Heart Disease Underdiagnosed in Women

CHICAGO, Jan. 31, 2006 — -- A new study finds as many as 3 million women at high risk for heart attacks may have no idea they're in danger.

Heart patient Shirley Kaswinkel says her episodes were frequent and frightening.

"To me, it seemed like someone was putting a pillow on my face, and I just couldn't get my oxygen," she said.

Each time, Kaswinkel would race to the emergency room. Five times, the answer was the same. "They performed heart tests and said nothing was wrong, and I began to believe them that nothing was wrong," she said.

But something was, in fact, wrong. It took 10 years, but Kaswinkel was eventually diagnosed with advanced heart disease. Her story is not unique.

The problem, according to newly published research from the National Institutes of Health, is that blockages in women build up evenly on the artery walls, narrowing the channel. Men's blockages tend to accumulate in visible clumps.

'Gold Standard' Misses Signs in Women

"We often did not detect it on coronary angiograms, which is basically our gold standard for diagnosing blockages of the arteries," said Dr. C. Noel Bairey Merz, medical director of the Preventive and Rehabilitative Cardiac Center at Cedars-Sinai Medical Center.

Heart attack symptoms in women can also be strikingly different. Instead of crushing chest pain, women may feel extreme fatigue, shortness of breath, nausea, dizziness, or experience pain in their shoulders, jaw and neck.

Women are also more likely to die. For 60 percent of women, experts say, the first sign of heart disease is a heart attack.

To accurately detect heart disease, women may require different tests to see how smaller coronary arteries respond to stress. They include cardiac MRIs, stress echocardiograms and micro heart catheterization.

The tests helped reveal Kaswinkel's condition.

"I'm not glad I have the problem, but I'm greatly relieved to know what the problem is," she said.

Kaswinkel now takes drugs to lower her blood pressure and cholesterol. But the treatment was only possible with the correct diagnosis.

ABC News' Barbara Pinto filed this report for "World News Tonight."