to be
postponed. The doctor had discovered that she had a heart disease.

Although the diagnosis came as a shock to Manley and her family, it saved her life. While h
heart condition was congenital, many women with heart diseases suffer the same symptom
that can be easily overlooked.

&
In fact, until 20 or 30 years
ago, heart disease was

considered primarily a mans

affliction and researchers

focused almost exclusively o

male subjects. Womens
cardiac symptoms went
largely un-researched.
That, despite the fact that
heart disease is the number
one killer of women,
according to the American

Heart Association. It is more

deadly for its female victims
than all forms of cancer
combined.

Today, however, much more is known about women and heart disease and Manley suggests
all women should know the signs of impending heart conditions.
I think a lot of people are just afraid of knowing, says Manley. So what should women
know about heart disease?

First, they should know that the rate of death for cardiac disease has actually increased for

women 35 to 50 years old in recent years, according to Mayo Clinic cardiologists. Second,
they should know that research over the last decade has shown that womens symptoms ar
often very different from mens.
While men often complain of chest pain as their most frequent symptom, women may
instead feel discomfort in the neck, jaw, shoulder, back, or arms as well as experience
nausea, vomiting or a feeling similar to indigestion.

Because theyre often more subtle, womens symptoms can be easily overlooked. Manley, fo
instance, initially thought her symptoms were attributed to the fact that she was just out of
shape.

Locally, Dr. DeLisa Fairweather, director of Translational Cardiovascular Research at

Jacksonvilles Mayo Clinic, has focused her research on understanding the differences
between men and women when it comes to heart disease.
Fairweather says that the human bodys immune system is regulated differently by sex
hormones. Her studies focus on separating her patients into different categories to better
understand how hormones play a part in the disease.

Because of the many differences between the genders, Fairweather explains that a treatmen
that works for men wont necessarily work for women.
Disease diagnosis is different; symptoms are different; pathology is different. We need to
have a different treatment.
Mayo Clinic suggests women see a doctor if they are experiencing the following symptoms:
Neck, jaw, shoulder, upper back or abdominal discomfort
Shortness of breath
Right arm pain
Nausea or vomiting
Sweating
Lightheadedness or dizziness
Unusual fatigue
In going forward with her research, Fairweather says her approach is to change the way
patients are treated for the disease. What were really trying to do right out of the gate is

going back with data we already have, analyzing it by sex and getting immediate discoveries
we can apply to patient care, so we can understand key questions going forward.

Not only do cardiac patients need to be separated by gender for treatments, women also nee
to be split up into pre- and post-menopause treatment groups, says Fairweather. This is du
to the significant drop in hormones in women after menopause.

Virginia Miller, who leads gender differences research at Mayo Clinic and specializes in how
menopause affects a womens susceptibility to heart disease, says changes in hormones
affect how the heart responds and contracts.

For example, women battling cardiovascular heart disease do so even more after menopaus
and during pregnancy.

Dr. Leslie Cooper, chair of the Department of Cardiology at Mayo Clinic, says that, men are
more likely than women to develop myocarditis. When they do, the disease is more severe
and the recovery from heart failure less complete.
Cooper explains that men are more susceptible to heart disease and that their cases are
more likely to result in death. Testosterone and estrogen affect immune cell function and
may lead to the changes in heart muscle cells that in turn lead to fatal arrhythmias in
males.

One of the things that most helped Manley recover was exercise, which experts say is also a
tremendous help in preventing heart disease. So far, its helped her avoid what she believed
to be the inevitable: a heart transplant. Nine years after receiving her diagnosis, she
underwent surgery at Mayo Clinic where the leaky valve and hole in her heart were fixed
successfully.
At this point, I dont know for sure if Ill ever need a heart transplant, says Manley. Its
only been three years since Ive had the surgery, but I feel 100 percent better.