Heart attack misdiagnosis in women

28 May

by Carolyn Thomas  ♥  @HeartSisters

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 admitted to hospital for observation in spite of ‘normal’ cardiac test results – as current treatment guidelines require.  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 or menopause.  Why is this?      

Women (especially younger women) with heart disease are far 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 women younger than 55 were seven times more likely to be misdiagnosed than their male counterparts. The consequences of this were enormous: being sent away from the hospital doubled the risk of dying.(1)

UPDATE: The 2018 Heart and Stroke Foundation Report called Ms. Understood concluded that women’s hearts are victims of a broken system that is ill-equipped to diagnose, treat and support them. Other alarming findings include: early heart attack signs are missed in 78% of women, five times more women die from heart disease than from breast cancer, two-thirds of all heart disease clinical research focuses only on men.

Dr. Jerome Groopman‘s book, How Doctors Think, helps to explain why misdiagnoses happen in the first place:

“Specialists in particular, are known to demonstrate unwarranted clinical certainty. They have trained for so long that they begin too easily to rely on their vast knowledge and overlook the variability in human biology.”

This so-called “disregard for uncertainty” was what I faced with that Emergency Department physician in 2008 who sent me home from hospital with a misdiagnosis of GERD (gastroesophageal reflux disease), despite the fact that I’d just presented with textbook heart attack symptoms like chest pain, nausea, sweating, and pain radiating down my left arm. His emphatic but unwarranted clinical certainty:

“You are in the right demographic to be having acid reflux!”

A PERSONAL ASIDE:  as if being misdiagnosed in mid-heart attack wasn’t bad enough, the ER nurse that fateful morning came up to my bedside at one point after the physician had moved on to the next patient, and warned me sternly that I’d have to stop asking questions of the doctor, adding:

“He is a very good doctor, and he does NOT like to be questioned.”

The question that I’d just had the temerity to ask him? 

“But doctor, what about this pain down my left arm?”

The medical error of a misdiagnosis like mine can include:

  • a complete failure to diagnose (totally missing the disease)
  • wrong diagnosis (for example, diagnosing acid reflux 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 also still, amazingly, a persistent myth that heart disease is a man’s disease

Even the name of the type of heart attack I survived (the so-called “widowmaker”) tells you that semantics reflect the medical profession’s historical assumption that this kind of myocardial infarction hits men, not women. It’s not, after all, called the “widowermaker”, is it?

Doctors may actually be reluctant to consider heart disease when a woman has cardiac symptoms, and instead will look for other causes. An American Heart Association study showed, in fact, that only 8% of family physicians and 17% of cardiologists were aware that heart disease kills more women than men each year.

UPDATE – June 22, 2016: A study published in the Journal of the American Heart Association reported: “Women presenting with cardiac arrest are less likely than male patients to undergo therapeutic procedures, including coronary angiography, percutaneous coronary interventions and targeted temperature management. Despite trends in improving survival after cardiac arrest over 10 years, women continue to have higher in‐hospital mortality when compared with men.”(2)

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 emergency treatment even when they experience serious cardiac symptoms. One survey, for example, suggests that only half of women indicated they would call 911 if they thought they were having a heart attack (and that’s down from 80% just five years earlier!). Few were even aware of women’s most common heart attack symptoms. 

And those symptoms can be more vague and atypical compared to men’s ‘Hollywood Heart Attack‘ symptoms. For many women in mid-heart attack, the words “chest pain” would not even be the ones they’d choose to describe their symptoms – instead, words like full, heavy, burning, pressure or aching might be more accurate descriptors.

And remember that 8-10% of women experience no chest symptoms at all during a heart attack.(3)  See also: How women can tell if they’re headed for a heart attack

It’s astonishing to me that even first-responders like ambulance 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 the disturbing results of a study at the University of Pennsylvania. See also: Fewer lights/sirens when a woman heart patient is in the ambulance

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.  See also: How  Can We Get Heart Patients Past the E.R. Gatekeepers?

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-chest pain symptoms during a cardiac event. Again, between 10-40% do not have ANY chest symptoms at all.

Why don’t diagnostic tests pick these up?  Women are less likely than men to receive some cardiac diagnostic tests in the first place, and some tests don’t work as well in women. In fact, most tests for diagnosing heart disease have been fine-tuned in studies focused on (white, middle-aged) men.

The treadmill stress test, for example, has been found to be less accurate in women than in men, and particularly for identifying single vessel or non-obstructive heart disease – which are both more common in women.

Even the standard EKG (or ECG – electrocardiogram) can be problematic – especially when it’s not offered to female patients in a timely manner. A Montreal study, for example, found that women were significantly less likely than men to receive an electrocardiogram within the recommended 10 minutes of arriving in hospital with suspected cardiac symptoms.(4) And even when we do finally get hooked up to a 12-lead EKG in a hospital’s Emergency Department, the doctors there may not be able to correctly interpret the “significant EKG changes” that identify heart disease. Previous research has reported a disturbing reality about diagnostic EKGs, which is the likelihood that high-risk EKG abnormalities may NOT be detected by physicians working in Emergency Medicine.(5)  See also: When Your “Significant EKG Changes” are Missed

The gold standard test for diagnosing coronary artery 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 Coronary Microvascular Disease (small vessel disease) or Prinzmetal’s Angina (a spasm disorder), do not show up during angiography unless the spasm happens to occur during the procedure. See also: Misdiagnosed: Women’s Coronary Microvascular and Spasm Pain

UPDATE January 31, 2016:  We’ve been waiting 92 years for this announcement, ladies. The American Heart Association released its first ever scientific statement on women’s heart attacks, confirming that “compared to men, women tend to be under-treated”, and including this finding: “While the most common heart attack symptom is chest pain or discomfort for both sexes, women are more likely to have atypical symptoms such as shortness of breath, nausea or vomiting, and back or jaw pain.”

How to help yourself get an accurate diagnosis:

  • Know your symptoms
  • Know your facts
  • Ask clarifying questions if you don’t understand what you’re being told
  • Be specific
  • Be objective
  • Get results

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

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

Dr. Jerome Groopman further recommends that you ask these critically important questions of your doctor:

  • “What else could it be?”  The cognitive mistakes that account for most misdiagnoses are not recognized by physicians; they largely reside below the level of conscious thinking. When you ask simply: “What else could it be?”, you help bring closer to the surface the reality of uncertainty in medicine.
  • “Is there anything that doesn’t fit?”  This follow-up should further prompt the physician to pause and let his/her mind roam more broadly.
  • “Is it possible I have more than one problem?”  Posing this question is another safeguard against one of the most common cognitive traps that all physicians fall into: search satisfaction. It should trigger the doctor to cast a wider net, to begin asking questions that have not yet been posed, to order more tests that might not have seemed necessary based on initial impressions.

© 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.
(2) L Kim et al. Sex‐Based Disparities in Incidence, Treatment, and Outcomes of Cardiac Arrest in the United States, 2003–2012. J Am Heart Assoc. 2016; 5: e003704
(3)  S. Dey et al, “GRACE: Acute coronary syndromes: Sex-related differences in the presentation, treatment and outcomes among patients with acute coronary syndromes: the Global Registry of Acute Coronary Events”, Heart  2009;95:1 2026.
(4)  Roxanne Pelletier et al. Sex-related differences in access to care among patients with premature acute coronary syndrome. Canadian Medical Association Journal. March 17, 2014. cmaj.131450 10.1503/cmaj.131450 
(5)  Frederick A. Masoudi et al. Implications of the failure to identify high-risk electrocardiogram findings for the quality of care of patients with acute myocardial infarction: results of the emergency department quality in myocardial infarction (EDQMI) study. Circulation. 2006; 114: 1565-1571


See also:


IMPORTANT NOTE from CAROLYN:   I am not a physician. Information on this site is not meant as a substitute for medical advice. If you are experiencing symptoms that are distressing enough to ask me about them, please see your doctor. Do NOT leave a comment here describing your symptoms.

ANOTHER IMPORTANT NOTE: Comments in response to this post are now closed. If you believe your symptoms could be heart-related, please seek a medical opinion from a physician.

64 Responses to “Heart attack misdiagnosis in women”

  1. Sara Howell September 3, 2016 at 8:01 pm #

    Hi, I am 18 years old and I have been experiencing a high heart rate. I would go from around 75 to 100 bpm and I could literally feel that flip flop feeling in my chest all day. The feeling of racing heart would wake me up at night. I am very afraid because when I went to get blood work done, everything was normal aside from potassium being a little low. My EKG came back normal. I am still waiting on thyroid results. Considering things came back normal and I am still experiencing these symptoms, I am afraid of a misdiagnosis.


    • Carolyn Thomas September 4, 2016 at 7:46 am #

      Hello Sara – I’m not a physician so cannot comment on your specific symptoms. I can tell you that generally this scenario is more common in women, and aggravated in those who smoke, drink large amounts of coffee or alcohol. Here’s a link to some basic info from the American Heart Association on fast heartbeat including some simple steps that might address it e.g. “pressing gently on the eyeballs with eyes closed” or “holding your nostrils closed while blowing air through your nose”. They also say: “Many people don’t need medical therapy for this.” See your family physician if it continues.


      • Sara Howell September 4, 2016 at 11:05 am #


        Liked by 1 person

  2. Stu July 28, 2016 at 7:03 pm #


    I have been having chest pain, left arm pain, back pain and pain in various parts of my body – mostly left side for over 7 months now. I even saw a cardiologist and he did holter test, echo test and stress test. All tests came normal which relieved me for some time but the discomfort continues. My left arm pain/tingling/discomfort is more than ever now. It comes and goes along with other symptoms I mentioned. In your opinion, what is the most accurate test for women for diagnosis of heart diseases? I fear it’s angina I have, but doctor has not disgnosed it correctly. I am 33 years old and of course that makes it difficult to be taken seriously by cardiologists.


    • Carolyn Thomas July 28, 2016 at 7:41 pm #

      Hi Stu – I am not a physician so of course cannot comment on your symptoms, other than to say that the tests the cardiologist ordered for you are the ones commonly done to identify heart disease. Other tests, like coronary reactivity testing, are sometimes used to diagnose specific types of heart disease like microvascular issues. You’re right – at your age, most physicians would consider heart disease to be a long shot. But something is causing these symptoms, and right now you just don’t know if they are heart-related or not. Try keeping a symptom journal for a few weeks to show to your GP, noting time of day, what you were doing/eating/feeling in the hours leading up to each episode. Pay special attention to pain in those “various parts” of the body you mentioned, too (i.e. not chest/back/arms) – depending on which body parts you mean, they may help to point your doctor towards a non-cardiac cause.

      I hope your symptoms are not due to your heart, and I hope you and your physician can solve the mystery. But I often say that whether we are diagnosed with heart disease or not, there is simply no downside to living life as if every single one of us knew for sure we were at high risk – meaning exercise every day, eat heart-smart foods, manage sleep and stress, don’t smoke, etc. That’s exactly what any doctor would advise you if you were to get a definitive cardiac diagnosis tomorrow.


  3. Rachel Green June 29, 2016 at 6:12 pm #

    Can someone give me advice? Two nights ago I worked out at the gym with 40 minutes of low intensity cardio (heart rate stayed around 130-140 while I was working out). About 2 hours later, sitting down, I got a terrible pain in my upper middle back on my spine. I thought maybe I had hurt something at the gym. I went to the bathroom, the pain spread from my middle back throughout my chest and became a 10 on a scale of pain from 1 to 10. It lasted about 10-15 minutes or so, and it hurt so terribly I couldn’t do anything except kneel on the floor crying. If I sat up straight the pain got worse, and if I sat with my chest to my knees it made the pain better.

    I’ve never experienced anything like this before. The pain just seemed to come out of nowhere and spread throughout my entire chest. I’m 28 and female and on the pill. My dad had his first heart attack around age 55…

    After the pain subsided a bit I felt incredibly weak and light headed. There were lingering pains in the left side of my chest, and a squeezing sensation on the left side too. I also started coughing a lot during this time (I don’t have a cold). It also was harder for me to speak at this time and I was stumbling over my words (I don’t have a stutter normally).

    I went to the ER. They did an EKG, chest x-ray, and a cat scan (they put iodine in my veins) to check for a blood clot in the lung. All the tests came back normal except for a blood test. I don’t remember the name of the blood test, but they said my results indicated that there could be a blood clot in the lung. My number from the blood test was 590 and they said a normal number is 500.

    Anyway, after staying there about 8 hours they released me at 7AM with no aftercare instructions or explanation for the pain. All they said was to follow up with my PCP. I don’t have a primary care physician…

    Two days later and I’m STILL experiencing chest pain and discomfort on the left side. I also feel like my heart is working harder whenever I walk up the stairs.

    What should I do???? They made me feel stupid for even going to the ER, but I feel like something is wrong since I’m still having chest pain and discomfort two days later.


    • Carolyn Thomas June 30, 2016 at 4:56 am #

      Hi Rachel. What an awful experience! I’m not a physician so of course cannot comment on your symptoms or possible diagnosis. I can tell you however that if a health care provider in Emergency tells a patient “could be a blood clot in the lung”, it’s worth returning to that E.R. or an urgent care clinic for follow-up, especially if your symptoms return or worsen. Best of luck to you…


  4. Barbara June 27, 2016 at 11:11 am #

    Now I suffer from anxiety. All these young and older woman who had Heart Attacks I’m sure they were not all 100% healthy there’s always something that’s going to cause it. High bp, high cholesterol etc. they never put on here what caused it.


    • Carolyn Thomas June 27, 2016 at 12:23 pm #

      Hi Barbara – it’s also important to remember that most heart disease is at least 20-30 years in the making. For some, this diagnosis is linked to a congenital heart condition they’ve had since birth; for others it could be a family history, for still others it’s high blood pressure, cholesterol, diabetes, smoking, pregnancy complications, etc. and for some women with absolutely no known risk factors at all, they have a heart attack caused by Spontaneous Coronary Artery Dissection (SCAD) and in fact, nobody actually knows for sure what has caused it. In general, heart disease is most likely the result of a combination of several risk factors over many years.


      • Barbara June 27, 2016 at 2:26 pm #

        Yes thank you for clarifying that. I always think I’m having a heart attack because of the anxiety. I used to take medicine but I stopped it because it did mess with the rhythm of my heart and it gave me pvc’s and pac’s which I never had before. You get pros and cons with the meds.


  5. Raewyn May 28, 2016 at 3:29 am #

    OMG I don’t know what to think about the information and comments I am reading.

    I had been experiencing pressure on the top left side of my chest for about 2 weeks. One day at 3pm I went to pick my daughters up from school but started to feel almost out of myself a little sick, did I want to vomit? maybe?? That feeling passed but I felt light headed, then my attention was draw to my fingers on my left hand; they felt strange as I moved them, my whole left shoulder began to ache, then began burning, then my arm felt like it was burning.

    I managed to take my daughter home and then with a friend proceed to the ER; in transit my left shoulder blade began to ache/pain. I forgot to mention I was sweating also. When I arrived I was asked questions about my symptoms and then admitted to ER; I received an ECG and blood tests were taken. I was feeling very calm, not stressed but very tired. My blood pressure was 138/89 instead of my normal 110/70; the nurse said that was fine.

    Long story short, after 4 hours tests were repeated; I was told I was anaemic but nothing else and sent home. That was 3 days ago. I still don’t feel 100%, very tired, a little short of breath and a continued feeling of pressure on my chest. The local doctor said I had a panic attack and I am awaiting further blood results. I just can’t believe I had a panic attack, I was so calm & then at the hospital, I was falling asleep. I’m 46.


    • Carolyn Thomas May 28, 2016 at 6:06 am #

      Raewyn, I’m not a physician so cannot comment specifically on your symptoms. They may or may not be heart-related – do not hesitate to seek further medical help if they continue or get worse.


  6. Elizabeth Ledgerwood May 8, 2016 at 5:56 pm #

    I love this article. It is probably because I was a 42 y/o female that was originally misdiagnosed and went through several of the events in your article. I was sent home from my first ER with a muscle relaxer and an explanation that I must have pulled a chest muscle while exercising that week. Thank goodness my husband fed me aspirin and took me to another ER the next day. I was in the waiting room with two men who had chest pain. I sat in the ER waiting room for 7 1/2 hours, watching as the two men went back and were released.

    When I was finally seen, I spent about 45 minutes in the back and then the fun started. I went from the occasional nurse visit… two in 45 minutes… to being surrounded. When I asked what was going on, they said I was headed to cardiac ICU. I honestly felt fine at the moment.

    When they took me back for an angiography a couple of hours later, the cardiologist told me he did not think he was going to find anything, but he was going to look. A 95% blockage and 1 stent later, I was good to go. I had no idea I was about to have a heart attack, but thank goodness for my over protective and persistent husband. If it weren’t for him, I would probably have been very relaxed (the muscle relaxers from the first ER) and very dead.

    Liked by 1 person

    • Carolyn Thomas May 8, 2016 at 6:46 pm #

      Hi Elizabeth! Have you thought about cloning that wonderful hubby of yours? He’s a keeper! And also very smart of you to listen to his insistence to keep seeking help.

      Your 7 1/2 hour wait in the ER waiting room is appalling for any patient, male or female, who presents with frickety-frackin’ CHEST PAIN! Your age likely worked against you (which should be irrelevant, but still too often seems to result in diagnostic delays for women).


  7. Teria Bradley April 30, 2016 at 8:38 pm #

    I think it’s horrible that the people you trust to be experts, and that you assume are doing everything possible to make sure you don’t lose your life, don’t really know what they are doing.

    As I read this article I could see all the wrong things happening to me in my visits (visits with an “s”) to the ER. I was even admitted once and kicked out the next day with no idea as to what happened to me. I still don’t know. There was a problem but they didn’t tell me what it was. I went recently and was told I had a heart murmur, anxiety, palpitations and unidentified chest pains. I was told to follow up with my doctor.

    I hesitated to go back because it felt like a waste of time. But because of this article and encouragement from a female friend who has heart problems, I will go back.


    • Carolyn Thomas April 30, 2016 at 8:51 pm #

      Hello Teria – I sure hope you did follow up with your doctor. Not knowing what’s wrong is frustrating, but when you say “there was a problem but they didn’t tell me what it was”, it’s important to remember that requesting a clear explanation of “what’s wrong” is up to you. If there were indeed something “wrong” that the hospital staff identified, it wouldn’t be kept secret from the patient. If/when you do go back to hospital again, please don’t leave without clear answers about what’s going on. Best of luck to you…


  8. Carla March 10, 2016 at 7:46 pm #

    Maybe someone out there can help me. I’m 47 years old and have had diabetes for 35 years, experienced chest pains off and on for several years but nothing ever shows. The other night I helped my mother pick my father up off the floor as he had fallen. While picking him up I did not experience any symptoms but right after I became very weak, very very lightheaded, broke out in a cold clammy sweat, could not breathe, and had a lot of pressure in the chest. It felt like I was going to pass out but I didn’t. I called my doctor’s office the next morning and was advised to go to the ER, but I did not go. I have gone in before with chest pain and they told me to have a seat in the waiting area, waited 45 minutes and got up and went to an ER out of town. But of course, nothing showed.

    Back to my current problems: I had waited it out this time because I had an upcoming appt with my doctor in 2 days. He did an EKG, supposedly was normal after a lot of puzzled looks and moving wires around and several questions as to if I was in pain and are you ok? Are you sure you’re ok? And getting another person to help, and them asking if I w,s ok? And are you nervous etc. My doctor was ok with the test and ordered blood test which came back ok as well.

    So why all those horrible symptoms, can it possibly be nothing at all? Any help would be greatly appreciated.

    Thank you in advance,


    • Carolyn Thomas March 12, 2016 at 4:04 pm #

      Hello Carla,
      I’m not a physician so can’t comment specifically on your symptoms. I can tell you generally that the next time you have ANY kind of diagnostic test at which you notice the kind of staff response you describe here, SPEAK UP! Ask questions of your doctor to help you understand what’s going on. Right now, something is causing these symptoms, and you just don’t know if they are heart-related or not. Best of luck to you, and meanwhile check out this post on the many causes of chest pain.


      • Carla March 13, 2016 at 2:59 pm #

        Thank you Carolyn for responding. You’re right, ask questions. I should have asked my doctor when he came back in after the EKG what his MA and nurse were seeing to make them keep asking me if I was ok. I agree, something is going on and I strongly feel it is something with my heart – it may not have been a heart attack or so that’s what they are saying, but I do believe it’s something with my heart. Today, my heart started beating faster and I broke out in sweats just doing dishes – I rested and it got better. I vacuumed later and the same thing happened and went away with rest.

        Do you or any out there know of anything natural that would help my symptoms since I don’t seem to be getting any help from the doctors in our area? Any help would be greatly appreciated.

        Thank you,


        • Carolyn Thomas March 13, 2016 at 3:15 pm #

          Hi Carla – again, I’m not a physician so cannot comment (except to say that if there were some “natural” product that actually could address symptoms that may or may not be heart-related, I’m not aware of it – and realistically, if such a product did exist, Big Pharma would have patented it in a big hurry by now!) Generally, what you’re describing (racing heart rate) could be palpitations – considered very common and usually not serious, as cardiologist Dr. David Sabgir once described:

          “We see more patients for palpitations than any other concern. In almost all situations, there is nothing to worry about.”

          Read Dr. Sabgir’s list of other factors that can cause palpitations, ranging from stress to low potassium levels, thyroid problems or caffeine consumption! Do some homework, and most of all, try to proactively manage your current stress levels (which can ironically worsen the very symptoms you’re describing). Many people find it useful to keep a symptom journal (record what you were doing/eating/feeling in the few hours leading up to each episode – sometimes interesting patterns can emerge to help solve the mystery). Good luck to you…


  9. Wendy January 26, 2016 at 6:33 pm #

    This is happening to me. I am 41, became suddenly ill 3 years ago. Was taken from work with chest pains, sweating, pasted out. I was sent home 2 hrs later with GERD (acid reflux). I was diagnosed with everything from gout to mental illness. Nobody did an EKG or anything heart-related. I haven’t been able to walk without losing breath for 3 years. The chest pains and not being able to breathe worsened recently. ER visit found I’ve had a heart attack and the bottom of my heart is so damaged it can not pump the blood out now – EF 48%. My primary care doctor informed me I am having congestive heart failure, prescribed me potassium and directives (ER found my electrolytes were off and potassium was very low) and sent me home. My last ER visit, the nurse told the transport guy I was only there wanting attention. I am waiting on referral to a cardiologist and urologist. They even put me on psych meds because it is all in my head. I can’t lay down without very sharp pains starting under my left breast, can’t take a deep breath.


    • Carolyn Thomas January 27, 2016 at 6:48 am #

      Wendy, this sounds like quite an ordeal you’ve been through for three years. I’m glad you finally have some answers, and I hope you get your cardiologist’s referral very very soon. Meanwhile, your only job while you’re waiting is to learn as much as you can about heart disease so you’ll be as informed as possible (and know what kinds of questions to ask your cardiologist). For example, a “normal” ejection fraction (EF) typically ranges from 55-70%; an EF of less than 40% may confirm a diagnosis of heart failure. Yours is not under 40%. Here’s a good resource (Cleveland Clinic, widely considered the top cardiac institute in North America) with lots more information for you. Go back to your GP and request a second opinion for your breathing and sharp pain issues, which may or may not be related to heart problems. Good luck to you…


  10. Starr September 18, 2015 at 5:18 pm #

    I went to the local ER (Sheffield, All) holding my chest and crying in pain yet was left to sit in waiting room for my turn. Then was called to the desk and asked what makes me think it’s my heart?
    Was treated somewhat like a patient with mild problem.


    • Carolyn Thomas September 18, 2015 at 5:30 pm #

      I can’t explain why that happened, Starr. Surprising that any ER, no matter where it’s located, wouldn’t treat chest pain as heart-related until proven otherwise – and not before.


  11. Farhana July 14, 2015 at 5:34 pm #

    I’ve been diagnosed with Ectopic Ventricular Beats and two of the four valves do not close completely when heart is pumping; which causes my heart to do extra pumping.

    Day before yesterday, I woke up feeling very tired and had difficulty breathing, my heartbeat was fast and later in the afternoon I started feeling chest pain. I called my cardiologist and was told to immediately go to ER. There they performed an EKG, blood work, and chest X-ray. They all came back ok.

    The doc on duty said I was probably having indigestion or perhaps my gallbladder was acting up. Wrote a prescription for Pepcid. Today I still woke up with breathing difficulty and a little bit of pain on the left side which is starting to creep into my underarm area and up my neck. I also have a horrible headache. I don’t know what to do 😦 I wish I had read this article earlier and had asked these questions.

    Liked by 1 person

    • Carolyn Thomas July 14, 2015 at 7:48 pm #

      Farhana, right now you just don’t know if your symptoms are heart-related or not. Do not hesitate to seek medical help again if your symptoms continue or worsen. Best of luck to you…


  12. MioMyo June 24, 2015 at 9:58 pm #

    Thank you for this article, Carolyn. This is funny but I have asked my doctor exactly the same questions as Dr. Jerome Groopman recommends. But of course, before I’ve read this article. And, the answers from this guy who is a honored cardiologist with MD letters after his name are funny too:

    “What else could it be?”“This is not your heart. You are coughing. This is not a heart related symptom at all. Coughing — is from your lungs” (no need to mention that my lungs and all other possible organs were triple checked before he said that);

    “Is there anything that doesn’t fit?”“Why are you so focused on your heart, may I know?”;

    “Is it possible I have more than one problem?”“Sure! There are many other causes of your symptoms. This is definitely not your heart. But you might have something with your lungs and acid reflux at the same time!” (genius!);

    I have asked more questions. I did not just get up and leave. I kept asking him until he started to yell to interrupt me. Below I provide exact quotations from our conversation:

    “Doctor, can you please tell me why 3 of my ER ECG’s are abnormal? Why do my 2 treadmills have ST changes?”“Well, hundreds of people live with such ECGs. The changes you have are not significant. Your major arteries are clear. This is not your heart.”

    “Could you please explain why it said here on one of my ECG interpretation: “Consider left valve dysfunction?”“Lots of people have left valve dysfunction. This is naturally occurring dysfunction, look here…” (he draws a picture)

    “Well, you mentioned my major arteries. What about minor ones?”“We checked them all!”

    “But, I remember my angio report. It is said there that “there is no major artery that has a blockage more than 50%. Nothing else.” — “Major arteries are the most important ones. There is no need to check little ones at all”.

    “Would you please perform a bedside test right now? It’s name is abdominojagular test and it will take only a minute of your time?”“NO. You don’t need that”.

    “Okay, thank you. But could you please suggest any other test to check my heart or vessels?”NO. As I said, angio is the most important test and you do not need to undergo any other. I will call your physician to find out why she keeps sending you to my office. Bye”

    Well. As it is obvious, questions do not help sometimes…

    Liked by 1 person

    • Carolyn Thomas June 25, 2015 at 1:51 pm #

      You are asking the right questions – it’s the answers that need further explanation!


      • MioMyo July 2, 2015 at 1:17 pm #

        Hi Carolyn!

        I luckily have an appointment at Vancouver with the doctor you have recommended (thank you!!!!). I have to wait couple of weeks until I see the doctor personally, she has already ordered a cardiac MRI for me (was never done before). Though my symptoms are worsening and my previous cardiologist (turned out to be only an internist actually) complained about my “meticulous demeanor” to my GP — I am so excited anyway!

        Do you mind I will publish the outcome and diagnosis when I receive it, here in the comments?

        I hope everything is well with you and you’ve had a fabulous Canada Day!

        Liked by 1 person

        • Carolyn Thomas July 2, 2015 at 5:11 pm #

          That’s wonderful news about your upcoming appointment in Vancouver. Yes, please let us know how it goes!


          • MioMyo July 11, 2015 at 12:55 pm #

            Hi Carolyn! I hope you are well & having a wonderful summer! I have met with Dr. S: she seems to be very knowledgeable & compassionate. She scheduled me for several examinations & tests. She suspected heart failure, but the first test still does not confirm it. I have to pass three more tests. And wanted to ask you: did you ever have a cardiac MRI and how is your experience?

            I’ve got prescriptions finally from the first visit and my symptoms are getting better.. It took 9 months to get the therapy and I hope it is not too late…


            Liked by 1 person

            • Carolyn Thomas July 11, 2015 at 1:50 pm #

              Hi again – great news about your symptoms improvement, and about your recent doctor’s appointment. No, I’ve never had a cardiac MRI. Best of luck with the rest of your diagnostic tests. Sounds like you are in good hands.


  13. Julie Stewart June 21, 2015 at 8:52 pm #

    My 34 year old daughter was in the ER three times, sent home two times for acid reflux, before she was diagnosed correctly and had a stent put in after a heart attack. They said she may have even had two MI’s. After follow up she was told the heart attacks were the kind that you usually drop dead from. Thank God she is still here. The nurse she had in the ER was even rude to her while she was there as if she was trying to get attention. I am so mad.

    Liked by 2 people

    • Carolyn Thomas June 22, 2015 at 6:21 am #

      Julie, no wonder you are mad! This is an appalling (yet common) reality especially for younger women – sometimes openly accused of attention-seeking or cocaine use in mid-heart attack. Thank goodness your daughter was smart enough to keep going back despite that acid reflux misdiagnosis (I wasn’t that smart – I was too embarrassed to go back to the ER for TWO WEEKS before symptoms became unbearable). Hope your daughter is doing well now…


  14. Kate June 9, 2015 at 9:42 pm #

    I have been having discomfort in my chest, neck, left arm, and pain in my jaw. I’ve gone to the ER two times for this. First time I was diagnosed with chest wall pain, took my medicine. About a month later I started to feel the same symptoms and the diagnosed that my ribs were inflamed and I might have acid reflux. Now they’re back what should I do?

    Liked by 1 person

    • Carolyn Thomas June 10, 2015 at 6:20 pm #

      Hi Kate,
      I’m not a physician so cannot offer any specific advice. But I can tell you that it appears docs have not been able to accurately nail down your diagnosis yet (chest wall pain? inflamed ribs? acid reflux?) As I always say to women in your situation, your symptoms may or may not be heart-related, but right now you just don’t know for sure. You did the right thing by seeking help when you did – do not hesitate to call for help again if symptoms persist or get worse. Best of luck in getting a definitive answer to this mystery.


    • Julie Stewart June 21, 2015 at 8:53 pm #

      Make them do an angiogram.


  15. Susan May 3, 2015 at 6:50 pm #

    On Feb. 14, I was sitting in a theater when the subtle chest pain, indigestion, tightness, pressure and eventually RIGHT shoulder pain that radiated to my jaw. At first I thought it must have been the popcorn I just ate with the disgusting “butter” (oil) I doused on top, but something told me that this was serious. Sort of a sense of “doom”. But I stayed in the theater to wait until the movie was over. I told my husband I needed to get out and get some air, which I did, and waited for him in the lobby. When he finally came out, he asked me if I was okay and I told him I didn’t think so. I did tell him that it could possibly be my heart, but wasn’t sure. He asked if we should go to the hospital and I told him maybe we should.

    During the long ride to the ER, he continued to ask if I still wanted to go, and I hesitated each time he asked but concluded that I probably should. The ER hooked me up to the EKG and it didn’t show any irregularities and they asked if I could wait out in the waiting room as they would like to do further tests when they get time. An hour later (heart attack symptoms lasted almost 2 hours) I started feeling 100% better, so I asked my husband to tell them we would be going home and I would follow up with my primary if I continued to have problems.

    We arrived back home and started to watch T.V. I started feeling similar symptoms but I thought that maybe with sleep they would go away. I turned off the T.V. at 1:00 a.m. and at 5:45, the symptoms were more intense. Something told me this was serious, and my husband didn’t need any convincing to get me back to the ER. FYI, never drive yourselves, always call 911 so your heart and life can be saved and also the paramedics can call the hospital to give them a head’s up.

    Upon arrival, an EKG was performed, and irregularities showed up and they got me into a room right away. The doctor came in and told me she wanted another EKG, which was performed, and I’m not sure if blood tests were done at that time (everything happened so fast), but she came back in and told me I was having a major heart attack and that a cardiologist was on his way in and that they needed to prep me for the Cath Lab.

    All of a sudden 8 people were standing over me working as fast as they could as time was of the essence. I ended up having 2 stents placed in one artery that was 100% blocked and one in an artery that was 90% blocked. The “widowmaker” was 50% blocked but they left that one alone.

    The moral of this story is that I do not doubt that my first attack went undiagnosed. I am so very fortunate and blessed I am alive and well. (For the most part, several survivors experience chest pains, shortness of breath, anxiety, fear, depression to name a few.

    It’s been 2 1/2 months and I am still healing. I always worked out, and basically watched what I ate, but genetically speaking, heart disease runs in my family. My father passed away from the same when he was in his early 70’s. I’m in my late 50’s, but looked and felt like I was in my 40’s. (Runs in the family).

    I want to get the word out that women are neglected, for the most part, by the medical community in regards to this health issue. My hope is that these doctors and medical professionals take women’s symptoms more seriously with regards to heart disease and especially the symptoms of heart attack in women, which can be different then men’s.

    Peace and love to you. ❤

    Liked by 2 people

  16. Sheri November 8, 2014 at 2:19 pm #

    I was prescribed Prednisone (steroid) for a respiratory illness that I’ve had for two months. I took my first dose yesterday when I was at work. An hour later, I experienced extreme chest pain, radiating to my lower jaw and down my left arm. I also experienced light-headness, shortness of breath, extreme pressure in my head and ears, and nausea.

    I called my husband, who picked me up and drove me to the hospital. When I got there, I told the Triage nurse my symptoms and she wrote down that my chief medical concern was “reaction to meds”. An hour later, the nurse checked my blood pressure and temperature, which were normal. I was taken to an exam room where I told her my symptoms again. Next, what I thought was a doctor came in and I told him my symptoms again. He said the doctor would be in right away. (Not sure what he was. He was dressed in blue scrubs). Then a woman came in and asked me what my symptoms were. I, again, told her my symptoms. She asked who my primary care doctor was and I told her that I don’t ever get to see the PCP when I go to his office, that I always see a Nurse Practitioner. She said that I should see an Internist instead of an NP and said that she, also, was a Nurse Practitioner.

    Next, the guy in blue scrubs came in and gave me four pills (2 Benadryl – antihistamines, and 2 Prilosec – protonics acid blockers). Then I passed out from the Benadryl. They checked on me 3 times and then said that I could go home. They told me to stay home from work for the next 3 days. I had been diagnosed with an allergic reaction to Prednisone.

    I was not given an EKG or ECG. I was not given a chest x-ray. No blood was taken to test for cardiac enzymes or electrolyte levels. I cannot believe it. My brother-in-law, who is a paramedic, said that there is a protocol that hospitals are required to follow for patients that come in with heart attack or stroke symptoms and that not one of those were followed. There is also a time limit for them to complete certain initial testing. Waiting to perform these tests could result in negative readings.

    I am sitting here today with dull chest pain still, extreme pressure in the head and ears, a bad cough and shortness of breath. I am debating calling 911 so that I will be taken BACK to the hospital in an ambulance and maybe, just maybe, given the proper medical tests to, at least, rule out cardiac problems and to determine if I have pneumonia. I’ve been to the doctor several times (I’m only able to see the NP however) for a bad cough, inability to breathe without labor, and extreme exhaustion. I have been given two courses of antibiotics, this prescription of prednisone, which gave extreme chest pains, and one nebulizer treatment, which caused an episode of chest pain during the treatment. I have not been given a chest x-ray, nor a lab test to determine if I have bronchitis, pneumonia, or respiratory infection.

    I’d also like to add that I have met my insurance deductible for the year and have met all out-of-pocket expenses. Why won’t any of these nurse practitioners run any tests and why can’t I see a regular doctor with full credentials? Who can I file a complaint with? I have never complained about having too many tests run. I am tired of going to the doctor only to be dismissed.


    • Carolyn Thomas November 8, 2014 at 5:43 pm #

      Hello Sheri – I’m not a physician so cannot comment on specifics, but I can tell you generally that what doctors look for is called a “differential diagnosis” (identifying which one of two or more conditions with similar symptoms is the one the patient is actually experiencing). That’s why it likely made sense to diagnose “reaction to meds” – given that you would have told the triage nurse that symptoms started so soon after taking your prednisone.

      For example, of all the cases of chest pain that cause patients to seek medical care, here’s what they end up being: musculoskeletal (36-49%), cardiac (15-18%), gastrointestinal (8-19%), pulmonary (5-10%), and psychiatric (8-11%). Having said that, I agree with your paramedic-brother-in-law: your symptoms certainly did sound like textbook cardiac signs, no matter what meds you happened to be taking at the time. If they continue, DO NOT hesitate to seek immediate help.


  17. Stephan Perea March 14, 2013 at 12:49 am #

    You might get indigestion from eating too much or too fast, eating high-fat foods, or eating when you’re stressed. Smoking, drinking too much alcohol, using some medicines, being tired, and having ongoing stress can also cause indigestion or make it worse. Sometimes the cause is a problem with the digestive tract, like an ulcer or GERD.


  18. Concerned May 13, 2012 at 1:06 pm #

    Thank you for this website, it has made me aware of the problems that can be faced by women who complain of symptoms that could be related to a heart attack.

    My own experience was on Weds/Thurs AM early hours. I had taken two Nurofen Express capsules (Ibuprofen) at about 1am for cold symptoms and an hour and a half later woke up with a strange feeling of being drugged, pupils dilated with tingling sensation and numbness of the lips (now I recognise it). I checked that I had not overdosed, first two of second strip, so not likely, and decided to ring 999 (*911 in North America).

    I was told that it didn’t sound serious, so NHS Direct would call me, by then I was experiencing some aching in the upper mid back and tingling down the right arm into the fingers which made the concerned lady on the other end of the phone send out an ambulance. The paramedics checked all vital signs which were normal and asked me if I really wanted to go to A&E and I thought perhaps I should. When I got there, because my signs were good I was sent through to Triage (looked upon as not serious enough for Emergency Medicine) where a GP saw me and said that because my heart sounded good and although I had not had any ECG tests sent me home saying that I had muscular symptoms which caused my aching symptoms and to stop using my computer for a couple of days.

    I therefore had to walk the length of the hospital to get some money to order a taxi home at such an early hour. I did as I was told, rested, had some buzzing in my ears which I put down to a slightly raised BP when paramedics had arrived, and have been exhausted ever since following exertion. Reading all of this I am now on the alert! It has been suggested to me to rule out muscular symptoms and to take it easy. Now I am not so sure ….


    • Carolyn Thomas May 13, 2012 at 3:23 pm #

      Dear Concerned – your symptoms may or may not be heart-related, but right now you just don’t know for sure. You absolutely did the right thing by seeking help when you did – do not hesitate to call for help again if symptoms persist or get worse.


      • Concerned May 22, 2012 at 3:29 am #

        Thanks for your comments! I work from home quite a bit but I am finding that on exertion I am still very tired and at the moment I am working in my bed which I have done quite a lot lately, and then off to a client this afternoon. It could be muscular as my Adam’s apple seems to be recognisable when I swallow but I am keeping an eye on this tiredness. My husband feels that this is stress and reminds me to switch off and relax as he is obviously concerned.

        I had an email from a client who told me that he had been IN HOSPITAL with a “suspected heart attack” although I have to say I don’t know all the details yet, but as you say it does show the difference in the way women are treated as opposed to men in these situations.


  19. Margaret April 17, 2012 at 2:50 am #

    I am at this moment sitting with pain in my left arm from shoulder to elbow – if I go to use the arm the pain intensifies. I have been having stabbing pains in my chest but they come and go they don’t last very long. I feel like I have eaten too much. I have been to the doctor’s but I feel they are not listening to me.


  20. Ch411 April 12, 2012 at 8:14 pm #

    Even the name of the heart attack you and I both survived ‘the widowmaker’ tells us that doctors still believe this to be a MAN’S HEART ATTACK. When will E.R. doctors get the message and stop telling women heart pts that they have -pick one- anxiety depression gall bladder fatigue menopause?

    Liked by 1 person

    • Carolyn Thomas April 15, 2012 at 8:18 am #

      I think the story that begins this post (male patient with “normal” cardiac test results being kept overnight for observation while women are being misdiagnosed and sent home) is the most telling illustration of how pervasive this issue is. Thanks for your comment here.


  21. Mary Newman December 10, 2010 at 8:28 am #

    Thanks for the information you have provided.

    I am a 54 year old woman who one month ago had an experience that was like an electrical shock through the upper body and both arms that lasted just a few minutes. After that was gone, I was left very weak and anytime I got up to do anything my heart rate would go up and most times my blood pressure would drop. I had indigestion also. This happened on Saturday and I went to see my family doctor on Monday. He ran an ekg and told me there was signs of a heart attack and sent me to the ER.

    They ran the blood work once, then four hours later and I had a ct scan. Was told it was not heart related, to go home and check with family doctor for stomach issues. My family doctor ordered a holter moniter and a stress test.

    Before I had either test I had another episode where I could not get my breath and my left arm went numb. By the time I reached the ER, I was shaking all over. My heart rate goes up all the time if I do anything, but if I lie down it will go to normal. Again, the ER told me there was nothing, probably anxiety.

    Since then, both my tests have come back with normal results, but I am still getting the rapid heart rate when I do almost everything. If I continue to be active, I will have other symptoms. I have requested an appointment with another doctor because I feel so frustrated.


  22. sreyanka October 25, 2010 at 9:33 pm #

    I am a 40 year old woman who a month ago had a heart attack.. I had the indigestion feeling that was so painful I had to call a friend and she came and said she was calling 911. The paramedics arrived and i was sitting in my chair freezing to death. I couldnt get enough air into my lungs fast enough. I was taken to the ER and it showed that i had had a mild heart attack. I was admitted to the icu and the next day they did a heart cath and found i was 90% blocked. i was told that i had to have a heart bypass and the next day at 5:30 am i was in surgery.


  23. Wendy September 14, 2010 at 3:26 pm #

    I am so frustrated.

    Let me start by saying I am a non smoker non drinker no known health problems and rarely have to go to the doctor. (by the way I hate going to the doctor because I feel he really doesn’t listen)

    Yesterday while I was at work I got dizzy my hands and forehead and face went numb and Then within 10 minutes I sounded drunk and was slurring my words unable to get the words out. I went to the ER because I thought I might be having a stroke. The ER did an ekg Chest xray Cat scan Echo cardiograham. The Cat scan had a spot on it they didn’t know what it was so they sent me to for an MRI. and they did blood work. Everything came back normal. The neurologist said he couldn’t see anything on the tests but it could be from a complicated migraine. Even without having a head ache. or it could be MS symptoms but they didn’t see that and there is no family history He doesn’t think it was a stroke because nothing showed on the test and both sides of my face were affected not just one. He did say my B12 level was low–219 so he ordered a b-12 shot. but sent me home saying I should take baby aspirin. and get a shot once a month and follow up with him in two weeks.

    Today just after eating lunch my left arm went numb and was tingling and I have been nauseous all day. I called my doctor who told me to come in and he basically said we have pretty much done every test there is to do he asked me what the neurologist said and then basically repeated it to me saying the b12 or the complicated migraine probably caused my problems and if the numbness persisted they could do a nerve test on my arm but to just watch it and keep track to see if there is a pattern.

    I am really concerned because Heart disease runs very strong in my family My dad had a triple bypass and a stroke his sisters and brother dies of heart failure(2) and an annurism. When I told him this was my concern because I have had chest pains in the past he said yes I can see in your chart you have had some stress. I told him not anything unusual–he had it in my file my problems were from stress I told him only the normal stress of a full time working mom. he said I think you can be confident it isn’t your heart but I am not confident. I feel anxious about it because I think he isn’t really listening to my concerns. I have an appointment with a different doctor Monday are there any tests I should ask about or should I just wait and keep track of my symptoms?


    • Carolyn Thomas September 14, 2010 at 6:07 pm #

      Hello Wendy,
      No wonder you are frustrated. I’m sorry you’re going through this.

      The standard cardiac diagnostic tests are an EKG and cardiac enzyme blood tests, particularly for troponins which are enzymes released into the bloodstream that are usually not measurable unless you’ve had heart muscle damage during a heart attack. After a cardiac event, troponin levels begin to rise in the blood 4-6 hours after the first symptoms, but can take 24-48 hours to peak. You no doubt already had cardiac enzymes tested yesterday but if your symptoms persist, do not wait for Monday’s appointment: go immediately back to the ER for further tests. And yes, do keep track of every symptom.

      Your symptoms may NOT be due to heart problems, but at this point you don’t know for sure. Something is causing them – what is it? I have met women with atypical heart attack symptoms ranging from a persistent cough to numbness in the lower lip. I have met countless women who in mid-heart attack were sent home from the ER with “normal” cardiac test results and reassured as you were that it was NOT a heart issue. But diagnosis is often complicated because there are many conditions with distressing symptoms that may mimic heart disease. That’s likely why your doctor appears not to be listening to your concerns – he may be stumped by all these “normal” test results. So much of medicine is just trying to eliminate what the problem ISN’T.

      You absolutely did the right thing by going to the ER immediately after yesterday’s symptoms, and again today going to see your doctor. Please keep going back if symptoms persist. You know your body – you know when something is “not right”.

      It’s unfortunately common for women to try to wait it out, see if things get better, keep quiet, not make a fuss. Don’t do that!!

      Best of luck to you,


  24. dg June 19, 2010 at 10:00 am #

    Thanks for the above. You’ve made me feel a whole lot better, knowing it’s not just me.

    Here in the UK, I’ve just found out that I’ve got a small heart defect, and minor heart attacks have been wrongly diagnosed for 14 years!

    It seems I started to get them when I developed an underactive thyroid, which raised my blood pressure from normally low to, initially, high. They got it down to normal, but this was high for me and the heart attacks started.

    I was told it was indigestion, gastric reflux, a funny turn – and doctor after doctor (including a hospital consultant) failed to recognise standard signs of a heart attack. It was only recently when I managed to get to the hospital during an attack that they realised what it was, gave me an angiogram and found the problem.


    • Carolyn Thomas June 20, 2010 at 7:58 am #

      Hello dg – when I was at Mayo Clinic five months after my own heart attack, I met dozens of women who told similar stories of being sent home from the Emergency Department with misdiagnoses ranging from acid reflux to anxiety attacks to gall bladder problems. And of course many docs believe that menopause itself is a nice little all-purpose diagnosis for whatever ails you!

      I think that we need to see two major shifts here: #1 – women need to be far more assertive about demanding quality care when we know that something is seriously wrong, and #2 – medical professionals need far more education on the realities of women’s heart disease.


      • MioMyo June 24, 2015 at 10:09 pm #

        Oh, gallbladder! I remember one of my visits to ER and the doctor said: “This is probably your gallbladder – gallbladder pain causes changes on your ECG.” I replied that my gallbladder was removed. Can you imagine his face after these words? 🙂


  25. jb May 28, 2009 at 7:49 pm #

    Thanks for this on heart disease mis-diagnosis. I look forward to each new essay, you clearly have natural ability for writing!



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