Woman in the ER -- Cue The Violins!

By Katherine Leon

Why is it when a woman with chest pain enters the ER, the waiting room soundtrack switches from ‘80s soft rock to dramatic symphonic numbers? Even in 2014, it’s not unusual to sense a weary sigh among staff that yet ANOTHER woman “thinks it’s her heart.”

Well, it most likely is her heart. Heart disease is the number one killer of women, more than all cancers combined. Why is this still the case, despite 12 years of the NHLBI’s Heart Truth campaign and 10 years of AHA’s Go Red for Women? How can this be?

The ER doc who sent me home after I arrived at the hospital by ambulance with classic heart attack symptoms may offer a clue. As he completed my discharge papers, he explained, “It’s not our job to find out what’s wrong with you. Our job is to tell you what isn’t, and this isn’t your heart.” He pointed out the obvious (at 38, I was “almost 40”) so should get my gallbladder checked.

At the time, that struck me as an odd perspective from a medical professional. It’s one of those surreal moments etched crystal clear in my memory. Sure, it was 4:30 p.m. on a weekday and I was in sateen pajamas and a not-so-pretty nursing bra. And yes, I was definitely anxious and nauseous, but acid reflux didn’t quite fit with the experience I’d had that day. I’d finished breastfeeding my 7-week-old and was hit by a Wile E. Coyote-caliber anvil on the chest that mashed the air out of me and sent pain through my upper back and into my jaw. My arms went numb. I did in fact have a heart attack that day, and another three days later. Finally, on the sixth day, I underwent a cardiac catheterization and emergency double bypass surgery to repair the damage caused by Spontaneous Coronary Artery Dissection (SCAD), an increasingly recognized form of heart attack and sudden death, predominantly in women.

In contrast, the ER staff knew quite well that day what was wrong with the guy a few curtains over who was cracked out on PCP. Did they do a few scans, labs, and send him on his way, saying, “It’s definitely not the drugs. Go see your internist.”? No, he hung out all day and seemed to be having a fabulous time harassing the nurses and exposing his genitals to anyone in range.

So perhaps the deck is stacked unfairly. Yet a snapshot of heart disease in women shows the urgency of our situation:

• Heart disease kills 1 in 3 women. That’s approximately one per minute.


• Ninety percent of women have at least one risk factor for developing heart disease.


• The symptoms of heart disease in women often differ from those in men, and may be misinterpreted as a result.


• Only half of women would call 9-1-1 if experiencing heart attack symptoms, but 79 percent say they would call to help someone else.


• In the past 30 years, the rate of men dying from heart disease has gone down, but the rate of women continues to increase.

What do these stats tell us? To me, they firmly suggest that women need to step up. We need to apply the same care and concern to ourselves that we do to a partner or our children. To put the situation in perspective of the workplace: if a woman is at risk of losing a promotion to a coworker, would she draw the curtains, crawl into bed and resign herself to the loss? No. And if she would, then we have more fundamental issues to address as women before we can conquer our heart disease crisis.

Health care providers share the blame, and key elements of physician training must be fixed. We must determine what causes doctors to minimize patient concerns. What mechanisms can we put in place to supplement poor communication skills in both parties? How can compassion be built into the system, regardless of personality traits and prejudices? This isn’t just a matter of thinking outside the box; this requires an entirely new space — a sphere of ideas. Doctors need to understand what it is to be a patient, in every sense of the word. And women need to value themselves enough to demand the respect and care they deserve.

“It’s not our job to find out what’s wrong with you. Our job is to tell you what isn’t, and this isn’t your heart.” I can still hear those words, with a crescendo of violins in the background.

Katherine Leon is co-founder of SCAD Alliance, a nonprofit devoted to improving care and outcomes of Spontaneous Coronary Artery Dissection, an under-diagnosed cause of heart attack and sudden death. Katherine survived SCAD, heart attack, and emergency double bypass surgery after the birth of her second son. The ordeal marked a new beginning for her as an advocate for patient empowerment, women with heart disease, and her fellow SCAD patients. She initiated the first large scale, single-center research of SCAD in 2010, and continues to support survivors, their families, and health partners. @SCADalliance

Woman in the ER -- Cue The Violins!