Cardiovascular events, continue as the number one factor in the death of Canadians with about 2/3 of the total being male. We’ve all watched intently as any number of television medical programs dramatize the paramedics running the oxygen masked male with acute shortness of breath and intense chest pain through the emergency department doors. He’s most likely between 40 and 55 years in age, definitely overweight, showing signs of premature aging and strong likelihood that he is a smoker who doesn’t exercise. The story rarely varies for these first timers … a sudden onset of squeezing intense central chest pain sometimes radiating to the left arm and significant nausea. A very accurate attention grabbing scenario indeed. On reflection though, can you remember similar portrayals of the female heart victims arriving in the ER? The answer is an emphatic NO.
Women are different and the medical establishment has been slow to address this difference for several reasons. The most obvious excuse for this lack of knowledge is the fact women have been under-represented in most clinical research studies. For the medical establishment chest pain has always been the gold standard for a cardiac diagnosis. With men, close interrogation usually reveals weeks, even months of less intense chest discomfort usually alleviated by decreasing activity level. But with women, less than half experience any significant level of pain before or during the heart attack. According to the American Journal of Cardiology, not only are women less likely to be diagnosed correctly when they first show cardiac symptoms, they are at least as likely to die as men following a first event. In the past, there might have been a understandable and natural history of the male breadwinner receiving priority as the family head, but times they are changing. More women are in the workforce with increasingly more stressful career lines.
Additional family and personal responsibilities mean women have less time for personal care especially fitness. But the biggest single factor clouding the clinical picture is the lack of stereotypical male symptoms in roughly half to two-thirds of female heart presenters. Yes, some women can have chest pain, even intense pain but that is only seen in about a third of victims. And yes, some women do have shortness of breath, again about a third of the total. More women are likely to be nauseated but the three critical differences between male and female presentations are as follows: Women often have been experiencing non-pain symptoms for perhaps weeks or even a month before they arrive, usually at family insistence, in the ER, whereas men characteristically present as more acute events. Two key clues as to the cardiac origin of a woman’s ER visit are her complaints of dramatic fatigue and an aura of unwellness, both symptoms which understandably lead to the numerically overloaded ER staff placing the patient in a less critical area of the department and the eventual discharge of the women with a non-cardiac diagnosis.
The aura of unwellness is often associated with a profound disturbance in sleep pattern in an otherwise previously well-rested woman. The salvage rates for female cardiac patients can be significantly improved. Women and doctors both need to reject the male model for assessing the possibility of cardiac disease. Women truly are different but we already knew this. Women need to be more insistent on a thorough assessment of their different gender-driven clinical appearances and the diagnosticians need to cast a broader clinical net to better serve this vulnerable half of the at-risk population.
Article by: Dr. David Carll