Media coverage of a study presented at the annual Canadian Cardiovascular Congress last month has left me and other Heart Sisters gobsmacked. One heart attack survivor told me:
“This ‘research’ has set back women’s awareness of heart attack symptoms by a full decade!”
What could have inspired a reaction like this? First, there are the media headlines, “The Heart Attack Myth”.
Second, there’s the research methodology (the way this study was designed). And finally there’s the reporting of the study’s conclusion: essentially, that there are no differences at all in heart attack symptoms between men and women.
This study looked at 305 patients undergoing routine, scheduled, non-emergency angioplasty procedures in hospital. (Watch this 30-second video describing an angioplasty procedure). Based on cardiac symptoms that patients reported during the momentary full blockage while the angioplasty balloon expands inside the coronary artery (ostensibly imitating what happens during an actual heart attack), the study’s author jumps to the conclusion that women always experience the same chest pain symptoms that men do during a real life heart attack.
Oddly enough, media coverage rarely touched on another of the study’s key findings: that women heart attack survivors in this study suffered “significantly more throat, neck and jaw pain” than men. Tragically, this omission is a missed educational opportunity. Where were the big headlines for this important news?
Scratch any heart attack survivor and you’ll likely uncover an amazing litany of weird symptoms – some so weird you’d never believe them to be remotely cardiac in nature. Lips turning numb, persistent coughing, elbow pain, earache, heavy sensation in the hands, vomiting, fever – do these sound like heart attack warning signs to you? Yet these and many other relatively unfamiliar symptoms are reported by women every day during real-life heart attacks. These unusual symptoms are important to know because 8-10% of women report no chest symptoms at all during a heart attack.(1) (Results of many studies on this absence of chest pain in women vary, by the way, from 8-42%).
Since I started doing public presentations about women and heart disease, it’s been an uphill battle to convince women of the need to recognize and respond immediately to heart attack symptoms – ALL symptoms. These may include the textbook sign of chest pain (as I experienced myself during my own heart attack) but also include many vague symptoms that women report. I have yet to meet any woman who is unaware that chest pain is linked with heart attack, but many are very surprised to learn about less common symptoms. If only media coverage of this study had featured women’s commonly experienced throat, neck, and jaw pain symptoms as the major headline, instead of the catchy but misleading “Heart Attack Myth”.
So I felt confused and dismayed by this study’s growing media pickup, as we say in public relations, as well as the buzz in cardiac circles among survivors, particularly about the media emphasis on chest pain. Staff at both Medpedia and our local Heart and Stroke Foundation office e-mailed me when the study hit the news to ask if I’d seen it yet.
I knew I had to go to an expert to answer growing concerns about what had become high-profile news. For me, that meant only one person: Mayo Clinic cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic in Rochester, Minnesota. I contacted Dr. Sharonne and asked for her own take on the ‘Heart Attack Myth’ news coverage. Here’s how she responded:
“Their study is not conclusive – that would be a bit of a stretch – but everything else that is quoted is factual and/or good advice, except for the last sentence in the second paragraph of the news release. (‘Both the media and some patient educational materials frequently suggest that women experience symptoms of a heart attack very differently from men,’ says cardiac nurse Martha Mackay, a Canadian Institutes of Health Research clinical research fellow and doctoral student at the UBC School of Nursing. “These findings suggest that this is simply not the case.’)
“Every patient has unique symptoms. While there may be a few more women with nausea and vomiting, and a few more men with obvious chest symptoms or radiation down the left arm, both may have a 25-30% ‘atypical’ presentation rate. So it is not accurate to state definitively that women have more ‘atypical’ symptoms. Women do have MORE symptoms, however, making it more challenging to sift through all of them and come up with a diagnosis.
“The other issue is that the only way we are going to get the answer to this is more research, and if we ask for more research, we cannot just reject as flawed any study that does not fit with what we believe. Instead, we have to put that research into perspective.
“No study, including this one, is the be-all/end-all. Each piece of research builds on the prior studies, and this one is valid to the point that it demonstrates that men and women experience similar symptoms when they have ischemia due to an acutely occluded coronary artery (which is what happens during a heart attack in many, but not all people). What it does not translate to is that there are no sex differences in heart attack symptoms. Not every heart attack occurs as a result of sudden, complete blockage such as this. And we do not have prospective sex-based data on symptoms.”
Dr. Sharonne Hayes also included in her e-mail to me something she had written two years ago for WomenHeart: The National Coalition for Women With Heart Disease:
“Even when women have ‘classic’ heart attack symptoms, they are more likely to be misdiagnosed and have delayed care compared to men. This has nothing to do with sex differences, but does have to do with the need for better health care provider education and diagnostic tools.
“Women need early detection (which means early recognition of symptoms), accurate diagnosis (symptoms taken seriously and investigated appropriately) and proper treatment.”
Find out more about heart attack signs that both men and women can experience. And no matter what symptoms you may experience, pay attention to that little voice that warns you ‘Something is wrong with me!’
You know your body. You know when something is not right. Don’t ignore that little voice, for it could save your life.
(1) 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.
UPDATE, JANUARY 31, 2016: The American Heart Association releases its first ever scientific statement on women’s heart attacks, concluding (as I’ve been writing here since 2009) that “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.” The summary of the statement: if you’re a woman having a heart attack, you’re more likely to be underdiagnosed – and then undertreated even when appropriately diagnosed – compared to our male counterparts.
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