- 2 days ago
Women are disadvantaged in healthcare — in some cases due to different symptoms in women than in men. This is especially true for heart conditions, where women even face lower survival rates after cardiac arrest.
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00:06uh-oh walking down the street and suddenly cardiac arrest your life could now depend on a passing
00:12stranger able to perform cpr and get your heart beating again but if you're a woman
00:18don't get your hopes up a potentially deadly gender gap on in good shape
00:38cardiac arrest can hit anyone at any time but women are far less likely to survive it
00:44passes by are more reluctant to perform cpr on them but why people are more hesitant when it
00:51comes to a woman's chest especially men i guess there's generally more inhibition
00:57men might be afraid of lady being accused of say sexual assault
01:03a situation paramedic sandro witt wants to change he teaches cpr courses for firefighters
01:10his equipment includes something of a rarity a female mannequin
01:17men have a survival rate of around 20 percent but women just 12 and a half percent
01:23a study conducted in the netherlands showed that women who suffer cardiac arrest died twice as
01:28frequently as men because passers-by are less likely to try to resuscitate them and another
01:34factor says gender medicine specialist claudia schmidtke is people failing to recognize the
01:38emergency when a man collapses we assume there's something seriously wrong but with a woman we tend
01:47to think she's just feeling faint there's that underlying assumption that men are sicker than
01:53women not just mean i think i think i think it's phone it's under a bit has also found that
01:58a lot
01:59of potential first aiders are wary of exposing a woman's chest in order to perform potentially
02:04life-saving compressions the name that they have seen and i thought you simply pull the bar up and out
02:09of the way what the area where i'm going to press has to be completely bare skin i need to
02:14start in the
02:16process in a lot of cases he says that inhibition prevents women from receiving the help they
02:21need people might avoid physical contact for cultural reasons it's more a fear of someone later
02:29accusing them of inappropriate conduct everyone is now familiar with the me too movement and people
02:38might be reluctant to touch or undress a woman and to expose the chest in order to perform cpr
02:49whether you're a first responder or a member of the public the first step is to remove any
02:54clothing that's in the way and then place your hands at the correct compression point
02:58sandrovitz says one question comes up repeatedly in his courses what do i do if a woman has breast
03:06implants the compression point is always the same regardless of what's on either side
03:11on the side look at my post-line the first one runs from here down to here you can either
03:17measure a
03:17third of the way up or take two fingers and place your hand above them otherwise there's no difference
03:26between performing cpr on a man or a woman firefighter corinna ahrens explains
03:34regardless of how big a woman's chest is you're inevitably going to come into contact with her
03:39breasts you have to ignore that and remind yourself that it's just skin with fat or muscle tissue
03:45underneath defibrillators are a vital aid now available in many public places they support
03:52resuscitation efforts by delivering electric shocks to restore the heart's rhythm
03:56yeah it's like yes ordinary providers of first aid like us just see someone lying on the ground
04:01who needs to be resuscitated and whether the heart has stopped completely or is in fibrillation
04:07is something the defibrillator can detect by performing an analysis of the heart
04:12and if it detects a cardiac arrest or fibrillation and a regular heartbeat the device will recommend an
04:19electric shock which after warning people to stay clear it then delivers
04:26it's like ideally the shock gets the heart beating again but cpr needs to continue until emergency
04:33crews arrive and take over helping more women to survive cardiac arrest starts with passers-by
04:40taking decisive action because prompt intervention can mean the difference between life and death
04:47there's also a difference between men and women when it comes to the symptoms of a heart attack
04:52typical warning signs for men at least are pain and tightness in the chest
04:57but for women it's different they often have pain in the upper abdomen or neck nausea vomiting and
05:03shortness of breath and women also face disadvantages in the ct scanner calcium deposits in their arteries
05:12tend to be smaller than in men and therefore appear less dangerous but the risk of a heart attack is
05:18similarly high in all too many cases heart issues in women are either misdiagnosed or detected too late
05:28for christina schaff light physical activities are no longer a major challenge
05:33but just a few months ago exertions like these would leave her short on energy and on breath
05:41it might be while just having a chat or talking while out on a walk there's always this moment when
05:47i feel i'm running out of breath so it's like right now and then i have to take a deep
05:52breath to get
05:53an affair christina's been living with these troubling symptoms for the past 30 years and often feels
06:00exhausted and drained her family doctor couldn't provide an explanation but then a colleague covering
06:09for him referred her to a cardiologist who in turn sent her to hospital there doctors at the cardiac
06:16catheterization lab inserted a thin tube through her veins and into her heart enabling them to detect any
06:22narrowing caused by calcium deposits in the arteries but they found nothing unusual the major coronary
06:28arteries weren't obstructed christina's symptoms persisted and she spent the next seven years trying and
06:34failing to find an explanation every single doctor said we don't know why you're so weak why your energy
06:43levels are so low and why you have all these symptoms they insisted it couldn't have anything to do with
06:51the heart but one physician refused to give up michael becker heads germany's first dedicated women's heart center he
07:02continued looking for the cause of christina shafts shortness of breath and tightness in her chest
07:07the cardiologist wasn't convinced by the results from the catheterization lab
07:16it's misleading because we've seen that you don't have any calcification which i in any case
07:21wouldn't have expected you're young physically active and have very few risk factors so we have
07:27to keep looking that's the crucial thing and something that doesn't occur to a lot of people
07:34for two days the doctor put his patient through a series of tests
07:39from blood pressure monitoring to recording her heart's electrical activity and using ultrasound to
07:45examine the organ exhaustively
07:50like her previous cardiologists he initially found nothing but one thing did occur to him
07:58with symptoms like these chest pressure shortness of breath palpitations especially in the evening or
08:05while the patient is resting you should also be considering coronary microvascular dysfunction
08:11that something is affecting the heart's smallest blood vessels that suspicion prompted him to order a
08:17further examination at the catheterization lab this time with the focus not on the major coronary arteries
08:23but on the far smaller ones that supply oxygen to the deeper layers of the heart muscle
08:29a provocation test is used to assess how the blood vessels respond to a specific substance
08:36the vessel should dilate which is how the body is supposed to react
08:44but you can see here how it actually goes into an extreme spasm which means far less blood
08:50reaches that area of the heart the eventual diagnosis vasospastic angina pectoris involves chest pain
09:01caused by a malfunction of the small coronary vessels due to them either not widening or dilating
09:07properly or suddenly seizing up in a spasm doctors can't say why this happens but do know that women
09:15are disproportionately affected over time the condition can damage the heart muscle
09:23and as cardiologist christina pietazoglu explains it can become especially dangerous if the small
09:29arteries have already incurred damage from calcification
09:37women with calcified vessels who are more prone to vascular spasm have a higher risk of heart
09:43attack which is what makes early detection and treatment so important it's the only option for
09:49heart attack prevention she and her team set up a consultation program specifically for women's heart
09:56health but making a diagnosis she says is further complicated by the fact that men and women often
10:02experience different symptoms typically angina pectoris symptoms occur on the left side of the chest
10:08and can radiate into the left arm or the left side of the neck but women more often experience pain
10:13on
10:13the right side of the body because their hearts beat differently so you need to be aware of that
10:18difference in symptoms the general risk factors for cardiovascular disease however are the same for men and women
10:29high blood pressure obesity diabetes unhealthy cholesterol levels smoking and stress all damage the coronary vessels
10:39in men the larger vessels tend to be more affected in women the smaller vessels are plus the drop in
10:46estrogen levels during menopause causes women's blood vessels to grow less elastic
10:52all of these factors can combine and contribute to spasms in the smaller blood vessels
10:58but we still have no single explanation for why this is likelier among women
11:04in christina scharf's case the cause is even more perplexing as she has none of the classic risk
11:09factors but what she does have is a strong awareness of her own body
11:16i knew something was wrong because the spasms in the heart area had been getting worse in recent
11:23years and that's why i never gave up a range of doctors had suggested her symptoms were actually
11:34psychological which she never believed and then she got her confirmation here at the rheinmaas hospital
11:41near the city of aachen first up you're not hysterical or crazy the second bit of good news is that
11:50we've
11:50now found the cause and third we can treat it effectively christina scharf is now taking calcium
11:58channel blockers which improve blood flow to the heart by relaxing the blood vessels the dosage is
12:04still being fine-tuned but she already has a lot more energy and stamina as if a clenched fist around
12:10her heart has now finally relaxed
12:17regular exercise is good for your heart whatever your sex but women's hearts benefit more from sport
12:24which also applies if you already have heart disease women have stronger immune systems
12:31which means better protection against infections though that also means greater risk of allergies
12:37and autoimmune illnesses many health issues women face are linked to menstruation but the topic remains
12:45taboo in many places and period pain is often dismissed as something women just have to live with
12:52allowing serious conditions to go unnoticed
12:58selene is 27 since she was 12 she's lived with a condition that went undiagnosed until just a year ago
13:07selene began menstruating at a young age and it hurt on some days the pain was so intense she had
13:13to skip
13:13school for years doctors didn't take it seriously
13:19it was very difficult and also hurtful because they kept saying they're just period pains as a woman
13:25it's something you simply have to live with
13:29she started taking the contraceptive pill early on for a while it made the symptoms manageable
13:38at 24 she had a child everything was fine until she began menstruating again afterwards and the pain returned with
13:48a vengeance
13:50it was so intense that i could only get through those days with painkillers
13:55it radiated into my leg and sometimes i could barely move it
14:00selene started going to a different gynecologist
14:04during an ultrasound exam a new doctor spotted something suspicious a possible tumor on her ovary
14:13it was a real shock i was really frightened and didn't know how to deal with it
14:20the doctors told me that based on my age they assumed it was benign
14:26but that they wouldn't know for sure until they'd removed it
14:29first when he's outside she was referred to dresden university hospital for further treatment
14:38there dr paulina wimberger initially suspected a cyst
14:42but in selene's case only a laparoscopy a minimally invasive surgical procedure
14:47could provide a definitive diagnosis i wanted the surgery because i wanted the pain to finally end
14:54end the hub the procedure confirmed suspicions the surgeon found a four centimeter wide cyst on her
15:02ovary and removed it and that wasn't all wimberger also discovered more abnormal tissue that helped
15:09explain selene's symptoms we also found lesions on the peritoneum and on the ligaments behind the
15:18uterus that extend toward the bowel all of these lesions were removed completely
15:26the diagnosis was clear selene has endometriosis a chronic inflammatory disease
15:35in women with the condition tissue similar to the lining of the uterus grows outside the organ
15:41the rogue tissue most commonly appears in the abdominal cavity and on the ovaries lesions can
15:47also develop on the bladder or the bowel because these growths respond to hormonal cycles
15:54they bleed during menstruation and trigger local inflammatory reactions which can cause severe pain
16:01the inflammation and symptoms can turn chronic and lead to bands of scar tissue called adhesions
16:10at last selene knew what the cause of her suffering was
16:18when i finally got the diagnosis i felt relieved i now knew i hadn't imagined it there really was
16:25something wrong all along the very small lesions can't be seen on ultrasound images but when all the
16:34visible lesions are removed patients often experience significantly fewer symptoms after the surgery
16:44the exact causes of endometriosis are still unknown at leipzig university hospital julia
16:50bartley and a team of microbiologists are investigating whether infection may play a role in the development
16:56and progression of the disease
17:00we know it's estrogen dependent and can affect women during their reproductive years
17:05but why some develop endometriosis lesions and others don't remains a major question
17:11and that makes it difficult to treat the root causes of the disease
17:17but help is available julia bartley emphasizes how important early diagnosis and effective treatment
17:24are for the patients affected chronic pain is much harder to treat than acute pain
17:34and consistent pain management can also help prevent secondary conditions
17:39such as depression which can result from severe and recurring pain
17:47it took selene 15 years to receive proper help
17:51she now takes medication daily containing the hormone progestin
17:57the goal is to reduce the buildup of uterine lining tissue
18:01that can help prevent new lesions from forming and to relieve symptoms
18:08i used to be constantly exhausted my partner at some point noticed that i was going to bed every
18:15evening at eight o'clock we hardly had any time together anymore
18:20since starting the medication that's changed i no longer feel as weak tired and drained
18:26i'm much more active than before back then i spent almost all my free time sleeping
18:36endometriosis is a chronic inflammatory condition
18:40so a diet rich in anti-inflammatory vegetables can also have positive effects
18:46when i pay attention to my diet and reduce stress i have far fewer symptoms i'm no longer exhausted and
18:55have much more energy
18:58stretching helps relieve pain as well and yoga has taught her an important lesson
19:03to take care of herself even when she's feeling stressed out
19:10men and women differ when it comes to athletic performance too
19:14disparities in bone and tendon strength make women more prone to injury
19:20men generally have more muscle mass giving them an edge when strength is a key factor
19:26but when it comes to skill and technique there's precious little to separate the sexes
19:31women's muscles tend to tire more slowly granting them superior endurance for competitive athletes
19:38this has an impact on training as does another gender related issue
19:46franziska ulrich lives and breathes sport
19:49she's preparing for her next high rocks competition a demanding mix of body strength and endurance events
19:54and her menstrual cycle is an important factor in her training regime
19:58i started tracking my cycle six years ago
20:03i see how i'm feeling and try to incorporate it depending on what phase i'm currently in
20:09and if it's a particularly intense phase i factor it into my training
20:14many women now use apps to gain insights into their cycle and not just athletes
20:20it's become a huge topic on social media too the aim being to customize your workout for each phase
20:26of menstruation in order to maximize performance but is it really that straightforward
20:33sports scientist edward isenmann has carried out studies on the question
20:37he's glad to see the relatively new development for cycle-based training getting so much attention
20:43when it comes to research women remain significantly underrepresented in both sports medicine and
20:50sports science so we have relatively little data on the potential effects of the menstrual cycle for
20:55example and there are also inconsistencies in that data the menstrual cycle typically lasts 28 days
21:04it begins with menstruation when levels of estrogen and progesterone are relatively low and many women
21:10experience unpleasant symptoms the follicular phase sees a rise in estrogen and in most women in
21:16their strength and energy levels too during ovulation those physical performance levels peak
21:23and during the luteal phase the estrogen level falls while progesterone rises and energy levels can drop
21:31the sports scientist says that training regimes need to be flexible and focus more on how the athlete
21:37actually feels instead of cycle-based programs he recommends cycle sinking
21:44a better approach is cycle aware training because there's enormous variation both from one cycle to
21:50the next and also between different women so you really have to treat things on an individual basis
21:57for franziska ulrich that currently means shifting down a gear
22:01she's in the second half of her cycle and isn't feeling a hundred percent
22:07when my period is about to start i might take an extra rest day if i feel my body needs
22:13it
22:14because it's working incredibly hard and burning a lot of energy
22:17i do less strength training and run shorter distances and do more cycling to give my ligaments some relief
22:24i do more repetitions but with lighter weights which all means adapting her training program
22:33that high rocks meet is coming up soon the eight disciplines awaiting her include strength and
22:38endurance challenges can athletes use their cycle to prepare more effectively a question that new
22:44studies aim to answer people used to insist on strength training in the first phase of the cycle
22:52due to the expected greater benefits but newer studies suggest that's oversimplified what we do
22:58know is strength training is generally important and that training needs to be consistent
23:04knowing her cycle also helps franziska on the mental front when her performance fluctuates
23:09she's not as tough on herself sometimes i'll feel weaker or i feel like things just aren't going
23:15well that day even though i'm doing the same workout as the week before but because i know
23:20which phase of my cycle i'm in i try to be a bit gentler with myself sports psychologist jana
23:26strahler understands that situation psychological factors also play a huge role in both our performance
23:35and motivation monitoring our cycle and understanding when our strong days are and when we might need
23:42more recovery gives us more self-confidence during weaker phases we can be kinder to ourselves and
23:52adjust our routine accordingly football coach julia zimic also says it's important to raise awareness
24:00about the issue she used to be a professional player herself including an eight-year stint at
24:05bayern munich i now see things from a coach's perspective in under 20 teams and at the professional
24:14level in fact in virtually all teams players cycles get tracked by a data collection and the issue is
24:21regularly discussed with the players we've come a long way and above all there's much less of a taboo
24:30the assistant coach of the switzerland women's team says the subject is becoming increasingly relevant
24:36in team sports at the moment it's more about seeing how the players are feeling including
24:44mentally sometimes it means someone might need pushing but also sometimes saying if that's all
24:50you've got today then that's okay just do what makes sense for you as a coach that also helps you
24:58put
24:58a player's performance into context there are a growing number of studies on the subject and understanding
25:06your cycle is always beneficial says researcher zaba shakalio
25:13the menstrual cycle is an extremely sensitive indicator of an athlete's health
25:19one of the first things to be affected when something isn't right is ovulation missed periods are another sign
25:27that's why it's important to track your cycle even if you can't necessarily base your training around it
25:35so the menstrual cycle is one important factor alongside sleep stress and diet and one that's
25:41always worth incorporating into your daily routine
25:47no doubt in good shape is an essential part of your schedule that's a winning routine whatever your gender
25:54keeping you up to speed on all things health related see you next time
26:11you
26:11you
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