Why do doctors ignore signs of heart attacks in women?

Publish date: 2024-05-05

On an episode of “Grey’s Anatomy” earlier this month, Dr. Miranda Bailey (played by Chandra Wilson) heads to the hospital convinced she is having a heart attack. But her male doctor is dismissive of her complaints and recommends she see a psychologist. Determined to be believed, Bailey goes to a second hospital to get the care she needs.

A new study published this month in Circulation, a journal of the American Heart Association, confirms Bailey’s concern that women have to fight hard to get proper medical treatment. Research by the Yale School of Public Health found that physicians are more likely to disregard heart-attack symptoms in younger female patients versus younger males.

Heart disease — the leading cause of death in the US — kills some 15,000 women under the age of 55 each year. In general, women tend to experience heart-attack symptoms that are more complex than the acute chest pain portrayed in movies. But neck and back aches, fatigue, burning in the chest and nausea — symptoms women may experience with heart episodes — are easy to mistake for overexertion, stress, indigestion or the flu. And often, young female patients and their doctors do, which could be why younger women are twice as likely to die after being hospitalized for a heart attack.

“We need to give better messages, particularly to young women, that there are multiple symptoms, some of which may not seem cardiac-related,” Judith Lichtman, an associate professor of epidemiology at the Yale School of Public Health and lead author on the study, tells The Post.

For the study, Lichtman and her co-researchers interviewed more than 2,000 female patients and nearly 1,000 male patients, ages 18 to 55, who were hospitalized for heart attacks. They found that nearly 30 percent of the women had seen a doctor for similar symptoms prior to being hospitalized, and the majority weren’t told their symptoms could be heart-related. By contrast, only 22 percent of men had previously seen a doctor, and only about a third were told their symptoms may not be heart-related.

Lichtman’s study also sought to gain a better understanding of how young women describe and experience heart attacks, in the hopes of helping clinicians expand their symptom vocabulary.

Alexa Elam is now quite capable of describing the heart attack she had at age 46, likening it to a meteorological map of a hurricane.

“It really felt like I had a swirling cloud under my sternum,” says Elam, who works in publishing and lives in New York City. But she had issues identifying the episode at the time.

Elam, who is now 49, was moving a load of laundry from the washer to the dryer when she felt a strange pop in her chest.

“After a few minutes I actually felt so weird I almost thought I should go to the hospital,” she says. “My husband said, ‘For a pulled muscle?’

“‘I know, you’re right. That’s crazy,’ I told him.”

But the feelings intensified: “I felt like I had no blood pressure left. I was like, ‘I feel like I’m dying.’”

Elam finally called 911 early the next morning. At the hospital, the doctor told her that she had a less-common type of heart attack called a coronary artery dissection, in which the wall of the artery weakens and tears, reducing or blocking blood flow. This type of heart attack tends to affect young women who have no known risk factors.

‘I can’t tell you how many women I’ve seen who say they felt something and wondered if it was a heart attack. That inkling is there, but for some reason it doesn’t convert into action.’

Elam now sees Dr. Harmony Reynolds, cardiologist and associate professor of medicine at NYU Langone Health who specializes in women’s heart health. Reynolds says the story of waiting it out is all too common for women. She’s observed that many women downplay their symptoms to both their doctors and themselves.

“I can’t tell you how many women I’ve seen who say they felt something and wondered if it was a heart attack. That inkling is there, but for some reason it doesn’t convert into action,” says Reynolds. “It worries me … Sometimes there’s precious time lost, in which heart muscle can be saved, and the waiting can be a really big deal.”

An even scarier situation can arise when the delay in care isn’t self-inflicted.

Just a few weeks after her 40th birthday, Tara Robinson awoke in the middle of the night with a burning feeling in her chest, numbness in her jaw, nausea and back pain. She went to the emergency room with her husband for what would end up being the first of three visits in a week — each time for different heart attacks that Robinson and the doctors in the ER didn’t realize she was having.

“It was like an electrical circuit was not connecting at all and was firing all over the place. That’s the only thing I knew, that this was different from my body,” says Robinson, now 44. For a number of months leading up to that week, Robinson had been concerned about her sore neck and intermittent pain in her left arm, which her primary care physician chalked up to stress.

At the ER, the doctor on call told her she was too young to have a heart attack, and Robinson, an elementary school counselor, who lives in Fort Worth, Texas, agreed with him. The average age for a heart attack in women is 70 years old, and women under age 55 account for roughly 5 percent or less of all heart-attack patients. The doctor at the ER sent Robinson home.

She was back a few days later when the symptoms returned. The EKG didn’t indicate she was having a cardiac event, but she insisted the hospital keep her overnight. They discharged her the next morning without any instructions. Then came the third visit, another overnight stay and morning discharge. Just hours later, at 4 p.m., she was rushed to the hospital with a massive heart attack, a 99 percent blockage in her main artery. Doctors inserted a stent to clear the blood flow.

Robinson’s experience prompted her to become a spokesperson for the American Heart Association’s Go Red For Women.

“I tell [women] that you’re the best advocate for your care. Nobody knows your body like you know it,” says Robinson, who has since learned that heart disease runs in her family. “And in the case of heart disease, with women dying every 80 seconds, we have no choice but to stand up for ourselves.”

Plan of attack

Tips and strategies for women to take charge of their heart health — and ensure the best outcome should a heart attack occur.

Know your risk

Existing conditions, such as diabetes or high blood pressure, as well as smoking or being overweight or obese can increase your risk of heart disease. Every woman, regardless of her age, should have an annual checkup with a primary care physician and ask for a full report on her heart health, including blood pressure, cholesterol, blood-sugar count, body mass index (BMI) and waist circumference.

Pinpoint symptoms

The warning signs of heart attacks are different in women than men. While pain, tightness and pressure in the chest are hallmarks of a heart attack, women are statistically more likely to experience a slew of other symptoms, including numbness in the jaw and arms, neck and back pain, dizziness, nausea, vomiting, severe fatigue, headache and the sensation of indigestion.

Speak up

Describe all of your symptoms in great detail to your doctor, and don’t be afraid to be direct. It is not silly or foolish to say, “I think I have the symptoms of a heart attack.” If the physician shoots down the possibility of this diagnosis without conducting any tests, ask him or her how she knows for certain that you’re not having a heart attack, advises cardiologist Harmony Reynolds.

Get tested

Emergency tests are not always accurate, but they are helpful. After checking heart rate and blood pressure, the gold-standard basic tests in an ER include an electrocardiogram (EKG) and blood work to measure certain biomarkers that may indicate heart failure, including heart-muscle death, which occurs when blood flow is restricted during a heart attack.

Practice prevention

The CDC recommends 150 minutes a week of moderate-intensity exercise, or 75 minutes a week of vigorous aerobic activity. Cardiologists also recommend patients adhere to the Mediterranean diet, which includes plenty of fruits and veggies, whole grains, nuts and seeds, fish and healthy fats such as olive oil and avocados.

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