The Reality Of Heart Disease: A Wake-Up Call For Women

The Reality Of Heart Disease: A Wake-Up Call For Women

In a timely opinion piece in The New York Times Sunday Review, “A Woman’s Heart Attack,” (September 28) Martha Weinman Lear LEA +0.45% eloquently describes her own journey of self education and a newly found awareness after experiencing what her own physician believes may be a viral syndrome, not recognizing the often subtle symptoms of a heart attack–which included nausea and vomiting, chest pressure, back pain, dizziness, and even diarrhea with chills.

Yes, even symptoms that seem like a stomach flu could potentially represent early signs of a heart attack in women.

As an practicing emergency medicine physician, I can attest to taking care of many women who seek care in the emergency department in a delayed fashion, in some cases days after experiencing such atypical symptoms as described above.

Part of the delay in deciding to see a medical provider may be from a patient’s lack of understanding of her symptoms; however, lack of knowledge of women’s unique heart attack symptoms by some medical providers may also account for some of the delay as well, as Lear clearly outlines in her essay.

“With more women dying of heart disease than all cancers combined, we have an obligation,” explained Dr. Suzanne Steinbaum, 
Director of Women’s Heart Health at the 
Heart and Vascular Institute, Lenox Hill Hospital in New York City. “It is hard to hear story after story of women who have suffered because of lack of awareness, lack of understanding and lack of adequate, aggressive and expedient treatment from the medical community.”

Lear also points out two important myths regarding diseases which kill women.

The first myth is that breast cancer is the top killer of women. Actually, heart disease is the number one killer and is responsible for more deaths among women than all types of cancer.

The second myth is that men and women experience similar symptoms when it comes to heart attacks. The truth is that women often do not experience crushing chest pain, but instead more often experience nausea and dizziness. Their chest pain may often be described as chest pressure radiating to the throat and accompanied by nausea.

Women also more commonly experience fatigue and restlessness or insomnia as presenting complaints with an impending heart attack. And, based on data and studies, women are more at risk of death within a year after having a heart attack. In fact, as Lear correctly points out, “men will experience more heart attacks as a whole, but a greater percentage of women die of them.”

The truth is that most women who experience heart attacks do not experience the classic “Hollywood” heart attack as Lear describes the symptoms of her husband’s heart attack, characterized by crushing or squeezing chest pain pressure or difficulty breathing.

“Women’s hearts have notoriously been neglected, and as heart disease remains the number one killer of all women, we must objectively understand this battle and do something about it,” explained Steinbaum. “Women’s symptoms are often much more subtle than the man’s typical squeezing chest pain, and they are not only difficult to diagnose from the doctor’s perspective, as the patient herself is not aware.”

The National Institutes of Health (NIH) recently set aside over 10 million dollars in grants for research to place more women in clinical trials, as women make up less than a quarter of participants in current cardiac research trials. This represents an important step to remove existing gender bias in both preclinical and clinical trials.

“As only 25% of participants in trials on the heart include women, it is necessary that women be included in research which is done to help generate new information about women’s hearts,” explained Steinbaum.

“We have failed women and their hearts, and it is about time we make up for it,” added Steinbaum.

Based on data that over 400,000 women annually have heart attacks, it is so important that medical providers educate women about the various signs and symptoms that accompany them.

Such symptoms as vague and persistent nausea along with vomiting, as well as dizziness that begins spontaneously could signal a heart attack. Chest pressure along with abdominal pain, back pain, and even persistent gastrointestinal symptoms including diarrhea need to be evaluated as well. Certainly these symptoms could be something other than a heart attack, but being aware that women can develop atypical symptoms is vital to prevent unnecessary delays to medical care.

The American Heart Association’s Go Red  campaign has been instrumental in raising awareness among women regarding the signs and symptoms of heart attacks, along with the importance of  avoiding delay to treatment.

The important message is not to delay if you experience a symptom that is not in your norm and becomes persistent, as Lear correctly points out. I applaud her efforts to raise awareness of heart disease among women.

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