Diagnosing – and misdiagnosing

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Yentl Syndrome: cardiology’s gender gap is alive and well

There’s a big fat yawning gap between heart disease diagnostic tests and resulting medical treatments – depending on whether doctors are looking at a male or a female patient lying there on the gurney. I’ve been saying this out loud ever since I came home from Mayo Clinic, where I first learned about the gender gap from Mayo cardiologists following my own heart attack misdiagnosis.

When asked if we might need to develop a new set of diagnostic/treatment protocol guidelines to specifically address this gap, Dr. Sharonne Hayes (founder of the Mayo Women’s Heart Clinic) responded:

“Part of the problem now is that the clinical practice guidelines are less likely to be applied to women compared to men.

“We know that when hospitals have systems in place to ensure they do provide care according to the guidelines, women’s outcomes improve.”

You may be wondering what it will take to put into place systems and guidelines (already used in male patients) for all patients, including women - in order to finally close that gender gap for good. Continue reading →

Tags: Dr. Bernadine Healy, Dr. Noel Bairey Merz, Dr. Sharonne Hayes, gender difference heart disease, gender gap, WPLongform, Yentl Syndrome

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Categories Diagnosing - and misdiagnosing, Women and heart attacks

When routine tasks trigger heart symptoms

1 Apr

by Carolyn Thomas ♥ @HeartSisters

household-chores Heart disease is a strange animal indeed. Our very first symptoms can range from mild shortness of breath on exertion to sudden death – and almost every possible symptom in between. My own were those of the textbook Hollywood Heart Attack (crushing central chest pain, nausea, sweating, and pain down my left arm) – yet I was sent home by Emergency Department staff with a misdiagnosis of indigestion – feeling very, very embarrassed for having made such a fuss over nothing. It took two weeks to be finally correctly diagnosed with myocardial infarction (heart attack) caused by a 99% blockage of my Left Anterior Descending Coronary artery. And it took several more months - and another trip back to hospital - to figure out what was causing ongoing distressing symptoms that were ultimately diagnosed as Inoperable Coronary Microvascular Disease (MVD) or dysfunction of the smaller coronary arteries.

But MVD is very tricky to diagnose because most standard coronary artery disease diagnostic tests - the kind that work so well at identifying big fat blockages in our larger arteries – may not be capable of catching it. Continue reading →

Tags: cardiac catheterization, coronary microvascular disease, Duke Activity Status Update, Hollywood Heart Attack, MVD, Non-Obstructive Coronary Artery Disease

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Categories Diagnosing - and misdiagnosing

Heart palpitations – what do they mean?

23 Jan

by Carolyn Thomas ♥ @HeartSisters

Dr. David Sabgir at one of his “Walk With A Doc” events

I love the concept of Walk With A Doc. This non-profit group was founded in 2005 by Dr. David Sabgir, an Ohio cardiologist. His reason was simple: telling his heart patients to get out and exercise just wasn’t working. His WWAD project involves recruiting volunteer physicians willing to lace up their sneakers and lead scheduled walks in their communities. These docs kick off each walk with a brief informational talk on some aspect of health. WWAD now boasts doctor-led neighbourhood walks all over the U.S. and Canada – as well as overseas in Russia, India, Australia and Abu Dhabi so far.

It’s absolutely free to register a Walk With A Doc program, and in return, physicians receive cool stuff like WWAD pedometers, T-shirts, banners, prescription pads so they can write WWAD orders for their patients, and even sample press releases to send to local media. If your doctor isn’t already leading a Walk With A Doc group in your community, please forward this info about how to get started. And while you’re waiting, here’s what Dr. Sabgir had to say in a recent WWAD newsletter about how he views the common patient experience of heart palpitations: Continue reading →

Tags: Dr. David Sabgir, Holter monitor, palpitations, Walk With A Doc

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Categories Diagnosing - and misdiagnosing, Living with heart disease

How can we get heart patients past the E.R. gatekeepers?

15 Nov

by Carolyn Thomas

Sometimes, people in my women’s heart health presentation audiences ask me if I’ve ever gone back to confront the physician who had misdiagnosed me with indigestion and sent me home from the E.R. – despite my textbook heart attack symptoms of chest pain, nausea, sweating and pain radiating down my left arm. No, my heart sisters, I never did. But what did happen was, I think, even more satisfyingly juicy.

Months after surviving that heart attack, and freshly fortified with Mayo Clinic cred after ‘graduating’ from their annual WomenHeart Science & Leadership training, I received an invitation to share what I’d just learned at Mayo to local docs and nurses working in Emergency Medicine. I was offered one whole hour on the agenda of their annual Staff Education Day to talk about my own fateful misdiagnosis – and how that scenario might be avoided for future female heart patients like me who present with clear cardiac symptoms but “normal” diagnostic tests. And as a patient advocate recently told physicians at a national symposium on integrated health care:

“The only way to heal a bad experience is to make it better for the next person.” Continue reading →

Tags: BC Ambulance Treatment Guidelines, Dr. Sharonne Hayes, Emergency Department, gender bias in diagnosing women, misdiagnosis of heart disease, paramedics, women's heart attacks

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Categories Diagnosing - and misdiagnosing, Women and heart attacks

Misdiagnosed: women’s coronary microvascular and spasm pain

15 Aug

by Carolyn Thomas

Findings from the federally funded Women’s Ischemia Syndrome Evaluation (WISE) study — a landmark investigation into ischemic heart disease (meaning reduced blood supply to the heart muscle) – are helping us to understand that, as the Harvard Women’s Health Watch puts it: heart disease – like cancer – is not one, but several disorders.

While I was at Mayo Clinic shortly after my heart attack, I also learned that at least two of these disorders are far more commonly seen in women than in men’s “Hollywood heart attacks”. These two heart conditions involve the smallest of the heart’s blood vessels in coronary microvascular disease (MVD) as well as non-obstructive issues like coronary artery spasm (CAS). Continue reading →

Tags: coronary artery spasm, coronary microvascular disease, endothelial cells, enothelial dysfunction, Prinzmetal's Variant Angina, vasospasm, vasospastic angina, WISE Study

Comments 20 Comments
Categories Cardiology 101, Diagnosing - and misdiagnosing

When your doctor mislabels you as an “anxious female”

4 Jun

by Carolyn Thomas ♥ @HeartSisters

Take it from me: the only thing worse than a heart attack is being misdiagnosed and sent home from hospital while you’re having it. And for women in particular, this is a tragically all-too-common reality. Research on cardiac misdiagnoses reported in The New England Journal of Medicine*, for example, looked at more than 10,000 heart patients (48% of them women) who had gone to their hospital Emergency Departments with chest pain or other significant heart attack symptoms. 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 home from the hospital in mid-heart attack doubled their chances of dying.

Some of the most popular cardiac misdiagnoses that heart attack survivors have told me about include guesses like indigestion, menopause, stress, gall bladder issues, exhaustion, pulled muscles, dehydration and more. But perhaps the most distressing misdiagnosis to trip from the lips of an Emergency Department physician is “anxiety”. This one single word is instantly both dismissive and embarrassing. And worse, to have the diagnosis of “anxious female” recorded permanently on a woman’s chart virtually guarantees a definitive psychiatric stereotype for all future medical visits. Continue reading →

Tags: anxiety, Cardiovascular Research Foundation, diagnosing heart attack in women, Dr. Alexandra J. Lansky, gender bias in diagnosing women, misdiagnosis