YAKIMA, Wash. -- Nancy DeHart suddenly had a little trouble walking at the grocery store while shopping for pumpkins.
Melissa Sauve became unusually winded after climbing a flight of stairs.
Carolyn Roy felt like she had pulled a muscle in her chest after shoveling rock in her yard.
Their stories are different, but all three Yakima women recently had a close call with heart disease and lived to talk about it.
And all say they were either in denial about their symptoms or simply didn't recognize them as heart-related. Now, in part because February is National Heart Month, they want to get a message out to others.
"I want to tell women all over this Valley," said DeHart, 66. "Don't deny it like I did."
Many women worry most about cancer and have come to understand the importance of regular screenings like mammograms.
But more women die of heart disease -- including stroke -- than from all cancers combined, according to the Centers for Disease Control and Prevention.
The American Heart Association says one in three women dies from cardiovascular disease, a rate that could be reduced if women paid more attention not only to their symptoms but their risk factors.
"Women tend to minimize pain," said Dr. Julia Robertson, a primary-care physician with Terrace Heights Family Physicians, which is affiliated with Yakima Regional Medical and Cardiac Center. "We'll have a pain and think, 'Is that my breast or shoulder?'"
Symptoms of a heart attack can be the conventional chest pain with exertion, or more subtle, like indigestion.
More physicians are talking openly with their female patients about heart health, encouraging them to change their risk factors, such as quitting smoking, exercising regularly and eating more vegetables.
Women tend to develop heart disease 10 years later than men, but by age 65, their risk equals that of men. Sadly, women aren't as good as men at changing their diet and keeping with an exercise regimen.
"Because men are stricken at an earlier age, they are more apt to stay with the exercise and nutrition changes," said René Moultry, a nurse who conducts cardiac rehabilitation at Yakima Valley Memorial Hospital's 16th Avenue Station.
Body-image issues are also more likely to keep women from the gym.
"It's more difficult for women," she said.
Nancy DeHart has been surrounded by heart disease for a long time. Her mother died of a heart attack. She lost a sister to heart disease. Another sister had a heart attack. Her brother has six stents. A cousin just died, too.
DeHart had a quintuple bypass four years ago.
On top of all the familial disease, DeHart has another risk factor: Type 2 diabetes.
"When you have diabetes, it moves the heart disease along faster. It's getting harder to stent and fix," she said.
A stent is a tiny piece of mesh that acts like scaffolding to keep the artery walls open so blood can flow.
DeHart gave her family a scare four years ago when she had trouble walking at Walmart, where she and her daughter were shopping for pumpkins. She took a couple of nitroglycerin pills for chest pain, but resisted her daughter's pleas to go to the hospital.
"I said, 'No, I want to go home.'"
Once home, she called her doctor and made an appointment for the next day. But the nurse called back and told her she needed to get to the hospital immediately. It turned out her daughter had called the nurse to enlist her help in getting DeHart to relent.
The next morning she had the bypass and the surgeon told her: "You're good for 20 years."
But a few days before Thanksgiving last year, DeHart had to take a nitroglycerin, her first since the bypass. This time, she went straight to the doctor. A stress test revealed another blockage and she went in for an angiogram and what she thought would be one stent.
"My family was expecting one stent in an hour, but two and a half hours later I came out with three stents," DeHart said.
DeHart has embraced dietary changes and is enlisting her entire family in an effort to eat more healthfully. A southerner by birth, she's had to give up her favorites.
"The cornbread and biscuits and gravy flowed. There was always good food," she said.
Now it's Cheerios for breakfast, more salad, chicken, vegetables and stir-fry. Some habits are hard to break.
"We've been going to Miner's since 1949. We still go now but we get the garden salad. If we get a hamburger, we halve it."
Carolyn Roy went five months ignoring an on-and-off pain in her chest. It was angina, but she explained it away.
When she had the pain after doing some heavy digging in her yard, she chalked it up to a pulled muscle or bruised sternum because her son had just injured his sternum in a football game.
"That word sternum just came to mind. It didn't make any sense but that's the way I dealt with it," Roy said.
One day last September, she became nauseated while walking up a slight hill in Roslyn with members of Foursquare Church, where she leads a recovery ministry.
Her primary-care doctor sent her to the Yakima Heart Center. An electrocardiogram, which measures how fast a wave of electricity moves through the heart to indicate possible blockages, was normal.
But Dr. Duane Monick of the Heart Center told Roy she had classic symptoms of a blockage and arranged another test. Still, Roy thought to herself: "They are just going to put me through a bunch of tests and $20,000 later they are going to say, 'There's nothing wrong with you.'"
She went to Regional for a coronary angiogram and the cardiologist found a 90 percent blockage in a major artery. It was opened with a stent and Roy recalls feeling immediately better.
Still, it was a serious wake-up call. "They were amazed I hadn't had a heart attack," Roy said.
Since then, Roy has taken charge of her cardiac health. She quit smoking, exercises regularly, bought a new heart-healthy cookbook and added lots more fruit and vegetables to her diet.
As a recovering alcoholic, Roy thought she knew what denial was.
"But I was in denial about my heart because I'm only 55 years old."
Nine years ago, Melissa Sauve -- a kayaker, hiker and jogger -- was climbing a flight of stairs at Universal Studios when she felt a sudden pain down her left arm and across her chest. She switched the backpack she was carrying from one shoulder to the other and continued.
A few weeks later, she was doing her usual jog up the terraces at Franklin Park when she had the same sensation.
"I stopped and it went away," Sauve recalled.
The symptoms went away for many years. Then one day in 2008, she was riding a stationary bike during physical therapy to recover from a broken leg. She cranked up the tension and there it was again: the sudden pain.
"I didn't say anything. I just turned the tension down again," she said.
Sauve mentioned the pain in passing to her rheumatologist, who sent her to a cardiologist. After several tests, he told her: "I never would've believed this but you have a heart problem."
The diagnosis was bifurcation blockage, which is the narrowing in a main artery and an adjoining side-branch vessel. The cardiologist placed a stent in the artery that was more severely blocked. Double-stenting in bifurcation blockage is technically demanding, said experts from the Cleveland Clinic, because of an increased risk of blood clot formation on the stents.
Sauve, 51, credits cardiac rehabilitation with removing her fears about exercising again.
But she looks back on all the years she had symptoms -- such as extreme fatigue in the morning when she got up, or feeling slightly woozy while brushing her teeth and leaning over the sink -- and thinks she made excuses.
"You hear about women and heart disease but maybe it's just not in front of us enough."
The lesson for women, said Monick of the Heart Center, is to not brush off anything that could be symptomatic of heart disease.
"The bottom line is that it's better to go talk to your physician than be your own diagnostician. If you don't have a primary-care doctor and are having alarming systems, go to the emergency room," he said.
* Leah Beth Ward can be reached at 509-577-7626 or lward@yakimaherald.com.
Heart Facts for Women
More than 430,000 women are silenced each year by cardiovascular disease -- and most of these deaths are preventable, says the American Heart Association.
Research by the National Institutes of Health (NIH) indicates that women often experience new or different physical symptoms as long as a month or more before experiencing heart attacks.
Fewer than 30 percent of women studied by NIH reported having chest pain or discomfort prior to their heart attacks, and 43 percent reported no chest pain during any phase of the attack.
Many women do have the textbook symptoms of mid-sternal pressure, a heaviness that radiates up the neck or arms provoked by exertion and relieved by stress.
Heart Disease Rates
Heart disease death rates by county, race and ethnicity from 2003 to 2005. Rates are for every 100,000 deaths.
Yakima County Fourth highest in the state at 177
San Juan CountyLowest in the state at 54
Stevens County Highest in the state at 196
Amer. Indian/Alaska Native 186
Black 163
White 132
Latino 103
Source: Washington state
Department of Health
