Heart attack misdiagnosis in women

~ Carolyn Thomas

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:

  • 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
  • even the laboratory mice, rats and rabbits used in early studies are male animals

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 8-40% (depending on which of many studies you read) 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. 

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

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 originally published June 22, 2016 doi: 10.1161/JAHA.116.003704
(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 20–26.
(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

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NOTE FROM CAROLYN:  I wrote much more about cardiac diagnosis and misdiagnosis in my book “A Woman’s Guide to Living with Heart Disease” . You can ask for it at your local bookshop, or order it online (paperback, hardcover or e-book) at Amazon, or order it directly from my publisher, Johns Hopkins University Press (use the code HTWN to save 20% off the list price).

 

See also:

 

ANOTHER 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.

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ANOTHER REALLY 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.

Published by Carolyn Thomas

64 thoughts on “Heart attack misdiagnosis in women”

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  2. 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

    1. 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…

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  3. 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

      1. 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

          1. 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…

            Hugs!

            Liked by 1 person

            1. 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.

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  4. 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

    1. 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…

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  5. 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

    1. 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.

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  6. 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. ❤

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  8. 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.

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    1. 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.

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  10. 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.

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  12. 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 ….

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    1. 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.

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      1. 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.

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  13. 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.

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  14. 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

    1. 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.

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  16. 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.

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  17. 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.

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  18. 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?

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    1. 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,
      C.

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  19. 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.

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    1. 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.
      Cheers,
      C.

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      1. 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? 🙂

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  20. 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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