When you think of “heart attack” what image comes to mind? Middle ages man, keeling over, clutching his chest, am I right?
Well, that’s about right for men. But quite incorrect for women.
Would you be able to spot the symptoms of a heart attack in a woman?
Read on (but in typical Chris-style… it’s storytime first)…
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The first time I heard about the differences between the symptoms of heart attacks in women and men was watching Grey’s Anatomy. Season 14 Episode 11.
Miranda Bailley (the Chief of Surgery at Grey Sloan Memorial Hospital) walks into another hospital and says who she is and that she is having a heart attack. After some standard tests, her concerns are dismissed by an intern. She explains that she knows she’s having an MI (myocardial infarction), tells him what they’re missing and what tests he should run.
After being dismissed (It’s probably indigestion… Is it anxiety? Are you stressed? You should talk to a psychiatrist…) she demands to speak to the Head of Cardiology who again mansplains why he doesn’t think it’s an MI.
Eventually she does have a full blown MI and deteriorates rapidly. But luckily her colleagues from Grey Sloan have by now come to this other hospital to save the day.
Phew.
[I love Grey’s Anatomy – did you know? One of very, very few things on telly that I’ve stuck with! And it’s in its 19th season.]
This episode stuck with me because prior to this I wasn’t aware of the differences in symptoms. And unless you’ve watched this episode or have an interest in cardiology, perhaps neither do you.
So here they are.
If you’re a women you’re more likely to experience more subtle symptoms like:
- Uncomfortable pressure, squeezing, fullness or pain in the centre of your chest…
- Pain or discomfort in one or both arms, the back, neck, jaw or stomach. The pain can be gradual or sudden, and it may wax and wane before becoming intense. If you’re asleep, it may wake you up.
- Stomach pain. Sometimes people mistake stomach pain that signals a heart attack with heartburn, the flu, or a stomach ulcer. Other times, women experience severe abdominal pressure that feels like an elephant sitting on your stomach.
- Shortness of breath with or without chest discomfort.
- Sweating. Breaking out in a nervous, cold sweat is common among women who are having a heart attack. It will feel more like stress-related sweating than perspiration from exercising or spending time outside in the heat.
- Nausea, vomiting or lightheadedness.
- Extreme fatigue. Day to day activities seem impossible, like walking to the bathroom.
I was reminded of this episode recently when I read this article thanks to a newsletter by the brilliant author of Invisible Women, Caroline Criado Perez. (If you haven’t heard of her yet totally recommend the book and her weekly newsletter). Although warning, you might get your eyes opened on exactly how gender-biased the world is. Which might make you a bit pissed.
Anyhow. Back to the article. In essence it’s calling out the shocking lack of sex disaggregated data in trials for heart conditions. This is a common theme in medical studies generally. Women are either excluded or underrepresented because, you know, hormones. But even if they are represented, the outcome data is infrequently (i.e. none in the trials reviewed by this paper) split to show outcomes between men and women.
[Pissed off levels rising]
The consequence of this is huge. We don’t know if drugs that treat men are as effective at treating women. We don’t know if dosage rates are calibrated for the fact that on average women are smaller and have lower lean muscle mass than men. We don’t know any effects between drug usage and hormones.
It’s enraging, it really is.
But while there’s nothing I can do about changing the way pharmaceutical companies run their trials (at least not this week) Here’s something I CAN do. Educate all the wonderful women around me on what to look out for. For yourselves, your sisters, friends and mothers.
Let me say it again – the symptoms are very different – read that list again.
And one more thing. Gender bias in diagnosis is real. The situation Miranda found herself is NOT over-dramatised. Being ignored or not taken seriously by your doctor is a real risk. Being misdiagnosed as anxious or stress is a real possibility.
And women are TWO TIMES more likely to die of a heart attack than men. Presumably because of everything discussed already: misdiagnosis, late diagnosis, lack of disaggregated data on the outcome of treatments.
So, if you do feel something is wrong, advocate strongly for yourself. Don’t be fobbed off by interns. Get your husbands educated too. And spread the word!
PS After I finished this blog I went to a photo depository to pic an image… Here’s what came up for “heart attack” Photos depict men clutching their chest. All vectors show the default human form of man.
And then when I searched women it’s still women clutching there chest in apparent agony. Which as we’ve learnt is unlikely to happen!!
[fml – Pissed off levels now at the max. Must go lift some heavy shit]
