The classic picture is usually a man, generally with cardiac risk factors, being rushed to a hospital with chest pain and his wife worriedly by his side. Newer research however is showing that not only do women experience angina and chest discomfort almost equally to men, but that they may be at greater risk for complications and death because they are not diagnosed properly.

Women are often assumed to be in better shape risk-factor wise than men and live longer - indeed, the average longevity of women is still longer than men and heart disease in women generally presents at a somewhat later age in women, usually closer to age 70. However, because women may have a more atypical presentation of chest pain than men and because their complaints are more often dismissed as anxiety or functional, finding the proper treatment in time for correction can be significantly delayed.

Heart attack symptoms in women can be significantly different than those in men. Instead of the squeezing, mid-chest pain that is the characteristic picture in males, women may present with nausea, dizziness, shortness of breath, or just plain sudden fatigue. Even the pain may be more referred to the shoulders, neck and jaw, and simulate a muscular rather than a cardiac presentation. Women may also not be diagnosed quickly enough despite a more characteristic presentation - over half of all women will have an actual heart attack as the first sign of heart disease.

Perhaps just as disturbing is that the definitive tests for spotting cardiac disease or heart blockage in men are often misinterpreted or not adequately explored in women. For instance, treadmill testing has a high false positive and negative rate in women, and the two most important parts of a woman’s treadmill result - the time on the treadmill and the heart rate recovery to normal, may be ignored in the face of changes on the electrocardiogram (EKG) itself that are more reliable in men.

Even more alarming is that even high risk women with heart disease may indeed have a negative angiogram in the face of significant heart disease. The angiogram, when dye is inserted to assess blockages in coronary circulation, is considered the gold standard by cardiologists in practice, but up to one-third of women who have a positive treadmill test may show “normal” coronary arteries. Women’s blockages are more evenly distributed on cardiac vessel walls compared to men’s being in clumps, and that even distribution may look like a normal flow, even though it is diminished. Women also have smaller coronary arteries than men, and the effect of stress, spasm, or closure may have a larger effect on these smaller vessels than they do in men as well.

Women are better diagnosed using cardiac imaging. Cardiac MRIs, electron beam CT scanning, and stress echocardiograms are much better tests if compromised cardiac function in women. Treating risk factors aggressively are just as important in women as in men, and delay cardiac disease progression and complications.