A Healthy Retirement?

Part II—"The Cruise"

by
Ann Henninger
Biology Department
Wartburg College, Waverly, Iowa

Jim and Nancy flew to Vancouver to start their cruise. The ship was like a city with thousands of people, lots of activities, and an abundance of delicious food and drink. The Towers enjoyed being wined and dined and kept busy day and night. They rarely missed the afternoon ice cream parties on deck.

Feeling a little guilty about eating so much food, the Towers joined other travelers for early morning and mid-afternoon power walks on deck. They planned to increase their speed and distance a little each day. Their goal was to walk a mile in 18 minutes by the end of the 10-day cruise.

The weather was clear and the scenery was breath-taking as they walked and talked. Early one morning, after about 15 minutes of power walking on deck, Nancy started feeling nauseous and had trouble breathing. "Jim, I think something is wrong with me," she said.

"Let's stop and rest for a few minutes. Maybe that will help," he said. Jim helped her to a deck chair and fussed with a blanket to protect her from the cool morning air. Nancy's nausea decreased and her breathing improved. They sat on deck chairs for the next hour watching the whales swimming beside the ship.

The next morning during their power walking Nancy experienced a similar problem. "Jim, now I'm sure that something is wrong. For weeks I've been feeling tired and have had a nagging backache. But this nausea and shortness of breath are new. I'm scared. Do you think I could be having a heart attack?" she said.

"Nah, I doubt it. I mean, you don't have chest pains or anything like that, do you? Don't you remember how I thought one of those whales was sitting on my chest and wouldn't get up when I had mine?" said Jim.

"You're probably right. I don't have chest pains," she said. "Maybe it's just all the recent changes in my life and eating too much of this rich food."

Later that day Jim and Nancy joined a small group from the ship for a land excursion. They snapped pictures of each other standing in front of totem poles and the picture-perfect scenery and joked about the possibility of getting a salmonburger at the fast food places back home. As the afternoon ended, a blast from the ship's horn warned them that it was time to head back to the ship.

As the group trotted down to the docks, Nancy pulled aside and Jim stayed to keep her company. Carol, a member of their group, slowed her pace, then went back to Nancy and Jim. "You two OK?" she asked.

"Yeah, I think so," replied Jim. "Nancy's been feeling pooped lately and has complained about a backache. Now she's having trouble keeping up with the group."

"What kind of pooped, Nancy?" asked Carol.

"Well, I think all the preparations for the trip wore me out," explained Nancy. "I expected to be energized by the vacation. But both yesterday and this morning as we were walking on deck, I started to feel nauseous and had trouble breathing. It scared me at first, but then it went away after I rested. Now, again, I'm having trouble walking fast."

"I don't mean to scare you, Nancy, but I think this could be serious," warned Carol.

"You do?" questioned Nancy. "You look so young. Have you had these problems too?"

"No, not me," Carol replied. "But some of my patients have. You see, I'm on this cruise for a small break between finishing a residency in family practice and joining a group practice in my hometown. I think you may be experiencing angina equivalent symptoms."

"What does that mean?" asked Jim.

"Women often have symptoms of coronary heart disease, and even of a heart attack, that are different from men's," explained Carol. "Nancy's back pain, fatigue, nausea, and shortness of breath are typical for women. Because the symptoms are different from typical male symptoms they are called 'angina equivalent symptoms.' For now, Nancy, your symptoms go away when you rest. But if they don't go away with rest, it's a good indication that you're actually having a heart attack. I think you should see a doctor who specializes in cardiology or internal medicine soon."

Questions:

How are angina equivalent symptoms different from classic angina symptoms?
What causes these symptoms?
Why do the symptoms lessen when Nancy rests?
Before reading this case study did you know that males and females often have different symptoms for coronary heart disease or a heart attack? If so, how did you find out?
How do medical researchers find out if individuals of both sexes and from diverse racial and ethnic backgrounds have similar symptoms or react the same to treatment?