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Silent Risk: Women and Heart Disease

Heart disease kills half a million American women each year. So why are women more afraid of breast cancer?

Missing the Diagnosis

Many women with heart disease say they were misdiagnosed in the early stages. In the survey, only 35% of the women and 68% of their doctors associated their symptoms with heart problems. Yet most of the women surveyed had typical cardiac symptoms, such as chest pain and arm pain or pressure, or shortness of breath. Others reported dizziness, nausea, fatigue, and back pain, which are less common symptoms.

Kastan was a 41-year-old non-smoker and a trim athlete when she began experiencing shortness of breath. She attributed it to asthma, which can be brought on by exercise. But it kept getting worse. On one bike ride, the symptoms became severe. Kastan's husband, a physician, said he doubted she had heart disease, nevertheless suggested she see a cardiologist. The cardiologist proclaimed her healthy. The very next week she collapsed in the mountains. "This time I had classic Hollywood heart attack symptoms with chest pain radiating up into my jaw and down my arm, shortness of breath, pasty pale skin and nausea," she says.

She immediately went to a second cardiologist. "He said to go home and exercise and we'll see what happens. The minute I started running I collapsed again." She finally had the cardiologist put her on the treadmill and raise the level of exertion. "Then he was the one who turned pasty pale. He said I had a blockage" in the arteries. The doctor quickly confirmed his suspicion by inserting a catheter to look into her arteries.

Kastan, who is now president of WomenHeart and on the board of the American Heart Association, says a walking treadmill test hadn't raise her heart rate sufficiently to pick up the blockage. "Dr. Hayes and the heart association are pushing for physicians to supplement a treadmill [stress] test with an EKG or thallium stress test [in women with suspected heart disease]," she says. "Those are more effective than treadmill tests, but none are 100%. The only way to see [a heart blockage] is with cardiac catheterization."

Hayes says health care providers need to become aware that heart disease is the number one killer of women, and to recognize gender differences that occur with heart disease, heart failure and arrhythmias. "When they have a woman in the office who is complaining of symptoms . . . they need to rethink their approach," she tells WebMD. Women need to be evaluated differently than men.

Physicians' Attitudes: Part of the Problem?

Doctors' lack of understanding may contribute to difficulty diagnosing heart disease in women. In the survey, 58% of women blamed problems in their medical care on physician attitudes and communication styles. "My husband thinks a lot of this has to do with the way I communicated, but I believe there's a lack of respect for what women say to their physicians," says Kastan. "I was seeing my second cardiologist three times a month. He'd put me on the treadmill and nothing would show up. The entire time I was talking to him, I didn't feel I was heard or believed. I felt I was annoying him."

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