Written by: Leah Bush
“The historic failings of cardiology to take a balanced approach to research have led to
fundamental flaws in the care for women with heart disease and has cost the lives of many
women.” - The Lancet editorial March 9, 2019
Let’s do some quick word association. I’ll say a word and you tell me the first picture you get in your mind. Ready?
Heart Attack.
Ok, that was two words, but I bet I can guess what you pictured. An older man - probably white with gray hair - grabbing his chest and falling over. Maybe he grabbed his left arm or started breathing heavily. Heart attacks are one of those things that are just ingrained in the zeitgeist due to TV, movies, even books (I’m looking at you, Hatchet). But what if I told you that wasn’t the whole picture? If I said that what you think of as the symptoms of a heart attack are really the common symptoms of a heart attack in a man, but that a woman could experience a heart attack right in front of you and you might not recognize anything resembling those symptoms? In fact, women can have a whole set of symptoms that go unrecognized, untreated, misdiagnosed, or dismissed as benign simply because they never consider that they could be having a heart attack.
I worked as a nurse in a critical care unit and a nurse practitioner in both cardiology and
emergency medicine. I’ve seen heart attacks of every severity in patients of every shape, size, age, gender, and race. Don’t hear what I’m not saying, yes women often do have the classic symptoms of a heart attack - but they are far more likely than men to have very different symptoms. Women are more likely than men to have nausea, vomiting, and indigestion. They may have pain between their shoulder blades or think that they have the flu due to fatigue and weakness. Some will experience extreme shortness of breath without even exerting themselves.
In rare cases, some women will have no symptoms at all. The disparity between men and
women who experience these symptoms ultimately means that women under the age of 55 are 7 times more likely to be misdiagnosed than men of the same age (4).
The misunderstanding and minimizing that women experience surrounding heart disease leads to a disturbing tendency among women - they routinely do not seek care for these symptoms despite feeling that something is wrong. They’ve internalized the minimization of their symptoms to the point that they dismiss their own concerns as unfounded. This is especially concerning when you consider that cardiovascular disease is the leading cause of death in women across the globe, accounting for 30% of all deaths in women (2).
Even if the heart attack doesn’t kill them, their outcomes are far worse. In women with heart disease who do not suffer death, they tend to experience an increased frequency of heart failure and lifelong complications (1).
Women have been found to receive the recommended medical treatment much less often than men when they present with symptoms, and were even noted to be transported to hospitals less frequently with sirens and lights in an ambulance (3). It isn’t hard to understand how a woman could minimize their condition when it doesn’t even seem serious enough to turn the ambulance lights on.
This is worrisome, right? Now, please don’t run to the ER next time you’re nauseated and insist you’re having a heart attack, that’s not the purpose of me writing this. But as women we need to understand what isn’t commonly disseminated to the masses, and we need to pay attention to our bodies. I may say this in every article I write, but I want every woman to understand and be confident in this fact: you know your body better than any healthcare provider. If you have concerns, your provider should take them seriously - and so should you. I am sure you are aware that the traditional risk factors of a heart attack are high blood pressure, diabetes, obesity (insert eye roll here), age, smoking, and family history of heart disease. I guarantee that you have heard these before, and let me be clear, these are significant and important. They are not, however, the end of the story.
Here’s the rest of the story: the American Heart Association has another list of NON traditional risk factors. Would you like to guess who these factors disproportionately impact?
(You’re gonna be shocked. It’s women). These risk factors are not commonly discussed among the general population or known by those who they directly impact the most. In my experience, these risks aren’t even commonly known among the medical community, which makes it all the more vital that women educate other women on these risk factors.
AHA Non-Traditional Heart Disease Risk Factors:
● A history of pre-term delivery
● Pre-eclampsia
● PCOS
● Gestational diabetes or hypertension
● Autoimmune diseases
(These risk factors? Several of these are going to be whole topics of their own here at a later
date)
If you had no idea that any of these factors raised your risk for a heart attack, don’t feel dumb. Until I started researching this on my own I didn’t realize the gravity of these risks either. So, I encourage you to assess your risks with this knowledge as well. Please, please, please find a provider who will listen to you and take your concerns seriously. Because the data is there. The facts are there. Now you know them.
Be your own advocate. As women, we are often the only one we’ve got.
References
1. Dunlay SM, Roger VL, Gender Differences in the Pathophysiology, Clinical Presentation,
and Outcomes of Ischemic Heart Failure. Curr Heart Fail Rep 9, 267-276 (2012)
2. Global Burden of Disease Collaborative Network Global Burden of Disease Study 2019
(GBD 2019) results Institute for Health Metrics and Evaluation, Seattle, WA, USA 2020
Http://ghdx.healthdata.org/gbd-results-tool
3. Lewis JF, Zeger SL, Li X, Mann NC, Newgard CD, Haynes S, Wood SF, Dai M, Simon
AE, McCarthy ML. Gender Differences in the Quality of EMS Care Nationwide for Chest
Pain and Out-of-Hospital Cardiac Arrest. Womens Health Issues. 2019 Mar-Apr;
29(2):116-124
4. Pope JH, Aufderheide TP, Ruthazer R, et al. “Missed diagnoses of acute cardiac
ischemia in the emergency department”. N Engl J Med. 2000; 342:1163-1170.
5. Garcia M, Mulvagh SL, Bairey Merz CN, Buring JE, Manson JE. Cardiovascular Disease
in Women. American Heart Association Journals. 2016 April 15; 118:1273-1293.
About the Author
Leah Bush - ElleTwo Contributor
Nurse Practitioner
Leah Bush is a Nurse Practitioner with over a decade of clinical experience in critical care, cardiac care, emergency medicine, and primary care settings. Her professional identity is rooted in her upbringing as the daughter of a pastor and cardiac nurse educator, experience in varied medical fields, and personal journey as a mother and kidney transplant patient. She has a passion for patient education and a desire to give every patient the care that they deserve but are often denied. This holds particularly true for her female patients, who are often the most overlooked and misunderstood patients in our healthcare system. Outside of work she is a lover of music, documentaries, and LSU football. Her personal heaven is warm buttered bread and a long nap, and her personal hell is matching children’s socks out of an endless sea of laundry. She’s been married to her husband Tony for 11 years, and they have 3 children together - James (10), Rebekah (4), and Henry (2). They’ve recently added another member to their family: a black-and-white house cat named Alfie.