"I thought I was almost invincible... and then I suddenly collapsed in the middle of the gym and no one really knew what was wrong with me."
Caitlin Lawrence's life changed in an instant when, at the age of 22, she suffered a serious heart attack before an important netball match.
As a woman who seemed completely healthy and in good physical shape, she never thought she might have heart problems.
But, that is a common misconception.
Cardiovascular disease is the leading cause of death worldwide in both men and women, but experts warn that women are often unaware that they may be at risk.
Caitlin says the day she collapsed in October 2023 will forever remain one of the most important in her life.
She doesn't remember the actual warm-up before the game, only that she felt a little sick.
"The next thing I remember is the paramedic's head above my face," says the 24-year-old from London.
After she collapsed, she was unconscious for six minutes.
"They really didn't know what was wrong with me," she says.
Examinations determined that she had a heart rhythm disorder, so she was implanted with a small device (implantable loop recorder) which continuously monitors the electrical activity of the heart.
Over time, she gradually started playing sports again.
However, in August last year, after a netball match on a hot weekend, she was called from the hospital because her doctor noticed worrying heart rate readings.
The device recorded a serious arrhythmia - a heart rhythm disorder.
Her heart rate was as high as 294 beats per minute for 11 seconds, which is well above the normal range of 100 to 170 beats per minute for people her age during physical activity.
Doctors told her it could have been fatal.
She was diagnosed with a rare heart disease - arrhythmogenic cardiomyopathy, which means that heart muscle cells do not develop properly.
Until then, Caitlin didn't know that the disease ran in her family.
Doctors also told her she would never be able to play netball professionally again.
"That was the worst thing I could have ever heard," she says.
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"It's not a disease of old men"
Cardiovascular diseases in women are often not diagnosed and treated, warns the World Heart Federation (WHF).
The reason, they say, is mistaken beliefs and lack of awareness, both among patients and healthcare workers.
"Every day we see women who are completely unaware that they have a cardiovascular problem," says Borjana Pervan, WHF's chief operating officer.
Heart attack symptoms, which can often be the first indication of an underlying disease, are more difficult to notice in women than in men.
The most common symptom of a heart attack - chest pain - is not always noticeable in women.
Instead, pain in women can be widespread and spread to the shoulders, neck, jaw, arms, stomach, and back.
Women may also experience unexplained anxiety, nausea, dizziness, shortness of breath, palpitations (feelings of a strong and rapid heartbeat), and cold sweats.
These symptoms are often preceded by unexplained, severe fatigue.
Health care workers may also not notice symptoms.
Pervan says she has seen countless examples, including a 27-year-old patient who had recently given birth and whose symptoms were wrongly attributed to postpartum depression.
"Women are less likely to go to the hospital when they experience symptoms," she says.
"They are less likely to receive urgent and appropriate treatment compared to men, and even when they do reach hospital, they have lower survival rates."
According to WHF data, cardiovascular diseases are the cause of 30 percent of all deaths in women.
The British Heart Foundation says that data from 2021 shows that more than nine million women worldwide died from cardiovascular disease that year, more than the population of Switzerland.
"This is not a disease of older men. That's a very dangerous assumption," says Pervan.
How to prevent cardiovascular diseases?
Hereditary heart diseases, like the one Caitlin has, account for about 20 percent of premature deaths from cardiovascular disease, says Pervan.
Lack of awareness about heart disease further increases the risk, which is why it is important for people to know if they have a family history of these diseases, she emphasizes.
The remaining 80 percent of premature deaths can be prevented by introducing better nutrition and more physical activity, limiting alcohol intake, and quitting smoking.
"But a big part of the problem is both social and systemic, because it's not all about people's personal choices about what they eat and what they buy," Pervan says.
The risks are further increased by the lack of clinical trials for women, poor information, and limited access to healthcare.
About 80 percent of deaths from cardiovascular disease worldwide occur in low- and middle-income countries, partly due to a lack of early detection programs, according to the World Health Organization (WHO).
While in most areas more men than women die from cardiovascular disease overall, in parts of the Middle East, North Africa and sub-Saharan Africa, such as Qatar, Mali and Congo, the situation is reversed and the death rate is higher for women.
"It's the muscle that keeps you alive"
Caitlin now has a cardioverter defibrillator implanted, a device that constantly monitors her heart rate.
If it detects another life-threatening heart rhythm disorder, the device will deliver an electric shock to return her heart to a normal rhythm.
Having survived the worst day of her life, she is determined to prevent the same thing from happening to other netball players.
Thanks to a campaign led by the Netball Players Association and the charity Cardiac Risk in the Young, the British Netball Super League has agreed to introduce cardiac screening for female athletes.
She says her experience has also taught her that young people need to be more aware of their heart health, "because it's not talked about enough."
If you feel your heart pounding, feel like it's going to jump out of your chest, or suddenly faint for no apparent reason, you should first get a heart checkup, advises Caitlin.
"It's a muscle that keeps you alive, so you need to control it regularly," she emphasizes.
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