Ten years ago, just two weeks after giving birth to her second child, Wakisha Stewart was out with her husband when she started feeling disoriented, nauseated, and short of breath. Stewart was a nursing assistant at the time, but despite her medical training, she didn’t immediately know what was happening—it wasn’t until she felt a crushing pain in her chest, neck, and jaw and was immobilized by the pain that she realized something was “terribly wrong.”
“Everything became a blur because now I’m realizing, ‘I’m 31 years old, and I’m having a heart attack! How? Why?’” Stewart recalled.
At the time of her heart attack, Stewart had no family history of cardiovascular issues. Fortunately, she went to the hospital for emergency medical care and received a diagnosis: She had suffered a spontaneous coronary artery dissection, known as a SCAD.
SCAD is an emergency cardiovascular condition that occurs when a tear forms in a blood vessel in the heart. According to a 2015 study in Circulation, at least 4% of all heart attacks are thought to be SCAD; this condition is seen primarily among women, especially new mothers like Stewart, who had recently given birth and also had a 5-year-old son at home. Researchers believe SCAD is understudied, underdiagnosed, and undertreated, particularly among women. SCAD is one of a wide variety of distinct cardiovascular health conditions, such as high blood pressure (hypertension); heart failure; heart attack (myocardial infarction); coronary heart disease; and stroke, including ischemic strokes caused by clots. Collectively, all of these cardiovascular health conditions are extremely common among African Americans.
However, all too often, Black mothers delay getting treatment for cardiovascular health needs because of all the other demands on their time that come with being family caregivers—pressures that Stewart understands intimately.
“I know it’s hard to be a working mother. The demands are endless, and I fell victim, even after my heart attack, to the idea that I can deal with everything, including my health issues, on my own or in silence,” Stewart told Prism. Now 41 years old, during the COVID-19 pandemic, she had to stop working as a nurse due to the stress of being an essential worker and a parent.
“We must take care of ourselves so that we can still be here to take care of our loved ones,” she said.
Why Black women should establish a heart health care team during pregnancy
“I think it is very important for African-American women to be seen during pregnancy and after delivery,” said Dr. Nisha Parikh, a noninvasive cardiologist, and echocardiographer. “Establishing a trusting relationship with a cardiologist is a good platform for her for the next few decades of heart health.”
Specific care team recommendations for pregnant people depend on individual medical profiles, Parikh said, so those without a history of cardiovascular issues should speak to their OB-GYN and primary care physician to see if there is an immediate need to see a cardiologist during pregnancy. Risk factors like high blood pressure and diabetes should be factored into the decision.
Parikh said that when it comes to high-risk patients with a documented history of cardiac health problems, like SCAD, it’s essential for cardiologists to see these patients every few months throughout the pregnancy.
“I would like to see [these patients] once a trimester at a minimum; we will follow her closely, with tests like ultrasounds of the heart, electrocardiograms, and of course history and physical examinations,” Parikh said.
In working with patients from Black communities, Parikh remains conscious of the wariness many patients feel toward medical professionals.
When working with a pregnant person, Parikh said, “I worry she may not have a high degree of trust in the health care system if she has felt let down by it and us in the past, so I want to do everything I can to earn that trust back, to care for her, and to make sure she and her baby are cared for during pregnancy and long afterward.”
Chronic cardiovascular risks among Black mothers can fly under the radar
More research is needed about prevention and early or earlier treatment for Black mothers, but broadly speaking, policymakers recognize that cardiovascular risks among mothers are a significant public health concern. According to the American Heart Association (AHA), an estimated 50,000 Black women die every year due to cardiovascular issues. Heart disease is a leading cause of death for women of all races, accounting for 20% of female deaths—well over 300,000 individuals—every year. At the same time, many of the challenges that can come with motherhood—sleep deprivation, stress, and even socioeconomic pressures—can contribute to cardiovascular health risks. Cardiovascular health, including untreated high blood pressure for an extended period of time, increased risk of heart attacks, strokes, and other related health risks, may impact Black mothers at higher rates—and at younger ages.
“Stress can, and will, tear your body apart and manifest in ways that can harm you mentally and physically,” said Stewart.
In particular, sleep challenges are a well-known feature of motherhood and among BIPOC caregivers, especially in the early months and years before young children reliably sleep through the night. At the same time, a growing body of research and articles—including several studies on racial and ethnic differences relating to sleep disturbances, race and socioeconomic factors relating to sleep duration, the role of race and socioeconomic status on sleep efficiency—shows that Black people are more likely to have poor “sleep health,” along with diagnosed chronic health conditions as compared with non-BIPOC individuals. BIPOC sleep health can be exacerbated by child caregiving potentially because of chronic sleep issues extending past children’s early years. Medical experts say that chronic sleep deprivation can lead to a range of health conditions, including cardiovascular health issues, immune system complications, and other health conditions, putting Black mothers at heightened risk.
Genetics and other factors can also play a role in health crises, so building awareness of family health history is also critical.
“We have to break the stigma and start discussing our family health history and not be ashamed of it,” said Stewart.
Medical experts say knowledge is power for Black caregivers
Lack of awareness of risks, long-term systematic racism, and inequitable access to health care also play a role. Organizations like the AHA and the Association of Black Cardiologists track these challenges and provide patient-oriented information online targeting Black patients and other people of color while also providing individuals and family members with resources to get connected to medical professionals.
“The years and years of systematic damage from slavery, the media [biases], housing discrimination and redlining, lack of opportunities, police brutality, health and food deserts, and racism and bias of caregivers all have played a role in African-American caregivers’ health and well-being,” said Tara Robinson, founder and CEO of the Black Heart Association.
Based in Fort Worth, Texas, Robinson is a native of Texas and a U.S. Army military veteran. Robinson had no idea that she had any hidden cardiovascular health issues until she experienced a “triple” heart attack over a period of three days at age 40.
At the time of Robinson’s heart attack, she had a teenage son and also worked as a full-time counselor for elementary school children with special educational and behavioral needs. While Robinson enjoyed the challenges of her career, she said that all of the caregiving roles she was juggling were incredibly stressful. Robinson strongly believes these and a host of other factors played a role in her triple-heart attack health crisis, which motivated her to create an earlier organization and Christian ministry focused on Black cardiovascular and health awareness. Then, in 2019, Robinson’s brother-in-law had a fatal heart attack. Following his death, Robinson went on to found the Black Heart Association to expand her reach and provide even greater awareness.
Medical experts agree that awareness is crucial to finding and managing cardiovascular risks for Black parents.
“Knowledge is power. You can’t treat or prevent what you don’t know you have,” said Dr. Kevin Kwaku, director of cardiac electrophysiology at Dartmouth-Hitchcock Medical Center.
Women’s cardiac symptoms often differ from men’s. According to the AHA, while women experience chest pain or discomfort with heart attacks, they sometimes describe feeling a dull “pressure” or extreme “physical discomfort” instead of sharp shooting chest pains that are more common with some men. Some women may also feel shortness of breath (with or without chest discomfort) and experience nausea, vomiting, and back or jaw pain, among other symptoms. The symptoms may lead women to believe they just had the flu or were getting sick and they got lightheaded, dizzy, or nauseated. During pregnancy, heart disease may present with similar symptoms.
Complex issues like SCAD can be harder to diagnose—instead, this serious medical condition is typically diagnosed after extensive cardiac testing, potentially including a heart catheterization, an invasive specialized procedure. Anytime someone has any family history of cardiovascular health problems, including SCAD, it’s essential to let medical professionals know. Additionally, any previous cardiac patient, including women of color who have had a cardiovascular health emergency in the past, are more likely to have a repeat cardiovascular health emergency within five years, research finds.
Experts say it’s essential for Black mothers to self-advocate, have preventive care, and seek out emergency health, especially for medical crises.
“It’s essential to get regular check-ups and to be aware of basic medical information like blood pressure readings,” Kwaku said, noting that cardiovascular issues should never be ignored, and treatment should not be delayed. “Unfortunately, many BIPOC families—and caregivers—are doubly victimized by inequities in both health and income; it becomes easy to see how these create self-perpetuating vicious cycles. It’s a kind of double jeopardy.”