1. Miracle, Vickie RN, EdD, CCRN, CCNS, CCRC, Editor, DCCN

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Far too many people, including healthcare providers, still believe that women do not have heart disease, at least until after menopause. The media has done a good job in trying to educate the public, especially women. Heart disease is a real threat to women at any age and is the leading killer of both women and men in the United States today. I recently conducted an informal poll before writing this editorial and found that most women still believe the leading cause of death for women is breast cancer. 1


So why is it so difficult to convince certain women about the risk of heart disease and the importance of taking action to reduce the risk? The blame can be placed partially on history. Only in the past few years has medical science realized that the chance of a premenopausal woman having heart disease is a real problem. Physicians of all specialties, including cardiology and gynecology, told patients that heart disease prior to menopause was very low. In addition, even after menopause, the risk of heart disease was low for those women who took hormone replacement therapy. After several studies, we know now this is not true, either. Hormone replacement therapy is not the magic bullet we all wanted and tried to believe.


Certain healthcare providers still are reluctant to admit that women do have heart disease, especially before menopause. For example, I recently cared for a 32-year-old woman who had been complaining of chest pain to her primary care physician for 3 months. The physician did not conduct any tests and told the patient she was too young to have heart disease. He then prescribed a sedative and told her to relax. She was not happy with this advice and lack of care and visited another primary care physician. The internist gave her the same information and prescribed a second sedative. Again, no cardiac testing was done. One week before I met her, she presented with chest pain to an ER at another hospital. Once again, the emergency physician told her there was nothing wrong with her heart based on her age. He advised her to take the sedatives prescribed by the other physicians. None of these physicians ordered an electrocardiogram (ECG) or recommended further testing.


I met this remarkable woman when she presented to the ER. She was complaining of chest pain and arrived in the ER via ambulance. The ER physician ordered an ECG and a cardiac profile. The ECG showed an acute anterior myocardial infarction (MI). She was immediately transferred to the cardiac catheterization laboratory for emergent percutaneous coronary artery angioplasty (PTCA). The PTCA was unsuccessful and she underwent emergent coronary artery bypass surgery (CABS). The surgery went well and she had no further complications.


I had the opportunity to talk with her after the surgery. I was conducting a research study about social support for women after CABS. She was angry at the healthcare system because she believed it had treated her badly. I agreed. I admired her courage and tenacity in continuing to seek healthcare for her heart disease. As we talked, she told me she had several risk factors for heart disease, but no one had ever asked before. She was a smoker and her mother died of a MI at the age of 30. She commented that nurses paid more attention to her symptoms and multiple risk factors than the physicians.


Recently the media has helped bring this topic to the attention of the public. Women's heart centers are opening at several facilities and are competing for patients. These facilities have an ongoing media attack to attract females to their centers. Even though this approach may be murky, it serves a good purpose. Women are starting to believe they can have heart disease and are seeking care.


Women may have different symptoms than men and this can make it more difficult to diagnose. 1 Women often complain of fatigue, shortness of air, palpitations, and chest pressure. Even those presenting with different symptoms may have heart disease. The risk factors for heart disease are the same for women and men: smoking, hypercholesterolemia, hypertension, diabetes, obesity, sedentary lifestyle, age, family history of heart disease, and stress. As nurses, we must assess women for these risk factors. If risk factors are present, we must educate our female patients on ways to reduce their risk of heart disease.


As critical care nurses, we have a responsibility to educate the public and other healthcare providers about the very real threat of heart disease to women. Preferably, we should make attempts to educate women before we see them in our critical care units. We must be proactive in this area, not reactive. We have several opportunities to educate the public. For example, volunteer to speak to women in various settings such as a class at a local community center or in schools or churches. We also must teach continuing education classes for healthcare providers about heart disease. Also, do not be afraid to confront a physician or any other healthcare provider who believes women do not have heart disease and may not be treating women appropriately or taking their complaints seriously. I did this recently when a cardiologist commented that he was tired of seeing women who thought they had heart problems and when "all they need is to calm down." A discussion about women and heart disease followed; hopefully he will be better prepared to address this issue with his female patients.


Remember, heart disease strikes 1 of every 2 Americans. Education is the key to reducing this number. As critical care nurses we can reduce the number of women dying from heart disease.




1. Cheek D, Cesan A. What's different about heart disease in women? Nursing2003. 2003; 33( 8):36-42. [Context Link]