Heart to Heart
From symptoms to survival, heart disease strikes men and women differently. Here's what you need to know.
No matter what the symptoms, it's important for anyone with a heart attack to be diagnosed quickly.
Aggie Landry was caring for her sick mother in Kansas City when she started to sweat and feel nauseated. She suspected food poisoning, but began having shortness of breath and chest pain. Minutes later, she was en route to a nearby hospital via ambulance.
Despite classic symptoms of a heart attack, the Dallas resident didn't fit the profile of a heart attack victim—she was in her 30s, physically fit, with low cholesterol and low blood pressure. After a battery of tests and incorrect tentative diagnoses of cocaine use and pulmonary embolism, the ER doctor was ready to send her home with a diagnosis of acid reflux.
Landry, a mother of three who was familiar with acid reflux from her pregnancies, insisted that he run her blood work again. Her demand probably saved her life. Minutes later she was rushed into surgery to repair her damaged heart. "If I had left the hospital, I never would have survived," she says.
Likelihoods Diverge
Landry's case was unusual—women don't generally suffer heart attacks until they are in their 60s, about 10 years later than men. "Because of the protective effect of hormones, the development of significant coronary artery disease occurs about a decade later in women," says Shelley Hall, M.D., a cardiologist on the medical staff at Baylor University Medical Center at Dallas.
For women who smoke, have diabetes or have had their ovaries removed, the age gap closes. And once people get into their 70s, women and men are equally likely to have heart disease. "Women simply catch up," Dr. Hall explains.
No matter what the symptoms, it's important for anyone with a heart attack to be diagnosed quickly.
In Landry's case, while the symptoms were the same as a heart attack caused by blocked blood vessels, the cause was different—a split in the heart's main artery, possibly caused by a genetic condition.
Pain or Fatigue?
There are classic symptoms of a heart attack—like those Aggie Landry felt. Typically, people describe chest pain that sometimes radiates down the arm or up to the neck, sweating, nausea and trouble breathing. "Men and women can both get these symptoms, but women less frequently have them," explains Peter Frenkel, M.D., a cardiologist on the medical staff at Baylor Medical Center at Garland. In fact, about 20 percent of women have atypical symptoms.
"Women often don't have the exact same pattern. Sometimes they have pain somewhere else in the chest, or they describe what they feel as discomfort, not pain. The pain is often more subtle with women," he adds. Women, more commonly than men, may complain of fatigue and a general feeling of malaise.
And while the classic symptoms are more common in men, atypical symptoms are not unheard of. James Pratt, 60, was warming up for a softball game when he crumbled to the ground.
"I never had any chest pain, but I had been having some problems with my back for a couple of years. My back would hurt and burn, but when I stretched it the pain would go away. Evidently I was having heart trouble and I didn't know it," he says.
A high school girl trained in CPR and an off-duty paramedic were able to help Pratt until an ambulance arrived, and doctors rushed him into surgery for a successful quadruple bypass at Baylor Medical Center at Irving.
Speed is Key
No matter what the symptoms, it's important for anyone with a heart attack to be diagnosed quickly, since fast treatment is key to protecting crucial heart muscle. According to research, "treatment for men and women should be the same, but in trials they do see discrepancies. It's hard to explain why," Dr. Hall says.
Certain factors may contribute:
- Women may delay seeking treatment.
- Women's atypical symptoms may be missed.
- Women's blood vessels may not be large enough, which creates technical challenges for stent placement and bypass.
Medications given in the early stages of a heart attack, such as aspirin, nitrates and beta blockers, seem to be equally effective in men and women, says Padmavathy Uppalapati, M.D., a cardiologist on the medical staff at Baylor Irving. And according to the American Heart Association, the same criteria for angioplasty, stenting and bypass apply to both genders.
Beyond the Heart Attack
Despite having similar criteria, however, a few factors make angioplasty and bypass more risky for women, on average, Dr. Uppalapati says. Because women sometimes ignore symptoms, their heart disease can be more advanced by the time they seek treatment. They also tend to be older, and thus are more likely to have other medical conditions, such as diabetes or a history of stroke, that can increase their risk of complications. And because their blood vessels are generally smaller, surgical procedures are more technically challenging. But once women get past the challenges of surgery, they recover as well as men do.
After treatment in Kansas City, Landry returned to Dallas for cardiac rehab and follow-up care at Baylor Dallas, under Dr. Hall's watchful eye. Today, nearly four years later, she is grateful that her three children, just 7, 5 and 2 years old when she had her heart attack, still have their mom in their lives.
By Stephanie Thurrott
For a referral to a cardiologist on the medical staff at Baylor, call 1-800-4BAYLOR or use our on-line physician directory.