A study has shown that women had a fifty per cent higher chance than men of receiving the wrong initial diagnosis following a heart attack…writes Dr Kailash Chand
Typically, when we think of a person with a heart attack, we envisage a middle aged man who is overweight, has diabetes and smokes. This is not always the case; heart attacks affect the wider spectrum of the population – including women.
Despite over 30,000 women dying of a heart attack in the UK each year, a study has shown that women had a fifty per cent higher chance than men of receiving the wrong initial diagnosis following a heart attack. Like men, some women also often fail to recognise the signs and symptoms of a heart attack.
Presently there are around 300,000 female heart attack survivors living in the UK today – many of these women will be living with heart failure as a consequence of their heart attack. The longer a heart attack is left undiagnosed and untreated, the more the heart muscle can be irreversibly damaged. Some findings:
Women generally present about 10 years later than men
Women present with a greater risk-factor burden.
Women are less likely than men to have typical angina
Women who present to the Accident and emergency/Casualty department with new onset chest pain are approached and diagnosed less aggressively than men.
Women have more chances to present with angina than heart attack but when they present with heart attack it is more fatal
Many cases of heart attack in women go unrecognized, particularly at younger ages or in patients with diabetes.
All women with intermediate or higher risk should be evaluated.
Treadmill exercise testing has a higher false-positive rate in women (for the diagnosis of obstructive coronary artery disease)
The prevalence of significant coronary disease found at the time of angiography is lower in women than men presenting with chest pain.
Most women with chest pain and no evidence of blockages on coronary angiography have cardiac syndrome X or microvascular disease
Screening for heart disease
1, Six minutes walk test: if you can walk more than 500 meters in six minutes you do not have significant blockages or if you can walk 2 km or climb two flight of stairs you do not have significant blockages
- Never ignore unexplained weakness, tiredness, first onset chest burning or first onset breathlessness after the age of 40
- If any member of your family male had heart disease before 55 or female before 65, it amounts to strong family history
- It will be a strong family history for Sri Devi family for future generations if her SCD is linked to blockages in the heart
What to do in sudden cardiac death
- Sudden cardiac arrest (SCA) and sudden cardiac death (SCD) refer to the sudden cessation of organised cardiac electrical activity
- The event is referred to as SCA (or aborted SCD) if an intervention (eg, CPR, defibrillation, cardioversion, anti-arrhythmic drug) or spontaneous reversion restores circulation. The event is called SCD if the patient dies.
- The exact mechanism of collapse in an individual patient is often impossible to establish since, for the vast majority of patients who die suddenly, cardiac electrical activity is not being monitored at the time of their collapse.
- However, in studies of patients who were having cardiac electrical activity monitored at the time of their event, ventricular tachycardia (VT) or ventricular fibrillation (VF) (very fats irregular heart beat) accounted for the majority of episodes, with bradycardia or asystole (no heart beat) accounting for nearly all of the remainder.
- In most patients with VT/VF, sustained ventricular arrhythmia is preceded by an increase in ventricular ectopy and the development of repetitive ventricular arrhythmia, particularly runs of non-sustained VT.
- There are many cardiac and non-cardiac causes for a sustained ventricular tachy-arrhythmia that can result in SCD. Among all SCD in all age groups, the majority (65 to 70 percent) are related to coronary heart disease, with other structural cardiac disease (approximately 10 percent), arrhythmias (irregular heart beat) in the absence of structural heart disease (5 to 10 percent), and non-cardiac causes (15 to 25 percent) responsible for the remaining deaths.
- Start CPR 10 in all cases of sudden cardiac arrest and continue till medical help arrives along with external electric shock machine.
- It may be advisable to opt for virtual autopsy along with blood molecular tests in cases of sudden cardiac death to know chances of similar episode in the family in future.
To conclude, coronary heart disease in women can be prevented. Whatever your situation, you can reduce the impact of your risk factors and improve your chances of preventing CHD by adopting healthy diet and healthy lifestyle habits.
(Dr Kailash Chand OBE is Honorary Vice President BMA, Chair Healthwatch Tameside and Former Deputy chair BMA council)