The Heart of the Matter

MANY OF US think we’d recognize the symptoms of a heart attack. Movies and television depict heart attack victims clutching their chests, gasping for air and collapsing. The reality for most women heart attack patients, however, is quite different, with symptoms that are less dramatic and consequently downplayed or misdiagnosed. Just ask heart attack survivor Carolyn Thomas.

In 2008, Carolyn was 58 and at the top of her game as a public relations professional and community volunteer. Active and health conscious, Carolyn was out for her morning walk when she suddenly experienced crushing chest pain, waves of nausea, sweating and radiating pain down her left arm. A trip to the emergency room was inconclusive; her cardiac tests, including EKG, blood work and stress test, all came back “normal.” The diagnosis? A bad case of acid reflux and a prescription for antacids. “I went home and continued to experience the same symptoms for a period of two weeks,” recalls Carolyn. “I tried to downplay what was happening, even joking that ‘I better not be having a heart attack!’ but deep down I knew something was seriously wrong.”

Carolyn’s gut instinct was accurate; her second trip to the emergency room confirmed that she’d had a myocardial infarction, and this time test results uncovered significant heart disease. Carolyn was rushed to the operating room and had a stainless steel stent implanted into one of her arteries, which was 99 percent blocked. “What I’ve learned since my heart attack is that many women still mistakenly consider heart disease to be a man’s problem, and sadly, so do some doctors,” says Carolyn. “The first doctor I saw in the ER sized me up quickly and thought I had indigestion. That experience is part of what motivated me to become active as a patient advocate.”

Educating and Advocating

Five months after her heart attack, Carolyn attended the annualWomenHeart Science & Leadership Symposium at the Mayo Clinic in Rochester, Minn. There, she met dozens of heart attack survivors whose stories mirrored her own. Many had also been sent home from emergency rooms, despite having textbook heart attack symptoms (one woman was told she needed antidepressants — she eventually underwent double bypass surgery). “I thought my story was dramatic until I met some of these other women. When I returned, I began blogging about my experience and launched a series of community presentations about heart health, eventually speaking to thousands of women,” says Carolyn.

Lifestyle and Heart Health

By now, it should be common knowledge that an inactive lifestyle and fast food diet are red flags for heart disease risk. But what about lesser known risk factors? One of the biggest surprises about Carolyn’s heart attack was that she already was living what she considered to be a healthy lifestyle. She was a distance runner who watched her weight and diet and considered herself to be in good shape. At 58, her career in public relations was stressful — but no more so than the typical business executive, proving yet again that what you don’t know can hurt you. “I didn’t know that the preeclampsia I experienced during pregnancy increased heart attack risk,” she says. “I learned at Mayo Clinic that women with pregnancy complications are four times more likely to develop heart disease.” Although symptoms can appear suddenly, heart disease actually develops slowly over the course of 20 or 30 years, which means that many young women may experience risk factors that can lead to heart disease decades down the road — when they least expect it.

According to the Mayo Clinic, other risk factors include high blood pressure, high cholesterol, chronic stress, inactivity, diabetes and smoking. The good news: Women who make even simple lifestyle changes can profoundly influence their odds of avoiding a heart attack. These lifestyle changes can include getting regular exercise; eating a low-salt, highfiber diet that is low in transfats; stopping smoking; practicing relaxation techniques; and managing stress.

Gender Disparity in Research

Even though the statistic that heart disease is the No. 1 killer of women is widely touted, misdiagnosis is still common, in part due to gender disparity when it comes to clinical trials and diagnostic tools. Research reported in the New England Journal of Medicine, for example, looked at more than 10,000 patients (48 percent women) who went to their hospital emergency rooms with chest pain or other heart attack symptoms. Investigators found that women younger than 55 were seven times more likely to be misdiagnosed than men of the same age. Part of the problem is that many diagnostic tools widely considered to be accurate in identifying heart disease in men are far less accurate in women, especially when it comes to specific types of cardiac events common to women, including single vessel coronary artery disease; nonobstructive coronary artery disease; and spontaneous coronary artery dissection (SCAD). Up to 80 percent of SCAD cases occur in young healthy women with no cardiac risk factors.

In another study, Toronto cardiologist Dr. Wendy Tsang reviewed landmark cardiac clinical trials published over a 10-year period in the Journal of the American Medical Association, The Lancet, and the New England Journal of Medicine. She found that although women comprise 53 percent of patients with cardiovascular disease, in clinical trials they represented only 34 percent with cardiac arrhythmias, 29 percent with coronary artery disease, and 25 percent with congestive heart failure. “Our study shows the proportion of women enrolled in landmark cardiovascular clinical trials is substantially lower than you would find in the general disease population,” says Tsang. “What is even more of a shock is that this underrepresentation has not drastically changed over the past decade.”¹

Many women are not alone in their ignorance. In a 2005 American Heart Association study, physicians were asked if they were aware that cardiovascular disease kills more women than men each year. Only 8 percent of family physicians and 17 percent of cardiologists were aware of this fact.

“Without accurate gender-specific diagnostic tests, how can our physicians even begin to decide on appropriate life-saving treatment, drugs or devices for us?” says Carolyn. “Until these cardiac tests are researched and developed, women heart patients will continue to be sent home from the ER misdiagnosed with everything from indigestion to anxiety or even menopause.”