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Tracey Conway’s Love Affair with Hearts by Wenda Reed

Tracey Conway dropped dead, and the people laughed.

On a January night in 1995, the Seattle comedienne had just participated in a sketch entitled ERR (a spoof on ER) about incompetent hospital personnel on the local televised comedy show Almost Live. While the camera crew was doing a final check and the cast was signing off, Conway collapsed and was caught by two fellow cast members. The studio audience laughed, thinking it was a continuation of the sketch. Another of the actors thought, “How much attention does this woman need?”

The host thought she had fainted until he saw that Conway’s eyes were open and looked odd; her body was jerking, and she was making strangled gasping sounds. In fact, she’d suffered sudden cardiac arrest — a total loss of heart function, breathing and consciousness. There were no doctors or nurses in the house, so a young volunteer fire-fighter did vigorous CPR for six or seven minutes until paramedics arrived. Conway remembers nothing, but the fire officials later gave her the form they’d filled out describing her condition. Where there was a spot to circle “dead” or “alive,” they’d circled “dead.” Twice.

Conway’s heart had gone into ventricular fibrillation. Its electrical activity had become disordered and chaotic so that, rather than pumping blood, it quivered and contracted in a rapid, unsynchronized way. It took 20 minutes and six shocks with a defibrillator to get Conway back. She made a full recovery and, two weeks later, the 38-year-old actress was back on the show. In the 13 years since, she has made lifestyle changes and has an internal defibrillator implanted just above her left breast.

How did this happen and could such a thing happen to the rest of us?

Both Conway and her brother, Mark, suffered from arrhythmia (irregular or fast heartbeats), and Mark died of sudden cardiac arrest in 1989 at age 39. After his death, Conway went to a cardiologist and began taking beta blockers, drugs that slow the heartbeat and even out its pace. Before the incident she had been stepping down the beta blockers and sometimes forgot to take them. She remembered that she was nervous and that her heart was beating faster before her last sketch of the evening, an unusual occurrence for her. Earlier in the show she had performed a skit where she smoked, and nicotine can aggravate her heart condition. She hadn’t eaten well that day. All of those factors may have contributed to over-taxing her heart.

Although Conway had risk factors, the scary thing about sudden cardiac arrest is that two-thirds of incidents occur without any prior indication of heart disease. “The only symptom is being light-headed,” Conway says. “It comes on super fast, and you’re out.” The survival rate is 6 to 7 percent, with survivors having received quick CPR and defibrillation.

We’d like to think sudden cardiac arrest is rare, but it kills about 250,000 people each year in the United States, according to the Centers for Disease Control and Prevention — about 300,000, according to the American Heart Association (AHA). As the Sudden Cardiac Arrest Foundation points out, this is more than the number who die from colorectal, breast and prostate cancers, auto accidents, AIDS, firearms and house fires combined. About 120,000 women die each year — 39 percent more than die from breast cancer.

The leading cause is underlying cardiovascular and coronary artery disease, according to the AHA. This is also the leading cause of the more common heart attack, which is an interruption of blood flow to the heart, causing death of heart tissue. About 1.1 million people in the United

States have heart attacks each year, and almost half of them — about 600,000 — die, according to the National Institutes of Health. There is some overlap between the two conditions: sometimes a heart attack causes cardiac arrest and sometimes it causes death by irreparably damaging the heart muscles.

Conway uses the analogies of electricity and plumbing. Sudden cardiac arrest is like an electrical circuit overload. Heart attacks are caused by backed-up plumbing — blockages in the arteries leading to the heart.

The take-home message is that heart disease is the Number 1 killer of American — and Washington state — women. While it may be impossible to predict sudden cardiac arrest if there are no symptoms, there are many ways to prevent underlying cardiovascular disease and reduce the risk of heart attacks.

TAKING CARE OF OUR HEARTS

Conway has parlayed her experience and her acting skills into presentations that she gives to women’s groups, hospitals, the American Heart Association and other organizations around the country. She begins with her own sudden death and incorporates a liberal dose of humor. In the presentation entitled “Drop Dead Gorgeous,” she recounts how one of the male cast members confessed years afterward that he couldn’t resist looking at her exposed breasts, and felt like the scum of the earth for doing so.

She segues into the differences between heart attacks and sudden cardiac arrest and gives simple demonstrations of how the heart works. Her message to participants is this: “Start a love affair with your heart.” She tells them there are plenty of things they can’t control, but that they can work on the lifestyle changes and priorities they can control. “Above all, do the things in your life that bring you joy — be generous with yourself,” she says.

How exactly do we take care of our hearts?

Last year, the American Heart Association and 11 other national health organizations reviewed nearly 7,000 scientific articles and came up with guidelines entitled “Heart Disease Prevention in Women.”

ASSESS YOUR RISK

“Heart disease isn’t something you either have or you don’t,” writes Lori Mosca, M.D., Ph.D., lead expert on the panel writing the guidelines. “It’s a risk that people have to a greater or lesser degree.” Scientists developed the Framingham Risk Assessment Calculator, and a modification of the test is posted on the American Heart Association’s Go Red for Women Web site.

Plug in your age, height, weight, waist size, personal and family history of heart disease or diabetes, your blood pressure, fasting blood sugar and cholesterol (total, good, bad and triglyceride) and whether you smoke, and you’ll get an estimated risk of having a heart attack or dying of coronary artery disease in the next 10 years. High blood pressure and high cholesterol and blood sugar levels increase the chance of heart disease.

Anyone with diabetes mellitus or chronic kidney disease is automatically considered high risk. “No matter what your age, discuss heart disease with your doctor,” advises Francesca Fabile, communications director for the local AHA affiliate. “Especially talk about family history — even if you are thin and active. There could be medications you need to take or symptoms to watch.”

Although occasional irregular or fast heartbeats are common and usually harmless, Conway recommends seeing a doctor if they are frequent or chaotic, or if you get dizzy or light-headed, particularly when exercising or going up stairs.

MAKE LIFESTYLE CHANGES

Eighty-three percent of people who die of heart disease are older than 65, and women generally get heart disease later in life than men do. However, cardiovascular disease is cumulative, and Fabile and others emphasize beginning preventative measures in our 20s.
There are four things we can all do to lower our lifetime risk of heart disease, according to the “Heart Disease Prevention in Women” guidelines:

• Stop smoking cigarettes and avoid secondhand tobacco smoke. Smokers' risk of developing coronary heart disease is two to four times that of nonsmokers. The risk increases for women who take birth control pills.

• Get at least 30 minutes of physical activity most days of the week. Not only does this exercise the heart muscle and keep it fit, but physical activity can help control blood cholesterol, diabetes and obesity, as well as help lower blood pressure in some people.

• Eat a diet that includes fruits, vegetables, whole grains, low-fat or nonfat dairy products, fish, legumes and sources of protein low in saturated fat (such as poultry, lean meats and plant sources). Limit trans-fatty acids, such as those found in hydrogenated oils. Those types of fats block arteries.

• Maintain a healthy weight. People who have excess body fat — especially if a lot of it is at the waist — are more likely to develop heart disease and stroke even if they have no other risk factors. Excess weight increases the heart's work. It also raises blood pressure and blood cholesterol and triglyceride levels, and lowers HDL ("good") cholesterol levels.

Under “primary interventions,” the AHA and other health organizations list working with your doctor to keep your blood pressure and cholesterol at optimum levels and keeping diabetes under control.

While stating that managing stress makes sense for overall health, an AHA report on stress and heart disease states that “current data don't yet support specific recommendations about stress reduction as a proven therapy for cardiovascular disease.” Even if it isn’t an independent risk factor, it may affect other factors such as high blood pressure, cholesterol, smoking, physical inactivity and over-eating.

DO MORE?

As a middle-aged woman with no particular risk factors, I wondered whether I should get an EKG (an electrocardiogram test that checks for problems with the electrical activity of the heart) or a stress test, or whether I should be taking daily low-dose aspirin tablets.

The answer is “No.” “Women should get an EKG and stress test if it is recommended by a doctor, but it’s not routinely recommended for all,” Fabile summarizes.

If you are at intermediate or high risk, you may be placed on aspirin therapy (baby aspirin or 162 mg maximum dose daily) to reduce pain and inflammation and inhibit the formation of blood clots. Aspirin has no proven benefit to women who have a low risk of heart attack, and there are potential risks of stomach bleeding or ulcers.

If you are in a high-risk category, you may be prescribed ACE (angiotensin- converting enzyme) inhibitor therapy to enlarge and dilate blood vessels and reduce blood pressure. Women with fast or irregular heartbeats may be treated with beta blockers to slow and regulate their heart rates.

Statin drugs are commonly prescribed to reduce total cholesterol and LDL (bad cholesterol). A new study presented at the American Heart Association in late 2008 finds that even people with low cholesterol could benefit from statins if they have high levels of high-sensitivity C-reactive protein, or CRP, which indicates inflammation in the body. At this point, the AHA is not recommending routine CRP testing, although preeclampsia or eclampsia during pregnancy may be an early indicator of cardiovascular disease.

Niacin or fibrates are also recommended for women with high levels of total or bad cholesterol or low levels of good cholesterol.

The panel of experts who prepared the guidelines advises against combined postmenopausal hormone therapy (estrogen and progesterone) to prevent heart disease. The recent Women’s Health Initiative study not only showed no benefit, but an increase in heart attacks, stroke and blood clots. The benefits of estrogen alone are still being studied. They also state that antioxidant supplements, such as vitamin E and beta carotene, do not prevent heart disease, may increase the risk of strokes, and may interfere with the benefits of statin therapy.

Whatever our risk factors, we all have only one heart — faithfully beating 60 to 100 beats per minute, 100,000 times a day, 2.5 to 3 billion times in an average lifetime. Shouldn’t we do all we can to keep it beating strongly?

Wenda Reed is a Seattle-area health writer and frequent contributor to Seattle Woman.

CALL 911 CAMPAIGN

A report on “Emergency Cardiac and Stroke Care in Washington,” released in October 2008 by the Washington State Department of Health, finds that less than half of all people who have a heart attack are treated with the most effective heart attack intervention. Part of the reason is lack of consistency in the way hospitals treat patients and fewer resources and specialists in rural areas, but part of it is people’s unwillingness to call 911.

“We’ve got to get people to recognize symptoms of heart attack and stroke and convince them to take it seriously. Often they have symptoms and don’t call 911,” says Secretary of Health Mary Selecky. “Each minute is critical for stroke and heart attack treatment.”

The Washington State Department of Health and the American Heart Association plan a “Call 911 Campaign” this spring. A big part of the campaign will be recognizing symptoms of a heart attack, which may be more subtle in women. They include:

• Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain. Women may feel as though their bra is too tight.

• Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.

• Shortness of breath. This can occur with or without chest discomfort.

• Other signs. Especially in women, other signs may include breaking out in a cold sweat, nausea, vomiting, light-headedness, extreme exhaustion, clamminess or flu symptoms.

“People are afraid of that $800 ambulance drive,” Fabile notes. “But in an ambulance you can be treated and given an EKG, and the paramedics can call ahead to the hospital.”

Conway is more conservative than most people because of her history of heart disease, but even she questioned bothering to go in for tests when she felt a dull pain in the middle of her chest during an airline flight. But she said she couldn’t very well advise other women to go to the hospital if they felt possible symptoms and then ignore this advice herself. She got the tests, and the pain turned out to be indigestion. “Listen to your body and go in,” she advises. “Remember that women’s symptoms may be less ‘classic’ than men’s.”

GO RED FOR WOMEN DAY IS FEB. 6

The American Heart Association urges women to wear red to raise awareness of heart disease on Go Red for Women Day Feb. 6. Go to www.goredforwomen.org to find tips on preventing heart disease, healthy recipes, information on local and national events and a free 12-week physical activity program. To take the Health Checkup, disable all pop-up blockers.

©2009 Caliope Publishing Company