Taking the Message to Heart

If I had those symptoms, I think I'd know something was really wrong. So why all the talk about women not getting help in time?

Part of the problem is that some women experience no symptoms at all: According to the American Heart Association, 64 percent of women who die suddenly from heart disease had no prior warnings, and 35 percent of heart attacks in women go unnoticed or unreported.

Women often don't think of heart attacks when they feel ill, said Sharonne Hayes, director of the Mayo Clinic Women's Heart Clinic in Rochester, Minn. "Women experience pain differently. They sense the pain differently. Whether the pain is different or whether this is cultural, we don't know," Hayes said.

If women are having heart attacks that are unnoticed and unreported, how do we know they are having them?

When they go for their yearly physical, the doctor hooks them up to an EKG (electrocardiogram), takes a look at the result and asks, "When did you have your heart attack?" King said we used to call these heart attacks "silent," but studies have shown that women usually knew they were sick -- maybe they stayed in bed for a week with what they thought was the flu -- but they didn't know they'd had a heart attack until their doctors told them.

In that case, why don't doctors just screen women more aggressively?

Good idea -- and many heart groups are urging docs to do just that. But getting more women to undergo routine physicals and screening for cardiovascular disease won't solve all the problems.

Why not?

Because simple screens were designed mostly for men, and they often miss heart problems in women. So it's hard for doctors to know which patients to refer for more complex tests.

Consider this. If a man comes in complaining of shortness of breath, the doc hooks him up to an EKG while he exercises on a treadmill and, bingo, he's got an answer.

But exercise stress tests are less reliable in women, said Roger Blumenthal, director of the Johns Hopkins Ciccarone Center for the Prevention of Heart Disease. The tests often need to be combined with other diagnostics such as an echocardiogram before and after exercise, and a nuclear scan, in which radioactive material injected into the veins shows how well the blood flows to the heart muscle. Then there's the question of how to interpret data to apply meaningfully to women.

Okay, but don't other ways of predicting risk work in women?