Aug. 21, 2012 -- A heart-attack surviving cardiologist says that comedian Rosie O'Donnell is lucky to be alive today, after she delayed seeking help for an impending heart attack, ignoring flu-like symptoms before seeing a doctor.
O'Donnell reported that she had suffered what her doctors called the "widow maker," a 99 percent blockage of the left descending artery that feeds the heart.
"The first thing we women do is become stupid," said Dr. Kathleen McNicholas, a former heart surgeon and medical director of performance improvement at Christiana Care Health System in Newark, Del. "She could have died. Sudden death in women is a reasonable presentation."
The former talk-show host, 50, wrote on "Rosie Blog," that last week she had helped an "enormous" woman out of a car: "A few hours later my body hurt, I had an ache in my chest both my arms were sore, everything felt bruised."
Two-thirds of women and one-third of doctors don't recognize the symptoms of heart attack in females, McNicholas said.
"These symptoms are often more subtle than the classic 'elephant sitting on your chest,'" she said. "The universal sign of a heart attack, clutching your chest, often doesn't apply to women."
O'Donnell likely had ischemia, or a "heart cramp," McNicholas said. "We can get through heart cramps, but she could have gone on to total occlusion," or obstruction.
But she gives the comedian a pat on the back for taking aspirin, a move that might have saved her life.
McNicholas, 64, knows all too well how hesitant women are to believe they are having a heart attack. She had one herself 10 years ago, undergoing quadruple-bypass surgery to repair blockages in her arteries.
Like O'Donnell, she delayed getting help for weeks, continuing to perform heart surgery, but feeling exhausted and carrying a "sense of dread."
"It's very typical of women," she said. "The symptoms are not quite as classic and we really don't want to believe it. We are queens of denial.
"And when you don't have a good story [the piercing elephant on the chest pain], you really don't want to go to the cardiologist and waste his time. ... You are just so tired and dragging yourself around and think you have the flu."
McNicholas said her doctor was just as bad. "I couldn't convince my cardiologist, who could have turned around and convinced me," she said
"We just suck it up."
Women at Risk for Heart Attack After Menopause
An estimated 400,000 women die every year of heart disease, 10 times more than die of breast cancer annually, according to the American Heart Association.
Symptoms can include pressure, a tightening or heaviness, not necessarily pain. Flu-like symptoms, nausea, shortness of breath and excessive fatigue are also common.
Some women just stay at home because it is not painful enough to seek help. Others even say their earlobes hurt, McNicholas said. And the risk increases as women reach menopause, "catching up" with men's risk.
McNicholas was in her "prime" when she had a heart attack at 54, working 100 hours a week as a surgeon and going to law school at night. "I had every reason to feel fatigued," she said.
"My back and shoulders ached," she said. "I looked gray, but we don't ask other people how we look or say how terrible we feel. We lay on the couch and figure it's going to pass.
"The point is we don't want to go to the emergency room and make a fool out of ourselves if we don't have a good story."
She didn't seek help for a month, but came to her senses while on holiday at the Jersey Shore when her sister reminded her that both her parents had died of heart disease.
"My sister slept on the same floor as me, and the next morning she said, 'You coughed all night. ... Mom coughed like that when she died.' ... That's what pushed me. You have to have someone else notice."
McNicholas began a program at Christiana Care called "No Heart Left Behind," encouraging teens to educate their middle-aged mothers about heart disease.
One of her students saved her mother-in-law's life on a ski vacation, insisting she go to the emergency room, even when everyone else around her said it was altitude sickness. The woman was perfectly fit, walking five miles a day.
As for O'Donnell, McNicholas said the comedian likely "sure looked like hell and should have said to her partner, 'How do I look?' and gone to the hospital."
O'Donnell is recovering. She is "resting at home and doing fine," according to her publicist. She also tweeted her support for the American Heart Association campaign "Go Red for Women": "Sign me up," she wrote. "Let's get the word out there -- count me in."
"I am lucky to be here," O'Donnell wrote on her blog. "Know the symptoms ladies, listen to the voice inside. The one we all so easily ignore. CALL 911."