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While science is only recently starting to understand why, his and her heart disease seem to follow very different scripts. From when blood pressure begins to rise, to where the pain of a heart attack is felt, to which medicines are — or aren't — prescribed, key differences between the sexes have emerged. Here's what to know.
Women experience heart attack pain differently than men do
As most people know, the sooner you recognize heart attack symptoms, the better, since your life can depend on getting to a hospital quickly.
In this area, women's heightened somatic awareness should give them an advantage, since it means they “feel pain sooner,” says C. Noel Bairey Merz, M.D., director of the Barbra Streisand Women's Heart Center at the Smidt Heart Institute at Cedars-Sinai Medical Center in Los Angeles. The catch? Women also feel pain less specifically.
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That means that during a heart attack, women may feel pain in their neck, chest or arm — areas that may or may not set off the necessary warning bells that a potentially life-threatening event is underway. When women report such varied and diffuse pain symptoms, doctors often think they have the flu, says Bairey Merz. “Physicians are less likely to attribute their more generalized symptoms to their heart."
While men tend to feel more localized pain further into the stages of a heart attack, for either sex the proper diagnosis can hinge on which questions are posed. “Asking a patient if they have chest pain is a really close-ended question. Everyone's perception of pain is different,” says Nieca Goldberg, M.D.,senior advisor of Women's Health Study at New York University Langone Health in New York City. For this reason, instead of asking if a patient's pain is “like a knife,” Goldberg asks if they have the more general “chest discomfort.”
Women respond differently to a common heart-attack screening test at the hospital
Even if a doctor thinks a woman is having a heart attack, the event may not show up on a standard test that looks for proteins in the blood (called troponins) that are released when heart muscle is damaged. The heart-attack screening tool is not as specific in women as it is in men, says Bairey Merz. More sensitive troponin tests are currently being used in the U.K.; having one of these tests, according to recent research, boosted women's odds of getting a heart attack diagnosis by 42 percent.
Getting to the hospital quickly and getting the right diagnosis are only part of the challenge for women with heart disease. There is a huge difference in how men and women are treated following a heart attack, as many studies over the years have shown.
In a study published in the Journal of the American College of Cardiology last October, researchers at the University of Edinburgh found that women with the same cardiac diagnosis as men received only half the recommended treatments.