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 diagnosed me correctly with “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)
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 acute symptoms and getting urgent medical help can be divided into three distinct phases:
- decision time – the period from the onset of acute symptoms to the decision to seek care (for example, calling 911)
- transport time – the period from the decision to seek care to arrival at the Emergency Department
- therapy time – the 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.
© 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.
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 20% off the list price when you order).