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HEALTH | winter 2006

The Beat of a Different Heart
It can be deadly to treat women's cardiac disease by male standards.

Suzie Arnegger's strange symptoms began in January 2004. Driving to her claims adjuster job, she temporarily lost distance vision. The 59-year-old from San Diego was diagnosed with an “optical migraine.”

Strolling through a museum weeks later, Arnegger got so nauseous she had to lie on the floor. Paramedics whisked her to a hospital, but an electrocardio-gram (EKG) found nothing awry. New diagnosis: inner ear problem.

Then Arnegger suffered face pain. “Migraines,” said two neurologists. A rheumatologist biopsied a head artery: nothing. In August, after uncontrollable diarrhea sent her to an emergency room, gastrointestinal tests were ordered. But as the physician left the room, “The elephant sat on my chest,” recalls Arnegger. “My arms went numb, that fast. I told the nurse, ‘Do an EKG now.’”

How Women's Hearts Vary From Men's

Here’s what researchers have recently discovered:

  • Women are less likely than men to survive heart bypass surgery, University of Chicago Hospitals cardiology fellow Dr. Ron Blankstein found. Even accounting for conditions such as diabetes and women’s smaller arteries, 4 percent of women die from bypass procedures, compared to 2 percent of men.
  • The common exercise treadmill test isn’t very good at finding women’s clogged arteries, reported Dr. Jannet Lewis of George Washington University Medical Center in the American Heart Journal last March. Of 29 women whose X-rays showed at least one significantly blocked artery, 20 had normal treadmill tests, she found, and among 67 women whose coronary arteries were clear, 32 had abnormal treadmill test results.
  • Heart-failure drug digitalis may not help women as much as it does men, and aspirin may not work as well at preventing women’s heart attacks, reported German cardiologist Verena Stangl in the August 2005 issue of European Heart Journal. Stangl pointed out that digitalis and other heart drugs are prescribed for women based on studies done on men.
  • Inherited hypertension is hugely affected by gender, reported Brinda K. Rana and Daniel T. O’Connor of the University of California, San Diego, School of Medicine at a recent American Heart Association conference. The hypertension-related genes they examined had opposite effects on males and females.

Each year, six times as many women die from heart attacks as from breast cancer. But women’s No. 1 killer disease is often missed - not just by patients but by physicians. Arnegger’s experience doesn’t surprise Andra Blomkalns, M.D., an emergency physician at University of Cincinnati Medical Center who researches the gender gap in heart-disease diagnosis and treatment.

“The key factor is that women often present differently,” says Blomkalns. “Just this past Easter, about 3 a.m., a 45-year-old woman came in and said, ‘I have a sharp pain in my back.’ ‘Sharp’ suggests to doctors something like a rib or lung problem. Thank God her EKG was classic, or I would have had a tough time getting her into the cath [catheterization] lab. When I told her she was having a heart attack, she said she was fine.

“How the world learned about heart disease is [from] men - their symptoms of substernal chest pain, pain down the arm, sweating and nausea,” she continues. “But women’s symptoms might be gastrointestinal. So a lot of physicians will go to gallbladder, peptic ulcer, pancreatitis and other abdominal diagnoses.”

As physicians puzzle out a woman’s symptoms, however, the heart attack damages heart muscle, leading to worse attacks later. Or the patient dies.

But guessing that a woman’s having a heart attack when she isn’t can kill, too. “When you’re looking at treating a heart attack, you’re looking at drugs that could cause bleeding in the head,” says Blomkalns.

Some tests are good at determining if a patient has heart disease; some are quick. None are both. “You could have a heart attack and still have a completely normal EKG,” explains Blomkalns. “By the time the tests are positive, you’re already too late. The goal is to find heart disease before it can kill off portions of your heart. We need something that works in 10 to 15 minutes.”

Blomkalns has also discovered, in a landmark study of nearly 36,000 Americans (her results were published in March 15, 2005’s Journal of the American College of Cardiology), that women are less likely than men to receive the correct health care after heart disease is diagnosed.

“Many studies have shown that to be the case,” agrees David Geffen School of Medicine at UCLA cardiologist and national quality-of-care expert Gregg C. Fonarow, M.D. “It’s true that if women have a cardiac event, they present with more subtle and different symptoms than men. But we see disparities in care even after a confirmed diagnosis of heart attack.” Adds WomenHeart, a Washington, D.C., advocacy group that studied
federal and American Heart Association data, “Women are less likely than men to receive beta-blockers, ACE inhibitors or even aspirin [three widely used remedies] after a heart attack.”

There are marked variations in care across hospitals and even among physicians within one hospital, says Fonarow. He suggests that women seeking cardiac treatment - or who want to know in advance where to find the best heart care for women - check the government’s Hospital Compare website, www.hospitalcompare.hhs.gov.

Researchers continue to uncover other gender differences in heart disease and treatment, but support from the National Institutes of Health (NIH) for studies in this arena has remained low in recent years, according to the Washington, D.C.-based non-profit Society for Women’s Health Research. The group found that overall gender-difference research received an average of only 3 percent of federal funding from 2000 through 2003. The NIH’s National Heart, Lung, and Blood Institute handed out less than 2 percent of its grants for gender-based research.

In Suzie Arnegger’s case, the heart attack she suffered in the ER fortunately appeared on the EKG she had insisted on. An angiogram then determined that one of her arteries was 99 percent clogged, another 93 percent.

“I was misdiagnosed by seven doctors and two emergency rooms,” she says. “And I’m not the only one who had these symptoms that women get: face pain, jaw, midback pain. Women also get flu-like symptoms. One woman in my heart support group kept telling her doctors, ‘I feel funny,’ until someone finally listened to her. You have to be your own advocate.”

The good news is that 80 percent of heart disease is considered preventable, so women should pay attention to healthy heart guidelines. But women should also demand that their hearts, if ailing, be treated with the same knowledge and care as men’s.

For more information, see the website of WomenHeart: The National Coalition for Women With Heart Disease.

Suzanne Batchelor is an independent journalist whose health and science articles have appeared on Women’s eNews, Medscape, CBS Healthwatch, WebMD and the radio series “Earth and Sky.”