The traditional concept that heart attack always presents with chest pain as a primary symptom leads to delays in many women getting timely intervention, according to leading cardiologists. Shakti Conclave 2.0, recently held in Bengaluru, focused on creating awareness around heart disease in women where cardiologists from different parts of India threw light on women’s heart health, bringing out critical issues like the gender differences in symptomatology of heart attacks.
The symptoms of heart attack can sometimes vary in men and women. A heart attack in men, typically characterised by chest pain, is considered the classic symptom. However, women may not always experience chest pain as a symptom of heart attack, experts said.
Heart attack symptoms differ in men and women
“Women may not typically complain of chest pain but show other symptoms such as fatigue, dizziness, fear or anxiety, which are less associated with a heart attack,” says Dr Sarita Rao, senior consultant, interventional cardiologist, director of Cathlab, Apollo Hospital, Indore.
According to Dr M Jyotsna, professor and HOD (Retd.), department of cardiology, Nizam’s Institute of Medical Sciences, Hyderabad, the difference in symptomatology in women leads to women receiving non-specific treatment and being sent back without their symptoms being addressed nor their cardiac health status being checked.
She also adds that there is a common hesitation among women and their families to get her hospitalized and under observation to find out if something is awry.
Dr Jyotsna opines that a good contraction in an echocardiogram (ECG) does not always assure that the person doesn’t have a heart condition, especially among women. “If the person is experiencing symptoms, they must be kept under observation, and further probing must be done.”
Women delay reporting heart attack symptoms
Dr Rao emphasizes that, on average, women delay reporting their symptoms two to three days later than men. “They are also in a worse condition than men when they seek medical attention,” she adds.
Agreeing with her, Dr Thomas Alexander, a senior interventional cardiologist at KMCH Hospital, Coimbatore, recalled a recent study done in Tamil Nadu as part of the acute heart attack program, which stumbled upon a worrisome finding that the average time of hospital presentation (the time between the onset of symptoms and seeking medical intervention) in heart attack cases was 320 minutes (5 hours, 20 minutes). “The cohort had 2,400 people who had had a heart attack, of which 20% were women,” said Dr Alexander, who was one of the researchers of the study.
Another researcher from the same study, Dr Ajit Mullasari, director of cardiology at the Institute of Cardiovascular Disease at MMM Hospital, Chennai, adds that women presented to the hospital 20 minutes later than men. “The mortality rate of women dying of heart attacks was double that of men, as per our study,” he said.
“Women’s health often doesn’t get the same priority as men, which includes getting timely tests done. This further contributes to delays in diagnosis and treatment,” adds Dr Rao. “A lack of financial independence in women plays a contributing role.”
“The late presentation causes them to miss out on the treatment options available during the golden hour, or first 60 minutes, during which the arteries can be repurposed, and the myocardium can be saved,” he says.
Dr Jyotsna adds that women’s recovery period is also often cut short as they are usually expected to get back on their feet and resume their chores, affecting secondary prevention and post-discharge care.
Gender gap in clinical trials
The experts point out that the lack of representation of women in clinical trials creates huge gaps in women attaining timely intervention for heart attacks and other cardiovascular diseases.
Dr Rao observes that there is a lack of representation of women in clinical trials, which is a prime reason for gaps in knowledge about symptomatology of heart disease in women.
“Women’s representation in most trials is below 20%. Most of the data available are largely based on men,” adds Dr Rao.
Heart disease kills more women than breast cancer
Women who menstruate tend to have a lower risk of heart disease than men due to the protective role of the estrogen hormone. However, if a woman of reproductive age has diabetes or a family history of heart conditions, it can override the hormonal advantage, says Dr Mullasari.
He stresses that heart disease is a bigger killer than breast cancer in women but far less talked about.
Pregnancy and cardiovascular diseases
According to Dr. Jyotsna, women must get regular checkups during and after pregnancy as a lot of pregnancy-related issues, like high blood pressure, gestational diabetes, and peripartum cardiomyopathy, can be harbingers of women developing cardiovascular conditions in the future.
Dr Mullasari emphasizes that women must lose pregnancy weight as soon as possible. Pregnancy can make women prone to mental health issues like depression, which can also put them at risk of cardiovascular diseases, he adds.
Takeaways
- The symptomatology of heart attacks is different in men and women. Women typically complain of symptoms like fatigue and dizziness over chest pain, which is a common symptom among men.
- Heart diseases are a bigger killer among women than breast cancer, but far less talked about.
- Women of reproductive age are vulnerable to heart conditions if they have diabetes or a family history of heart conditions.
