Lucky: Fran Halcrow, from Penicuik, Scotland, suffered from all the tell-tale symptoms – but survived her condition
The locum GP Fran Halcrow saw about her intense exhaustion was certain it was just part of the menopause.
But Fran, 56, and a mother of three, believed there was more to it.
‘I wasn’t just a bit tired, I would feel exhausted after day-to-day things such as ironing, and after work I would fall asleep on the sofa,’ says Fran, who is duty manager of a care home.
‘It had been gradually building for a year — I’d had to give up aqua aerobics because I just didn’t have the energy.
‘But when I went to the GP in 2017, they kept saying, “how’s your mood, how are you finding the menopause?” and suggested I might be depressed.
‘I did say I’d actually been through the menopause years before.’
Over the next year she started getting breathless when walking up even slight inclines ‘and I was used to hour-long dog walks’, she adds.
Then, last October, while watching TV one evening at home in Penicuik, Scotland, with husband Kenneth, 60, a bus driver, she felt crushing chest pain and went to hospital the next day.
Fran was told she had a ‘mild leak’ in a heart valve and that she would be sent a follow-up appointment.
It would take six months — and many phone calls — before she saw a cardiologist, during which time her intense fatigue intensified.
‘By then I couldn’t make the three-minute walk to the doctor’s surgery without a rest, and I was so breathless and tired even having a shower was exhausting.
‘I had been back and forth to the GP in the run up but I was told there was nothing more to do — they had to wait for my appointment.’
When she finally saw a cardiologist in March he told her the cause of her symptoms: heart failure. It had been caused by the valve problem and high blood pressure she’d had for years.
Heart failure is when the heart is unable to pump blood around the heart as efficiently as it should. There are multiple causes — from a heart attack to poorly treated high blood pressure and viruses — all of which damage the heart muscle.
Fact: Women account for 40 per cent of the 900,000 people diagnosed with heart failure
Symptoms include breathlessness (as blood and fluid pools in the lungs), fatigue and fluid retention as the kidneys hang on to water and salt to try to push up blood pressure (so that the heart does not have to pump so hard) — resulting in swollen ankles for example. It can be life threatening.
Fran’s symptoms were textbook — so why did she wait so long for a diagnosis? There was one major factor working against Fran — being a woman.
Last week, a damning report from the All-Party Parliamentary Group on Women’s Health said women are needlessly dying of heart attacks and strokes because they are seen as ‘male diseases’.
And, it seems the same applies to women with heart failure.
Women account for 40 per cent of the 900,000 people diagnosed with heart failure.
Yet in May a study by researchers from the University of Oxford, published in PLoS Medicine, found doctors are far more likely to miss the signs of heart failure in women, with women 9 per cent less likely to be diagnosed correctly by GPs than men.
As a result, women are more likely to be diagnosed at hospital when their symptoms have become severe.
‘Doctors are not as alert to the signs and symptoms in women as they are in men,’ says Amanda Varnava, a consultant cardiologist at Hammersmith Hospital in London. ‘If women feel fatigued, doctors may put it down to age or weight, whereas in men they might be more likely to consider “is this heart-related?”’ The symptoms of heart failure don’t vary between the sexes, but the causes do.
In men, the most common cause is heart disease or having had a heart attack. In women, the chief cause is uncontrolled high blood pressure as over the years this puts a strain on the heart. (Thanks to the protective effects of oestrogen, women are less likely to have a heart attack before they reach the menopause than men).
Did you know this? In men, the most common cause is heart disease or having had a heart attack. In women, the chief cause is uncontrolled high blood pressure as over the years this puts a strain on the heart
However, even women who are at high risk of heart failure don’t seem to be subject to the same level of scrutiny as men in the same boat.
‘If a slightly younger man has had a heart attack, he and his GP are already thinking about follow-ups and checking for heart failure,’ says Dr Varnava. ‘But no one thinks to offer the same follow-up to a woman with long-standing high blood pressure and neither she nor her GP appreciate what a risk factor that is for heart failure.
‘There is also a tendency to think that if someone is breathless or has swollen ankles then that’s because they are just unfit or getting older — but these kinds of symptoms should not be dismissed and should be investigated,’ says Professor John Cleland, a heart failure specialist at the University of Glasgow.
Professor Cleland says heart failure is so underdiagnosed — especially among women — that the true figure affected could run into the millions.
‘I think four million is a reasonable estimate,’ he says. ‘We have found there are at least as many treated as are undiagnosed,’ he says. When two years ago Jackie Thomson, 50, a healthcare worker became so breathless she couldn’t walk up the stairs, she was told four times in a month by doctors in A & E that she had a virus. On her fourth visit she was seen by a respiratory consultant, who, on finding no sign of ‘a viral lung infection’, sent Jackie for an echocardiogram, a scan that can show how well the heart is working. And that’s when her heart failure was spotted.
‘When they broke me the news, I cried and cried,’ says Jackie, who lives in West Lothian with her partner Thomas and youngest son, 21.
‘I thought, “that’s it; I’m going to die,” They said I must have had it for years.’ She is now on antidepressants as the shock of the diagnosis hit her so hard.
Yet there are treatments that have ‘revolutionised’ the outlook of those with heart failure, says Dr Varnava. Typically two or more medications are needed, usually beta-blockers to slow the heart, ACE inhibitors to relax blood vessels so the heart has to work less hard to pump blood round the body and a form of diuretic to help reduce fluid retention.
These can reduce the symptoms, and, in some cases improve the strength of the heart as well as reducing the risk of premature death. But to work best they should be given early on in the condition.
‘Early diagnosis can add three or more years of good quality life,’ adds Professor Cleland.
However, currently two thirds of heart failure cases (in men and women) are only diagnosed when they are so severe they require hospital treatment.
Four months after Fran’s diagnosis her heart function is so weakened she can barely lead an independent life. She is about to start a new drug on top of the blood pressure medication she takes, and desperately hopes it will help.
‘I can’t even lift shopping from the belt to the trolley,’ she says. ‘I get light-headed and dizzy and I can’t look after my little grandson any more as he’s so fast I couldn’t react quickly enough to keep him out of danger.
‘I’ve gone from being a professional with an active life to someone who can barely look after my grandchildren,’ she adds.
‘I try not to get down but it’s hard.’ She has been off sick from work since last year.
‘It is better that heart failure patients are diagnosed by a GP then at hospital — leaving it later means it is more costly to the NHS and women are missing out on treatments that can manage their symptoms and improve their quality of life,’ says Dr Varnava.
‘There needs to be greater awareness among GPs about the risk factors for heart failure so that if they see an older female patient with long-standing high blood pressure they know that she is at risk of heart failure.’
■ More information from heart failure charity pumpingmarvellous.org