Menstuff® has compiled the following information on What
happens during a Heart Attack. Related Issues: Heart
Heart Attack Quiz
What You Need to Know About Heart Attacks: An Overview of Heart Attacks
A Post-Heart Attack Checklist: What Should Happen After a Heart Attack
Year's Biggest Game Puts Men at Risk
Gender gap remains for heart attack care
Heart Health for Men, Women
What Happens During a Heart Attack?
The heart muscle requires a constant supply of oxygen-rich blood to nourish it. The coronary arteries provide the heart with this critical blood supply. If you have coronary artery disease, those arteries become narrow and blood cannot flow as well as it should. Fatty matter, calcium, proteins and inflammatory cells build up within the arteries to form plaques of different sizes. The plaque deposits are hard on the outside and soft and mushy on the inside.
When the plaque's hard, outer shell cracks (plaque rupture), platelets (disc-shaped particles in the blood that aid clotting) come to the area, and blood clots form around the plaque. If a blood clot totally blocks the artery, the heart muscle becomes "starved" for oxygen. Within a short time, death of heart muscle cells occurs, causing permanent damage. This is called a myocardial infarction (MI), or heart attack.
While it is unusual, a heart attack can also be caused by a spasm of a coronary artery. During coronary spasm, the coronary arteries restrict or spasm on and off, reducing blood supply to the heart muscle (ischemia). It may occur at rest and can even occur in people without significant coronary artery disease.
Each coronary artery supplies blood to a region of heart muscle. The amount of damage to the heart muscle depends on the size of the area supplied by the blocked artery and the time between injury and treatment.
Healing of the heart muscle begins soon after a heart attack and takes about eight weeks. Just like a skin wound, the heart's wound heals and a scar will form in the damaged area. But, the new scar tissue does not contract or pump as well as healthy heart muscle tissue. So, the heart's pumping ability is lessened after a heart attack. The amount of lost pumping ability depends on the size and location of the scar.
What Are the Symptoms of a Heart Attack?
Symptoms of a heart attack include:
During a heart attack, symptoms last 30 minutes or longer and are not relieved by rest or oral medications (medications taken by mouth).
Some people have a heart attack without having any symptoms (a "silent" myocardial infarction). A silent MI can occur in any person, though it is more common among diabetics.
What Do I Do if I Have a Heart Attack?
Quick treatment to open the blocked artery is essential to lessen the amount of damage. At the first signs of a heart attack, call for emergency treatment (usually 911). The best time to treat a heart attack is within one to two hours of the first onset of symptoms. Waiting longer than that increases the damage to your heart and reduces your chance of survival.
Keep in mind that chest discomfort can be described many ways. It can occur in the chest or in the arms, back or jaw. If you have symptoms, take notice. These are your heart disease warning signs. Seek medical care immediately.
How Is a Heart Attack Diagnosed?
Once the emergency care team arrives, they will ask you about your symptoms and begin to evaluate you. The diagnosis of the heart attack is based on your symptoms, ECG and the results of your blood tests. The goal of treatment is to treat you quickly and limit heart muscle damage.
Tests You Take
How Is a Heart Attack Treated?
Once heart attack is diagnosed, treatment begins immediately -- possibly in the ambulance or emergency room. Medications and surgical procedures are used to treat a heart attack.
What Medications Are Used to Treat a Heart Attack?
The goals of medication therapy are to break up or prevent blood clots, prevent platelets from gathering and sticking to the plaque, stabilize the plaque and prevent further ischemia.
These medications must be given as soon as possible (within one to two hours from the start of your heart attack) to decrease the amount of heart damage. The longer the delay in starting these drugs, the more damage can occur and the less benefit they can provide.
Medications for this purpose may include:
Other drugs, given during or after a heart attack, lessen your heart's work, improve the functioning of the heart, widen or dilate your blood vessels, decrease your pain and guard against any life-threatening heart rhythms.
What Other Treatment Options Are There?
During or shortly after a heart attack, you may go to the cardiac catheterization laboratory for direct evaluation of the status of your heart, arteries and the amount of heart damage. In some cases, procedures (such as angioplasty or stents) are used to open up your narrowed or blocked arteries. These procedures may be combined with thrombolytic therapy (drug treatments) to open up the narrowed arteries, as well as to break up any clots that are blocking them.
If necessary, bypass surgery may be performed to restore the heart muscle's supply of blood.
Treatments (medications, open heart surgery and interventional procedures, like angioplasty) do not cure coronary artery disease. Having had a heart attack or treatment does not mean you will never have another heart attack; it can happen again. But, there are several steps you can take to prevent further attacks.
How Are Subsequent Heart Attacks Prevented?
The goal after your heart attack is to keep your heart healthy and reduce your risks of having another heart attack. Your best bet to ward off future attacks are to take your medications, change your lifestyle, and see you doctor for regular heart checkups.
Why Do I Need to Take Medicine After a Heart Attack?
Medications are prescribed after a heart attack to:
Other medications may be prescribed if needed. These include medications to treat irregular heartbeats, lower blood pressure, control angina and treat heart failure.
It is important to know the names of your medications, what they are used for and how often and at what times you need to take them. Your doctor or nurse should review your medications with you. Keep a list of your medications and bring them to each of your doctor visits. If you have questions about your medications, ask your doctor or pharmacist.
What Lifestyle Changes Will I Need to Make?
There is no cure for coronary artery disease. In order to prevent the progression of this disease, you must follow your doctor's advice and make necessary lifestyle changes. You can stop smoking, lower your blood cholesterol, control your diabetes and high blood pressure, follow an exercise plan, maintain an ideal body weight, and control stress.
When Will I See My Doctor Again After I Leave the Hospital?
Make a doctor's appointment for four to six weeks after you leave the hospital. Your doctor will want to check the progress of your recovery. Your doctor may ask you to undergo diagnostic tests (such as an exercise stress test at regular intervals. These tests can help your doctor diagnose the presence or progression of blockages in your coronary arteries and plan treatment.
Call your doctor sooner if you have symptoms such as chest pain that becomes more frequent, increases in intensity, lasts longer, or spreads to other areas; shortness of breath, especially at rest; dizziness, or irregular heartbeats.
Reviewed by the doctors at The Cleveland Clinic Heart Center.
What You Need to Know About Heart
Attacks: An Overview of Heart Attacks
A heart attack (or myocardial infarction) is a very serious condition in which a portion of the heart muscle dies, usually because its blood supply is interrupted. Typically, a heart attack occurs when an atherosclerotic plaque suddenly ruptures in a coronary artery (an artery that supplies blood to the heart muscle), causing an acute blockage in the artery.
A heart attack can have several nasty consequences.
It usually (but not always) produces significant acute symptoms, especially chest pain, dyspnea (shortness of breath), or a sense of impending doom. If the heart muscle damage is extensive enough heart failure can develop, either acutely with the heart attack itself, or later on. A heart attack often produces electrical instability in the heart, which can lead to sudden death from ventricular fibrillation.
In the best-case scenariowhich is far more likely if you act quickly when you experience the symptoms of a heart attack, and your doctors immediately recognize the problem and rapidly administer the right treatmenta heart attack is a big wake-up call. It indicates that you have a chronic disease (coronary artery disease, or CAD) that has already done at least some damage to your heart and is likely to do more damage unless you take the right steps. In a less-than-best-case scenario, a heart attack can produce significant disability and premature death. Either way, a myocardial infarction is a profound event in anyones life.
If you have had a heart attack, or if your risk of having one is elevated, there is a lot you need to know. By understanding the causes, symptoms, preventive measures, and treatment of heart attacks, and by working closely with your doctor, you can optimize your chances of living a long life in good health.
What Causes Heart Attacks?
Most typically, heart attacks are caused by an acute rupture of a plaque in a coronary artery. The plaque rupture triggers the clotting mechanism within the artery and a blood clot forms. The blood clot blocks the artery to at least some extent. If the acute blockage is severe enough, the heart muscle supplied by that artery begins to dieand a heart attack occurs.
The question of why plaques rupture, and which plaques are most likely to rupture, is an area of active medical research. While sometimes a plaque will rupture after some kind of triggering event (such as severe physical or emotional stress), much more often plaque rupture occurs for no apparent reason, quite sporadically, and without any identifiable triggers.
Furthermore, it is not at all clear that the larger plaques doctors tend to worry about (the kind identified after a heart catheterization as being significant blockages) are more prone to rupture than smaller, much more innocent-looking plaques. The fact is, anyone who has CAD must be regarded as being at risk for a heart attackwhether or not their plaques are labeled as significantand should be treated accordingly.
'Types' of Heart Attacks
A ruptured coronary artery plaque actually can produce at least three different clinical conditions, which are all lumped together under the name acute coronary syndrome, or ACS. Symptoms with all three kinds of ACS tend to be similar, and all three are considered medical emergencies. However, only two of them are considered heart attacks.
The first kind of ACS is called unstable angina. In unstable angina, the blood clot resulting from a plaque rupture is not large enough (or does not last long enough) to produce permanent damage to the heart muscleso unstable angina is not a heart attack.
However, without aggressive treatment unstable angina is often followed in the near future by a heart attack. Read about unstable angina.
The next kind of ACS is called ST-elevation myocardial infarction (STEMI). This name comes from the fact that the ST segment portion of the electrocardiogram (ECG) appears elevated in this, the most severe form of ACS. With a STEMI, the blood clot is extensive and severe, so a large part of the heart muscle supplied by the damaged artery will die without rapid treatment. Read about STEMI.
The third kind of ACS is non-ST segment elevation myocardial infarction (NSTEMI), which can be thought of as a condition that is intermediate between unstable angina and STEMI. Here, the blockage of the coronary artery is only partial, but it is still large enough to produce at least some damage to the heart muscle. Read about NSTEMI.
Both STEMI and NSTEMI, without adequate treatment, will produce permanent damage to the heart muscle, so both these types of ACS are considered to be heart attacks.
It is important for doctors to distinguish between these two types of heart attacks because the acute treatment can differ between them.
Symptoms of a Heart Attack
The classic symptom of a heart attack is chest pain, that may radiate to the jaw or arm, and that may be accompanied by sweating, and a feeling of intense fear or impending doom.
However, many people with heart attacks dont have these classic symptoms. They may not have chest pain at allor any pain. They may describe their symptoms as a pressure, or a nondescript discomfortjust a funny feeling. And the symptoms may not localize to the chest, but instead to the back, shoulders, neck, arms, or the pit of the stomach.
People with acute myocardial infarctions may have sudden nausea or vomiting, or shortness of breath. Or, they may simply have what they describe as heartburn and nothing else.
All too often, the symptoms of a heart attack are of such a character that they are relatively easy to brush off. It is easy to just wait to see if they go away by themselves. And many times, they do. These people are the ones who will be diagnosed later on, when they finally see a doctor, as having had a so-called silent heart attack.
The trouble is that all heart attackseven the silent onesproduce permanent damage to the heart muscle, often enough damage to cause disability, or shorten life expectancy by a significant amount. To limit the damage, it is critical to recognize that a heart attack may be occurring, and get medical help immediately, while the heart muscle is still salvageable.
Consequences of a Heart Attack
Immediate Consequences. In addition to producing the kinds of symptoms we just talked about, an acute heart attack can cause more severe problems. If the amount of heart muscle affected by the blocked coronary artery is extensive, a person having a heart attack may experience acute heart failure. This heart failure may produce severe shortness of breath, low blood pressure, lightheadedness or syncope, and multi-organ failure. Unless blood flow can be restored to the affected heart muscle very rapidly, this type of acute heart failure often results in death.
In addition, during an acute heart attack the dying heart muscle can become very electrically unstable, and is prone to ventricular fibrillation. So the risk of sudden death within the first few hours of a heart attack is elevated. However, the ventricular fibrillation can usually be treated very effectively (by defibrillation) if it occurs when a person is under medical care. This is yet another reason why it is very important not to try to just ride out any symptoms that may represent a heart attack.
Later Consequences. Even after the acute phase of a heart attack is over, there are still several concerns that need to be addressed.
First, the damage done to the heart muscle may leave the heart weakened, and heart failure may eventually develop. Second, depending on the amount of permanent damage done to the heart muscle, the risk of sudden death may be permanently elevated. Thirdly, the very fact that a heart attack has occurred places a person at a very high risk of subsequent heart attacks.
What all this means is that the treatment of a heart attack does not end when the acute event has ended. Ongoing treatment aimed at preventing or mitigating all three of these late consequence outcomes is critical.
How Is a Heart Attack Diagnosed?
Diagnosing a heart attack is usually not too difficultas long as a persons symptoms alert medical personnel to that possibility. All too often, a person experiencing symptoms they think may be related to their heart will, due to wishful thinking, downplay the symptoms when they arrive in the emergency room. This is the wrong approach. The more quickly the medical personnel are alerted to the possibility of a myocardial infarction, the more quickly they will act to make or rule out that diagnosis.
Remember that, when it comes to a heart attack, every minute counts. So if you are even the least bit concerned that your symptoms may be coming from your heart, you need to say, I think Im having a heart attack. This will get the ball rolling immediately.
In most cases, recording an ECG (which may show changes characteristic of a heart attack) and sending off a blood test to measure cardiac enzymes (which will detect whether damage to heart cells is occurring) will confirm or disprove the diagnosis of heart attack quickly. The sooner the diagnosis is made, the sooner appropriate steps can be taken to stop the damage.
Treatment: The Critical First Hours
An acute heart attack is a medical emergency. Heart muscle is actively dying, and immediate treatment is critical. Minutes can make the difference between complete recovery and permanent disability or death. This is why nobody should ever ignore any disturbing, unexplained symptoms that occur anywhere above the waist.
Once a person is under medical care and an ongoing myocardial infarction has been diagnosed, treatment begins immediately. This acute treatment usually consists of two simultaneous approaches: stabilization and revascularization.
Stabilization consists of getting rid of the acute symptoms, relieving stress on the heart muscle, supporting the blood pressure (if necessary), taking steps to stabilize the ruptured plaque, and stopping the formation of blood clots in the damaged artery. This is done by administering nitroglycerin, oxygen, morphine, beta blockers, a statin, aspirin, and another anti-platelet drug such as Plavix.
However, the real key to a good outcome is to revascularize the dying heart musclethat is, to restore blood flow through the blocked coronary arteryand to do it as quickly as possible. Most permanent cardiac damage can be avoided if the artery can be re-opened within roughly four hours. And at least some permanent damage can be prevented if the artery is opened within eight to 12 hours. Obviously, time is critical.
With a STEMI (the kind of heart attack in which the coronary artery is completely blocked), revascularization is accomplished, preferably, by using invasive therapyangioplasty and stenting. Sometimes this approach is infeasible or too risky, in which case thrombolytic therapy (a clot-busting drug) is used to dissolve the clot and restore blood flow.
With an NSTEMI (the kind of heart attack in which the coronary artery is only partially blocked), thrombolytic therapy has been shown to cause more harm than good, and should be avoided. Sometimes people with an NSTEMI can be treated with stabilization measures alone (which turns out to be the same way unstable angina is treated). However, most cardiologists believe that stenting is more effective in preserving cardiac muscle with NSTEMI, and is often the preferred approach for both STEMI and NSTEMI.
The overall goal during the first few hours is to make sure blood flow is restored to the at-risk heart muscle, to take steps to prevent the immediate re-formation of a blood clot, and to reduce the workload of the overtaxed heart. In the great majority of casesespecially if treatment is begun quicklypeople with acute heart attacks are quite stable within 24 hours.
After the First Day: Youve Survived a Heart AttackNow What?
Once you have successfully navigated the acute phase of a heart attackthe first 24 hours or soit is time for you and your doctors to initiate treatment aimed at preventing the three late consequences of a heart attack: heart failure, sudden death, and further heart attacks.
A heart attack kills some of the heart muscle. The dead heart muscle is converted to scar tissue, which holds the heart together but does not contribute to the work of the heart. Whether or not a person develops heart failure after a heart attack depends on the extent of the damage and on how the remaining heart muscle adjusts to the new situation. The remaining, normal heart muscle often responds by changing its shape, a process called remodeling. While a certain amount of remodeling may be beneficial at first, more chronically, remodeling can lead to heart failure. Read about cardiac remodeling.
There are several things that doctors should do to help their patients hearts to avoid cardiac remodeling and help prevent heart failure. Chief among these are the use of beta blockers and ACE inhibitors, but other steps are required as well. You should be aware of all the steps available for preventing heart failure, and make sure your doctor is recommending the ones that apply to you.
The post-heart attack discussion that is most often skipped by cardiologists is the discussion about sudden death. This is a topic that many doctors find very hard to talk about. However, sudden death is a substantial risk for many people after a heart attack, especially people who have had a lot of damage to their heart muscle. Furthermore, the risk of sudden death can be substantially lowered, in people whose risk is very high, by the use of an implantable defibrillator. Clear guidelines exist regarding which people ought to be considered for an implantable defibrillator after a heart attack, and your doctor owes you a discussion of whether you may be one of those people.
A person who has survived a heart attack knows something about themselves they might not have known before: They have CAD, and they are at a greatly increased risk for another heart attack. That risk can be substantially improved with medications and adopting a healthy lifestyle. In addition to beta blockers and ACE inhibitors (useful for preventing cardiac remodeling), most people who have had a heart attack need to be on statins and aspirin, and possibly on medication to treat or prevent further angina (such as nitrates or calcium channel blockers).
Lifestyle measures that substantially improve future cardiac risk include ending all tobacco use, eating a heart healthy diet, controlling weight, gaining excellent control of diabetes and hypertension (if you have these), and engaging in regular exercise (preferably beginning with a formal cardiac rehabilitation program).
A Post-Heart Attack Checklist
Thats a whole lot for you to be aware of and to think about. Guess what? Its also a whole lot for your doctor to be aware of and think about. And in todays harried medical environment, it is possible that even the most conscientious doctor will miss some of the critical steps necessary to ensure an optimal outcome after a heart attack.
So heres a post-heart attack checklist that you may find useful. Go over each line of this checklist with your doctor, to make sure neither of you inadvertently neglect a step toward your optimal cardiac health. Youve been through a lot togetherlets not let either of you allow the ball to be dropped now.
A post-heart attack checklist.
A Word From Verywell
A heart attack is serious business. Fortunately, with what weve learned about heart attacks in the last few decades, and with the newer therapies that have been devised to treat them, the chances of dying or having permanent disability after a heart attack have been greatly diminished.
However, in order to receive all the benefits of these remarkable medical advances, you need to know everything you can about heart attacksin particular, how to recognize that you may be having one, and what you should expect in the way of treatment. We hope this article will get you started with what you need to know.
Amsterdam EA, Wenger NK, Brindis RG, et al. 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 130:2354.
Goldberger JJ, Cain ME, Hohnloser SH, et al. American Heart Association/American College of Cardiology Foundation/Heart Rhythm Society scientific statement on noninvasive risk stratification techniques for identifying patients at risk for sudden cardiac death: a scientific statement from the American Heart Association Council on Clinical Cardiology Committee on Electrocardiography and Arrhythmias and Council on Epidemiology and Prevention. Circulation 2008; 118:1497.
Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation 2009; 119:e391.
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2013; 127:e362.
Thygesen K, Alpert JS, White HD, et al. Universal
definition of myocardial infarction: Kristian Thygesen, Joseph S.
Alpert and Harvey D. White on behalf of the Joint ESC/ACCF/AHA/WHF
Task Force for the Redefinition of Myocardial Infarction. Eur Heart J
A Post-Heart Attack Checklist: What Should
Happen After a Heart Attack
Doctors and hospitals have mobilized nicely to provide adequate acute care for the person showing up with an acute myocardial infarction. But sometimes they drop the ball when it comes to giving appropriate care after those first critical hours. Most caregivers try very hard to accomplish everything that needs to be accomplished in the few days after a heart attack. Occasionally, however, everything that needs to be accomplished is simply overwhelming, to them and to their patients. As a consequence, all too often people with heart attacks don't receive all the assessments, education, and treatment they need to assure an optimal long-term outcome.
What You Need To Know
The key to successfully navigating your way to a long, healthy life after a heart attack is you. You need to know what kind of testing should be done, what kind of referrals should be made, and which kinds of medications (and other treatments) should be started, or at least strongly considered.
If anything falls through the cracks, you should bring it to your doctors attention.
Doctors really do want to do the right thing. It's just that, given all the pressure and constraints they're operating under, from both insurance companies and the government, sometimes you need to remind them of who they're really obligated to, and what your expectations are in that regard.
And so, you need to have the right expectations.
To this end, here is a convenient checklist of the things that should be done ideally before you even leave the hospital after your heart attack.
Use this checklist to make sure all the important bases are covered, and that you and your doctor are both doing all the right things to improve chances of long-term survival, and long-term good health.
Here are a few articles that explain the reasoning behind the post-heart attack checklist:
Preventing Another Heart Attack
Preventing Heart Failure
Preventing Sudden Death
A Post-Heart Attack Checklist:
1. Lifestyle changes and other education:
2) Assessing the risk of another heart attack in the near future:
3) The amount of damage done to my heart has been assessed by:
-- I (do / do not) have some degree of heart failure.
4) Important numbers I need to know:
5) Names and doses of medications prescribed for me:
6) Preventing sudden death
Smith, SC Jr, Allen, J, Blair, SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol 2006; 47:2130.
O'Gara PT, Kushner FG, Ascheim DD, et al. 2013
ACCF/AHA guideline for the management of ST-elevation myocardial
infarction: executive summary: a report of the American College of
Cardiology Foundation/American Heart Association Task Force on
Practice Guidelines. Circulation 2013; 127:529.
Gender gap remains
for heart attack care
Overall, women survive heart attacks about as well as men when they are under a hospital's care. But the study found that a gender gap remains when women have the most serious type of heart attack. Women also get less of the recommended medicines and procedures than men, or it takes longer to get them.
"We're doing better but not good enough for women," said Dr. Hani Jneid, lead author of the study from Baylor College of Medicine in Houston.
The data came from 420 hospitals enrolled in an American Heart Association program to get doctors to follow guidelines for treating heart attack patients. Previous research has suggested that women's heart attacks were treated less aggressively.
The research was funded by the heart association and the findings were reported Monday in the group's medical journal, Circulation.
Dr. Nieca Goldberg, a cardiologist who specializes in women's care, said the study suggests that women's heart attack symptoms still are not being taken seriously. Some women don't have typical symptoms like chest pains, she said, but may have pain lower in their bodies or severe shortness of breath.
"This really continues to be very disappointing," said Goldberg, who is director of the Women's Heart Center at NYU Langone Medical Center in New York. "I think my colleagues need to get on the stick."
The study examined the hospital treatment for 78,254 heart attack victims to see if guidelines were followed and how many died. Hospitals in the heart association's "Get with the Guidelines" program are required to put that information in a registry.
When they looked at heart attacks overall, about the same number of men and women died in the hospital. But when they looked at the most serious kind of heart attack, there was a difference.
These heart attacks are caused by a total blockage of an artery, which deprives the heart muscle of oxygen and blood and causes part of it to die. Diagnosis is done with an electrocardiogram, which spots distinctive changes. Quick action is needed to open up the artery to restore blood flow, either with a clot-dissolving drug or an angioplasty.
About a third of the heart attacks in the study were major ones. The raw numbers showed 10 percent of the women with massive heart attacks died in the hospital, compared to about 6 percent of the men. After taking into account the women's older age and other differences, the researchers said the women in the study were 12 percent more likely to die of a major heart attack in the hospital than men.
The researchers said women were also less likely to get recommended medicines, like an aspirin within 24 hours. And they were less likely to get treatment to restore blood flow, or it wasn't given quickly enough.
Jneid said there may have been good reasons behind some of the differences; the researchers didn't know whether the treatment decisions were appropriate or not for specific patients.
But "there's no reason to see a disparity in something as simple as an aspirin," said Jneid.
Another of the researchers, Dr. Laura Wexler of the University of Cincinnati College of Medicine, noted that heart disease is usually thought of as a man's disease, but it is the leading cause of death among women.
"It's very important for the public women and the people
who love them to get over the idea that it's not a disease of
women," she said.