Women suffering from heart attacks wait longer than men for treatment

A woman who suffers a heart attack may have to wait longer than a man for treatment, which could have a negative impact on her prognosis, warn two Montreal experts.

Women experience the same symptoms as men during a heart attack, explains Dr. Jessica Forcillo, a cardiac surgeon at the Centre hospitalier de l'Université de Montréal (CHUM).

However, she notes that women tend to describe their symptoms differently than men, sending doctors on the wrong track.

"Men who come to the emergency room [with a heart attack], we call it the Hollywood presentation: a spot in the chest, radiating to the arm or jaw," she said. "Women, we think, have the same kind of symptoms, but they express it differently, making it difficult for the treating physician to connect it to a heart attack."

Some of the symptoms, such as nausea, hot flashes and fatigue, can be "confusing," she added.

"So women come, present, they don't have a diagnosis, and finally they are diagnosed with something, and end up in surgery," Forcillo lamented.

Cardiologist Christine Pacheco recalls that for a long time, doctors used the "bikini approach, which is the approach of looking primarily at the woman's reproductive health system, and then really kind of ignoring the rest."

"I had a patient who had chest pain, discomfort, who went to her primary care physician who said, 'Oh well, maybe it's heartburn, here's a bottle of Pepto-Bismol, go home,'" said Pacheco, who is the only physician in Quebec with a specialty in women's health. "Then finally, two weeks later, I saw her in the emergency room because her symptoms worsened."

Delays in proper management often result in avoidable sequelae, she adds.

Pacheco explains in that patient's initial evaluation, heart disease was ruled out "because, historically, in the medical community, heart disease in women has been somewhat dismissed."

That means the necessary tests a patient may need also get delayed.

A recent U.S. study found electrocardiograms and blood tests to detect heart attacks occurred later in women than in men, hindering proper disease management.

Pacheco and Forcillo are two of the founders of Cardio F, a CHUM clinic that specializes in the prevention, diagnosis and treatment of cardiovascular disease in women.

However, they insist the blame can't be entirely on the doctors; women may also take longer than men to figure out what's happening to them "since cardiovascular disease has traditionally been a male affair."

The experts note less than a quarter of women have ever discussed their cardiovascular risk with their doctor.

Yet, one in three Canadian women will develop cardiovascular disease in their lifetime, killing five times as many women as breast cancer.

Canadian data show that women between the ages of 18 and 65 are more likely than men to die within a year of having a heart attack.

Some studies indicate that young women die at a higher rate than men, and the symptoms they describe seem different -- they may experience less pain than older women, and the causes of their heart attacks may vary.

"For younger women, it's also multiple work-family roles," said Forcillo. "We've also seen this increase during the COVID-19 period with stress cardiomyopathy; it's called 'Broken Heart Syndrome,' which is more prevalent in younger women. It's a mechanism of infarction that is not a blockage in the arteries, but it's related to stress that occurs more in younger women."

While well-known risk factors such as obesity, smoking and physical inactivity can affect members of both sexes, there are others specific to women, such as high blood pressure, diabetes during pregnancy, fertility treatments, depression and early menstruation.

-- This report by The Canadian Press was first published in French on May 20, 2022.