The winner of the 2021 Clarence W. Sorensen Distinguished Dissertation Award is Dr. John R. Blakeman, Ph.D. ’20, who earned his doctorate in the Mennonite College of Nursing. His dissertation, A Holistic Exploration of Fatigue Experienced by Women Before a Myocardial Infarction, explores the warning signs of heart attacks in women.

“Regardless of sex or gender, more people die from heart disease each year than from any other cause.  In fact, on average, every 40 seconds, someone in the United States experiences a myocardial infarction, commonly called a heart attack. For years, we have been trying to find ways to quickly identify people experiencing a heart attack, as the earlier we identify an active heart attack, the earlier we can intervene. 

“Women experience several symptoms in the weeks and months leading up to a heart attack, such as fatigue, shortness of breath, notable decreases in sleep quality, and chest symptoms, like chest heaviness, pressure, tightness, discomfort, or pain. Of these symptoms, fatigue is the most common warning symptom of impending heart attack, experienced by at least three out of every four women who suffer a heart attack.  Of course, all humans experience some degree of fatigue throughout life; we all have a night where we don’t sleep that well, or maybe we have worked very hard and just feel exhausted.  So, on the surface, it seems that it would be difficult to use fatigue as a warning symptom of heart attack or heart disease specifically, since it is such a common symptom. But I wondered if there were unique dimensions of this heart attack-related fatigue that I could identify, so that we could better recognize this symptom. 

“Ultimately, I was able to highlight some key attributes of heart-attack related fatigue experienced by these women, setting the stage for additional research work in the future. The fatigue that these women experienced before their heart attack was overwhelming and new in nature – that is, it was a clear change from how they felt at a baseline. Sometimes, the fatigue became severe and stayed severe over time, while, other times, the fatigue grew worse over time. Most women reported fatigue that started at least three months before their heart attack, though several had fatigue for six or more months prior. They described how they had to stop doing things that they had once enjoyed, such as gardening, and many even noted that this fatigue interfered with their activities of daily living, such as dressing or bathing. Some described falling asleep incredibly easily, and others noted that they did not have enough energy to walk more than a few feet. Most often, this fatigue was described narratively as severe tiredness or as a lack of energy, though a few women described how the fatigue made their brain feel “foggy” or “cloudy.”  One critical takeaway is that the majority of the women experienced this symptom for months prior to their heart attack. We have time to intervene. If we can do a better job of helping women recognize this overwhelming, unusual fatigue as a heart attack symptom, and if we can make sure health care professionals also realize how important this symptom is, we can hopefully reduce the number of heart attacks that are occurring.”

The annual Sorensen Distinguished Dissertation Award is sponsored by the Graduate School of Illinois State University.