Kathy Kastan, three years ago at the age of 40, had the classic symptoms of heart disease as it affects women, including feeling exceptionally tired and dizzy while exercising. But three doctors failed to diagnose her condition. Kastan, a marathon runner and the mother of three boys, says they should have known.
"I was very frustrated," she said. "I felt like I wasn't being heard."
While on a hiking trip eight months later, Kastan collapsed and required emergency bypass surgery.
"I'm just lucky that I didn't die," she said. Today, Kastan is president of the board of directors of WomenHeart, a national organization dedicated to reducing death and disability among women living with heart disease, and she also serves on the board of directors for the southeast affiliate of the American Heart Association. She now speaks with women's groups, the media, and political leaders about heart disease and ways women can partner with their doctors while seeking treatment.
"The consequences of not fully appreciating the differences between the sexes with respect to heart disease is that women may die needlessly, and their families and loved ones may suffer unnecessarily," said Dr. Lori Mosca, director of preventive cardiology at New York-Presbyterian Hospital.
Misdiagnosis due to gender differences starts with early detection. The standard stress tests are less reliable on women, in part because estrogen levels can actually interfere with the electrical signals, making results more difficult to interpret.
Women Have Different Symptoms
Women may also have different symptoms than men. A heart attack may not produce a crushing chest pain in women, but more ambiguous signs: indigestion, anxiety, as well as severe fatigue.
The symptoms are so general that doctors may be more likely to miss a woman's heart attack -- one reason, perhaps, why women are more likely to die from their heart attack than men.
"The numbers are quite remarkable," said Dr. Paula Johnson, chief of the division of women's health at Brigham and Women's Hospital in Boston. "In the first year, 38 percent of women will die after their heart attack."
The risks of treatment can also be different for women. Women given angioplasty, for example, to open up blocked arteries suffer higher complication rates than men. Women having bypass surgery are twice as likely to die from the procedure itself.
"Women have smaller blood vessels feeding their heart and they may be technically more difficult to operate on," said Mosca.
Finally, and perhaps most troubling, undertreatment is more common among women. Studies show women are less likely to receive cardiac rehabilitation, or even basic cholesterol-lowering medications, than men.
The sad fact, say researchers, is that heart disease studies ignored women for decades, and some doctors today are still slow to properly diagnose and treat the disease.