By Victoria Cayce

Linda was feeling bad. Really bad. She had been overly tired for a week, but since her kids had just gotten over a bug they picked up at school she assumed that the nausea and fatigue were related and went back to plowing through her busy day. Then her upper back began to ache. The dull pain in her chest was making it hard to breathe and she was sweating. She ignored it and kept on going. Three hours later, Linda was dead at the age of 45.

Remember back in high school when your teacher was telling you that knowing how to diagram a sentence would be important later in life? While a dangling participle is not a likely cause of death, she may have been on to something. Good communication, or the lack of it, is directly linked to the outcomes of cardiac patient care. And that is a matter of life and death.

In the story above, the hypothetical Linda ignores her symptoms because she simply doesn’t know that heart attacks often present differently in females than they do in males. If she had been aware, she would have been more likely to seek emergency treatment that might have saved her life. Sadly, the story of Linda plays out in real life every day.

Leading Cause of Death in Women

While more and more people have become aware of the dangers of breast cancer and the need for self-examination, many more women are completely uninformed about their heart health. The case for informing women of the dangers of breast cancer is laudable; however, these same women are at greater risk of dying from a heart attack or stroke. According to the Center for Disease Control 1 in 31 women die from some form of cancer each year while one in every four women die from heart disease. The key to improving these numbers is at the local level; healthcare professionals are on the front lines and must do a better job of educating their patients about the risks and symptoms of heart disease in women.

Perceptions are Everything

Studies have shown that the public has a perception that heart attacks happen more frequently in men. The great disconnect for women is not helped by the media, which tends to portray the dramatic “Hollywood heart attack” of someone (often a male) who is gripping their chest before they collapse. In reality, many women experience either no symptoms or a dull pain or discomfort that may radiate to the throat, arm, or jaw.

Medical providers can do a lot to break this myth by simply talking to their patients about the differences and making information more accessible for them. For example, doctors could start by adding a few questions to the forms that new patients fill out regarding their family history of heart disease. They would follow up by briefly explaining the warning signs for female patients.  The questionnaire might include targeted keywords related to the symptoms such as:

• Have you been feeling excessively tired in the last few weeks?
• Have you experienced pain in your neck, back or jaw?
• Have you been having stomach pain?
• Have you been having chest discomfort or pain?

When patients leave, a nurse, technician, or a member of the office staff could hand them a packet that contains small laminated poster with a magnetized back that can hang on a refrigerator door. Medical offices can also display colorful informational posters that clearly explain things that female patients and their families should know including:

• How minutes count when someone is having a heart attack
• How they should give someone with the symptoms of a heart attack an aspirin
• The differences in male and female heart symptoms

Another reason that female patients tend to press on and ignore heart related symptoms is that they do not feel emotionally comfortable seeking medical care. They may also regard their own symptoms as trivial. Doctors and nurses need to create an environment in which female patients especially feel comfortable reporting their symptoms. To address this issue, medical providers must create an atmosphere of trust.

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Open Doors Save Lives

For instance, when discussing issues related to cardiac care, physicians and their staff need to stress the fact that they have an open door policy, and that symptoms should never, ever be ignored. Explaining that it is OK to seek medical care (and that they will not be dismissed out of hand) will go a long way in removing the emotional barriers to care and alleviating fears of being dismissed or labeled a hypochondriac.

Unfortunately, the fear of being labeled may not be that far off of the mark as a study published in the New England Journal of Medicine involving more than 10,000 cardiac patients (48% were women) demonstrated that females under the age of 55 were seven times more likely to be turned away than male patients while they were actually experiencing a heart attack. The most common misdiagnosis assigned was listed as “anxiety.”

Women Say it Differently

In part, this problem may be related to the fact that women often use different verbal clues to express their symptoms. For instance, female patients are much more likely to complain of “discomfort” while male patients use the word “pain.” When combined with the more subtle symptoms of heart attacks in women, this tendency can easily lead to a misdiagnosis.

Furthermore, in an American Medical Association study that included more than one million patients, females were found to be twice as likely to die while hospitalized when their symptoms (including changes in an EKG) were not expressed in the classic way that males do when experiencing in a heart attack.

Communication is therefore even more critical to providing appropriate care to female patients. Medical providers must go beyond the basics and employ active listening that allow for the inherent differences of male versus female speech patterns and word usage. They must then apply more aggressive treatment strategies when a heart attack is suspected. In other words, they must be willing to dig deeper when females present with less specific and immediate heart related symptoms.

Communicating in a Social World

Marketing campaigns have had a significant impact on breast cancer awareness. The Susan G Komen Foundation, for instance, uses social media, blogs, touching real-life stories and marathons to help raise funds and awareness. Doctors and nurses can use the same approaches to educate women about heart attack symptoms. They can get their message on social media. They can write engaging blog posts with relatable stories and critical information about heart attack symptoms in men and women.  Their posts can include valuable resources, too, including tools for heart health such as the Heart Attack Risk Calculator.

Local health care providers also can incorporate national awareness campaigns into their grassroots efforts. The American Heart Association has created a short film to educate women called Just a Little Heart Attack that is very sharable and could be embedded in social media. Additionally, medical personnel can spread information by holding heart health awareness events that offer free cholesterol checks and heart health screenings. Volunteers could hand out:

• Red bracelets ( The American Heart Association has designated red as the color for heart awareness)
• T-shirts with heart health slogans and information
• Red balloons
• Memorabilia such as cups, magnets and bumper stickers aimed at increasing awareness

Doctors and hospitals also can team up with professional writers and marketers to create slogans and messages that the public can understand and respond to. They can connect with local news stations to get the word out about events.

Anyone working in a busy practice understands that time is extremely limited. But bolstering medical practice’s heart attack awareness efforts with a social medial campaign, as well as a blog aimed at a lay audience, gives you the ability to get your critical message across to far more people. The point is to get the word out as often and as clearly as possible, and ultimately, to save lives.