But Goldberg found a 99% blockage in one of the heart’s most important arteries — a blockage so dire that it is still commonly referred to as “the widowmaker.”
“Even the terminology describing the lesion is so gendered,” she said.
Experts like Goldberg have pointed out how sexism in the medical field has cost lives: Because research and treatments for heart disease were historically designed for men, many women and their doctors have missed the signs and risks of heart attacks, which can be very different between the genders.
One reason for this, Wenger said, was that men developed heart attacks at younger ages.
“They were at the peak of their careers,” she said. “They were visible. They were in the workplace.”
Women, on the other hand, “were not paid much attention to,” she said.
“In the earlier years, even the basic research was done on male animals,” she said. “It was cheaper.”
For men’s heart health, a long history of research paid off in droves, said Wenger; heart disease among men dropped precipitously from the 1980s. But women would not see the same benefits until the 2000s.
The way to a woman’s heart
Medicine was slow to adopt the concept of gender differences, Wenger said, but when it came to heart health, the differences were plentiful.
These tests still offer crucial information, Goldberg said, but doctors should know which test to choose and how to interpret them.
Though heart attacks often arise from a blocked artery, women are more likely to have conditions that affect the walls of arteries but do not block them. Researchers now suspect that these kinds of heart attacks, some thought to be rare and fatal, have also been happening in obscurity.
Ellen Robin, a health care administrator in San Diego, experienced this firsthand when, in 2010, “an elephant walked into the room and sat on my chest.”
“I knew I was in trouble,” she said.
Her husband tried to convince her over the phone that she was having a heart attack, but all Robin could think about was the ambulance bill. So she drove herself to the hospital, where her doctors hooked her up to an EKG.
Her reading was normal, but her symptoms did not stop.
She was given an appointment two days later at a catheterization lab, where doctors open up blocked arteries with stents. But she had another heart attack the night before her appointment.
“In the meantime, I’m thinking, ‘that’s what I get for eating a hamburger,’ ” Robin said, adding that she was an otherwise healthy 54-year-old with a normal weight and blood pressure.
When she finally arrived at the cath lab, doctors put a stent into one of the tiny arteries supplying blood to her heart. But she wasn’t having an ordinary heart attack. The artery tore, and her doctors added three more stents.
Robin was diagnosed with a rare type of heart attack known as spontaneous coronary artery dissection, or SCAD. There was no plaque blocking her artery; rather, the artery’s inner wall had suddenly torn. Blood then pooled between the layers of the arterial wall, like a blood pressure cuff filling with air, and blocked the flow of blood to her heart.
She recalled her doctor saying, “I’ve never had a SCAD patient in the 30 years that I’ve been a cardiologist.
“We usually find you in the morgue.”
Advocacy drives a change of heart
Like the discovery of widespread heart disease among women, doctors are finding that SCAD is more common than previously thought. With an increase in awareness has come an increase in research and resources for heart conditions that affect women, Wenger said.
“Some of it has been science, but a lot of it has been advocacy,” she said.
In 2009, a woman approached her at a WomenHeart conference and asked, “What is Mayo doing about research on SCAD?”
“It’s probably so rare,” Hayes replied. “We could never research it.”
The woman was a member of an online message board for women with heart disease. She was one of 70 in a subgroup for SCAD survivors. These women, who were scattered all over the world, were looking for someone to research them; they didn’t believe that SCAD was as rare and deadly as their doctors had led them to believe.
“I had just been told that there were 70 women who had all gotten together and were eager for somebody to do research,” said Hayes.
“We scaled it up, thinking that maybe we’d someday get 200 patients enrolled,” she said.
SCAD survivor Robin, who now runs a Facebook group of about 1,200 other survivors, is one of those research participants helping answer key questions like why SCAD recurs in some people and how doctors can better diagnose and treat it.
Women’s health advocates point to SCAD as a recent example of how the medical field can be pushed to address gender disparities in heart health through science, advocacy and awareness.
“It’s about empowered women and what they can do when they’re determined,” Hayes said.
“It’s a work in progress,” Goldberg said, but it’s paying off.
In 2013, fewer women than men died of cardiovascular disease for the first time in nearly 30 years.
“We were delighted to be in second place,” Wenger said, adding that the gender gap in heart health is far from closed, especially in a field with so few female cardiologists like herself.
“There’s lots of work” left to do, she said. “I think we’ve just begun the journey.”