As a man with a history of heart concerns, I know what to be aware of in me, and know what symptoms would send me off to the hospital (or to the phone — don’t exert yourself if experiencing heart attack symptoms!) But there are women I care about too, so it’s useful to know that women often experience different symptoms.
The study also found that women often fail to realize that they are having a heart attack – and so do doctors. This is because heart attack symptoms in women can be different than they are in men. The symptoms we most commonly associate with a heart attack, like pain in the left arm and tightness in the chest, don’t always occur in women. The study found that 42% of women who have heart attacks never experience the “classic heart attack symptom” of tightness or pain in the chest. Instead, they may develop pain in the back or jaw, light-headedness, nausea, vomiting and shortness of breath.
Heart attacks kill people of both sexes, but they affect female bodies differently than they affect male ones. The problem with having “male” as the default in medical research, and even in public health awareness campaigns, is that it fails to account for these differences, often with serious or even fatal consequences. The common heart attack symptoms for female bodies are ones we often associate with panic attacks or anxiety, especially when they appear in women.
Take care of yourselves!
(Also on Sb)
Unfortunately, women are common victims in the diagnosis via statistical likelihood approach taken by most doctors today. Definitely educate yourself and keep pressing when you know something is wrong.
A lot of health issues in women are dismissed as anxiety. I’ve sat in the ER with a severe asthma attack and been scolded for wasting resources on anxiety (when my oxygen saturation was depressed, my lung function numbers were low, I was coughing continuously, and having prolonged expirations – aside from wheezing, I had pretty much a textbook severe asthma presentation).
My sister waited for over a year before her doc would actually agree to investigate a swollen, spongy, non-tender lymph node that became two, and three, and then six above and below the diaphram with superior vena cava syndrome. She almost certainly has lymphoma, but the doc still won’t biopsy because anxiety or some bullshit.
My grandmother spent six months getting progressively sicker, eventually needing to be admitted to ICU for two weeks and hospitalized for three months. The cause: Drug interactions from the twenty-odd medications the doctor had her on. Her symptoms were dismissed as anxiety until she nearly died (she’s now only on six medications).
I could go on, but my point is that it’s not just heart attacks this happens for.
Even if it turns out that nothing serious IS wrong, you should never feel strange or be scolded for showing up at the ER is you are presenting with heart attack symptoms as it’s always better to be safe. Unfortunately women are often dismissed or even dismiss symptoms in themselves as anxiety, etc.
I had two heart attacks and then an emergency bypass a couple of years ago. I was only 38 and in what I would have said was excellent health. In fact, everything was great except for the two coronary arteries that started dissecting. I am lucky to be on the planet at all as it’s often diagnosed post-mortem and doctors don’t necessarily know what they are looking at when they see it in an angiogram (may think it is plaque about to rupture, etc.)In any case, the kicker of my story is that I had one heart attack that I dismissed as the flu when I started vomiting. Though my HA was classic in other ways: chest pain, sweating, etc. That night I went to bed. The next day I went to work. Pain was gone but my heart kept fluttering. I did at one point look up HA symptoms for women and realized I matched every single symptom listed (there were about 8). Did I go to the ER at that point? NO. Because I had low cholesterol, low blood pressure, and no other risk factors I thought I couldn’t be having a heart attack. I thought about calling my doctor, but by the time I was going to pick up the phone, it was after 5. Then I felt better and my heart stopped fluttering or doing anything strange. I had 4 days before I had another HA, which hit me like a ton of bricks. Then I knew immediately and got to the ER.
Interestingly, at the ER, it was a while before anything showed up on the EKG even though my troponin levels were high. Eventually the EKG went crazy, but women often don’t even present abnormal EKGs.
Thanks for posting, PZ. In the week or two before all this I had been really tired and nauseous a lot. I just didn’t pay attention. Take care of yourselves, know the symptoms, and most importantly: act on them. And if it turns out to be nothing serious, then the ER trip/doctor visit was exactly what you should have done anyway!
She almost certainly has lymphoma, but the doc still won’t biopsy because anxiety or some bullshit.
Get a new doctor. This does sound like lymphoma and if it’s not it might be something else bad.
Or…let me guess: she can only go to this doctor because of HMO restrictions, right? My brother in law’s sister had uterine bleeding for a year while she was taking a drug that increases her risk for uterine cancer before they finally did the hysterectomy. (By dumb luck, it wasn’t cancer.)
Maybe try the old “to relieve my anxiety” line: your sister could ask for a biopsy to relieve her anxiety about what the enlarged lymph nodes might be. Sometimes that works to get a biopsy done.
#2, ischemgeek:
This drives me nuts. I’ve lost count of how many female friends have heard this. The worst was a friend of mine who felt like crap (more or less her words) after a research trip to the south Pacific. After 6 months or so, she was told by a doc that she was depressed. She answered, as nearly as I can remember, “Of course I’m depressed, I’ve been sick for 6 months!” with suitable expetives (she was a fairly… expressive… individual!). Inevitably, she finally found that she had some parasite from the island she’d visited. But in the meantime, she was sick for around a year, lost her assistantship, lost time as a grad student, and almost dropped out of school.
I, on the other hand, as an educated, somewhat older, male grad student way back when, literally never felt as though my concerns were dismissed in this fashion.
It’s bad enough, and well known enough, that when my wife gets sick for any reason, she or I sarcastically comment (and she realizes the sarcasm when it comes from me) that it must be all in her head.
I’m convinced that part of the reason for malpractice suits being common in the US is this attitude among doctors.
We’re ignored a lot. I could write books on how I can have presentations for certain things for months or years, or, hell, decades, and get a pat on the head. Here’s two weeks worth of anti-biotics, or anti-depressants.
Fuckers.
I finally gave up.
I’ve presented for MS since I was 20, including the optic problems, the fatigue, the sudden balance problems, the weird dizzy episodes, the shoulder problems, the leg that sometimes doesn’t want to move, the MS hug, and–my favorite–the bizarro heat sensitivity.
All these sexist pig MDs hear is me complaining about fatigue. You’d think they’d understand that it might not be in my head when I describe it as very similar to being punched so hard I fall to the ground–but without the pain of taking a fist to the face. It doesn’t matter if I’m doing something, or just sitting there. It can hit whenever it feels like knocking me down.
But it’s all in my head, right?
“The study also found that women often fail to realize that they are having a heart attack – and so do doctors. This is because heart attack symptoms in women can be different than they are in men.”
It’s another example of sexism in medicine – because men’s bodies change very little, they are considered “normal” and drugs are tested only on men. The result was “approved” drugs like AZT that worked well for men but not so well for women, with problems such as birth defects.
http://mothering.com/breastfeeding/azt-roulette-the-impossible-choices-facing-hiv-positive-women?page=0,5
I also once read about the survival rates of women with HIV during the early years of AIDS. While men were surviving several years, women were dying within 6-18 months because the doctors were looking for male symptoms, not female symptoms. It’s arrogance, pure and simple.
Happened to a friend of my mother’s some years ago; she had been feeling a bit rough for several days, visited mum, who told her it sounded like a heart problem, called the ambulance and she had a bypass later that evening. Being in a civilised country there were no problems with ‘health insurance’ or ‘paying’ to worry about. She was, what, 45-ish at the time.
So given that the symptoms are so often written off as ‘panic attacks’ has anyone considered that maybe it’s the other way round and perhaps the ‘panic attacks’ are actually cardiac problems that ought to be taken a bit more seriously? And are there any decent attempts at better public education on the issue? There’s not much practical benefit to pushing the medicals to do better if the bulk of the potential victims aren’t getting the message as well.
this isn’t funny. I have symptoms like that all the fucking time, how am I supposed to tell when it’s a heart attack? I can’t run to the ER twice a month every time my jaw and my gut are complaining at the same time. :-(
well ok, I don’t vomit twice a month, so, um, I guess I send myself to the ER if my jaw and my gut complain simultanously AND I’m actually puking, but that seems… decidedly too unsafe.
note to self: leave this country ASAP
matriarchy with whines about how everyone focuses on women’s health but there’s no special posts about men’s health (again) in 3… 2… 1…
(well, hopefully not. hopefully he got sufficiently trounced in the last thread he showed up to not come back)
– – – – – – – –
anyway: I’m seriously pissed hearing the stories about women’s problems being dismissed as “anxiety” or “depression”. I haven’t experience that, but probably only because I’ve only been to a doctor what… 3 times in the last 10 years (once for an ear infection, once just in case it was an ear infection because I had to be on an airplane the next day, and once for what turned out to be small, benign cysts on my ovaries)
oh, and I suppose the visits to PP for the IUD. and now I shall stop talking to myself and spamming this thread :-p
We had a tragic example of this in our family. We lost a 42 year old sister-in-law. My brother-in-law took her to the military hospital where they were stationed in Japan. She was sent home with meds for GERD. She died sometime in the night with a massive heart attack.
We women are ignored or misdiagnosed constantly. I have autoimmune issues. Since these diseases, especially Lupus, are considered “women’s diseases”, it is very difficult to get doctors to take us seriously. On the support group site that I belong to, most of us have been told “it’s all in your head” at least once.
I managed to find a great female rheumatologist in San Antonio, who was taking me seriously and was treating me. We moved to another state, and my new rheumatologist ordered new lab tests and concluded that I was fine. Duh, do ya think maybe the meds were actually working? I have a hard time just getting her to renew my prescriptions once in a while. The PCP is even worse. He took one look at my list of symptoms and told me that I might be a hypochondriac.
I would hate to see what would happen with these docs if I actually had HA symptoms.
And, of course, if you’re a fat woman, any medical problem you have will be dismissed as a result of being fat, and you won’t be treated for it; you’ll just be told abusely to go home and lose weight. Which, of course, is super easy.
This isn`t a new thing. Back in my medical school days, more than 10 years ago, we were taught that women with cardiac problems often presented atypically, and that cardiac events must always be considered in the differential diagnosis of anxiety-like symptoms. Indeed, it was presented as an already well-established fact, and a well known pitfall that physicians must be able to recognize and avoid. (In other words, this has been known for several decades at the least)
Indeed, IIRC, failing to order a full cardiac workup on any female over age 40 presenting with anxiety-like symptoms on the Canadian licensing exam is an egregious error that automatically fails the candidate even if every other question on the exam is answered completely correctly.
That this is STILL news, and STILL a barrier in the way of women getting optimal care, is simply appalling.
Holy crap. I hope you filed a complaint! That’s a malpractice suit waiting to happen.
left0ver1under @7:
You’re citing a known crank website, please provide better citations.
Ugh.
I have a family history of women dying “suddenly, with no prior symptoms” of what autopsies revealed to be heart disease. Well, they were short of breath a lot, and complained of pain and tightness in their chests, but that doesn’t mean anything, right?
I also have a family history of women who, in their later years, develop problems with their circulation and vision, and who get dizzy at intervals that seem to correlate with when and what they last ate. But it is only in the past ~10 – 15 years that some of them have bought blood-glucose meters, much less paid attention to whatever “200 mg/dL” means.
The number of horror stories I have to tell about my own health are too many. The most glaring ones include the shrink who told my parents that their (abnormal speech, stimming, repetitive motions and behaviors) daughter couldn’t possibly be autistic, because “girls can’t be,” the pediatrician who told my parents that the only reason to be concerned about my large and pronounced goiter was cosmetic, the otolaryngologist who scolded me for mouth-breathing (I had a severely deviated septum, one completely blocked nasal passage, and one blocked 60%), and the ER doc who decided to lecture me about bulimia when I presented with classic symptoms of an ovarian cyst, including a distended and tender abdomen, stabbing pain, breast tenderness, and nausea.
Women’s heart problems are certainly dismissed, and not only by male doctors.
About two years ago, my wife (who wasn’t quite 50) was having chest pain that spread into her left arm with moderate exercise. Living in an area with a world-class medical school, my wife found and made an appointment with a woman cardiologist who happens to be one of the leaders in the field. Knowing as we did that women’s heart concerns are often dismissed by male doctors, it was heartening to know that she would be seeing a woman.
However, after learning of her symptoms and the long family history of cardio-vascular disease, the doctor told her there was nothing to worry about. My wife, the consummate consumer, insisted on having a stress test and the doctor reluctantly went along but told her “they won’t find anything.”
Perhaps given the lack of urgency felt by the doctor, it was many weeks before my wife finally had the stress test. She lasted less than 30 seconds and almost collapsed. They rushed over the cardiologist, apparently an unusual occurrence, who recommended an angiogram as soon as possible. The next day (now there’s urgency), my wife had the angiogram along with 4 stents placed in her heart arteries.
You might note that my wife’s symptoms were at least superficially more typical of male than female heart problems. So, as someone suggested above, diagnoses by “statistical likelihood” is dicey any way you look at it and it pays to be well informed before seeing any doctor.
Fuck, I feel so lucky now. I’ve been on the testing treadmill for some time now with what seems to be a post-infectious fatigue that won’t go away, and shortness of breath. No patronising. LOTS of tests. Referrals to specialists to chase down minor symptoms that might be clues. Cardiograms and CT scans. It turns out that my heart is just fine, but the shortness of breath was taken completely seriously.
Go Australia! Our public health system isn’t perfect, and I’ve had what seems to me like quite a lot of out of pocket costs, but it’s soooo much better than all these US horror stories.
I knew someone who missed out on early cancer treatment and then died because her doctor was convinced she was suffering from anxiety.
what.
what?
what?
what?!
I’ve been there too. “I was depressed – it was all in my head”. Turns out that it was all in my head, just not the way he meant.
Mary P
Ms. Daisy Cutter, Gynofascist in a Spiffy Hugo Boss Uniform @14
AND we fat women would never ever think to lose weight unless some manz type doctor told us to. I mean, female and fat, IQ must be about room temperature, right?
Jesus goddamn Christ. Just when I think I won’t hear anymore stories (today) about women’s health crises being dismissed, I read how common it STILL is to write off their heart disease symptoms. HULK SMASH.
As a man who presented all the classic symptoms — sweating, chest pain, radiating pain in the left arm and left side of the face— but at the very young age of 36, I had a team of doctors running to get me into cardiac catheterization. It’s hard enough to know when you have to be seriously aggressive about seeking help when you’re atypical (“too young,” “otherwise healthy,” etc.) That women get denied simple stress tests and EKGs when they’re sensible enough to do what most people don’t do and actually call 911 or show up and say “I think I’m having a heart attack”. . .fuck.
IBTP. And muchly.
@nms
Basically.
@Lyn @Daisy
Also, a formerly-thin woman who gains weight must be devastated by this. If she’s cheerfully blasé and happy to be in remission and recovering from the side effects of chemo, then she’s off in the head.
OMFG this sounds exactly like me, except I’ve only dealt with it for 3 years. I was 19 with my first “real” attack where I gradually went blind in my right eye. Scary as fuck. They said it was most likely MS but couldn’t diagnose me because this is my first attack, had no brain damage and no history of MS in family. So I got 3 days of steroids and sent home. Vision cleared up to my normal can’t see far away shit in about 2 months. I was worried sick but I got great care.
Then last year, my legs got all tingly, and I couldn’t feel anything in them like normal. It was pins and needles like when they fall asleep, but all the time. It slowly climbed up to my hips. I went back to the same damn hospital where I went from my eye. NO ONE listened.
I heard jokes about getting fucked too hard, only not in those words, anxiety, just wanted a bed, welfare queen on state assistance etc. They made a big deal out of my IUD because its a Catholic hospital apparently. I had my child there for godsakes, I didn’t even realize it then. Before the only concern for my IUD was what was it made out of and how would it react in the MRI.
GRRRR. Sorry haven’t read the rest of the thread, just got to this comment and it hit home hard.
Firstly, nausea, vomiting and shortness of breath ARE classical heart attack symptoms.
Also, pain in the back is also a classical symptom for a back-wall heart attack (in both sexes), which frequently lack other classical symptoms, like like the tightness in the chest or pain creeping in the left arm.
Can’t help but noticing that “classic symptoms” are for men, while women are “atypical” (#15).
Shows subtle differences? Differences from what?
Oh. Wait.
My father died of coronary heart disease when he was 62. My mother had had her first heart attack when whe was 48, so when I started with heart problems at the age of 46 I was interested. (I’m still here almost 20 years later)
As it happens I was training to be a fitness instructor at the time so it became even more interesting if only because we were learning about cardiology and oxygen transport at the time.
A short time later I was head-hunted by the head of fitness for Leeds to join a community based cardiac rehab programme that he was setting up – I would have been a fool to say, No!
During my studies I was amazed to find out that medical studies carried out to determine the various pathways in females when compared to males were ‘so difficult’ because of hormonal differences they gave up and guessedtrapolated instead. Neddless to say they were not very good and although they have improved they aint got it right yet.
… even when it all started before you went fat. So it’s not only me then.
I’ve been chronically tired for over 4 years. Can’t do any physical exercise (by that term I mean simple walking) without feeling like crap (dizzy, sleepy, sluggish), when I was fitter than average and could run for hours on end before. Sometimes, for no specific reason that I can fathom, I will get so tired as to sleep entire days. I catch every single thing I come in contact with, including oral thrush (that puzzled the doctor). I had a stress test with a cardiologist, of course, and that’s exactly what he said : my problems are caused by overweight. Even though I was not overweight when it all started. Go figure.
I’ve been thought depressed and burned-out (since I work and study at the same time), even though I am positively cheerful, considering how limited I am by my symptoms. By now I probably have a nice “hypochondriac” tag in my medical file, even though before this episode, I did not even go once a year in a doctor’s office.
So what do I do ?
I’ve learned to live with the fatigue. I organize my life according to my limits. Exercise has been mostly banned so that I can remain productive in my daily life (most employers won’t keep a worker who has to spend half a week asleep on their pay rolls). I don’t drive at night. I use week-ends as sleep-fests when I’m too exhausted.
You don’t have any choice when nobody will take you seriously except goddamn quacks.
@kemist: Has your thyroid been checked? Severe fatigue and weight gain are classic symptoms of thyroid disease. So classic that I’m pretty sure you’ll roll your eyes and say “duh, of course I did!” at this suggestion, but just in case…
@dianne
Yep, got TSH and free T4 done at the beginning because there are cases on both sides of my family. I had slightly elevated TSH but even though it is now corrected, I feel more or less the same, except now I’m not constantly cold. No anemia (in fact I’m in the upper range for iron), no sign of mononucleosis. I also had cortisol dosed – normal.
According to all this, I’m totally healthy. Except that healthy people my age don’t get pneumonia or oral thrush, feel like they’ve just got a chemo treatment after taking a walk or sleep for whole days.
I, too, present classic MS symptoms – balance issues, dizziness, pronounced fatigue, optic neuritis symptoms, pain in limbs, loss of sensation, and weakness.
Additionally, my mother, aunt, and cousin – two generations of our family – all have been diagnosed with MS.
The first neurologist I saw decided that my concerns were “negligible” and told me that the fatigue would be alleviated if I slept more. Yup. 14 hours a night sometimes, and apparently she felt that wasn’t enough.
The second neurologist I saw told me that the family history *actually indicated against MS* because it couldn’t possibly run in families, that my symptoms looked like fibromyalgia, and simply wanted to have me take MRI after MRI despite his unwillingness to give me anti-anxiety drugs for the claustrophobic procedure and the terrific stress that aggravated the symptoms he was unwilling to treat. After a lumbar puncture that showed no O-bands (like the others in my family with an MS diagnosis), he dismissed me from his care.
I’ve been dealing with the symptoms with massage for the pain and numbness. It’s all I can do, because the neurologists with whom I’ve come into contact don’t care about the visible lesions on my brain, or the mind that has to reside in it.
Except that healthy people my age don’t get pneumonia or oral thrush, feel like they’ve just got a chemo treatment after taking a walk or sleep for whole days.
You’ll like my next set of suggestions even less. Have you been tested for HIV? Autoimmune problems besides hypothyroidism (this isn’t highly scientific but it’s my impression that autoimmune disease in general tends to run in families)? Could you be being exposed to some sort of chemo-like drug or heavy metals? Supplements, including apparently mainstream supplements like some vitamins, are notorious for poor quality control in their ingredients. Or if you live in some place where there’s industry or fracking, the source might be the water. If your iron is truly elevated and not just the upper limit of normal, you might have hemochromatosis, a condition involving iron overload eventually leading to liver failure.
Not that you should tell me your complete medical history, of course-please feel free to tell me to fuck off with the personal questions- but you could talk to your doctor if you haven’t been tested for any of the above and are still lacking for diagnosis.
Oh good grief. I just want to pack the lot of you with MS symptoms up and ship you to my father, who has been a neurologist with an MS specialty for nigh on fifty years now. He has a top-notch reputation in diagnosis of tricky and atypical MS patients – his great secret? He sits down with his new patients, talks to them extensively, and believes what they tell him about their symptoms unless he has strong reason to think otherwise (kind of the opposite of how House is portrayed). The enraging thing is that he is often the first physician to do so, even for patients who have been having symptoms for years and been to scads of different doctors.
Sometimes it’s amazing what a little belief in your patients will do. In my father’s case, it made his career.
Please, please persist. The average length of time between onset of first symptoms and diagnosis in MS is way too long, and largely the neurologists’ fault, but there are good ones out there to be found, I promise.
tapetum,
I appreciate it, but I’m having a hard time holding out much hope. (While Relapsing-Remitting has a lot of stuff coming out to treat it, Secondary-Progressive… not so much.)
If he’s in the Chicago area though…
I just learned about this a few days ago in the blogosphere, and I’m so glad that it’s covered here too.
Though hearing that when these symptoms manifest in women, they get written off as “anxiety” or “depression” makes me wonder if that’s related to the whole “women are more prone to depression” thing. It could have artificially inflated the numbers by misdiagnosing them.
That is in fact a possibility, jamie.
It is also possible that women are in fact depressed, as living in a world that devalues them is pretty damn depressing.
Sounds like the story of my life; I first started getting fluttering in my heart and tachycardia when I was 17, after a bout of glandular fever. Diagnosis: panic attacks. I started getting chest pains in my thirties, and classic angina pain (jaw/left arm pain, feeling like an elephant was sitting on my chest) when I was 39. Diagnosis? Indigestion.
I’d like to second Alethea’s praise of Australian physicians, though, because both heart disorders were finally diagnosed at the age of 49, a year or so after arriving in Adelaide. Although the particular ancient cardiologist I was under was useless, his junior did all the right tests and diagnosed atrial fibrillation and unstable (Prinzmetal’s) angina; and my current cardiologist in Canberra was brilliant at adjusting my medications until both conditions were as much under control as possible.
I could write a book about missed and mistaken diagnoses in other areas, but I’ll just say that my experiences have been pretty much the same as most of the other women in this thread.