For decades, women had heart attacks in silence

2/16/2017, 6 a.m.
Cardiologist Dr. Nieca Goldberg had been taught that heart attacks were a man's problem, but that didn't stop her from ...

— Some risk factors for heart disease -- such as premature birth and autoimmune conditions like lupus -- are unique to women. Certain heart medications can also affect women differently. And the tests doctors use to diagnose heart disease may be biased toward men.

The traditional treadmill test, which uses benchmarks largely set by men, may give a false estimate of a woman's risk of heart disease. Angiograms and CT scans can miss the causes of heart attacks in women, whose smaller arteries are prone to conditions that may not show plaque buildup. A "clear" scan does not mean a woman is out of the woods, researchers warn.

These tests still offer crucial information, Goldberg said, but doctors should know which test to choose and how to interpret them.

Though heart attacks often arise from a blocked artery, women are more likely to have conditions that affect the walls of arteries but do not block them. Researchers now suspect that these kinds of heart attacks, some thought to be rare and fatal, have also been happening in obscurity.

Ellen Robin, a health care administrator in San Diego, experienced this firsthand when, in 2010, "an elephant walked into the room and sat on my chest."

"I knew I was in trouble," she said.

Her husband tried to convince her over the phone that she was having a heart attack, but all Robin could think about was the ambulance bill. So she drove herself to the hospital, where her doctors hooked her up to an EKG.

Her reading was normal, but her symptoms did not stop.

She was given an appointment two days later at a catheterization lab, where doctors open up blocked arteries with stents. But she had another heart attack the night before her appointment.

"In the meantime, I'm thinking, 'that's what I get for eating a hamburger,' " Robin said, adding that she was an otherwise healthy 54-year-old with a normal weight and blood pressure.

When she finally arrived at the cath lab, doctors put a stent into one of the tiny arteries supplying blood to her heart. But she wasn't having an ordinary heart attack. The artery tore, and her doctors added three more stents.

Robin was diagnosed with a rare type of heart attack known as spontaneous coronary artery dissection, or SCAD. There was no plaque blocking her artery; rather, the artery's inner wall had suddenly torn. Blood then pooled between the layers of the arterial wall, like a blood pressure cuff filling with air, and blocked the flow of blood to her heart.

She recalled her doctor saying, "I've never had a SCAD patient in the 30 years that I've been a cardiologist.

"We usually find you in the morgue."

Advocacy drives a change of heart

Like the discovery of widespread heart disease among women, doctors are finding that SCAD is more common than previously thought. With an increase in awareness has come an increase in research and resources for heart conditions that affect women, Wenger said.