‘Knowing & Going’ – act fast when heart attack symptoms hit

22 May


by Carolyn Thomas  @HeartSisters

I finally realized that I was in big trouble during a five-hour flight from Ottawa to Vancouver last May.  But I’d been told emphatically by an Emergency Department physician two weeks earlier that my problem was just acid reflux – not a heart attack.

So for two weeks, I’d endured increasingly debilitating attacks of chest pain, pain radiating down my left arm, sweating and nausea.  But hey! – at least I knew it wasn’t my heart.  A man with the letters M.D. after his name had told me so.

I suffered two more attacks in the Ottawa airport before boarding, and two more during that endless flight to Vancouver.  At no time did I consider saying anything to the Air Canada flight attendants about my growing distress.  I sure didn’t want to be one of those passengers they have to turn the plane around for because of a medical emergency. How embarrassing would that be – and all just for indigestion?

Women like me are more likely than men to delay seeking treatment despite clear signs of a heart attack, a behaviour pattern that has puzzled cardiologists and contributes to the higher mortality rate from heart attack among women.  

And even when we do seek help immediately, as a study published in the New England Journal of Medicine showed, women are seven times more likely to be misdiagnosed and sent home from the Emergency Department in mid-heart attack compared to men.(1)

A fascinating Oregon Health & Science University study published in The American Journal of Critical Care confirmed women’s treatment-seeking delay behaviour – and also helped me feel less embarrassed and alone for my own treatment-seeking delay decisions.  Oregon researchers identified six common patterns of behaviour between the time that women first know they are experiencing serious symptoms and the time when they go for help.  

These six patterns are:

  • knowing and going (women acknowledged something was wrong, made a decision to seek care, and acted on their decision within a relatively short time, typically 5-15 minutes)
  • knowing and letting someone else take over (women told someone they had symptoms and were willing to go along with recommendations to seek immediate medical care)
  • knowing and going on the patient’s own terms (women wanted to remain in control, were not willing to let others make decisions for them, and openly acknowledged that they did not like to ask others for help – these are the women who drive themselves to Emergency!)
  • knowing and waiting (women decided that they needed help but delayed seeking treatment because they did not want to disturb others )
  • managing an alternative hypothesis (women decided symptoms were due to indigestion or other non-cardiac causes, and were reluctant to call 911 “in case there’s nothing wrong and I’d feel like a fool”  – until their severe symptoms changed or became unbearable)
  • minimizing (women tried to ignore their symptoms or hoped the symptoms would go away, and did not recognize that their symptoms were heart-related)

Even women in that first ‘knowing and going’ behaviour group admitted being confused about the symptoms of a heart attack. The biggest obstacle to reducing women’s treatment-seeking delays, according to the Journal of  Social Science & Medicine, is in fact women’s lack of awareness in interpreting heart attack symptoms.

This period between the onset of symptoms and actively seeking help is termed treatment-seeking delay behaviour. It can be divided into three phases:

  1. decision time – the period from the onset of acute symptoms to the decision to seek care (for example, calling 911)
  2. transport time – the period from the decision to seek care to arrival at the Emergency Department
  3. therapy timethe period from arrival at the Emergency Department to the start of medical treatment

Only the first phase is the one you have complete control over. Don’t blow it.

Now learn more about women’s heart attack symptoms – and then don’t delay seeking treatment.  

You know your own body.  

You know if something does not feel right.  

If you experience troubling symptoms that may be heart-related, do the following:

  • Call 911 immediately.
  • Do not drive yourself to hospital, and do not let anybody else drive you unless absolutely unavoidable.
  • Chew one full-strength uncoated aspirin while you’re waiting for the ambulance (chewing just dissolves it faster so it’s absorbed faster; you can drink water with it).

Please do NOT do what I did by delaying my decision to get help. Put yourself in that ‘knowing and going’ behaviour group.

© 2009 Carolyn Thomas  www.myheartsisters.org

(1) Pope JH, Aufderheide TP, Ruthazer R, et al. Missed diagnoses of acute cardiac ischemia in the emergency department. N Engl J Med. 2000;342:1163-1170.

See also:



NOTE FROM CAROLYN:  This article was republished in the March 2012 issue of Flourish magazine.  I wrote lots more about women’s treatment-seeking delay behaviour in my new book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, November 2017).


15 Responses to “‘Knowing & Going’ – act fast when heart attack symptoms hit”

  1. Letlhogonolo Peter Monabe May 16, 2016 at 12:57 pm #

    I have all the symptoms of a heart attack and the worst is shortness of breath. Thank you for this information. It never clicked in my mind that I could be in such a big risk.


  2. Nitro Mama November 30, 2014 at 3:08 pm #

    When I was in the cardiac unit of a local hospital, my roommate had had a heart attack during a plane flight. She described her embarrassment when the pilot announced that the plane would be making an unscheduled stop at JFK due to a sick passenger. She had been stuck in the hospital for several weeks because of a near kidney failure due to reaction to the dye they used before a test. I no longer recall which test.

    I had an aunt who had a heart attack on a plane, she thought it was indigestion and asked for some soda water. After she got home, she became concerned when she was walking up subway steps and she became breathless. I am happy to say the heart attack took place at age 61 and she lived to 91.

    Liked by 1 person

    • Carolyn Thomas November 30, 2014 at 4:57 pm #

      I sure like that 30 year survival story, Nitro! And your hospital roommate’s story had a happy ending BECAUSE she was willing to face embarrassment at being “that” passenger on the plane. Smart lady…


  3. U.K. Lass August 15, 2011 at 6:13 am #

    I think I recognised myself in all of these categories except the first “knowing and going” that’s the one thing I DIDN’T do when my heart attack symptoms first hit. At least I’m not so embarrassed now after reading this to realise I’m NOT ALONE in delaying this treatment-seeking behaviour. Thanks so much. Love your site.


    • Lynda October 14, 2011 at 2:09 am #

      U.K. Lass – “realise I’m NOT ALONE in delaying this treatment-seeking behaviour…”
      That’s just exactly how I felt reading this, too, and also after seeing the Elizabeth Banks film that is featured here.


    • Oyawe August 14, 2012 at 11:44 pm #

      Medical check is strongly advice due to similarities in symptoms of heartburn and heart attack


  4. RN in NYC August 2, 2011 at 5:57 pm #

    This is absolutely fascinating – and yet disturbing. Women make up all kinds of reasons to DELAY seeking help, even during a serious cardiac event. How many times do women have to hear CALL 911!! before they can stop making up these deadly excuses?

    Love your blog, thanks for this!!!!!

    Liked by 1 person

  5. CrisBetewsky July 6, 2009 at 12:43 pm #

    Hello! Thanks for the post on heart issues. It is really amazing! I will definitely share it with my friends.


  6. Gary Patton June 15, 2009 at 7:29 pm #

    I will recommend this article to my friends and family, because it’s really helpful and a good reminder for all of us, not just women, to pay attention and take action when we believe something is not right.


  7. Kathy Black June 14, 2009 at 5:48 pm #

    Hi, very useful post. I have been wondering about this issue, so thanks for telling us about this Oregon study.


  8. Kelly Brown June 12, 2009 at 11:14 am #

    Hi, gr8 information about the importance of GETTING MEDICAL HELP quickly. Thx for this !



  1. Traci Bold - January 4, 2016

    […] Not all of these signs occur in every heart attack.  Pay attention if these signs come on suddenly or feel unusual for you. Sometimes they go away and then return. They usually come on with exertion, but may also appear when you’re at rest. Women typically wait longer than men to call for help.  Find out why… HEART SISTERS […]


  2. EPIC Primary Care - September 17, 2015

    […] Not all of these signs occur in every heart attack.  Pay attention if these signs come on suddenly or feel unusual for you. Sometimes they go away and then return. They usually come on with exertion, but may also appear when you’re at rest. Women typically wait longer than men to call for help.  Find out why. HEART SISTERS […]


  3. Newjane.com - October 27, 2010

    We have put a link to this article from our website […] HEART SISTERS: in Oregon have actually studied women heart attack survivors to investigate this treatment-seeking delay behaviour […]


  4. EveryJane - October 12, 2010

    We have put a link to this article from our website […] HEART SISTERS […]


Your opinion matters. What do you think?

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: