A woman attending one of my heart health presentations told me of her recent trip to the Emergency Department of our local hospital, and an overheard conversation between the (male) doctor and the (male) patient in the bed next door beyond the curtain:  ”Your blood tests came back fine, your EKG tests are fine – but we’re going to keep you for observation just to rule out a heart attack”.

A male patient is thus kept in hospital for observation in spite of  ’normal’ cardiac test results. But I and countless other females in mid-heart attack are being sent home from Emergency following ‘normal’ test results like his, and with misdiagnoses ranging from indigestion to anxiety attacks to menopause.  Why is this?      

Women (especially younger women) with heart disease are more likely than men to be misdiagnosed.  Research on cardiac misdiagnoses reported in the New England Journal of Medicine looked at more than 10,000 patients (48% women) who went to their hospital Emergency Departments with chest pain or other heart attack symptoms. Investigators found that one in every 50 people who had suffered a heart attack was misdiagnosed and sent home from hospital. Women younger than 55 were seven times more likely to be misdiagnosed than men of the same age. The consequences of this were enormous: being sent away from the hospital doubled the chances of dying.

The medical error of misdiagnosis can include:

• a complete failure to diagnose (totally missing the disease)
• wrong diagnosis (for example, diagnosing anxiety instead of a heart attack)
• partial misdiagnosis (diagnosing the wrong subtype of heart disease or the wrong cause of the disease or its complications)
• delayed diagnosis (when a doctor does not recognize a disease until long after it should have been identified)

There is a persistent myth that heart disease is a man’s disease.  Doctors may actually be reluctant to consider heart disease when a woman has cardiac symptoms, and instead will look for other causes. A 2005 American Heart Association study showed that only 8% of family physicians and 17% of cardiologists knew that heart disease kills more women than men each year.

And women themselves are less likely than men to realize how vulnerable they are to heart disease.  A number of studies report that women are  more likely to delay seeking treatment even when they experience serious cardiac symptoms. And those symptoms can be more vague and atypical compared to men’s.

Even first-responders like paramedics are less likely to provide standard levels of care to women who call 911 with cardiac symptoms compared to their male counterparts, according to a study at the University of Pennsylvania.  Researchers found significant differences in both aspirin and nitroglycerin therapy offered to women vs. men. In fact, this study showed that of the women transported to hospital by ambulance who were suffering from heart attacks, not one was given aspirin by paramedics en route. Once women do arrive at hospital, both nurses and physicians working in Emergency Departments report a bias towards looking for heart attack pain symptoms, even though a majority acknowledge that women often present with vague, non-pain symptoms during a cardiac event.

Why don’t diagnostic tests pick these up? Women are less likely than men to receive some cardiac diagnostic tests, and some tests don’t work as well in women. Most tests for diagnosing heart disease have been fine-tuned in studies containing mostly men. The treadmill stress test, for example, has been found to be much less accurate in women than in men, and particularly for identifying single vessel heart disease – which is more common in women. The ‘gold standard’ test for diagnosing heart disease in both men and women is the angiogram, but studies also show that women are less likely than men to be referred for angiography. And some types of non-obstructive heart disease like Prinzmetal’s Angina do not show up during angiography unless the coronary artery spasm happens to occur during the procedure.

How to help yourself get an accurate diagnosis:

• Know your symptoms
• Know your facts
• Be specific
• Be objective
• Get results

What to do if you think you’ve been misdiagnosed:

• Do not feel embarrassed to speak up
• Get more tests/ask for repeat tests
• Get a second opinion
• Keep going back until you are diagnosed accurately

© Carolyn Thomas  www.myheartsisters.org  2009

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