Ask Dr. H: Women's heart attacks differ, as Rosie's shows

Question: I was surprised to hear Rosie O'Donnell had a heart attack recently and initially ignored the symptoms she had because they weren't classic heart attack symptoms. Then I learned, women can have different symptoms from men when having a heart attack. Could you elaborate on the differences?

Answer: Rosie developed heart attack symptoms after helping another woman get out of her car. She said she experienced chest pain, muscle soreness and nausea, which she initially thought might be due to a pulled muscle. She wisely discovered on the Internet that her symptoms were consistent with a possible heart attack. She took aspirin and the next day saw her doctor, who immediately hospitalized her. She was incredibly lucky not to die from the 99 percent blockage in one of her critical heart arteries, which is now flowing fine with a cardiac stent in place.

Heart disease is not just a man's disease; it is the No. 1 cause of death in adult women. Diagnosing a heart attack or acute unstable angina (critical blockage) in women can be tricky for a couple of reasons.

Chest pains in women are too often ascribed to stress, anxiety or a muscle strain. The classic signs of a heart attack (left-side chest pain that radiates down the left arm or into the neck and jaw) are seen less often than the vague symptoms of shortness of breath, nausea, abdominal or upper back discomfort, fatigue, light-headedness and sweating.

Women can have a heart attack and experience no chest pain at all. Women also report  vague nonspecific symptoms such as unusual fatigue, sleep disturbance, shortness of breath, indigestion and anxiety shortly before having a heart attack. As Rosie later said, "Know the symptoms, ladies. Listen to the voice inside, the one we so easily ignore."

Qestion: I am an HIV-positive man diagnosed in 1999 who has done great with antiviral medication to the point that my viral load is now undetectable. I read, with great interest, a news story about a man who was cured of all HIV from his body. Are we close to being able to say that doctors can cure HIV infection?

Answer: Although the story of Timothy Brown, an HIV-positive American (diagnosed in 1995) living in Berlin was cured of all HIV virus in his body provides us with hope that we will one day have a cure for HIV infection, we are not there yet.

Brown was diagnosed with an aggressive form of leukemia called acute myelogenous leukemia (AML). When chemotherapy failed to bring about remission of his cancer, his oncologist, Gero Hutter, in Berlin came up with a revolutionary treatment. Hutter and his team found a bone-marrow donor with a novel genetic mutation that provides complete immunity against the HIV virus.

In 2006, Brown underwent a bone-marrow transplant where he received marrow from a donor with the CCR5 receptor mutation (present in just 1 percent of the northern European population). The result was that not only is Brown cancer-free, but he is also HIV-free.

This is different from your situation, in which the virus is undetectable in your bloodstream but presumably still present in various tissues throughout your body. Brown underwent biopsies of brain tissue, intestines, liver, lymph nodes and bone marrow that confirmed complete eradication of the HIV virus.

Two HIV-positive Bostonians recently underwent bone marrow transplantation for leukemia and also show no traces of HIV in their new immune systems. Unlike Brown, their bone- marrow transplants did not have the CCR5 mutation, so they still take HIV medication as a precaution against any possible dormant virus in their tissues.

Since bone-marrow transplantation solely to attempt HIV cure is risky and expensive, researchers are studying other ways to introduce the CCR5 gene mutation into the body to eradicate HIV.