“Women can certainly have the traditional symptoms [of a heart attack] — the elephant-on-my-chest pressure, shortness of breath, and pain,” says Dr. Jennifer Morrow. “But I see a lot of patients with a little bit of jaw pain, or their shoulder is aching, or something just doesn’t feel quite right.”
Photographs by Brandon Dill.
In the past, millions of men and women died from heart disease. In recent years, cardiologists have seen spectacular — almost miraculous — advances in medications, procedures, and technology. So we come to the present, and this sobering fact remains: Coronary disease, including heart attacks and strokes, remains the number-one killer in America.
“Heart disease, in fact, kills more women than all cancers combined, and that includes breast cancer,” says Dr. Jennifer Morrow, a cardiologist with the Stern Cardiovascular Center. “Women also have a higher risk of actually dying from a heart attack than men, with an estimated 38 percent risk of death, compared to 25 percent in men.”
As one of only a half dozen female cardiologists in Memphis, Morrow takes a personal interest in treating women with heart ailments, and she knows she faces a challenge. “To this day,” she says, “we face an uphill battle in terms of recognizing how common heart disease is in women.”
How does a Hutchison School graduate earn a degree from Johns Hopkins University — in French, not anything related to medicine — and somehow end up back in Memphis as a cardiologist? Well, part of that journey involved the break-in of a U-Haul trailer, and “the stars must have been aligned,” Morrow laughs, sitting in a conference room between visits to patients at Baptist Memorial Hospital.
Her father was a radiologist; her Japanese-born mother worked at the Nissan distribution center here. Because other family members lived in Baltimore, Morrow decided to attend Johns Hopkins University, where she hoped to major in classics and French. Almost as soon as she arrived, however, most of the top classics professors left for another institution, and she was forced to add credits in science and math to complete her degree in French.
That combination steered her toward a career in medicine. “I always loved languages,” she says. “They come easy to me, but science also comes easy to me, and at some point I decided that medicine was the best combination of utilizing social interactions with people and science.”
She applied to the University of Tennessee College of Medicine, as well as a medical school in Chicago, and decided to head north. But after having second thoughts, she returned home to Memphis to discuss the situation with her mother. On the day before she was set to leave, someone broke into her rented trailer. “I decided that was a sign that it was not in the stars for me to go to Chicago,” she says.
Instead, she enrolled at UT, “the place where I really needed to be,” and earned her M.D. there in 1998. Afterward came a residency in internal medicine at the University of Maryland, followed by a fellowship in cardiology at the same school.
Two doctors she hails as “excellent mentors” helped Morrow find her career path. “One was Dr. Jay Sullivan, an amazing cardiologist here, who really pushed me to consider the field of cardiology,” she says. “The other was Dr. Judith Soberman at UT, who was very inspiring.”
Morrow first started working with Cardiology Specialists of Memphis before taking a position with Stern in 2006. She obviously enjoys her work — anyone who spends any time with Morrow sees that — but she notes that cardiology “continues to be a male-driven field. If you look at the physicians listed on the Stern website, you’ll see only two women, Stacy Smith and me. And Smith retired last year. I feel like I am the proverbial last woman standing.”
Dr. Jennifer Morrow and Tiffany Crider, LPN, review heart scans at Stern.
Three or four female cardiologists work for other groups in town, but Morrow thinks her field doesn’t attract women for two basic reasons. In the first place, “it is very procedure-driven. Just as with gastroenterology, you do a lot of ablations and heart catheterizations, and I think that simply appeals to men more than women.”
The main factor, though, is the lifestyle of a cardiologist — or perhaps the lack of one. “We are busier at nights, we are on call more than other fields, and we are required to be at the hospital when anyone is sick,” she says. “You have to think about how you would balance that time with a family. Sure, men think about that as well, but I think it’s less of a pressing concern for them.”
In Morrow’s case, her family includes her husband, Dany Beylerian. A native of France, he is an international dealer of antique textiles, buying and selling tapestries, weaving, and other artwork to collectors and museums. She has two boys, 10-year-old Max and 4-year-old George, and recently added a puppy to the household “just to make things more chaotic,” she laughs. “My second job begins when I come home,” adding that she’s involved in a lot of activities with St. George’s School, which her boys attend, so she decided to focus on diagnostic, rather than interventional, cardiology.
In other words, she’s rarely in the emergency room treating someone who has suffered a heart attack. “I’m predominantly office-based now,” she says. “In fact, Stern is piloting a program where we rotate: This is my week at the hospital, and next week is when I’m at the office. It’s much more efficient, rather than being pulled back and forth. That’s not healthy for any of us. Everyone has their own circadian rhythm, and mine does not involve me being anywhere at 2 a.m. but at home with my family.”
As a diagnostic specialist, Morrow’s job is to look for warning signs and symptoms before it’s too late. That can be an especially challenging task if her patient is a woman.
“Women can certainly have the traditional symptoms — the elephant-on-my-chest pressure, shortness of breath, and pain,” she says. “But I see a lot of patients with a little bit of jaw pain, or their shoulder is aching, or something just doesn’t feel quite right.”
Focusing attention on the unique symptoms presented by women has only happened fairly recently. Morrow gives credit to the American Heart Association, especially its Go Red for Women campaign (see page 53) for “pushing, piloting, and pioneering this new awareness — probably born from a general concept that women’s health is perhaps a slightly different field.”
One problem is that many patients, both men and women, simply refuse to believe they have a heart condition. “So many people are shocked when I diagnose them with heart failure or a heart condition,” she says. “They say, ‘How could this happen to me?’”
Women, in particular, face three unique challenges. For one, it’s a cruel irony that the most effective medications used to treat breast cancer can, in fact, cause fatal heart attacks. A group of medicines called anthracyclines, such as the often-prescribed Adriamycin commonly used in chemotherapy, is actually “cardio-toxic,” as is another drug, Herceptin.
The medical community has finally become aware of this potentially deadly side effect, and cancer patients are now monitored carefully by oncologists and cardiologists. Stern, in fact, has a cardio-oncology program in place now, “so that both specialties follow at-risk patients very closely,” Morrow says.
Another unique heart problem faced by women is postpartum cardiomyopathy — heart failure following a pregnancy or the birth of a child. The symptoms, and death, can occur over a rather long span, from the last trimester of pregnancy all the way to five months after giving birth.
“First recognized in the 1930s, this type of heart failure is still not completely understood,” says Morrow. What’s more, any treatment is difficult during pregnancy, since the medications can be harmful to the fetus. Even if the woman survives, only about half of the patients fully recover their heart function, and up to 7 percent may need a full heart transplant.
The third killer of women is the so-called “broken heart syndrome,” a heart attack brought on by intense physical or emotional stress. The technical term is takotsubo cardiomyopathy — the first word being the Japanese term for octopus, since that’s the distinctive shape of the wavelength on the patient’s electrocardiagram (EKG). It often strikes women who have suddenly lost their husbands or children and is believed to be caused by an abnormal, and prolonged, surge of adrenaline.
“Luckily, this is treatable in many women,” says Morrow. “I think the increasing recognition of this particular disease state has improved mortality rates, because in the past women never sought early care for it. But the earlier we make a diagnosis and start medicines, the better chance you have.”
One of the great advances in heart care has been the development of new imaging techniques. In the past, patients had EKGs to check their heart function. Later came treadmills, sometimes with radioactive dye injected into a vein, to give an actual view of the heart while it was under stress. Echocardiograms provide a three-dimensional image of the heart in action, so doctors can measure blood flow, monitor valve function, and other factors.
Now there is a new procedure, called strain echocardiography, which Morrow explains “actually looks at the heart muscle itself to evaluate it for strain, rather than just looking at the muscle function, heart size, and valvular function.”
Morrow wishes patients would get checked earlier for high cholesterol and other problems. A simple 20-minute scan can provide a “calcium score,” an indication of where blockage may have built up in arteries. Unfortunately, many insurance companies refuse to pay for this test, and even though the out-of-pocket cost is only $99 at Stern and other heart clinics that offer it, “sometimes that $99 is prohibitive for a lot of people,” Morrow says.
It’s always been assumed that blockages cause heart attacks, since they impede blood flow to the heart muscle. Or do they? “We’re still trying to identify which blockages are at-risk,” says Morrow. “In 2019, we are still not really clear about that. We don’t understand which patients with 70 percent blockage are likely to progress to 99 percent blockage, versus which patients with 70 percent can remain stable for the rest of their lives.”
At present, there is no medicine that dissolves blockages throughout the body. The only way to remove them is with surgical intervention, usually by threading special catheters into arteries and veins and using stents — coiled springs that expand the partially (or sometimes fully) blocked blood vessel. That procedure carries its own risks. Pieces of a clot can dislodge as the cardiologist pushes the stent into place, causing another blockage “downstream,” which may be even more dangerous than the initial clot, especially if those pieces end up in the brain. What’s more, before the use of stents specially coated with blood thinners, new clots tended to develop around the stent itself.
We simply have to find a way for patients to have better outcomes,” says Morrow. “You’ve heard it said, over and over again, that the United States has the highest healthcare costs in the modern world, but the worst outcomes.”
One solution, at least regarding heart care, is to follow a healthier lifestyle, so men and women won’t end up as heart patients sooner than they expected to be. Patients need to know their risk factors, which can include their age, family history, race, cholesterol numbers, blood pressure, and amount of physical activity. Some of these can’t be changed; if a patient’s father or mother died from heart disease at an early age, this should be a warning sign to reduce or eliminate the risks that can be controlled. A healthier diet can lower high blood sugar. Medications can control blood pressure, and others, especially statins, can lower LDL (the “bad” cholesterol), though there is at present no medicine that effectively raises the HDL (or “good” cholesterol).
Above all else, stop smoking. And that includes “vaping” too, or the use of the new electronic cigarettes. Morrow, for one, doesn’t trust them because it’s too early to determine what effect that ultimately has on your heart and lungs. “It’s still nicotine," she says. "You’re still incinerating it, vaporizing it, and smoking it, so I have my suspicions about the risks, but we just don’t know yet.”
It all comes down to patients taking responsibility for their own health. “The days of your doctor telling you to do this, or do that, are long gone,” she says. “Our job is to arm people with information, and then allow them to make a decision, along with us. We offer them options, and we sit and make a decision together. I think that’s how healthcareshould be.”
