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


by Carolyn Thomas  @HeartSisters

I finally realized that I was in big trouble during a five-hour flight from Ottawa to Vancouver.  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?

I did somehow survive that flight, and returned to Emergency after I arrived home – but still not thinking “heart”. What I really wanted, I thought at the time, were serious drugs to combat this brutal case of acid reflux I’d been misdiagnosed with. . . It was at that second visit that staff finally called in a cardiologist, who this time told me emphatically that I had “significant heart disease”.   See also: When heart attack symptoms disappear – and then come back

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)

An interesting 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 acute symptoms and getting urgent medical help can be divided into three distinct 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.

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.

© 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:

The symptomatic tipping point during heart attack

This is NOT what a woman’s heart attack looks like

Too embarrassed to call 911 during a heart attack?

Why wouldn’t you call 911 for heart attack symptoms?

‘Gaslighting’ – or, why women are just too darned emotional during their heart attacks

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

Early warning signs: how women can tell if they’re headed for a heart attack

Heart attack misdiagnosis in women

Why we ignore serious symptoms

Denial and its deadly role in surviving a heart attack

NOTE FROM CAROLYN:  I wrote more about women’s treatment-seeking delay behaviour in my book, A Woman’s Guide to Living with Heart Disease (Johns Hopkins University Press, 2017). You can ask for this book at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon – or order it directly from Johns Hopkins University Press (use their code HTWN to save 30% off the list price when you order).



15 thoughts on “‘Knowing & Going’ – act fast when heart attack symptoms hit

  1. 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.


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  4. 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

    1. 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…


  5. 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.

    Liked by 1 person

  6. 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

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


  10. 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.

    Liked by 1 person

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