Kritzler-Egeland’s story and symptoms are far from unique, says Puja Parikh, MD, an assistant professor of cardiovascular medicine at Stony Brook Medicine, in Stony Brook, New York, and one of the authors of a review of research published in the August 2018 issue of Current Cardiology Reports. Dr. Parikh’s review confirms years of research that has shown there are differences between men and women when it comes to heart attacks, including symptoms, treatment, and outcomes. Among the most significant findings of the review, says Parikh, is that women have wait times that are 30 percent longer from the time symptoms start until their first contact with medical help compared with men, and wait times that are 20 percent longer from first arriving at the hospital until specific treatment for the heart attack, compared with men. The review also notes that women and their doctors tend to disregard symptoms more often, leading to delays in care. “In patients with a [heart attack] symptom, recognition is essential for prompt medical action,” says Parikh. Martha Gulati, MD, the editor in chief of the American College of Cardiology’s CardioSmart website and the chief of cardiology at the University of Arizona College of Medicine in Phoenix, adds, “This bias in the treatment of women with heart disease has been well-established for many decades.” Dr. Gulati thinks that women, practicing physicians, and medical students all need more education on the specific symptoms of heart attack in women. “We need to understand that heart disease remains the number one killer of women. Women need timely care, guideline recommended therapies, and to be treated as aggressively as men.”
Tips for Heart Attack Prevention in Women
Knowing your risk factors, and doing something about them, can prevent heart attacks in the first place, says Suzanne Steinbaum, DO, a spokesperson for the American Heart Association’s Go Red for Women heart disease awareness program, and the director of the women’s cardiovascular prevention, health, and wellness division at Mt. Sinai Heart in New York City. “Knowing your numbers [blood pressure, cholesterol, blood sugar, BMI] is the first step,” she says. “The next step is understanding that if your risk is high, you need to pay extra attention to your heart symptoms.” Think you’re having a heart attack? Dr. Steinbaum says women need to get to the emergency room and say, “I think I’m having a heart attack.” That will trigger a series of events that can save your life. If you know you may be at risk for heart disease, don’t leave the ER if you had symptoms that you think are heart related without knowing that doctors have checked your heart and made sure you haven’t had a heart attack, Gulati adds. The American Heart Association (AHA) recommends several screening tests for women, some beginning as early as age 20. Keep a notebook on hand when you get test results so you can share the information with other doctors and keep track of test results over time. Tests include:
Weight and BMIWaist circumferenceBlood pressureCholesterol levelsFasting blood glucose levels to see if you’re at risk for or have diabetes
To diagnose and follow more serious heart disease, more-invasive tests are needed. These can include:
Electrocardiogram (ECG) Electrodes are attached to your skin to measure the electrical activity of your heart. The readings help your doctor look for signs of an active or prior heart attack.Echocardiogram An echocardiogram uses sound waves to produce a video image of your heart, which shows doctors the size and shape of your heart and any abnormalities. It also measures how well your heart is pumping blood.Stress test Stress tests measure how your heart responds to exertion. The test is usually done by having you walk on a treadmill while attached to an ECG machine. Your doctor may also have you wear a mask to measure how effectively your heart and lungs exchange oxygen and carbon dioxide.Cardiac computerized tomography (CT) scan For a cardiac scan, patients are inside a doughnut-shaped machine or on a table; an X-ray tube inside the machine rotates around your body and captures images of your heart and chest.Magnetic resonance imaging (MRI) Similar to a CT cardiac scan, for a cardiac MRI, patients lie on a table inside a tube-like machine that produces a magnetic field to create high resolution images of the heart.Coronary angiogram A flexible catheter is inserted into a blood vessel in your arm or groin area and threaded through the blood vessel to your coronary arteries. A dye injected into the catheter lets doctors see on an X-ray any areas of narrowing or blockage of the coronary arteries.
