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

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 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 have died from the 99 percent blockage present in one of her critical heart arteries - now flowing fine with a cardiac stent in place.

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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. First of all, chest pains in women are too often dismissed as due to stress, anxiety or a muscle strain. Secondly, the classic signs of a heart attack (left sided chest pain with radiation of pain 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, lightheadedness and sweating. Women can be having a heart attack and experience no chest pain at all. Women also report having vague non-specific 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."

Question: I am an HIV positive man diagnosed in 1999 who has done great with anti-viral medication to the point that my HIV 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? - L.E., San Francisco

Answer: While the story of Timothy Brown, an HIV positive American (diagnosed in 1995) living in Berlin who was cured of all HIV virus from his body provides us with hope that we will one day have a cure for HIV infection, we are not there yet. Timothy 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 Dr. Gero Hutter in Berlin came up with a revolutionary treatment idea. Dr. Hutter and his team found a very specific bone marrow donor with a novel genetic mutation that provides complete immunity against the HIV virus. In 2006, Mr. Brown underwent a bone marrow transplant in which he received bone 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 Mr. Brown cancer-free but he is HIV free. This is different from your situation, where the virus is undetectable in your bloodstream but presumably still present in various tissues throughout your body. Mr. Brown received biopsies of brain tissue, intestines, liver, lymph nodes and bone marrow that all confirmed complete eradication of the HIV virus. Two HIV-positive Bostonians may who recently underwent bone marrow transplantation for leukemia are also showing no traces of virus in their new immune systems. Unlike Mr. Brown, their bone marrow transplants did not have the CCR5 mutation, so they are still taking HIV medication as a precaution against possible dormant virus in their tissues.

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

Dr. Mitchell Hecht is a physician specializing in internal medicine. Send questions to him at: "Ask Dr. H," P.O. Box 767787, Atlanta, Ga. 30076.


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