The classic picture is usually a man, generally with cardiac risk factors, being rushed to a hospital with chest pain and a worried wife by his side. Newer research however is showing that not only do women experience angina and chest discomfort almost as frequently as men, but that women 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 heart disease in women generally presents at a later age - generally closer to age 70. However, because women may have a more atypical presentation of chest pain than men and because their complaints are dismissed as anxiety or functional, finding the proper treatment in time for correction may 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 experience nausea, dizziness, shortness of breath, or just fatigue. Even the pain may be more referred to the shoulders, neck, and jaw and simulate a muscular rather than a cardiac 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 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 both 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 time to normal, may be ignored in the face of ST depression results that are more reliable predictors in men.
Even more alarming is the fact 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, 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 distinguishable clumps, and that more evenly 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 those smaller vessels than they do in men.
Women are better diagnosed using cardiac imaging. Cardiac MRIs, electron beam CT scanning, and stress echocardiograms are much better tests of compromised cardiac function in women. Treating risk factors aggressively is just as important in women as in men, and may delay cardiac disease progression and complications. Additionally, a high index of suspicion of older women with chest pain is key to preventative life-saving measures and treatment.