The Silent Symptoms of Heart Attacks
Heart attacks have been commercialized as a dramatic event - the person cries out in pain, falls to their knees, and clutches their chest. This, however, is not the case for 33% of women. Cardiac events are built and tested on datasets dominated by cisgender men, and by looking for these symptoms, women often miss the window for life-saving treatment.
The structure of the cardiovascular system is innately different between men and women. Classic heart attacks tend to involve a blockage in the large arteries. Women generally have smaller hearts and narrower blood vessels than men, and thus, the symptoms can manifest pressure, shortness of breath, nausea, or lightheadedness - all of which can occur without the crushing chest pain that heart attacks are normally associated with. These physiological differences, paired with a social conditioning that forces women to downplay their pain, leads to start ramifications in treatment times.
“Women wait an average of 54 hours to seek treatment vs. 16 hours for men.”
Time is money, and this is particularly true of heart attacks. Heart muscle cells do not regenerate, and after being starved of oxygen, they begin to die, replaced by scar tissue. This scar tissue is inert; it does not beat or pump, and reduces the overall function of the heart. Heart failure rises dramatically following a cardiac event like a heart attack. “Women face a 20 percent higher risk than men of dying or having heart failure during the five years following a heart attack.” Eventually, if enough of the heart is damaged due to a delay in treatment, the heart itself becomes too weak to supply blood to essential organs, like the brain. And so, because women tend to arrive later and are less likely to receive aggressive treatment when compared to their male counterparts, they are nearly twice as likely to die.
Misogyny runs rampant in the healthcare industry, written in silent ink. For decades, women’s health was synonymous with reproductive health, when there are much more physiological differences between the sexes. Heart attacks are just one of many facets of how women receive unequal care.Narrative medicine, however, as a tool, offers a path forward; personalized medicine and treatment plans directly address symptoms and causes of them, looking past rigid, old ways that look over underrepresented groups. Narrative medicine isn’t just about a doctor listening, but rather, it refuses a patient to be edited. It views past clinical bias and takes what is being said seriously.
To share your story is the part of narrative medicine that can help redefine treatment for the next generation of women. A symptom you may have is not just “atypical”, but is an artifact of decades of misogyny.
By: Jacob Nacomel (he/him) | Podcast Director, Academic Committee Member
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