In Heart Attack, Gender Matters

"I walked into the emergency room with heart attack symptoms, and for the next three hours was challenged by the medical team," she told McKenzie. "Being only 45 years old, and appearing healthy, they felt I was looking for attention."

Part of the problem may be that for women, in many cases, heart attack symptoms may not be so obvious.

"It is more challenging to decide on how best to care for the average woman compared to the average man having a heart attack," Hayes said. "Her symptoms may be more subtle and there are more of them. Her many other medical problems may need to be taken into consideration, or may distract from the cardiac evaluation."

It's also possible that more women with major heart attacks survive the trip to the hospital and die there, while more men may die before they arrive, said Jneid, who trained as an interventional cardiologist at Massachusetts General Hospital in Boston.

"But this is speculation," he said.

For patients with heart attacks, rapid diagnosis and treatment are essential. When appropriate medical care is delayed, more of the heart muscle is likely to be damaged -- and the risks of complications and death are higher. Therefore, experts say, it is important for all health care workers to be tuned into the possibility of heart attack.

"Health care providers, including EMS personnel, should be made aware of the atypical symptoms of heart attack that are more likely to occur in women, particularly elderly women," said Dr. Malissa Wood, co-director of the Corrigan Women's Heart Health Program at Massachusetts General Hospital. "This can lead to expedited triage and treatment of these women."

Cardiologists also stress the importance of patient awareness.

"Women need to understand their symptoms of heart disease may be different" from men's, said Dr. Suzanne Steinbaum, director of the Women and Heart Disease program at Lenox Hill Hospital in New York City. These may include "shortness of breath or jaw pain, back pain, fatigue, nausea, or even flu-like symptoms. And symptoms that may be concerning, including palpitations [a feeling of the heart racing in the chest] or dizziness, should be evaluated," Steinbaum said.

If women feel that they aren't being taken seriously in the emergency room setting, "they need to ask for a heart problem to be [ruled out]," Hayes said.

Disparities in heart attack care are only part of the problem, however, she said.

"We fall short in treating women for high cholesterol [and] heart failure, implanting lifesaving medical devices [like cardiac defibrillators], and [encouraging] participation in cardiac rehabilitation, to name a few," she said. She stressed the importance of preventative measures, which may include medications and lifestyle modification, in lowering women's heart attack risks.

Closing the Gap

Moving forward, Jneid's group plans to study whether "closing the gap" -- making statistical adjustments for gender differences in heart attack care -- can account for the difference in death rates. They also want to explore how factors, such as ethnicity and weight, come into play.

Hayes agrees that more research is needed to establish why the gender gap persists -- and how it can be eliminated.

"[We need] better protocols of care to help clinicians ... so doctors can see the forest and not just the many trees," she said.

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