Doctors still baffled by difference in heart attack symptoms for men, women

MANATEE ­-- Key Rosser has been looking at pictures of beating hearts on TV monitors for 12 years. The nearly-always smiling blonde is the ECHO/Vascular Technologist Supervisor at Heart & Vascular Center of Bradenton, which is located at 6001 21st Ave. W., a stone's throw from Blake Medical Center.

"You see this?" Rosser says recently, looking at the image of a heart with a red blip going off and on the screen. "That red blip is a hole in the heart, probably from birth. The woman patient is not having any symptoms from it, however."

The ultrasound paddle that Rosser uses to send the images to the screen can also coax out more serious cardiac problems in women, problems like plaque build up or arteries damaged by smoking that can lead to a heart attack.

But there is still one mystery involving women's heart health that Rosser can't solve from her machine. In fact it seems no one has yet solved it.

Why is it that women often have radically different heart attack symptoms from men?

"I don't now why the symptoms are different, but they are," Rosser said last week. "While men will usually experience intense chest pain, I have found women will first experience a heart attack as arm pain or jaw pain."

4 local doctors urge women to be heart-aware

Four prominent Bradenton cardiologists all agreed last week that women present different cardiac attack symptoms than men and all expressed concern that women sometimes miss the signals.

Since February is American Heart Month, the doctors all want to fo

cus attention on this major women's health issue.

Dr. Joseph N. Pace is a cardiologist and electrophysiologist who works with Rosser and also sees patients at Blake Medical Center. An electrophysiologist is a cardiac sub-specialist who deals in the electrical rhythms of the heart, like palpitations. Pace has been at Heart & Vascular Center for 18 years.

Dr. Jason Okuhara is an interventional cardiologist at Lakewood Ranch Cardiology, 8340 Lakewood Ranch Blvd., on the campus of Lakewood Ranch Medical Center. An interventional cardiologist is trained at treating an active heart attack. He is board certified in interventional cardiology, internal medicine and echo cardiography.

Dr. Christopher Davis is also an interventional cardiologist and practices at Bradenton Heart Center, 2010 59th St. W.

Dr. Jay Mathews is an interventional cardiologist at Bradenton Cardiology Center, 316 Manatee Ave. W.

No one knows the answer yet

Okuhara, who can fix cardiac problems using minimally invasive procedures, said that no one knows why the sexes have different cardiac symptoms.

"There have been different theories, but we are not sure," Okuhara said. "But what we do know is that risk factors go a long way to determining if a woman will get these symptoms. Smoking, obesity, diabetes, high cholesterol, these are the things we try to focus on to reduce the chances of a cardio event."

Mathews is also baffled by the different symptoms between men and women. Human hearts are structurally all the same, he said.

"I am sure it has something to do with hormone level," Mathews said. "Perhaps the fact that the brains of men and women are wired differently has something to do with the different heart attack symptoms. We also know woman have higher pain threshold. Women can be having severe symptoms and not complain about it. Their perception of pain is different."

There are a few non-structural differences between the hearts of men and women that may one day help solve the mystery. Scientists have noticed that women get heart disease later than men, Pace said.

"The rate that a man may get heart disease is far greater than a woman early on in their lives," Pace said. "But once the woman is post-menopause, around her late 40s, they have the same rate. So, the women are behind men at the front end but catch up on the back side."

Also, research has shown that women's first heart attacks tend to be lethal more often than men's.

"No one has come up with a reason why for that either," Pace said.

What is no mystery is that heart disease kills more American women than all forms of cancer combined, including breast cancer, Davis said.

"As with men, the most common presenting symptom of heart attack in women is chest pain or chest discomfort," Davis said. "However, women may also present with many other vague symptoms such as pain in the arms, back, jaw, or abdominal discomfort. Women may also present more commonly with shortness of breath, nausea and vomiting, dizziness and fatigue which may sometimes obscure the early diagnosis of heart attack."

"They can have shortness of breath," Okuhara said. "Sometimes they feel cold sweats, nausea and they attribute this to hot flashes. But they can persist and lead to pain and discomfort in the arms, back and neck and jaw."

One of Okuhara's most recent patients was a woman in her mid-50s.

"She thought she had indigestion for a few days and it turned out to be a blocked artery," Okuhara said.

It is important that women recognize these uncommon symptoms as more than 60% of women who died suddenly from coronary heart disease had no previous symptoms, Davis said.

"It's often lack of recognition that they are having a heart attack," Mathews said. "Women are 28 percent more likely to die of heart attack in comparison to men because they ignore the symptoms."

Mathews also puts some blame on his own medical community.

"The treatment is often not the same," Mathews said. "When a man comes in complaining of pain in the chest, immediately everyone thinks of the heart. But woman can have more vague chest region symptoms, like fluttering in the chest, heart burn or shortness of breath and not get attention for a heart attack."

All four doctors emphasize that every woman needs to know her risk factors, if any.

"If they are a smoker, overweight, have diabetes, are physically inactive or have a family history, and if they are older, they need to have cardiac vascular screening," Mathews said.

Mathews will speak about women and heart disease during a luncheon called "Matters of the Heart" at Renaissance on 9th on Friday, Feb. 13,

In his experience, Okuhara has noticed that women don't often have the classic clutching of the chest then they are having an attack.

Okuhara advises women to increase exercise or activity if possible and maintain an active lifestyle.

"I would say to women, regardless if they feel they are pictures of perfect health, if they have symptoms, do not ignore them," Okuhara said. "It can happen unexpected in any women. All the patients I recently treated for cardiac arrest were healthy."

Pace said he has seen women whose hearts have been damaged by heart attacks that have been left untreated for days or even a week because they didn't think they were having cardiac arrest.

"Women are more stoic," Pace said. "I think they ignore it or put up with the symptoms for a long time and when the symptoms don't get any better they know they need help."

Richard Dymond, Herald reporter, can be reached at 941-745-7072 or contact him via Twitter@RichardDymond.

This story was originally published February 10, 2015 at 12:00 AM with the headline "Doctors still baffled by difference in heart attack symptoms for men, women ."