Women and Heart Disease: In the ER

Jackie Priaulx was dying. For 10 days. No one knew why. The electrocardiogram (ECG) didn’t show anything. Besides, she was a healthy, 49-year-old woman who was trim and active.

As it turns out, Priaulx was having a heart attack. When doctors finally figured out what was wrong, 10 percent of her heart was damaged.

“I thought I was going to die,” Priaulx said. “How could this possibly happen to me? Never in the world would it have occurred to me to worry about heart disease.”

The first doctor she saw told her it was a virus and sent her home to rest. After crushing heart pains began and she went to the emergency room, another doctor told her it was shingles.

That was only 10 years ago.

Priaulx isn’t the only woman with such a nightmare experience. Women are dying at epidemic proportions because of coronary artery disease (CAD). And part of the problem may be that women, their families and health care providers just don’t recognize the signs.

There’s no mistaking the facts. Each year, 500,000 women die of heart-related illnesses such as stroke and heart attack. And 50,000 more women than men die annually.

Women are dying

Women are 20 percent more likely than men to die in the hospital following a heart attack, according to a study in the Archives of Internal Medicine. Women are also less likely to receive clot-busting (anti-thrombolytic) therapy promptly or undergo coronary angiography, angioplasty or bypass surgery.

“Doctors are trained to diagnose heart disease in men like (Vice President) Dick Cheney,” says Nancy Loving, executive director of Womenheart, a patient advocacy nonprofit group that grew up in the 1990s. “They don’t look for it in women.” Loving, who adds that the gender gap is immense, also is a heart attack survivor.

Symptoms

Heart attack symptoms for women are described in the context of a man’s symptoms. Most commonly, heart attacks in men involve a crushing pain. According to this frame of reference, women have atypical symptoms or, rather, symptoms that are atypical for a man and not for a woman. They can be:

  • A severe discomfort in the lower chest, stomach, jaw, arms and shoulder
  • Nausea, dizziness, shortness of breath
  • Difficulty breathing without chest pain
  • Unexplained feelings of anxiety, weakness or fatigue without chest pain
  • Palpitations, cold sweats or paleness without chest pain.

Sixty-three percent of women who die suddenly from coronary heart disease, caused by a build up of fat and cholesterol in the arteries, don’t have warning symptoms. Early detection through the monitoring of risk factors, such as smoking and diet, and the testing for cholesterol levels may be the among the best ways to prevent heart attack and stroke deaths in women.

But that’s not happening.

Loving blames part of the problem on what she calls “bikini medicine,” where mammograms and pap smears are emphasized.

“Many women stay much too long with their OB/GYNs and use them as their primary care doctors,” she says. “They don’t see an internist until their mid-50s when their heart disease is more advanced than men’s.”

Survival

And because diagnosis is made later than in men, the prognosis for survival is considerably lower, according to Jennifer H. Mieres, M.D., director of nuclear cardiology at North Shore University Hospital in New York. She is a nationally recognized expert on heart disease in women.

At least 40 percent of women who have heart attacks die within one year compared with 24 percent of men, according to the Agency For HealthCare Research and Quality.

That’s because many women get less aggressive treatment. A recent study done for the first time by The American Heart Association found more women than men die each year of heart disease, with women receiving only 42 percent of all cardiac and vascular surgeries and procedures, 29 percent of bypass surgeries and 39 percent of angioplasties. Women are more likely than men to die after a heart attack or bypass surgery and often do not receive appropriate care or medications after these events.

Different needs

Compounding the ignorance factor is that women test differently on the exercise ECG due to variable factors such as hormonal status and exercise capacity, Mieres said. Often, an ECG does not pick up the telltale signs of a heart attack. It could be different physiologies, hormones or even less sensitivity to the test. Among the best way to look for the problem is through cardiac imaging with exercise or pharmacologic stress tests.

Even heart disease studies have historically been based on men. A recent clinical trial for artificial heart transplants only included men. To have women in these trials is important, Mieres says. Women’s physiology is different from a man, with heart and body size possibly playing a role.

Although heart disease research had been done for decades, women still weren’t being included in clinical trials until 1990 when Congress directed the National Institutes of Medicine to include women.

But today only 25 percent of participants are women for reasons such as pregnancy, family demands, work obligations and, most importantly, the misconceptions that heart disease is a man’s problem.

So what does this all mean?

“We can’t sit around, waiting for the doctors to be retrained,” said Loving of WomenHeart. “Women need to know what questions to ask, how to keep themselves healthy and how to take charge of their health. ”

External Sources

WomenHeart
The American Heart Association
The American Stroke Association
The National Heart, Blood, and Lung Institute
The National Cholesterol Education Program
The Women’s Health Initiative
The National Women’s Health Resource Center