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The Globe and Mail

Why is heart disease in Canadian women still being missed?

This story is part of Work in Progress, The Globe's look at the global struggle for gender parity.

Carolyn Thomas went to her local emergency room complaining of chest pain, nausea and pain in her left arm. Acid reflux, the doctor told her, and sent her home.

For the next two weeks, Thomas's symptoms continued unabated, even after she took antacids. Eventually, she landed back in the hospital where doctors realized she had been misdiagnosed. Thomas didn't have acid reflux. She was having a heart attack.

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Eight years later, Thomas has recovered. In hindsight, she says it's clear she was dealing with something much more serious. But at the time, she felt so embarrassed to be making such a big deal over what the doctors told her was a minor issue.

Her story isn't a one-off. Across Canada, vast numbers of women are misdiagnosed and undertreated because they and many of the health-care professionals around them don't recognize the symptoms of heart disease in women or understand the risks.

Heart disease – a group of conditions that includes heart attacks, angina, atrial fibrillation and heart failure – is one of the leading killers of women in Canada, accounting for nearly one in five deaths in 2011, the most recent figures available. Despite this, it's still considered by many to be a disease that primarily affects men. It's time for that to change.

It's impossible to say how many women are impacted by heart disease gender bias. But consider the following: Last year, a study by the Paris Cardiovascular Research Centre in France found that women are more likely to die following treatment for a heart attack and that fewer women are given angioplasty following a heart attack (a procedure to widen narrowed arteries) than men.

A 2011 study in the journal Circulation: Cardiovascular Quality and Outcomes found that about 70 per cent of the studies used to get approval for high-risk cardiovascular devices, such as stents or artificial valves, predominantly featured men.

A 2013 study in the same journal found that women from the ages of 30 to 55 who had suffered heart attacks routinely delayed getting treatment because they didn't realize their symptoms were heart-related. When they did seek treatment, many didn't get a complete clinical work-up or diagnosis. Lisa McDonnell, program manager with the Canadian Women's Heart Health Centre says that all too often, women with heart disease are told they have anxiety, depression or are just going through menopause.

"Often times, it's just a bias as a result of age," McDonnell said.

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The good news is there are some positive signs of change: In 2014, a group of experts at the World Heart Federation's World Congress of Cardiology called for more research focusing on women's heart risks, better information delivery to health-care professionals and specific treatments for females.

In January, the American Heart Association published its first-ever scientific statement specifically focusing on heart attacks in women. It underscores the need for health professionals to develop a better understanding of the differences between men and women when it comes to heart problems.

And in April, the Canadian Women's Heart Health Centre, based at the University of Ottawa's Heart Institute, will hold its first ever national conference focusing on women's heart health.

But there is a long way to go.

One of the challenges is getting more women and health professionals to understand that heart disease symptoms and onset aren't necessarily the same in women and men.

The American Heart Association reports that while chest pain or discomfort is the most common symptom, women are also more likely to experience atypical symptoms, including shortness of breath, nausea and back or jaw pain. McDonnell notes that many women also experience early warning signs of a heart attack for a few days or weeks, which can include indigestion, anxiety, sleeping problems or changes in headache severity.

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Another hurdle is developing tools that can take into account these differences to help health professionals make a diagnosis and figure out the best treatment. Men often have blockages in the main arteries of the heart that can be easily seen. In women, the blockages are often less severe, meaning they may not be picked up by physicians or treated appropriately, even though they are still causing serious damage to the heart.

One possible solution is to introduce curriculum in medical schools about these crucial differences. Experts such as McDonnell also advocate for clinical guidelines that focus specifically on women – make a document available to all health professionals that succinctly explains women's heart risk factors, how their symptoms may differ from men's symptoms (which they learned in medical school) and how best to treat.

Those guidelines currently don't exist in Canada. It's well past time for an update.

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