Same heart attack, same misdiagnosis – but one big difference

~ Carolyn Thomas

by Carolyn Thomas  ♥  @HeartSisters

Our two stories are freakishly the same in so many ways:

♥ In 58-year old Nancy Bradley’s story, she went to the Emergency Department at the Royal Inland Hospital near her home in Kamloops as soon as she felt alarming symptoms she knew might be heart-related: dizziness, sweating, shortness of breath and “an elephant sitting on my chest” feeling. (In my story, I was 58 as well, and I went to Emergency at the Royal Jubilee Hospital near my home in Victoria as soon as my own alarming heart attack symptoms started).

♥ All of Nancy’s cardiac diagnostic tests seemed to be “normal”. (All of my diagnostic tests seemed to be “normal”, too).

♥ Nancy’s Emergency physician suspected heartburn, and suggested she take antacid drugs. (My Emergency physician suspected heartburn, and suggested that I take antacids). 

♥ Nancy was sent home, misdiagnosed with acid reflux within five hours of the onset of symptoms. (I was sent home, misdiagnosed with acid reflux within five hours of the onset of my symptoms).

♥ For the next two weeks, when her symptoms flared up, Nancy chewed antacids as directed by that Emergency physician. (For the next two weeks, when my symptoms flared up, I chewed antacids just like the doctor had told me, too).

♥ Two weeks after being misdiagnosed, Nancy finally returned to the same Emergency Department because her symptoms were so bad, she thought she was dying. (Two weeks after I was misdiagnosed, I returned to my Emergency Department because my symptoms were so bad, I thought I was dying).

♥ Each of us learned right away during this second trip to hospital that we were indeed having a heart attack just as we had first suspected, and each of us were immediately admitted for emergency treatment of a 95 per cent blocked coronary artery.

The striking difference: my heart attack happened in 2008, but Nancy’s happened 10 years later.

A number of physicians – in both Emergency Medicine and in Cardiology – have reassured me personally that what happened to me 10 years ago could not possibly happen today, because physicians are more aware of women’s heart disease differences now, and because cardiac diagnostic tests have improved since 2008.

But that’s what makes Nancy’s story so much more disturbing than mine – because it means that, a full decade later, we’re still seeing many female heart patients who are still not being diagnosed or treated in the same way our male counterparts are. As Mayo Clinic cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, told me on Twitter after she read Nancy ‘s story:*

Screen Shot 2018-02-24 at 6.34.40 AM

This means that heart patients like Nancy are still suffering needlessly.

It means that despite study after study, report after report, expert after expert confirming this pervasive cardiology gender gap, the reality remains that when women seek help, they don’t always get it.

One such report was Ms. Understood, Canada’s Heart and Stroke Foundation’s 2018 Heart Report. The 20-page document, which features Nancy Bradley’s dramatic misdiagnosis and survival story, pulls no punches by summarizing its findings:

“Women’s hearts are victims of a broken system that is ill-equipped to diagnose, treat and support them.”

This conclusion is no surprise to informed physicians, researchers, and patients like me who write about them. It is, apparently, a surprise to many of the journalists who covered the launch of this report on February 1st, as Heart and Stroke Foundation staff told me later that day: “In so many media interviews, journalists are saying what a ‘surprise’  the Heart Report is!”

(SURPRISE?!?  These journalists have clearly not been reading either my blog or my book, A Woman’s Guide to Living with Heart Disease.)

Cardiologist Dr. Noel Bairey Merz, Director of the Barbra Streisand Women’s Heart Center at UCLA, bluntly describes this reality for them:

“We are 50 years behind in our knowledge about optimal screening, diagnosis, and treatment regimens for heart disease in women compared to what we know about heart disease in men – and every day, women pay the price.”

The Heart and Stroke report included these highlights (or, more accurately, lowlights):

• Heart disease is the leading cause of premature death for women in Canada.

• Early heart attack signs were missed in 78% of women.
 
• Every 20 minutes a woman in Canada dies from heart
disease.
 
• Five times as many women die from heart disease as
breast cancer.
 
• Two-thirds of heart disease clinical research focuses
only on men.
 
• Women who have a heart attack are more likely to die or
suffer a second heart attack compared to men.
.
The report also describes women’s cardiac care as a “reality defined by unders“:
“Today, when it comes to heart disease, women are under-researched, under-diagnosed and under–treated, under-supported and under-aware.
.
“This complex mix of ‘unders’ began in health research where, for decades, specific therapies were tested in controlled studies on primarily middle-aged, white male subjects. The assumption was that one-size-fits-all.”
That assumption, by the way, includes not just those middle-aged, white male human subjects. Even in animal studies, researchers have used male rats, mice and rabbits in the lab for decades. But you can see what’s been happening: medical decisions made because they seem valid in males (mice or men) end up being applied to women as if we are exactly the same as men.
.
We are not.
.
As cardiologist Dr. Tara Sedlak, director of the Leslie Diamond Women’s Heart Health Centre in Vancouver, wrote in this report:
.
“Gender bias still exists.
.
“Physicians may look for other causes of a woman’s symptoms, without first doing appropriate tests to rule out cardiac issues. It may not be intentional, yet when there are differences in medical care for men and women across large numbers of patients, it is an indication there is still systemic bias.”

The report also addresses how diagnostic tests are not created equal:

“While no test is 100% accurate, some perform worse for women. The exercise treadmill (or stress) test for cardiac output is far less sensitive for women compared to men, and even worse for younger women compared to older women.
.
“A misleading diagnosis delays early treatment. For heart attack, the key to effectively treating and minimizing irreversible damage is time: open up the arteries quickly, restore blood flow quickly.”
A subject that deserves far more attention is the subject of heart disease in women of South Asian, Chinese or Afro-Caribbean descent, and in Indigenous or First Nations women. This report tells us that they are even more vulnerable to heart disease than we Caucasian women are.
.
For example, Cree heart transplant patient Esther Sanderson reminded the rest of us about this practical reality, especially among those who live in Canada’s North:
.

“Most First Nations communities do not have a doctor and there are no specialists.

“On-reserve, there are language problems – not only dialect, but also ‘doctor jargon’.  Many people who have been through the residential school experience are hesitant to ask questions of people in authority, so may not understand their condition or medication.
.
“The health care and treatment at the very beginning of these people’s medical journey is crucial. If that doesn’t work well, they are reluctant to return.
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“I believe that the healthcare system can learn from the experience of Indigenous people. We all need the biomedical model to determine a diagnosis, but it is up to us to figure out what will restore our health – within ourselves, our family and our community. We must understand that spiritual, cultural and traditional healing are all important.” 
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The 2018 Heart Report contains a number of creative recommendations to combat this gender bias (please read this compelling report to learn more), but until each one is embedded throughout the healthcare system – starting in medical school – will they actually make a difference?
 .
And what can women do for ourselves while we’re waiting around for our assorted healthcare systems to get onboard?
.
Until women decide to:

. . . then 10 years from now, we’ll still be reading disturbing stories about many more Nancys and Carolyns – and wondering when somebody, somewhere is going to somehow start doing something to help them.

If the tables were turned, if Nancy Bradley and I had been 58-year old men seeking help at our respective Emergency Departments presenting with identical cardiac symptoms, I’m willing to bet my next squirt of nitro spray that males would not be patted on the head and sent home with an antacid drug recommendation. Here’s why I believe this:
.
.

“Consider this story shared with me by a woman attending one of my Heart-Smart Women presentations. While lying on a gurney in the Emergency Department, she overheard this conversation between a physician and one of his (male) patients beyond the curtain separating her from the next bed. The doctor told the (male) patient:

“Your blood tests came back fine, your EKG tests are fine – but we’re going to admit you for observation just to rule out a heart attack”.

“So yet another male patient is thus kept in hospital for observation in spite of his ‘normal’ cardiac test results.”

But Nancy and I and countless other females in mid-heart attack are being sent home from Emergency mistakenly diagnosed with acid reflux or anxiety or menopause or a dog’s breakfast of other popular misdiagnosis options.

As Nancy told the Heart and Stroke Foundation recently:

“I would recommend that women be persistent. You know your own body; a person needs to follow their own gut feeling.

“Looking back, maybe I should have insisted more to the Emergency doctor the first time I went. I knew there was something wrong with my heart. I just knew it.”

.

♥

NOTE FROM CAROLYN: If you’re an American reading this, and assuming that this new report’s findings are unique to Canada, think again. I’ve been documenting American and international reports for years, including these:

♥ January 2020:  Professor Mark Woodward at the University of Oxford drops a bombshell in his report called Cardiovascular Disease and the Female Disadvantage

♥ February, 2018:  Women are more likely than men to seek care for their cardiac symptoms during the week before hospitalization – but both women and their physicians are less likely to attribute these early cardiac symptoms to heart disease compared to men. Pioneer cardiologist Dr. Nanette Wenger weighs in on the VIRGO study, published in Cardiology.

♥ January 2016:   The American Heart Association released its first ever scientific statement on women’s heart attacks (that’s ‘first’ – as in the first one in its entire 92-year history!) confirming that “compared to men, women tend to be under-treated”, and “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.”

♥ February 2016: Focused Cardiovascular Care for Women: The Need and Role in Clinical Practice, a report published in the journal, Mayo Clinic Proceedings on why we need Women’s Heart Clinics that can specifically address the many unique considerations of women’s heart disease, concluding: “The public health cost of misdiagnosed or undiagnosed cardiac disease in women is significant.”

♥

* Troponins are a type of cardiac enzyme found in blood tests when the heart muscle is damaged during a heart attack.

Q: What changes do you think would make the biggest difference in closing this cardiology gender gap?

♥

ANOTHER NOTE FROM CAROLYN: I wrote much more about the cardiology gender gap in Chapter 3 of 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 JHUP code HTWN to save 30% off the list price).

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See also:

Read more about Nancy Bradley’s story in this Toronto Star interview.

When Your “Significant EKG Changes” are Missed

Yentl Syndrome: Cardiology’s Gender Gap is Alive and Well

How Does It Really Feel to Have a Heart Attack? Women Survivors Tell Their Stories

Diagnosis – and Misdiagnosis – of Women’s Heart Disease

14 Reasons To Be Glad You’re A Man When You’re Having a Heart Attack

His and Hers Heart Attacks

Heart Attack – or an Attack of Heartburn?

Is it a Heart Attack – or a Panic Attack?

What is Causing my Chest Pain?

When Your Doctor Mislabels You As an “Anxious Female”

Heart Disease: Not Just A Man’s Disease Anymore

How Doctors Discovered That Women Have Heart Disease, Too

Gender Differences in Heart Attack Treatment Contribute To Women’s Higher Death Rates

How a Woman’s Heart Attack is Different From A Man’s

Much more about the cardiology gender gap in my book A Woman’s Guide to Living With Heart Disease (Johns Hopkins University Press)

Published by Carolyn Thomas

37 thoughts on “Same heart attack, same misdiagnosis – but one big difference”

  1. Wow! Everything you write is so true and it’s what i’ve been saying to people for years. And it’s still happening.

    In December 2021 I thought I was having a heart attack. Tight chest, felt really sick when I walked just 10 paces. I just did not feel right. I wrote to my GP that morning telling them I thought I was having an heart attack and they told me to dial 999. I did. The ambulance arrived quickly (2 men) and diagnosed me with acid reflux and left me with a peppermint teabag!

    That afternoon my GP rang me to see how I’d got on. I told him the ambulance men left me at home and said it was acid reflux. He asked how I felt, I told him I’d not got out of bed all day I felt so bad.

    He told me to go to Emergency myself, so my husband took me. Turned out I had had a heart attack and I was fitted with 3 stents the following morning!

    They told me I could have been dead if I’d waited another day. My symptoms were not that typical of a heart attack, however they were 100% NOT symptoms of acid reflux! I reported the ambulance men and I got an apology from them.

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    1. Hello B – ambulance paramedics who leave a peppermint tea bag? Is that the newest official treatment guideline?!?

      This acid reflux misdiagnosis (very common in women) is often a reflection of both gender bias (which healthcare professionals may be unaware of – that’s called “implicit” bias) plus diagnostic tests being developed and researched for decades only on (white, middle-aged) men – NOT on women. I’m guessing your ambulance guys did an ECG test that looked “normal” to them (hence the tea bag!)

      Correctly interpreting a 12-lead ECG can be tricky – even for cardiologists. Just yesterday I read a study that reported “There is no uniform way to teach doctors-in-training how to interpret an ECG or assess their competence in the interpretation.”

      Emergency staff can do additional tests in hospital like a blood test for cardiac enzyme called troponin and other tests – but in your case, it sounds like the two ambulance attendants closed you down with their misdiagnosis so their diagnostic tools were limited. A famous study that I’ve written about here showed, for example, that ambulance drivers are significantly less likely to turn on flashing lights and sirens when a female heart patient is in their ambulance compared to male heart patients! That must stop!

      I’m glad your GP was so pro-active, and that you were finally correctly diagnosed and treated! And I also hope those two paramedics learned a valuable lesson in your case so they’re not so quick to automatically dismiss the women they’re supposed to be helping. ❤️

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      1. Hi Carolyn. Thanks for your reply. I’ve now watched some of your video interviews and you’ve inspired me to do something about this ‘implicit gender bias’ here in the UK.

        Peppermint tea for women and a blue light ambulance service for men, just doesn’t sound right to me!

        I went onto the British Heart Foundation (BHF) website and found a section dedicated to symptoms in women but unfortunately it gives out mixed messages and includes a link to a very contradictory article of research on myths about women’s symptoms.

        Here is a link, https://www.bhf.org.uk/search?keyword=Women+symptoms&run=1that leads to other links that I think you may be interested in. I’d love to hear your views.

        Thanks!
        B

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        1. Hi again B – My understanding is that the BHF article (written five years ago) is correct in one important area: it is true, and many studies duplicate this finding, that CHEST PAIN (or discomfort, or fullness, or heaviness, or ache – but remember that women often do NOT use the word “pain” to describe their chest symptoms) is the most common cardiac symptom in both men and women.

          At Mayo Clinic, cardiologists told us that any symptom that’s unusual for you – between neck and navel that is worse with exertion and improves with rest – should be considered CARDIAC until proven otherwise. That’s pretty clear.

          It’s also clear, according to many cardiac researchers, that we should not be using the word “atypical” to describe cardiac symptoms in either men or women. The new 2021 official Chest Pain Treatment Guidelines specifically say “atypical is OUT!”

          Cardiologist Dr. Sharonne Hayes, founder of the Mayo Women’s Heart Clinic, says it best, in my opinion: she advises : “Focus less on symptom DIFFERENCES (which multiple studies suggest are few and can’t be relied upon for diagnosis) and more on symptom RECOGNITION by patients AND physicians, which continues to contribute to disparities in outcomes.”

          My question whenever women’s cardiac symptoms are described as “atypical”: Why are our symptoms called “atypical” when women make up over half of the population?!?! They’re not atypical. They’re perfectly typical if you’re a woman.

          Any symptom that is unusual, never-before- experienced and comes on with exertion and goes away with rest requires immediate medical attention to rule out a cardiac cause.

          Thanks again for sharing your experience! ❤️

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  2. Wow. This post showed up on my email feed this morning, three years after it was originally posted. Looking at the date, I realized that it was during the two week period between initially experiencing heart symptoms, being sent home with a possible diagnosis of something other than heart issues, given a Holter monitor mostly to pacify me, and then finally ending up in the ER on Feb 12th with three blocked arteries needing stents. (This post is dated Feb 5th). In fact, my original response to this was describing my experience in real time.

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    1. Hi Charlotte! I wonder what is going on behind the tech scenes today with my WordPress blog host?!? Yes, you did indeed comment, replying to Holly’s response to this post on February 4, 2018 – same day as the post was published (scroll down to the bottom to see it). I’m thinking that you may have been contacted if you had originally clicked on the ‘let me know about future comments to this post” button back in 2018.

      That certainly was a traumatic experience for you three years ago! Thanks as always for sharing your experience and opinions here for the rest of us!

      Take care, stay safe. . . ♥

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  4. Great to have read this report! Difficult to ‘reason’ with your doctor. You are the ‘unqualified’ person. Easily labelled ‘hypochondriac’. Will discuss MY condition with doctor again, in light of this information.

    THANKS!!

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  5. Did I need to have my pacemaker checked every so often because ever since 2011 when I had this inserted, I’ve never had it checked or tested. What do I need to do, is that important, can I sue my doctor or what?

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    1. Hello Dena – the battery in your pacemaker may need replacing every 8-10 years. Some devices may need to be adjusted if your medical condition or lifestyle changes, or if you have unusual symptoms. Before you decide on suing your doctor, why not book an appointment to discuss this now? More background info here from Johns Hopkins University.

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  6. Hi
    Thursday night: I had severe pressure in my left arm, it feels like a vise was squeezing it. Then numbness extended to my fingers and pain to my neck. I chewed aspirin. But didn’t go to the ER.

    I am a massage therapist, and on Friday had to do my 3 treatments that day sitting half the time because I felt breathless and pressure in my chest.
    Went to Urgent Care. They suggested I go to the ER. The EKG had findings of possible past episodes. But the enzyme blood test showed nothing.

    So I went to work Saturday. Again the pressure and breathlessness wouldn’t stop and I sat during as much of each massage as I could. ( I usually am very active while massaging Clients.)

    Sunday am, felt like an elephant pressure. Two aspirins and finally at 2 pm went to the ER.

    They said the EKG was normal. While waiting for the blood test, I told the Dr “I have a blood vessel that popped out on my left Temple, it’s slowly going away, but I have never had it until this episode” he replied “I am not here to look at your head”.

    He came back and told me the blood test was normal and referred me to the specialist I saw in 2017 that said my heart was fine after a stress test. Even though I get breathless walking and pain.

    The ER Dr told me to get more exercise (I had confided in him that I had breathlessness and pressure and pain 2 years ago and the stress test was normal and they prescribed asthma inhalers that didn’t change my breathlessness, exhaustion or pain).

    And that after Thursday’s episode I realized that the symptoms never went away, I had just altered my life so that I wasn’t active enough to bring them on. And when they would start, I unconsciously stopped my activity.

    So his answer was too get more exercise and suggested either a pulled muscle caused the numbness, or an anxiety attack. I accepted this. But then last night after resting all day, the pressure and pain keep persisting.

    After looking for information on whether a heart attack can be misdiagnosed as anxiety, I found your website.

    This is 2019. In Albuquerque, New Mexico. At Lovelace’s WOMEN’S hospital.

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  7. In October 2017 I went to the doc and was treated for acid reflux. Had burning in chest, back, teeth hurt at times. Five days later couldn’t walk, organs were shutting down, was having a heart attack, 100% blocked on my right side. Getting better now, walk with a crutch, but wish he would have done an EKG that day.

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    1. You’re welcome, Jennifer. I’m impressed by the range of important issues you and your team cover in this report. Kudos to all of you! I hope we will soon be able to look back on reports about women’s heart health with all of these discouraging stats and remember the ‘bad old days’ that are no more!

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  11. I guess I was “lucky” that my cardiac event (increasingly unstable angina; not clear to this day if I actually had a heart attack) happened in Chiang Mai, Thailand.

    I got excellent care there, although the Thai cardiologist told me only one blockage was found which was perhaps wrong. The Canadian cardiologist who finally read my Thai angiogram after 3 years said I had 2 additional blockages, not needing stenting. My current cardiologist didn’t even want to see the angiogram (what? they don’t know how to do this kind of medical care anywhere outside North Ameria?)

    I had to push for that reading through another local doctor. My most recent experience about considering gender was when I had a carotid intimal thickness ultrasound here in Canada. The results said I had the carotid arteries “of a 69-year-old” and I’m 64. I asked if that was a man or woman I was being compared to and if there is a difference in the interpretation. No one had ever asked the doctor at the Lipid Clinic or the cardiologist she consulted. I will not get an answer, I’m sure. Much needs to change.

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    1. Ellen, what a brilliant question to ask that doc at the Lipid Clinic after your ultrasound!! You’re so right – much needs to change!

      You are the second person to tell me of the impressive cardiac care received in a Thai hospital. The fact that your current cardiologist didn’t even want to see that angio speaks more of the arrogance of North American physicians than of the quality of foreign medical practice.

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  12. One place to start would be at the medical school level. Train all medical students, both male and female, on the urgent need to get past gender bias and treat women’s heart symptoms seriously. Require all physicians to take yearly courses in women’s heart issues and yearly refresher courses in sensitivity training.

    None of this will solve the problem fast, but it could be a start. Offer more women’s heart health educational meetings at local hospitals. Advertise these meetings in local media. Further, crank up the AHA’s publicity campaigns. Get somebody [preferably a highly knowledgeable woman] who’s a real PR pro at the head of a really strong campaign to educate women and men and cardiologists and PCPs and other human beings on women’s heart health and/or lack thereof.

    I have yet to see these issues focused on as strongly as, for instance, the breast cancer efforts.

    And: Your blog, Carolyn, is still one of the very, very few of its kind. Neither my PCP nor my cardiologist was aware of its existence until I told them about it — and I only found it by accident.

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    1. Thank you so much for your kind words, Sandra! I agree 100% with you about the crucial importance of making big changes starting in med school. Tomorrow!

      And I think this 2018 Heart Report from the Heart and Stroke Foundation is an example of a tremendous awareness-building tool for all of us. Please read the whole report, and then share it with the women you care about!

      I suspect that women’s heart disease as a ’cause’ is unlikely to catch up with the pinkification called breast cancer awareness any time soon – but if we each do our little bit, I believe we can make things better for women’s hearts, one woman at a time…

      Another unexpected PR tool recently was the Grey’s Anatomy TV show all about women’s heart attacks! Strong messages about women’s atypical cardiac symptoms, cardiac risk factors, etc went blazing out over one hour to 9 million G.A. viewers. One cardiologist, Dr. Melissa Walton-Shirley reviewed the show here!

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  13. This describes my mother’s experience perfectly. She was sent home with a diagnosis of indigestion, despite a medical history of heart issues. She passed a stress test with flying colors, two weeks before she died of a heart attack.

    My solution? A woman cardiologist. My cardiologist is very collaborative in her approach and takes my concerns very seriously. I recently “passed a stress test with flying colors” but she said that it was in no way a perfect test. We decided that the next appropriate step was something more conclusive. I hate to be sexist, and I’m sure there are a lot of aware male doctors, but honestly? I just find that women listen better and take me more seriously.

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    1. Hi Wendy – Tragic story about your mother. My condolences to you on such a sad and preventable loss.

      I’ve met lots of male cardiologists who are awesome communicators (including my own!) But a recent study suggests that female physicians actually do have better patient outcomes compared to their male colleagues!

      This 2018 Heart Report specifically talks about the reliability of the treadmill stress test in women (=not great!) I wrote more about the treadmill test here.

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  14. My symptoms started mid-1980’s, I had two heart attacks between late 1980 and 1990. None were recognized or believed. Anti-depressants were pushed at me, drs said it was stress, nerves, my difficult home life. All EKG’s showed nothing.

    It became humiliating to mention my continuing heart symptoms, so … I stopped mentioning them. Until days after my 69th birthday. Three very severe heart attacks within a week and a half. I told no one, chewed handfuls of aspirins until the symptoms subsided, and went about my day to day life. Until the third one, I knew I needed to tell. Called drs office, nurse said “go to ER” … I did, but three days later, I had things to arrange at home, just in case.

    I went to the ER, spent 8 hours there until an ICU bed was available. Bottom line: I had TEN blocked arteries. Betting they didn’t happen overnight, betting I was suffering all those years as each artery took its time getting blocked.

    Two male cousins had their heart disease noted after their very first symptom – both had bypass surgery … one of them only had one blocked artery, the other had two. I, the female who was ignored all those years and Rx’d anti-depressants, had TEN blocked arteries. I had quadruple bypass, only four were able to be repaired, the other six, still in me, were too small to repair.

    I’ll be 78 in two months, I survived the heart surgery – and the three day coma induced because my heart kept failing immediately after the surgery was completed. The medical team worked very hard to save my life. I’m grateful.

    But I’m not grateful to any of the drs who ignored my symptoms since my mid-40’s. Especially that heart disease was rampant in my family!

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    1. Michelle, I hardly know where to start responding! TEN BLOCKAGES? I wonder how many other women have simply stopped mentioning ongoing symptoms to their physicians because they’d given up hoping to be taken seriously… And to have the concurrent examples of the speedy service offered to your (male) cousins makes this feel even worse!

      I wanted to mention family history here, since you brought it up. We know that only first-degree relatives count when it comes to determining if a person has a family history of heart disease: for example, if your Dad or brother had a cardiac event before age 55, or if your Mum or sister had a cardiac event before age 65, then you’re considered to have a family history risk factor. There’s no evidence to show any direct family history risk associated with grandparents, cousins, aunts, uncles, etc. More on that here…

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  15. I think that most doctors have never experienced the conditions that they are attempting to diagnose. I think those conditions have non-known/predicted outlying symptoms and those symptoms are not taught in school – this wisdom is taught by practice. I think most medical school programs have a set agenda that includes an impossibly hard schedule and so much of it is focused on the biology/chemistry of the condition rather than the communication aspect.

    That leaves the ill patient holding the responsibility bag to communicate (one way) to their attending physician. A lot of those physicians are in a nutcracker between hospital leadership exerting financially-driven constrains (GOMER = “get out of my ER!”), financial constraints associated with the debt load carried by the physicians, exhaustion, and they have never been “just a normal mortal”. EVERY single element of their education was hand fed to them.

    My aunt fell and called the transit to take her to the hospital to be checked out. Her hip hurt. Wanna bet that she told the nurse that she fell and hurt her hip? That is what her daughter told me before telling me how she spent the day in the emergency dept with her elderly mom.

    When I called my aunt, after the fact, I asked her to describe her morning. The first response is that it was a normal morning but that she wasn’t feeling well and had gone to the kitchen to take some pain medicine, then fell and her hip hurt. She took quite a while to get well enough to get to the phone.

    “What does your normal morning look like?” Did she eat breakfast? She guessed so. “What did you eat for breakfast?”

    “Oh I have oatmeal every day then I watch TV. I got up to take some Tylenol because I didn’t feel well. While at the kitchen sink, I felt so hot – like I was in an oven then don’t recall how I got onto the floor.”

    The point of this long winded response is that to communicate with an ill person takes time and patience. Well, doctors have patients not patience in their over-scheduled day.

    My aunt was sent home with a bottle of baby aspirin and told to return if she felt chest pains. Hmmm. So many heart attacks have no chest pains. GOMER. She got turfed from the ER because she didn’t meet the hospital “metrics” on what a heart attack should look like.

    I told her to call her GP and request a follow up appointment within days and ask to see a cardiologist. The GP said that it could wait two weeks.

    Then the GP received the medical records from the ER visit and called her into the office the next day and my aunt was given some labs and a Holter monitor to begin to obtain the data to truly diagnose – to rule in/out – whether the heart was involved.

    The point being is that wisdom comes with experience. Knowledge comes from education…but it’s wisdom and the ability to communicate that moves the rock.

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    1. Beautifully said, Anne. And another reminder that sometimes the presenting complaint is NOT the MOST IMPORTANT problem, particularly with the elderly like your aunt, who often have lots of other health problems, or with those who live with mental health issues. And yes, it is possible to have both a sore hip and heart disease, or anxiety and a heart attack… all at the same time.

      I really don’t expect my physicians to have to go through a cardiac event in order to diagnose/treat me appropriately (my GP who sent me straight to hospital for a ruptured appendix at age 16, for example, had never suffered appendicitis himself, but what he did have was curiosity, knowledge, and then a willingness to make swift medical decisions about my care based on current treatment guidelines).

      Although I do agree with you – I’m sure that when doctors do become patients, they can’t help but become better doctors.

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  16. About 20 years ago, my Dad went to emergency because he felt very bad, and knew something bad was going on. (He was 81). He could barely talk, couldn’t walk, and couldn’t think normally. We sat with him in a small room for about 2 hrs, then a young doctor came in and told us “we should take him home, he just a lonely old man seeking attention”. We called Dad’s personal doctor and he immediately called the emergency room, and insisted they admit him, until he (the personal doctor) could get there and examined him.

    Another hour later they took him upstairs for treatment. Dad was having a STROKE!

    Dad recovered slowly, lots of therapy, and lived another 5 years, before the internal damage from the slow action on the stroke, caught up with him.

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    1. Gary, that’s a horrible story: “…he’s just a lonely old man seeking attention”. Appalling! You bring up such an important point: it’s not only women heart patients who are dismissed – the elderly face barriers to appropriate care for many conditions that most of us can’t even imagine. Thank goodness you called your father’s GP.

      Do you wonder what happened to that young doctor who misdiagnosed your Dad? My guess: absolutely nothing, given that our healthcare systems do not require mandatory reporting of diagnostic errors.

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  17. I think the only change that would actually work would be requiring all cardiologists to be women who have survived heart attacks!

    And less than a month ago a (male) Mayo Clinic cardiologist told me my 2x month chest pain, not associated with exertion, starting in the cheekbone and then centered in my heart, was acid reflux. I’ve had acid reflux, and assured him this was nothing like it, but was dismissed anyway.

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    1. Thanks for this, Holly. Somehow, I suspect that your recommended change ain’t gonna happen any time soon (although there’s nothing quite like doctors who become patients to finally ‘get’ it, as I wrote about here). Also I know it’s possible to be a male cardiologist (or an Emergency physician) without a cardiac history, yet still able to take women’s symptoms seriously – because I have met lots of them!

      Now, I’m not a physician, but I can tell you quite confidently that pain at rest in the cheekbone is quite likely NOT acid reflux. It may well not be heart-related (you just don’t know yet) but acid reflux? What a totally non-creative, out-of-the-blue guess!! That should be downright embarrassing to the entire medical profession!

      Almost as bad as when I witnessed my friend being told by a hospitalist (trailing a small gaggle of med students behind him!) that her Stevens-Johnson Syndrome (that had swollen her eyes, throat, tongue, lips into massive bloody weeping sores) was “Bell’s Palsy”….

      Yikes.

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    2. Holly, I think you best describe our experience when you say you were “dismissed anyway”.

      I am finding that my doctors are more and more likely to dismiss my symptoms as I have hit middle age, gained weight, and developed a serious of symptoms that don’t “fit in the box”.

      Most recently has been a long series of misdiagnoses related to what is now finally being recognized as a rare autoimmune disease that nearly resulted in blindness several weeks ago. I had been persistently complaining of the painful symptoms for months, but was continued to be treated for anxiety, depression and a nod to fibromyalgia (always with a reference to how pain & depression go hand in hand).

      Now, the treatment for this disease involves high dose steroids which is causing heart symptoms….I am trying to get the new doctor’s attention about that…and you guessed it–being dismissed. It’s a lot of work to be a patient (I know you’ve written a bit about this, Carolyn!), and this week will be all about getting attention for this too.

      Another thing that has had me relating to this experience of women being dismissed was watching this week’s Grey’s Anatomy. For those who haven’t seen it, it’s an episode where a woman doctor checks herself into another hospital’s ER with a self-diagnosed heart attack. Yet, in spite of her knowledge, experience and otherwise respect in her field, she is questioned and dismissed as a possible heart attack patient after the most basic screenings.

      Most significant to her screening was that once they identified her as being under chronic stress (who isn’t?) and taking anxiety meds, she was told that her heart is fine. Ultimately, of course, in the world of TV land, her colleagues swoop in and correctly diagnose her and save her life.

      How lucky for her–but what about the rest of us who can’t get past the doctors who have us profiled as anxious, stressed, depressed and with gastric reflux? There doesn’t seem to be a way to get their attention focused on our real symptoms until we are in critical condition.

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      1. Charlotte, I’m so glad you weighed in here with your compelling story, picking up on Holly’s discouraging “dismissed anyway” comment. Sheeesh…. when does it end? Why is it necessary to FIGHT to be taken seriously? Good luck to you this week…

        I too watched the Grey’s Anatomy episode this past week (just in time to kick off HEART MONTH!) Here’s a very good review of that show by cardiologist Dr. Melissa Walton-Shirley. I agreed with her take, and I’ll also add that the scene where the Chief of Cardiology meekly steps aside to allow the (superior) cardiologist from another hospital step in to save the day was a bit much!!!

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  18. I think your assessment is spot on and it is shameful to realize that in this day and age, women are still being treated as second class citizens.

    I appreciate your website and I appreciate that due to your experience you have provided the rest of us with information that assures us that we have the very best information available to us.

    There is one other issue that seems prevalent in this situation and that is the issue of woman not wanting to make a fuss or, as I call it: “Everyone in the family is more important than me.”

    Sorry ladies, that simply is not true.

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    1. You have hit upon such an important point, Francene! Our need to put everybody else’s needs ahead of our own, and our reluctance to make a fuss is actually well-documented. There are in fact countless clinical researchers whose specialty is studying what they call women’s “treatment-seeking delay” during a heart attack!

      This has got to stop! I’m hoping that with my daughter’s generation (she’s in her 30s) we might start seeing an end to this pervasive tendency among women.

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