Why are heart attacks often misdiagnosed in women?

Here’s why women don’t always get the right answers or care after having a heart attack, plus what you can do to protect yourself.

When it comes to recovering after a heart attack, every minute counts. The more time that passes without being treated, the more heart tissue breaks down or dies. Unfortunately, too many women are missing this important window of time. But why are heart attacks often misdiagnosed in women?

One reason is that they’re more likely to put off going to the hospital than men. In fact, women were more likely to wait more than 12 hours to seek medical help than men, a 2021 study found. That’s because women often mistake their heart symptoms for stress or anxiety, the researchers suggest.

Patients aren’t the only ones who misread symptoms. In the same study, doctors were more likely to link chest pain with a heart-related cause in men than in women. With women, they were more likely to suspect anxiety or a musculoskeletal issue. As a result, more women were misdiagnosed than men. That can result in treatment delay. In turn, that raises the risk of long-term health problems and even death.

Because of these differences, experts are working on ways to find heart attacks earlier in women. For example, they’re studying tests that are better at finding changes in blood flow, which could signify blood vessel or heart muscle damage. Teaching healthcare workers about what to look for in patients is also key.

Over the past several years, emergency departments have gotten much better about recognizing signs of a heart attack in women and treating them promptly, says Nieca Goldberg, M.D. Dr. Goldberg is the medical director of Atria New York City and a clinical associate professor of medicine at NYU Grossman School of Medicine.

But as with most things healthcare, the patient also plays an important role. After all, you can get the medical care you need for heart symptoms only if you go to the hospital and tell them what’s going on. In other words, you need to learn how to advocate effectively for your heart health. Here are some ways to do that.

Know your heart health numbers.

The following measures can help you keep tabs on your heart health. If any of these numbers get too high, your risk of a heart attack goes up:

  • Blood pressure. It should be under 120/80.
  • Weight. Your primary care physician (PCP) can help you figure out a healthy range for your body and activity level.
  • Cholesterol. There are 3 numbers to know. Your total cholesterol, which should be under 200. Your LDL or “bad” cholesterol, which should be under 100. And your HDL or “good” cholesterol, which should be above 50.
  • Blood glucose. Your fasting blood sugar should be under 100. There’s also your A1C level. (This is a snapshot of your blood sugar levels over 3 months.) If your PCP measures yours, it should be under 5.7%.
  • Waist size. Women who have a waist circumference greater than 35 inches are at higher risk of a heart attack.

If any of these numbers are high for you and you find yourself at the hospital with heart symptoms, be sure to tell your doctor. Let them know you have a history of high cholesterol, for example. It will signal them to think more seriously about a possible heart attack.

Have trouble remembering your numbers? Try saving them in a digital health management app, such as Wellframe, on your smartphone. Or jot them down in a health journal. Be sure to bring your phone or journal with you to the hospital.

Learn the different signs of a heart attack.

Chest pain or discomfort are the most common heart attack symptoms for all sexes. But women can also have a heart attack without any chest pressure, says Dr. Goldberg. Their symptoms can also be very subtle. And they’re easy to mistake for heartburn, flu, or just getting older.

If you have ovaries, tThese are the other heart attack signs to women should watch for besides chest pain:

  • Shortness of breath.
  • Pressure or pain in the lower chest or upper abdomen.
  • Dizziness.
  • Lightheadedness or fainting.
  • Nausea or vomiting.
  • Back or jaw pain.
  • Extreme fatigue.

Don’t wait to seek treatment.

“When you’re having symptoms is no time to Google ‘heart attack symptoms,’” says Dr. Goldberg. “When heart attack symptoms come, they are relentless. If you find that steps like changing your position don’t help, then you should call 911.”

If you’re really unsure and it’s during normal business hours, it’s okay to call your doctor, says Dr. Goldberg. When you speak to them, let them know the following:

  • When your symptoms started.
  • How frequently they come back.
  • How intense they are.
  • If they get better with rest.

“Stick to these 4 basics. They will help your physician understand that this may be urgent,” Dr. Goldberg says.

But if it’s after hours, don’t wait for your PCP to call you back. Instead, call 911, says Dr. Goldberg. While you’re waiting for the ambulance, chew up and swallow an aspirin. It can help reduce damage to your heart and your risk of dying by 25%.

And if you’re thinking of driving yourself to the hospital (or having someone drive you), don’t. Calling 911 is the fastest way to get lifesaving treatment. An emergency medical services (EMS) team can begin treatment as soon as they arrive. You’ll usually get faster treatment once you’re at the hospital, too.

Know what to expect at the hospital.

Once you’re in the ER, the doctors will most likely do a test known as a coronary angiogram. They will run a dye through your blood vessels. It helps them find any narrowing or blockages. But this test can be less effective in women. The reason: They’re more likely to have a type of thin, smooth plaque that’s harder to see on an angiogram.

So if your angiogram is negative, it’s a good idea to ask your doctor for other blood tests to rule out a heart attack. These tests look for substances released by injured heart cells, such as:

  • Troponin.
  • Creatine kinase-MB.
  • Myoglobin.
  • High levels of any of these may mean you’ve had a heart attack.

If you have had a heart attack, you may be given 1 or more of these medications:

  • Thrombolytics. This type of medication breaks up blood clots. It helps open blocked arteries.
  • Blood thinners. These stop blood cells from clumping together and forming new clots.
  • Nitrates. They help widen your arteries and increase blood flow to your heart.
  • Beta blockers. They lower your blood pressure to help reduce your heart’s workload.
  • ACE inhibitors. They also help lower your blood pressure.

You may also need a medical procedure known as angioplasty. This involves placing a tube in the blocked artery to increase blood flow to the heart.

Trust your instincts.

If you ever have doubts about seeking treatment for your heart health or asking for different tests or medications, remember this: Women do worse than men after having a heart attack. They’re more likely to die within a few weeks or even a year. That’s true across the board, at any age.

But if you know how to recognize the symptoms and you seek medical treatment right away, you can do a lot to improve your odds, says Dr. Goldberg. So don’t be afraid to speak up and put your health first. It could truly save your life.

To learn more ways to be sure you’re getting the best possible healthcare, ask your health plan if you have access to Wellframe.

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