Ask Dr. Pat

Dr. Pat Consults: Heart Disease in Women: Recognizing the Symptoms

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Dr. Patricia Yarberry Allen is a collaborative physician who writes a weekly Medical Monday” column for Women’s Voices for Change. (Search our archives for her posts, calling on the expertise of medical specialists, on topics from angiography to vulvar melanoma.)

This is American Heart Month. Accordingly, this week’s post addresses the concerns of a woman whose mother died after ignoring the symptoms that, in women, indicate a possible heart attack. She has asked cardiologist James. A. Blake, Clinical Assistant Professor of Medicine at Weill Cornell Medical College in New York City, to describe the heart-disease symptoms to which attention must be paid.


Dear Dr. Pat:

My mother had a heart attack when she was 60.  She was never athletic and was about 20 pounds overweight.  She had some high blood pressure but took only one pill a day for that; she took no other medicines.

She saw her general doctor because she had these episodes of heartburn accompanied by exhaustion when she was 59. These episodes usually occurred when she was climbing up to the attic with boxes, mowing the lawn, or some other strenuous activity. 

She was not much of a complainer. When she saw the doctor after a particularly bad bout, he told her to lose weight and to take an over-the-counter medicine for the heartburn. She didn’t even have an EKG. The next week she had a prolonged bout of the same symptoms and blamed it on a heavy meal she had eaten. We spoke that night and she didn’t feel as if she should do anything but rest, since the doctor had reassured her.

She died sometime during the night of a massive heart attack. The autopsy showed that she had severe blockage in the arteries to her heart and a slightly enlarged heart. I read that women die more frequently from heart attacks and heart disease because their symptoms aren’t those that men have, and that doctors often don’t pay attention to the symptoms that women have. I feel responsible, of course, because I feel that I should have urged her to go to the ER. 

What are the common heart-attack symptoms women have which should trigger an evaluation in an emergency room or urge her to get a referral to a cardiologist? Do we know why women have poor outcomes when they have a heart attack? 


Dr. Blake Responds:

Dear Joan:

Coronary artery disease (CAD), caused by an accumulation of atherosclerotic plaque in the heart’s arterial blood supply, is far and away the No. 1 killer in women. Most women and men have deep fears of developing cancer, but the facts are different. Heart disease kills more women than all forms of cancer combined.

Underappreciation of the prevalence of CAD in women often leads to diagnostic delays or omissions—a problem that is particularly noteworthy among young women with symptoms of heart disease. In such young women, as illustrated by this unfortunate case, misdiagnosis often has serious or catastrophic consequences.  Even when CAD is diagnosed with obvious complications of the disease like a heart attack (myocardial infarction, or “MI,”),  the prognosis in women is worse than in their male counterparts.

Next page: Biology vs. Bias 

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  • Delores Lyon May 14, 2015 at 3:16 pm

    Thanks for sharing this advice on detecting heart disease in women. I had no idea that some women aren’t diagnosed with heart disease because of bias from the doctor. It sounds like it is really important to have a doctor that knows all of the symptoms of heart disease, and who is not willing to rule a high triglyceride count out as part of the woman’s biology. Heart conditions are really serious, and should be treated very seriously if there is any chance you could have one!

  • Margret Avery February 23, 2015 at 11:53 am

    This is a great article Dr. Pat – thanks for posting!