Our expert is C. Noel Bairey Merz, MD, FACC, FAHA, Women’s Guild Endowed Chair in Women’s Health, Director, Barbara Streisand Women’s Heart Center & Linda Joy Pollin Women’s Heart Health Program, Cedars-Sinai Medical Center; Professor of Medicine, UCLA Geffen School of Medicine.
If there is a medical topic you would like to see explored here, please let me know!
HEART DISEASE IS A WOMAN’S DISEASE
In the 1950s, we all thought heart disease was a man’s disease. However, more women are dying of heart disease than men. Also, even though the mortality rates for both men and women are declining, there remains one group whose heart attack mortality has not declined: women under 50. The fact is, heart disease kills more women at all ages than breast cancer. We tend to be less aware of women and heart disease than we are of breast cancer because someone with breast cancer will typically live a long time, as opposed to a woman with heart disease, who may die suddenly and no longer be with us.
HEART DISEASE PRESENTS DIFFERENTLY IN WOMEN
Part of the reason more women are dying of heart disease than men is that too often we expect the symptoms of a heart attack for a woman to be the same as that for a man. We expect a horrible heart pain that comes on suddenly, the kind where someone is clutching at his or her chest. Then, in the emergency room, when we test the person with an EKG, we’re looking for a big clot in the middle of the artery. While women sometimes exhibit these symptoms, the female pattern for a heart attack can be entirely different. A woman’s heart attack is typically not from a major clot in an artery, but rather at the microvascular level, whereby flow is distributed in such a way that she’s experiencing the coronary obstruction that goes with a heart attack. Women distribute the coronary fatty plaque differently from the way men do, perhaps similarly to how men get beer bellies while women are more likely to have their fat distributed all over as cellulite. The way a woman lays down fat in her coronary arteries often means there’s no visible fat throughout her coronary arteries during a routine coronary angiogram. Even so, it can still mean coronary obstruction of the microvasculature. Standard tests that are designed to look for blockages in the larger coronary arteries don’t generally detect coronary microvascular disease, and the fact that she’s having a heart attack may not at all be obvious. Too often she’ll be sent home with an inaccurate explanation such as, for example, “Maybe it was gas.”
WOMEN DO NOT GET LIFESAVING TREATMENT AS QUICKLY AS MEN
Since a woman may not recognize her symptoms, she may delay going to the emergency room, which means that the lifesaving techniques she needs are not as rapidly available to her. The same problem occurs with her health care providers. Since she may not be correctly diagnosed, she is far less likely to get immediate life-saving treatment. The diagnostic enzymes that would reveal a heart attack in a man may miss the fact that she’s having a heart attack; the male reference standards for these tests are often inappropriate for a woman. As a result, a woman with a heart attack is much more likely than a man to be dead in a year.
EDUCATE YOUR PATIENTS ABOUT THE SYMPTOMS OF A HEART ATTACK IN WOMEN.
Let your patients know that the symptoms of a heart attack for her may be quite different from her image of a heart attack. The symptoms can include:
1 Uncomfortable pressure, squeezing, fullness or pain in the center of her chest. It lasts more than a few minutes, or goes away and comes back.
2 Pain or discomfort in one or both arms, the back, neck, jaw or stomach.
3 Shortness of breath with or without chest discomfort.
4 Other signs such as breaking out in a cold sweat, nausea or lightheadedness.
If she has these symptoms, she should call 9-1-1 and get to the hospital.
TO SAVE LIVES, ADVOCATE FOR ESTABLISHING SEX-SPECIFC REFERENCES
There’s a low hanging fruit for improving health care for women and it is: advocate for gender-specific guidelines for diagnosing heart disease. For that matter, advocate for gender-specific guidelines in every discipline.