‘Time equals muscle’ during women’s heart attacks

6 Jun

RLM071

by Carolyn Thomas  @HeartSisters

Here’s why it’s so important to call for an ambulance immediately if you think you might be having a heart attack. A heart attack (or myocardial infarction) is the death of heart muscle from the sudden blockage of a coronary artery.

This blockage deprives your heart muscle – or myocardium – of blood and oxygen. If blood flow is not restored to your heart muscle within 20-40 minutes, irreversible death of the muscle will begin to occur. Muscle continues to die for 6-8 hours, at which time your heart attack will be described as ‘complete’.  Depending on how much heart muscle is damaged, disability or death can result.

But if you actually do live through this, your dead heart muscle will eventually be replaced by scar tissue. So as you can imagine, every minute counts.

Time equals muscle.  Immediate medical intervention – preferably within the first hour of onset of symptoms – is aimed at quickly restoring blood flow to the heart muscle to prevent or minimize this permanent damage. Tragically, women typically wait longer with serious symptoms before seeking help – one reason that women’s cardiac outcomes are more deadly than men’s.

Another reason is that, as reported in The New England Journal of Medicine, women are up to seven times more likely to be misdiagnosed in mid-heart attack and sent home from Emergency Departments compared to our male counterparts.*

When you’re admitted to hospital, blood tests are used to determine the extent of damage to your heart muscle by measuring levels of certain cardiac enzymes. Doctors look for:

  • cardiac troponin T and I – elevated troponin levels are specific to a heart injury; troponin levels typically begin to rise 2-6 hours after a heart attack for men, and over time within 10-24 hours for women. Elevated levels can still be detected a week or more after the onset of chest pain.
ormal levels of cardiac troponin in the blood are very low, but they rise sharply and quickly in response to a heart muscle injury, usually within two or three hours after the beginning of a heart attack. Unlike creatine kinase (CK), cardiac troponin will also rise in response to angina, which is one reason the two tests are often performed together.
Cardiac troponin is more sensitive to damage than CK and is therefore valuable at detecting mild heart attacks and early detection of other heart problems. Troponin T and I levels have also been used to help predict a patient’s heart attack risk because of their sensitivity and the fact that elevated levels are specific to a heart injuryormal levels of cardiac troponin in the blood are very low, but they rise sharply and quickly in response to a heart muscle injury, usually within two or three hours after the beginning of a heart attack. Unlike creatine kinase (CK), cardiac troponin will also rise in response to angina, which is one reason the two tests are often performed together.Cardiac troponin is more sensitive to damage than CK and is therefore valuable at detecting mild heart attacks and early detection of other heart problems. Troponin T and I levels have also been used to help predict a patient’s heart attack risk because of their sensitivity and the fact that elevated levels are specific to a heart injury.
  • creatinine phosphokinase (CPK or CK) – typically increase to above-normal levels about 4-6 hours after a heart attack and may remain elevated for up to 48 hours afterwards

All of these are enzymes released into the blood by your dying heart muscles whose surrounding membranes have dissolved.

High levels confirm diagnosis of a heart attack. Cardiac enzyme tests are often repeated over several hours for comparison. Practice guidelines recommend that blood samples for these tests are drawn every 8-12 hours for 1-2 days after a suspected heart attack.

This is not what happened to me, by the way.

I was discharged from the Emergency Department just five hours after I presented with textbook heart attack symptoms of chest pain, nausea, sweating and pain radiating down my left arm. Both blood tests (administered at about two and four hours post-admission) showed “normal” troponins. Five hours later, I was back home, misdiagnosed with GERD (Gastroesophageal Reflux Disease).

What should have happened, instead of sending me home with this acid reflux misdiagnosis and a pat on the head?

I should have been ordered to return to the lab for more blood tests for the next 1-2 days as treatment guidelines dictates.

Recently, a woman in one of my heart health presentations told me of her experience in Emergency for an unrelated medical issue, where she overheard a conversation between the (male) doctor and the (male) patient behind the curtain in the neighbouring bed. The doctor told the patient:

“Your EKG is fine. All your blood tests are fine. But we’re going to keep you for observation just to make sure it’s not your heart.”

Thus yet another man is treated according to practice guidelines, while women continue to be misdiagnosed and sent home in mid-heart attack.

© Carolyn Thomas  www.myheartsisters.org

* 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.

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6 Responses to “‘Time equals muscle’ during women’s heart attacks”

  1. AGauthier July 13, 2014 at 6:13 pm #

    “This is not what happened to me, by the way. I was discharged from the Emergency Department just five hours after I presented with textbook heart attack symptoms of chest pain, nausea, sweating and pain radiating down my left arm. Both blood tests (administered at about two and four hours post-admission) showed “normal” troponins. Five hours later, I was back home, misdiagnosed with GERD (Gastroesophageal Reflux Disease).”

    The exact same thing happened to me. I was told initially by the ER dr that the troponin levels were slightly elevated (out of the normal range) and I was admitted. The cardiac dr on the floor told me the levels were fine and released me less than 24 hrs after the heart attack happened. It was almost a month before I had a nuclear stress test, which according to my primary showed “an area of dead muscle consistent with a heart attack”. To this day my cardiologist has never said whether or not it was a heart attack.

    Like

    • Carolyn Thomas July 13, 2014 at 9:40 pm #

      Sounds like you had duelling diagnoses. Ask to see the medical record of that hospital admission and have your doctor explain exactly what’s recorded.

      Like

  2. Tonie March 23, 2010 at 12:33 pm #

    This is extremely good advice especially for those of us who like to live in denial, wishful thinking and other distractions. Get help FAST seems to be the wisest move. Act now, ask questions later… Many thanks for this.

    Like

  3. Debi D. March 16, 2010 at 5:01 pm #

    Time equals muscle. Such a valuable lesson. We have no time to lose during an emergency. Thank you for this important reminder. Ladies out there, do not wait. Call 911.

    Like

  4. Krista March 16, 2010 at 8:12 am #

    Nice job, very comprehensive. Thanks for this overview about exactly what happens during a heart attack. It also helps to motivate us to ACT FAST at the first sign of any troubling symptom.

    Like

  5. Dr. Ken March 14, 2010 at 6:52 pm #

    “Troponin levels typically begin to rise 2-4 hours after a heart attack for men, and over time within 10-24 hours for women…”

    I agree with your conclusions here. This is an important yet frequently overlooked diagnostic difference for emergency personnel to remember. As you’ve mentioned frequently in other essays here, many women are sent home in error from the E.R. even in mid-heart attack with misdiagnoses because of what are believed to be test results within normal range.

    Like

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