April 16, 2024 – Tonya Farmer was driving on the interstate in Atlanta when severe chest pains began. She called 911, experiencing pain and difficulty breathing and believed she was in critical danger.
When she arrived at the local emergency room, she said she was having a heart attack. Yet none of the hospital staff responded until a man in the waiting room asked loudly if anyone had heard him.
“I guess I looked too young to have a heart attack,” Farmer said.
Her story highlights the huge problem of gender disparities in the diagnosis and treatment of heart disease. Results from the 2014-2020 National Hospital Ambulatory Medical Care Survey showed that American women visiting emergency departments waited 29 percent longer, on average, to be seen and evaluated for heart attacks than men.
These delays can be life-threatening, especially for young women who are at risk for spontaneous coronary artery dissection (SCAD), a type of heart attack that accounts for 1 in 3 acute heart events in women under 50. which causes
“There are still stereotypes that heart attack patients only look like older, white men,” says Erin Mikos, MD, director of Women’s Cardiovascular Health and the Johns Hopkins Cicaron Center for the Prevention of Heart Disease. said the associate director of preventive cardiology at Baltimore for Prevention. “SCAD patients don’t have the risk factors we think of for heart attacks; they have normal cholesterol, normal blood pressure, they look healthy, exercise regularly and eat a healthy diet.
Getting to the heart of SCAD
Unlike most heart attacks (which are caused by plaque buildup or blood clots in the arteries), SCAD is the result of a tear in the middle layer of the artery wall where blood begins to pool. Which separates the wall layers. This ultimately restricts blood flow. The average patient is premenopausal and between 44 and 53 years of age, but SCAD also accounts for 15% to 43% of heart attacks in women who have recently given birth.
Researchers believe that SCAD may be related to hormones and their effects on connective tissue, pre-existing connective tissue disorders such as Ehlers-Danlos syndromeor abnormal cell growth in the artery walls (fibromuscular dysplasia) that causes the arteries to bulge.
Another theory is extreme emotional or physical stress.
“In about 50 percent of cases, we see extreme emotional stress and in about 20 percent to 30 percent, too much exercise,” Mikos said. “We’ve hypothesized that these stressors reactivate the emotional nervous system, increase blood pressure, and heart rate, and you have this adrenaline surge; This can be the thing that triggers the event if the artery is already fragile or prone to rupture,” he said.
Faces of SCAD
The lack of answers and information about SCAD has a significant impact on the women who experience it.
“The frustration that these patients have is real,” said Sharon Hayes, MD, founder of the Women’s Heart Clinic at the Mayo Clinic in Rochester, MN. “They are not getting answers. They’re worried that they’re going to die, about having another SCAD,” he said.
Nakeia Jackson is a travel nurse living in Alton, IL. She had her first SCAD when she was 28 years old. Now 34, Jackson said she doesn’t trust small community hospitals to do the right thing. “They don’t know how to treat them,” he said.
After 24 hours of pulling chest pains and no response, she went straight to Barnes Hospital in St. Louis and to the doctors who would save her life.
“I was blindsided,” said Jennifer Maxwell from Cedar Rapids, IA. He had the first of three SCADs at age 40. Now 55, Maxwell said she was training for a marathon outdoors in the cold Iowa winter when she woke up one day with tightness and pressure in her chest and shortness of breath, and she went to a local hospital.
“The hospital didn’t take it seriously,” he said. “They didn’t put a monitor on me, didn’t call a cardiologist, didn’t do an EKG,” she said. “I felt unknown,” he said. “The attending physician told me that I was 40 years old and healthy, and that it was only anxiety.”
SCAD sister
SCAD leaves an indelible mark. Initial treatments range from watchful waiting to the administration of medications and advice to avoid strenuous activity and heavy lifting, all aimed at avoiding potential triggers. But the evidence supporting these treatments is sketchy and somewhat weak. “We are guided by the growing evidence. We’ve had some great successes but we’re not there yet,” Hayes said.
Doctors are also unable to predict which women will experience recurrent episodes, a concern that leaves many women with mental health issues as they navigate the aftermath. “It makes sense; They were young and did everything right and then this bad thing happened to them,” Mikos said. “They live with anxiety, but too much anxiety can make things worse, so part of my counseling is to encourage patients to get help for stress and anxiety.
The lack of evidence and proper medical treatment has kept many of these women out of the walls of clinics and emergency rooms. Connecting with others with similar experiences has made a significant difference in their lives.
“I feel empowered,” said Jo Ann Girardeau, a 61-year-old SCAD survivor. He attributes much of his success to organization woman heart There he found invaluable resources that eventually led him to volunteer as a “champion,” a group of advocates and educators.
“Seeing other women thrive, not just survive, is very encouraging,” she said. “Others have found peace.” SCAD ResearchA non-profit organization that raises funds to support scientific research, provides education, and hosts several Facebook groups for survivors and their families.
When you ask these women what they wish they had known before their SCAD, their advice comes quickly:
- Girardo: “Learn to use your words correctly and do not underestimate your situation; the doctor only knows what you are telling him.
- Hari: “Find a doctor who is with you.” If you see a doctor who doesn’t answer you or doesn’t answer your questions, go to someone else and don’t stop until you get the answers you need.”
- Jackson: “Any symptoms that you think might be a heart attack, go get checked out right away.” Many doctors are not familiar with SCAD, so you will have to advocate for yourself.
- Maxwell: “You can’t assume when you walk into the ER and say you have chest pains that someone is going to know it’s your heart.” Women present heart symptoms differently than men. So you need to make sure you fight for yourself.
