— CardioSmart (@CardioSmart) February 21, 2018
Tears streamed from her deep, blue eyes, wide open with a mix of fear and disbelief.
“This just isn’t possible,” she cried. What she thought was a bad case of indigestion had turned out to be much worse—our cardiac monitor revealed she was having a heart attack.
She’d been annoyed at her friend for calling 911 during a dinner party, but as we loaded her into the back of the ambulance, she gave her friend a hug and thanked her.
Fortunately, our patient survived, but throughout my career as a paramedic, I’ve seen many women not think they were sick, only to learn they were having a heart attack. The frightening truth is that many women don’t receive the same level of education and care that men do when it comes to heart health, and it’s killing them needlessly.
“Women are under-diagnosed in mid-heart attack compared to men, and we’re under-treated even when appropriately diagnosed,” said Carolyn Thomas, heart attack survivor and author of A Woman’s Guide to Living with Heart Disease.
Many don’t realize that heart disease is the leading cause of death in women—more than respiratory diseases and all forms of cancer combined, and a whopping five times as many women will die from heart disease as breast cancer.
And when it comes to recognizing a heart attack—when one or more of the arteries supplying blood to the heart become blocked—many aren’t aware that women experience different signs and symptoms than men do. While two-thirds of men suffer the “Hollywood-style” heart attack with clutching chest pain, many women won’t have any chest pain at all.
Instead, they have many of these symptoms:
>> Nausea, fatigue, or sudden shortness of breath
>> Heartburn or indigestion that’s different than normal
>> Waves of pain in one or both arms or shoulders
>> Pain that moves to the neck and jaw
>> Cold sweats and difficulty sleeping
In “A Typical Heart,” a 2019 short documentary exploring the deadly disparity between male and female heart disease, several women shared their experiences:
“I was typing away and I felt a cramp in my right arm which can be pretty normal, but then It felt like a physical wave I could trace up my shoulder. I was 33, but I never felt anything like this.” ~ Karyna Parsons
“The symptoms leading up to my heart attack were missed. My arm pain was diagnosed as tendinitis. I’m just looking to educate women so that we don’t miss things in the future. Too many women are dying far too young.” ~ Heather Evans
“I felt immediate pain on my chest, and intense radiating pain on my neck and my jaw, and going down my arm.” ~ Grace Diersson
“Chest pain, shortness of breath, nausea, sweating, and pain down my left arm. Even I know pain down my arm is not a sign of indigestion. That was my first introduction to getting misdiagnosed.” ~ Carolyn Thomas
But things are beginning to change. In 2018, the Heart and Stroke Foundation of Canada released the Ms. Understood report—the first to acknowledge that health systems were not well equipped to diagnose and treat women with heart disease. They concluded that heart attack symptoms go unrecognized in 53 percent of women.
While women’s hearts look the same as men’s, there are significant differences in the way heart disease affects female hearts.
“Women tend to have disease in the small vessels of their heart, while men are more likely to have disease in their major arteries,” said Dr. Tara Sedlak, Director of the Leslie Diamond Women’s Heart Health Centre in Canada.
This disease of the small arteries, called microvascular disease, is often missed on an angiogram—the standard diagnostic tool used to detect heart disease. It’s three times more common in women than men, and those who have it are at much higher risk of heart attacks and death.
According to The American Heart Association’s Go Red For Women Movement, younger women are at risk more than ever before.
“Cardiovascular disease is not just a problem for older women or men. Heart disease and stroke can affect a woman at any age, and new research shows heart attacks are on the rise in younger women.”
Even when women have more classic symptoms of a heart attack, healthcare providers and many women themselves don’t believe it could possibly be a heart attack. This can be catastrophic—early heart attack symptoms are missed in up to 78 percent of women.
“Gender bias still exists—physicians may look for other causes of women’s symptoms without first doing appropriate tests to rule out cardiac issues,” Dr. Sedlak warned.
Traditionally, most of the research and testing have been geared toward men. Only recently have risk factors specific to women gained attention. Those related to pregnancy, menopause, and depression have been underappreciated, as have other causes of heart attacks much more common in women—such as spasms of coronary arteries and small tears that develop inside of them that block vital blood flow to the heart muscle.
Because these are frequently missed, many women suffering heart attacks don’t get the help they need—often told by doctors that there’s nothing wrong, only to be sent home with a diagnosis of indigestion or anxiety.
Even if women are appropriately diagnosed with a heart attack, they’re not getting the same care that men receive.
“After a heart attack, women tend to not have the same type of investigations that a man might have. Similarly, they’re not sent home on the same life-saving medications that we know prevent another heart attack,” said Dr. Kara Nerenberg, Assistant Professor at the University of Calgary.
Here are some ways women can empower themselves when it comes to heart health:
>> Improve awareness and understanding of women’s heart health. Misinformation among doctors and patients is leading to unnecessary loss of life.
>> Advocate for yourself by speaking with your doctor about female-specific heart health issues, and ask lots of questions. Making sure you and your doctor are on the same page makes you a better advocate for yourself and others.
>> Consider adding early heart health checkups to your self-care routine. Women learn to do self-exams for breast cancer at a young age, yet heart disease is deadlier.
>> Incorporate a heart-healthy diet and exercise to improve overall health.
>> Women don’t have to go it alone. Reaching out to other women for support and information can only be helpful, as many women are having similar experiences.
>> Learn the risk factors as well as the signs and symptoms of a heart attack common to women—and take them seriously.
>> Women survivors say that they knew weeks before their heart attack that something was wrong. Trust what your body’s telling you—you know best when something’s not right.
Don’t ignore the signs and symptoms—the life you save may just be your own.