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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 continued...

    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."

    She says he couldn't believe what he was seeing and perhaps had preconceived notions about young women and heart disease. "I don't know how much it was a feminist issue or his frustration at not being able to get me well," she says.

    Kastan remained ill following double bypass surgery. "Friends started wondering if some of this was in my head," she says. She contacted WomenHeart for support and was urged to go to a women's heart clinic. She went to Hayes. "She listened. She may challenge me, but she always supports me. She'd never question me as an intelligent human being or question my feelings."

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