Coronary artery disease, the leading cause of death in America, claims the lives of hundreds of thousands of people each year. The classic textbook symptom patients complain of is that “it feels like an elephant is sitting on my chest.” However, the human body does not always read medical school texts and patients can present with a variety of symptoms felt due to other, more benign.
I remember in my residency training, an elderly diabetic patient came into the emergency room and said that he had bad “indigestion”, but when I looked at how low his blood pressure was and how he looked, I immediately knew he was having a heart attack.
The textbook case of ACS, also known as an acute coronary syndrome, consists of a pressure sensation in the middle of the chest or on the left side. The pain often radiates to the left arm, jaw, neck, or back. There may be accompanying nausea, vomiting, sweating, shortness of breath, or dizziness. However, many individuals suffer heart attacks and have few, if any symptoms, especially women and diabetics. As a matter of fact, it is not uncommon to pick up "Q waves" on a routine EKG which commonly signifies that the patient had a heart attack sometime in the past. When asked, people frequently do not recall ever having had symptoms suspicious for a heart attack, yet when further testing is done, it turns out that they have potentially serious underlying heart disease.
During a routine yearly physician exam, I noted Q waves on a patient's EKG. He denied any history of heart disease or recalling any symptoms consistent with a prior heart attack. Nevertheless, I sent him to see a cardiologist and the following day he underwent a coronary artery bypass graft because tests showed he had very advance heart disease and was at risk of having a heart attack if no intervention was undertaken. This scenario plays out over and over again.
Unfortunately, data show that women are not referred for diagnostic and therapeutic intervention for heart disease as often as are their male counterparts, a poor reflection of the current health care system. For this, and other reasons, it is imperative that women know what to look for should they develop signs concerning for heart disease. Furthermore, we need to disseminate this information to others to increase awareness among women that while heart disease is the most common cause of death in women, at least in America, it is all too often overlooked or inadequately evaluated.